Background: Health literacy is an essential factor that decreases the risk of adverse outcomes in diabetes. Inadequate literacy was found to be common in patients with diabetes mellitus. Healthcare professionals are often overestimated patients’ abilities to understand health information and do not recognize it as a problem.
Purpose: The purpose of this study was to examine health literacy among patients with type 2 diabetes mellitus in Indonesia.
Method: A cross-sectional design was used. A convenience sampling was applied to recruit patients with type 2 diabetes mellitus from an outpatient internal medicine department in Sleman regency, Yogyakarta, Indonesia from September 2017 to January 2018. Two research assistants were recruited to collect the data. The demographic questionnaire, the Charlson Comorbidity Index, and the European Health Literacy Survey - Questionnaire (HLS-EU-Q47) were applied. Data analysis involved descriptive statistic, bivariate analysis. Hierarchical linear regression was used to identify the predictors of health literacy
Results: Total of 152 subjects participated in this study. Majority of them are female (n = 97; 63.8%), married (n = 140; 92.1%), and had low monthly income ($ 87.6, SD = 110.5). The average score of health literacy was 29.5 (SD = 3.4) from the possible range score 0-50. The final model of hierarchical linear regression analysis explained 21.8% variance of health literacy. Age (β = -0.233, p < .05), monthly income (β = 0.23, p < .05), total number of complications (β = -0.24, p < .01), and duration of diabetes (β = 0.01, p < .05) were the significant predictors of health literacy.
Conclusion: Problematic health literacy has been found to be prevailing in patients with type 2 diabetes mellitus in Yogyakarta, Indonesia. Age, monthly income, total number of complications and duration of diabetes were potential predictors of health literacy in this population.

Adams, R.J., Appleton, S.L., Hill, C.L., Dodd, M., Findlay, C. & Wilson, D.H. (2009). Risks associated with low functional health literacy in an Australian Population. Medical Journal of Australia, 191(10):530-534.
Al Sayah, F., Qiu, W., & Johnson, J. A. (2016). Health literacy and health-related quality of life in adults with type 2 diabetes: a longitudinal study. Quality of Life Research, 25(6), 1487-1494. doi:10.1007/s11136-015-1184-3.
Al Sayah, F., Williams, B., & Johnson, J. A. (2013). Measuring health literacy in individuals with diabetes: A Systematic review and evaluation of available measures. Health Education & Behavior, 40(1), 42-55. doi: 10.1177/1090198111436341.
American Diabetes Association. (2010). Diagnosis and classification of diabetes mellitus. Diabetes Care, 31 (Supplement 1), S62-S69.
American Diabetes Association. 2017. Standards of medical care in diabetes-2017: Classification and diagnosis of diabetes. Diabetes Care, 40 (Supplement 1). doi:10.2337/dc17-s005.
Amin, N., & Doupis, J. (2016). Diabetic foot disease: From the evaluation of the “foot at risk” to the novel diabetic ulcer treatment modalities. World Journal of Diabetes, 7(7), 153.
Amoah, P. A. (2018). Social participation, health literacy, and health and well-being: A cross-sectional study in Ghana. SSM-Population Health, 4, 263-270. doi: 10.1016/j.ssmph.2018.02.005.
Aslantekin, F., Uluşen, M., Kaplan, B., & Uysal, M. (2013). An evaluation of health literacy situations of patients with type 2 diabetes. Medical Journal of Islamic World Academy of Sciences, 21(3), 105-114.
Australian Bureau of Statistics.(2006) Health literacy Australia. Retrieved from http://abs.gov.au/AUSSTATS/abs@.nsf/Latestproducts/4233.0Main%20Features22006?opendocument&tabname=Summary&prodno=4233.0&issue=2006&num=&view=330_2006.pdf
Baig, A. A., Wilkes, A. E., Davis, A. M., Peek, M. E., Huang, E. S., Bell, D. S., & Chin, M. H. (2010). Review Paper: The use of quality improvement and health information technology approaches to improve diabetes outcome in African American and Hispanic patients. Medical Care Research and Review, 67 (5 suppl), 163S-197S. doi: 10.1177/1077558710374621.
