期刊
PUBLIC HEALTH REPORTS
卷 121, 期 3, 页码 245-254出版社
ASSOC SCHOOLS PUBLIC HEALTH
DOI: 10.1177/003335490612100305
关键词
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资金
- NCRR NIH HHS [M01 RR000083, K-23 RR16539-03, K23 RR016539] Funding Source: Medline
- NICHD NIH HHS [R01 HD046113, R01 HD046113-01] Funding Source: Medline
- NIDDK NIH HHS [R01 DK065664, R01 DK065664-02] Funding Source: Medline
Objectives. We sought to determine whether literacy mediates the relationship between education and glycemic control among diabetes patients. Methods. We measured educational attainment, literacy using the Short Test of Functional Health Literacy in Adults (s-TOFHLA), and glycemic control (HbA1c) in 395 diabetes patients at a U.S. public hospital. We performed path analysis to compare two competing models to explain glycemic control. The direct effects model estimated how education was related to HbA1c; the mediational model estimated the strength of the direct relationship when the additional pathway from education to literacy to HbA1c was added. Results. Both the model with a direct effect of education on HbA1c and the model with literacy as a mediator were supported by good fit to observed data. The mediational model, however, was a significant improvement, with the additional path from literacy to HbA1c reducing the discrepancy from observed data (p < 0.01). After including this path, the direct relationship between education and HbA1c fell to a non-significant threshold. Conclusions. In a low-income population with diabetes, literacy mediated the relationship between education and glycemic control. This finding has important implications for both education and health policy.
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