Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia.
Academic Unit, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
BMJ Open. 2019 Jul 30;9(7):e025349. doi: 10.1136/bmjopen-2018-025349.
Poor health literacy (HL) is associated with poorer health outcomes in diabetes but little is known about its effects on foot disease. This study was aimed to determine the associations between HL and diabetic foot disease.
This is a cross-sectional analysis of baseline data from a prospective study of foot disease.
Attendees of the Royal Hobart Hospital's Diabetes outpatient clinics.
222 people with type 1 or type 2 diabetes aged >40 years and without a history of foot disease, psychotic disorders or dementia.
Outcomes were peripheral neuropathy, peripheral arterial disease and foot deformity according to published guidelines. The exposure, HL, was measured using the short form Test of Functional Health Literacy in Adults (S-TOFHLA) and the Health Literacy Questionnaire (HLQ). Covariates included demographic characteristics, medical history, psychological measures and foot care behaviour.
Of 222 participants, 204 had adequate HL. (Mean (SD) S-TOFHLA scores were 31.9 (6.7)), mean(SD) HLQ scores were 134.4 (18.4)). In univariable but not multivariable analyses, higher S-TOFHLA scores were associated with lower overall risk for foot disease (OR 0.96, 95% CI 0.93 to 0.99) and loss of protective sensation (OR 0.95, 95% CI 0.91 to 0.995).
These data provide little support for clinically important impacts of HL on risk factors for diabetic foot disease. However, in the absence of longitudinal data, such effects cannot be ruled out. Longitudinal studies measuring incident foot disease are needed to properly judge the potential for interventions improving HL to reduce the incidence of diabetic foot disease.
健康素养较差（HL）与糖尿病患者的健康结果较差相关，但关于其对足部疾病的影响知之甚少。本研究旨在确定 HL 与糖尿病足部疾病之间的关系。
这是一项针对足部疾病前瞻性研究基线数据的横断面分析。
霍巴特皇家医院糖尿病门诊。
222 名年龄>40 岁且无足部疾病、精神障碍或痴呆病史的 1 型或 2 型糖尿病患者。
根据已发表的指南，将周围神经病变、周围动脉疾病和足部畸形作为结局。使用成人功能性健康素养测试（S-TOFHLA）简短形式和健康素养问卷（HLQ）来衡量 HL 这一暴露因素。协变量包括人口统计学特征、病史、心理测量和足部护理行为。
在 222 名参与者中，有 204 人具有足够的 HL。（S-TOFHLA 评分的平均值（标准差）为 31.9（6.7），HLQ 评分的平均值（标准差）为 134.4（18.4））。在单变量但不是多变量分析中，较高的 S-TOFHLA 评分与足部疾病（OR 0.96，95%CI 0.93 至 0.99）和保护性感觉丧失（OR 0.95，95%CI 0.91 至 0.995）的总体风险降低相关。
这些数据几乎没有提供 HL 对糖尿病足部疾病危险因素的临床重要影响的证据。然而，由于缺乏纵向数据，不能排除这种影响。需要进行前瞻性研究，测量足部疾病的发生率，以正确判断改善 HL 以降低糖尿病足部疾病发生率的干预措施的潜力。
