The relationship between health literacy and self-management in persons living with type 2 diabetes mellitus : a cross-sectional survey study

Abstract

Background Few studies have explored the relationship between health literacy and diabetes self-management in Europe. Individuals living with type 2 diabetes mellitus have a distinct self-management when compared to other classifications of diabetes. Moreover, each country may have different forms of support. Personal health literacy focuses on the individual rather than the organisation. The “Integrated Model of Healthy Literacy” was used as a theoretical framework in this present study. This addresses health literacy as a dynamic process and identifies health behaviours as influencing factors. Objectives The aim of this study was to explore the relationship between health literacy and diabetes self-management and glycaemic control amongst Maltese adults. Design A cross-sectional research design was used in this study. Methods Convenience sampling was used to recruit 381 participants from Diabetes Clinics in Malta. Data was collected by a questionnaire which included 16 items measuring health literacy from the ‘European Health Literacy Survey Questionnaire’ and 20 items from the ‘Diabetes self-management questionnaire-revised”. Recent laboratory test results for glycated haemoglobin levels were recorded as a measure of blood glucose control. Multiple regression was used to identify the predictors of health literacy. Spearman’s correlation was used to identify the relationships between health literacy and diabetes self-management and HbA1c. Results The results indicated that 47% (n= 179) of the participants had inadequate health literacy, 12.6% (n= 48) had limited health literacy whilst 40.4% (n= 154) had sufficient health literacy. The most significant predictors of health literacy were educational level, household monthly Net income and family history of diabetes. The results demonstrated medium-high diabetes self-management with medication taking being the strongest aspect of self-management. HbA1c values indicated that 27% of individuals had good glycaemic control, 47.5% had medium control and 25.5% had poor glycaemic control. Health literacy was significantly positively related to diabetes self-management and significantly negatively related to HbA1c levels. Conclusions Health literacy was poor amongst this cohort of persons living with type 2 diabetes. The results of this study indicating the importance of health literacy in encouraging self-management and in increasing the likelihood of good diabetes control highlight the importance of diabetes education. Diabetes nurse specialists are particularly placed to promote education and health literacy amongst persons with type 2 diabetes. Other health professionals however also have a role in assessing any areas in relation to diabetes care which need clarification. This should happen at every patient encounter.