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Investigation of the Relationship Between Health Literacy and Self-Care Agency in Patients with Type 2 Diabetes: A Descriptive and Correlational Study

Year 2025, Volume: 10 Issue: 4, 390 - 398, 20.12.2025
https://doi.org/10.26453/otjhs.1780032

Abstract

Objective: This study aimed to examine the relationship between health literacy and self-care agency in patients with type 2 diabetes.
Materials and Methods: This descriptive and correlational study was conducted with 128 patients diagnosed with type 2 diabetes who were receiving treatment in the internal medicine clinics of a city hospital. Data were collected by the researcher between July 2021 and February 2022 using the Descriptive Characteristics Form, the Diabetes Health Literacy Scale, and the Diabetes Self-Care Agency Scale.
Results: The mean total score on the Diabetes Health Literacy Scale was 34.07 ± 11.75. The subscale scores were as follows: Functional Health Literacy – 12.39 ± 4.95, Interactive Health Literacy – 7.20 ± 3.05, and Critical Health Literacy – 14.46 ± 5.82. The mean total score on the Diabetes Self-Care Agency Scale was 82.19 ± 12.97. A statistically significant, positive, moderate correlation was found between the total self-care agency score and the total score, interactive, and critical subscale scores of the health literacy scale (p < 0.001).
Conclusions: The participants demonstrated moderate levels of both health literacy and self-care agency. Health literacy is a key factor in the management of chronic diseases such as diabetes, as it influences individuals’ ability to access information, make informed decisions, adhere to treatment, and maintain quality of life. Enhancing health literacy is essential for improving self-care capacity and the sense of personal responsibility in disease management.

Ethical Statement

The study granted an Institutional Review Board approval from Süleyman Demirel University Health Sciences Ethics Committee (Date:11.08.2021, decision no: 52/2). This study followed the principles of the Declaration of Helsinki.

