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Journal of General Internal Medicine

Erschienen in:

15.03.2019

The Role of Health Literacy in Diabetes Knowledge, Self-Care, and Glycemic Control: a Meta-analysis

verfasst von: Laura Marciano, M.Sc., Anne-Linda Camerini, Ph.D., Peter J. Schulz, Ph.D.

Erschienen in: Journal of General Internal Medicine | Ausgabe 6/2019

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Abstract

Background

Empirical evidence on how health literacy affects diabetes outcomes is inconsistent. The purpose of this meta-analysis was to quantitatively summarize the findings on the associations between health literacy and diabetes knowledge, self-care activities, and glycemic control as disease-related outcomes, with specific focus on the type of health literacy assessment.

Data Sources

Nine databases (MEDLINE, CINAHL, Communication and Mass Media Complete, PsychInfo, PsychArticles, Psychology and Behavioral Sciences Collection, ERIC, Sociology, Embase) were searched for peer-reviewed original research articles published until 31 March 2018.

Methods

Studies with type 1 and/or type 2 diabetes patients aged 18 or older, providing a calculable baseline effect size for functional health literacy and diabetes knowledge, self-care activities, or HbA1C were included.

Results

The meta-analysis includes 61 studies with a total of 18,905 patients. The majority were conducted in the USA, on type 2 diabetes patients, and used the S-TOFHLA as a performance-based or the BHLS as a perception-based measure of functional health literacy. Meta-analytic results show that all three outcomes are related to health literacy. Diabetes knowledge was best predicted by performance-based health literacy measures, self-care by self-report measures, and glycemic control equally by both types of health literacy assessment.

Discussion

Health literacy plays a substantial role in diabetes knowledge. Findings for the role of health literacy in self-care and glycemic control remain heterogeneous, partly due to the type of health literacy assessment (performance- vs. perception-based). This has implications for the use of health literacy measures in clinical settings and original research. This meta-analysis was limited to functional health literacy and, due to the paucity of studies, did not investigate the role of other dimensions including communicative and critical health literacy.

Nur mit Berechtigung zugänglich

American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2011;34 (Suppl 1):S62–9CrossRefPubMedCentral

Ogurtsova K, Fernandes JD da R, Huang Y, Linnenkamp U, Guariguata L, Cho NH, et al. IDF diabetes atlas: global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract 2017;128:40–50CrossRefPubMed

Huang ES, Basu A, O’Grady M, Capretta JC. Projecting the future diabetes population size and related costs for the U.S. Diabetes Care 2009;32(12):2225–9CrossRefPubMedPubMedCentral

Ratzan S, Parker R. Introduction. In National Library of Medicine Current Bibliographies in Medicine: Health Literacy. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services, 2000

Simonds S. Health education as social policy. Health Educ Monogr 1974;21:1–10CrossRef

Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med 2011;155(2):97–107CrossRefPubMed

Al Sayah F, Williams B, Johnson JA. Measuring health literacy in individuals with diabetes: a systematic review and evaluation of available measures. Health Educ Behav Off Publ Soc Public Health Educ 2013;40(1):42–55

Bailey SC, Brega AG, Crutchfield TM, Elasy T, Herr H, Kaphingst K, et al. Update on health literacy and diabetes. Diabetes Educ 2014;40(5):581–604CrossRefPubMedPubMedCentral

Cavanaugh KL. Health literacy in diabetes care: explanation, evidence and equipment. Diabetes Manag Lond Engl 2011;1(2):191–9CrossRef

10.

Caruso R, Magon A, Baroni I, Dellafiore F, Arrigoni C, Pittella F, et al. Health literacy in type 2 diabetes patients: a systematic review of systematic reviews. Acta Diabetol 2018;55(1):1–12CrossRefPubMed

11.

Kim SH, Lee A. Health-literacy-sensitive diabetes self-management interventions: a systematic review and meta-analysis. Worldviews Evid Based Nurs 2016;13(4):324–33CrossRefPubMed

12.

