Health Literacy and Type 2 Diabetes: A Case Study in Complexity

Health literacy is a high stakes literacy that requires patients to navigate multiple activity systems (Engestrom, 2001) and engage in a variety of complex literacy practices. This is a case study of literacy practices used by patients with type 2 diabetes as they learn to manage their disease. The site for the study was a Diabetes Education Center. Data were collected via interviews with medical staff and patients, as well as observations of individual education sessions. Data were analyzed using activity systems analysis (Yamagata-Lynch, 2010). Literacy practices patients engaged in at the Center and at home were varied and complex. These practices used specific tools and followed certain rules. The activity settings of the Center and patient’s homes were interconnected. Tensions existed within the systems. This study provides a window into patients’ experiences with literacy while navigating a real-world health care situation. The complexity of the literacy practices patients engaged in should be taken into consideration when defining and assessing health literacy, when creating health education programs, and when considering needed patient supports.