616-P: Path Analysis to Assess the Effect of Health Literacy on Glycemic Control in African-American Adults

Background: While health literacy has been shown to influence health outcomes, recent evidence suggests nearly 25% of African American (AA) adults have below basic health literacy compared to only 9% of White Americans. This disparity may contribute to poorer outcomes observed in AA adults with type 2 diabetes mellitus (T2DM). Therefore, the aim of this study was to assess the pathways for the relationship between health literacy and diabetes outcomes in AA adults with T2DM.

Methods: Data from 277 AA adults with T2DM from the southeastern U.S. were analyzed. Path analysis was used to assess the direct and indirect relationships between health literacy (comprehension and numeracy) and self-care and between self-care and glycemic control (HbA1c). We hypothesized that health literacy would have both a direct and indirect effect on HbA1c via self-care behaviors (specific diet, general diet, exercise, blood sugar monitoring, foot care).

Results: In the path analysis for comprehension, health literacy did not have a direct effect on HbA1c (p=0.247), but did have a direct effect on specific diet (β=-0.18; p=0.002), blood sugar monitoring (β =-0.21; p<0.0001), and foot care (β=-0.13; p=0.032) and an indirect effect on HbA1c through specific diet (β=-0.13; p=0.043) and blood sugar monitoring (β=-0.29; p<0.0001). In the path analysis for numeracy, health literacy had a direct effect on glycemic control (β=-0.12; p=0.047) and specific diet (β=-0.13; p=0.039), blood sugar monitoring (β=-0.14; p=0.019), and foot care (β=-0.12; p=0.048) and an indirect effect on HbA1c through specific diet (β=-0.13; p=0.042) and blood sugar monitoring (β=-0.29; p<0.0001).

Conclusions: In this sample of AA adults with T2DM, only numeracy had a direct effect on glycemic control, whereas both comprehension and numeracy had direct effects on self-care behaviors. These findings suggest the need for greater emphasis on increased numeracy for interventions in AA adults with T2DM.