Frisch A-L, Camerini L, Diviani N, Schulz PJ. Defining and measuring health literacy: how can we profit from other literacy domains? Health Promot Int 2012;27(1):117–26CrossRefPubMed

13.

Lee E-H, Kim C-J, Lee J, Moon SH. Self-administered health literacy instruments for people with diabetes: systematic review of measurement properties. J Adv Nurs 2017;73(9):2035–48CrossRefPubMed

14.

Davis TC, Long SW, Jackson RH, Mayeaux EJ, George RB, Murphy PW, et al. Rapid estimate of adult literacy in medicine: a shortened screening instrument. Fam Med 1993;25(6):391–5PubMed

15.

Parker RM, Baker DW, Williams MV, Nurss JR. The test of functional health literacy in adults. J Gen Intern Med 1995;10(10):537–41CrossRefPubMed

16.

Chew LD, Griffin JM, Partin MR, Noorbaloochi S, Grill JP, Snyder A, et al. Validation of screening questions for limited health literacy in a large VA outpatient population. J Gen Intern Med 2008;23(5):561–6CrossRefPubMedPubMedCentral

17.

Kiechle ES, Bailey SC, Hedlund LA, Viera AJ, Sheridan SL. Different measures, different outcomes? A systematic review of performance-based versus self-reported measures of health literacy and numeracy. J Gen Intern Med 2015;30(10):1538–46CrossRefPubMedPubMedCentral

18.

Lyons TJ, Basu A. Biomarkers in diabetes: hemoglobin a1c, vascular and tissue markers. Transl Res 2012;159(4):303–12CrossRefPubMedPubMedCentral

19.

Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 2000;283(15):2008–12CrossRefPubMed

20.

Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 2015;349:g7647

21.

Lüdecke D. Package “esc”: effect size computation for meta analysis [Internet]. 2018. Available from https://github.com/strengejacke/esc Accessed 18 July 2018

22.

Schwarzer G, Carpenter JR, Rücker G. Meta-analysis with R (Use R!). Cham, Switzerland, Springer International Publishing, 2015CrossRef

23.

Peterson RA, Brown SP. On the use of beta coefficients in meta-analysis. J Appl Psychol 2005;90(1):175–81CrossRefPubMed

24.

Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 2014;14:135CrossRefPubMedPubMedCentral

25.

IntHout J, Ioannidis JP, Borm GF. The Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis is straightforward and considerably outperforms the standard DerSimonian-Laird method. BMC Med Res Methodol 2014;14:25CrossRefPubMedPubMedCentral

26.

Borenstein M, Hedges L, Rothstein H. Meta-analysis: fixed effect vs. random effects. [Online White Paper] Available from https://www.meta-analysis.com/downloads/Meta-analysis%20fixed%20effect%20vs%20random%20effects.pdf. Accessed 11 December 2018

27.

Ried K. Interpreting and understanding meta-analysis graphs—a practical guide. Aust Fam Physician 2006;35(8):635–8PubMed

28.

Higgins JP, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions. Chichester, UK, Wiley, 2008

29.

Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315(7109):629–34CrossRefPubMedPubMedCentral

30.

Al Sayah F, Majumdar SR, Johnson JA. Association of inadequate health literacy with health outcomes in patients with type 2 diabetes and depression: secondary analysis of a controlled trial. Can J Diabetes 2015;39(4):259–65CrossRefPubMed

31.

Al Sayah F, Majumdar SR, Egede LE, Johnson JA. Associations between health literacy and health outcomes in a predominantly low-income African American population with type 2 diabetes. J Health Commun 2015;20(5):581–8CrossRefPubMed

32.

Al Sayah F, Soprovich A, Qiu W, Edwards AL, Johnson JA. Diabetic foot disease, self-care and clinical monitoring in adults with type 2 diabetes: the Alberta’s caring for diabetes (ABCD) COHORT STUDY. Can J Diabetes 2015;39 Suppl 3:S120–126CrossRefPubMed

33.

Al Sayah F, Williams B, Pederson JL, Majumdar SR, Johnson JA. Health literacy and nurses’ communication with type 2 diabetes patients in primary care settings. Nurs Res 2014;63(6):408–17CrossRefPubMed

34.

