Construction of a health literacy prediction model for diabetic patients: A multicenter study.

Objectives: To achieve a rapid assessment of health literacy (HL) levels among diabetic patients. Methods: A questionnaire survey was conducted among diabetic patients from nine communities in Nantong City, Jiangsu Province, China, using convenient sampling. Based on the survey results, data from three communities were randomly selected as the test set, with the remaining data used as the training set. Feature selection was performed using recursive feature elimination. Predictive models were established and compared using logistic regression (LR), random forest (RF), and support vector machine (SVM). Calibration curves, decomposition plots, and partial dependence plots were drawn to evaluate and interpret the models. Results: In November 2023, a total of 802 valid questionnaires were received. Eight variables were selected for modeling: educational level, exercise habits, average monthly household income, dietary control, age, medication for blood sugar control, duration of diabetes, and number of cohabitants. The recall for LR in the three communities was 0.778, 0.800, and 0.862 [area under the curve (AUC): 0.810, 0.792, and 0.775]. For RF, the recall values were 0.879, 0.877, and 0.923 (AUC: 0.781, 0.710, and 0.710). For SVM, the recall values were 0.859, 0.862, and 0.877 (AUC: 0.813, 0.759, and 0.770). Model evaluation showed that as the data volume increased, the calibration curves became more ideal. Conclusions: As one of the few HL prediction models for diabetic patients in mainland China that is built based on multi-center survey data and evaluated through multi-center assessment, this model can quickly identify patients with insufficient HL using a small amount of objective personal information.