title: Associations among health literacy, diabetes knowledge, and self-management behavior in adults with diabetes: results of a dutch cross-sectional study.
abstract: Various studies have examined the association between health literacy and self-management behavior, but few have explored ways through which this occurs. The present study examines to what extent health literacy is associated with diabetes self-management behavior and to what extent diabetes knowledge is a mechanism in this association. The study was based on cross-sectional data retrieved from patient registrations and questionnaires completed in 2010. The sample included 1,714 predominantly type 2 diabetes patients, with a mean age of 67 years. Diabetes self-management was indicated by HbA1c level, glucose self-control and self-reported monitoring of glucose levels, physical activity, and smoking. Multilevel analyses were applied based on multiple imputed data. Lower health literacy was significantly associated with less diabetes knowledge, higher HbA1c level, less self-control of glucose level, and less physical activity. Participants with more diabetes knowledge were less likely to smoke and more likely to control glucose levels. Diabetes knowledge was a mediator in the association between health literacy and glucose self-control and between health literacy and smoking. This study indicates that higher health literacy may contribute to participation in certain self-management activities, in some cases through diabetes knowledge. Diabetes knowledge and health literacy skills may be important targets for interventions promoting diabetes self-management.
authors.affiliation: a Centre for Nutrition, Prevention and Health Services , National Institute for Public Health and the Environment , Bilthoven , The Netherlands.
authors.forename: Iris
authors.initials: I
authors.lastname: van der Heide
authors.forename: Ellen
authors.initials: E
authors.lastname: Uiters
authors.forename: Jany
authors.initials: J
authors.lastname: Rademakers
authors.forename: Jeroen N
authors.initials: JN
authors.lastname: Struijs
authors.forename: A Jantine
authors.initials: AJ
authors.lastname: Schuit
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Baan
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D055361:Multilevel Analysis; D009426:Netherlands; D012648:Self Care / Q000523:psychology*; D057566:Self Report; D012907:Smoking / Q000523:psychology; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human