Alghodaier H, Jradi H, Mohammad NS, Bawazir A. Validation of a diabetes numeracy test in Arabic. PLOS ONE 2017;12(5):e0175442CrossRefPubMedPubMedCentral

35.

Bains S., Osborn C.Y., Egede L.E. Association of health literacy and diabetes self-care utilizing the information-motivationbehavioral skills model. J Investig Med 2010;58(2):481

36.

Bohanny W, Wu S-FV, Liu C-Y, Yeh S-H, Tsay S-L, Wang T-J. Health literacy, self-efficacy, and self-care behaviors in patients with type 2 diabetes mellitus. J Am Assoc Nurse Pract 2013;25(9):495–502PubMed

37.

Bowen ME, Cavanaugh KL, Wolff K, Davis D, Gregory B, Rothman RL. Numeracy and dietary intake in patients with type 2 diabetes. Diabetes Educ 2013;39(2):240–7CrossRefPubMedPubMedCentral

38.

Brega AG, Ang A, Vega W, Jiang L, Beals J, Mitchell CM, et al. Mechanisms underlying the relationship between health literacy and glycemic control in American Indians and Alaska Natives. Patient Educ Couns 2012;88(1):61–8CrossRefPubMed

39.

Cavanaugh K, Huizinga MM, Wallston KA, Gebretsadik T, Shintani A, Davis D, et al. Association of numeracy and diabetes control. Ann Intern Med 2008;148(10):737–46CrossRefPubMed

40.

Chahardah-Cherik S, Gheibizadeh M, Jahani S, Cheraghian B. The relationship between health literacy and health promoting behaviors in patients with type 2 diabetes. Int J Community Based Nurs Midwifery 2018;6(1):65–75

41.

Chen G-D, Huang C-N, Yang Y-S, Lew-Ting C-Y. Patient perception of understanding health education and instructions has moderating effect on glycemic control. BMC Public Health 2014;14:683CrossRefPubMedPubMedCentral

42.

Coccaro EF, Drossos T, Phillipson L. HbA1c levels as a function of emotional regulation and emotional intelligence in patients with type 2 diabetes. Prim Care Diabetes 2016;10(5):334–41CrossRefPubMed

43.

DeWalt DA, Boone RS, Pignone MP. Literacy and its relationship with self-efficacy, trust, and participation in medical decision making. Am J Health Behav 2007;31(Suppl1):S27–35CrossRefPubMed

44.

Eyuboglu E, Schulz PJ. Do health literacy and patient empowerment affect self-care behaviour? A survey study among Turkish patients with diabetes. BMJ Open 2016;6(3):e010186CrossRefPubMedPubMedCentral

45.

Ferguson MO, Long JA, Zhu J, Small DS, Lawson B, Glick HA, et al. Low health literacy predicts misperceptions of diabetes control in patients with persistently elevated a1c. Diabetes Educ 2015;41(3):309–19CrossRefPubMed

46.

Gazmararian JA, Williams MV, Peel J, Baker DW. Health literacy and knowledge of chronic disease. Patient Educ Couns 2003;51(3):267–75CrossRefPubMed

47.

Gerber B.S., Brodsky I.G., Lawless K.A., Smolin L.I., Arozullah A.M., Smith E.V., et al. Implementation and evaluation of a low-literacy diabetes education computer multimedia application. Diabetes Care 2005;28(7):1574–80CrossRefPubMed

48.

Gordilho Souza J, Apolinario D, Magaldi RM, Busse AL, Campora F, Jacob-Filho W. Functional health literacy and glycaemic control in older adults with type 2 diabetes: a cross-sectional study. BMJ Open 2014;4(2):e004180CrossRef

49.

Huizinga MM, Elasy TA, Wallston KA, Cavanaugh K, Davis D, Gregory RP, et al. Development and validation of the Diabetes Numeracy Test (DNT). BMC Health Serv Res 2008;8:96CrossRefPubMedPubMedCentral

50.