Supporting Institution

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Thanks

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References

  • World Health Organization. World health statistics 2024: Monitoring health for the SDGs, sustainable development goals. Geneva, Switzerland: World Health Organization; 2024. http://www.who.int Accessed June 28, 2025.
  • International Diabetes Federation. IDF Diabetes Atlas 11th Edition-2025. Brussels, Belgium: International diabetes federation; 2025. https://diabetesatlas.org/ Accessed June 25, 2025.
  • Coyle ME, Francis K, Chapman Y. Self-management activities in diabetes care: a systematic review. Aust Health Rev. 2013;37(4):513-522. doi:10.1071/AH13060
  • Mogre V, Johnson NA, Tzelepis F, Paul C. Barriers to diabetic self-care: A qualitative study of patients' and healthcare providers' perspectives. J Clin Nurs. 2019;28(11-12):2296-2308. doi:10.1111/jocn.14835
  • ALSharit BA, Alhalal EA. Effects of health literacy on type 2 diabetic patients' glycemic control, self-management, and quality of life. Saudi Med J. 2022;43(5):465-472. doi:10.15537/smj.2022.43.5.20210917
  • Sadeghi S, Borzu ZA, Shirzadi S, Jahanfar S, Abadi YG, Taziki M. Investigating e-health literacy and its relationship with self-care behaviors among Iranian middle-aged type 2 diabetes: a cross-sectional study. BMC Public Health. 2025;25(1):1376. doi:10.1186/s12889-025-22648-w
  • Butayeva J, Ratan ZA, Downie S, Hosseinzadeh H. The impact of health literacy interventions on glycemic control and self-management outcomes among type 2 diabetes mellitus: A systematic review. J Diabetes. 2023;15(9):724-735. doi:10.1111/1753-0407.13436
  • Tørris C, Nortvedt L. Health literacy and self-care among adult immigrants with type 2 diabetes: a scoping review. BMC Public Health. 2024;24(1):3248. doi:10.1186/s12889-024-20749-6
  • Tawfik MY, Mohamed RA, Elsaid NMAB. Pathways linking health literacy to diabetes risk scores in a non-diabetic population in Ismailia, Egypt: a cross sectional study design. BMC Public Health. 2025;25(1):2170. doi:10.1186/s12889-025-23526-1
  • Nutbeam D, Muscat DM. Health promotion glossary 2021. Health Promotion Int. 2021;36(6):1578–1598. doi:10.1093/heapro/daab067
  • Correia JC, Fakih El Khoury C, El Chaar D, et al. Use of digital self-care solutions for diabetes long-term management: a scoping review protocol. BMJ Open. 2025;15(10):e100506. doi:10.1136/bmjopen-2025-100506
  • White RO, Chakkalakal RJ, Presley CA, et al. Perceptions of provider communication among vulnerable patients with diabetes: influences of medical mistrust and health literacy. J Health Commun. 2016;21(sup2):127-134. doi:10.1080/10810730.2016.1207116
  • Ong-Artborirak P, Seangpraw K, Boonyathee S, Auttama N, Winaiprasert P. Health literacy, self-efficacy, self-care behaviors, and glycemic control among older adults with type 2 diabetes mellitus: a cross-sectional study in Thai communities. BMC Geriatr. 2023;23(1):297. doi:10.1186/s12877-023-04010-0
  • Bailey SC, Brega AG, Crutchfield TM, et al. Update on health literacy and diabetes. Diabetes Educ. 2014;40(5):581-604. doi:10.1177/0145721714540220
  • Jafari A, Moshki M, Ghelichi-Ghojogh M, Nejatian M. Role of diabetes health literacy, psychological status, self-care behaviors, and life satisfaction in predicting quality of life in type 2 diabetes. Sci Rep. 2024;14(1):1635. doi:10.1038/s41598-024-51245-x
  • Karakurt P, Kaşıkçı M. Validity and reliability of the Turkish version of the diabetes self-care scale. Int J Diabetes Dev Ctries. 2015; 35:148-156.
  • Agralı H, Akyar I. Turkish validation and reliability of health literacy scale for diabetic patients. Acıbadem Univ J Health Sci. 2018;9(3):314-21.
  • Ishikawa H, Takeuchi T, Yano E. Measuring functional, communicative, and critical health literacy among diabetic patients. Diabetes Care. 2008;31(5):874-879. doi:10.2337/dc07-1932
  • Lee NP, Fisher WP Jr. Evaluation of the Diabetes Self-Care Scale. J Appl Meas. 2005;6(4):366-381.
  • de Carvalho AC, Silva MT, Treptow ILG, et al. Health literacy in patients with Type 2 Diabetes Mellitus: A systematic review. Clinics (Sao Paulo), 2025;80: 100774. doi:10.1016/j.clinsp.2025.100774
  • Li J, Lin Y, Li X, et al. Mediating Effects of Health Literacy Between Self-Efficacy and Quality of Life in Patients with Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes. 2025;18:3625-3637. doi:10.2147/DMSO.S546698
  • Nugent TL, Galea AM, Sammut R. Health literacy, self-management and glycaemic control in persons living with type 2 diabetes mellitus: a cross-sectional study. Pract Diab, 2023;40:28-34. doi:10.1002/pdi.2467
  • Ziady HH, El-Zeiny NAE, Fetohy EM, Hew SAH, Hagras EMA. Assessment of diabetes health literacy and its predictors among diabetic older adults attending geriatric clubs, 2024. Alexandria J Med. 2025;61(1):1–10. doi:10.1080/20905068.2025.2464362
  • Dilekçi NN, Aşiret GD. Relationship Between Health Literacy and Self-Care Management of Type 2 Diabetic Patients. J Res Dev Nurs. 2025;27(2):142-156. doi:10.69487/hemarge.1582908
  • Al-Qerem W, Jarab A, Al-Qerem W, Al-Qerem W. The association between health literacy and quality of life of patients with type 2 diabetes mellitus in Jordan. PLoS ONE. 2024; 19(4): e0312833. doi:10.1371/journal.pone.0312833
  • Abdulsalam FI, Srichaijaroonpong S, Phoosuwan N, Phoosuwan N. Effectiveness of a Health Literacy and Diabetes Self-Management Education (DSME) Improvement Program for People With Type 2 Diabetes Mellitus: A Community-Based Quasiexperimental Study in Thailand. J Diabetes Res. 2025;2025:2640702. doi:10.1155/jdr/2640702
  • Mukhtar T, Babur MN, Abbas R, Irshad A, Kiran Q. Digital Health Literacy: A systematic review of interventions and their influence on healthcare access and sustainable development Goal-3 (SDG-3). Pak J Med Sci. 2025;41(3):910-918. doi:10.12669/pjms.41.3.10639
  • Jang Y, Yang Y. Effects of e-health literacy on health-related quality of life in young adults with type 2 diabetes: Parallel mediation of diabetes self-efficacy and self-care behaviors. Appl Nurs Res. 2025;82:151917. doi:10.1016/j.apnr.2025.151917
  • Roshan-Nejad M, Hosseini M, Vasli P, et al. Effect of health literacy-based teach-back training on quality of life and treatment adherence in type 2 diabetes: an experimental study. Sci Rep 2025;15: 551. doi:10.1038/s41598-024-84399-9

