Translating health literacy evidence into nursing practice: implications for diabetes self-care management in Saudi Arabian primary healthcare

Background Despite established links between health literacy (HL) deficits and poor diabetes self-care, the translation of this evidence into culturally adapted nursing interventions within Saudi Arabian primary healthcare (PHC) remains underdeveloped. This paper translates previously published findings from an underserved population in southern Riyadh, together with international evidence and guidelines, into a proposed practice framework for diabetes nursing. Methods This practice-translation paper combined a secondary synthesis of a published cross-sectional study of 92 adults with type 2 diabetes attending five PHC centers in southern Riyadh with a narrative (non-systematic) review of nursing literature and guidelines. Orem's Self-Care Deficit Nursing Theory and Nutbeam's Health Literacy Model guided a three-stage framework development process, and each recommendation was labeled as directly informed by the study findings, drawn from guidelines, or proposed as an authors' adaptation. Results In the underlying study, 53.2% of participants had inadequate or problematic HL on the 12-item European Health Literacy Survey Questionnaire (HLS-Q12), and HL was positively associated with diabetes self-care management (r s = 0.64, 95% CI 0.50–0.75, p < 0.01); this association persisted after adjustment for age, income, and education. Lower HL and poorer self-care were also associated with older age and lower income. The proposed framework specifies individual-level actions (structured HL assessment using the HLS-Q12, communication based on the Universal Precautions Approach, and the teach-back method adapted for Arabic-speaking patients), organizational actions (health literacy-stratified care pathways and culturally tailored Diabetes Self-Management Education and Support (DSMES) programs), and policy actions. Outcomes listed for the proposed interventions are anticipated and have not been evaluated. Conclusions Nurses in Saudi Arabian primary healthcare are well placed to lead HL-responsive diabetes care, but the framework is a hypothesis-generating proposal. Its feasibility, acceptability, and effectiveness need to be tested through stakeholder review and prospective implementation studies before it is adopted as a standard of care within the Saudi Ministry of Health framework.