Bains, S. S., & Egede, L. E. (2011). Associations between health literacy, diabetes knowledge, self-care behaviors, and glycemic control in a low income population with type 2 diabetes. Diabetes Technology & Therapeutics, 13(3), 335-341. doi: 10.1089/dia.2010.0160.
Baker, D. W. (2006). The meaning and the measure of health literacy. Journal of General Internal Medicine, 21(8), 878-883. doi: 10.1111/j.1525-1497.2006.00540.x.
Baker, D. W., Williams, M. V., Parker, R. M., Gazmararian, J. A., & Nurss, J. (1999). Development of a brief test to measure functional health literacy. Patient Education and Counseling, 38(1), 33-42. doi: 10.1016/S0738-3991(98)00116-5.
Bass, P. F., Wilson, J. F., & Griffith, C. H. (2003). A shortened instrument for literacy screening. Journal of General Internal Medicine, 18(12), 1036-1038. doi:10.1111/j.1525-1497.2003.10651.x.
Benjamins, M. R., Ellison, C. G., Krause, N., & Marcum, J. P. (2011). Religion and preventive service use: Do congregational support and religious beliefs explain the relationship between attendance and utilization?. Journal of Behavioral Medicine, 34, 462-476.
Berens, E. M., Vogt, D., Messer, M., Hurrelmann, K., & Schaeffer, D. (2016). Health literacy among different age groups in Germany: results of a cross-sectional survey. BMC Public Health, 16(1), 1151. doi: 10.1186/s12889-016-3810-6.
Berkman, N. D., Davis, T. C., & McCormack, L. (2010). Health literacy: What is it?. Journal of Health Communication, 15(S2), 9-19.
Berkman, N.D., Sheridan, S.L., Donahue, K.E., Halpern, D.J., Viera, A., Crotty, K., Holland, A., Brasure, M., Lohr, K. N., Harden, E., Tant, E., Wallace, I. and Viswanathan, M. (2011). Health literacy interventions and outcomes: An updated systematic review. Agency for Healthcare Research and Quality: Rockville, MD.
Black, S., Maitland, C., Hilbers, J., & Orinuela, K. (2017). Diabetes literacy and informal social support: A qualitative study of patients at a diabetes center. Journal of Clinical Nursing, 26(1-2), 248-257. doi: 10.1111/jocn.13383.
Bland, J. M., & Altman, D. G. (1997). Statistics notes: Cronbach's alpha. Biomed Journal, 314(7080), 572. doi: 10.1136/bmj.314.7080.572.
Bohanny, W., Wu, S. F. V., Liu, C. Y., Yeh, S. H., Tsay, S. L., & Wang, T. J. (2013). Health literacy, self‐efficacy, and self‐care behaviors in patients with type 2 diabetes mellitus. Journal of the American Association of Nurse Practitioners, 25(9), 495-502.
Boren, S. A. (2009). A review of health literacy and diabetes: Opportunities for technology. Journal of Diabetes Science and Technology, 3(1), 202-209. doi: 10.1177/193229680900300124.
Cavanaugh, K. L. (2011). Health literacy in diabetes care: Explanation, evidence, and equipment. Diabetes Management, 1(2), 191-199.doi: 10.2217/dmt.11.5.
Cavanaugh, K., Huizinga, M. M., Wallston, K. A., Gebretsadik, T., Shintani, A., Davis, D., ... & Pignone, M. (2008). Association of numeracy and diabetes control. Annals of Internal Medicine, 148(10), 737-746. doi: 10.7326/0003-4819-148-10-200805200-00006.
Centers for Disease Control and Prevention (CDC. (2011). Use of hepatitis B vaccination for adults with diabetes mellitus: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. Morbidity and Mortality Weekly Report, 20(50), 1709.
