Associations among health literacy, diabetes knowledge, and self-management behavior in adults with diabetes: results of a dutch cross-sectional study

Factors associated with disease knowledge and attitude among ambulatory patients with type 2 diabetes - a multicenter study

BACKGROUND

Diabetes is a multifactorial disease state that requires adequate patient monitoring for improved health outcomes. Diabetes knowledge and attitude, and associated factors such as medication adherence, medication discrepancy, health literacy, and glycemic control were evaluated in this study. The selected factors were also compared with diabetes knowledge and attitude.

METHODS

A cross-sectional study was carried out among ambulatory diabetes patients in three tertiary healthcare facilities in Nigeria. An interviewer-administered semi-structured questionnaire was utilized for data collection. Data was analysed using descriptive and inferential statistics with the level of significance set at p < 0.05.

RESULTS

A total of 188 diabetes patients participated in the study; 51 (27.1%) at the Federal Medical Center, Abeokuta, 69 (36.7%) at the University College Hospital, Ibadan, and 68 (36.2%) at the University of Ilorin Teaching Hospital, Ilorin. One hundred and twelve (59.6%) female patients participated in the study and patients' average age was 58.69 ± 13.68 years. Medication discrepancy was observed among 101 (53.7%) patients. One hundred and three (54.8%), 47 (25.0%) and 38 (20.2%) had high, medium, and low medication adherence, respectively. Ninety-one (48.4%) had high health literacy. Mean diabetes knowledge score was 14.64 ± 2.55 points out of a maximum obtainable score of 18 points. Mean diabetes attitude of patients was 62.50 ± 6.86 points out of a maximum obtainable score of 70 points. Significant positive association was observed between diabetes knowledge and health literacy (Beta = 0.021, p = 0.029). Diabetes knowledge was higher in patients with higher level of formal education (p = 0.046), higher diabetes attitude (p < 0.001) and high health literacy (p = 0.002). Patients' diabetes attitude was higher in individuals older than 60 years of age (p = 0.029), and those with high health literacy (p = 0.005).

CONCLUSIONS

The diabetes patients displayed good disease knowledge, attitude and medication adherence. Average levels of health literacy and medication discrepancy was observed among the patients. Significant differences were observed between patients' diabetes knowledge and level of formal education, diabetes attitude, health literacy and age. Patients' health literacy was significantly associated with diabetes knowledge.

Keep it CooL! Results of a two-year CooL-intervention: a descriptive case series study

BACKGROUND

Coaching on Lifestyle (CooL) is a two-year healthcare intervention for people with overweight or obesity, stimulating weight reduction by promoting sustained healthier behavior. The objective of this study is to investigate the effects of CooL on participants' anthropometrics, personal factors and behavioral factors over the two-year timeframe of CooL.

METHODS

A descriptive case series study, using a broad set of routinely collected data on anthropometrics, personal factors and behavioral factors of adults living across the Netherlands. The data were collected between November 2018 and December 2021 among participants of CooL (N = 746) at three moments during the intervention: at baseline (T0), at 8 months (T1) after completion of phase 1 and at 24 months (T2) after ending CooL. Changes over time were analyzed using paired t-tests comparing baseline to T1 and baseline to T2. In addition, potential differences on outcomes in subgroups based on education level, weight status and group size were examined using paired t-tests and ANOVA-tests.

RESULTS

The results showed positive changes on all outcomes at 24 months compared to baseline. The largest effects were on perceived health, attentiveness towards meal size and meal composition (large effect size). Mean weight loss was 4.13 kg (SD 7.54), and mean waist circumference decreased with 4.37 centimeters (SD 8.59), indicating a medium to large effect size. Changes were consistent across subgroups varying in educational level, BMI at baseline and group size.

CONCLUSION

The study demonstrated sustained weight-related effects of CooL over 24 months supporting its two-year duration. The results indicate that CooL, though not for every individual, is in general appropriate and effective for different group sizes and for a wide variety of participants regardless of level of education, or BMI at baseline.

TRIAL REGISTRATION

Dutch Trial Register NTRNL6061 (13-01-2017). Registered at Overview of Medical Research in the Netherlands (OMON), via https://www.onderzoekmetmensen.nl/ .

Information Seeking and Receiving of Older Adults with Diabetes in the Online Health Community: An Information Need Contextualization Perspective

Online health communities (OHCs) are important online health communication channels for older adults with diabetes to access health information. When seeking health information, they often disclose a variety of contextual information (e.g., socio-economic situations) in their questions. Selective contextual information disclosure is a type of communication strategy for users in OHCs to elicit replies from others. In this study, we adopted text analysis to investigate what contextual information older adults with diabetes disclose to articulate their information needs and used the fixed-effect Poisson model to examine the relationships between different types of contextual information disclosure and informational support receipt. Our analyses were based on a dataset of 4,505 questions and corresponding replies from an online diabetes community. The results showed that cognitive information is the most frequently disclosed contextual information, while older adults tend to disclose demographic information in their questions less. Providing demographic and situational details in questions can enhance informational support receiving, resulting in an increased number of informational supports. However, disclosing cognitive, affective, informational channels, or support information does not significantly affect the informational support receiving. These findings can contribute to extending our existing understanding of information seekers' communication strategies in OHCs.

The role of social support and self-management on glycemic control of type 2 diabetes mellitus with complications in Ghana: A cross-sectional study

Background and Aims

Diabetes mellitus (DM) can result in detrimental complications which are connected with long-term impairments and disabilities. Chronic complications are well-known consequences of type 2 diabetes mellitus (T2DM) progression, which reduce patient quality of life, place a burden on the healthcare system, and increase mortality. Measures to promote health outcomes for people with DM are scanty; the study therefore aimed at determining the effects of self-management and social support on glycemic control of T2DM with complications in Ghana.

Methods

A cross-sectional design using convenience sampling was conducted on 400 T2DM patients using Hensarling's Diabetes Family Support Scale and Summary of Diabetes Self‑Care Activities scale. Data analysis was conducted using descriptive, Pearson Moment Product Correlation and Binary Logistic Regression on self-management, social support, and glycemic control in T2DM patients.

Results

Social support among participants was high and there was a positive correlation or relationship between social support and T2DM self-management. There was a correlation between social support and self-management (r = 0.149, p < 0.05) and diet control (r = 0.221, p < 0.05). The results also showed a significant correlation between medication adherence and glycemic management (r = 0.116, p < 0.05) while female T2DM participants, individuals with at least primary education were less likely to have low self-management relative to T2DM.

Conclusion

Though the level of T2DM self-management was high it does not translate to good glycemic control. Focused health education programs should be incorporated into patients' care plans which will be particularly relevant for patients with T2DM and will contribute to positive physiological and psychological outcomes. Furthermore, a more robust monitoring and follow-up scheme should be scaled up or instituted for patients with T2DM.

Self-care behaviors and associated factors among individuals with type 2 diabetes in Ghana: a systematic review

BACKGROUND

Self-care remains an effective model for diabetes management and care in low-and-middle-income countries due to the limited resources available for the clinical management of the disease and its complications This study examined adherence to self-care behaviors and associated factors among people with type 2 diabetes in Ghana.

METHODS

PubMed, PsycINFO, Scopus, Web of Science, Embase and Google scholar were used to identify quantitative observational studies published between 1990 and September 30, 2023. Studies exclusive to persons with type 2 diabetes ≥ 18 years of age in a Ghanaian setting were included in this review. Findings of primary studies were analyzed using narrative synthesis.

