Sağlık okuryazarlığı seviyesinin tip 2 diyabet riski üzerindeki potansiyel etkisi: Kesitsel bir çalışma
Yıl 2026,
Cilt: 11 Sayı: 1, 1 - 12, 05.02.2026
Pınar Duru
,
Figen Akay
,
Özlem Örsal
Öz
Bu çalışma, bakanlık çalışanlarının sağlık okuryazarlığı (SOY) düzeylerini ve Tip 2 diyabet (T2D) gelişim risklerini incelemeyi ve SOY ile T2D gelişim riski arasındaki ilişkiyi değerlendirmeyi amaçlamıştır. Kesitsel tasarımda yürütülen çalışma, Ekim 2020–Mart 2021 tarihleri arasında Türkiye Cumhuriyeti Çevre, Şehircilik ve İklim Değişikliği Bakanlığı’nda çalışan 351 katılımcıdan elde edilen verileri kapsamaktadır. Veri toplamada Türkiye Sağlık Okuryazarlığı Ölçeği (TSOY-32) ve Finlandiya Diyabet Risk Skoru (FINDRISC) kullanılmıştır. Katılımcıların SOY ortalama puanı 31,92±7,85 olup çalışanların %59’unun SOY düzeyinin sorunlu/yetersiz olduğu belirlenmiştir. Çalışanların %9,4’ü önümüzdeki 10 yıl içinde T2D geliştirme açısından “yüksek”, %1,1’i ise “çok yüksek” risk grubunda yer almıştır. Tanımlayıcı bulgular SOY düzeyi azaldıkça T2D riskinin arttığını göstermiştir. Ancak çoklu doğrusal regresyon analizinde, yaş ve genel sağlık algısı gibi değişkenler kontrol edildiğinde, SOY’nın T2D riski ile bağımsız bir ilişki göstermediği saptanmıştır. Bu bulgular, SOY’nın doğrudan bir belirleyici olmasa da koruyucu sağlık davranışları ile ilişkisi nedeniyle diyabetten korunma programlarında dikkate alınması gereken bir unsur olduğunu göstermektedir. Çalışanlarda düşük SOY’nın yaygın olması, diyabet önleme girişimlerinde SOY’nın sistematik olarak değerlendirilmesi ve güçlendirilmesi gerektiğini ortaya koymaktadır. SOY ile T2D riski arasındaki potansiyel nedensel ilişkilerin daha iyi anlaşılabilmesi için boylamsal çalışmalara ihtiyaç vardır.
Kaynakça
-
Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012;12:1-13. DOI:10.1186/1471-2458-12-80.
-
Parnell TA, Stichler JF, Barton AJ, Loan LA, Boyle DK, Allen PE. A concept analysis of health literacy. Nurs Forum. 2019;54(3):315-27. DOI:10.1111/nuf.12331.
-
Stormacq C, Van den Broucke S, Wosinski J. Does health literacy mediate the relationship between socioeconomic status and health disparities?Integrative review. Health Promot Int. 2019;34(5):e1-e17. DOI:10.1093/heapro/day062.
-
Nutbeam D, Levin-Zamir D, Rowlands G. Health literacy and health promotion in context. Glob Health Promot. 2018;25(4):3-5. DOI:10.1177/1757975918814436.
-
World Health Organization. Diabetes. Available from: https://www.who.int/news-room/fact-sheets/detail/diabetes; 2024 [updated 14 November 2024].
-
Song Z, Gao M, Lv J, Yu C, Guo Y, Bian Z, et al. Metabolically healthy obesity, transition to unhealthy phenotypes, and type 2 diabetes in 0.5 million Chinese adults: the China Kadoorie Biobank. Eur J Endocrinol. 2022;186(2):233-44. DOI:10.1530/EJE-21-0743.
-
Llavero-Valero M, Escalada-San Martín J, Martínez-González MA, Basterra-Gortari FJ, de la Fuente-Arrillaga C, Bes-Rastrollo M. Ultra-processed foods and type-2 diabetes risk in the SUN project: A prospective cohort study. Clin Nutr. 2021;40(5):2817-24. DOI:10.1016/j.clnu.2021.03.039.
