title: Low Health Literacy Predicts Misperceptions of Diabetes Control in Patients With Persistently Elevated A1C.
abstract: The purpose of this study is to identify factors associated with perceived control of diabetes in a group of poorly controlled patients. Identifying factors associated with perceived control in these patients is an important step in improving actual control as measured by A1C. As health literacy is essential for understanding complex medical information, we hypothesized that low health literacy would be associated with inaccurate perceptions of diabetes control.
  
  
  
  A cross-sectional analysis was performed on 280 adults with type 2 diabetes whose last 2 A1C measurements were >8.0%. Participants were recruited primarily from 6 University of Pennsylvania primary care practices. Perceived control and factors potentially associated with this outcome, including health literacy, were assessed during an in-person interview. Health literacy was measured using the Rapid Estimate of Adult Literacy.
  
  
  
  Thirty-nine percent of patients responded that they were managing to control their diabetes well or very well. However, 57% of those at the seventh to eighth-grade health literacy level and 61% of those at the level of sixth grade and below reported that they were controlling their diabetes well or very well.
  
  
  
  In this population of patients with poorly controlled diabetes, a majority of those with low health literacy believed that they were controlling their disease well or very well. Patients who believe that they are already controlling their diabetes well may be less likely to make changes to improve control. Health care providers and educators should consider health literacy when discussing control of diabetes and when setting management goals with patients.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Ferguson, Dr Long, Miss Lawson, Dr Glick, Dr Schapira)
authors.forename: Monica O
authors.initials: MO
authors.lastname: Ferguson
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Ferguson, Dr Long, Miss Lawson, Dr Glick, Dr Schapira)|Philadelphia VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania (Dr Long, Dr Schapira)|Leonard Davis Institute of Health Economics, Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Long, Mr Zhu, Dr Small, Dr Schapira)
authors.forename: Judith A
authors.initials: JA
authors.lastname: Long
authors.affiliation: Leonard Davis Institute of Health Economics, Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Long, Mr Zhu, Dr Small, Dr Schapira)
authors.forename: Jingsan
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Leonard Davis Institute of Health Economics, Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Long, Mr Zhu, Dr Small, Dr Schapira)|Department of Statistics, Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Small)
authors.forename: Dylan S
authors.initials: DS
authors.lastname: Small
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Ferguson, Dr Long, Miss Lawson, Dr Glick, Dr Schapira)
authors.forename: Brittany
authors.initials: B
authors.lastname: Lawson
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Ferguson, Dr Long, Miss Lawson, Dr Glick, Dr Schapira)
authors.forename: Henry A
authors.initials: HA
authors.lastname: Glick
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Ferguson, Dr Long, Miss Lawson, Dr Glick, Dr Schapira)|Philadelphia VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania (Dr Long, Dr Schapira)|Leonard Davis Institute of Health Economics, Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Long, Mr Zhu, Dr Small, Dr Schapira)
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Schapira
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000523:psychology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D057220:Health Literacy; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010465:Perception; D015143:Philadelphia; D011320:Primary Health Care; D016032:Randomized Controlled Trials as Topic; D012648:Self Care / Q000523:psychology*
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human