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Multicenter Study
. 2006 May-Jun;121(3):245-54.
doi: 10.1177/003335490612100305.

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

Dean Schillinger  1 , Lauren R Barton, Andrew J Karter, Frances Wang, Nancy Adler
Affiliations
Multicenter Study

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

Dean Schillinger et al. Public Health Rep. 2006 May-Jun.

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.

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Figures

Figure 1
Figure 1
Path analytic model testing the direct effect of educational attainment levels on log-transformed HbA1c values in low-income adults with diabetes
Figure 2
Figure 2
Path analytic model testing the mediational effect of educational attainment levels on log-transformed HbA1c values via literacy among low-income adults with diabetes
Figure 3
Figure 3
Characteristics of study patients (N=395)
See this image and copyright information in PMC

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