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Research Article | DOI: https://doi.org/10.31579/2639-4162/295
1Department of Public Health, Monroe College, King Graduate School, United States.
2History of Health and Social Justice Research Group, University of Saskatchewan, Canada
*Corresponding Author: Kolade Folami, Department of Public Health, Monroe College, King Graduate School, United States.
Citation: Kolade Folami and Sesan M. Johnson, (2025), Do People with Lower Health Literacy Have Worse Diabetes Control? Insights from NHANES 2017–2020, J. General Medicine and Clinical Practice, 8(9); DOI: 10.31579/2639-4162/295
Copyright: © 2025, Kolade Folami. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 05 August 2025 | Accepted: 18 August 2025 | Published: 03 September 2025
Keywords: health literacy; diabetes; glycemic control; nhanes
Background: Glycemic control is necessary for reducing related complications in diabetic patients. However, disparities- often described as gaps in glycemic control- exist across all social and demographic groups. This study examines whether lower health literacy, proxied by educational attainment, is associated with low glycemic control among U.S. adults with diabetes.
Methods: Data were extracted from the 2017-2020 National Health and Nutrition Examination Survey (NHANES). 1,423 adults aged 18 and older who self-reported a diabetes diagnosis were included. Glycemic control was measured using hemoglobin A1c (HbA1c) levels. The level of education was used as a proxy for health literacy. Descriptive statistics and one-way ANOVA were conducted to compare mean HbA1c values across education groups, with post hoc Tukey tests used to measure pairwise differences.
Results: HbA1c levels is negatively associated with educational attainment. Participants with less a 9th-grade education had the highest mean HbA1c (7.78 %), while college graduates had the lowest (7.13%). ANOVA results showed a statistically significant difference between HbA1c across education levels F(4,1253) =3.59, p=0.006). The only significant pairwise difference was between those with less than a 9th-grade education and college graduates (p=0.003).
Conclusion: Lower educational attainment, a proxy for limited health literacy, is associated with poorer glycemic control. These findings emphasize the need for diabetes education and management strategies designed for people with low literacy. This is needed to reduce disparities and improve health outcomes.
About 38.4 million persons, as of 2021, are diabetic in the United States [1]. This is 11.6% of the population, and out of this figure, 8.7 million persons are undiagnosed [2]. The reduction and progressive elimination of the incidence of diabetes is one of the goals of Healthy People 2030. But the 2017-2020 data from the Office of Disease Prevention and Health Promotion (ODPHP) of 18% suggests that no progress is being made towards bringing down the percentage of the U.S. adult population with HbA1c>9% from the 2016 baseline of 18.7% to the targeted 11.6% [3]. Importantly, individuals who are 18 and above are the most affected, constituting 99 percent of diabetic cases. Smalls et al. [4] posited that HbA1c, or Hemoglobin A1c, has a wide acceptance as an indicator of quality diabetes management, the possibility of developing diabetes-related complications, and a measure of severity of the condition. Therefore, there is a need to re-examine the existing data to identify and understand the factors affecting the Healthy People 2030 goal of reducing the incidence of diabetes in the population. The purpose of this study is to determine whether people with lower health literacy have worse diabetes control. As such, it shall be argued that worse or adverse diabetes control is connected to significantly low health literacy and self-management.
Health literacy has been identified as critical to the improvement of self-management [5]. Health literacy is defined as a person’s knowledge, capacity, and motive to gain, comprehend, and deploy health information for decision-making purposes across the health continuum [6]. As such, an individual’s proficiency in critical health literacy is seen as a more effective method for increasing self-management behaviors, when contrasted with a sole reliance on self-confidence or social support mechanisms among people with chronic diseases. Conflating education with health literacy is not always straightforward, as a study of hospital emergency room visits found that individuals with low health literacy and high education had a high probability of emergency room revisits [7]. At the same time, when health literacy is conceived as the use of reading, listening, data analysis, and decision-making skills during health situations, it was submitted that educational intervention is important for the enhancement of health literacy [8]. In other words, education is a sine qua non for health literacy, and by extension, self-management.
