Health Literacy and Health Outcomes in Diabetes: A Systematic Review

ABSTRACTBACKGROUNDLow health literacy is considered a potential barrier to improving health outcomes in people with diabetes and other chronic conditions, although the evidence has not been previously systematically reviewed.OBJECTIVETo identify, appraise, and synthesize research evidence on the relationships between health literacy (functional, interactive, and critical) or numeracy and health outcomes (i.e., knowledge, behavioral and clinical) in people with diabetes.METHODSEnglish-language articles that addressed the relationship between health literacy or numeracy and at least one health outcome in people with diabetes were identified by two reviewers through searching six scientific databases, and hand-searching journals and reference lists.FINDINGSSeven hundred twenty-three citations were identified and screened, 196 were considered, and 34 publications reporting data from 24 studies met the inclusion criteria and were included in this review. Consistent and sufficient evidence showed a positive association between health literacy and diabetes knowledge (eight studies). There was a lack of consistent evidence on the relationship between health literacy or numeracy and clinical outcomes, e.g., A1C (13 studies), self-reported complications (two studies), and achievement of clinical goals (one study); behavioral outcomes, e.g., self-monitoring of blood glucose (one study), self-efficacy (five studies); or patient-provider interactions (i.e., patient-physician communication, information exchange, decision-making, and trust), and other outcomes. The majority of the studies were from US primary care setting (87.5 %), and there were no randomized or other trials to improve health literacy.CONCLUSIONSLow health literacy is consistently associated with poorer diabetes knowledge. However, there is little sufficient or consistent evidence suggesting that it is independently associated with processes or outcomes of diabetes-related care. Based on these findings, it may be premature to routinely screen for low health literacy as a means for improving diabetes-related health-related outcomes.

[1]  S. Gabriel,et al.  Systematic Review of the Literature , 2021, Adherence to Antiretroviral Therapy among Perinatal Women in Guyana.

[2]  N. Adler,et al.  Correlates of Patient-Reported Racial/Ethnic Health Care Discrimination in the Diabetes Study of Northern California (DISTANCE) , 2011, Journal of health care for the poor and underserved.

[3]  Kristine Yaffe,et al.  Limited Literacy in Older People and Disparities in Health and Healthcare Access , 2006, Journal of the American Geriatrics Society.

[4]  Michael Pignone,et al.  Influence of patient literacy on the effectiveness of a primary care-based diabetes disease management program. , 2004, JAMA.

[5]  Chandra Y Osborn,et al.  Self-Efficacy Links Health Literacy and Numeracy to Glycemic Control , 2010, Journal of health communication.

[6]  Sunil Kripalani,et al.  Bridging the digital divide in diabetes: family support and implications for health literacy. , 2011, Diabetes technology & therapeutics.

[7]  Perri Klass,et al.  Literacy and child health: a systematic review. , 2009, Archives of pediatrics & adolescent medicine.

[8]  H. Ishikawa,et al.  The relationship of patient participation and diabetes outcomes for patients with high vs. low health literacy. , 2011, Patient education and counseling.

[9]  Stacey L. Sheridan,et al.  Health literacy interventions and outcomes , 2011 .

[10]  S. Saha,et al.  Variation in Estimates of Limited Health Literacy by Assessment Instruments and Non-Response Bias , 2010, Journal of General Internal Medicine.

[11]  D. Schillinger,et al.  Closing the loop: physician communication with diabetic patients who have low health literacy. , 2003, Archives of internal medicine.

[12]  J. Gazmararian,et al.  The impact of health literacy on self-monitoring of blood glucose in patients with diabetes receiving care in an inner-city hospital. , 2010, Journal of the National Medical Association.

[13]  J. Kopec,et al.  Impact of chronic conditions. , 2003, Health reports.

[14]  Josephine M. Mancuso.  Impact of health literacy and patient trust on glycemic control in an urban USA population. , 2010, Nursing & health sciences.

[15]  Darcie L. Keller,et al.  Impact of Health Literacy on Health Outcomes in Ambulatory Care Patients: A Systematic Review , 2008, The Annals of pharmacotherapy.

[16]  Elizabeth G Hill,et al.  The Relationship Between Health Literacy and Diabetes Knowledge and Readiness to Take Health Actions , 2007, The Diabetes educator.

[17]  R. S. Boone,et al.  Literacy and its relationship with self-efficacy, trust, and participation in medical decision making. , 2007, American journal of health behavior.

[18]  Nancy D Berkman,et al.  Literacy and health outcomes. A systematic review of the literature , 2004, Journal of general internal medicine.

[19]  S. Kripalani,et al.  Development and validation of a Spanish diabetes-specific numeracy measure: DNT-15 Latino. , 2011, Diabetes technology & therapeutics.

[20]  Mark V. Williams,et al.  Relationship of functional health literacy to patients' knowledge of their chronic disease. A study of patients with hypertension and diabetes. , 1998, Archives of internal medicine.

[21]  J. Feinglass,et al.  In search of 'low health literacy': threshold vs. gradient effect of literacy on health status and mortality. , 2010, Social science & medicine.