RESULTS

Twelve studies, presenting data on a total of 2,671 persons with type 2 diabetes, were included. All the studies were published in the last decade (2015-2022) and a majority of them were from the Greater Accra Region. The mean number of days (per week) participants adhered to a self-care behavior were in the ranges of 3.9-4.4 for diet, 4.2-4.8 for physical activity, 0.5-2.2 for self-monitoring of blood glucose (SMBG), and 2.9-5.0 for foot care. Adherence rates for medication were in the range of 33.5-84.5%. Patient-related factors, sociodemographic/economic-related factors, condition-related factors, and healthcare system-related factors were associated with various self-care behaviors.

CONCLUSION

Adherence to self-care behaviors among persons with type 2 diabetes in Ghana remains an ongoing challenge with significant variations in adherence among patients with different characteristics.

A multimedia program for caregivers of pediatric patients with chronic kidney disease in Guatemala

OBJECTIVES

A multimedia medication training program for parents and legal guardians of children with chronic kidney disease (CKD) aimed to improve comprehension CKD and general information about medications used in pediatric patients attending The Foundation for Children with Kidney Disease (FUNDANIER, Guatemala City).

METHODS

A quasi-experimental study was carried out to measure the impact of the educational intervention on medication knowledge, at FUNDANIER from September to October 2019. Means and standard deviations was used to described test results. A Wilcoxon test was performed, to compare scores of pre and post-tests. Odds Ratio (OR) was used to determine if there was an improvement in the knowledge score before and after the intervention. Results There was significant improvement in knowledge scores knowledge before and after the intervention(27/35 versus 33/35, P < 0.005). Mestizo participants had higher odds of improvement before and after the intervention (OR 7, CI: 0.6-78). Parent-guardians with prior education, and who spoke Spanish had higher odds of improved knowledge scores (OR 3.2, CI:0.3-35; OR 1.1 CI: 0.1-14 respectively).

CONCLUSION

Caregivers who participated in the educational workshop improved and retained information related to CKD comprehension and medications used. This study provides a model for educational modules that can be used, tested, and applied in other chronic disease settings in low to middle income countries.

PRACTICE IMPLICATIONS

A culturally relevant multimedia CKD educational platform was effective in improving medication knowledge among parent/guardians of children with CKD in a low literacy setting.

The relationship between health literacy and successful aging in elderly individuals with type 2 diabetes

OBJECTIVE

In the study, it was aimed to evaluate the relationship between health literacy and successful aging in elderly individuals with type 2 diabetes.

METHODS

This descriptive study was conducted with the participation of 415 elderly patients with type 2 diabetes who presented to the diabetics outpatient clinic between April-September 2021. The study data were collected through Identifying Information Form, Health Literacy Scale, and Successful Aging Scale. In the analysis of the data, descriptive statistics, Pearson correlation analysis, One-Way ANOVA, and student's t test were used.

RESULTS

Health Literacy Scale total mean score of the elderly individuals was found as 55.50 ± 6.08, and their Successful Aging Scale total mean score was determined to be 38.91 ± 2.05. A positive correlation was found between Health Literacy Scale total mean score and Successful Aging Scale total mean score, while a negative relationship was determined between Successful Aging Scale mean score and HbA1c values (p < 0.001).

CONCLUSION

As a result of the study, it was concluded that elderly patients with type 2 diabetes who had high levels of health literacy had high levels of successful aging as well.

Health literacy, self-efficacy, self-care behaviors, and glycemic control among older adults with type 2 diabetes mellitus: a cross-sectional study in Thai communities

BACKGROUND

Properly understanding the health information of people with type 2 diabetes mellitus (T2DM) is the basis for better risk factor management, which also positively affects their quality of life. The aim of this study was to investigate diabetes health literacy (HL), self-efficacy, and self-care behaviors associated with glycemic control among older adults with T2DM in northern Thai communities.

METHODS

A cross-sectional study was conducted among 414 older adults over the age of 60 diagnosed with T2DM. The study was conducted in Phayao Province from January to May 2022. Simple random sampling of the patient list for the Java Health Center Information System program was used. Questionnaires were used to collect data on diabetes HL, self-efficacy, and self-care behaviors. Blood samples were tested for estimated glomerular filtration rate (eGFR) and glycemic controls, such as fasting blood sugar (FBS) and glycated hemoglobin (HbA1c).

RESULTS

The mean age of participants was 67.1 years. FBS (mean ± SD = 108.5 ± 29.5 mg/dL) and HbA1c (mean ± SD = 6.6 ± 1.2%) levels were found to be abnormal in 50.5% (≥ 126 mg/dL) and 17.4% (≥ 6.5%) of the subjects, respectively. There was a strong correlation between HL and self-efficacy (r = 0.78), HL and self-care behaviors (r = 0.76), and self-efficacy and self-care behaviors (r = 0.84). The eGFR was significantly correlated with diabetes HL (r = 0.23), self-efficacy (r = 0.14), self-care behaviors (r = 0.16), and HbA1c (r = -0.16) scores. Linear regression after adjusting for sex, age, education, DM duration, smoking, and drinking alcohol showed that FBS level was inversely associated with diabetes HL (Beta = -0.21, R² = 11.0%), self-efficacy (Beta = -0.43, R² = 22.2%), and self-care behavior (Beta = -0.35, R² = 17.8%), whereas HbA1C level was negatively associated with diabetes HL (Beta = -0.52, R² = 23.8%), self-efficacy (Beta = -0.39, R² = 19.1%), and self-care behavior (Beta = -0.42, R² = 20.7%).

CONCLUSION

Diabetes HL was related to self-efficacy and self-care behaviors in elderly T2DM patients and was shown to influence their health, including glycemic control. These findings suggest that implementing HL programs to build competence in self-efficacy expectations is important for contributing to improvements in diabetes preventive care behaviors and HbA1c control.

Pharmacist-led intervention aimed at deprescribing and appropriate use of cardiometabolic medication among people with type 2 diabetes

BACKGROUND

Potential overtreatment with cardiometabolic medication (i.e., glucose lowering medication, antihypertensives and statins) has been observed in 10-40% of older people with type 2 diabetes (T2D).

OBJECTIVE

The potential effects of a pharmacist-led clinical medication review targeted at T2D patients who were at high risk of hypoglycaemia will be investigated.

METHODS

A quasi-experimental study was conducted in 14 Dutch community pharmacies. Patients with a high risk of hypoglycaemia were identified using a previously developed algorithm. Pharmacists confirmed eligibility and selected patients for the intervention. Remaining eligible patients were included as controls receiving usual care. The primary outcome was the proportion of intervention patients for whom an action on deprescribing or appropriate use of cardiometabolic medication was implemented. After three months, changes in cardiometabolic medication were compared between the intervention and control group using a Fischer exact test.

RESULTS

In total 90 intervention patients and 107 control patients were included. Intervention patients had an average age of 70, used on average 10 medications, five of which were cardiometabolic medication. For half of the intervention patients an action on deprescribing cardiometabolic medication was implemented (n = 25) and/or an advice about appropriate use of cardiometabolic medication was given (n = 22). In 48% of intervention patients at least one cardiometabolic medication (e.g. insulin, sulfonylurea, diuretic, beta-blocker, statin) was either stopped or reduced in dose compared to 31% of control patients (p = 0.018).

CONCLUSIONS

A pharmacist-led tailored clinical medication review has the potential to increase deprescribing and improve appropriate use of cardiometabolic medication in half of T2D patients at high risk of hypoglycaemia.

