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Learning Objective 1: examine the relationship among socioeconomic status/demographics, health literacy, patient trust, diabetes knowledge, self-care activities, depression, and glycemic control.
Learning Objective 2: discuss the relative influence of health literacy, patient trust, diabetes knowledge, self-care activities, and depression on glycemic control.
Constructed from theory synthesis, the conceptual framework postulates that patient trust and health literacy are associated with HbA1c. Socioeconomic status and demographics influence health literacy and patient trust subsequently shaping diabetes knowledge. Diabetes knowledge is related to performance of self-care activities, which in turn, affects diabetes complications, specifically depression, thereby impacting HbA1c. Implementing a cross-sectional design, a convenience sample of 102 uninsured patients with diabetes was recruited from two urban primary care clinics. Multiple regression was calculated to predict the impact of health literacy, patient trust, self-care activities, diabetes knowledge, and depression on HbA1c. Correlations, requiring a corrected significance of p<0.01, were analyzed among socioeconomic status, demographics, health literacy, patient trust, diabetes knowledge, self-care activities, depression, and HbA1c.
The regression model was significant with patient trust and depression accounting for 28.5% of the variance in HbA1c. There was a significant positive correlation between socioeconomic status and health literacy (rho=.35), diabetes knowledge and health literacy (rho=.30), and depression and HbA1c (r=.34). There was a significant negative correlation between patient trust and HbA1c (rho=-.43). Results support promotion of the patient/provider relationship, depression screening within the diabetic population, and exploration of new strategies for diabetes education. Future research is needed to advance the framework, ascertain what defines and engenders patient trust, and to determine the role of health literacy in glycemic control.