{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T22:29:03Z","timestamp":1787956143411,"version":"build-2784847793"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T00:00:00Z","timestamp":1661299200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004663","name":"Ministry of Science and Technology, Taiwan","doi-asserted-by":"publisher","award":["MOST 109-2410-H-227-001-SSS"],"award-info":[{"award-number":["MOST 109-2410-H-227-001-SSS"]}],"id":[{"id":"10.13039\/501100004663","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Health literacy plays a crucial role in managing chronic health conditions. Previous studies have revealed the positive relationship between health literacy and diabetes knowledge but few studies have focused on peripheral vascular disease (PVD) in diabetes in relation to health literacy in diabetes management. This study investigated the relationship between the risk for PVD and health literacy level with other determining factors among patients with type 2 diabetes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>We conducted a survey on health literacy using the Mandarin Multidimensional Health Literacy Questionnaire in the department of metabolism and endocrine systems at a regional hospital in northern Taiwan from December 2021 to May 2022 and obtained data from the hospital's health information system (HIS) from 2013 to 2020 to identify occurrences of PVD (<jats:italic>n<\/jats:italic> = 429). We performed logistic regression analysis to identify the relationship between PVD events and health literacy levels (overall and in five separate subdimensions) adjusted with other variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A longer duration of diabetes increased the risk for PVD events (<jats:italic>P<\/jats:italic> = 0.044 and 0.028). In terms of health literacy, the overall level was not significant; however, the dimension of higher levels of health literacy in acquiring health information increased the risk for PVD events (<jats:italic>P<\/jats:italic> = 0.034). Other variables were not significantly associated with the risk for PVD events.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study examined the risk for PVD events in terms of the duration of diabetes and provided evidence across the range of dimensions of health literacy concerning the ability to control diabetes. Those with a higher level of health literacy may be more aware of their disease situation, seek and cooperate with their healthcare providers earlier, and have more opportunities to be made aware of their health status from regular checkups than those with inadequate health literacy. These results may help providers make available more self-management tools that are adequate and sustainable for diabetes patients with poor health literacy.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2022.946889","type":"journal-article","created":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T06:01:02Z","timestamp":1661320862000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Modest association between health literacy and risk for peripheral vascular disease in patients with type 2 diabetes"],"prefix":"10.3389","volume":"10","author":[{"given":"Shang-Jyh","family":"Chiou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yen-Jung","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuomeng","family":"Liao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chih-Dao","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,8,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"546","DOI":"10.4103\/2230-8210.183480","article-title":"Microvasular and macrovascular complications in diabetes mellitus: distinct or continuum?","volume":"20","author":"Chawla","year":"2016","journal-title":"Indian J Endocrinol Metab."},{"key":"B2","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1111\/dme.14196","article-title":"Assessing the impact of diabetes on quality of life: what have the past 25 years taught us?","volume":"37","author":"Speight","year":"2020","journal-title":"Diabet Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1177\/2047487319880043","article-title":"Innovations in personalised diabetes care and risk management","volume":"26","author":"Nijpels","year":"2019","journal-title":"Eur J Prev Cardiol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1016\/j.jclinepi.2018.05.010","article-title":"Health literacy in chronic disease management: a matter of interaction","volume":"102","author":"van der Heide","year":"2018","journal-title":"J Clin Epidemiol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1016\/j.ijcard.2018.08.090","article-title":"Improving health literacy in patients with chronic conditions: a call to action","volume":"273","author":"Dunn","year":"2018","journal-title":"Int J Cardiol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"97","DOI":"10.7326\/0003-4819-155-2-201107190-00005","article-title":"Low health literacy and health outcomes: an updated systematic review","volume":"155","author":"Berkman","year":"2011","journal-title":"Ann Intern Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1228","DOI":"10.1111\/j.1525-1497.2004.40153.x","article-title":"Literacy and health outcomes: a systematic review of the literature","volume":"19","author":"Dewalt","year":"2004","journal-title":"J Gen Intern Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"191","DOI":"10.2217\/dmt.11.5","article-title":"Health literacy in diabetes care: explanation, evidence and equipment","volume":"1","author":"Cavanaugh","year":"2011","journal-title":"Diabetes Manag."},{"key":"B9","first-page":"257","article-title":"Health status of illiterate adults: relation between literacy and health status among persons with low literacy skills","volume":"5","author":"Weiss","year":"1992","journal-title":"J Am Board Fam Pract."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.2105\/AJPH.87.6.1027","article-title":"The relationship of patient reading ability to self-reported health and use of health services","volume":"87","author":"Baker","year":"1997","journal-title":"Am J Public Health."},{"key":"B11","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1046\/j.1525-1497.1998.00242.x","article-title":"Health literacy and the risk of hospital admission","volume":"13","author":"Baker","year":"1998","journal-title":"J Gen Intern Med."},{"key":"B12","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1080\/00015458.2009.11680493","article-title":"Diabetes and peripheral vascular disease","volume":"109","author":"Huysman","year":"2009","journal-title":"Acta Chir Belg."