Knowledge, Attitudes, Perceptions, and Acceptance of COVID-19 Vaccination among Pharmacy and Non-Pharmacy Students

University students are a sub-group of the population at high risk of COVID-19 infection, and their judgments on vaccination affect the public attitudes towards vaccination. Thus, the present study aimed to assess the knowledge, attitudes, perceptions, and acceptance of the COVID-19 vaccine among pharmacy and non-pharmacy students. A cross-sectional study was conducted by enrolling pharmacy (375) and non-pharmacy (225) students from the universities in Lahore. Chi-square analysis was used for significant frequency distributions and a 5-point Likert scale was used to score attitude, perception, and acceptance. The majority of the students were aged between 19-24 years, hailing from urban and middle-class families with good self-reported health. The preferred vaccine was Pfizer, followed by Sinopharm and Sinovac. The major source of information was social media, followed by government campaigns and family members. The pharmacy students demonstrated better knowledge and positive attitudes toward COVID-19 vaccination. The non-pharmacy students scored higher for the questions based on scientific leads, myths, and baffling conspiracies. The non-pharmacy students showed higher hesitancy/barrier total scores related to their trust in the health system, COVID-19 vaccine storage, and efficacy. Data suggested that pharmacy students exhibited better knowledge, positive attitudes, and perceptions about COVID-19 vaccination. Overall, vaccine efficacy and safety were mutual concerns. Nonetheless, non-pharmacy students were hesitant due to mistrust in the health system of Pakistan.

Differences in the Mediating Role of HL in Socioeconomic Inequalities in Health Across Age Groups: Results from the Dutch Doetinchem Cohort Study

BACKGROUND

Although it is known that health literacy (HL) plays an explanatory role in educational inequalities in health, it is unknown whether this role varies across age groups.

OBJECTIVE

The purpose of this study was to investigate whether the mediating role of HL in educational inequalities in four health outcomes varies across age groups: age 46 to 58 years, age 59 to 71 years, and age 72 to 84 years.

METHODS

We used data from the Dutch Doetinchem Cohort Study, which included 3,448 participants. We included years of education as predictor, chronic illness prevalence and incidence, mental and self-perceived health as outcomes, and HL, based on self-report, as mediator. We used multiple-group mediation models to compare indirect effects across age groups.

KEY RESULTS

In the complete sample without age stratification, HL partly mediated the effect of education on all health outcomes except for incidence of chronic diseases. These indirect effect estimates were larger for subjective (self-perceived health, proportion mediated [PM] = 37%, and mental health, PM = 37%) than for objective health outcomes (prevalence of chronic disease, PM = 17%). For the prevalence of chronic disease, the indirect effect estimate was significantly larger among individuals age 46 to 58 years compared to individuals age 59 to 71 years and for incidence of chronic disease also compared to individuals age 72 to 84 years. All other indirect effect estimates did not differ significantly between age groups. Using an alternative cut-off point for HL or adjusting for cognitive functioning did not meaningfully change the results.

CONCLUSIONS

Overall, we found that the explanatory role of HL in educational inequalities in mental and subjective health was stable but that it varied across age groups for chronic diseases, where it was largest among individuals age 46 to 58 years. Future studies may investigate the benefits of starting to intervene on HL from a younger age but means to improve HL may also benefit the subjective health of older adults with lower education. [HLRP: HL Research and Practice. 2023;7(1):e26-e38.] Plain Language Summary: This study examined age-group differences in the mediating role of HL in the relationship between education and health. Overall, we found that the explanatory role of HL in educational inequalities in mental and subjective health was stable but that it varied across age groups for chronic diseases, where it was largest among individuals age 46 to 58 years compared to individuals age 59 to 71 years and individuals age 72 to 84 years.

Patients' and family members' knowledge, attitudes and perceived family support for SMBG in type 2 diabetes: a fuzzy-set qualitative comparative analysis

AIMS AND OBJECTIVES

To examine the combined effects of the patient's and family members' knowledge, attitudes and perceived family support on self-monitoring of blood glucose (SMBG) behaviour of patients with type 2 diabetes.

DESIGN

A cross-sectional design using the framework of knowledge-attitude-behaviour (KAB) combined with family support.

SETTING

Shanghai, China.

PARTICIPANTS

Seventy type 2 diabetes patient-family member dyads recruited from 26 residential committees in Shanghai were investigated. Twenty-three health providers were interviewed.

PRIMARY OUTCOME MEASURES

The knowledge, attitudes and perceived family support of patients' and their family members' data were measured through scales. Combined effects were analysed by a fuzzy-set qualitative comparative analysis (fsQCA) using fsQCA V.3.0. Other analyses and calculations were performed by STATA V.14.0.

RESULTS

SMBG was very poor (20%), and behaviour was characterised by 'multiple complications,' and 'all paths lead to the same destination' for patients. There were two solution paths toward patients' SMBG (solution coverage=0.4239, solution consistency=0.7604). One path was the combination of 'patients with low risk perception, the patients' and family members' perceived negative support', the other was the combination of 'patients with high risk perception, the patients' perceived negative support'. In both paths, basic knowledge serves as an auxiliary condition.

CONCLUSION

The study revealed that for patients with high and low risk perceptions that are relatively difficult to change, we could strengthen family support to achieve the desired SMBG behaviour. Knowledge is not a prerequisite to achieving SMBG. Moreover, negative family support plays a crucial role. Perceived family support by patients is more important than perceived family support by family members, which suggests that family members should improve support for patients so that the patients can perceive more family support.

The Influence of Family Caregiver Knowledge and Behavior on Elderly Diabetic Patients' Quality of Life in Northern Thailand

The quality of life (QoL) of elderly diabetic patients may be affected by caregiver factors, but this has received little empirical support. The objective of this cross-sectional study is to determine the influence of family caregivers’ diabetes knowledge and behavior on the QoL among elderly patients with diabetes mellitus (DM). The participants included 354 elderly patients with Type 2 DM and their family caregivers, who were recruited through multistage sampling from five districts in Chiang Mai, Thailand. Face-to-face interviews with DM patients were conducted using the Thai Simplified Diabetes Knowledge Scale (T-SDKS), the Thai version of the Diabetes Self-Management Questionnaire (DSMQ) for self-care behaviors, and the Thai version of the World Health Organization Quality of Life for Older People (WHOQOL-OLD) scale. For caregivers, their diabetes knowledge was measured by T-SDKS and patient-care or supportive behaviors were developed based on DSMQ. The results showed a moderate level of QoL among elderly diabetic patients. According to simple linear regression analysis, the QoL score among elderly DM patients was positively associated with their diabetes knowledge (B = 1.25), self-care behaviors (B = 3.00), caregivers’ knowledge (B = 0.97), and supportive behavior from caregivers (B = 2.92) at a significance level of p < 0.01. In the multivariable model, patients’ self-care behaviors (B = 1.58, p = 0.001), caregivers’ knowledge (B = 0.58, p = 0.001), and patient-care behaviors (B = 1.38, p = 0.004) were significantly associated with QoL among DM patients when controlling for patient factors, including age, body mass index (BMI), education, and living arrangements, which accounted for 27.0% of the variance. This indicates that caregivers’ adequate diabetes knowledge and appropriate supportive behaviors may impact the QoL of elderly diabetic patients. Health care providers should prioritize motivating and empowering family caregivers to pay more attention to the patient for the success goal.

From Health Campaign to Interpersonal Communication: Does Traditional Diet Culture Hinder the Communication of the Chinese Gongkuai Campaign?

