Livneh's (2001) quality-of-life-based model of psychosocial adaptation to chronic illness and disability (CID) provides a framework to conceptualize the process through which individuals negotiate challenges due to altered health. Drawing on this model, the current study examined the relationship between three process variables, health literacy, self-efficacy and knowledge of CID and quality of life outcomes among 126 individuals with diabetes. Four outcomes were studied, employment, physical and psychological well-being and social relationships.I hypothesized that these process variables predict quality of life. I also postulated that health literacy affects quality of life indirectly, through knowledge of CID and diabetes management self-efficacy. This study also investigated the prevalence of low health literacy in this population and tested whether health literacy skills are related to disparities in health outcomes based on race/ethnicity, socio-economic status (SES), and age.Findings suggest that low health literacy is not prevalent in this group. Four in five(81.7%) individuals with diabetes have adequate health literacy. In examining whether health disparities in race/ethnicity, SES and age are reflected in health literacy scores, current findings support significant race/ethnicity effects on both reading and numeracy and on overall health literacy as well. There were no differences in health literacy scores based on SES and age. There was a lack of association between health literacy and the quality of life domains investigated. In terms of employment, individuals who worked, performed slightly higher on the health literacy test, but the differences were not statistically significant. Results were different in relation to diabetes knowledge and diabetes management self-efficacy. Findings suggest an unadjusted effect of self-efficacy and diabetes knowledge on employment. In the adjusted model, physical health and the level of interference of diabetes with activities of daily living (ADLs) are the main statistically significant independent effects that explain the odds of one being employed. Although high levels of self-reported diabetes management self-efficacy is strongly associated with employment, the causal pathways for this relationship is likely to be through physical health and the lack of interference of diabetes with ADLs. In relation to physical health, the effect of diabetes management self-efficacy holds in the adjusted model as well, supporting the presence of an independent non-redundant effect. Level of understanding of diabetes and its treatment positively affects physical health. Results of regression analysis indicate that higher levels of diabetes management self-efficacy and a better understanding of diabetes and its treatment is associated with better psychological well-being and social relationships as well.The structural and predictive utility of Livneh's model was partially supported by these findings. Empirical evidence from this research substantiates the relevance of diabetes management self-efficacy and the level of understanding of diabetes and its treatment on different quality of life domains. The current findings have applicability for vocational rehabilitation. This research evidence supports the importance to involve vocational rehabilitation customers who have diabetes in diabetes knowledge and self-efficacy training. Clinical interventions that teach factual knowledge and health management behaviors could help individuals improve their understanding of their medical condition and enhance self-efficacy, which in turn has benefits on several quality of life domains.
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