-
Gao L, Zhang Y, Wang X, Dong H. Association of apolipoproteins A1 and B with type 2 diabetes and fasting blood glucose: a cross-sectional study. BMC Endocr Disord. 2021;21(1):59. DOI:10.1186/s12902-021-00726-5.
-
Wittenbecher C, Guasch-Ferre M, Haslam DE, Dennis C, Li J, Bhupathiraju SN, et al. Changes in metabolomics profiles over ten years and subsequent risk of developing type 2 diabetes: Results from the Nurses’ Health Study. EBioMedicine. 2022;75:1-14. DOI:10.1016/j.ebiom.2021.103799.
-
Evans M, Morgan AR, Patel D, Dhatariya K, Greenwood S, Newland-Jones P, et al. RiskPrediction of the Diabetes Missing Million: Identifying Individuals at High Risk of Diabetes and Related Complications. Diabetes Ther. 2021;12(1):87-105. DOI:10.1007/s13300-020-00963-2.11.
-
Kickbusch I, Pelikan JM, Apfel F, Tsouros AD. The solid facts: Health literacy. Denmark: The World Health Organisation Regional Office for Europe. 2013.
-
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.
-
Batalha MJ, Gabriel T, Alves B, Soledade A, Passadouro R, Dias SS. Exploring the association between health literacy and diabetes risk in adults: insights from a pilot study in Leiria. Port J Public Health. 2025;43(2):86–94. DOI:10.1159/000545596.
-
Tajdar D, Lühmann D, Fertmann R, Steinberg T, van den Bussche H, Scherer M, et al. Low health literacy is associated with higher risk of type 2 diabetes: a cross-sectional study in Germany. BMC Public Health. 2021;21(1):1-12. DOI:10.1186/s12889-021-10508-2.
-
Cochran WG. Sampling techniques 3rd ed. ed. New York: John Wiley & Sons; 1977.
-
Comparative report of health literacy in eight EU member states. The European Health Literacy Survey HLS-EU. [Internet]. 2012. Available from: https://www.healthliteracyeurope.net/hls-eu17.
-
Okyay P, Abacıgil F, Harlak H. Türkiye sağlık okuryazarlığı ölçeği-32 [Turkey health literacy scale-32], in Türkiye sağlık okuryazarlığı ölçekleri güvenirlik ve geçerlilik çalışması [Turkey Health Literacy Scale reliability and validity study], P. Okyay and F. Abacıgil, Editors. 2016, Anıl Reklam Matbaa: Ankara. p. 43-61.
-
Lindstrom J, Tuomilehto J. The diabetes risk score: a practical tool to predict type 2 diabetes risk. Diabetes Care. 2003;26(3):725-31. DOI:10.2337/diacare.26.3.725.
-
Ture N, Emecen AN, Unal B. Validation of the Finnish Diabetes Risk Score and development of a country-specific diabetes prediction model for Turkey. Prim. Heath Care Res. Dev. 2025;26(e18). DOI:10.1017/S1463423625000180.
-
TEMD, Türkiye Endokrinoloji ve Metabolizma Derneği (TEMD) Diabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu - 2019 [Turkish Society of Endocrinology and Metabolism (TEMD) Diabetes Mellitus and Its Complications Diagnosis, Treatment and Follow-up Guide - 2019]. 2019.
-
Tabachnick BG, Fidell LS. Using Multivariate Statistics Sixth ed. ed. 2013, Boston: Pearson.
-
Ulas-Kadioglu B, Soylar P. The Effect of Body Weight on Eating Behavior and Risk for Diabetes, Health Literacy Among Turkish Adults. Prog Nutr. 2021;23(1):1-9. DOI:10.23751/pn.v23i1.8797.
-
O’Meara L, Williams SL, Ames K, Lawson C, Saluja S, Vandelanotte C. Low health literacy is associated with risk of developing type 2 diabetes in a nonclinical population. Diabetes Educ. 2019;45(4):431-41. DOI:10.1177/0145721719857548.