Interpersonal communication is beneficial in promoting individuals' tendency to accept health-campaign-targeted behavior. Based on the protective action decision model, this study investigated the key factors underlying individual's interpersonal communication on the Gongkuai campaign, which was carried out during Coronavirus disease 2019 (COVID-19). The main goal of the Gongkuai campaign was to change traditional communal eating habits and reduce public health risks. An online questionnaire survey involving 618 respondents was conducted in China after the 2020 Gongkuai campaign propagated, and the data were analyzed by using the structural equation modeling technique. The results indicated that health campaign exposure is a critical determinant of perceived campaign-related knowledge and health risk perception, which are significant predictors of interpersonal communication. Meanwhile, campaign-related knowledge can elicit risk perception. Furthermore, campaign exposure influenced interpersonal communication in ways that traditional diet culture did not predict. Risk perception was also unaffected by traditional diet culture. It is worth noting that individuals' agreement with traditional diet culture does not hinder health campaign-generated interpersonal communication in the context of public health crisis. Based on the findings, theoretical and policy implications for motivating interpersonal communication were discussed, and research limitations were pointed out.

Providing evidence from practice: Evaluating 4.5 years of implementing diabetes education support program in carbohydrate management

OBJECTIVE

To evaluate personal and economical outcomes of CarbSmart, a 3-hour person-centered, theory-based program implemented throughout Australia, targeting optimal dietary carbohydrate management.

METHODS

More than 500 CarbSmart programs were implemented over 4.5 years. Pre-, post-, (N = 4656) and 3-month follow-up assessments (N = 188) of knowledge, empowerment, confidence, and patient activation were collected from people with diabetes. Participant satisfaction and potential annual cost-savings were calculated.

FINDINGS

Repeated measures ANCOVAs showed large improvements pre- to post-program in all outcome variables (d = 0.80-1.68), which were maintained at 3-month follow-up in a sub-sample. Participant satisfaction was high (Net Promoter Score = 72.3). Potential annual cost-savings nation-wide were estimated at US$512million.

CONCLUSION

This paper provides evidence that CarbSmart is effective in improving behavioral indicators of self-management outcomes in Australians living with diabetes.

PRACTICE IMPLICATIONS

CarbSmart has the potential to prevent diabetes-related complications. However, not engaging people living with diabetes with lower levels of patient activation at baseline was recognized as a future opportunity to improve the impact of our service. Strategies are needed to engage people with lower activation levels to improve outcomes in vulnerable and at-risk populations.

FUNDING

The development of CarbSmart was funded by Diabetes WA, the national implementation of CarbSmart by the National Diabetes Services Scheme, an initiative of the Australian Government.

LitKDM2 study: the impact of health Literacy and knowledge about the disease on the metabolic control of type 2 diabetes mellitus

AIMS

Diabetes mellitus (DM) is a common chronic disease with serious individual and socioeconomic consequences. Low health literacy (HL) has been associated with higher morbimortality. Health knowledge about DM (HK-DM) may also influence individual health. We aimed to assess HL and HK-DM in patients with type 2 DM and their associations with metabolic control.

METHODS

Our sample comprised 194 diabetic patients from a primary care health centre. We collected clinical and demographic data and applied two validated questionnaires, the Newest Vital Sign (NST) and Diabetes Knowledge Test (DKT), to assess HL and HK-DM, respectively. Metabolic control was defined as HbA1c < 7.0%. Participants were classified according to the NST as having "high likelihood of limited HL" (HLL-HL), "possibility of limited HL" (PL-HL), or "adequate HL" (A-HL) and by the DKT as having "low", "average" and "good" HK. Statistical analysis included logistic regression models, using p < 0.05 as a cut-off for statistical significance.

RESULTS

Overall, 72.7 and 34.7% of participants had HLL-HL and low HK-DM, respectively. A-HL (OR = 6.02; 95% CI: 1.691-21.450) and PL-HL (OR = 4.78; 95% CI: 1.350-16.899) were significantly associated with better metabolic control than HLL-HL. We did not find a significant association between HK-DM and metabolic control.

CONCLUSIONS

HL seems to be associated with better metabolic control. We also found a high prevalence of illiteracy and scarce knowledge about DM. Primary care physicians should promote HL to help patients achieve better metabolic control.

Structured diabetes self-management education and its association with perceived diabetes knowledge, information, and disease distress: Results of a nationwide population-based study

OBJECTIVE

To evaluate, how participation in structured diabetes self-management education (DSME) programs is associated with perceived level of knowledge about diabetes, information needs, information sources and disease distress.

METHODS

We included 796 ever- and 277 never-DSME participants of the population-based survey "Disease knowledge and information needs - Diabetes mellitus (2017)" from Germany. Data on perceived level of diabetes knowledge (12 items), information needs (11 items), information sources (13 items) and disease distress (2 indices) were collected. Multiple logistic regression analyses were used to examine the association of DSME-participation with these outcomes.

RESULTS

DSME-participants showed a higher level of diabetes knowledge compared to never-DSME participants, particularly in aspects concerning diabetes in general (odds ratio 2.53; 95% confidence intervals 1.48-4.33), treatment (2.41; 1.36-4.26), acute complications (1.91; 1.07-3.41) and diabetes in everyday life (1.83; 1.04-3.22). DSME-participants showed higher information needs regarding late complications (1.51; 1.04-2.18) and acute complications (1.71; 1.71-2.48) than DSME never participants. DSME-participants more frequently consulted diabetologists (5.54; 3.56-8.60) and diabetes care specialists (5.62; 3.61-8.75) as information sources. DSME participation was not associated with disease distress.

CONCLUSION

DSME is a valuable tool for improving individual knowledge about diabetes. However, DSME should focus more on psychosocial aspects to reduce the disease burden.

Carbohydrate Knowledge Observed to be Low in Vietnamese Women With Gestational Diabetes Mellitus

OBJECTIVE

To assess carbohydrate knowledge of Vietnamese women with gestational diabetes mellitus (GDM) and explore factors associated with carbohydrate knowledge.

METHODS

Vietnamese women (n = 100) with GDM completed an online questionnaire about self-efficacy in managing blood glucose, the habit of regularly self-monitoring blood glucose activities at home, and an adapted culturally tailored carbohydrate quiz for the target population.

RESULTS

Participants (30 ± 4 years) answered on average 51% of the carbohydrate knowledge questions correctly, showing most difficulty in identifying honey, milk, and orange juice as carbohydrate sources. Only 46% of participants correctly identified carbohydrate content on nutrition labels, and 58% practice self-monitoring blood glucose activities at home. Carbohydrate knowledge was positively associated with self-efficacy in blood glucose management (r² = 0.101, P = 0.003) and practicing self-monitoring blood glucose (r² = 0.064, P = 0.013).

CONCLUSIONS AND IMPLICATIONS

There is a need to provide nutrition education about carbohydrate knowledge and blood glucose control to Vietnamese women to manage GDM.

A qualitative study exploring the barriers to attending structured education programmes among adults with type 2 diabetes

BACKGROUND

Diabetes self-management education, a universally recommended component of diabetes care, aims to support self-management in people with type 2 diabetes. However, attendance is low (approx. 10%). Previous research investigating the reasons for low attendance have not yet linked findings to theory, making it difficult to translate findings into practice. This study explores why some adults with type 2 diabetes do not attend diabetes self-management education and considers how services can be adapted accordingly, using Andersen's Behavioural Model of Health Service Utilisation as a framework.

METHODS

A cross-sectional semi-structured qualitative interview study was carried out. Semi-structured interviews were conducted by telephone with 14 adults with type 2 diabetes who had verbally declined their invitation to attend diabetes self-management education in Bath and North East Somerset, UK, within the last 2 years. Data were analysed using inductive thematic analysis before mapping the themes onto the factors of Andersen's Behavioural Model.

RESULTS

Two main themes were identified: 'perceived need' and 'practical barriers'. The former theme explored participants' tendency to decline diabetes education when they perceived they did not need the programme. This perception tended to arise from participants' high self-efficacy to manage their type 2 diabetes, the low priority they attributed to their condition and limited knowledge about the programme. The latter theme, 'practical barriers', explored the notion that some participants wanted to attend but were unable to due to other commitments and/or transportation issues in getting to the venue.

