Study on the relationship between social support, health information-seeking behavior, and health literacy among rural patients with diabetes: a cross-sectional study

Abstract

To explore the current status and relationships among health literacy, social support, and health information-seeking behaviors among rural patients with diabetes and to provide a basis for developing targeted interventions to improve health management in this population. Fifteen county-level hospitals across five cities (Nanning, Guilin, Hechi, Chongzuo, and Yulin) in the Guangxi Zhuang Autonomous Region of China. The study was reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Rural patients with diabetes (2,280) were recruited using a multistage stratified random sampling method between January and July, 2022. A total of 2,178 valid questionnaires were included in the final analysis. The primary outcome measures were total scores on the Social Support Rating Scale (SSR), Diabetes Health Information-Seeking Behavior Scale (HISB), and Health Literacy Scale (HLS). The secondary outcome was the mediating effect of health information-seeking behaviors, analyzed using structural equation modeling (SEM). The total scores for health literacy, social support, and health information-seeking behavior were (30.47 ± 9.36), 22 (IQR: 22, 30), and (109.45 ± 18.50), respectively. Spearman’s correlation analysis revealed significant positive correlations between all three variables (all p < 0.01). SEM analysis showed that social support was directly associated with health literacy (effect = 0.285, 95% CI: 0.247 to 0.322) and had a significant indirect association through health information-seeking behavior (effect = 0.160, 95% CI: 0.142 to 0.179). The mediating effect accounted for 36.0% of the total effect. The model fit indices were satisfactory (GFI = 0.958, AGFI = 0.935, CFI = 0.950, RMSEA = 0.072). Social support, health information-seeking behavior, and health literacy were positively correlated among rural patients with diabetes, with health information-seeking behavior partially mediating the relationship between social support and health literacy. These findings suggest that interventions targeting the enhancement of social support and the promotion of active health information-seeking may be promising approaches to improving health literacy in this population.