Cassy F Dingena1, Elisabeth J den Brok1, Nefeli M Dimitropoulou1, Bastiaan E de Galan1, on behalf of the MELISSA consortium
1Cardiovascular Research Institute Maastricht, Maastricht University, the Netherlands
cassy.dingena@maastrichtuniversity.nl
Background: Effective diabetes self-management requires health literacy to navigate complex treatment regimens, interact with healthcare professionals, and cope with complications, all of which can influence disease burden and profoundly affect treatment satisfaction and quality-of-life. We assessed patient-reported outcomes (PROs) and their association with health literacy.
Methods: This ongoing study aimed at mapping health literacy among adults with insulin-treated diabetes from outpatient clinics in the Netherlands, Denmark, Greece, and Germany. Participants completed the Health Literacy Questionnaire (HLQ©) and PRO questionnaires: Audit of Diabetes-Dependent Quality-of-Life (ADDQoL©), Diabetes Treatment Satisfaction Questionnaire (DTSQS©) and Problem Areas in Diabetes (PAID©). Associations between health literacy domains and PROs were assessed using Spearman correlations.
Results: Eighty-two participants were included (54% male, median age 58 [IQR: 35-66]), 74% type 1 diabetes, median diabetes duration 18 years [IQR: 10-28], mean HbA1c 58±13mmol/mol, 66% on multiple daily injections). Median scores of the ADDQoL, DSTQs and PAID were -3 (IQR: -4 to -2), 30 (IQR: 26-33), and 48 (IQR: 36-64), respectively. Individuals scored lowest on HLQ domain 5 “Appraisal of health information” (2.98±0.46). Higher scores on HLQ 2 “Having sufficient health information”, 6 “Engaging with healthcare providers”, 8 “Finding sufficient health information”, and 9 “Understanding health information”, were linked to higher treatment satisfaction (Spearman’s ρ = 0.37, 0.28, 0.36, 0.32, all p<0.02). Contrastingly, higher scores on HLQ 3 “Actively managing health to act” and 4 “Social support” were associated with lower treatment satisfaction (Spearman’s ρ = -0.23 and -0.36, both p<0.05). No statistically significant associations were observed between HLQ domains and either ADDQoL or PAID.
Conclusion: Several domains of health literacy were associated with treatment satisfaction, whereas no clear relationships were observed with quality-of-life or diabetes distress. These findings highlight the nuanced role of health literacy and underscore the need to pair diabetes management with targeted education and patient support strategies.