Chizia, O. S., & Bellingham-Young, D. (2017). Socioeconomic Determinants of Type 2 Diabetes in England. Journal of Health and Social Care Improvement, Volume 1 issue 3, pp52-61.
Ciorniciuc, V. (n.d.). Charlson Comorbidity Index (CCI) Calculator. Retrieved from https://www.thecalculator.co/health/Charlson-Comorbidity-Index-(CCI)-Calculator-765.html.
De Castro, S. H., Brito, G. N., & Gomes, M. B. (2014). Health literacy skills in type 2 diabetes mellitus outpatients from an university-affiliated hospital in Rio de Janeiro, Brazil. Diabetology & Metabolic Syndrome, 6(1), 1. doi: 10.1186/1758-5996-6-126.
DeWalt, D. A., Boone, R. S., & Pignone, M. P. (2007). Literacy and its relationship with self-efficacy, trust, and participation in medical decision making. American Journal of Health Behavior, 31(1), S27-S35.
Duong, T. V., Aringazina, A., Baisunova, G., Pham, T. V., Pham, K. M., Truong, T. Q., ... & Huang, H. L. (2016). Measuring health literacy in Asia: Validation of the HLS-EU-Q47 survey tool in six Asian countries. Journal of Epidemiology. doi: 10.1016/j.je.2016.09.005.
Duong, V. T., Lin, I. F., Sorensen, K., Pelikan, J. M., Van Den Broucke, S., Lin, Y. C., & Chang, P. W. (2015). Health Literacy in Taiwan: A Population-Based Study. Asia Pac J Public Health, 27(8), 871-880. doi:10.1177/1010539515607962.
Emerging Risk Factors Collaboration. (2010). Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: A collaborative meta-analysis of 102 prospective studies. The Lancet, 375(9733), 2215-2222. doi: 10.1016/S0140-6736(10)60484-9.
Ferguson, M. O., Long, J. A., Zhu, J., Small, D. S., Lawson, B., Glick, H. A., & Schapira, M. M. (2015). Low health literacy predicts misperceptions of diabetes control in patients with persistently elevated A1C. The Diabetes Educator, 41(3), 309-319. doi: 10.1177/0145721715572446.
Fles, R., Bos, A. C. R. K., Rachmawati, D., Waliyanti, E., Tan, I. B., Haryana, S. M., ... & Dewi, F. S. T. (2017). The role of Indonesian patients’ health behaviors in delaying the diagnosis of nasopharyngeal carcinoma. BMC Public Health, 17(1), 510. doi: 10.1186/s12889-017-4429-y.
Gazmararian, J. A., Williams, M. V., Peel, J., & Baker, D. W. (2003). Health literacy and knowledge of chronic disease. Patient Education and Counseling, 51(3), 267-275 doi:10.1016/S0738-3991(02)00239-2.
Guzys, D., Kenny, A., Dickson-Swift, V., & Threlkeld, G. (2015). A critical review of population health literacy assessment. BMC Public Health, 15(1), 215.doi: 10.1186/s12889-015-1551-6.
HLS-EU Consortium. (2012). Comparative report of health literacy in eight EU member states. The European health literacy survey HLS-EU.
Holt, C. L., Shipp, M., Eloubeidi, M., Fouad, M. N., Britt, K., & Norena, M. (2011). Your body is the temple: Impact of a spiritually based colorectal cancer educational intervention delivered through community health advisors. Health Promotion Practice, 12(4), 577-588.
Institute of Medicine. (2004). Health literacy: A prescription to end confusion. Washington DC: The National Academic.
International Diabetes Federation. (2015). Diabetes Atlas (7th ed). Brussels: International Diabetes Federation. Retrieved from http://www.diabetesatlas.org/
International Diabetes Federation.(2013). Diabetes Atlas (5th ed). Brussels: International Diabetes Federation. Retrieved from www.diabetesatlas.org/resources/previous-editions.html
Jeong, J., Park, N., Shin, S. Y. (2014). The influence of health literacy and diabetes knowledge on diabetes self-care activities in Korean low-income elders with diabetes. Journal of Korean Academy of Community Health Nursing, 25(3), 217-224. doi: 10.12799/jkachn.2014.25.3.217.
