Health Literacy, Self-Efficacy, and Associated Factors Among Patients with Diabetes

Abstract

Background: High levels of health literacy (HL) and self-efficacy (SE) are important steps in managing diabetes. Previous studies have investigated the role played by the individual constructs (HL or SE) on self-care behaviors and health outcomes in patients with diabetes. However, our understanding of the relationship between HL and SE is limited. Methods: Literature was searched in PubMed, Medline (via OvidSP), CINAHL (via EBSCOhost), ProQuest Medical Library, and Science Direct using keywords “diabetes,” “diabetic,” “DM,” “T1DM,” “T2DM,” “health literacy,” “HL,” “common HL,” “diabetes HL,” “SE,” “general SE,” and “diabetes SE.” The keywords were limited by “MeSH terms” and “Title and Abstracts.” Key Results: Eleven studies were included in this systematic review. Communicative and critical HL were prominent in this relationship. Among the 11 reviewed studies, a positive relationship between communicative/critical HL and SE in diabetes care was illustrated, but the relationship between functional HL and SE remained controversial. Factors positively associated with HL and SE were educational level, employment status, annual income, social support, clarity of the physician's explanation, and empowerment perception. Discussion: Health professionals should act to improve communicative and critical HL so that patients may be more confident in managing diabetes. Clarity in health professionals' explanations and social support would be helpful in enabling patients with diabetes to build up their SE and HL. [ HLRP: Health Literacy Research and Practice . 2018;2(2):e67–e77.] Plain Language Summary: This study is the first systematic review to investigate the relationship between health literacy (HL) and self-efficacy (SE) among persons with diabetes. Even though the relationship between HL and SE needs to be further explored, communicative and critical HL were found to be positively associated with SE. Therefore, to support people in building up SE, health professionals should consider actions that support communication and critical thinking in health settings.

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“…Still, Caruso et al (160) describe HL and self-efficacy as a knowledge gap in diabetes care, since the findings are inconsistent: some studies have found an association between self-efficacy and HL, and others have not. Xu et al (161) also conducted a literature review on HL and self-efficacy in patients with diabetes, and found that 8 out of 11 studies identified a positive association between selfefficacy and all three of Nutbeam's three levels of HL (functional HL, interactive HL, and critical HL) (161). However, Xu et al found that interactive and critical HL explained more variance in self-efficacy than functional HL.…”

“…However, Xu et al found that interactive and critical HL explained more variance in self-efficacy than functional HL. This could imply that individuals possessing interactive and critical HL in addition to functional literacy have higher levels of self-efficacy and more self-confidence in their self-care abilities (161). Different measurements of HL could also produce different results.…”

“…Different measurements of HL could also produce different results. When using subjective measures of HL, there is a possibility that the respondents with higher levels of self-efficacy overestimate their skills related to HL, and therefore rate their HL to be higher (161).…”

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