Impact of health literacy on diabetes outcomes: a cross-sectional study from Lahore, Pakistan

Abstract

Objectives: To evaluate the functional health literacy of patients with type 2 diabetes in Lahore and its impact on glycaemic control.

Study design: A six-month cross-sectional study.

Methods: Health literacy in 204 patients with diabetes was evaluated using a validated questionnaire (Short Test of Functional Health Literacy [s-TOFHLA]).

Results: The frequency distribution among various age groups (P = 0.003), education levels (P = 0.0005), socio-economic status levels (P = 0.0005) and glycated haemoglobin (HbA_1C) levels (P = 0.0005) differed significantly with health literacy level. The majority of patients with diabetes (86.1%) with poor glycaemic control (HbA_1C >9%) had inadequate health literacy and were more likely to have retinopathy (odds ratio = 13.1, P = 0.003). Health literacy levels were not significantly different when compared for antidiabetic therapies (P = 0.234). Significant associations were observed between predictors of glycaemic control (s-TOFHLA score [P = 0.0005], education status [P = 0.0005] and disease risks [P = 0.005]) and HbA_1C, level. However, after adjusting for basic characteristics, only s-TOFHLA score had a significant association with HbA_1C level (P = 0.001).

Conclusions: These data suggest that inadequate health literacy is potentially associated with poor glycaemic control, and microvascular and macrovascular complications, particularly retinopathy. As such, educational and training programmes should be introduced to improve functional health literacy of patients with diabetes for better glycaemic control.

Keywords: Diabetes; Glycaemic control; Glycated haemoglobin; Health literacy; Lahore; Retinopathy.