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Health Literacy and Health Outcomes in Diabetes Open Access


Other title
Health literacy
Systematic review
Type of item
Degree grantor
University of Alberta
Author or creator
Al Sayah, Fatima
Supervisor and department
Williams, Beverly (Faculty of Nursing, University of Alberta)
Majumdar, Sumit R. (Department of Medicine, University of Alberta)
Johnson, Jeff A. (School of Public Health Sciences, University of Alberta)
Examining committee member and department
Rothman, Russell (Department of Medicine, Vanderbilt University)
Simpson, Scot (Pharmaceutical Sciences, University of Alberta)
Department of Public Health Sciences
Faculty of Nursing
Public Health
Date accepted
Graduation date
Doctor of Philosophy
Degree level
There is a general agreement that a relationship exists between health literacy (HL) and health outcomes. Nonetheless, there are critical gaps in the measurement of HL and in the evidence on the impact of inadequate HL on health outcomes, especially in the diabetes population. These gaps need to be addressed before any recommendations regarding HL screening or interventions are implemented. To address these gaps, first we conducted two systematic reviews, one in which we reviewed the evidence on the relationship between HL and health outcomes in the diabetes population, and the other consisted of a review and evaluation of HL measures used in this population. Then we conducted a validation study that examined the measurement properties of a HL measure; a longitudinal study that examined the associations between HL and health outcomes in individuals with diabetes; and last, a qualitative study that examined the use of interactive communication loops and medical jargon in relation to HL in nurses’ interaction with individuals with diabetes. We found that the evidence on the impact of HL on health outcomes in the diabetes population is limited and inconclusive; measures of HL are not comprehensive enough with limited evidence on their measurement properties; the 3-brief screening questions are potentially a useful measure for screening for inadequate HL; inadequate HL was not associated with worse health outcomes in individuals with diabetes and depressive symptoms; and healthcare providers may place high demands on patients through their communication and interaction with them. Despite the use of rigorous research methods and the robust evidence generated, the overall available evidence on these relationships is still inconsistent and thus inconclusive. Our work highlights two crucial questions that need to be examined “how to comprehensively measure HL?” and “whether HL is modifiable?” Until, these questions – and others – are answered and conclusive evidence is available, we believe that, outside of the study setting, it might be premature to invest in routinely screening for HL or to trying to improve HL for the purposes of improving patient-related outcomes in diabetes, although there might be other reasons to do so.
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
Citation for previous publication
Al Sayah F, Majumdar SR, Williams B, Robertson S, Johnson JA. Health literacy and health outcomes in Diabetes: A systematic review. Journal of General Internal Medicine 2013 Mar; 28(3): 444-52.Al Sayah F, Williams B, Johnson JA. Measuring health literacy in individuals with diabetes: a systematic review and evaluation of available measures. Health Education and Behavior 2013 Feb; 40(1): 42-55.

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