Diabetes self-management in patients with low health literacy: ordering findings from literature in a health literacy framework

Objective: To review studies on the association between health literacy (HL), diabetes self-management and possible mediating variables.

Methods: We systematically searched for empirical studies in PubMed. Findings were ordered by a HL framework that outlines routes between HL, sociocognitive determinants and health actions.

Results: Of the 11 relevant studies, three reported a significant positive association between HL and specific diabetes self-management domains. Ten studies investigated the association between HL and knowledge (n=8), beliefs (n=2), self-efficacy (n=3) and/or social support (n=1). Significant associations were found between HL and knowledge (n=6), self-efficacy (n=1) and social support (n=1). Of the three studies evaluating the effect of these sociocognitive variables on diabetes self-management, only one found proof for a mediating variable (social support) in the pathway between HL and self-management.

Conclusion: There is only limited evidence for a significant association between HL and diabetes self-management, and for the mediating role of sociocognitive variables in this pathway.

Practice implications: Longitudinal studies, including HL, diabetes self-management and potential mediators, are needed to substantiate possible associations between these variables. Such research is essential to enable evidence-based development of interventions to increase adequate and sustainable self-management in diabetic patients with low HL.