Highlights
- •To advance the theoretical framework how health literacy affects health outcomes.
- •One of the few to examine the ordering of mediating variables in the HL framework.
- •The HL–outcome relationship is mediated by knowledge and stages of change.
- •This study contributes to a deeper understanding of the health literacy framework.
Abstract
Aims
Health literacy has been recognized as a key construct associated with clinical outcomes;
however, few studies have explored the mechanism underlying the association. The transtheoretical
model (TTM) has long been considered a useful conceptualization in the process of
intentional behavior change. Stages of change lies at the heart of the TTM as studies
of change have found that people move through a series of stages when modifying behavior.
This study focuses on the role of knowledge and stages of change (SOC) as serial mediators
linking health literacy to glycemic control.
Methods
In this cross-sectional survey, a total of 232 patients with type 2 diabetes participated
in this study. Participants completed questionnaires for assessing health literacy,
readiness to consume healthy foods, and a dietary knowledge test specific to diabetes.
Results
Low health literacy was significantly associated with worse glycemic control. Statistical
evaluation supported the serial mediation model, in which knowledge and SOC formed
a serial mediation chain that accounted for the indirect effect of health literacy
on glycemic control. In other words, dietary knowledge significantly motivated participants
to move into the later stages of behavior change, which in turn improved the outcome
of glycemic control.
Conclusions
The results indicate that the ordering of mediators in the pathway between health
literacy and health outcome may be complex, help explain the conflicting results of
the past, and form a basis for the development of interventions promoting self-management
of diabetes through glycemic control.
Keywords
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Article info
Publication history
Published online: August 30, 2016
Accepted:
August 9,
2016
Received in revised form:
July 15,
2016
Received:
October 1,
2015
Identification
Copyright
© 2016 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