-
Ydirin CSB. Health literacy and health-promoting behaviors among adults at risk for diabetes in a remote Filipino community. Belitung Nursing Journal. 2021;7(2):88-97.
-
Nanayakkara N, Curtis AJ, Heritier S, Gadowski AM, Pavkov ME, Kenealy T, et al. Impact of age at type 2 diabetes mellitus diagnosis on mortality and vascular complications: systematic review and meta-analyses. Diabetologia. 2021;64(2):275-87. DOI:10.1007/s00125-020-05319-w.
-
Yildiz T, Zuhur S, Zuhur SS. Diabetes Risk Assessment and Awareness in a University Academics and Employees. Med Bull Sisli Etfal Hosp. 2021;55(4):524-31. DOI:10.14744/SEMB.2021.84770.
-
Ismail L, Materwala H, Al-Kaabi J. Association of risk factors with type 2 diabetes: A systematic review. Comput Struct Biotechnol J. 2021;19:1759-85. DOI:10.1016/j.csbj.2021.03.003.
-
Kwak S, Lee Y, Baek S, Shin J. Effects of subjective health perception on health behavior and cardiovascular disease risk factors in patients with prediabetes and diabetes. Int. J. Environ. Res. Public Health. 2022;19(13):7900. DOI:10.3390/ijerph19137900.
-
Lee SH, Tao S, Kim HS. The prevalence of metabolic syndrome and its related risk complications among Koreans. Nutrients. 2019;11(8):1755. DOI:10.3390/nu11081755.
-
Hone P, Black J, Sathish T, Kapoor N, Cao Y, Haregu T, et al. Determinants of health service utilization among adults at high risk of developing type 2 diabetes in Kerala, India. Asia Pac J Public Health. 2022;34(4):377-83. DOI:10.1177/10105395211072497.
-
Fitria E, Sylvia EI, Datak G, editors. Health literacy and diabetes risk factors score. Proceedings of the International Conference on Applied Science and Health; 2019 [cited 2025 Nov. 30];(4):641-6. Available from: https://publications.inschool.id/index.php/icash/article/view/686
Potential impact of health literacy level on type 2 diabetes risk: A cross-sectional study
Yıl 2026,
Cilt: 11 Sayı: 1, 1 - 12, 05.02.2026
Pınar Duru
,
Figen Akay
,
Özlem Örsal
Öz
This study aimed to examine the health literacy (HL) levels of ministry employees, assess their risk of developing type 2 diabetes (T2D), and evaluate the relationship between HL and the risk of developing T2D. Conducted using a cross-sectional design, the study included data from 351 participants working at the Republic of Türkiye Ministry of Environment, Urbanization, and Climate Change between October 2020 and March 2021. Data were collected using the Turkish Health Literacy Scale (TSOY-32) and the Finnish Diabetes Risk Score (FINDRISC). The mean HL score of participants was 31.92±7.85, with 59% of employees classified as having problematic or inadequate HL. Regarding T2D risk, 9.4% of participants were categorized as “high risk” and 1.1% as “very high risk” for developing T2D within the next 10 years. Descriptive findings indicated that as HL levels decreased, the risk of T2D increased. However, multiple linear regression analysis showed that HL was not independently associated with T2D risk when variables such as age and perceived general health were controlled. These findings suggest that although HL is not a direct determinant of T2D risk, it remains an important factor to consider in diabetes prevention programs due to its association with preventive health behaviors. The high prevalence of low HL among employees highlights the need for systematic assessment and enhancement of HL in workplace diabetes prevention initiatives. Longitudinal studies are necessary to understand better the potential causal relationships between HL and the risk of T2D.
Etik Beyan
First, permission to use the scales was received from the respective authors who developed the scales used in this study. The institutional approval of the Ministry of Environment and Urbanization, Department of Support Services dated 05/11/2019 (No:259105), and the ethical approval of the Eskişehir Osmangazi University Non-Interventional Clinical Research Ethics Committee dated 10/12/2019 (No:37) were obtained. All participants voluntarily agreed to participate in the study, which was carried out in accordance with the Helsinki Declaration Principles.
