Health literacy and medication beliefs in adults with type 2 diabetes enrolled in therapeutic patient education: a cross-sectional study

Therapeutic patient education is a cornerstone of type 2 diabetes management. Medication beliefs, as conceptualized by the Necessity–Concerns Framework, influence how patients perceive and engage with long-term treatment. Health literacy may shape these beliefs, yet its relationship with medication beliefs remains insufficiently explored in adults with type 2 diabetes, particularly in real-world therapeutic patient education settings. We conducted a cross-sectional analysis of baseline data from the DIABREVAL cohort, a structured therapeutic patient education programme conducted in primary care in France. Medication beliefs were assessed using the Beliefs about Medicines Questionnaire-Specific (BMQ-Specific). Health literacy was measured using the Newest Vital Sign (NVS), socioeconomic deprivation using the EPICES score, and educational attainment using three predefined categories. Linear regression models with progressive adjustment for deprivation, age and educational attainment were performed using multiple imputation, with complete-case sensitivity analyses. A total of 494 adults with type 2 diabetes were included (mean age 64.4 ± 10.1 years; 54.0% men). Limited health literacy was common, with 62.8% of participants scoring below 4 on the NVS. Higher health literacy was independently associated with lower medication concerns (β = −0.28, p = 0.047), whereas no independent association was observed with perceived necessity of treatment. Educational attainment and socioeconomic deprivation were not independently associated with medication beliefs, while older age was independently associated with stronger necessity beliefs. These findings suggest that health literacy may be more closely associated with how patients perceive treatment-related risks than with their perceived necessity of treatment. Integrating the assessment of health literacy and medication beliefs into therapeutic education and routine clinical care may help healthcare professionals identify medication-related concerns and support more personalised communication and counselling strategies.