Tip 2 Diyabet Hastalarında Sağlık Okuryazarlığı ile Öz Bakım Gücü Arasındaki İlişkinin İncelenmesi: Tanımlayıcı ve Korelasyonel Bir Çalışma

Year 2025, Volume: 10 Issue: 4, 390 - 398, 20.12.2025
https://doi.org/10.26453/otjhs.1780032

Abstract

Amaç: Bu çalışma, tip 2 diyabet tanısı almış bireylerde sağlık okuryazarlığı ile öz bakım gücü arasındaki ilişkiyi incelemek amacıyla yapılmıştır.
Materyal ve Metot: Tanımlayıcı ve ilişki arayıcı nitelikteki bu araştırma, bir şehir hastanesinin dahiliye kliniklerinde tedavi gören 128 tip 2 diyabet hastası ile yürütülmüştür. Veriler, Temmuz 2021 – Şubat 2022 tarihleri arasında araştırmacı tarafından “Tanıtıcı Özellikler Formu”, “Diyabet Sağlık Okuryazarlığı Ölçeği” ve “Diyabet Öz Bakım Gücü Ölçeği” kullanılarak toplanmıştır.
Bulgular: Diyabet Sağlık Okuryazarlığı Ölçeği toplam puan ortalaması 34,07 ± 11,75 olarak bulunmuştur. Alt boyut ortalama puanları sırasıyla; Fonksiyonel Sağlık Okuryazarlığı 12,39 ± 4,95, Etkileşimsel Sağlık Okuryazarlığı 7,20 ± 3,05 ve Eleştirel Sağlık Okuryazarlığı 14,46 ± 5,82’dir. Diyabet Öz Bakım Gücü Ölçeği toplam puan ortalaması ise 82,19 ± 12,97’dir. Sağlık okuryazarlığı ile öz bakım gücü arasındaki ilişki incelendiğinde; Öz Bakım Gücü Ölçeği toplam puanı ile Sağlık Okuryazarlığı Ölçeği' nin toplam, etkileşimsel ve eleştirel alt boyut puanları arasında orta düzeyde, pozitif ve anlamlı bir ilişki saptanmıştır (p <0,001).
Sonuç: Araştırmaya katılan bireylerin sağlık okuryazarlığı ve öz bakım gücü düzeylerinin orta seviyede olduğu belirlenmiştir. Sağlık okuryazarlığı, diyabet gibi kronik hastalıkların yönetiminde önemli bir faktördür ve bireylerin hastalığıyla ilgili bilgiye ulaşma, karar verme, tedaviye uyum sağlama ve yaşam kalitesini sürdürme becerilerini doğrudan etkilemektedir. Bu nedenle, bireylerin öz bakım becerilerinin ve sorumluluklarının artırılması için sağlık okuryazarlığının geliştirilmesi önem taşımaktadır.

Ethical Statement

Bu çalışma, Süleyman Demirel Üniversitesi Sağlık Bilimleri Etik Kurulu'ndan Kurumsal İnceleme Kurulu onayı almıştır (Tarih: 11.08.2021, karar no: 52/2). Bu çalışma, Helsinki Bildirgesi'nin ilkelerine uygun olarak yürütülmüştür.

