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Health Literacy and Its Association with Diabetes Knowledge, Self-Efficacy and Disease Self-Management among African Americans with Diabetes Mellitus

Article excerpt

Abstract: The purpose of this descriptive correlational study was to examine health literacy and its association with diabetes knowledge, perceived self-efficacy and disease self-management among African Americans with diabetes mellitus. Fifty Englishspeaking, adult African American participants with diabetes mellitus were recruited from a community health center and a church located in the Midwestern United States. Data were collected at a single point in time utilizing the Rapid Estimate of Adult Literacy in Medicine (REALM), Diabetes Knowledge Test (DKT), Diabetes Self-efficacy Scale, and Summary of Diabetes Self-care Activities (SDSCA) Questionnaire. Bivariate associations were identified for health literacy with diabetes knowledge level; diabetes knowledge level with dietary selfcare activities; and self-efficacy with dietary, exercise, and foot care self-care activities. Diabetes knowledge level and self-efficacy were independent predictors for dietary self-care activities, while self efficacy was the sole independent predictor for foot self-care. Means for health literacy and diabetes self-care activities were influenced by demographic factors examined.

Key Words: Health Literacy, Diabetes Mellitus, Self-Efficacy, Disease Self-Management, African Americans

Low literacy is associated with difficulty understanding written or verbal medical advice, adverse health outcomes, and negative effects on the health of individuals (U.S. Department of Health & Human Services. Agency for Healthcare Research and Quality [AHRQ], 2004). For persons with diabetes, low literacy skills make it difficult to read and understand information on insulin dosages and administration, dietary instructions for a food exchange list, and information about physical activity (Doak, Doak, & Root, 1996). Thus, low literacy may impair an individual's functioning in the health care environment, affect patientphysician communication, and lead to substandard medical care (AHRQ, 2004). Low literacy is more prevalent in people with fewer years of education, those of certain racial or ethnic groups and the elderly (AHRQ, 2004). Low literacy increases the risk for health disparities in African Americans (National Institute of Nursing Research [NINR] and National Center on Minority Health and Health Disparities [NCMHHD], 2001; Sentell & Halpin, 2006; Smedley, Smith, & Nelson, 2003). Diabetes is more common among African Americans and certain other minority populations; and diabetes complications are leading causes of morbidity and mortality in the United States (Center for Disease Control [CDC], 2005). While there has been improvement in the overall health of the U.S. population, racial and ethnic minorities experience higher rates of morbidity and mortality than non-minorities,(NINR & NCMHHD, 2001; Smedley et al., 2003) and African Americans, Hispanics, and Native Americans experience approximately a 50% to 100% higher burden of illness and mortality due to diabetes than white Americans (Smedley et al.,2003)

Diabetes self care is recognized as an essential component of effective glycemic control and self-management is key to achieving optimal health outcomes (Lorig et al., 1999; Meers et al., 1996 & The Diabetes Control and Complications Trial Research Group, 1993). Skills for diabetes self care require the ability to gather information, self-monitor blood glucose levels, and adjust food intake related to activity, stress, and illness. These skills are developed via patient education which relies heavily on written material about the disease process, medical management, and self-care instructions; yet the educational materials are often written at too high of a level for low-literate patients to understand essential information (Williams, Baker, Parker, & Nurss, 1998). Along with adequate literacy, studies have shown chronic disease self-management to be improved with enhanced self-efficacy (Farrell, Wicks, & Martin, 2004). …