Health literacy has been associated with diabetes management, glycemic control, and self-efficacy of diabetes patients [9,10]. Health literacy influences diabetes knowledge, adherence to medication, and glucose monitoring [9]. Health literacy and self-management are central to the present study. There is limited recent U.S. national-level analysis using the National Health and Nutrition Survey data. Gaps in glycemic control are the disparities in blood glucose outcomes-importantly HbA1c levels, between subgroups of a given population. As such, these gaps or disparities often portray broader health inequities rooted in historical, social, economic, cultural, and educational disadvantages. Most studies on the gap/disparities in glycemic control have largely focused on race, ethnicity, and socio-economic factors as the predictors. As such, the studies largely focus on binary comparison of health outcomes and glycemic control between Blacks and Whites, or white versus Blacks and Latinos/Hispanics. For instance, studies that found low glycemic control by Blacks and Hispanics/Latinos often discount economic factors as explanatory variables [11-14].
Another category of studies, which largely discounted race, associated low glycemic control with factors like education level, Body Mass Index (BMI), duration of diabetes, aggregate cholesterol, clinical inertia due to attitudes of healthcare providers, therapy inertia due to cost and acceptability of insulin, access to Medicaid, and ineffectiveness of behavioral and technological interventions [15-18]. The above studies leave no room for individual self-efficacy based on personal beliefs and health knowledge. Consequently, there is a need to examine the likelihood of disparities in glycemic control between adults with high and low health literacy, as proxied by educational attainment.
Research Question
This study has a single research question: Do adults with lower educational attainment have higher HbA1c levels?
Objective
Examination of whether lower health literacy (measured via education) is associated with worse diabetes control (measured by HbA1c).
Theoretical Framework
The Health Belief Model (HBM) is one of the intrapersonal-level models of the behavioral foundations of public health [19]. The HBM focuses on the mode of the individual's perception of threats to health and the resultant decisive action, due to the premium
| HBM Construct | Application to the Study |
| Perceived Susceptibility | Persons with low health literacy, proxied by education, may not fully understand their risk of diabetes complications |
| Perceived Severity | There is a possibility of underestimating the seriousness of, or the long-term damage caused by, high blood glucose. |
| Perceived Benefits | Limited health literacy could hamper the understanding of how lifestyle and medication influence health outcomes |
| Perceived Barriers | Barrier to action |
| Cues to Action | There is a possibility of ineffectiveness of health messages, doctors’ advice, and appropriate reminders if not literacy-sensitive. |
| Self-Efficacy | Confidence is important to self-efficacy. Individuals with lower health literacy may feel less confident in managing their condition via appropriate health decisions. |
Table 1
Each component of the HBM is influenced by health literacy. For instance, on self-efficacy, it has been noted that there is little or no incentive to act without the belief that individual action can produce desired results [21], and instructional practices often develop an individual’s self-efficacy [22]. Importantly, health literacy has a direct effect on perceived susceptibility, perceived severity, and perceived barriers in the HBM [23]. Overall, HBM helps explain why individuals with lower literacy/education may have poorer self-care behaviors and outcomes in general and lower glycemic control in particular.
The study made use of the National Health and Nutrition Examination Survey 2017-2020, a cross-sectional and nationally representative study conducted by the Centers for Disease Control and Prevention (CDC). This makes it a secondary study with a quantitative research design. The sample inclusion and exclusion criteria are adults (age≥18) with self-reported diabetes (DIQ010=Yes).
| Type of Variable | NHANES Code | Description |
| Health Literacy | DMDEDUC2 | Education level (categorical) |
| Diabetes Control | LBXGH | HbA1c% (continuous) |
| Demographics | RIDAGEYR, RIAGENDR, RIDRETH3 | Age, sex, race/ethnicity |
Table 2: Key variables.
The study made use of descriptive (frequencies and means) and bivariate analysis (one-way ANOVA). The Tukey post hoc test was conducted for group differences. Analysis was done with the software, SPSS version 30.
