Abstract
BACKGROUND: Type 1 diabetes (T1D) in children and adolescents requires daily self-care and strong parental support. Mothers' health literacy plays a crucial role in promoting effective diabetes management. This study aimed to examine the relationship between mothers' health literacy and self-care behaviours in children and adolescents with T1D. METHODS: In this cross-sectional study, 310 mother–child dyads were recruited from diabetes clinics in Mashhad, Iran, in 2025. Mothers' health literacy was assessed using the Short Test of Functional Health Literacy in Adults (S-TOFHLA). Self-care behaviours were evaluated using the Self-Management of Type 1 Diabetes in Adolescents (SMOD-A) questionnaire. Due to non-normal data distribution, non-parametric tests, including the Mann-Whitney U test, Pearson correlation and multiple linear regression, were used for analysis. RESULTS: The mean mothers' health literacy score was 71.56, and the mean self-care score in children was 124.34. A significant positive correlation was found between mothers' health literacy and all self-care dimensions (r=0.40–0.44, p <0.001). Significant differences in literacy and self-care scores were observed based on the child’s age, diabetes duration, mothers education and diabetes-related training. Regression analysis identified child’s age and maternal diabetes education as significant predictors of self-care (R²≈0.48, p <0.001). CONCLUSION: Mothers' health literacy is positively associated with self-care behaviours in children and adolescents with T1D. These findings highlight the importance of considering mothers' health literacy when designing educational and support strategies, while also taking into account limitations such as the poor numerical literacy of the S-TOFHLA. Future longitudinal and interventional studies are warranted to explore how enhancing mothers' health literacy may influence children’s diabetes self-care and outcomes over time.