},{"key":"B13","doi-asserted-by":"publisher","first-page":"894","DOI":"10.2337\/diacare.25.5.894","article-title":"UKPDS 59: hyperglycemia and other potentially modifiable risk factors for peripheral vascular disease in type 2 diabetes","volume":"25","author":"Adler","year":"2002","journal-title":"Diabetes Care."},{"key":"B14","doi-asserted-by":"publisher","first-page":"16","DOI":"10.2337\/diacare.24.1.16","article-title":"The Starr County Diabetes Education Study: development of the Spanish-language diabetes knowledge questionnaire","volume":"24","author":"Garcia","year":"2001","journal-title":"Diabetes care."},{"key":"B15","doi-asserted-by":"publisher","first-page":"53","DOI":"10.5116\/ijme.4dfb.8dfd","article-title":"Making sense of Cronbach's alpha","volume":"2","author":"Tavakol","year":"2011","journal-title":"Int J Med Educ."},{"key":"B16","doi-asserted-by":"publisher","first-page":"e23182","DOI":"10.1097\/MD.0000000000023182","article-title":"Mandarin multidimensional health literacy questionnaire for patient supporting groups: a quality improvement article","volume":"99","author":"Wu","year":"2020","journal-title":"Medicine."},{"key":"B17","doi-asserted-by":"publisher","first-page":"5702","DOI":"10.3390\/ijerph17165702","article-title":"Health literacy varies according to different background disease natures and characteristics of participants for patient support groups","volume":"17","author":"Wu","year":"2020","journal-title":"Int J Environ Res Public Health."},{"key":"B18","doi-asserted-by":"publisher","first-page":"556","DOI":"10.6288\/TJPH201736106061","article-title":"Development of Mandarin Multidimensional Health Literacy Questionnaire (MMHLQ)","volume":"36","author":"Wei","year":"2017","journal-title":"Taiwan J Public Health."},{"key":"B19","doi-asserted-by":"publisher","first-page":"2333721416630492","DOI":"10.1177\/2333721416630492","article-title":"Health literacy and older adults: a systematic review","volume":"2","author":"Chesser","year":"2016","journal-title":"Gerontol Geriatr Med."},{"key":"B20","doi-asserted-by":"publisher","first-page":"S368","DOI":"10.1093\/geronb\/55.6.S368","article-title":"The association between age and health literacy among elderly persons","volume":"55","author":"Baker","year":"2000","journal-title":"J Gerontol B Psychol Sci Soc Sci."},{"key":"B21","doi-asserted-by":"publisher","first-page":"e0208091","DOI":"10.1371\/journal.pone.0208091","article-title":"Validity and measurement invariance across sex, age, and education level of the French short versions of the European Health Literacy Survey Questionnaire","volume":"13","author":"Rouquette","year":"2018","journal-title":"PLoS ONE."},{"key":"B22","doi-asserted-by":"publisher","first-page":"127","DOI":"10.4103\/jehp.jehp_65_18","article-title":"Investigating the effect of education on health literacy and its relation to health-promoting behaviors in health center","volume":"7","author":"Bayati","year":"2018","journal-title":"J Educ Health Promot."},{"key":"B23","volume-title":"Health Literacy: The Solid Facts","author":"Kickbusch","year":"2013"},{"key":"B24","doi-asserted-by":"publisher","first-page":"962","DOI":"10.1007\/s11606-010-1389-7","article-title":"Hypoglycemia is more common among type 2 diabetes patients with limited health literacy: the Diabetes Study of Northern California (DISTANCE)","volume":"25","author":"Sarkar","year":"2010","journal-title":"J Gen Intern Med."},{"key":"B25","doi-asserted-by":"publisher","first-page":"E9","DOI":"10.1097\/NNR.0000000000000401","article-title":"Self-management behaviors, glycemic control, and metabolic syndrome in type 2 diabetes","volume":"69","author":"Ji","year":"2020","journal-title":"Nurs Res."},{"key":"B26","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/S0027-9684(15)30469-7","article-title":"The impact of health literacy on self-monitoring of blood glucose in patients with diabetes receiving care in an inner-city hospital","volume":"102","author":"Mbaezue","year":"2010","journal-title":"J Natl Med Assoc."},{"key":"B27","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1007\/s11606-012-2241-z","article-title":"Health literacy and health outcomes in diabetes: a systematic review","volume":"28","author":"Al Sayah","year":"2013","journal-title":"J Gen Intern Med."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1007\/s11606-019-04832-y","article-title":"The role of health literacy in diabetes knowledge, self-care, and glycemic control: a meta-analysis","volume":"34","author":"Marciano","year":"2019","journal-title":"J Gen Intern Med."},{"key":"B29","doi-asserted-by":"publisher","first-page":"961","DOI":"10.4239\/wjd.v6.i7.961","article-title":"Peripheral artery disease in patients with diabetes: epidemiology, mechanisms, and outcomes","volume":"6","author":"Thiruvoipati","year":"2015","journal-title":"World J Diabetes."},{"key":"B30","doi-asserted-by":"publisher","first-page":"1479164120914845","DOI":"10.1177\/1479164120914845","article-title":"Peripheral arterial disease and type 2 diabetes: Older patients still exhibit a survival benefit from glucose control","volume":"17","author":"H\u00f6baus","year":"2020","journal-title":"Diabetes Vasc Dis Res."},{"key":"B31","doi-asserted-by":"publisher","first-page":"2623","DOI":"10.1161\/CIRCULATIONAHA.105.608679","article-title":"Risk factors for progression of peripheral arterial disease in large and small vessels","volume":"113","author":"Aboyans","year":"2006","journal-title":"Circulation."},{"key":"B32","first-page":"57","article-title":"A study of prevalence of peripheral arterial disease in type 2 diabetes mellitus patients in a teaching hospital","volume":"66","author":"Shukla","year":"2018","journal-title":"J Assoc Physicians India."},{"key":"B33","doi-asserted-by":"publisher","first-page":"827","DOI":"10.4239\/wjd.v12.i6.827","article-title":"Diabetes and peripheral artery disease: a review","volume":"12","author":"Soyoye","year":"2021","journal-title":"World J Diabetes."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2022.946889\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T06:01:10Z","timestamp":1661320870000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2022.946889\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,24]]},"references-count":33,"alternative-id":["10.3389\/fpubh.2022.946889"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2022.946889","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,24]]},"article-number":"946889"}}