Sample Characteristics
The sample consisted of 1,423 U.S. adults with self-reported diabetes, drawn from 2017-2020 NHANES dataset. The gender distribution consists of 53.5% male and 46.5 percentage female. Racial and ethnic composition is made up of 32.5% Non-Hispanic White, 28.8% Non-Hispanic Black, 12.8% Mexican American, 10.5% Other Hispanic, 10.2% Asian, and 5.2% of multiracial or other ethnicities. Education attainment is used here as the proxy for health literacy, and in terms of that, 13.1% of the study participants attained less than a 9th-grade education, 13.6% had no diploma (9 to 11th grade), 24.6% had graduated from high school or earned a GED, 30.9% had some university education or associate degree, and 17.8% graduated from college.
| Education Level | Frequency | Percent | Valid Percent | Cumulative Percent | |
| Valid | Less than 9th grade | 186 | 13.1 | 13.1 | 13.1 |
| 9–11th grade (no diploma) | 193 | 13.6 | 13.6 | 26.7 | |
| High school/GED | 349 | 24.5 | 24.6 | 51.3 | |
| Some college/AA | 438 | 30.8 | 30.9 | 82.2 | |
| College graduate | 252 | 17.7 | 17.8 | 100.0 | |
| Total | 1418 | 99.6 | 100.0 | ||
| Missing | System | 5 | .4 | ||
| Total | 1423 | 100.0 | |||
Table 3: Education Level.
| Diagnosed with diabetes | Frequency | Percent | Valid Percent | Cumulative Percent | |
| Valid | Yes | 1423 | 100.0 | 100.0 | 100.0 |
Table 4: Diagnosed with diabetes.
Glycemic control by education level
The mean HbA1c values consistently declined with increasing education levels. Specifically, participants with less than 9th-grade schooling had the highest mean HbA1c (Mean=7.78%, Standard Deviation=1.77), while college/university graduates had the lowest mean HbA1c (Mean=7.13%, Standard Deviation=1.32). This pattern suggested a negative relationship between educational attainment and HbA1c levels.
| Cases | ||||||
| Included | Excluded | Total | ||||
| N | Percent | N | Percent | N | Percent | |
| Glycohemoglobin (%) * Education Level | 1258 | 88.4% | 165 | 11.6% | 1423 | 100.0% |
Table 5: Aggregate glycohemoglobin by education values.
| Glycohemoglobin (%) | |||
| Education Level | Mean | Std. Deviation | N |
| Less than 9th grade | 7.7753 | 1.76529 | 158 |
| 9–11th grade (no diploma) | 7.5342 | 1.74066 | 158 |
| High school/GED | 7.5129 | 1.77263 | 317 |
| Some college/AA | 7.4640 | 1.76897 | 406 |
| College graduate | 7.1297 | 1.31595 | 219 |
| Total | 7.4661 | 1.70265 | 1258 |
Table 6: Mean Distribution.
The negative association between educational attainment and HbA1c levels is confirmed by a one-way ANOVA as statistically significant, F (4,1253) = 3.59, p=.006.
| Glycohemoglobin (%) | |||||
| Sum of Squares | df | Mean Square | F | Sig. | |
| Between Groups | 41.322 | 4 | 10.331 | 3.593 | .006 |
| Within Groups | 3602.758 | 1253 | 2.875 | ||
| Total | 3644.081 | 1257 | |||
Table 7: One-way ANOVA.
