title: Diabetes self-management support for patients with low health literacy: Perceptions of patients and providers.
abstract: BACKGROUND
  The aim of the present study was to explore perceptions and strategies of health care providers regarding diabetes self-management support for patients with low health literacy (LHL), and to compare their self-management support with the needs of patients with LHL and type 2 diabetes. This study serves as a problem analysis for systematic intervention development to improve diabetes self-management among patients with LHL.
  
  
  METHODS
  This qualitative study used in-depth interviews with general practitioners (n = 4), nurse practitioners (n = 5), and patients with LHL (n = 31). The results of the interviews with health care providers guided the patient interviews. In addition, we observed 10 general practice consultations.
  
  
  RESULTS
  Providers described patients with LHL as uninvolved and less motivated patients who do not understand self-management. Their main strategy to improve self-management was to provide standard information on a repeated basis. Patients with LHL seemed to have a different view of diabetes self-management than their providers. Most demonstrated a low awareness of what self-management involves, but did not express needing more information. They reported several practical barriers to self-management, although they seemed reluctant to use the information provided to overcome them.
  
  
  CONCLUSIONS
  Providing and repeating information does not fit the needs of patients with LHL regarding diabetes self-management support. Health care providers do not seem to have the insight or the tools to systematically support diabetes self-management in this group. Systematic intervention development with a focus on skills-based approaches rather than cognition development may improve diabetes self-management support of patients with LHL.
authors.affiliation: Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Mirjam P
authors.initials: MP
authors.lastname: Fransen
authors.forename: Erik J A J
authors.initials: EJ
authors.lastname: Beune
authors.forename: Abigail M
authors.initials: AM
authors.lastname: Baim-Lance
authors.forename: Raynold C
authors.initials: RC
authors.lastname: Bruessing
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Essink-Bot
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology* / Q000628:therapy*; D019468:Disease Management; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D010465:Perception; D036301:Qualitative Research; D012648:Self Care
keywords: diabetes; health literacy; self-care; 关键词：糖尿病，健康素养，自我管理。