Health literacy and diabetic foot ulcer healing
ABSTRACT
The adherence by patients to diabetic foot ulcer therapy is often difficult. The
goal of this study was to begin to understand how a patient’s health literacy
affects their foot ulcer management decisions. Initially using a cross-sectional
study design, we evaluated diabetics with foot ulcers within 4 weeks of being
asked to participate in a longitudinal study. We assessed health literacy using
measures of general health literacy, diabetes health literacy, diabetes selfefficacy,
and diabetes numeracy. Individuals enrolled in the study had higher
health literacy based on the Short Test of Functional Health Literacy in Adults
[33.8 (SD 2.3) versus 27.3 (SD 9.6); p50.009] as compared to individuals who
previously declined an invitation to enroll in the study. Furthermore, patients
with lower Short Test of Functional Health Literacy in Adults scores had larger
(p50.04) and older (p50.125) wounds (markers for poorer prognosis). Other
measures of literacy showed similar results. In conclusion, those with diminished
health literacy were less likely to enroll in an investigational study and had
wounds that were less likely to heal.
Nearly 90% of individuals with diabetes and lower extremity
amputation (LEA) have histories of foot ulcers or have lower
extremity findings consistent with peripheral arterial disease
(PAD) and/or neuropathy.1 It is not clear that patients understand
that these medical ailments are associated with LEA
risk.2 The incidence of LEA varies widely in the US even
after adjustment for socioeconomic factors like income, race,
and physician availability.3 At least some of the geographic
variation in LEA is associated with health screening behaviors
and availability of diabetes education.4 However, overall
the reason for the variation in LEA is unknown.
Health literacy is broadly defined as the degree to which
individuals have the capacity to obtain, process and understand
basic health information and services needed to make
appropriate health decisions.5,6 The goal of this study was to
begin to understand how a patient’s health literacy affects
their decisions as to how their foot ulcers are managed