Jiménez-Garcia, R., Lopez-de-Andres, A., Hernandez-Barrera, V., Gómez-Campelo, P., San Andrés-Rebollo, F. J., de Burgos-Lunar, C., ... & Salinero-Fort, M. A. (2017). Influenza vaccination in people with type 2 diabetes, coverage, predictors of uptake, and perceptions. Result of the MADIABETES cohort a 7 years follow up study. Vaccine, 35(1), 101-108. doi: 10.1016/j.vaccine.2016.11.039.
Johnson, D. R., Nichol, K. L., & Lipczynski, K. (2008). Barriers to adult immunization. The American Journal of Medicine, 121(7), S28-S35. doi: 10.1016/j.amjmed.2008.05.005.
Katsilambros, N., Dounis, E., Makrilakis, K., Tentolouris, N., & Tsapogas, P. (2010). Atlas of The Diabetic Foot (2nd ed.). UK: Wiley-Blackwell.
Kautzky-Willer, A., Harreiter, J., & Pacini, G. (2016). Sex and gender differences in risk, pathophysiology and complications of type 2 diabetes mellitus. Endocrine reviews, 37(3), 278-316.
Kelly, P. A., & Haidet, P. (2007). Physician overestimation of patient literacy: A potential source of health care disparities. Patient Education and Counseling, 66(1), 119-122. doi: 10.1016/j.pec.2006.10.007
Kirsch, I. S. (1993). Adult literacy in America: A first look at the results of the National Adult Literacy Survey. Washington, DC : US Government Printing Office, Superintendent of Documents, 20402 (Stock No. 065-000-00588-3).
Koay, K., Schofield, P., &Jefford, M. (2012). Importance of health literacy in oncology. Asia-Pasific Journal of Clinical Oncology, 8(1), 14-23.
Kobayashi, L. C., Wardle, J., Wolf, M. S., & von Wagner, C. (2014). Aging and functional health literacy: A systematic review and meta-analysis. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences. doi: 10.1093/geronb/gbu161.
Kutner M, Greenberg E, Jin Y, Paulsen C. (2006). The Health Literacy of America’s Adults: Results From the 2003 National Assessment of Adult Literacy (NCES 2006–483) U.S. Department of Education; Washington, DC: National Center for Education Statistics. Retrieved from http://nces.ed.gov/pubs2006/2006483.pdf
Laramee, A. S., Morris, N., & Littenberg, B. (2007). Relationship of literacy and heart failure in adults with diabetes. BMC Health Services Research, 7(1), 98. doi: 10.1186/1472-6963-7-98
Lee, H. Y., Won, J. C., Kang, Y. J., Yoon, S. H., Choi, E. O., Bae, J. Y., ... & Lee, Y. M. (2010). Type 2 diabetes in urban and rural districts in Korea: factors associated with prevalence difference. Journal of Korean Medical Science, 25(12), 1777-1783.
Lee, S. Y. D., Tsai, T. I., Tsai, Y. W., & Kuo, K. N. (2010). Health literacy, health status, and healthcare utilization of Taiwanese adults: results from a national survey. BMC Public Health, 10(1), 614.doi: 10.1186/1471-2458-10-
Lee, T. C., Glynn, R. J., Peña, J. M., Paynter, N. P., Conen, D., Ridker, P. M., ... & Albert, M. A. (2011). Socioeconomic status and incident type 2 diabetes mellitus: Data from the Women's Health Study. PloS One, 6(12), e27670 .doi: 10.1371/journal.pone.0027670
Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D. (2016). Medical-Surgical Nursing-E-Book: Assessment and Management of Clinical Problems, Single Volume. Elsevier Health Sciences.
