Addressing Health Literacy and Numeracy to Improve Diabetes Education and Care

Abstract

The prevalence of diabetes is increasing at staggering rates. In 2007 in the United States, estimates suggested that nearly 24 million individuals had diabetes, and another 57 million were at increased clinical risk of developing this chronic disease (i.e., pre-diabetes).1 Diabetes has consistently been among the top causes of morbidity and mortality among patients with chronic disease, and the costs associated with diabetes care place significant financial burden on our health care system.2,3 Additionally, care for patients with diabetes has remained suboptimal, particularly for racial and ethnic minorities, the poor, and the uninsured.4–7 As discussed in the previous articles in this From Research to Practice section (p. 216–237), potential barriers to the provision of optimal care and patients' execution of successful self-management may include low health literacy and numeracy. A growing body of evidence supports the association between limited health literacy and numeracy and poorer diabetes outcomes.8–12 Patients with diabetes and limited health literacy or numeracy are more likely to have poorer disease knowledge and symptom recognition,13,14 poorer glycemic control,8,10 greater difficulty interpreting food labels and estimating portion sizes,15,16 lower self-confidence in diabetes management (i.e., self-efficacy), fewer self-management behaviors,8,12 and poorer communication with thei providers.17 Analyses comparing the influence of low literacy and numeracy together on glycemic control suggest that numeracy is more closely related to glycemic control than literacy.8,11 The challenge in caring for patients with limited health literacy and numeracy is that deficits in these skills are not always intuitively obvious to providers and educators,18 and, if these skills are not specifically assessed, such deficits may go unrecognized. Some may argue that both patients and providers may become uncomfortable with providers' …