Association of health literacy with diabetes outcomes
Association of health literacy with diabetes outcomes
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DOI：
10.1001/jama.288.4.475
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发表时间：
2002-07-24
影响因子：
120.7
通讯作者：
Bindman, AB
中科院分区：
文献类型：
--
作者：
Schillinger, D;Grumbach, K;Bindman, AB
健康素养是衡量患者阅读、理解和执行医疗指示的能力。少数种族和族裔、老年人和慢性病患者，特别是公共部门的患者，普遍缺乏卫生知识。关于健康素养影响临床健康outcomes.Objectives的程度知之甚少，为了研究2型糖尿病患者的健康素养和糖尿病结局之间的关系，设计，设置，对408名英语和西班牙语学生进行了横断面观察研究，从一所大学的2个初级保健诊所的临床数据库中确定的年龄大于30岁且患有2型糖尿病的说话患者-附属公立医院在旧金山弗朗西斯科，加利福尼亚州。参与者在2000年6月至12月期间登记并填写问卷。我们使用成人功能性健康素养简易测试（s-TOFHLA）以英语或西班牙语评估患者的健康素养。主要结果测量最近的血红蛋白A（1c）（HbA（1c））水平。如果患者的HbA（1c）处于最低四分位数，则将其归类为血糖控制严格，如果处于最高四分位数，则将其归类为血糖控制较差。结果在调整患者的社会人口学特征、抑郁症状、社会支持、治疗方案和糖尿病年数后，s-TOFHLA评分每降低1分，HbA（1c）值增加0.02（P= 0.02）。健康素养不足的患者比健康素养充足的患者更不可能实现严格的血糖控制（HbA（1c）小于或等于7.2%;调整的比值比[OR]，0.57; 95%可信区间[CI]，0.32-1.00; P= 0.05），并且更可能血糖控制不佳（HbA（1c）大于或等于9.5%;调整后的OR，2.03; 95%CI，1.11-3.73; P= 0.02）和报告有视网膜病变（调整后的OR，2.33; 95%CI，1.19-4.57; P= 0.01）。健康知识普及不足可能会导致弱势群体在糖尿病相关问题上承受不成比例的负担。工作重点应放在制定和评估干预措施，以改善健康素养不足的患者的糖尿病结局。
Context Health literacy is a measure of patients' ability to read, comprehend, and act on medical instructions. Poor health literacy is common among racial and ethnic minorities, elderly persons, and patients with chronic conditions, particularly in public-sector settings. Little is known about the extent to which health literacy affects clinical health outcomes.Objectives To examine the association between health literacy and diabetes outcomes among patients with type 2 diabetes.Design, Setting, and Participants Cross-sectional observational study of 408 English- and Spanish-speaking patients who were older than 30 years and had type 2 diabetes identified from the clinical database of 2 primary care clinics of a University-affiliated public hospital in San Francisco, Calif. Participants were enrolled and completed questionnaires between June and December 2000. We assessed patients' health literacy by using the short-form Test of Functional Health Literacy in Adults (s-TOFHLA) in English or SpanishMain Outcome Measures Most recent hemoglobin A(1c) (HbA(1c)) level. Patients were classified as having tight glycemic control if their HbA(1c) was in the lowest quartile and poor control if it was in the highest quartile. We also measured the presence of self-reported diabetes complications.Results After adjusting for patients' sociodemographic characteristics, depressive symptoms, social support, treatment regimen, and years with diabetes, for each 1-point decrement in s-TOFHLA score, the HbA(1c), value increased by 0.02 (P=.02). Patients with inadequate health literacy were less likely than patients with adequate health literacy to achieve tight glycemic control (HbA(1c) less than or equal to 7.2%; adjusted odds ratio [OR], 0.57; 95% confidence interval [CI], 0.32-1.00; P=.05) and were more likely to have poor glycemic control (HbA(1c) greater than or equal to9.5%; adjusted OR, 2.03; 95% Cl, 1.11-3.73; P=.02) and to report having retinopathy (adjusted OR, 2.33; 95% Cl, 1.19-4.57; P=.01).Conclusions Among primary care patients with type 2 diabetes, inadequate health literacy is independently associated with worse glycemic control and higher rates of retinopathy. Inadequate health literacy may contribute to the disproportionate burden of diabetes-related problems among disadvantaged populations. Efforts should focus on developing and evaluating interventions to improve diabetes outcomes among patients with inadequate health literacy.