The Association of Health Literacy Level with Self-Care Behaviors and Glycemic Control in a Low Education Population with Type 2 Diabetes Mellitus: A Cross-Sectional Study in Iran

Khalil Maleki Chollou,1 Saber Gaffari-fam,2 Towhid Babazadeh,3 Amin Daemi,4 Ali Bahadori,5 Sohrab Heidari2 1Department of Nursing, Sarab Faculty of Medical Sciences, Sarab, Iran; 2School of Nursing of Miandoab City, Urmia University of Medical Sciences, Urmia, Iran; 3Department of Public Health, Sarab Faculty of Medical Sciences, Sarab, Iran; 4Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran; 5Food and Drug Safety Research Center, Tabriz University of Medical Science, Tabriz, IranCorrespondence: Towhid BabazadehDepartment of Public Health, Sarab Faculty of Medical Sciences, Sarab, IranTel +98 41 4322 4586Fax +98 41 4323 7412Email towhid.babazadeh@gmal.comIntroduction: Promoting Health Literacy (HL) can be a priority in strategic healthcare planning of the countries. Low HL is prevalent in some societies which make barriers to successful self-care of diseases. The aim of this study was to examine the association of HL with self-care behaviors and glycemic control in a low education population with type 2 diabetes mellitus.Methods: This cross-sectional study was conducted in Sarab city, Iran. The 192 participants were patients diagnosed as type 2 diabetes and with low level of education. Convenient sampling method was applied and the participants were chosen by their medical records in health-care centers. To collect data a valid and reliable tool was used based on HL dimensions and self-care behaviors. Using hierarchical logistic regression, the possible association of variables with self-care behaviors and glycemic control was assessed.Results: The mean age of study participants was 58.12 (± 11.83) years. A 28.8% of the variation in the self-care behaviors is explained by the HL and the demographic variables (R= 0.288%; p-value< 0.05). Furthermore, decision-making was the strongest predictor of self-care behaviors (β= 0.451). Approximately 80% of the variation in the HbA1c is explained by the HL, self-care behaviors, and the demographic variables (R= 0.804%; p-value< 0.05).Conclusion: This study revealed that the HL dimensions predicted approximately one-fourth of self-care behaviors and the self-care behaviors and HL dimensions about eight-tenths of HbA1c in this population. These findings call for the need for interventional programs on HL to improve the self-care behaviors and HbA1c control.Keywords: health literacy, diabetes mellitus, hemoglobin A1c protein, self-care