Abstract
Purpose: This study is aimed at investigating health literacy (HL) among diabetes mellitus (DM) patients using a comprehensive, scientific, feasible, and suitable HL assessment indicator system tailored for the diabetic population in mainland China and systematically analyzing the factors influencing HL in this population. Methods: The Delphi expert consultation method was employed to initially draft and refine the Diabetes Health Literacy Evaluation Indicator System (DHLEIS). The reliability and representativeness of the indicator system were tested through metrics including the active coefficient, authority degree, and coordination degree. A HL survey questionnaire for diabetic patients was developed based on DHLEIS and administered to diabetic patients across five hospitals in Nantong and Yancheng cities, Jiangsu Province. The random forest method was utilized to deeply analyze the impact of various factors on HL and its four dimensions and to identify the core influencing factors. Results: Analysis of 707 questionnaires based on the DHLEIS revealed that nine factors-age, sex, body shape, income, exercise, education level, duration of DM, whether insulin is injected, and the number of cohabitants-significantly impact the HL levels. Among these, age, duration of DM, education level, and number of cohabitants were particularly influential across the four dimensions of health knowledge, awareness, behavior, and skills. Factors related to health knowledge and skills were the most significant contributors to overall HL. Conclusions: The multidimensional analysis of factors influencing HL offers valuable insights into characterizing varying levels of HL among diabetic patients. This approach supports targeted cognitive improvements and the effective enhancement of health skills, ultimately leading to better health outcomes.