{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T13:47:14Z","timestamp":1784641634582,"version":"3.55.0"},"reference-count":53,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2018,6,20]],"date-time":"2018-06-20T00:00:00Z","timestamp":1529452800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet. Med."],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>People with diabetes have low health literacy, but the role of the latter in diabetic foot disease is unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To determine, through a systematic review and meta\u2010analysis, if health literacy is associated with diabetic foot disease, its risk factors, or foot care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We searched PubMed, <jats:styled-content style=\"fixed-case\">EMBASE<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> CINAHL<\/jats:styled-content>, Web of Science, Scopus and Science Direct. All studies were screened and data extracted by two independent reviewers. Studies in English with valid and reliable measures of health literacy and published tests of association were included. Data were extracted on the associations between the outcomes and health literacy. Meta\u2010analyses were performed using random effects models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixteen articles were included in the systematic review, with 11 in the meta\u2010analysis. In people with inadequate health literacy, the odds of having diabetic foot disease were twice those in people with adequate health literacy, but this was not statistically significant [odds ratio 1.99 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.83, 4.78); two studies in 1278 participants]. There was no statistically significant difference in health literacy levels between people with and without peripheral neuropathy [standardized mean difference \u20130.14 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u20130.47, 0.18); two studies in 399 participants]. There was no association between health literacy and foot care [correlation coefficient 0.01 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u20130.07, 0.10); seven studies in 1033 participants].<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There were insufficient data to exclude associations between health literacy and diabetic foot disease and its risk factors, but health literacy appears unlikely to have a role in foot care. The contribution of low health literacy to diabetic foot disease requires definitive assessment through robust longitudinal studies.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.13694","type":"journal-article","created":{"date-parts":[[2018,5,26]],"date-time":"2018-05-26T08:26:13Z","timestamp":1527323173000},"page":"1470-1479","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Associations of health literacy with diabetic foot outcomes: a systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8082-5050","authenticated-orcid":false,"given":"P. Y.","family":"Chen","sequence":"first","affiliation":[{"name":"Faculty of Health University of Tasmania Hobart Tasmania Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9757-9976","authenticated-orcid":false,"given":"S.","family":"Elmer","sequence":"additional","affiliation":[{"name":"Faculty of Health University of Tasmania Hobart Tasmania Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2122-1622","authenticated-orcid":false,"given":"M.","family":"Callisaya","sequence":"additional","affiliation":[{"name":"Menzies Institute for Medical Research University of Tasmania Hobart Tasmania Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3897-2908","authenticated-orcid":false,"given":"K.","family":"Wills","sequence":"additional","affiliation":[{"name":"Menzies Institute for Medical Research University of Tasmania Hobart Tasmania Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. M.","family":"Greenaway","sequence":"additional","affiliation":[{"name":"School of Medicine University of Tasmania Hobart Tasmania Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4112-3491","authenticated-orcid":false,"given":"T. M.","family":"Winzenberg","sequence":"additional","affiliation":[{"name":"Faculty of Health University of Tasmania Hobart Tasmania Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,6,20]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Diabetes: the silent pandemic and its impact on Australia. Canberra Australia: Diabetes Australia 2012."},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)67698-2"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.21.7.1071"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.2319"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1615439"},{"key":"e_1_2_8_7_1","article-title":"IWGDF Guidance on the prevention of foot ulcers in at\u2010risk patients with diabetes","author":"Bus SA","year":"2015","journal-title":"International Symposium of the Diabetic Foot, The Hague, The Netherlands"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.2701"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.12968\/jowc.2014.23.5.247"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2003.10.014"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.4103\/2249-4863.192340"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp08X319657"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapro\/13.4.349"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.158.2.166"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.4.475"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1497.2004.40153.x"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-012-2241-z"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/41.10.1155"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1177\/1090198111436341"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2296-7-49"},{"key":"e_1_2_8_21_1","unstructured":"BorensteinM HedgesLV HigginsJPT RothsteinHR.Converting Among Effect Sizes.2009. In: Introduction to Meta\u2010Analysis [Internet]. John Wiley & Sons."},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1037\/0021-9010.90.1.175"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11162-011-9232-5"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2010.0160"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1177\/0145721715572446"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2296-14-40"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc07-1932"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.320.7249.1574"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1080\/01621459.2000.10473905"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v036.i03"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anr.2016.01.005"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2015.08.021"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/wrr.12311"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-7-98"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-010186"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2013.0177"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2014.06.011"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1080\/10810730.2015.1061071"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.92.8.1278"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.1998.00242.x"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-155-2-201107190-00005"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0738-3991(02)00239-2"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.3109\/09638288.2012.677936"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.22.1.157"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-9136(199710)14:10<867::AID-DIA475>3.0.CO;2-L"},{"key":"e_1_2_8_46_1","unstructured":"NHMRC.National Evidence\u2010Based Guideline on Prevention Identification and Management of Foot Complications in Diabetes (Part of the Guidelines on Management of Type 2 Diabetes). Melbourne Australia; NHMRC 2011."},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.23.7.943"},{"key":"e_1_2_8_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.04.005"},{"key":"e_1_2_8_49_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-13-658"},{"key":"e_1_2_8_50_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.293.2.217"},{"key":"e_1_2_8_51_1","first-page":"25","article-title":"Health literacy and its association with diabetes knowledge, self\u2010efficacy and disease self\u2010management among African Americans with diabetes mellitus","volume":"22","author":"McCleary\u2010Jones V","year":"2011","journal-title":"ABNF J"},{"key":"e_1_2_8_52_1","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2011.0070"},{"key":"e_1_2_8_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2012.12.018"},{"key":"e_1_2_8_54_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.27.12.2980"}],"container-title":["Diabetic Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fdme.13694","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dme.13694","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,16]],"date-time":"2023-09-16T07:24:34Z","timestamp":1694849074000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/dme.13694"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,6,20]]},"references-count":53,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2018,11]]}},"alternative-id":["10.1111\/dme.13694"],"URL":"https:\/\/doi.org\/10.1111\/dme.13694","archive":["Portico"],"relation":{},"ISSN":["0742-3071","1464-5491"],"issn-type":[{"value":"0742-3071","type":"print"},{"value":"1464-5491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,6,20]]},"assertion":[{"value":"2018-05-23","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-06-20","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}