Date of Conferral

7-21-2026

Date of Award

July 2026

Degree

Doctor of Public Health (DrPH)

School

Health Sciences

Advisor

Richard Palmer

Abstract

Limited health literacy is a significant barrier to effective diabetes self-management among adults with type 2 diabetes mellitus (T2DM), yet nationally representative evidence using comprehensive health literacy measures remains limited. Guided by the health belief model, the purpose of this quantitative, secondary data analysis using cross-sectional data was to examine the relationship between health literacy and diabetes self-care behaviors among U.S. adults with T2DM and determine whether education level moderated this relationship. Data from the 2016 Behavioral Risk Factor Surveillance System were analyzed for U.S. adults (N = 9, 535) with self-reported T2DM. Diabetes self-care behaviors included blood glucose monitoring, foot care, A1C testing, eye examinations, healthcare utilization, and diabetes education. Hierarchical multiple regression and moderation analyses were conducted while controlling for demographic and socioeconomic covariates. Health literacy significantly predicted diabetes self-care behaviors in both unadjusted (B = 0.472, p < .001) and adjusted models (B = 0.359, p < .001), and education significantly moderated this relationship (B = 0.618–0.727, p ≤ .007). These findings identify health literacy as an important determinant of diabetes self-management and suggest the need for increased outreach to T2DM patients with low health literacy. The implications for positive social change include informing health literacy–focused education, clinical practice, and public health policies that improve diabetes self-management, leading to reduced health disparities and improved health outcomes among adults with T2DM.

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