Communicative and critical health literacy, and self-management behaviors in end-stage renal disease patients with diabetes on hemodialysis

Objective: Health Literacy (HL) has been linked to disease self-management and various health outcomes, and can be separated into components of functional, communicative and critical skills. The high comorbidity between diabetes and end-stage renal disease (ESRD) poses concerns for compromised disease self-management. This study aimed to identify the relationships between HL and self-management behaviors in end-stage renal disease patients with diabetes. Methods: Self-report questionnaires measuring HL and self-management with the Functional, Communicative and Critical HL scale and Summary of Diabetes Self-Care Activities, respectively, were implemented with a sample of 63 patients. Socio-demographic and clinical characteristics were obtained from medical records. Results: Self-management in diabetes was associated with communicative and critical HL, but not functional HL. Educational attainment was associated only with functional HL. No relationship between HL and glycated hemoglobin (Hb(A1c)) was identified. Conclusion: Communicative and critical HL skills are associated with self-management in ESRD patients with diabetes. Education levels are not related to self-management. Practice implications: Healthcare professionals and health information aiming to improve self-management in ESRD patients with diabetes should consider their capacities of communicative and critical HL instead of solely assessing functional HL. (C) 2013 Elsevier Ireland Ltd. All rights reserved.