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Abstract
The mechanisms underlying the relationship between health literacy, numeracy, and glycemic control are unclear. We explored the role of diabetes self-efficacy in the predicted pathway linking health literacy and numeracy to glycemic control (A1C). Adults with type 1 or type 2 diabetes mellitus (N = 383) were enrolled in a cross-sectional study at primary care and diabetes clinics at three medical centers. Data collected included demographic information, health literacy, general numeracy, and A1C. Path models estimated relations among health literacy, numeracy, and diabetes self-efficacy as predictors of A1C. Health literacy (r = 0.14, p < .01) and numeracy (r = 0.17, p < .001) were each associated with greater diabetes self-efficacy, and greater diabetes self-efficacy was associated with lower A1C levels (r = −0.25, p < .001). When considered in combination, numeracy was related to diabetes self-efficacy (r = 0.13, p < .05), and the effect of health literacy on diabetes self-efficacy was reduced to non-significance (r = 0.06, p = .30). Health literacy and numeracy are each associated with greater diabetes self-efficacy, and greater diabetes self-efficacy is associated with lower A1C levels. Diabetes self-efficacy may be an important target of interventions to improve diabetes control and promote health equity related to health literacy and general numeracy skills needed for diabetes management.
This research was funded with support from the American Diabetes Association (Novo Nordisk Clinical Research Award), the Pfizer Clear Health Communication Initiative, and the Vanderbilt Diabetes Research and Training Center (NIDDK P60 DK020593). Dr. Osborn is supported by an NIH Diversity Supplement Award (NIDDK P60 DK020593). Dr. Cavanaugh is supported by a National Kidney Foundation Young Investigator Grant and also by NIH NIDDK K23 DK080952. Dr. Rothman was also currently supported by an NIDDK Career Development Award (NIDDK K23 DK065294).
Notes
Note: †Chi-square and independent samples t-tests comparing across health literacy and numeracy grade level. REALM = Rapid Estimate of Adult Literacy in Medicine Health literacy; WRAT-3 R = Wide Range Achievement Test, 3rd edition (General numeracy); BMI = Body Mass Index.
