Abstract
Health literacy is considered to be an emerging determinant of health behaviors and outcomes. The underlying mechanisms linking health literacy to diabetes self-management are currently unclear. This study assessed a mediation model consisting of a direct pathway between health literacy and self-management, and indirect pathways via social isolation only, self-efficacy only, and social isolation and self-efficacy serially in people with type 2 diabetes. A cross-sectional design was employed, and a total of 524 participants were recruited from outpatient clinics of multi-institutions from June 2020 to February 2021. The mediation model was analyzed using the PROCESS macro on SPSS with bootstrap bias-corrected 95% confidence intervals (CIs) with 10,000 bootstrapping iterations. Health literacy positively affected self-management. The estimated indirect effect of health literacy on self-management via social isolation was significant, at 0.018 (95% CI = 0.004–0.036). The indirect effect via self-efficacy was estimated at 0.214 (95% CI = 0.165–0.266). The indirect effect via social isolation and self-efficacy serially was 0.013 (95% CI = 0.006–0.023). The findings of this study suggest that clinical practice can be improved through more comprehensive diabetes self-management interventions that promote all of the components of health literacy, social contacts/networks, and self-efficacy in particular.
Highlights
Introduction2 diabetes accounts for about 90% of all diabetes cases [1]
This study found that health literacy was directly related to self-management, which is consistent with a previous literature review and other empirical studies [5,6]
A systematic review of 13 health literacy instruments performed on people with diabetes recommended the use of disease-specific instruments in clinical practice [37]
Summary
2 diabetes accounts for about 90% of all diabetes cases [1] These people need to perform ongoing self-management in their daily lives, such as physical exercise, healthy diets, emotional coping, taking medication, self-monitoring of blood glucose, symptom regulation, and foot inspections [2]. Self-management plays a pivotal role in successful treatments for improving metabolic control and the quality of life, and reducing the risk of complications and health-care costs [1]. It is important for health professionals to identify factors that increase the risk of and to promote diabetes self-management in order to develop evidence-based interventions to improve self-management among people with type 2 diabetes
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