Health literacy and associated factors among people with diabetes in the Brazilian Amazon
Edmilson dos Santos Nogueira, Iasmin Machado Soares, Rafael Martins da Costa, Amanda Laranjeira Alves, Hércules Lázaro Morais Campos, Elisa Brosina de Leon
Abstract
Introduction: health literacy is crucial for managing type 2 diabetes mellitus (T2DM). In the Brazilian Amazon, geographical barriers limit access to care, exacerbating low adherence and poor glycemic control, impacting the disease progression.
Objective: to analyze patterns of health literacy and their associations with sociodemographic, clinical, and behavioral factors among individuals with T2DM in the Brazilian Amazon, using a network analysis approach.
Methods: a cross-sectional study was conducted with 137 adults with T2DM receiving care in six Primary Health Care units in a Brazilian Amazon city. Health literacy was assessed using the Brazilian version of the Test of Functional Health Literacy in Adults, and diabetes knowledge was measured using the DiAbeTes Education Questionnaire (DATE-Q). Sociodemographic, clinical, and behavioral data were collected through structured interviews. Descriptive and inferential analyses were performed, and network analysis was applied to explore the interrelationships among variables.
Results: most participants had inadequate health literacy (57.7%), and only 1.5% had adequate literacy. Lower literacy levels were significantly associated with older age, fewer years of schooling, lower income, unemployment, and longer diabetes duration (p<0.05). Individuals with lower literacy also reported poorer dietary practices and lower adherence to recommended self-care behaviors. In the network model, health literacy emerged as a central node, with the highest strength and betweenness indices, closely connected to education, retirement status, and age, indicating its key role in the structure of associations.
Conclusion: the prevalence of low health literacy among participants was 57.7%. Lower health literacy was significantly associated with older age, fewer years of schooling, lower income, and longer diabetes duration. These factors may be related to barriers to understanding and accessing health services in the region, such as low income and limited access.
Keywords: Vulnerable population, Chronic diseases, Health literacy, Public Health, rural population.
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