McCleary-Jones, V. (2011). Health literacy and its associated with diabetes knowledge, self-efficacy, and disease self-management among African Americans with diabetes mellitus. ABNF Journal, 22(2).
Ministry of Health Indonesia. (2012). Buletin Jendela Data Dan Informasi Kesehatan Penyakit Tidak Menular. Jakarta: Depkes.
Ministry of Health Republic of Indonesia. (2000). Pedoman Pembinaan Kesehatan Usia Lanjut bagi Petugas Kesehatan. Jakarta: Ministry of Health Republic of Indonesia.
Milken Institute. (2016). New Models for Financing Vaccination Programs in Southeast Asia. Retrieved from https://assets1b.milkeninstitute.org/assets/Publication/InnovationLab/PDF/VaxPrgrmsSEAsia4WEB.pdf

Mirowsky, J., & Ross, C. E. (2005). Education, learned effectiveness and health. London Review of Education, 3(3), 205-220.
Moeini, B., Maghsodi, S. H., Kangavari, M., Afshari, M., & Tagh, J. Z. (2016). Factors associated with health literacy and self-care behaviors among Iranian diabetic patients: A cross-sectional study. Journal of Communication in Healthcare, 9(4), 279-287. doi:10.1080/17538068.2016.1217968.
Mohammadi, Z., Banihashemi, A. T., Asgharifard, H., Bahramian, M., Baradaran, H. R., & Khamseh, M. E. (2015). Health literacy and its influencing factors in Iranian diabetic patients. Medical Journal of The Islamic Republic of Iran, 29, 230.
Morris, N. S., MacLean, C.D., & Littenberg, B. (2006). Literacy and health outcome: a cross-sectional study in 1002 adults with diabetes. BMC Family Practice, 7(1), 49. doi: 10.1186/1471-2296-7-49.
Moss, T. R. (2014). The impact of health literacy on clinical outcomes for adults with type 2 diabetes mellitus. Advances in Diabetes and Metabolism, 2(1), 10-19. doi: 10.13189/adm.2014.020103.
Nakayama, K., Osaka, W., Togari, T., Ishikawa, H., Yonekura, Y., Sekido, A., & Matsumoto, M. (2015). Comprehensive health literacy in Japan is lower than in Europe: a validated Japanese-language assessment of health literacy. BMC Public Health, 15(1), 505. doi: 10.1186/s12889-015-1835-x.
National Adult Literacy Agency. (2009). Health Literacy in Ireland. Retrieved from https://www.nala.ie/sites/default/files/publications/health_literacy_in_ireland_nala_2012.pdf
National Institute of Health Research and Development. (2014). Population Health Basic Health Research - RISKESDAS 2013. Jakarta, Indonesia: Ministry of Health Republic of Indonesia.
Ng, M., Fleming, T., Robinson, M., Thomson, B., Graetz, N., Margono, C., ... & Abraham, J. P. (2014). Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 384(9945), 766-781. doi: 10.1016/S0140-6736(14)60460-8.
Nielsen-BoHealth literacyman, L., Panzer, A. M., & Kindig, D. A. (Eds.). (2004). Health literacy: A prescription to end confusion. National Academies Press.
Nutbeam, D. (2000). Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International, 15(3), 259-267.
Paasche-Orlow, M. K., &Wolf, M. S. (2007). The casual pathways linking health literacy to health outcomes. American Journal of Health Behavior, 31(Supplement 1), S19-S26.
