Is diabetes-specific health literacy associated with diabetes-related outcomes in older adults?

J Diabetes. 2011 Jun;3(2):138-46. doi: 10.1111/j.1753-0407.2011.00112.x.


Background: The present study examined the association between a measure of diabetes-specific health literacy and three different Type 2 diabetes outcome indicators in a national sample of older adults.

Methods: Data were taken from the Health and Retirement Study (HRS) 2003 Diabetes module and the HRS 2002 core wave. Analysis was performed on data from 1318 respondents aged 42-96 years [mean (±SD) 67.96 ± 8.65 years] who submitted responses on all relevant independent variable measures along with an HbA1c test kit. The index of diabetes-specific health literacy was constructed from responses to 10 diabetes self-care regimen items (α = 0.927).

Results: Using a multivariate regression strategy to analyze weighted data, the diabetes-specific health literacy index was significantly and positively associated with self-graded assessment of diabetes self-care (R2 = 0.231). However, diabetes-specific health literacy was not independently associated with the HbA1c level or the average number of days five recommended self-management behaviors were practiced each week.

Conclusions: No previous single study has focused on the relationship between diabetes-specific health literacy and multiple diabetes-related outcomes. The direct association of diabetes-specific health literacy with patients' assessment of their self-care practice acumen is useful information for the design of effective patient intervention and/or communication strategies. Health literacy is a broad, multidimensional construct that bridges basic literacy skills and various health and illness contexts. Because it is so important to adults engaged in the self-management of chronic illness, indicators of disease-specific knowledge and/or understanding should be included in efforts to measure health literacy.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Glucose / metabolism*
  • Diabetes Mellitus, Type 2 / blood*
  • Diabetes Mellitus, Type 2 / therapy*
  • Glycated Hemoglobin / analysis
  • Glycated Hemoglobin / metabolism*
  • Health Literacy / standards*
  • Humans
  • Logistic Models
  • Middle Aged
  • Multivariate Analysis
  • Self Care / methods
  • Socioeconomic Factors
  • Surveys and Questionnaires
  • United States


  • Blood Glucose
  • Glycated Hemoglobin A