[Health literacy profiles in type 2 diabetes: The ERMIES-Ethnosocio study]

Health literacy refers to the competences and resources required by individuals to meet the complex demands of health in modern society. This paper describes and analyses the health literacy profiles of type 2 diabetic patients included in a 2-year long self-management education programme.

Nested in the ERMIES randomized controlled trial conducted in Reunion island, the ERMIES Ethnosocio study explored health literacy by means of two complementary approaches: description of health literacy profiles via the French version of the multidimensional "Health Literacy Questionnaire", and a socio-anthropological perspective based on 40 semi-structured interviews carried out in 2012 and then in 2015.

The results highlight the existence of 8 constitutive variables in the management of type 2 diabetes in an ordinary context: diet, physical activity, treatment and monitoring of disease (disease management), access to knowledge and skills (health knowledge), relationships with health professionals and social support (expertise, support and social network). They also emphasize the differentiated relationships of individuals to each of these variables, ranging from functional to interactive or critical "levels".

Considering the development of health literacy with patients and health professionals, and by questioning educational and therapeutic interventions as differentiating processes, this research opens up new perspectives for the approach to social inequalities in health. The combination of social sciences, medical sciences and public health is proving fruitful and potentially operative, provided that the definitions, methods, and strengths and limitations of selected prospects are clearly defined.