Modeling patient empowerment and health literacy to glycemic control in insulin-treated patients: A prospective study

Abstract

ObjectiveTo model the pathways of patient empowerment (PE) and health literacy (HL) to glycemic control specific to insulin-treated patients by prospective design. MethodsInsulin-treated patients with type 2 diabetes (T2DM) (N = 185) were recruited by convenience sampling. Data of personal characteristics, PE, and HL were collected by questionnaires at baseline and 9 months later. The 9-month glycosylated hemoglobin (HbA1c) levels of each participant were collected from medical records. Structural equation modeling was used to test a hypothesized model. ResultsBaseline and 9-month communicative HL and critical HL significantly and negatively correlated with 9-month HbA1c levels. Structural equation modeling supported that baseline and 9-month PE significantly affected HL at corresponding time points. Baseline PE indirectly affected 9-month HL through 9-month PE. The 9-month HL directly affected 9-month HbA1c. Baseline HL indirectly affected 9-month HbA1c through 9-month HL. ConclusionCommunicative HL and critical HL rather than functional HL were crucial in improving glycemic control. PE is essential to improve HL in insulin-treated patients. Practice ImplicationsHealthcare providers could apply the empowerment approach to educate insulin-treated patients. Through reciprocal dynamic process of PE, insulin-treated patients with T2DM might improve their communicative and critical HL; and finally, glycemic control could be improved.