Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Ann M. Mayo, DNSc, RN, FAAN, Chairperson; Razel Milo, PhD, DNP, FNP-C, APRN, Co-Chairperson; Ruth Bush, PhD, Committee Member; Shiloh A. Williams, PhD, MSN, RN, NPD-BC, CNE, Committee Member


Health Literacy, Diabetes, HbA1c, Rural Border Region


Aims/Objectives: The purpose of this study was to describe the relationships between select sociodemographic and clinical characteristics, individual health literacy levels, and hemoglobin A1c (HbA1c) levels among Hispanic patients with diabetes living in a rural border region.

Background: The frequency of complications from diabetes can increase as HbA1c levels rise, causing the person with diabetes to be at greater risk for blindness, amputation, or renal failure. Unfortunately, people of Hispanic background are at higher risk of developing diabetes compared to non-Hispanic Whites. Many people living in rural towns that border Mexico are of Hispanic background, increasing their risk of developing diabetes.

Design: Descriptive correlational study.

Methods: A retrospective data set of cases aged 18–65 years with a diagnosis of type 1 or 2 diabetes was acquired from the electronic medical records of two clinics and one hospital located in a rural border region. A descriptive correlational design was used for this database study. The independent variables for the study were sociodemographic and clinical characteristics and health literacy. The dependent variable was the HbA1c level.

Data Analysis: Data analysis included descriptive and inferential statistics. All data were analyzed using the Statistical Product and Service Solutions (SPSS) 28.0 software.

Findings: The study sample’s mean HbA1c level was elevated at 9.2% and the mean health literacy level was 2.23, meaning there was the possibility of limited health literacy. Significant associations were found between age, primary language, education level, and HbA1c level. Health literacy was not related to HbA1c level.

Relevance to Research: This study suggests that regardless of health literacy levels, people who suffer from diabetes and live in a rural border town typically have high HbA1c levels. Further research is recommended to improve HbA1c levels among people living with diabetes in a rural border town.

Relevance to Nursing Practice: This study described select variables associated with HbA1c levels. Targeting patients in specific age groups, with certain educational levels and a specified primary language with strategic patient education topics may improve HbA1c levels.

Document Type

Dissertation: Open Access



Available for download on Friday, November 28, 2025