CONCLUSIONS

All sub-themes resonated with one or more factors of Andersen's Behavioural Model indicating that the model may help to elucidate attendance barriers and ways to improve services. To fully understand low attendance to diabetes education, the complex and individualised reasons for non-attendance must be recognised and a person-centred approach should be taken to understand people's experience, needs and capabilities.

Change is possible: How increased patient activation is associated with favorable changes in well-being, self-management and health outcomes among people with type 2 diabetes mellitus: A prospective longitudinal study

OBJECTIVE

To examine the relationship between risk factors for low patient activation and change in patient activation, well-being, and health outcomes in people with type 2 diabetes mellitus (T2DM).

METHOD

A longitudinal prospective study was conducted with measurements at baseline and 20-week follow-up among 603 people with T2DM participating in a group-based walking intervention. Patient activation and risk factors were assessed using online questionnaires. Health outcomes were assessed in participants' general practices.

RESULTS

No association was found between risk factors for activation and change in patient activation. Patient activation significantly increased (t(602) = 2.53, p = 0.012) and was associated with an increase in emotional well-being (β = 0.22), exercise behavior (β = 0.17), general diet behavior (β = 0.20), and a reduction in BMI (β = -0.28), weight (β = -0.29), and HbA1c (β = -0.27).

CONCLUSION

Favorable changes in patient activation, self-management, well-being, and health outcomes occurred during a walking intervention, despite highly prevalent risk factors for low activation and less engagement in self-management.

PRACTICE IMPLICATIONS

Group-based walking interventions might empower people with T2DM to begin taking a larger role in their self-care and improve (mental) health outcomes. Vulnerable groups of patients (with multiple risk factors for low activation) can change and presumably need this kind of interventions to be able to change.

What are the self-management experiences of the elderly with diabetes? A systematic review of qualitative research

BACKGROUND

The number of elderly individuals with diabetes is dramatically increasing. Diabetes is a long-term condition and a noncommunicable disease and requires intensive daily self-management. Understanding of self-management from the patients’ perspectives is important to nurses, healthcare providers, and researchers and benefits people by improving their self-management skills.

AIM

To examine and synthesize qualitative studies that explore the experiences of elderly people in self-managing diabetes.

METHODS

Electronic databases were searched, including MEDLINE, CINAH, PsycINFO, PubMed, CNKI, and WANFADATA. Relevant research was identified by manually searching reference lists and gray literature. Only English and Chinese publications were included. The Critical Appraisal Skills Program was used to assess the quality of the research. The Confidence in the Evidence from Reviews of Qualitative research approach was used to assess the confidence of the findings.

RESULTS

A total of 10 qualitative studies were included, and content analysis was performed. Five themes were identified: The need for knowledge about diabetes care, support systems, functional decline, attitudes toward diabetes, and healthy lifestyle challenges.

CONCLUSION

This present review provides a deep and broad understanding of the experiences in the self-management of diabetes and can be valuable to nursing practice and provide recommendations for future research.

Diabetes knowledge, fatalism and type 2 diabetes-preventive behavior in an ethnically diverse sample of college students

Objective This study examined diabetes knowledge, health fatalism (the belief that health outcomes are outside one's control), and their interaction, as predictors of Type 2 Diabetes preventive behavior. Participants: Ethnically diverse college students (N = 345) without prior diagnosis of diabetes. Methods: Cross-sectional design using validated self-report measures. Results: Respondents answered approximately half of the diabetes knowledge items correctly. Physical activity and sedentary behavior were not predicted by diabetes knowledge, fatalism, or their interaction. Higher diabetes knowledge was associated with a healthier diet among individuals with low fatalism. Greater fatalism was associated with a poorer diet among individuals with moderate or high diabetes knowledge. Conclusions: Diabetes knowledge was moderate in this college student sample. Greater knowledge was linked with a healthier diet among those with sense of personal control over their health. College health educators may consider emphasizing modifiability of health behaviors in conjunction with Type 2 diabetes education efforts.

The Instruments Used to Assess Health Literacy and Pharmacotherapy Literacy of Diabetes Mellitus Type 2 Patients: A Scoping Review

Background: Patients with chronic diseases, like diabetes need to continuously perform tasks associated with self-management especially with medications they use. It is shown that the patients with diabetes with limited HL and PTHL cannot read medication labels correctly, may misuse their medications, spend much more on therapy and generally have difficulties in understanding printed care instructions and perceiving health advice and warnings. There has been an increasing demand for valid and reliable instruments for HL and PTHL assessment in this population. This review aims to search and critically discuss instruments used to assess HL and PTHL in people with type 2 diabetes and propose their use in different settings. Methods: Authors conducted a comprehensive, electronic search of original studies using a structured approach of the Scopus and PubMed databases, during November and the first 2 weeks of December 2020 to find relevant papers. The review was conducted in accordance with the Cochrane guidelines and the reporting was based on the PRISMA-ScR. The comparison of instruments was made by utilizing a comparison model related to their structure, measurement scope, range, psychometric properties, validation, strengths, and limitations. Results: The final number of included studies was 24, extracting the following identified instruments: Korean Functional Test HL, NVS, FCCHL, HLS-EU-47, TOFLHA, S-TOFHLA, REALM-R, 3-brief SQ, REALM, HLQ and DNT-15. In all, FCCHL and 3-brief SQ are shown with the broadest measurement scopes. They are quick, easy, and inexpensive for administration. FCCHL can be considered the most useful and comprehensive instrument to screen for inadequate HL. The limitation is that the English version is not validated. Three-brief SQ has many advantages in comparison to other instruments, including that it is less likely to cause anxiety and shame. These instruments can be considered the best for measuring functional HL in patients with diabetes mellitus type 2 and other chronic diseases. PTHL instruments (REALM and DNT-15) did not find the best application in this population. Conclusions: The future research should be directed in validation of the FCCHL in English and establishing of the structural validity of this questionnaire. Developing a specific PTHL questionnaire for this population will be of great help in management of their disease.

A cross-sectional analysis of health literacy: patient- versus family doctor-reported and associations with self-efficacy and chronic disease

BACKGROUND

Adequate health literacy (HL) levels contribute to good health outcomes and successful disease self-management in patients with chronic disease. Hence, it is essential that family doctors recognize patients with inadequate HL in need of additional support. This study had two aims: (1) to assess and compare patient self-reported versus family doctor-rated HL estimates, and (2) to explore associations between patient-reported HL, self-efficacy and chronic diseases.

METHODS

Participants in this cross-sectional survey were recruited through general practices in North Rhine-Westphalia, Germany. Patient self-reported HL was measured using the European Health Literacy Survey-16. Family doctor-rated HL was measured with an adapted version of this instrument. Using crosstabulations patient-reported and family doctor-rated HL estimates were compared for 346 patient-family doctor pairs. Associations between HL, self-efficacy and chronic disease were investigated using regression analyses.

RESULTS

Patient-reported and family doctor-rated HL estimates were concordant in 38% of all cases. On average family doctors rated their patients' HL lower than patients rated their own HL. The lower average family doctor ratings were more pronounced when patients were older, male and had more than one chronic disease. Female family doctors rated HL of male patients lower than their male colleagues. Patient reported HL had a significant positive association with self-efficacy. Mediation analysis provided support that self-efficacy acts as mediator between HL and the number of chronic diseases.

CONCLUSIONS

Our study findings indicate a significant discrepancy between patients' self-reported HL and externally rated HL by family doctors. A more systematic utilization of HL screeners might help reduce this discrepancy. At the same time, consideration should be given to enhancing communication training for family doctors and addressing critical HL skills in patient education.

