48-LB: Associations between Health Literacy and Patient Perceptions of Care in Poorly Controlled Diabetes

Abstract

Background: Low health literacy (HL) is a barrier to improving health outcomes in patients with type 2 diabetes (T2DM). The Newest Vital Sign (NVS) is a validated, short questionnaire for assessing HL. The relationship between NVS HL and patient-reported diabetes behavioral and patient-provider interaction measures, particularly among patients with poor glycemic control, is currently unknown. Methods: Cross-sectional analysis of baseline data of 248 Veterans with poorly controlled T2DM (maintenance of hemoglobin A1c (HbA1c) ≥8.5% despite engagement with diabetes care) from a randomized trial of a telehealth intervention. NVS was collected at baseline, along with other demographic, clinical, and psychosocial metrics. We used multivariable regression with restricted cubic splines for continuous covariates to explore associations between baseline NVS and four measures (Diabetes Knowledge Questionnaire (DKQ), Diabetes Self-Management Questionnaire (DSMQ), Perceived Competence Scale (PCS), and Healthcare Climate Questionnaire (HCCQ)). Results: The sample had a mean age of 58.1 (SD = 8.3) years, was 78.6% male and 76.2% non-White. Average HbA1c was 9.8 (SD = 1.5) and average NVS was 3.4 (SD = 2.0). After adjusting for demographic, clinical, and psychosocial factors, NVS was significantly associated (linearly) with DKQ and PCS scores, but not DSMQ or HCCQ scores. For every 1-point increase in NVS, the DKQ score increased by 0.33 (95% CI 0.13, 0.52, P = 0.0010) and PCS score decreased by 0.11 (95% CI -0.21, -0.0081, P = 0.034), indicating that higher HL is associated with higher diabetes knowledge and lower perceived competence. Conclusions: The direct association of NVS HL with DKQ scores is consistent with literature using other HL metrics among general T2DM populations; however, the indirect association of NVS HL with PCS scores is less intuitive, suggesting a possible misplaced confidence among patients with higher HL yet poor glycemic control despite diabetes care engagement. Disclosure E. A. Kobe: None. J. German: None. D. Soliman: None. A. Alexopoulos: None. A. S. Jeffreys: None. D. Edelman: None. C. Coffman: None. M. Crowley: None. Funding National Center For Advancing Translational Sciences (TL1TR002555 to E.A.K.); U.S. Department of Veterans Affairs (IIR 16-213 to M.C.)