Relationships of health literacy to self‐care behaviors in people with diabetes aged 60 and above: Empowerment as a mediator

To examine the relationships of health literacy to diabetes self-care behaviors (diet, physical exercise, foot care and blood glucose monitoring) through empowerment controlling for diabetes education.Potential mechanisms of how health literacy links to health outcomes have not clearly elucidated.A cross-sectional study design was used.Participants were recruited from three community health centers in South Korea from September 2016 to April 2017 using a convenience sampling method. A total of 136 people with diabetes aged 60 and above were participated in this study. The main study variables of health literacy, empowerment and diabetes self-care activities were assessed using self-reported questionnaires. This study applied a simple mediation analysis with a single covariate using the PROCESS macro, with health literacy entered as an antecedent variable, empowerment as a mediator, diabetes self-care behaviors as outcome variables and diabetes education as a covariate.After controlling for diabetes education, the indirect effects of health literacy to self-care behaviors through empowerment were significant when the self-care behaviors were particularly diet and physical exercise. Whereas, the indirect effects were not significant when the self-care behaviors were foot care and blood glucose monitoring.This study indicates that the people with higher health literacy were more empowered and those with higher empowerment were more likely to eat healthy foods and exercise. In the light of these findings, a health literacy-tailored empowerment enhancing program may be important targets for interventions promoting diabetes self-care behaviors of diet and physical exercise.