Palumbo, R. (2017). Examining the impacts of health literacy on healthcare costs. An evidence synthesis. Health Services Management Research, 30(4), 197-212. doi: 10.1177/0951484817733366
Palumbo, R., Annarumma, C., Adinolfi, P., Musella, M., & Piscopo, G. (2016). The Italian health literacy project: insights from the assessment of health literacy skills in Italy. Health policy, 120(9), 1087-1094. doi: 10.1016/j.healthpol.2016.08.007
Pang, T. (2009). Vaccination in developing countries: problems, challenges and opportunities. Encyclopedia of life support systems (EOLSS): UNESCO-EOLSS. Retrieved from https://www.eolss.net/Sample-Chapters/C03/E1-14-05-06.pdf
Parikh, N. S., Parker, R. M., Nurss, J. R., Baker, D. W., & Williams, M. V. (1996). Shame and health literacy: The unspoken connection. Patient Education and Counseling, 27(1), 33-39. doi: 10.1016/0738-3991(95)00787-3.
Parker, R. M., Baker, D. W., Williams, M. V., & Nurss, J. R. (1995). The test of functional health literacy in adults. Journal of General Internal Medicine, 10(10), 537-541. doi: 10.1007/BF02640361.
Perkumpulan Endokrinologi Indonesia. (2011) Konsensus pengelolaan dan pencegahan diabetes melitus tipe 2 di Indonesia, 4-10, 15-29.
Powell, C. K., & Kripalani, S. (2005). Brief report: resident recognition of low literacy as a risk factor in hospital readmission. Journal of General Internal Medicine, 20(11), 1042-1044. doi:10.1111/j.1525-1497.2005.0220.x
Powell, C. K., Hill, E. G., & Clancy, D. E. (2007). The relationship between health literacy and diabetes knowledge and readiness to take health actions. The Diabetes Educator, 33, 144-151.
Puspitasari, N., & Widjanarko, B. (2017). Faktor-Faktor yang Berhubungan dengan Pemanfaatan Senam Lansia di Posyandu Kelurahan Sendangmulyo, Kota Semarang. Jurnal Kesehatan Masyarakat (e-Journal), 5(5), 1032-1041.
Qin, L., & Xu, H. (2016). A cross-sectional study of the effect of health literacy on diabetes prevention and control among elderly individuals with prediabetes in rural China. BMJ Open, 6(5), e011077. doi: bmjopen-2016-011077.
Ramos-Nino, M. E., MacLean, C. D., & Littenberg, B. (2007). Association between cancer prevalence and use of thiazolidinediones: results from the Vermont Diabetes Information System. BMC Medicine, 5(1), 17.
Reaven, G. M. (1988). Role of insulin resistance in human disease. Diabetes, 37(12), 1595-1607. doi: 10.2337/diab.37.12.1595.
Rothman, R. L., DeWalt, D. A., Malone, R., Bryant, B., Shintani, A., Crigler, B., . . . Pignone, M. (2004). Influence of patient literacy on the effectiveness of a primary care–based diabetes disease management program. Jama, 292(14), 1711-1716. doi:10.1001/jama.292.14.1711
Rutten, G. E. H. M., De Grauw, W. J. C., Nijpels, G., Goudswaard, A. N., Uitewaal, P. J. M., Van der Does, F. E. E., ... & Bouma, M. (2009). NHG-Standaard Diabetes mellitus type 2. In NHG-Standaarden 2009 (pp. 160-191). Bohn Stafleu van Loghum. doi: 10.1007/978-90-313-6614-9_8
Salimi, M., Sarchahi, S., Zolfaghari, P., Daghyanous, B., Mozaffari, H., Montazeri, M., & Sohrabi, M. B. (2017). Health literacy among patients with diabetes mellitus type 2 in Northeast Area of Iran. International Journal of Health Studies, 3(1).
