Departments of Public Health (Drs Luo and Bell), Family Medicine (Drs Patil and Cummings and Ms Adams), and Biostatistics (Dr Wu), East Carolina University, Greenville, North Carolina.
J Public Health Manag Pract. 2020 May/Jun;26(3):280-286. doi: 10.1097/PHH.0000000000000984.
This study evaluated a novel composite measure of health literacy and numeracy by assessing its predictive validity for diabetes self-care activities and glycemic control.
Patients (N = 102) with type 2 diabetes were recruited from a family medicine clinic at an academic medical center. Combined health literacy was assessed by combining the results of the Health Literacy Scale and the Subjective Numeracy Scale. Self-management activities were assessed by the Summary of Diabetes Self-Care Activities scale. Hemoglobin A1c (A1c) values were extracted from patients' medical records to assess glycemic control. Path models were used to test the predicted pathways linking health literacy and numeracy, independently and together, to self-management activities and glycemic control.
The mean combined literacy score was 72.0 (range, 33-104); the mean health literacy score alone was 43.9 (range, 14-56); and the mean numeracy score alone was 28.1 (range, 8-48). The direct effects results showed that the combined health literacy score (B = 0.107, P < .05) and the health literacy score alone (B = 0.234, P < .05) were significantly associated with self-care activities. The health literacy score alone also had a significant direct effect on A1c (B = -0.081, P < .05). The indirect effects of the combined health literacy on glycemic control through self-care activities were not statistically significant.
Findings from this study suggest that the combined health literacy has predictive validity for self-care activities whereas the health literacy alone has predictive validity for glycemic control. More research is needed to validate these findings. Higher patient health literacy skills were not consistently associated with higher perceived numeracy skills. Additional attention and efforts should be made to make sure patients understand medical instructions involving numerical calculations.
本研究通过评估健康素养和计算能力的综合新指标，来评估其对糖尿病自我护理活动和血糖控制的预测效度。
从一家学术医疗中心的家庭医学诊所招募了 102 名 2 型糖尿病患者。综合健康素养通过结合健康素养量表和主观计算能力量表的结果来评估。通过糖尿病自我护理活动总结量表评估自我管理活动。从患者的病历中提取血红蛋白 A1c（A1c）值以评估血糖控制情况。使用路径模型测试健康素养和计算能力分别以及共同对自我管理活动和血糖控制的预测途径。
平均综合读写能力得分为 72.0（范围，33-104）；单独的健康读写能力平均得分为 43.9（范围，14-56）；单独的计算能力平均得分为 28.1（范围，8-48）。直接效应结果表明，综合健康素养得分（B = 0.107，P <.05）和单独的健康素养得分（B = 0.234，P <.05）与自我护理活动显著相关。单独的健康素养得分也对 A1c 有显著的直接影响（B = -0.081，P <.05）。综合健康素养通过自我护理活动对血糖控制的间接影响不具有统计学意义。
本研究结果表明，综合健康素养对自我护理活动具有预测效度，而单独的健康素养对血糖控制具有预测效度。需要更多的研究来验证这些发现。更高的患者健康素养技能并不总是与更高的感知计算技能相关。应更加关注并努力确保患者理解涉及数值计算的医疗说明。
