The Pharmaceutical Journal
Vol 269 No 7208 p125
27 July 2002

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"Health literacy" impacts on diabetes

Inadequate health literacy is associated with poorer glycaemic control and higher rates of retinopathy among type 2 diabetes patients, and could be contributing to the disproportionate burden of diabetes complications found among racial and ethnic minorities, a new study has concluded (JAMA 2002;288:475).

Researchers assessed the health literacy of 408 English- and Spanish-speaking type 2 diabetes patients being treated in primary care. They used a 36-item timed comprehension test, that measured the patients' ability to read, comprehend and act on medical instructions.

After adjusting for confounding factors, they found that patients who had inadequate health literacy were less likely to achieve tight glycaemic control (HbA_1c of 7.2 or under) than those with adequate health literacy. In addition, patients with poor health literacy were approximately twice as likely to have a HbA_1c of 9.5 or more and more than twice as likely to report having retinopathy.

These patients tended to be older, non-white, Spanish-speaking females who had received only limited education. They were more likely to misread prescription medication labels, appointment slips or nutrition labels, while patients with marginal health literacy struggled with more complex materials, such as educational leaflets.

The researchers say such patients are less likely to interpret correctly or act on self-monitoring results, even after being given educational materials, and that poor health literacy is more prevalent among racial and ethnic minorities. They conclude that interventions to improve diabetes outcomes in these patients should be developed and evaluated, in an attempt to decrease the high rates of diabetes complications that occur in these groups.

Tim O'Donoghue, of the Green Light Pharmacy in Euston, London, has tailored a diabetes service to the needs of his local Bangladeshi community. He told The Journal it was more than simply a question of literacy. "You have to have good links with the community and you have to understand the culture. There are some words and concepts that are not represented in Bengali — it is essential to have translators who are respected, influential members of the community who can explain what it is all about."

Mr O'Donoghue added that close links with community leaders and evening seminars organised at the pharmacy had "certainly" improved patients' understanding of the disease and their clinical outcomes.