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Low Health Literacy, Lack of Knowledge, and Self-Control Hinder Healthy Lifestyles in Diverse Patients with Steatotic Liver Disease

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Abstract

Introduction

In parallel with the obesity and diabetes epidemics, steatotic liver disease (SLD) has emerged as a major global public health concern. The mainstay of therapy is counseling on weight loss and increased exercise. However, such lifestyle modifications infrequently lead to success. We aimed to identify barriers to diet and lifestyle modification in patients with SLD.

Methods

Patients with SLD completed a 14-item questionnaire that assigned barriers to healthy eating to three categories: lack of knowledge, lack of self-control, and lack of time, with a higher summary score indicating more perceived barriers. We administered assessments of health literacy and physical activity. We analyzed the data using descriptive statistics and ordinal regression analysis.

Results

We included 151 participants with a median age of 64; 54% were female and 68.2% were Hispanic. Median BMI was 31.9 kg/m2. Most respondents, 68.2%, had low health literacy and were either underactive, 29.1% or sedentary, 23.2%. Lack of self-control was the strongest barrier to achieving a healthy lifestyle, followed by lack of knowledge. Lack of time was not significant barrier. Patients with the most significant barriers were more likely to have obesity, low health literacy, and be sedentary.

Discussion

Lack of self-control and knowledge are the greatest barriers to adopting a healthy lifestyle in patients with SLD. Future clinical interventions should integrate education that targets various health literacy levels with behavioral approaches to improve a sense of agency.

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Funding

Partial salary support for GS, SC and PJ comes from R01MD012565-04, awarded by The National Institutes of Health and the National Institute on Minority Health and Health Disparities. The NIH was not involved in study design or in the collection, analysis, or interpretation of data. Further, the NIH did not contribute to the writing of this manuscript or decision to submit for publication.

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Authors and Affiliations

  1. Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14Th Street, Miami, FL, 33136, USA

    Gloria Figueroa, Stephanie Castañeda, Hayley McLean, Jasmine Dukandar, Paul Martin, Luis Araya-Acero & Patricia D. Jones

  2. Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA

    Gloria Figueroa, Stephanie Castañeda, Hayley McLean & Sara M. St. George

  3. University of Miami/Jackson Memorial Hospital Internal Medicine Residency, Miami, FL, USA

    Shanique Wilson

  4. Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA

    Sara M. St. George & Patricia D. Jones

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  1. Gloria Figueroa
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Contributions

Guarantor of the article: PDJ, MD, and MSCR. Project conception and design: GF, SC, HM, JD, SW, PM, and PDJ. Data acquisition, analysis or interpretation: GF, SC, HM, LA, and PDJ. Critical revision: GF, SC, HM, JD, SW, PM, SMS, LA, and PDJ. Final approval of manuscript: GF, SC, HM, JD, SW, PM, SMS, LA, and PDJ.

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Correspondence to Patricia D. Jones.

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Figueroa, G., Castañeda, S., McLean, H. et al. Low Health Literacy, Lack of Knowledge, and Self-Control Hinder Healthy Lifestyles in Diverse Patients with Steatotic Liver Disease. Dig Dis Sci 69, 384–398 (2024). https://doi.org/10.1007/s10620-023-08212-9

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