Al Sayah F, Majumdar SR, Williams B, Robertson S, Johnson JA, et al.
Journal of general internal medicine. Date of publication 2013 Mar 1;volume 28(3):444-52.
1. J Gen Intern Med. 2013 Mar;28(3):444-52. doi: 10.1007/s11606-012-2241-z. Epub
2012 Oct 13.
Health literacy and health outcomes in diabetes: a systematic review.
Al Sayah F(1), Majumdar SR, Williams B, Robertson S, Johnson JA.
Author information:
(1)School of Public Health, University of Alberta, Edmonton, AB, T6G 2E1, Canada.
BACKGROUND: Low health literacy is considered a potential barrier to improving
health outcomes in people with diabetes and other chronic conditions, although
the evidence has not been previously systematically reviewed.
OBJECTIVE: To identify, appraise, and synthesize research evidence on the
relationships between health literacy (functional, interactive, and critical) or
numeracy and health outcomes (i.e., knowledge, behavioral and clinical) in people
with diabetes.
METHODS: English-language articles that addressed the relationship between health
literacy or numeracy and at least one health outcome in people with diabetes were
identified by two reviewers through searching six scientific databases, and
hand-searching journals and reference lists.
FINDINGS: Seven hundred twenty-three citations were identified and screened, 196
were considered, and 34 publications reporting data from 24 studies met the
inclusion criteria and were included in this review. Consistent and sufficient
evidence showed a positive association between health literacy and diabetes
knowledge (eight studies). There was a lack of consistent evidence on the
relationship between health literacy or numeracy and clinical outcomes, e.g., A1C
(13 studies), self-reported complications (two studies), and achievement of
clinical goals (one study); behavioral outcomes, e.g., self-monitoring of blood
glucose (one study), self-efficacy (five studies); or patient-provider
interactions (i.e., patient-physician communication, information exchange,
decision-making, and trust), and other outcomes. The majority of the studies were
from US primary care setting (87.5 %), and there were no randomized or other
trials to improve health literacy.
CONCLUSIONS: Low health literacy is consistently associated with poorer diabetes
knowledge. However, there is little sufficient or consistent evidence suggesting
that it is independently associated with processes or outcomes of
diabetes-related care. Based on these findings, it may be premature to routinely
screen for low health literacy as a means for improving diabetes-related
health-related outcomes.
DOI: 10.1007/s11606-012-2241-z
PMCID: PMC3579965
PMID: 23065575 [Indexed for MEDLINE]
