Ferguson Monica O, Long Judith A, Zhu Jingsan, Small Dylan S, Lawson Brittany, Glick Henry A, Schapira Marilyn M
Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Ferguson, Dr Long, Miss Lawson, Dr Glick, Dr Schapira)
Philadelphia VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania (Dr Long, Dr Schapira)
Diabetes Educ. 2015 Jun;41(3):309-19. doi: 10.1177/0145721715572446. Epub 2015 Feb 19.
The purpose of this study is to identify factors associated with perceived control of diabetes in a group of poorly controlled patients. Identifying factors associated with perceived control in these patients is an important step in improving actual control as measured by A1C. As health literacy is essential for understanding complex medical information, we hypothesized that low health literacy would be associated with inaccurate perceptions of diabetes control.
A cross-sectional analysis was performed on 280 adults with type 2 diabetes whose last 2 A1C measurements were >8.0%. Participants were recruited primarily from 6 University of Pennsylvania primary care practices. Perceived control and factors potentially associated with this outcome, including health literacy, were assessed during an in-person interview. Health literacy was measured using the Rapid Estimate of Adult Literacy.
Thirty-nine percent of patients responded that they were managing to control their diabetes well or very well. However, 57% of those at the seventh to eighth-grade health literacy level and 61% of those at the level of sixth grade and below reported that they were controlling their diabetes well or very well.
In this population of patients with poorly controlled diabetes, a majority of those with low health literacy believed that they were controlling their disease well or very well. Patients who believe that they are already controlling their diabetes well may be less likely to make changes to improve control. Health care providers and educators should consider health literacy when discussing control of diabetes and when setting management goals with patients.
本研究旨在确定一组血糖控制不佳的患者中与糖尿病自我管理认知相关的因素。识别这些患者中与自我管理认知相关的因素是改善糖化血红蛋白（A1C）所衡量的实际血糖控制的重要一步。由于健康素养对于理解复杂的医学信息至关重要，我们假设低健康素养会与对糖尿病控制的认知不准确相关。
对280名2型糖尿病成年人进行横断面分析，他们最近两次A1C测量值均>8.0%。参与者主要从宾夕法尼亚大学的6个初级保健机构招募。在面对面访谈中评估自我管理认知以及可能与该结果相关的因素，包括健康素养。使用成人识字率快速评估法测量健康素养。
39%的患者表示他们能够很好或非常好地控制糖尿病。然而，健康素养处于七年级至八年级水平的患者中有57%，六年级及以下水平的患者中有61%报告称他们能够很好或非常好地控制糖尿病。
在这群血糖控制不佳的糖尿病患者中，大多数健康素养较低的患者认为他们能够很好或非常好地控制自己的疾病。认为自己已经很好地控制糖尿病的患者可能不太可能做出改变以改善控制。医疗保健提供者和教育工作者在讨论糖尿病控制以及与患者设定管理目标时应考虑健康素养。
