Qom University of Medical Sciences Journal

Introduction
Diabetes is one of the most common metabolic diseases in the world. This disease is associated with hyperglycemia and complete or partial failure of insulin secretion in the body. It is estimated that the number of diabetic patients in the world will reach 592 million by 2035. Type 2 diabetes (T2D) is the most common type of diabetes, accounting for 90% of the cases. It is a chronic and debilitating disease and causes numerous psychological, social, and physical problems, and has negative effects on the patients’ performance. It is associated with poor lifestyle, low physical activity, and poor improper eating habits. Health literacy and self-efficacy are among the most important factors that affect the self-care behaviors of patients with diabetes. Self-efficacy is considered as one of the components of the social-cognitive theory and an important construct of the health belief model, especially when the model is used to predict lifestyle changes during chronic diseases. On the other hand, health literacy is the ability to find, understand, and use health information and services to promote health-related behaviors. The present study aims to investigate the relationship between health literacy and self-efficacy in patients with T2D in Yazd, Iran.
Method
This is a descriptive correlational study. Participants were 100 patients with T2D referred to the diabetes clinic in Yazd province in 2020 who were selected using a sequential sampling method. The inclusion criteria were availability of medical record, diagnosis with T2D for at least one year, no gestational diabetes, receiving medication therapy, and being able to read and write. On the other hand, unwillingness to participate in the study was one of the exclusion criteria. The data were collected using the Health Literacy for Iranian Adults (HELIA), the General Self-efficacy Scale of Scherer et al. (1982), and a demographic form surveying educational level, occupation, type of diabetes treatment, and age. The collected data were analyzed using Pearson’s correlation test and independent t-test in SPSS v. 21 software, and the significance level was set at 0.05.data
Results
Participants were married women (50%) and men (50%) with T2D. The demographic characteristics indicated that 55%, 24%, 14%, 4%, 1%, and 2% of the patients had primary education, high school education, diploma, associate degree, bachelor’s degree, and master’s degree, respectively. The age range of the participants was 37-65 years; 6%, 13%, 15%, 17%, 16 %, 19%, and 14% were aged 37-41, 41-45, 45-49, 49-53, 53-57, 57-61, and 61-65 years, respectively. In addition, about 46% were employed, 45% were housekeeper, and 9% were retired.
The mean score of self-efficacy and health literacy were 56±8 and 56±11, respectively. For the health literacy components including reading skills, ability to access, ability to understand, ability to assess, and decision-making, the mean scores were 46±20, 64±13, 60±13, 54±14, and 58±14, respectively. In the multiple regression model, the correlation coefficient (R) of the total health literacy with self-efficacy was 0.39, and the value of R squared was 0.15, indicating that about 15% of the changes in the self-efficacy variable were explained or predicted by the health literacy variable. The results of the independent t-test showed a significant difference between the women and men with T2D in terms of health literacy and its components as well as the self-efficacy level (P<0.01), where women had higher self-efficacy than men, but the health literacy of men was higher. Regarding the components of health literacy, women obtained higher scores in the ability to access, ability to understand, and decision-making, while men had higher scores in reading and assessment skills.
Discussion
Health literacy and its components have a significant positive relationship with self-efficacy in T2D patients. Due to low level of health literacy in female patients and low level of self-efficacy in male patients in the present study, it seems necessary to develop interventions using health education models to increase the health literacy and self-efficacy of patients and help them improve their quality of life.
Ethical Considerations
Compliance with ethical guidelines
All ethical principles are considered in this article. The participants were informed of the purpose of the research and its implementation stages. They were also assured about the confidentiality of their information and were free to leave the study whenever they wished, and if desired, the research results would be available to them.

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.
Authors contributions
All authors equally contributed to preparing this article.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
All authors woulf like to thank all the patients who participated in this research, as well as to the officials of Yazd Diabetes Clinic Center who made it possible to carry out the research.