Inoue M, Takahashi M, Kai I. Impact of communicative and critical health literacy on understanding of diabetes care and self-efficacy in diabetes management: a cross-sectional study of primary care in Japan. BMC Fam Pract 2013;14:40CrossRefPubMedPubMedCentral

51.

Ishikawa H, Takeuchi T, Yano E. Measuring functional, communicative, and critical health literacy among diabetic patients. Diabetes Care 2008;31(5):874–9CrossRefPubMed

52.

Jeppesen KM, Hull BP, Raines M, Miser WF. A validation study of the Spoken Knowledge in Low Literacy in Diabetes Scale (SKILLD). J Gen Intern Med. 2012;27(2):207–12CrossRefPubMed

53.

Jihye Jeong, Namhee Park, So Young Shin. The influence of health literacy and diabetes knowledge on diabetes self-care activities in Korean low-income elders with diabetes. J Korean Acad Community Health Nurs Jiyeog Sahoe Ganho Hakoeji 2014;25(3):217–24CrossRef

54.

Juul L, Rowlands G, Maindal HT. Relationships between health literacy, motivation and diet and physical activity in people with type 2 diabetes participating in peer-led support groups. Prim Care Diabetes 2018;12(4):331–7CrossRefPubMed

55.

Kim S, Love F, Quistberg DA, Shea JA. Association of health literacy with self-management behavior in patients with diabetes. Diabetes Care 2004;27(12):2980–2CrossRefPubMed

56.

Lai AY, Ishikawa H, Kiuchi T, Mooppil N, Griva K. Communicative and critical health literacy, and self-management behaviors in end-stage renal disease patients with diabetes on hemodialysis. Patient Educ Couns 2013;91(2):221–7CrossRefPubMed

57.

Lee Y-J, Shin S-J, Wang R-H, Lin K-D, Lee Y-L, Wang Y-H. Pathways of empowerment perceptions, health literacy, self-efficacy, and self-care behaviors to glycemic control in patients with type 2 diabetes mellitus. Patient Educ Couns 2016;99(2):287–94CrossRefPubMed

58.

Leung AY, Lou VW, Cheung MK, Chan SS, Chi I. Development and validation of Chinese health literacy scale for diabetes. J Clin Nurs 2013;22(15/16):2090–9CrossRefPubMed

59.

Mancuso JM. Impact of health literacy and patient trust on glycemic control in an urban USA population. Nurs Health Sci. 2010;12(1):94–104CrossRefPubMed

60.

Maneze D, Everett B, Astorga C, Yogendran D, Salamonson Y. The influence of health literacy and depression on diabetes self-management: a cross-sectional study. J Diabetes Res 2016;2016:3458969CrossRefPubMedPubMedCentral

61.

Mayberry LS, Rothman RL, Osborn CY. Family members’ obstructive behaviors appear to be more harmful among adults with type 2 diabetes and limited health literacy. J Health Commun 2014;19:132–43CrossRefPubMedPubMedCentral

62.

McCleary-Jones V. Health Literacy and its association with diabetes knowledge, self-efficacy and disease self-management among African Americans with diabetes mellitus. ABNF J 2011;22(2):25–32PubMed

63.

Miser WF, Jeppesen KM, Wallace LS. Clinical utility of a brief screen for health literacy and numeracy among adults with diabetes mellitus. Fam Med 2013;45(6):417–23PubMed

64.

Morris NS, MacLean CD, Littenberg B. Literacy and health outcomes: a cross-sectional study in 1002 adults with diabetes. BMC Fam Pract 2006;7:49CrossRefPubMedPubMedCentral

65.

Morris NS, MacLean CD, Littenberg B. Change in health literacy over 2 years in older adults with diabetes. Diabetes Educ 2013;39(5):638–46CrossRefPubMed

66.

Newsome C., Mallawaarachchi I., Garcia J., Ray G. Association between health literacy and diabetes control in a pharmacist-run disease state management clinic. Cogent Med 2016;3: 1269628CrossRef

67.