Supporting Institution

-

Thanks

-

References

  • World Health Organization. World health statistics 2024: Monitoring health for the SDGs, sustainable development goals. Geneva, Switzerland: World Health Organization; 2024. http://www.who.int Accessed June 28, 2025.
  • International Diabetes Federation. IDF Diabetes Atlas 11th Edition-2025. Brussels, Belgium: International diabetes federation; 2025. https://diabetesatlas.org/ Accessed June 25, 2025.
  • Coyle ME, Francis K, Chapman Y. Self-management activities in diabetes care: a systematic review. Aust Health Rev. 2013;37(4):513-522. doi:10.1071/AH13060
  • Mogre V, Johnson NA, Tzelepis F, Paul C. Barriers to diabetic self-care: A qualitative study of patients' and healthcare providers' perspectives. J Clin Nurs. 2019;28(11-12):2296-2308. doi:10.1111/jocn.14835
  • ALSharit BA, Alhalal EA. Effects of health literacy on type 2 diabetic patients' glycemic control, self-management, and quality of life. Saudi Med J. 2022;43(5):465-472. doi:10.15537/smj.2022.43.5.20210917
  • Sadeghi S, Borzu ZA, Shirzadi S, Jahanfar S, Abadi YG, Taziki M. Investigating e-health literacy and its relationship with self-care behaviors among Iranian middle-aged type 2 diabetes: a cross-sectional study. BMC Public Health. 2025;25(1):1376. doi:10.1186/s12889-025-22648-w
  • Butayeva J, Ratan ZA, Downie S, Hosseinzadeh H. The impact of health literacy interventions on glycemic control and self-management outcomes among type 2 diabetes mellitus: A systematic review. J Diabetes. 2023;15(9):724-735. doi:10.1111/1753-0407.13436
  • Tørris C, Nortvedt L. Health literacy and self-care among adult immigrants with type 2 diabetes: a scoping review. BMC Public Health. 2024;24(1):3248. doi:10.1186/s12889-024-20749-6
  • Tawfik MY, Mohamed RA, Elsaid NMAB. Pathways linking health literacy to diabetes risk scores in a non-diabetic population in Ismailia, Egypt: a cross sectional study design. BMC Public Health. 2025;25(1):2170. doi:10.1186/s12889-025-23526-1
  • Nutbeam D, Muscat DM. Health promotion glossary 2021. Health Promotion Int. 2021;36(6):1578–1598. doi:10.1093/heapro/daab067
  • Correia JC, Fakih El Khoury C, El Chaar D, et al. Use of digital self-care solutions for diabetes long-term management: a scoping review protocol. BMJ Open. 2025;15(10):e100506. doi:10.1136/bmjopen-2025-100506
  • White RO, Chakkalakal RJ, Presley CA, et al. Perceptions of provider communication among vulnerable patients with diabetes: influences of medical mistrust and health literacy. J Health Commun. 2016;21(sup2):127-134. doi:10.1080/10810730.2016.1207116
  • Ong-Artborirak P, Seangpraw K, Boonyathee S, Auttama N, Winaiprasert P. Health literacy, self-efficacy, self-care behaviors, and glycemic control among older adults with type 2 diabetes mellitus: a cross-sectional study in Thai communities. BMC Geriatr. 2023;23(1):297. doi:10.1186/s12877-023-04010-0
  • Bailey SC, Brega AG, Crutchfield TM, et al. Update on health literacy and diabetes. Diabetes Educ. 2014;40(5):581-604. doi:10.1177/0145721714540220
  • Jafari A, Moshki M, Ghelichi-Ghojogh M, Nejatian M. Role of diabetes health literacy, psychological status, self-care behaviors, and life satisfaction in predicting quality of life in type 2 diabetes. Sci Rep. 2024;14(1):1635. doi:10.1038/s41598-024-51245-x
  • Karakurt P, Kaşıkçı M. Validity and reliability of the Turkish version of the diabetes self-care scale. Int J Diabetes Dev Ctries. 2015; 35:148-156.
