• complication awareness;
  • diabetic control;
  • health literacy;
  • nursing;
  • Short-form Test of Functional Health Literacy in Adults (C-S-TOFHLA);
  • type 2 diabetes mellitus


Title. Health literacy, complication awareness, and diabetic control in patients with type 2 diabetes mellitus

Aim.  This paper is a report of a study to examine the relationship between health literacy, complication awareness and diabetic control among patients with type 2 diabetes mellitus, and to validate a Chinese version of the Short-form Test of Functional Health Literacy in Adults.

Background.  There is a rapidly increasing trend in the prevalence of diabetes mellitus in Asian countries. Alongside the considerable progress in recent decades of health education in the field of diabetes care, the effects of health literacy and complication awareness have received increasing attention over the past 10 years.

Method.  This study was conducted from September 2005 to February 2006 with 149 Chinese patients (mean = 59·8 years, range: 27–90 years) who were undergoing/had undergone diabetic complication assessment. Survey data were collected using a structured questionnaire incorporating demographics; assessment of complication awareness in two sections: a self-developed 10-item patient awareness score and a modified Chinese version of the Summary of Diabetes Self-Care Activities measure; and health literacy as measured by the Chinese version of the Short Test of Functional Health Literacy in Adults. Diabetic control was assessed by the most recent HbA1c level.

Findings.  Health literacy (< 0·001) and patient awareness scores were negatively correlated to diabetic control (= 0·035), but management of treatment in the Summary of Diabetes Self-Care Activities measure (= 0·030), gender (= 0·023) and duration of diabetes (< 0·001) were positively correlated to HbA1c.

Conclusion.  To develop effective patient education and improve patients’ diabetic control and own complications, educational strategies need to consider patients’ health literacy levels and self-care skills.