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Impact of functional, communicative and critical health literacy on glycemic control among patients with type 2 diabetes, and the mediating role of self-care

Authors Yarmohammadi S, Momenyan S, Ghaffari M, Ali R, Azizpour M

Received 3 March 2019

Accepted for publication 7 May 2019

Published 18 June 2019 Volume 2019:12 Pages 427—435


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Mei-chun Cheung

Soudabeh Yarmohammadi,1 Somayeh Momenyan,2 Mohtasham Ghaffari,3 Ramezankhani Ali,4 Mohyeddin Azizpour5

1Research Center for Environmental Determinants of Health (RCEDH), Kermanshah University of Medical Sciences, Kermanshah, Iran; 2Department of Biostatistics, Faculty of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 3Health Education & Health Promotion, Environmental and Occupational Hazards Control Research Center, School of Public Health & Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 4Department of Public Health, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 5School of Public Health & Safety, Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Background: Health literacy (HL) could influence self-care behaviors and further affect HbA1c values. Understanding the mechanism relationships between HL, self-care behaviors and HbA1c could provide the valuable knowledge for developing evidence-based interventions in diabetic patients. In this study, we hypothesized that HL and its subscales would be related to self-care behaviors and that HL would be indirectly related to glycemic control (HbA1c) via relations with self-care behaviors among diabetes patients.
Methods: This cross-sectional study was performed on 300 patients with type 2 diabetes referred to five educational hospitals affiliated to Shahid Beheshti University of Medical Sciences in 2018. The Persian version of Functional, Communicative, and Critical Health Literacy (FCCHL) questionnaire and the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire were used. Also, recent HbA1c values were extracted from patients’ medical records. Structural equation modeling (SEM) was also used to investigate the relationships between the variables.
Results: The SEM results showed the direct standardized path of the total HL score, functional HL, communicative HL and critical HL on HbA1c were nonsignificant in the model with mediator. While the indirect effect of the total HL score (β = −0.24, P=0.042), functional HL (β = −0.15, P=0.01), communicative HL (β = −0.16, P=0.01) and critical HL (β = −0.22, P=0.03) on HbA1c through the mediation of self-care behaviors were significant.
Conclusion: The results of this study indicated that HL and particularly critical HL are significant factors in reducing HbA1c in patients with type 2 diabetes through the mediation of self-care behaviors.

Keywords: type 2 diabetes, health literacy, self-care, glycemic control

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