Associations between health literacy, diabetes knowledge and self-management behaviour among adults with diabetes: results of a Dutch cross-sectional study

Background Various studies examined the association between health literacy and self-management behaviour but few explored ways through which this occurs. The present study examines to what extent health literacy is associated with diabetes self-management behaviour and to what extent diabetes knowledge is a mechanism in this association. Method The study was based on cross-sectional data retrieved from patient registrations and questionnaires completed in 2010. The sample included 1714 predominantly type 2 diabetes patients, with a mean age of 67. Diabetes self-management was indicated by HbA1c level, glucose self-control and self-reported monitoring of glucose levels, physical activity and smoking. Multilevel analyses were applied based on multiple imputed data. Results Lower health literacy was significantly associated with less diabetes knowledge, higher HbA1c level, less self-control of glucose level and less physical activity. Participants with more diabetes knowledge were less likely to smoke and more likely to control glucose levels. Diabetes knowledge was a mediator in the association between health literacy and glucose self-control and between health literacy and smoking. Conclusion This study indicates that higher health literacy may contribute to participation in certain self-management activities, in some cases via diabetes knowledge. Diabetes knowledge and health literacy skills may be important targets for interventions promoting diabetes self-management.