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Cognition, educational attainment and diabetes distress predict poor health literacy in diabetes: A cross-sectional analysis of the SHELLED study

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Chen, P, Callisaya, M ORCID: 0000-0003-2122-1622, Wills, K ORCID: 0000-0003-3897-2908, Greenaway, T and Winzenberg, T ORCID: 0000-0002-4112-3491 2022 , 'Cognition, educational attainment and diabetes distress predict poor health literacy in diabetes: A cross-sectional analysis of the SHELLED study' , PLoS ONE, vol. 17, no. 4 , e0267265 , doi: 10.1371/journal.pone.0267265.

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Abstract

ObjectivesTo identify factors that predict poor health literacy amongst people with diabetes.DesignCross-sectional analysis of baseline data from a prospective study of diabetic foot disease.SettingPatients attending a tertiary hospital diabetes outpatient clinic in Tasmania, Australia.Participants222 people with diabetes mellitus, aged >40 years, with no history of foot ulceration, psychotic disorders or dementia.Outcome measuresHealth literacy was measured using the short form Test of Functional Health Literacy in Adults (functional health literacy), and the Health Literacy Questionnaire (HLQ), which measures nine domains of health literacy. Predictors included demographic characteristics, cognition, diabetes distress, depression, and educational attainment.ResultsIn multivariable analysis, greater educational attainment (OR 0.88, 95% CI 0.76, 0.99) and poorer cognition (OR 0.71, 95% CI 0.63, 0.79) were associated with poorer functional health literacy. Age was negatively associated with domains of appraisal of health information and ability to find good health information (both beta = -0.01). Educational attainment was positively associated with four domains, namely having sufficient information to manage my health, actively managing my health, appraisal of and ability to find good health information (beta ranging from +0.03 to 0.04). Diabetes distress was negatively associated with five domains: having sufficient information to manage my health, social support for health, ability to actively engage with healthcare providers, navigating the healthcare system and ability to find good health information (beta ranging from -0.14 to -0.18).ConclusionPoorer cognition and poorer educational attainment may be detrimental for an individuals functional health literacy, and education, diabetes distress and older age detrimental across multiple health literacy domains. Clinicians and policy makers should be attuned to these factors when communicating with people with diabetes and in designing healthcare systems to be more health-literacy friendly in order to improve diabetes outcomes.

Item Type: Article
Authors/Creators:Chen, P and Callisaya, M and Wills, K and Greenaway, T and Winzenberg, T
Keywords: cognition, diabetes, health, literacy
Journal or Publication Title: PLoS ONE
Publisher: Public Library of Science
ISSN: 1932-6203
DOI / ID Number: 10.1371/journal.pone.0267265
Copyright Information:

© 2022. Chen et al. This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) License, (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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