title: Health literacy, self-efficacy, and self-care behaviors in patients with type 2 diabetes mellitus.
abstract: OBJECTIVE
  The study purpose was to explore the relationships among health literacy, self-efficacy, and self-care behaviors of patients with type 2 diabetes.
  
  
  METHODS
  A cross-sectional study with a descriptive correlational design was conducted. Patients (N = 150) with type 2 diabetes were recruited from diabetes clinics in the Marshall Islands. Levels of health literacy, self-efficacy, and self-care behaviors were assessed by a questionnaire.
  
  
  CONCLUSIONS
  Health literacy, receiving diabetes education, and employment status together explained 11.8% of the variance in self-efficacy (F((3,147)) = 7.58, p < .001). Patients who had higher health literacy, received more diabetes-related education, were currently employed and had better self-efficacy. Self-efficacy and marital status together explained 16.7% of the variance in self-care behaviors (F((2,148)) = 15.96, p < .001). Patients who had higher self-efficacy and who were married had better self-care behaviors.
  
  
  CONCLUSIONS
  Strategies are needed to incorporate the concept of self-efficacy in the design of diabetes education to promote patients' self-care behaviors, with an emphasis on dealing with hyper- or hypoglycemia, following the diet plan, and checking blood sugar levels as recommended. Diabetes education material that requires a lower literacy level may be needed for older or unemployed adult populations.
authors.affiliation: Department of Nursing, College of Marshall Islands, Majuro Atoll, Marshall Islands.
authors.forename: Walton
authors.initials: W
authors.lastname: Bohanny
authors.forename: Shu-Fang Vivienne
authors.initials: SF
authors.lastname: Wu
authors.forename: Chieh-Yu
authors.initials: CY
authors.lastname: Liu
authors.forename: Shu-Hui
authors.initials: SH
authors.lastname: Yeh
authors.forename: Shiow-Luan
authors.initials: SL
authors.lastname: Tsay
authors.forename: Tsae-Jyy
authors.initials: TJ
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012648:Self Care; D020377:Self Efficacy; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: Diabetes mellitus; health literacy; self-care behavior; self-efficacy; vulnerable populations