Health literacy and diabetes self-care activities: The mediating effect of knowledge and patient activation

Background: An association between health literacy and health outcomes has been widely reported in the literature. However, models exploring the links between health literacy and the outcomes of health literacy need further testing. The purpose of this study was to examine the pathways of health literacy on diabetes self-care activities amongst patients with Type 2 diabetes. Methods: A cross-sectional survey using secondary data analysis was conducted on 155 patients with Type 2 diabetes recruited from the diabetes clinics of two university hospitals in a metropolitan city in South Korea. Structural equation modelling analysis using bootstrapping was carried out using the AMOS software. Results: Health literacy had no significant direct effect on diabetes self-care activities. Rather, health literacy had a significant indirect effect on diabetes self-care activities mediated through diabetes knowledge and patient activation. Conclusion: These findings indicate that interventions intended to improve self-care activity amongst older adults with low health literacy should include strategies to enhance patients' knowledge, as well as their activation for diabetes self-care.