“When knowing is not enough”: The relationship between emotional distress, health literacy and diabetes management.

New research from Belgium shows diabetes distress and depression moderate the relationship between health literacy and diabetes self-management. 

By Jennifer Halliday


Low health literacy and diabetes-specific health literacy (collectively referred to hereon as health literacy) have been associated with sub-optimal glycaemic outcomes, whilst emotional distress has been linked with both sub-optimal diabetes self-management and outcomes. However, little is known about the interaction between health literacy and emotional distress and their combined impact on diabetes self-management. Belgian researchers, Schinckus and colleagues, set out to investigate whether emotional distress moderates the interactions between health literacy and diabetes self-management behaviours in people with type 2 diabetes.

This study involved completion of validated questionnaires by 128 adults with type 2 diabetes. The study found: 1) health literacy was associated with diabetes self-management; 2) diabetes distress was not directly associated with diabetes self-management, but it did moderate the effects of health literacy on diabetes self-management; 3) depression was not associated with diabetes self-management, but it did moderate the effect of health literacy on diabetes self-management. The authors also explored the interactions of the previously mentioned constructs with self-efficacy, but the results were not significant.

Based on these findings, a person with higher health literacy is more likely to perform optimal diabetes self-management. However, if that person is experiencing emotional distress, the positive impact of health literacy will likely be lessened and their diabetes self-management will likely diminish. The authors suggest that this might be due to emotional burden interfering with the cognitive resources needed to continually perform daily diabetes self-management behaviours.

Schinckus L, Dangoisse F, Van den Broucke S, Mikolajczak M (2018). When knowing is not enough: Emotional distress and depression reduce the positive effects of health literacy on diabetes self-management. Patient Education and Counseling, 101(2): 324-330.