title: Do health literacy and patient empowerment affect self-care behaviour? A survey study among Turkish patients with diabetes.
abstract: OBJECTIVE
  This study aimed to assess the impact of health literacy and patient empowerment on diabetes self-care behaviour in patients in metropolitan Turkish diabetes centres. The conceptual background is provided by the psychological health empowerment model, which holds that health literacy without patient empowerment comes down to wasting health resources, while empowerment without health literacy can lead to dangerous or suboptimal health behaviour.
  
  
  METHODS
  A cross-sectional study was conducted with 167 patients over the age of 18 from one of two diabetes clinics in a major Turkish City. Self-administered questionnaires were distributed to eligible outpatients who had an appointment in one of the clinics. Health literacy was measured by a newly translated Turkish version of the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the Chew self-report scale. Patient empowerment was measured by a 12-item scale based on Spreitzer's conceptualisation of psychological empowerment in the workplace. Self-care behaviour was measured by the Self-care behaviours were measured by the Summary of Diabetes Self-Care Activities Measure (SDSCA). Level of diabetes knowledge was measured by Diabetes Knowledge Test.
  
  
  RESULTS
  Two subscales of empowerment, impact and self-determination, predicted self-reported frequency of self-care behaviours. Neither health literacy nor diabetes knowledge had an effect on self-care behaviours.
  
  
  CONCLUSIONS
  Health literacy might be more effective in clinical decisions while empowerment might exert a stronger influence on habitual health behaviours.
authors.affiliation: Public Relations and Publicity Department, Maltepe University, Marmara Eğitim Köyü, Istanbul, Turkey.
authors.forename: Ezgi
authors.initials: E
authors.lastname: Eyüboğlu
authors.affiliation: Institute of Communication and Health, Universita' della Svizzera Italiana, Lugano, Switzerland.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Schulz
mesh_terms: D000328:Adult; D015190:Blood Glucose Self-Monitoring / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D012648:Self Care / Q000523:psychology / Q000706:statistics & numerical data*; D057566:Self Report; D014421:Turkey / Q000453:epidemiology
keywords: diabetes management behaviors; health literacy; patient empowerment