Background: It is unknown whether family members or friends (‘supporters’) tailor their assistance to the unique needs of patients with diabetes and low HL.

Methods: Surveys were conducted among 239 VA healthcare system patients with type 2 diabetes who were 30-70 years old, had A1c>8% or high blood pressure, did not have dementia or need help with basic activities of daily living, and had an unpaid supporter who was involved in their care. Patients reported the frequency of supporter involvement with diabetes management roles (e.g., help filling medications). HL was assessed using two items from the well-validated Chew scale: 1) How often do you have problems learning about medical conditions because of difficulty understanding written information (0=none of the time, 4=all of the time), and 2) How confident are you filling out medical forms by yourself (0=extremely, 4=not at all). Those responding ‘3’ (somewhat) or greater were designated as low health literacy. Logistic regression models were used to identify the independent association between patient HL and types of supporter assistance.

Findings: Patients with low HL were significantly more likely than patients with adequate HL to have a supporter with low HL (32% vs. 18% of supporters, p=0.02). Low patient HL was significantly associated with higher odds of supporters helping with: deciding when to call doctor (AOR=2.21, 95% CI: 1.10-4.42); remembering medical appointments (AOR=2.48, 95% CI: 1.24-4.98); navigating the health system (AOR=2.67, 95% CI: 1.34-5.32); and attending medical appointments with patient (AOR=2.11, 95% CI: 1.11-3.96). Patient HL was not associated with whether supporters helped with filling or taking medications, or managing diet and exercise.

Conclusion: Supporters of patients with low HL were more likely to have low HL themselves, and to help patients with care coordination and equally likely to help with carrying out diabetes medication and lifestyle behaviors compared to patients with adequate HL.


B. Fields: None. A.A. Lee: None. J. Piette: None. R.B. Trivedi: None. D. Obrosky: None. M.K. Mor: Stock/Shareholder; Spouse/Partner; AbbVie Inc. M. Heisler: None. A. Rosland: None.


U.S. Department of Veterans Affairs (IIR 14–074-1); Michigan Center for Diabetes Translational Research (NIDDK5P60-DK09292); Michigan Claude D. Pepper Older Americans Independence Center (NIA AG-024824)

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