Health literacy and self-efficacy in patients with diabetic coronary artery disease: a cross-sectional correlational study

Effective self-management is crucial for patients with diabetic coronary artery disease (CAD), as it is associated with a lower risk of major adverse cardiovascular events and mortality. Health literacy (HL) and self-efficacy (SE) are key determinants of health behaviors and treatment adherence in chronic diseases, and inadequate HL and SE in this population may contribute to poor glycemic control, reduced treatment adherence, and worse cardiovascular outcomes. This study was designed to investigate the correlation between health literacy and self-efficacy in patients with diabetic CAD. This descriptive, cross-sectional, correlational study was conducted with 90 patients with diabetic coronary artery disease who were recruited by convenience sampling from the inpatient wards of a city hospital in Isparta, Türkiye, between August 2021 and February 2022. Data were collected using a Descriptive Characteristics Form, the Health Literacy Scale in Adult Patients with Diabetes, and the Type 2 Diabetes Self-Efficacy Scale. Data were analyzed using nonparametric tests (Mann-Whitney U test, Kruskal-Wallis test) and the Pearson correlation coefficient, with statistical significance set at p < 0.05. The mean age of the 90 participants was 58.95 ± 10.88 years; 62.2% were women, 53.3% were primary-school graduates, and 84.4% were married. The mean total Health Literacy Scale (HLS) score was 30.80 ± 11.45 (possible range 14–56), corresponding to a moderate level of health literacy (Functional: 10.98 ± 4.43; Interactive/communicative: 13.02 ± 6.04; Critical: 6.78 ± 3.19). The mean Type 2 Diabetes Self-Efficacy Scale score was 69.38 ± 10.03 (possible range 20–100), indicating a moderate-to-high level of self-efficacy (Diet and foot care: 39.95 ± 7.36; Medical treatment: 19.31 ± 3.03; Physical exercise: 10.12 ± 2.62). A significant positive correlation was found between the total HLS and self-efficacy scores ( r = 0.358, p = 0.001); higher health literacy was associated with higher self-efficacy. Age was negatively correlated with health literacy ( r =–0.276, p = 0.008), and participants with higher educational and employment status reported higher scores. The positive correlation between health literacy and self-efficacy underscores the relevance of both factors to the self-management of diabetic CAD. Routine assessment of health literacy should be integrated into diabetic CAD education programs so that patients with low health literacy can be identified early and offered tailored education and structured follow-up to support their self-efficacy and treatment adherence. Because of the cross-sectional design, these findings indicate association rather than causation and should be confirmed in longitudinal studies.