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Public Health Rep. 2006 May-Jun;121(3):245-54.

Does literacy mediate the relationship between education and health outcomes? A study of a low-income population with diabetes.

Author information

  • 1Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA. dschillinger@medsfgh.ucsf.edu

Abstract

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.

PMID:
16640146
[PubMed - indexed for MEDLINE]
PMCID:
PMC1525295
Free PMC Article
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