Relationships between health literacy, motivation and diet and physical activity in people with type 2 diabetes participating in peer-led support groups

  • Lise Juul
    Corresponding author at: Department of Clinical Medicine, Danish Centre for Mindfulness, Aarhus University, Jens Chr. Skous Vej 4, 8000 Aarhus, Denmark.
    Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, Denmark

    Department of Clinical Medicine, Danish Centre for Mindfulness, Aarhus University, Denmark
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  • Gill Rowlands
    Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, Denmark

    Institute of Health and Society, University of Newcastle, UK
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  • Helle Terkildsen Maindal
    Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, Denmark

    Steno Diabetes Center, Health Promotion Research, Copenhagen, Denmark
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Published:March 17, 2018DOI:


      • HL and motivation and health behavior in people with type 2 diabetes were examined.
      • Functional health literacy was associated with following recommended diet.
      • Autonomous motivation was associated with following recommended diet.
      • Autonomous motivation was associated with physical activity.



      To investigate associations between health literacy (HL) and diet and physical activity, and motivation and diet and physical activity in Danish people with type 2 diabetes.


      We used a cross-sectional design including 194 individuals with type 2 diabetes participating in peer-led support groups provided by the Danish Diabetes Association between January–December 2015. The participants completed a questionnaire at the first meeting including; The Summary of Diabetes Self-Care Activities (SDSCA) measure, The Treatment Self-Regulation Questionnaire (TSRQ) (Self-Determination Theory) measuring type of motivation, and two HL scales: The HLS-EU-Q16, and the Diabetes Health Literacy scale (Ishikawa, H). Data were analyzed using linear regression models adjusting for age, gender, educational level, diabetes duration, motivation and HL.


      The adjusted β (95%CI) showed that autonomous motivation and functional HL were associated with following recommended diet: autonomous motivation; 0.43 (0.06; 0.80) and functional HL; 0.52 (0.02; 1.00). Autonomous motivation was related to following physical activity recommendations; β (95%CI) 0.56 (0.16; 0.96).


      This study indicates that, for people with type 2 diabetes, functional HL and autonomous motivation may be important drivers for following diet recommendations, and autonomous motivation may be the most important factor for following recommendations regarding physical activity. These concepts may therefore be highly relevant to address in interventions to people with type 2 diabetes. Different interventions are suggested.


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