Health Literacy, Processing Capacity, Illness Knowledge, and Actionable Memory for Medication Taking in Type 2 Diabetes: Cross-Sectional Analysis

BACKGROUND

Patient knowledge about the purpose of medications is crucial to ensure safe and correct use, so it is an important index of adherence in patients with chronic illness.

OBJECTIVE

We examined how health literacy and its components (processing capacity and knowledge about illness) influence memory for medication purposes.

DESIGN

We conducted a cross-sectional study to examine memory for medication purposes in relation to health literacy, processing capacity, and illness knowledge among patients with diabetes in outpatient clinics.

PARTICIPANTS

Six hundred seventy-four adults who were diagnosed with type II diabetes mellitus, age 40 years or older, taking 5 or more current medications, native speakers of English, and with glycosylated hemoglobin (HbA1c) of 6.0 or more, were recruited to the study.

MAIN MEASURES

We included measures of processing capacity, illness knowledge, health literacy, and actionable memory for medication taking (memory for medication purpose).

KEY RESULTS

Results suggested an association between health literacy and both processing capacity and health knowledge, with some evidence that knowledge can compensate for limited processing capacity in order to maintain health literacy. Furthermore, health literacy was associated with memory for medication purposes, with processing capacity and health knowledge partly mediating this association. This pattern of results supports the process-knowledge model of health literacy.

CONCLUSIONS

Our findings establish the role of health literacy in medication taking, in relation to broader cognitive abilities and knowledge. Implications for improving the learning of medication purpose among diverse older adults with chronic illness are discussed.

TRIAL REGISTRATION

NIH trial registry number: NCT01296633.

Large diversity in Danish health literacy profiles: perspectives for care of long-term illness and multimorbidity

BACKGROUND

Health literacy is an important, modifiable, social determinant of health. This study aims to explore health literacy challenges of people with long-term illness or multimorbidity and provide detailed profiles revealing health literacy strengths and weaknesses within a Danish population.

METHODS

In this cross-sectional study among Danish individuals (n = 490), health literacy was assessed using the nine-scale Health Literacy Questionnaire (HLQ). Using multiple logistic regression and hierarchical cluster analysis, we estimated the association between HLQ scale scores and the likelihood of long-term illness and multimorbidity, and identified socio-demographic and health characteristics related to profiles of health literacy strengths and weaknesses.

RESULTS

An increase in 'actively managing my health' and 'social support for health' decreased the odds of having a long-term illness [odds ratio, OR 0.53 (0.31-0.9); OR 0.43 (0.24-0.74)] and multimorbidity [OR 0.51 (0.26-0.98); OR 0.33 (0.17-0.62)], respectively. Conversely, an increase in 'healthcare provider support' increased the odds of having long-term illness [OR 2.97 (1.78-5.08)] and multimorbidity [OR 2.94 (1.53-5.87)], respectively. Five profiles were identified based on the cluster analysis. Each cluster was characterized by specific health characteristics, e.g. Cluster A by better health status (χ2 = 39.976 (4), P < 0.001) and well-being (χ2 = 28.832 (4), P < 0.001) and Cluster D by poor health status (χ2 = 39.976 (4), P < 0.001) and increased likelihood of long-term illness (χ2 = 18.641 (4), P < 0.001).

CONCLUSIONS

The association of health literacy with long-term illness and multimorbidity in combination with the health literacy profiling based on cluster analysis provides a comprehensive needs assessment and a promising starting point for the development of health literacy responsive interventions.

Type 2 diabetes patients' views on prevention of hypoglycaemia - a mixed methods study investigating self-management issues and self-identified causes of hypoglycaemia

Background

Hypoglycaemia is a common and potentially avoidable adverse event in people with type 2 diabetes (T2D). It can reduce quality of life, increase healthcare costs, and reduce treatment success. We investigated self-management issues associated with hypoglycaemia and self-identified causes of hypoglycaemia in these patients.

Methods

In this mixed methods study qualitative semi-structured interviews were performed, which informed a subsequent quantitative survey in T2D patients. All interviews were audio recorded, transcribed verbatim and coded independently by two coders using directed content analysis, guided by the Theoretical Domains Framework. Descriptive statistics were used to quantify the self-management issues and causes of hypoglycaemia collected in the survey for the respondents that had experienced at least one hypoglycaemic event in the past.

Results

Sixteen participants were interviewed, aged 59–84 years. Participants perceived difficulties in managing deviations from routine, and they sometimes lacked procedural knowledge to adjust medication, nutrition or physical activity to manage their glucose levels. Grief and loss of support due to the loss of a partner interfered with self-management and lead to hypoglycaemic events. Work ethic lead some participant to overexerting themselves, which in turn lead to hypoglycaemic events. The participants had difficulties preventing hypoglycaemic events, because they did not know the cause, suffered from impaired hypoglycaemia awareness and/or did not want to regularly measure their blood glucose. When they did recognise a cause, they identified issues with nutrition, physical activity, stress or medication. In total, 40% of respondents reported regular stress as an issue, 24% reported that they regularly overestimated their physical abilities, and 22% indicated they did not always know how to adjust their medication. Around 16% of patients could not always remember whether they took their medication, and 42% always took their medication at regular times. Among the 83 respondents with at least one hypoglycaemic event, common causes for hypoglycaemia mentioned were related to physical activity (67%), low food intake (52%), deviations from routine (35%) and emotional burden (28%). Accidental overuse of medication was reported by 10%.

Conclusion

People with T2D experience various issues with self-managing their glucose levels. This study underlines the importance of daily routine and being able to adjust medication in relation to more physical activity or less food intake as well as the ability to reduce and manage stress to prevent hypoglycaemic events.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-021-01466-0.

Development of a plain-language guide for discussing breast cancer genetic counseling and testing with patients with limited health literacy

PURPOSE

Due to limited health literacy and resulting ineffective communication between healthcare professionals and patients, not all eligible patients are offered breast cancer genetic counseling and testing. We aimed to develop a plain-language guide to increase effective communication about genetic counseling and testing with breast cancer patients with limited health literacy.

METHODS

Together with oncological healthcare professionals, we drafted a list of jargon words frequently used during (breast) cancer genetic counseling. In a focus group interview with breast cancer counselees with limited health literacy, who had received genetic counseling before, we reformulated these words in plain language. Low-literate individuals, who are not familiar with breast cancer care or genetic counseling, reflected on the draft of the guide. Completeness, acceptability, and perceived usability were tested in an online questionnaire among healthcare professionals.

RESULTS

The result is a plain-language guide for genetic counseling and testing with 33 frequently used jargon words and a reformulation of these words in plain language. Acceptability and perceived usefulness of the guide among healthcare professionals (n = 58) were high.

CONCLUSION

The plain-language guide provides opportunities to facilitate communication about genetic counseling and testing with patients with limited health literacy and could enhance opportunities for patients to make informed decisions to participate in genetic testing. As the intention from healthcare professionals to use the plain-language guide is high, implementation of the guide in a real-life setting seems promising.

The boomerang effect of tuberculosis knowledge and self-efficacy on Chinese parents' intention to seek timely treatment and adhere to doctors' regimens

OBJECTIVE

The present study tested the level of tuberculosis (TB) knowledge of Chinese parents whose children attended kindergarten, primary school, and middle school, and examined whether their TB knowledge and self-efficacy in TB management exhibited a curvilinear relationship with their intention to seek timely TB treatment and adhere to doctors' regimens if their children are infected with TB.

METHODS

An online cross-sectional survey (N = 1129) was conducted. TB knowledge was assessed based on the manual provided by the Chinese Center for Disease Control and Prevention (CDC). Hierarchical polynomial regression was conducted to test the proposed curvilinear relationships.