Santoso H, Ismail A (2009). Memahami Krisis Lanjut Usia (Cetakan I). Jakarta: PT BPK Gunung Mulia
Sari, A. P., & Syahrul, F. (2014). Faktor yang Berhubungan Dengan Tindakan Vaksinasi HPV Pada Wanita Usia Dewasa. Jurnal Berkala Epidemiologi, Vol. 2, No. 3 September 2014: 321–330. Surabaya. Departemen Epidemiologi FKM Unair. Retrieved from https://e-journal.unair.ac.id/JBE/article/viewFile/1299/1058
Sarkar, U., Karter, A., Liu, J. Y., Moffet, H. H., Adler, N. E., & Schillinger, D. (2010). Hypoglycemia is more common among type 2 diabetes patients with limited health literacy: The diabetes study of Northern California (DISTANCE). Journal of General Internal Medicine, 25, 962-967
Sayah, F. A., Majumdar, S. R., Egede, L. E., & Johnson, J. A. (2015). Associations between health literacy and health outcomes in a predominantly low-income African American population with type 2 diabetes. Journal of Health Communication, 20(5), 581-588. doi:10.1080/10810730.2015.1012235.
Schaeffer, D., Berens, E. M., & Vogt, D. (2017). Health Literacy in the German population: Results of a representative survey. Deutsches Ärzteblatt International, 114(4), 53. doi: 10.3238/arztebl.2017.0053.
Schillinger, D., Bindman, A., Wang, F., Stewart, F., Stewart, A., & Piette, J. (2004). Functional health literacy and the quality of physician-patient communication among diabetes patients. Patient Education and Counseling, 52, 315-323.
Schillinger, D., Grumbach, K., Piette, J., Wang, F., Osmond, D., Daher, C., ... & Bindman, A. B. (2002). Association of health literacy with diabetes outcomes. Jama, 288(4), 475-482. doi:10.1001/jama.288.4.475.
Seale, H., Sitaresmi, M. N., Atthobari, J., Heywood, A. E., Kaur, R., MacIntyre, R. C., ... & Padmawati, R. S. (2015). Knowledge and attitudes towards rotavirus diarrhea and the vaccine amongst healthcare providers in Yogyakarta Indonesia. BMC Health Services Research, 15(1), 528. doi: 10.1186/s12913-015-1187-3.
Simon, M. A., Li, Y., & Dong, X. (2014). Levels of health literacy in a community-dwelling population of Chinese older adults. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 69(Suppl_2), S54-S60.
Simonds, S. K. (1974). Health Education as Social Policy. Health Education & Behavior, 2(1 Suppl), 1-10. doi:10.1177/10901981740020s102.
Singh, S. G., & Aiken, J. (2017). The effect of health literacy level on health outcomes in patients with diabetes at a type v health centre in Western Jamaica. International Journal of Nursing Sciences, 4(3), 266-270.
Soewondo, P., Ferrario, A., & Tahapary, D. L. (2013). Challenges in diabetes management in Indonesia: A literature review. Globalization and Health, 9(1), 63. doi: 10.1186/1744-8603-9-63.
Soewondo, P., Soegondo, S., Suastika, K., Pranoto, A., Soeatmadji, D. W., & Tjokroprawiro, A. (2010). The DiabCare Asia 2008 study-Outcomes on control and complications of type 2 diabetic patients in Indonesia. Medical Journal of Indonesia,19(4), 235.
Sørensen, K., Broucke, S. V., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., & Brand, H. (2012). Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health, 12(1). doi:10.1186/1471-2458-12-80.
Sørensen, K., Van den Broucke, S., Pelikan, J. M., Fullam, J., Doyle, G., Slonska, Z., ... & Brand, H. (2013). Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HEALTH LITERACY-EU-Q). BMC Public Health, 13(1), 948. doi: 10.1186/1471-2458-13-948.
Souza, J. G., Apolinario, D., Magaldi, R. M., Busse, A. L., Campora, F., & Jacob-Filho, W. (2014). Functional health literacy and glycaemic control in older adults with type 2 diabetes: A cross-sectional study. BMJ Open, 4(2), e004180. doi:10.1136/bmjopen-2013-004180
Stratton, I. M., Adler, A. I., Neil, H. A. W., Matthews, D. R., Manley, S. E., Cull, C. A., ... & Holman, R. R. (2000). Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ, 321(7258), 405-412. doi: 10.1136/bmj.321.7258.405.
The Indonesia Agency of health research and development. (2013). National basic health research. Jakarta: Ministry of Health Indonesia.
