title: Health literacy and quality of care of patients with diabetes: A cross-sectional analysis.
abstract: Limited health literacy (HL) may lead to poor health outcomes and inappropriate healthcare use, particularly in patients with chronic diseases. We aimed to assess the association between functional HL (FHL) and quality of care, as measured by process- and outcome-of-care indicators, in patients with diabetes.
  
  
  
  This cross-sectional study used data from the 2013 CoDiab-VD cohort follow-up, which included non-institutionalised adults with diabetes from canton of Vaud, Switzerland. Using self-administered questionnaires, we collected patients' characteristics, processes [annual HbA1C check, lipid profile, urine test, foot examination, influenza vaccination, eye examination (24 months), physical activity and diet recommendations] and outcomes of care (HbA1C knowledge, HbA1C value, SF-12, ADDQoL, PACIC, self-efficacy). A single validated screening question assessed FHL. Unadjusted and adjusted regression analyses were performed.
  
  
  
  Of 381 patients 52.5% (95%CI: 47.5%-57.5%), 40.7% (95%CI: 35.7%-45.6%) and 6.8% (95%CI: 4.3%-9.4%) reported high, medium and poor FHL, respectively. Significant associations were found for two out of seven outcomes of care; lower self-efficacy scores associated with medium and poor FHL (adjusted: β -0.6, 95%CI -0.9 to -0.2 and β -1.8, 95%CI -2.5 to -1.2, respectively), lower SF-12 mental scores associated with poor FHL (adjusted: β -8.4, 95%CI -12.5 to -4.2).
  
  
  
  This study found few outcomes of care associated with FHL. Further exploration of the impact of limited HL on quality of care indicators will help tailor initiatives - both on patients' and providers' side - to improve diabetes care.
authors.affiliation: Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. Electronic address: Emilie.Zuercher@chuv.ch.
authors.forename: Emilie
authors.initials: E
authors.lastname: Zuercher
authors.affiliation: Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. Electronic address: iddiatta@gmail.com.
authors.forename: Ibrahima Dina
authors.initials: ID
authors.lastname: Diatta
authors.affiliation: Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. Electronic address: Bernard.Burnand@chuv.ch.
authors.forename: Bernard
authors.initials: B
authors.lastname: Burnand
authors.affiliation: Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. Electronic address: Isabelle.Peytremann-Bridevaux@chuv.ch.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Peytremann-Bridevaux
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D017064:Process Assessment, Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care; D012648:Self Care; D020377:Self Efficacy; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013557:Switzerland; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human
keywords: Diabetes; Health literacy; Quality of care