RESULTS

Chinese parents lacked knowledge about risks of TB and how to prevent TB. TB knowledge and self-efficacy in TB management motivated Chinese parents to seek timely TB treatment and adhere to doctors' regimens, but too much knowledge and self-efficacy predicted both intentions negatively.

CONCLUSION

Excessive levels of self-efficacy in self-management and health knowledge could backfire.

PRACTICE IMPLICATION

Practitioners should elevate Chinese parents' perceptions of severity of TB and susceptibility to TB. Additionally, health education should not be limited to providing medical facts but offer guidance on how to access professional medical resources. Self-efficacy in self-management should not be elevated.

Type 2 diabetes self-management schemas across diverse health literacy levels: a qualitative investigation

OBJECTIVE

The aim of this study was to explore how people with diabetes and diverse health literacy levels conceptualise their experience and efforts to engage in self-management behaviours (their self-management 'schemas').

DESIGN

A qualitative design was applied.

METHODS

Twenty-six people in Sydney, Australia, took part in semi-structured interviews, which were audio-recorded and coded using Framework analysis.

RESULTS

Half the participants (54%) had limited health literacy, whereas 38% adequate health literacy (using Newest Vital Sign). Regardless of health literacy, people described how monitoring increased self-management awareness and signalled periods of low self-management ('lulls'). Accounts of monitoring to sustain motivation were more apparent for participants with adequate health literacy. Most participants described simple and flexible rules (e.g. use artificial sweeteners; eat in moderation). Two schemas related to 'lulls': a 'problem-solving orientation' depicted lulls as inevitable and was associated with varied coping strategies; a 'willpower orientation' attributed lulls to lack of 'willpower,' and described willpower as a main coping strategy.

CONCLUSION

There is considerable variation in how people think about their diabetes self-management and the strategies they use. Health literacy may contribute to some of this variation. Self-management interventions could benefit from depicting motivation as fluctuating and challenging ideas about willpower and self-blame.

Health Literacy Mediates the Association Between Socioeconomic Status and Productive Aging Among Elderly Chinese Adults in a Newly Urbanized Community

Productive aging, or older adults engaging in paid or unpaid activities that produce socially valued goods or services, has been suggested to have the beneficial impact on older adults' health and well-being. We performed a cross-sectional study to examine the influence of health literacy on the relationship between socioeconomic status (SES) and productive aging among older Chinese adults in a newly urbanized community. Data was collected from 995 older adults from a newly urbanized community between June and August 2013 in Chengdu, China. We used structural equation modeling (SEM) to test the hypothesized relationship among SES, health literacy and productive aging. Results showed that education attainment and income had a direct positive effect on health literacy (β = 0.47and β = 0.15, respectively). Education had a partial indirect effect on productive aging through health literacy (β = 0.27). And health literacy was an important factor in improving the productive aging of the elderly. Interventions targeting health education and health promotion should be taken to improve health literacy of older adults under the background of urbanization, especially for those with lower SES.

Building a House of Skills-A Study of Functional Health Literacy and Numeracy among Patients with Type 2 Diabetes in Hungary

The purpose of this study is to explore functional health literacy (FHL) and numeracy skills in an insulin-treated, type 2 diabetes mellitus (T2DM) patient population, and their impact on diabetes self-care activities. A non-experimental, cross-sectional quantitative design was used for this study. The sample consisted of 102 T2DM patients on insulin therapy, including 42 males and 60 females, with a mean age of 64.75 years (SD = 9.180) and an average diabetes duration of 10.76 years (SD = 6.702). Independent variables were sociodemographic variables (e.g., age, educational level, etc.) and diabetes and health-related factors (e.g., duration of diabetes (years), the frequency of blood glucose testing/day, etc.). For this study, the participants completed the reading comprehension exercise from the Short Test of Functional Health Literacy (S-TOFHLA) and the Shortened Version of the Diabetes Numeracy Test (DNT-15), which specifically evaluates the numeracy skills of patients living with diabetes. The associations between the variables were examined with Spearman’s rank correlation. Multivariate regression analysis was performed to examine whether measured FHL skills impact diabetes self-care activities. We found that DNT-15 test (β = 0.174, t(96) = 2.412, p < 0.018) had significant effect on the frequency of blood glucose testing/day. Moreover, the problem areas for patients with T2DM mostly included multi-step calculations according to food label interpretations, and adequate insulin dosage based on current blood glucose levels and carbohydrate intake. The results of regression analyses and Spearman’s rank correlation indicated that limited FHL and diabetes numeracy skills not only influenced the participants’ behaviors related to self-management, but they also affected their health outcomes. Thus, besides the personalization of insulin treatment, it is indispensable to provide more precise information on different types of insulin administration and more refined educational materials based on medical nutrition therapy.

Health Literacy in Adult Oncology: An Integrative Review

PROBLEM IDENTIFICATION

Patients with cancer face high expectations for performing health literacy activities necessary for self-management and decision making, but only 12% of adults in the United States are proficient in health literacy. This review explores evidence regarding what is known about functional, interactive, and critical health literacy in adult oncology populations.

LITERATURE SEARCH

The review was conducted by searching extensively in the CINAHL® Plus database.

DATA EVALUATION

Of 614 articles retrieved from the literature search, 22 were included in the final sample. Most were cross-sectional, descriptive, correlational studies.

SYNTHESIS

Health literacy research in the United States focuses primarily on functional health literacy, but studies that include interactive and/or critical health literacy indicate their applicability in adult oncology populations.

IMPLICATIONS FOR RESEARCH

Additional research is needed to clarify the role of health literacy in cancer care to develop effective interventions that facilitate self-management and decision making.

Effects of Objective and Subjective Health Literacy on Patients' Accurate Judgment of Health Information and Decision-Making Ability: Survey Study

Background

Interpreting health information and acquiring health knowledge have become more important with the accumulation of scientific medical knowledge and ideals of patient autonomy. Health literacy and its tremendous success as a concept can be considered an admission that not all is well in the distribution of health knowledge. The internet makes health information much more easily accessible than ever, but it introduces its own problems, of which health disinformation is a major one.

Objective

The objective of this study was to determine whether objective and subjective health literacy are independent concepts and to test which of the two was associated more strongly with accurate judgments of the quality of a medical website and with behavioral intentions beneficial to health.

Methods

A survey on depression and its treatments was conducted online (n=362). The Newest Vital Sign was employed to measure objective, performance-based health literacy, and the eHealth Literacy Scale was used to measure subjective, perception-based health literacy. Correlations, comparisons of means, linear and binary logistic regression, and mediation models were used to determine the associations.

Results

Objective and subjective health literacy were weakly associated with one another (r=0.06, P=.24). High objective health literacy levels were associated with an inclination to behave in ways that are beneficial to one’s own or others’ health (Exp[B]=2.068, P=.004) and an ability to recognize low-quality online sources of health information (β=–.4698, P=.005). The recognition also improved participants’ choice of treatment (β=–.3345, P<.001). Objective health literacy helped people to recognize misinformation on health websites and improved their judgment on their treatment for depression.

Conclusions

Self-reported, perception-based health literacy should be treated as a separate concept from objective, performance-based health literacy. Only objective health literacy appears to have the potential to prevent people from becoming victims of health disinformation.