  • Agralı H, Akyar I. Turkish validation and reliability of health literacy scale for diabetic patients. Acıbadem Univ J Health Sci. 2018;9(3):314-21.
  • Ishikawa H, Takeuchi T, Yano E. Measuring functional, communicative, and critical health literacy among diabetic patients. Diabetes Care. 2008;31(5):874-879. doi:10.2337/dc07-1932
  • Lee NP, Fisher WP Jr. Evaluation of the Diabetes Self-Care Scale. J Appl Meas. 2005;6(4):366-381.
  • de Carvalho AC, Silva MT, Treptow ILG, et al. Health literacy in patients with Type 2 Diabetes Mellitus: A systematic review. Clinics (Sao Paulo), 2025;80: 100774. doi:10.1016/j.clinsp.2025.100774
  • Li J, Lin Y, Li X, et al. Mediating Effects of Health Literacy Between Self-Efficacy and Quality of Life in Patients with Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes. 2025;18:3625-3637. doi:10.2147/DMSO.S546698
  • Nugent TL, Galea AM, Sammut R. Health literacy, self-management and glycaemic control in persons living with type 2 diabetes mellitus: a cross-sectional study. Pract Diab, 2023;40:28-34. doi:10.1002/pdi.2467
  • Ziady HH, El-Zeiny NAE, Fetohy EM, Hew SAH, Hagras EMA. Assessment of diabetes health literacy and its predictors among diabetic older adults attending geriatric clubs, 2024. Alexandria J Med. 2025;61(1):1–10. doi:10.1080/20905068.2025.2464362
  • Dilekçi NN, Aşiret GD. Relationship Between Health Literacy and Self-Care Management of Type 2 Diabetic Patients. J Res Dev Nurs. 2025;27(2):142-156. doi:10.69487/hemarge.1582908
  • Al-Qerem W, Jarab A, Al-Qerem W, Al-Qerem W. The association between health literacy and quality of life of patients with type 2 diabetes mellitus in Jordan. PLoS ONE. 2024; 19(4): e0312833. doi:10.1371/journal.pone.0312833
  • Abdulsalam FI, Srichaijaroonpong S, Phoosuwan N, Phoosuwan N. Effectiveness of a Health Literacy and Diabetes Self-Management Education (DSME) Improvement Program for People With Type 2 Diabetes Mellitus: A Community-Based Quasiexperimental Study in Thailand. J Diabetes Res. 2025;2025:2640702. doi:10.1155/jdr/2640702
  • Mukhtar T, Babur MN, Abbas R, Irshad A, Kiran Q. Digital Health Literacy: A systematic review of interventions and their influence on healthcare access and sustainable development Goal-3 (SDG-3). Pak J Med Sci. 2025;41(3):910-918. doi:10.12669/pjms.41.3.10639
  • Jang Y, Yang Y. Effects of e-health literacy on health-related quality of life in young adults with type 2 diabetes: Parallel mediation of diabetes self-efficacy and self-care behaviors. Appl Nurs Res. 2025;82:151917. doi:10.1016/j.apnr.2025.151917
  • Roshan-Nejad M, Hosseini M, Vasli P, et al. Effect of health literacy-based teach-back training on quality of life and treatment adherence in type 2 diabetes: an experimental study. Sci Rep 2025;15: 551. doi:10.1038/s41598-024-84399-9
There are 29 citations in total.

Details

Primary Language English
Subjects ​Internal Diseases Nursing​
Journal Section Research Article
Authors

Hatice Ağralı 0000-0002-1935-6635

Betül Bayrak 0000-0003-4482-440X

Submission Date September 9, 2025
Acceptance Date November 27, 2025
Publication Date December 20, 2025
Published in Issue Year 2025 Volume: 10 Issue: 4

Cite

AMA Ağralı H, Bayrak B. Investigation of the Relationship Between Health Literacy and Self-Care Agency in Patients with Type 2 Diabetes: A Descriptive and Correlational Study. OTJHS. December 2025;10(4):390-398. doi:10.26453/otjhs.1780032

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