Empirical evidence on how health literacy affects diabetes outcomes is inconsistent. The purpose of this meta-analysis was to quantitatively summarize the findings on the associations between health literacy and diabetes knowledge, self-care activities, and glycemic control as disease-related outcomes, with specific focus on the type of health literacy assessment. Nine databases (MEDLINE, CINAHL, Communication and Mass Media Complete, PsychInfo, PsychArticles, Psychology and Behavioral Sciences Collection, ERIC, Sociology, Embase) were searched for peer-reviewed original research articles published until 31 March 2018. Studies with type 1 and/or type 2 diabetes patients aged 18 or older, providing a calculable baseline effect size for functional health literacy and diabetes knowledge, self-care activities, or HbA1C were included. The meta-analysis includes 61 studies with a total of 18,905 patients. The majority were conducted in the USA, on type 2 diabetes patients, and used the S-TOFHLA as a performance-based or the BHLS as a perception-based measure of functional health literacy. Meta-analytic results show that all three outcomes are related to health literacy. Diabetes knowledge was best predicted by performance-based health literacy measures, self-care by self-report measures, and glycemic control equally by both types of health literacy assessment. Health literacy plays a substantial role in diabetes knowledge. Findings for the role of health literacy in self-care and glycemic control remain heterogeneous, partly due to the type of health literacy assessment (performance- vs. perception-based). This has implications for the use of health literacy measures in clinical settings and original research. This meta-analysis was limited to functional health literacy and, due to the paucity of studies, did not investigate the role of other dimensions including communicative and critical health literacy.

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The Role of Health Literacy in Diabetes Knowledge, Self-Care, and Glycemic Control: a Meta-analysis

Shared decision-making, central to evidence-based medicine and good patient care, begins and ends with the patient. It is the process by which a clinician and a patient jointly make a health decision after discussing options, potential benefits and harms, and considering the patient's values and preferences. Patient empowerment is crucial to shared decision-making and occurs when a patient accepts responsibility for his or her health. They can then learn to solve their own problems with information and support from professionals. Patient empowerment begins with the provider acknowledging that patients are ultimately in control of their care and aims to increase a patient's capacity to think critically and make autonomous, informed decisions about their health. This article explores the various components of shared decision-making in scenarios such as hypertension and hyperlipidemia, heart failure, and diabetes. It explores barriers and the potential for improving medication adherence, disease awareness, and self-management of chronic disease.

Shared Decision-Making and Patient Empowerment in Preventive Cardiology.

https://www.asian-nursingresearch.com/article/S1976-1317(16)00015-3/pdf

A Structural Equation Model Linking Health Literacy to Self-efficacy, Self-care Activities, and Health-related Quality of Life in Patients with Type 2 Diabetes.

Although management of diabetes mellitus is improving, inadequately managed cases still exist. Prevention of diabetes mellitus requires an integrated and holistic approach based on the origin of the disease. In Europe only half of diagnosed patients with diabetes mellitus have good glycaemic control. Inadequate glycaemic control is significantly increasing the use of healthcare resources, the medical costs and mortality rates. A review was conducted in order to summarise and discuss central themes for prevention. A search of the databases PubMed, CINAHL, Cochrane and Google Scholar between January 2010-May 2019 was undertaken. The following keywords: 'diabetes mellitus', 'cardiovascular diseases', 'empowerment', 'self-management education' and 'lifestyle factors' were used in different combinations to identify eligible articles. Important variables for the prevention of diabetes mellitus and its complications are self-management of diabetes mellitus and the management of risk factors. Education and support for self-management are fundamental when caring for people with a chronic disease like diabetes mellitus. In order to achieve effective self-management including lifestyle modification it is also crucial to motivate people. In this review, the role of the three main pillars in diabetes care are identified and discussed; patient empowerment, self-management education and lifestyle modification in the management of people with diabetes mellitus.

https://journals.sagepub.com/doi/pdf/10.1177/2047487319885455

Lifestyle factors, self-management and patient empowerment in diabetes care

Aims To investigate the relationships among social support, health literacy, and self-management, and the factors influencing self-management of chronic kidney disease (CKD). Design Cross-sectional study. Methods A random sample of 410 patients was recruited from nephrology clinics. Data were collected using structured questionnaires and chart reviews from January 2013 to February 2014. Hierarchical regression analysis was used to determine the predictive factors of self-management behaviors and ∆R2 to determine each variable's explanatory power. Findings Health literacy and social support were positively correlated with self-management behaviors. Furthermore, social support, health literacy, and marital status were significant predictors of self-management behaviors. Social support had a relatively greater explanatory power for self-management behaviors than did health literacy. Particularly, healthcare provider support had the greatest influence on patients' self-management behaviors. Conclusions Health literacy and social support play independent positive roles in self-management behaviors of patients with CKD, with social support having a particularly dominant role. Further research using a systems approach to improving self-management behaviors is necessary to clarify the role of social support. Clinical relevance Health literacy and social support are independently and positively related to self-management. Social support, which is a system-level factor, is a relatively stronger and crucial predictor than is health literacy. Nurses have to refine self-management programs to focus on families and adopt a systems approach to help CKD patients improve their self-management behaviors.

The Roles of Social Support and Health Literacy in Self-Management Among Patients With Chronic Kidney Disease.

Pathways of empowerment perceptions, health literacy, self-efficacy, and self-care behaviors to glycemic control in patients with type 2 diabetes mellitus.

Yi-Hsien Wang

Papers

Pathways of empowerment perceptions, health literacy, self-efficacy, and self-care behaviors to glycemic control in patients with type 2 diabetes mellitus.