title: Diabetes self-management in patients with low health literacy: ordering findings from literature in a health literacy framework.
abstract: OBJECTIVE
  To review studies on the association between health literacy (HL), diabetes self-management and possible mediating variables.
  
  
  METHODS
  We systematically searched for empirical studies in PubMed. Findings were ordered by a HL framework that outlines routes between HL, sociocognitive determinants and health actions.
  
  
  RESULTS
  Of the 11 relevant studies, three reported a significant positive association between HL and specific diabetes self-management domains. Ten studies investigated the association between HL and knowledge (n=8), beliefs (n=2), self-efficacy (n=3) and/or social support (n=1). Significant associations were found between HL and knowledge (n=6), self-efficacy (n=1) and social support (n=1). Of the three studies evaluating the effect of these sociocognitive variables on diabetes self-management, only one found proof for a mediating variable (social support) in the pathway between HL and self-management.
  
  
  CONCLUSIONS
  There is only limited evidence for a significant association between HL and diabetes self-management, and for the mediating role of sociocognitive variables in this pathway.
  
  
  CONCLUSIONS
  Longitudinal studies, including HL, diabetes self-management and potential mediators, are needed to substantiate possible associations between these variables. Such research is essential to enable evidence-based development of interventions to increase adequate and sustainable self-management in diabetic patients with low HL.
authors.affiliation: Department of Public Health, Amsterdam Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. m.p.fransen@amc.uva.nl
authors.forename: Mirjam P
authors.initials: MP
authors.lastname: Fransen
authors.forename: Christian
authors.initials: C
authors.lastname: von Wagner
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Essink-Bot
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D011369:Professional-Patient Relations; D012648:Self Care; D020377:Self Efficacy; D012944:Social Support