Health Literacy and Patient-Reported Outcomes: A Cross-Sectional Study of Underserved English- and Spanish-Speaking Patients With Type 2 Diabetes
Health Literacy and Patient-Reported Outcomes: A Cross-Sectional Study of Underserved English- and Spanish-Speaking Patients With Type 2 Diabetes
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DOI：
10.1080/10810730.2015.1061071
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发表时间：
2015-10-09
影响因子：
4.4
通讯作者：
Baker, David W.
中科院分区：
文献类型：
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作者：
Hahn, Elizabeth A.;Burns, James L.;Baker, David W.
本研究探讨了患者特征，健康行为和健康结果之间的关联，并探讨了健康素养作为结果的潜在中介的作用。英语和西班牙语的2型糖尿病成年人使用双语多媒体触摸屏完成问卷调查。弱势群体的行为模型指导多变量回归和中介检验。因变量为糖尿病自我护理、健康状况和沟通满意度。自变量包括社会人口学和临床特征，健康素养，健康信念和自我效能。与英语使用者相比，西班牙语使用者的健康素养较低，身体，心理和整体健康状况较差。较高的健康素养与社会对饮食的支持较少、饮食和药物障碍较少、年龄较小、糖尿病知识较高以及与卫生保健专业人员交谈以获得糖尿病信息有关。与预期相反，健康素养与糖尿病自我护理，健康状况或沟通满意度无关，并且它没有介导其他因素对这些结果的影响。糖尿病自我效能与健康行为和结果显著相关。西班牙语偏好和健康状况较差之间的关联并不受这一群体较低的健康素养的影响。提高健康相关的自我效能可能是改善2型糖尿病患者预后的重要临床策略。
This study examined associations between patient characteristics, health behaviors, and health outcomes and explored the role of health literacy as a potential mediator of outcomes. English- and Spanish-speaking adults with Type 2 diabetes used a bilingual multimedia touchscreen to complete questionnaires. The behavioral model for vulnerable populations guided multivariable regression and mediation testing. Dependent variables were diabetes self-care, health status, and satisfaction with communication. Independent variables included sociodemographic and clinical characteristics, health literacy, health beliefs, and self-efficacy. Spanish speakers had lower health literacy and poorer physical, mental, and overall health compared to English speakers. Higher health literacy was associated with less social support for diet, fewer diet and medication barriers, younger age, higher diabetes knowledge, and talking with health care professionals to get diabetes information. In contrast to expectations, health literacy was not associated with diabetes self-care, health status, or satisfaction with communication, and it did not mediate the effects of other factors on these outcomes. Diabetes self-efficacy was significantly associated with health behaviors and outcomes. The association between Spanish language preference and poorer health was not mediated by this group's lower health literacy. Increasing health-related self-efficacy might be an important clinical strategy for improving outcomes in underserved patients with Type 2 diabetes.