Post hoc tests using the Tukey HSD test showed that the mean HbA1c for individuals with less than a 9th-grade was significantly higher than for participants with a university degree (p=.003). It is noteworthy that though other pairwise comparisons did not reach statistical significance, a visible trend associated lower HbA1c with higher levels of education. The homogenous subset analysis in Table 1.8 further supported this trend by grouping college graduates into a distinct subset with the lowest HbA1c values, while all other educational categories are grouped in the second, higher-risk clusters (higher HbA1c values).
| Dependent Variable: Glycohemoglobin (%) | ||||||
| Tukey HSD | ||||||
| (I) Education Level | (J) Education Level | Mean Difference (I-J) | Std. Error | Sig. | 95% Confidence Interval | |
| Lower Bound | Upper Bound | |||||
| Less than 9th grade | 9–11th grade (no diploma) | .24114 | .19078 | .713 | -.2800 | .7623 |
| High school/GED | .26238 | .16513 | .505 | -.1887 | .7135 | |
| Some college/AA | .31128 | .15900 | .288 | -.1231 | .7456 | |
| College graduate | .64564* | .17700 | .003 | .1621 | 1.1291 | |
| 9–11th grade (no diploma) | Less than 9th grade | -.24114 | .19078 | .713 | -.7623 | .2800 |
| High school/GED | .02124 | .16513 | 1.000 | -.4299 | .4723 | |
| Some college/AA | .07014 | .15900 | .992 | -.3642 | .5045 | |
| College graduate | .40450 | .17700 | .150 | -.0790 | .8880 | |
| High school/GED | Less than 9th grade | -.26238 | .16513 | .505 | -.7135 | .1887 |
| 9–11th grade (no diploma) | -.02124 | .16513 | 1.000 | -.4723 | .4299 | |
| Some college/AA | .04889 | .12709 | .995 | -.2983 | .3961 | |
| College graduate | .38325 | .14900 | .076 | -.0238 | .7903 | |
| Some college/AA | Less than 9th grade | -.31128 | .15900 | .288 | -.7456 | .1231 |
| 9–11th grade (no diploma) | -.07014 | .15900 | .992 | -.5045 | .3642 | |
| High school/GED | -.04889 | .12709 | .995 | -.3961 | .2983 | |
| College graduate | .33436 | .14217 | .130 | -.0540 | .7227 | |
| College graduate | Less than 9th grade | -.64564* | .17700 | .003 | -1.1291 | -.1621 |
| 9–11th grade (no diploma) | -.40450 | .17700 | .150 | -.8880 | .0790 | |
| High school/GED | -.38325 | .14900 | .076 | -.7903 | .0238 | |
| Some college/AA | -.33436 | .14217 | .130 | -.7227 | .0540 | |
| *. The mean difference is significant at the .050 level. | ||||||
Table 8: Multiple comparisons.
| Glycohemoglobin (%) | |||
| Tukey HSDa,b | |||
| Education Level | N | Subset for alpha = .050 | |
| 1 | 2 | ||
| College graduate | 219 | 7.1297 | |
| Some college/AA | 406 | 7.4640 | 7.4640 |
| High school/GED | 317 | 7.5129 | 7.5129 |
| 9–11th grade (no diploma) | 158 | 7.5342 | 7.5342 |
| Less than 9th grade | 158 | 7.7753 | |
| Sig. | .092 | .307 | |
| Means for groups in homogeneous subsets are displayed. | |||
| a. Uses Harmonic Mean Sample Size = 218.894. | |||
| b. The group sizes are unequal. The harmonic mean of the group sizes is used. Type I error levels are not guaranteed. | |||
Table 9: Homogenous subsets.
In this study of 1,423 U.S. adults with self-reported diabetes (2017–2020 NHANES data), we identified a clear, graded inverse relationship between educational attainment—our proxy for health literacy—and glycemic control as measured by HbA1c. Specifically, those with less than 9th-grade education had the highest mean HbA1c (7.78 ± 1.77 %), whereas college graduates exhibited the lowest (7.13 ± 1.32 %). This gradient was statistically significant (ANOVA, F (4, 1253) = 3.59, p = .006), and post hoc pairwise comparisons revealed a significant difference between the lowest and highest education extremes (p = .003). Our results align well with previous observational and meta-analytic findings that lower educational levels or limited health literacy correlate with poorer glycemic outcomes. For example, meta-analytic evidence has consistently shown that lower health literacy is associated with reduced diabetes knowledge, self-care behaviors, and suboptimal glycemic control [24]. A more recent meta-analysis confirmed that interventions designed to improve health literacy can significantly reduce HbA1c levels [25].