Teşekkür
The authors would like to extend their sincere thanks to anyone who contributed to this study. This study was previously presented as an oral presentation at the 10th International Istanbul Scientific Research Congress on 23-25 July 2022, in İstanbul, Türkiye.
Kaynakça
-
Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012;12:1-13. DOI:10.1186/1471-2458-12-80.
-
Parnell TA, Stichler JF, Barton AJ, Loan LA, Boyle DK, Allen PE. A concept analysis of health literacy. Nurs Forum. 2019;54(3):315-27. DOI:10.1111/nuf.12331.
-
Stormacq C, Van den Broucke S, Wosinski J. Does health literacy mediate the relationship between socioeconomic status and health disparities?Integrative review. Health Promot Int. 2019;34(5):e1-e17. DOI:10.1093/heapro/day062.
-
Nutbeam D, Levin-Zamir D, Rowlands G. Health literacy and health promotion in context. Glob Health Promot. 2018;25(4):3-5. DOI:10.1177/1757975918814436.
-
World Health Organization. Diabetes. Available from: https://www.who.int/news-room/fact-sheets/detail/diabetes; 2024 [updated 14 November 2024].
-
Song Z, Gao M, Lv J, Yu C, Guo Y, Bian Z, et al. Metabolically healthy obesity, transition to unhealthy phenotypes, and type 2 diabetes in 0.5 million Chinese adults: the China Kadoorie Biobank. Eur J Endocrinol. 2022;186(2):233-44. DOI:10.1530/EJE-21-0743.
-
Llavero-Valero M, Escalada-San Martín J, Martínez-González MA, Basterra-Gortari FJ, de la Fuente-Arrillaga C, Bes-Rastrollo M. Ultra-processed foods and type-2 diabetes risk in the SUN project: A prospective cohort study. Clin Nutr. 2021;40(5):2817-24. DOI:10.1016/j.clnu.2021.03.039.
-
Gao L, Zhang Y, Wang X, Dong H. Association of apolipoproteins A1 and B with type 2 diabetes and fasting blood glucose: a cross-sectional study. BMC Endocr Disord. 2021;21(1):59. DOI:10.1186/s12902-021-00726-5.
-
Wittenbecher C, Guasch-Ferre M, Haslam DE, Dennis C, Li J, Bhupathiraju SN, et al. Changes in metabolomics profiles over ten years and subsequent risk of developing type 2 diabetes: Results from the Nurses’ Health Study. EBioMedicine. 2022;75:1-14. DOI:10.1016/j.ebiom.2021.103799.
-
Evans M, Morgan AR, Patel D, Dhatariya K, Greenwood S, Newland-Jones P, et al. RiskPrediction of the Diabetes Missing Million: Identifying Individuals at High Risk of Diabetes and Related Complications. Diabetes Ther. 2021;12(1):87-105. DOI:10.1007/s13300-020-00963-2.11.
-
Kickbusch I, Pelikan JM, Apfel F, Tsouros AD. The solid facts: Health literacy. Denmark: The World Health Organisation Regional Office for Europe. 2013.
-
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.
-
Batalha MJ, Gabriel T, Alves B, Soledade A, Passadouro R, Dias SS. Exploring the association between health literacy and diabetes risk in adults: insights from a pilot study in Leiria. Port J Public Health. 2025;43(2):86–94. DOI:10.1159/000545596.
-
Tajdar D, Lühmann D, Fertmann R, Steinberg T, van den Bussche H, Scherer M, et al. Low health literacy is associated with higher risk of type 2 diabetes: a cross-sectional study in Germany. BMC Public Health. 2021;21(1):1-12. DOI:10.1186/s12889-021-10508-2.
-
Cochran WG. Sampling techniques 3rd ed. ed. New York: John Wiley & Sons; 1977.
-
Comparative report of health literacy in eight EU member states. The European Health Literacy Survey HLS-EU. [Internet]. 2012. Available from: https://www.healthliteracyeurope.net/hls-eu17.
