ArticleBMJ open diabetes research & care2026
Health literacy profiles of people living with type 2 diabetes: a cluster-based approach to inform tailored interventions-the Entred 3 study.
Article in BMJ open diabetes research & care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionHealth literacy is a multidimensional determinant of health that influences diabetes outcomes and social inequities in health (SIH). Studies often measure it unidimensionally, failing to capture people's diverse health literacy skills. We identified multidimensional health literacy profiles among adults living with type 2 diabetes (T2D) in France and described their clinical, behavioral and social characteristics with a view to informing future tailored interventions. RESEARCH DESIGN AND
methodsThis study used a cross-sectional design based on a subsample of the Entred 3 national survey, combining self-reported questionnaire data with linked administrative health data covering the previous 10 years. Health literacy was assessed using the Health Literacy Questionnaire (HLQ) among 510 individuals with T2D who completed the cross-sectional survey online. Hierarchical clustering based on standardized HLQ scores identified distinct health literacy clusters.
resultsWe identified 13 health literacy clusters among the online survey participants, labelled from A to M, five requiring tailored public health and clinical responses. Substantial heterogeneity concerning health literacy skills and associations with SIH and health outcomes was observed. For example, cluster A demonstrated strong self-management skills counteracted by severe barriers to care navigation and information comprehension in a highly vulnerable setting. Furthermore, cluster D reflected globally low health literacy scores, poor health outcomes and high exposure to risk factors despite recent diabetes diagnosis. A third example is cluster K, which highlighted strong relational and cognitive skills but limited engagement in self-care and significant exposure to risk factors despite favorable socioeconomic conditions.
conclusionsHealth literacy profiles reflect complex combinations of skills, risks and social determinants, which can potentially inform how to tailor public health interventions, so that no group is left behind.
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