Diabetes self-management in patients with low health literacy: Ordering findings from literature in a health literacy framework

Objective: To review studies on the association between health literacy (HL), diabetes self-management and possible mediating variables. Methods: We systematically searched for empirical studies in PubMed. Findings were ordered by a HL framework that outlines routes between HL, sociocognitive determinants and health actions. Results: Of the 11 relevant studies, three reported a significant positive association between HL and specific diabetes self-management domains. Ten studies investigated the association between HL and knowledge (n = 8), beliefs (n = 2), self-efficacy (n = 3) and/or social support (n = 1). Significant associations were found between HL and knowledge (n = 6), self-efficacy (n = 1) and social support (n = 1). Of the three studies evaluating the effect of these sociocognitive variables on diabetes self-management, only one found proof for a mediating variable (social support) in the pathway between HL and self-management. Conclusion: There is only limited evidence for a significant association between HL and diabetes self-management, and for the mediating role of sociocognitive variables in this pathway. Practice implications: Longitudinal studies, including HL, diabetes self-management and potential mediators, are needed to substantiate possible associations between these variables. Such research is essential to enable evidence-based development of interventions to increase adequate and sustainable self-management in diabetic patients with low HL. (C) 2011 Elsevier Ireland Ltd. All rights reserved