Niknami M, Mirbalouchzehi A, Zareban I, Kalkalinia E, Gasem Rikhtgarha, Hosseinzadeh H. Association of health literacy with type 2 diabetes mellitus self-management and clinical outcomes within the primary care setting of Iran. Aust J Prim Health 2018;24(2):162–70CrossRefPubMed

68.

Osborn CY, Cavanaugh K, Wallston KA, Rothman RL. Self-efficacy links health literacy and numeracy to glycemic control. J Health Commun 2010;15:146–58CrossRefPubMedPubMedCentral

69.

Osborn CY, Cavanaugh K, Wallston KA, White RO, Rothman RL, Osborn CY, et al. Diabetes numeracy: an overlooked factor in understanding racial disparities in glycemic control. Diabetes Care 2009;32(9):1614–9CrossRefPubMedPubMedCentral

70.

Powell CK, Hill EG, Clancy DE. The relationship between health literacy and diabetes knowledge and readiness to take health actions. Diabetes Educ 2007;33(1):144–51CrossRefPubMed

71.

Radwan M, Elsous A, Al-Sharif H, Abu Mustafa A. Glycemic control among primary care patients with type 2 diabetes mellitus in the Gaza Strip, Palestine. Ther Adv Endocrinol Metab 2018;9(1):3–14CrossRefPubMed

72.

Reisi M, Mostafavi F, Javadzade H, Mahaki B, Tavassoli E, Sharifirad G. Impact of health literacy, self-efficacy, and outcome expectations on adherence to self-care behaviors in Iranians with type 2 diabetes. Oman Med J 2016;31(1):52–9CrossRefPubMedPubMedCentral

73.

Rothman RL, DeWalt DA, Malone R, Bryant B, Shintani A, Crigler B, et al. Influence of patient literacy on the effectiveness of a primary care-based diabetes disease management program. JAMA 2004;292(14):1711–6CrossRefPubMed

74.

Rothman RL, Malone R, Bryant B, Wolfe C, Padgett P, DeWalt DA, et al. The spoken knowledge in low literacy in diabetes scale: a diabetes knowledge scale for vulnerable patients. Diabetes Educ 2005;31(2):215–24CrossRefPubMed

75.

Saeed H, Saleem Z, Naeem R, Shahzadi I, Islam M. Impact of health literacy on diabetes outcomes: a cross-sectional study from Lahore, Pakistan. Public Health 2018;156:8–14CrossRefPubMed

76.

Schillinger D, Barton LR, Karter AJ, Wang F, Adler N. Does literacy mediate the relationship between education and health outcomes? A study of a low-income population with diabetes. Public Health Rep Wash DC 1974 2006;121(3):245–54

77.

Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, et al. Association of health literacy with diabetes outcomes. JAMA 2002;288(4):475–82CrossRefPubMed

78.

Schillinger D, Piette J, Grumbach K, Wang F, Wilson C, Daher C, et al. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med 2003;163(1):83–90CrossRefPubMed

79.

Swavely D, Vorderstrasse A, Maldonado E, Eid S, Etchason J. Implementation and evaluation of a low health literacy and culturally sensitive diabetes education program. J Healthc Qual Promot Excell Healthc 2014;36(6):16–23

80.

Tang YH, Pang SMC, Chan MF, Yeung GSP, Yeung VTF. Health literacy, complication awareness, and diabetic control in patients with type 2 diabetes mellitus. J Adv Nurs 2008;62(1):74–83CrossRefPubMed

81.

Thabit H, Shah S, Nash M, Brema I, Nolan JJ, Martin G. Globalization, immigration and diabetes self-management: an empirical study amongst immigrants with type 2 diabetes mellitus in Ireland. QJM Mon J Assoc Physicians 2009;102(10):713–20CrossRef

82.

van der Heide I, Uiters E, Rademakers J, Struijs JN, Schuit AJ, Baan CA. Associations among health literacy, diabetes knowledge, and self-management behavior in adults with diabetes: results of a Dutch cross-sectional study. J Health Commun 2014;19:115–31CrossRefPubMed

83.