Toçi, E., Burazeri, G., Sørensen, K., Kamberi, H., & Brand, H. (2014). Concurrent validation of two key health literacy instruments in a South Eastern European population. The European Journal of Public Health, cku190. doi:10.1093/eurpub/cku190.
UK Prospective Diabetes Study (UKPDS) Group. (1998). Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). The Lancet, 352(9131), 837-853. doi: 10.1016/S0140-6736(98)07019-6.
Vamos, E. P., Pape, U. J., Curcin, V., Harris, M. J., Valabhji, J., Majeed, A., & Millett, C. (2016). Effectiveness of the influenza vaccine in preventing admission to hospital and death in people with type 2 diabetes. Canadian Medical Association Journal, 188(14), E342-E351.
Van der Heide, I., Rademakers, J., Schipper, M., Droomers, M., Sørensen, K., & Uiters, E. (2013). Health Literacy of Dutch adults: a cross-sectional survey. BMC Public Health, 13(1), 179. doi: 10-1186/1471-2458-13-179.
Van Duong, T., Chang, P. W., Yang, S. H., Chen, M. C., Chao, W. T., Chen, T., ... & Huang, H. L. (2017). A new comprehensive short-form health literacy survey tool for patients in general. Asian Nursing Research, 11(1), 30-35.
Wallace Williams, S., Dilworth-Anderson, P., & Goodwin, P. Y. (2003). Caregiver role strain: The contribution of multiple roles and available resources in African-American women. Aging & Mental Health, 7(2), 103-112.
Wass, J., & Owen, K. (2014). Oxford Hand Book of Endocrinology and Diabetes (H. Turner Ed. 3rd ed.). New York, USA: Oxford University Press.
Weissman, J. S., Stern, R., Fielding, S. L., & Epstein, A. M. (1991). Delayed access to health care: risk factors, reasons, and consequences. Annals of Internal Medicine, 114(4), 325-331.
White, R. O., Wolff, K., Cavanaugh, K. L., & Rothman, R. (2010). Addressing health literacy and numeracy to improve diabetes education and care. Diabetes Spectrum, 23(4), 238-243. doi: 10.2337/diaspect.23.4.238.
Willems, S., De Maesschalck, S., Deveugele, M., Derese, A., & De Maeseneer, J. (2005). Socio-economic status of the patient and doctor–patient communication: does it make a difference?. Patient Education and Counseling, 56(2), 139-146.
Williams, M. V., Baker, D. W., Parker, R. M., & Nurss, J. R. (1998). Relationship of functional health literacy to patients' knowledge of their chronic disease: a study of patients with hypertension and diabetes. Archives of Internal Medicine, 158(2), 166-172. doi:10.1001/archinte.158.2.166.
World Health Organization (WHO. (2013). Health literacy. The solid facts. Health. Retrieved from http://www.thehealthwell.info/search-results/health-literacy-solid-facts
World Health Organization. (1999). Definition, diagnosis, and classification of diabetes mellitus and its complications: report of a WHO consultation. In Definition, diagnosis and classification of diabetes mellitus and its complications: report of a WHO consultation (pp. 59-59).
World Health Organization. (2013) Health Literacy. The Solid Facts [Online]. Retrieved from: http://www.thehealthwell.info/node/534072
Zahnd, W. E., Scaife, S. L., & Francis, M. L. (2009). Health literacy skills in rural and urban populations. American Journal of Health Behavior, 33(5), 550-557. doi: 10.5993/AJHB.33.5.8.
Zimmerman, E. B., Woolf, S. H., & Haley, A. (2015). Understanding the relationship between education and health: a review of the evidence and an examination of community perspectives. Population health: behavioral and social science insights. Rockville (MD): Agency for Health-care Research and Quality, 347-84.
Zimmerman, E., & Woolf, S. H. (2014). Understanding the relationship between education and health. Institute of Medicine of the National Academies.