A systematic review of the prevalence, predictors and impact of limited health literacy in type 2 diabetes

• Main Author: Tang, Rachel Li Jin
• Other Authors: Sin Sei Ching, Joanna
• Format: Theses and Dissertations
• Language: English
• Published: 2018
• Subjects: DRNTU::Library and information science::General
• Online Access: http://hdl.handle.net/10356/76104
• Institution: Nanyang Technological University

Limited health literacy (HL) has been proposed to adversely impact health outcomes in people with Type 2 diabetes (T2D), although studies have produced inconsistent findings. This present study aims to synthesize and evaluate the literature evidence on the prevalence, predictors and impact on outcomes of limited health literacy in Type 2 Diabetes. A systematic literature review was conducted through searching of five databases, using terms related to HL and T2D. The study included full text studies that were available in English, which had a population of at least 50 adults with T2D, used a validated measure of HL and reported a prevalence of limited HL (category A) or reported the impact of limited HL on outcomes (Category B). These papers were evaluated for quality by two independent coders and the final selection included a total of 47 articles, of which 29 were in category A, and 36 in category B (with an overlap of 18 articles). Meta-analysis of papers in category A showed that limited HL is common in T2D, with a pooled prevalence of 36.7% (CI 28.3% – 46.0%), and 95% prediction interval of 0.0619 to 0.8371. Analysis of papers in category B showed that limited health literacy was associated with lower education level, older age, lower income level, minority ethnicity and lower language proficiency. Among the primary health outcomes, our review suggests that limited HL is most likely to have an impact on health-related quality of life (HRQoL) and hypoglycaemia, though there were only a few studies on this topic. However, the association between limited HL and glycated haemoglobin (HbA1c), a measure of glycemic control, was mixed. In terms of secondary outcomes, limited HL was shown to be linked with poorer diabetes knowledge and understanding, reduced communication capacity and diminished self-efficacy. Overall, this review has identified a number of new studies relevant to understanding the role of health literacy in diabetes, though further research is needed to fully elucidate the pathways linking limited health literacy with outcomes.