Wallace AS, Seligman HK, Davis TC, Schillinger D, Arnold CL, Bryant-Shilliday B, et al. Literacy-appropriate educational materials and brief counseling improve diabetes self-management. Patient Educ Couns 2009;75(3):328–33CrossRefPubMedPubMedCentral

84.

White RO, Osborn CY, Gebretsadik T, Kripalani S, Rothman RL. Health literacy, physician trust, and diabetes-related self-care activities in Hispanics with limited resources. J Health Care Poor Underserved 2013;24(4):1756–68CrossRefPubMedPubMedCentral

85.

White RO, Osborn CY, Gebretsadik T, Kripalani S, Rothman RL, White RO 3rd, et al. Development and validation of a Spanish diabetes-specific numeracy measure: DNT-15 Latino. Diabetes Technol Ther 2011;13(9):893–8CrossRefPubMedPubMedCentral

86.

Williams MV, Baker DW, Parker RM, Nurss JR. Relationship of functional health literacy to patients’ knowledge of their chronic disease. A study of patients with hypertension and diabetes. Arch Intern Med 1998;158(2):166–72CrossRefPubMed

87.

Woodard LD, Landrum CR, Amspoker AB, Ramsey D, Naik AD. Interaction between functional health literacy, patient activation, and glycemic control. Patient Prefer Adherence 2014;8:1019–24CrossRefPubMedPubMedCentral

88.

Yamashita T, Kart CS. Is diabetes-specific health literacy associated with diabetes-related outcomes in older adults? J Diabetes 2011;3(2):138–46CrossRefPubMed

89.

Young CF, Yun K, Kang E, Shubrook JH, Dugan JA. Correlations between A1C and diabetes knowledge, diabetes numeracy, and food security in a vulnerable type 2 diabetes population. Diabetes Spectr 2018;31(2):177–83CrossRefPubMedPubMedCentral

90.

Zuercher E, Diatta ID, Burnand B, Peytremann-Bridevaux I. Health literacy and quality of care of patients with diabetes: a cross-sectional analysis. Prim Care Diabetes 2017;11(3):233–40CrossRefPubMed

91.

Gomes MB, Santos DC, Pizarro MH, Barros BSV, de Melo LGN, Negrato CA. Does knowledge on diabetes management influence glycemic control? A nationwide study in patients with type 1 diabetes in Brazil. Patient Prefer Adherence 2018;12:53–62CrossRefPubMedPubMedCentral

92.

Kueh YC, Morris T, Ismail A-A-S. The effect of diabetes knowledge and attitudes on self-management and quality of life among people with type 2 diabetes. Psychol Health Med 2017;22(2):138–44CrossRefPubMed

93.

Schulz PJ, Nakamoto K. Health literacy and patient empowerment in health communication: the importance of separating conjoined twins. Patient Educ Couns 2013;90(1):4–11CrossRefPubMed

94.

Sarkar U, Fisher L, Schillinger D Is Self-efficacy associated with diabetes self-management across race/ethnicity and health literacy? Diabetes Care 2006;29(4):823–9CrossRefPubMed

95.

Althubaiti A. Information bias in health research: definition, pitfalls, and adjustment methods. J Multidiscip Healthc 2016;9:211–7CrossRefPubMedPubMedCentral

96.

Parikh NS, Parker RM, Nurss JR, Baker DW, Williams MV. Shame and health literacy: the unspoken connection. Patient Educ Couns 1996;27(1):33–9CrossRefPubMed

Titel: The Role of Health Literacy in Diabetes Knowledge, Self-Care, and Glycemic Control: a Meta-analysis
verfasst von: Laura Marciano, M.Sc.
Anne-Linda Camerini, Ph.D.
Peter J. Schulz, Ph.D.
Publikationsdatum: 15.03.2019
Verlag: Springer US
Erschienen in: Journal of General Internal Medicine / Ausgabe 6/2019
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-019-04832-y

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The Role of Health Literacy in Diabetes Knowledge, Self-Care, and Glycemic Control: a Meta-analysis

Abstract

Background

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Methods

Results

Discussion

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