Potential mechanisms of how health literacy links to health outcomes have not clearly elucidated. The aim of the present study was to examine a simple mediation model of the relationships among health literacy, empowerment, and self-care behaviors while controlling for the covariate of diabetes education. The hypothesis to be tested was that relationships between health literacy and self-care behaviors (diet, physical exercise, foot care, and blood glucose monitoring) are mediated by empowerment in patients with diabetes when controlling for diabetes education.
Methods:
A cross-sectional study design was used. A total of 136 participants were recruited from three community health centers in South Korea using a convenience sampling method. Patients with diabetes who were articulate in the Korean language and aged at least 60 years were invited to participate. Health literacy, empowerment, and self-care behaviors were assessed using structured questionnaires. The hypotheses were tested using the PROCESS program for SPSS with a 95% bias corrected bootstrap confidence interval (95% BC bootstrap CI) with 10,000 bootstrap resamples from the data.
Results:
After controlling for diabetes education, the indirect effects of health literacy to self-care behaviors through empowerment were significant when the self-care behaviors were particularly diet (95% BC bootstrap CI = 0.09- 0.91), and physical exercise (95% BC bootstrap CI = 0.17-1.16). Whereas, the indirect effects were not significant when the self-care behaviors were foot care and blood glucose monitoring.
Conclusion:
The present study is the first to have demonstrated patient empowerment mediating the linkages of health literacy to diabetes self-care behaviors, particularly diet and physical exercise. This study indicates that the patients with higher health literacy were more empowered, and those with higher empowerment were more likely to eat healthy foods and exercise. In the light of these findings, a health literacy-tailored empowerment enhancing program may be important targets for interventions promoting diabetes self-care behaviors of diet and physical exercise.