title: Health Literacy and Patient-Reported Outcomes: A Cross-Sectional Study of Underserved English- and Spanish-Speaking Patients With Type 2 Diabetes.
abstract: This study examined associations between patient characteristics, health behaviors, and health outcomes and explored the role of health literacy as a potential mediator of outcomes. English- and Spanish-speaking adults with Type 2 diabetes used a bilingual multimedia touchscreen to complete questionnaires. The behavioral model for vulnerable populations guided multivariable regression and mediation testing. Dependent variables were diabetes self-care, health status, and satisfaction with communication. Independent variables included sociodemographic and clinical characteristics, health literacy, health beliefs, and self-efficacy. Spanish speakers had lower health literacy and poorer physical, mental, and overall health compared to English speakers. Higher health literacy was associated with less social support for diet, fewer diet and medication barriers, younger age, higher diabetes knowledge, and talking with health care professionals to get diabetes information. In contrast to expectations, health literacy was not associated with diabetes self-care, health status, or satisfaction with communication, and it did not mediate the effects of other factors on these outcomes. Diabetes self-efficacy was significantly associated with health behaviors and outcomes. The association between Spanish language preference and poorer health was not mediated by this group's lower health literacy. Increasing health-related self-efficacy might be an important clinical strategy for improving outcomes in underserved patients with Type 2 diabetes.
authors.affiliation: a Department of Medical Social Sciences , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA.|b Center for Patient-Centered Outcomes , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Hahn
authors.affiliation: a Department of Medical Social Sciences , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Burns
authors.affiliation: c Department of Medicine and Health Innovation Program , University of Wisconsin School of Medicine and Public Health , Madison , Wisconsin , USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Jacobs
authors.affiliation: d Department of Medicine , Stroger Hospital, and Rush University Medical Center , Chicago , Illinois , USA.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Ganschow
authors.affiliation: a Department of Medical Social Sciences , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA.|b Center for Patient-Centered Outcomes , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA.
authors.forename: Sofia F
authors.initials: SF
authors.lastname: Garcia
authors.affiliation: a Department of Medical Social Sciences , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Rutsohn
authors.affiliation: e Healthcare Quality Evaluation , The Joint Commission , Oakbrook Terrace , Illinois , USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Baker
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology / Q000628:therapy*; D005260:Female; D015438:Health Behavior; D057220:Health Literacy / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D019303:Multilingualism; D063868:Patient Outcome Assessment; D012648:Self Care / Q000523:psychology; D020377:Self Efficacy; D035862:Vulnerable Populations / Q000523:psychology / Q000706:statistics & numerical data