Association of Functional Health Literacy with Glycemic, Sleep, Lifestyle, and Sociodemographic Factors of Female Type 2 Diabetic patients in Bangladesh

Articles in Press

Document Type : Original Article

Authors

1 Department of Public Health, University of Science and Technology Chittagong, Chattogram, Bangladesh. 2. Department of Public Health, Daffodil International University (DIU), Dhaka, Bangladesh

2 Department of Public Health, Daffodil International University (DIU), Dhaka, Bangladesh.

3 Department of Public Health and Informatics, Jahangirnagar University, Dhaka, Bangladesh.

4 Department of Statistics, Government Titumir College, Dhaka, Bangladesh.

Abstract

Background and Objectives: The purpose of this study was to assess the association of Functional Health Literacy (FHL) level and glycemic control, sleep, lifestyle behaviors, and socio-demographic factors among female patients with diabetes in Bangladesh.

Material and Methods: It was a cross-sectional study among 337 patients with diabetes who visited 3 different diabetic centers in Dhaka city. A structured questionnaire including Bengali adaptation of the S-TOFHLA was used to collect data. Pearson's χ2 test, and multi-nominal regression were used to find association of significant predictors with FHL level.

Result: Among participants, 22% had inadequate, 52% had marginal, and 26% had adequate FHL. FHL level was found significantly associated (p<0.05) with sociodemographic (economic status, occupation, education), lifestyle (physical activity, job type, transportation, social media use), sleep duration/quality and clinical diabetes factors (treatment regimen, family history, FBS, HbA1c). Regression analysis revealed that Sleep duration and glycemic parameters significantly predicted functional health literacy (FHL). Compared to <6 hours of sleep, durations of 6–8 hours (OR=10.38, 95% CI: 1.99–54.08, p=0.01) and >10 hours (OR=7.24, 95% CI: 1.21–43.37, p=0.03) significantly increased the odds of inadequate FHL. Conversely, elevated glycemic markers paradoxically lowered inadequate FHL likelihood, including fasting blood sugar of 6.7–7.6 mmol/L (OR=0.003, p=0.01), postprandial glucose of 8.7–9.6 mmol/L (OR=0.000, p<0.001), and HbA1c of 6.7–8.6% (OR=0.008, p=0.05). Furthermore, a sibling history of diabetes was significantly protective (OR=0.023, p=0.05). Education, occupation, income, physical activity, and treatment regimen show no significant independent effects in this model.

Conclusion: The findings highlight sleep duration and certain glycemic ranges as key correlates of functional health literacy, though the directionality of associations requires further investigation. Interventions to increase FHL may equivalently improve diabetes management. Future research should utilize longitudinal research designs to rigorously evaluate the efficacy of these health literacy interventions.

Keywords

Acknowledgments: None to acknowledge.


Availability of data and material: Data and materials may be shared for reasonable requests by the corresponding author.


Conflicts of interest: The authors declare no known competing interests that could have appeared to influence the work reported in this paper.


Consent for publication: Not applicable. 


Ethics approval and consent to participate: The study received ethical approval from the Research Ethics Committee of the Faculty of Health and Life Sciences, Daffodil International University (Ref no. FHLS-REC/DIU/2023/0031) in compliance with the Helsinki Declaration. The questionnaire was evaluated by subject matter experts and epidemiologists. A pilot survey was carried out prior to the final one to ensure that the questionnaire was reasonable. The study's background and objectives were explicitly explained to participants prior to their voluntary participation, and confidentiality and anonymity were rigorously maintained.


Funding: No funding or incentives were received for this research project and publication of the manuscript.


Authors’ Contributions: S.B.H. conceptualized the manuscript and contributed for supervision, data preparation and analysis, writing – original draft, and writing – review and editing; M.M.I. contributed for data preparation and analysis, writing – original draft; M.K.S. contributed for literature review, writing – original draft; K.M.R. contributed for data preparation and analysis, and writing – original draft; S.H. contributed for data preparation and analysis, writing – original draft; A.B.M.A.C. contributed for supervision, and writing – review and editing.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

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Available Online from 07 June 2026

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