Other observational investigations—such as those assessing literacy as a mediator between education and glycemic control—demonstrate similar patterns: patients with less formal education often struggle to understand diabetes management instructions, leading to persistently elevated HbA1c [26]. Thus, our pattern of highest HbA1c among the lowest‑educated and lowest among the most educated is entirely consistent with the broader evidence base. The magnitude of difference we found, approximately 0.65 % lower HbA1c in college graduates compared to those below 9th‑grade, exceeds thresholds considered clinically relevant. The DCCT established that even 0.5 % reductions in HbA1c yield meaningful decreases in microvascular complications. Prior culturally tailored education programs achieved around 0.6–0.8 % reductions within months [27]. Hence, our observed difference aligns with effect sizes previously linked to improved long-term outcomes.Although we used educational attainment as a proxy, our findings strongly suggest that health literacy may mediate the observed relationship. Low educational achievement has been associated with limited health literacy, which in turn affects the ability to interpret medication instructions, adjust lifestyle, self-monitor blood glucose, and engage in preventive behaviors [28]. Interventional trials employing literacy‑sensitive strategies, such as simplified language, teach‑back methods, visuals, and culturally appropriate materials, have proven effective at improving both knowledge and glycemic outcomes [24]. Our sample’s racial–ethnic makeup, 32.5 % non-Hispanic White, 28.8 % non-Hispanic Black, 12.8 % Mexican American, etc, mirrors known disparities in diabetes prevalence and outcomes. National data documents that adults with less than high school education have twice the diabetes prevalence of college graduates, and that Black and Hispanic populations bear a disproportionate burden of poor glycemic outcomes and complications [29]. Systemic barriers, including limited educational opportunity, food insecurity, and healthcare access gaps, compound low health literacy in these communities [30]. Given these findings, diabetes self-management education (DSME) programs should be explicitly designed for individuals with lower literacy levels. Strategies may include audio‑visual aids, pictorial instruction, avoidance of medical jargon, simplified and actionable instructions, teach-back verification, and community health worker engagement. Meta-analyses show such tailored interventions can meaningfully reduce HbA1c [24,25]. Culturally competent interventions, those delivered by language-matched educators or community health workers, have previously led to ~0.8 % HbA1c reductions within three months [27].
Policy efforts should elevate health literacy as a core social determinant of health, integrate literacy assessment into clinical encounters, and support resource allocation for literacy-sensitive education materials in both clinical and community settings. Embedding these strategies into national initiatives, such as Healthy People 2030, would be consistent with calls to reduce health disparities via enhanced communication and access [31].
As with other cross-sectional analyses, causality cannot be conclusively established; educational attainment likely correlates with numerous unmeasured social and economic factors such as income, access to care, and neighborhood environment. Additionally, education is an imperfect proxy for functional health literacy; direct measures of health literacy were not collected in NHANES during our period and may capture discrete cognitive, language, and numeracy skills more precisely (e.g. direct instruments, not education level). Nonetheless, the graded pattern observed across education categories, and its consistency with prior research that used validated literacy scales, supports our interpretation.
Gaps in Glycemic control refer to the disparities in blood glucose outcomes between population subgroups. These disparities often portray bigger health inequities that is grounded in socio-economic, educational, and historical disadvantages. This study has examined the probability of the existence of such disparity between adults with low literacy versus high health literacy. Educational attainment approximated health literacy, and it was found that there is negative association between educational attainment and HbA1c levels. In other words, the higher the educational attainment, the lower the HbA1C levels, and ipso facto, the higher the glycemic control. Stemming from above, a progressive improvement in health literacy is essential for closing diabetes control gaps between patients with higher and lower educational attainment. This is necessary for the attainment of the Healthy People 2030 goal of the reduction of diabetes to 11 percent of the population.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
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Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Giselle Pentón-Rol.
