Social Networks and Health Literacy Among Latinx Patients with Type 2 Diabetes Mellitus at a Community Health Center

Background and Purpose: Latinx patients with type 2 diabetes mellitus (T2DM) near the Mexico-United States (US) border in the Southwest region face challenges due to low health literacy. Health literacy is a fundamental resource for diabetes management in the maze-like fragmented health care system of the U.S.. Functional health literacy that measures patients’ ability to read and understand written documents have been studied widely. It is important to adopt multi-dimensionality of health literacy to focus on communicative and critical health literacy, which assess the extent to which patients actively engage in appraisal of existing health literacy within social context. Social network theories propose that an individual with social networks from diverse backgrounds have advantages in mobilizing quality information through social interactions. Relying on this proposition, we examined whether Latinx patients with T2DM embedded in “networks of diverse people” had better health literacy and diabetes knowledge.

Methods: We recruited Latinx patients with T2DM from a community health center within an urban area where Latinx immigrants concentrate. Bilingual recruiters conducted a cross-sectional survey with 102 Latinx patients with T2DM. We conducted personal network analysis (PNA) that incorporated nine name generating questions and a series of name interpreting questions. To measure diversity of social networks, we focused on size, constraint, attributes of network member heterogeneity such as strength of relationship, and other measures that show network members degree of diversity (e.g., proportion of network members who are kins). To measure health literacy, we administered a validated measure focusing on functional, communicative, and critical health literacy. Additionally, diabetes-related knowledge was assessed. We controlled for patient-level confounding factors that include gender, marital status, primary language use, and age. We conducted multiple regression analyses with a single attribute of social networks due to the risk of collinearity between correlates measured by PNA (N=95).

Results: Latinx patients had higher functional health literacy when they reported larger network size (β=.22; p<.05), higher heterogeneity regarding strength of relationship (β=.32; p<.05), and higher degree of health matters discussion with each network member (β=.25; p<.05). Respondents had lower functional health literacy when they reported higher average strength of relationship (β=-.25; p<.05). Communicative health literacy was higher when Latinx patients reported higher proportion of social ties deemed regularly exercising (β=.23; p<.05). Yet, those with higher heterogeneity regarding reasons for name nomination were associated with lower communicative health literacy (β=-.22; p<.05). When patients reported a health professional in their social networks, they had better diabetes related knowledge (β=.22; p<.001).

Conclusions and Implications: We discovered preliminary evidence supporting the proposition that Latinx patients with T2DM benefit from diverse social networks in terms of health literacy. Yet, the findings should be accepted with caution due to the small sample size and exploratory nature of the way this study was designed given little adoption of PNA for the study topic. We need more studies to understand dynamics by which open social networks enhance health literacy and recommend more efforts to gather data on one’s social environment with PNA.