[22]  Darren A. DeWalt,et al.  Health Literacy and Child Health Outcomes: A Systematic Review of the Literature , 2009, Pediatrics.

[23]  Douglas K Owens,et al.  AHRQ series paper 5: grading the strength of a body of evidence when comparing medical interventions--agency for healthcare research and quality and the effective health-care program. , 2010, Journal of clinical epidemiology.

[24]  S. Kripalani,et al.  Health literacy and control in the medical encounter: a mixed-methods analysis. , 2009, Journal of the National Medical Association.

[25]  M. Wolf,et al.  Health literacy and functional health status among older adults. , 2005, Archives of internal medicine.

[26]  Jill Boylston Herndon,et al.  Health literacy and emergency department outcomes: a systematic review. , 2011, Annals of emergency medicine.

[27]  Stacey L. Sheridan,et al.  Low Health Literacy and Health Outcomes: An Updated Systematic Review , 2011, Annals of Internal Medicine.

[28]  S. Pang,et al.  Health literacy, complication awareness, and diabetic control in patients with type 2 diabetes mellitus. , 2008, Journal of advanced nursing.

[29]  Judy A Shea,et al.  Association of health literacy with self-management behavior in patients with diabetes. , 2004, Diabetes care.

[30]  Khan Mk,et al.  Health literacy: report of the Council on Scientific Affairs. Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association. , 1999, JAMA.

[31]  Nancy D Berkman,et al.  Health Literacy: What Is It? , 2010, Journal of health communication.

[32]  D. Nutbeam.  The evolving concept of health literacy. , 2008, Social science & medicine.

[33]  Urmimala Sarkar,et al.  Hypoglycemia is More Common Among Type 2 Diabetes Patients with Limited Health Literacy: The Diabetes Study of Northern California (DISTANCE) , 2010, Journal of General Internal Medicine.

[34]  V. Entwistle,et al.  Health in the 'hidden population' of people with low literacy. A systematic review of the literature , 2010, BMC public health.

[35]  Benjamin Littenberg,et al.  The Single Item Literacy Screener: Evaluation of a brief instrument to identify limited reading ability , 2006, BMC family practice.

[36]  Jeffrey A. Johnson,et al.  Measuring Health Literacy in Individuals With Diabetes , 2013, Health education & behavior : the official publication of the Society for Public Health Education.

[37]  L. Egede,et al.  Associations between health literacy, diabetes knowledge, self-care behaviors, and glycemic control in a low income population with type 2 diabetes. , 2011, Diabetes technology & therapeutics.

[38]  D. Schillinger,et al.  Association of health literacy with diabetes outcomes. , 2002, JAMA.

[39]  C. Y. Osborn,et al.  Health literacy, diabetes self-care, and glycemic control in adults with type 2 diabetes. , 2010, Diabetes technology & therapeutics.

[40]  R. Rothman,et al.  Addressing Health Literacy and Numeracy to Improve Diabetes Education and Care , 2010, Diabetes Spectrum.

[41]  Rima E Rudd.  Low health literacy. , 2011, Annals of internal medicine.

[42]  N. Adler,et al.  Does Literacy Mediate the Relationship between Education and Health Outcomes? A Study of a Low-Income Population with Diabetes , 2006, Public health reports.

[43]  D. DeWalt,et al.  The Influence of Literacy on Patient-Reported Experiences of Diabetes Self-Management Support , 2010, Nursing research.

[44]  D. Roter,et al.  Health literacy and the JAMA Patient Page. , 1999, JAMA.

[45]  Dianne Davis,et al.  Addressing Literacy and Numeracy to Improve Diabetes Care , 2009, Diabetes Care.

[46]  Mark V. Williams,et al.  Health literacy and knowledge of chronic disease. , 2003, Patient education and counseling.

[47]  J. Nolan,et al.  Globalization, immigration and diabetes self-management: an empirical study amongst immigrants with type 2 diabetes mellitus in Ireland. , 2009, QJM : monthly journal of the Association of Physicians.

[48]  B. Littenberg,et al.  Relationship of literacy and heart failure in adults with diabetes , 2007, BMC Health Services Research.

[49]  Dean Schillinger,et al.  Functional health literacy and the quality of physician-patient communication among diabetes patients. , 2004, Patient education and counseling.

[50]  Everett V. Smith,et al.  The assessment of diabetes knowledge and self-efficacy in a diverse population using Rasch measurement. , 2006, Journal of applied measurement.

[51]  Robert Nguyen,et al.  The Literacy Divide: Health Literacy and the Use of an Internet-Based Patient Portal in an Integrated Health System—Results from the Diabetes Study of Northern California (DISTANCE) , 2010, Journal of health communication.

[52]  Y. Yamazaki,et al.  Patient health literacy and patient-physician information exchange during a visit. , 2009, Family practice.

[53]  S. Cole,et al.  Overadjustment Bias and Unnecessary Adjustment in Epidemiologic Studies , 2009, Epidemiology.