Pathways linking health literacy to diabetes risk scores in a non-diabetic population in Ismailia, Egypt: a cross sectional study design.

Background: Type 2 diabetes mellitus (T2DM) is a growing public health issue in Egypt. Health literacy (HL) is a modifiable factor influencing diabetes risk (DR), but the pathways through which HL impacts diabetes risk remain unclear. This study aimed to examine the direct and indirect pathways linking HL to DR in a non-diabetic population.

Methods: A cross-sectional study was conducted from July 2022 to August 2023 among employees in the administrative sectors of 16 faculties at Suez Canal University, Ismailia, Egypt. Each faculty was treated as a cluster for sampling. Eligible participants were those without a diagnosis of T2DM. Exclusion criteria included use of antidiabetic medications, cancer diagnosis, long-term corticosteroid or immunosuppressant use, or pregnancy. Sample size from each sector was determined proportionally based on the number of eligible employees, and participants were randomly selected from a coded list. Data were collected via structured face-to-face interviews using validated tools to assess HL, self-efficacy (SE), diabetes knowledge (DK), preventive health behaviors (PHB), and DR, measured by the ARABRISK score. Statistical analyses included Spearman correlations, non-parametric tests, and Structural Equation Modeling (SEM) via SAS PROC CALIS to assess direct and indirect pathways from HL to DR, controlling for significant covariates.

Results: Of the participants, 59.4% had inadequate/problematic HL, and 54.8% had moderate-to-high DR. HL was positively correlated with DK (r = 0.275), SE (r = 0.379), and PHB (r = 0.514) and negatively correlated with DR (r=-0.542), all with p-values < 0.001. The strongest negative correlation was between PHB and DR (r=-0.957). SEM revealed a weak but significant direct effect of HL on DR (β= - 0.05108, p < 0.001). The most substantial indirect effect was observed through PHB (β= - 0.93663, p < 0.001). Additional indirect pathways through DK and SE also emerged, although SE had no significant effect on PHB.

Conclusions: HL reduces DR primarily through its effect on PHB. While DK and SE contribute, their effects are less pronounced. Interventions that enhance HL and support healthy behaviors may help prevent T2DM in at-risk populations. Future research should use longitudinal designs, diabetes-specific HL tools, objective risk measures; explore psychosocial mediators; and study diverse populations.