Objective: This study assessed associations among health literacy, diabetes knowledge, self-care, and glycemic control in a low income, predominately minority population with type 2 diabetes. Methods: One hundred twenty-five adults with diabetes were recruited from a primary care clinic. Subjects completed validated surveys to measure health literacy, diabetes knowledge, and self-care (medication adherence, diet, exercise, blood sugar testing, and foot care). Hemoglobin A1c values were extracted from the medical record. Spearman's correlation and multiple linear regression were used to assess the relationship among health literacy, diabetes knowledge, self-care, and glycemic control controlling for covariates. Results: Cronbach's a was 0.95 for the Revised Rapid Estimate of Adult Literacy in Medicine. The majority of the sample was <65 years old (50.7%), female (72.5%), and African American (71.4%), had less than a high school education (68.2%) and a household income <$15,000 (64.2%), and reported their health status as worse than last year (73.9%). In adjusted models that examined the associations among health literacy, diabetes knowledge, medication adherence, and self-care, health literacy was only significantly associated with diabetes knowledge (b ¼ 0.55; 95% confidence interval [CI] 0.29, 0.82). In the final adjusted model for independent factors associated with glycemic control, both diabetes knowledge (b ¼ 0.12; 95% CI 0.01, 0.23) and perceived health status (b ¼ 1.14; 95% CI 0.13, 2.16) were significantly associated with glycemic control, whereas health literacy was not associated with glycemic control (b ¼ À0.03; 95% CI À0.19, 0.13). Conclusions: Diabetes knowledge and perceived health status are the most important factors associated with glycemic control in this population. Health literacy appears to exert its influence through diabetes knowledge and is not directly related to self-care or medication adherence.

Background: Although limited health literacy is a barrier to disease management and has been associated with poor glycemic control, the mechanisms underlying the relationships between health literacy and diabetes outcomes are unknown. We examined the relationships between health literacy, determinants of diabetes self-care, and glycemic control in adults with type 2 diabetes. Methods: Patients with diabetes were recruited from an outpatient primary care clinic. We collected information on demographics, health literacy, diabetes knowledge, diabetes fatalism, social support, and diabetes self-care, and hemoglobin A1c values were extracted from the medical record. Structural equation models tested the predicted pathways linking health literacy to diabetes self-care and glycemic control. Results: No direct relationship was observed between health literacy and diabetes self-care or glycemic control. Health literacy had a direct effect on social support (r ¼ À0.20, P < 0.05) and through social support had an indirect effect on diabetes self-care (r ¼ À0.07) and on glycemic control (r ¼ À0.01). More diabetes knowledge (r ¼ 0.22, P < 0.05), less fatalism (r ¼ À0.22, P < 0.05), and more social support (r ¼ 0.27, P < 0.01) were independent, direct predictors of diabetes self-care and through self-care were related to glycemic control (r ¼ À0.20, P < 0.05). Conclusions: Our findings suggest health literacy has an indirect effect on diabetes self-care and glycemic control through its association with social support. This suggests that for patients with limited health literacy, enhancing social support would facilitate diabetes self-care and improved glycemic control.

BackgroundIn the United States, it is estimated that 40% of adults utilize complementary and alternative medicine (CAM) therapies. Recently, national surveys report that over 90 million adults have inadequate health literacy. To date, no study has assessed health literacy and its effect on CAM use. The primary objective of this study was to assess the relationship between health literacy and CAM use independent of educational attainment. Second objective was to evaluate the differential effect of health literacy on CAM use by race.Methods351 patients were recruited from an outpatient primary care clinic. Validated surveys assessed CAM use (I-CAM-Q), health literacy (REALM-R), and demographic information. We compared demographics by health literacy (adequate vs. inadequate) and overall and individual CAM categories by health literacy using chi square statistics. We found a race by health literacy interaction and ran sequential logistic regression models stratified by race to test the association between health literacy and overall CAM use (Model 1), Model 1 + education (Model 2), and Model 2 + other demographic characteristics (Model 3). We reported the adjusted effect of health literacy on CAM use for both whites and African Americans separately.Results75% of the participants had adequate literacy and 80% used CAM. CAM use differed by CAM category. Among whites, adequate health literacy was significantly associated with increased CAM use in both unadjusted (Model 1, OR 7.68; p = 0.001) and models adjusted for education (Model 2, OR 7.70; p = 0.002) and other sociodemographics (Model 3, OR 9.42; p = 0.01). Among African Americans, adequate health literacy was not associated with CAM use in any of the models.ConclusionsWe found a race by literacy interaction suggesting that the relationship between health literacy and CAM use differed significantly by race. Adequate health literacy among whites is associated with increased CAM use, but not associated with CAM use in African Americans.

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later, Olson and Windish 1 show that this aspect of care is lacking. I am alarmed that such a high proportion of patients did not know their diagnosis on their day of discharge and were not aware of the possible adverse effects of new medications. It is little wonder that rehospitalization rates are so high when patients do not have basic information about their own medical condition and treatment. It has been shown that patients who do not have a clear understanding of their after-hospital care instructions are 70% more likely to be readmitted or visit the emergency department than patients who do. 3 This reinforces the importance of having good systems of communication between health care providers and patients.The fact that only 18% of patients could name their primary physician and that 56% felt that their physicians never discussed their fears and anxieties indicates poor interpersonal performance, not only by the physicians but by the multidisciplinary team as a whole. Interpersonal and technical abilities are 2 important elements of a health care professional's performance: "the interpersonal process is the vehicle by which technical care is implemented and on which its success depends." 4(p1744)Poor patient-physician communication is not limited to inpatient health care settings: in an outpatient, multicenter study, Weiner et al 5 found that physicians provided error-prone "care" in 78% of contextually complicated encounters. Physicians' care plans were inappropriate because they did not take into account environmental and behavioral factors affecting their patients' ability to carry out the recommended treatment.It is not a good enough excuse that health care professionals are too busy to provide effective and customized care plans for patients. Patient-centered care is everyone's business and needs to be systematically built into our health care systems. To create a culture of patientcentered practice, we require strong leadership at the macro and micro levels, and structures and processes are necessary to train and support multidisciplinary teams. There is increasing pressure on the health care system to provide timely, safe, effective, efficient, and equitable care. But what is the use if we do not empower our patients to care for themselves?