The relationship between health literacy and diabetes knowledge and readiness to take health actions

PURPOSE The purpose of this study was to explore the relationship among health literacy, patients' readiness to take health actions, and diabetes knowledge among individuals with type 2 diabetes. METHODS Sixty-eight patients with type 2 diabetes receiving care in an academic general internal medicine clinic were administered the Rapid Estimate of Adult Literacy in Medicine (REALM) literacy instrument prior to completing the Diabetes Health Belief Model (DHBM) scale and Diabetes Knowledge Test (DKT). Multivariable linear regression was used to assess the association between REALM literacy level, DKT score, DHBM scale score, and most recent hemoglobin A1C level while controlling for other covariates of interest. RESULTS After controlling for other covariates of interest, no significant association between DHBM scale score and REALM literacy level was found (P =.29). However, both DKT score and most recent hemoglobin A1C level were found to be significantly associated with patient literacy (P =.004 and P =.02, respectively). Based on the multivariable model, patients with less than a fourth-grade literacy level had 13% lower DKT scores (95% confidence interval [0], -28% to -2%; P =.08) and 1.36% higher most recent hemoglobin A1C levels (95% Cl, 1.06% to 1.73%; P=.02) relative to those with a high school literacy level. CONCLUSIONS Low health literacy is a problem faced by many patients that affects their ability to navigate the health care system and manage their chronic illnesses. While low health literacy was significantly associated with worse glycemic control and poorer disease knowledge in patients with type 2 diabetes, there was no significant relationship with their readiness to take action in disease management.