-
Okyay P, Abacıgil F, Harlak H. Türkiye sağlık okuryazarlığı ölçeği-32 [Turkey health literacy scale-32], in Türkiye sağlık okuryazarlığı ölçekleri güvenirlik ve geçerlilik çalışması [Turkey Health Literacy Scale reliability and validity study], P. Okyay and F. Abacıgil, Editors. 2016, Anıl Reklam Matbaa: Ankara. p. 43-61.
-
Lindstrom J, Tuomilehto J. The diabetes risk score: a practical tool to predict type 2 diabetes risk. Diabetes Care. 2003;26(3):725-31. DOI:10.2337/diacare.26.3.725.
-
Ture N, Emecen AN, Unal B. Validation of the Finnish Diabetes Risk Score and development of a country-specific diabetes prediction model for Turkey. Prim. Heath Care Res. Dev. 2025;26(e18). DOI:10.1017/S1463423625000180.
-
TEMD, Türkiye Endokrinoloji ve Metabolizma Derneği (TEMD) Diabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu - 2019 [Turkish Society of Endocrinology and Metabolism (TEMD) Diabetes Mellitus and Its Complications Diagnosis, Treatment and Follow-up Guide - 2019]. 2019.
-
Tabachnick BG, Fidell LS. Using Multivariate Statistics Sixth ed. ed. 2013, Boston: Pearson.
-
Ulas-Kadioglu B, Soylar P. The Effect of Body Weight on Eating Behavior and Risk for Diabetes, Health Literacy Among Turkish Adults. Prog Nutr. 2021;23(1):1-9. DOI:10.23751/pn.v23i1.8797.
-
O’Meara L, Williams SL, Ames K, Lawson C, Saluja S, Vandelanotte C. Low health literacy is associated with risk of developing type 2 diabetes in a nonclinical population. Diabetes Educ. 2019;45(4):431-41. DOI:10.1177/0145721719857548.
-
Ydirin CSB. Health literacy and health-promoting behaviors among adults at risk for diabetes in a remote Filipino community. Belitung Nursing Journal. 2021;7(2):88-97.
-
Nanayakkara N, Curtis AJ, Heritier S, Gadowski AM, Pavkov ME, Kenealy T, et al. Impact of age at type 2 diabetes mellitus diagnosis on mortality and vascular complications: systematic review and meta-analyses. Diabetologia. 2021;64(2):275-87. DOI:10.1007/s00125-020-05319-w.
-
Yildiz T, Zuhur S, Zuhur SS. Diabetes Risk Assessment and Awareness in a University Academics and Employees. Med Bull Sisli Etfal Hosp. 2021;55(4):524-31. DOI:10.14744/SEMB.2021.84770.
-
Ismail L, Materwala H, Al-Kaabi J. Association of risk factors with type 2 diabetes: A systematic review. Comput Struct Biotechnol J. 2021;19:1759-85. DOI:10.1016/j.csbj.2021.03.003.
-
Kwak S, Lee Y, Baek S, Shin J. Effects of subjective health perception on health behavior and cardiovascular disease risk factors in patients with prediabetes and diabetes. Int. J. Environ. Res. Public Health. 2022;19(13):7900. DOI:10.3390/ijerph19137900.
-
Lee SH, Tao S, Kim HS. The prevalence of metabolic syndrome and its related risk complications among Koreans. Nutrients. 2019;11(8):1755. DOI:10.3390/nu11081755.
-
Hone P, Black J, Sathish T, Kapoor N, Cao Y, Haregu T, et al. Determinants of health service utilization among adults at high risk of developing type 2 diabetes in Kerala, India. Asia Pac J Public Health. 2022;34(4):377-83. DOI:10.1177/10105395211072497.
-
Fitria E, Sylvia EI, Datak G, editors. Health literacy and diabetes risk factors score. Proceedings of the International Conference on Applied Science and Health; 2019 [cited 2025 Nov. 30];(4):641-6. Available from: https://publications.inschool.id/index.php/icash/article/view/686