Health Literacy and Quality of Life in Young Adults From The Belgian Crohn's Disease Registry Compared to Type 1 Diabetes Mellitus

Background and Aims: The management of chronic inflammatory bowel diseases in youth is challenging. We aimed to determine health literacy (HL), quality of life (QoL) and clinical outcomes in young adults from the BELgian CROhn's disease registry (BELCRO) in comparison to type 1 diabetes mellitus (DM) as a control. Methods: In this prospective and observational study, young adults with Crohn's disease (CD) diagnosed < 18 years and with > 5 years disease duration and a comparable group of patients with DM completed validated HL, QoL and work productivity and activity impairment questionnaires (HLS-EU-Q16, EQ-5D-5L and WPAI). HL was scored as sufficient (13-16), problematic (9-12) or inadequate (0-8). QoL was dichotomized into "no problems" (EQ-5D level 1) or "problems" (EQ-5D levels 2 to 5). Non-parametric (Mann-Whitney U) analyses and Spearman correlations were performed. Results: A total of 52 CD (median [IQR] age of 25.0 [23.8-27.0], 64% male) and 50 DM (age 20.0 [19.0-22.0], 50% male) patients were included. HL was 14.0 [11.0-16.0] for CD and 14.0 [11.3-14.8] for DM (p = 0.6) with similar proportions of sufficient (60 vs. 68%, p = 0.4), problematic (34 vs. 26%, p = 0.3) and inadequate HL (both 6%, p = 1). Although QoL was comparable for CD and DM (77.0 [68.8-82.0] vs. 75.0 [65.0-80.0] %, p =0.4), CD had a trend for higher pain/discomfort (50 vs. 32%, p = 0.06). HL and QoL correlated in CD (r = 0.6, p < 0.001) and DM patients (r = 0.6, p < 0.001). Fewer CD patients with recent hospitalization/surgery had sufficient HL (31 vs. 69%, p = 0.01) and had lower QoL (70.0 [60.0-77.0] vs. 80.0 [70.0-85.0], p = 0.04) compared to those without. Conclusions: Selected young Belgian adults suffering from CD for >5 years have similar and sufficient HL compared to DM patients. However, CD patients requiring hospitalization/surgery have lower HL, which indicates the need for targeted educational programs.

Health Literacy Interventions to Improve Health Outcomes in Low- and Middle-Income Countries

BACKGROUND

Health care systems in many low- and middle-income countries (LMICs) face considerable challenges in providing high-quality, affordable, and universally accessible care. Feasible solutions to these issues require health literacy (HL) interventions for people who live in LMICs. Low HL is a significant problem in many LMICs because of the low levels of general literacy and poorly resourced and functioning health systems. A comprehensive understanding of HL interventions is essential to determine whether these interventions meet the health information needs of people who live in LMICs and to develop other effective HL interventions specifically for people who live in LMICs, improve health outcomes, and reduce inequalities.

METHODS

A medical research librarian developed and implemented search strategies to identify relevant evidence. Included studies needed to contain HL in LMICs component to understand or evaluate HL interventions that target people who live in LMICs. Two reviewers selected studies, conducted quality assessments, and extracted data by using standard forms. Discussion or third-party adjudication resolved disagreements. The collected data include the design of the study, type of HL intervention, target audience, theoretical influences, approaches to evaluating the intervention delivered, intervention received, intervention fidelity, intervention reach, data analysis, and study outcomes.

KEY RESULTS

The reviewers systematically analyzed the data from 23 published research studies, including 20 quantitative, 1 qualitative, and 2 mixed-method studies, on HL interventions to improve the health outcomes in LMICs. The various HL interventions for different groups of the population depend on the health outcomes of the study. The reviewers identified four themes: traditional HL interventions, art-based HL interventions, interactive learning strategies, and technology-based HL interventions. The researchers of a few studies also used multicomponent interventions to improve the HL of the population.

DISCUSSION

Despite global improvements in health indicators over time, such as decreased mortality and morbidity, significant challenges remain regarding the quality of the delivery of health care in many LMICs. All of the HL interventions were effective and significantly improved the knowledge and awareness of the population. However, based on the literature review, the reviewers found significant evidence that only a limited number of HL interventions are delivered through innovative and technological learning strategies. In addition, the sustainability and scalability of these interventions is not clear. Therefore, future research on sustainability measures for effective HL interventions in LMICs is still needed. [HLRP: Health Literacy Research and Practice. 2020;4(4):e250-e266.].

Adequacy of health literacy and its effect on diabetes self-management: a meta-analysis

This study evaluated the role of health literacy (HL) in the self-management of diabetes. A literature search was conducted in electronic databases and studies were selected using precise eligibility criteria. A meta-analysis was conducted to estimate the HL adequacy rate, factors affecting the adequacy of HL and correlations between HL and diabetes self-management variables. Thirty-three studies were included in the analysis. The HL adequacy rate was 67% (95% confidence interval (CI) 57, 76). Compared with patients with inadequate HL, patients with adequate HL were younger (mean difference -5.2 years; 95% CI -7.2, -3.2; P<0.00001), more likely to have a high school or higher level of education (odds ratio (OR) 8.39; 95% CI 5.03, 13.99]; P<0.00001) and were less likely to belong to a low-income group (OR 0.36; 95% CI 0.23, 0.56; P<0.00001). HL was positively correlated with self-monitoring (r=0.19; 95% CI 0.11, 0.27; P<0.00001), dietary and physical care (r=0.12; 95% CI 0.07, 0.18; P=0.009), diabetes knowledge (r=0.29; 95% CI 0.09, 0.45; P<0.001), self-efficacy (r=0.28; 95% CI 0.15, 0.41; P<0.00001), self-care (0.24; 95% CI 0.16, 0.31; P<0.00001), formal education (r=0.35; 95% CI 0.18, 0.53; P<0.00001) and social support (r=0.2; 95% CI 0.07, 0.33; P<0.00001). Patient age (r=-0.28; 95% CI -0.39, -0.17; P<0.00001) was inversely correlated with HL. In conclusion, 67% of diabetes patients had adequate HL, with a higher rate among better educated and higher income groups. HL had a statistically significant but weak positive correlation with diabetes self-management variables.

Adherence to the oral contraceptive pill: the roles of health literacy and knowledge

OBJECTIVE

The oral contraceptive pill is the most widely used method of contraception and when adhered to perfectly is 99% effective at preventing pregnancy. However, adherence to the pill is relatively low. Knowledge has shown to be important in continuation of the pill, and previous research shows the importance of health literacy in adhering to medication in chronic illnesses, but its role has yet to be explored in this behavior.

METHODS

This cross-sectional study examined the associations between health literacy, knowledge of the pill and adherence, as well as the predictive ability of these two variables and their interaction, in predicting adherence. Recruited through CloudResearch, 193 women (M age = 32.63 years, SD = 5.98) residing in the United States completed the Health Literacy Skills Instrument - Short Form, a previously validated measure of oral contraceptive pill knowledge and the Medication Adherence Report Scale.

RESULTS

Results showed a strong positive correlation between health literacy and adherence (r = .76) and moderate associations between health literacy and knowledge (r = .42), and knowledge and adherence (r = .42). The final model of the hierarchical multiple regression accounted for 59.8% of variance in adherence, with health literacy (β = .69) and length of time taking the pill (β = .13) the only significant predictors of adherence.

CONCLUSION

Family planning clinics should consider assessing the patient's health literacy skills before prescribing the pill to ensure patients fully understand the requirements.

Validation of the International Classification of Functioning, Disability and Health (ICF) core set for Diabetes Mellitus from nurses' perspective using the Delphi method

Purpose: To explore content validity of the ICF core set for Diabetes Mellitus from nurses' perspective.Materials and methods: A two-round Delphi study was conducted with nurses specialized in diabetes care, who were recruited by purposive sampling. Level of agreement on relevance of ICF categories was calculated using Item-level Content Validity Index.Results: Twenty-seven nurses judged 147 second-level ICF categories on relevance for people with Diabetes Mellitus. Agreement was reached on 65 (44.2%) categories, of which 46 were from the ICF core set for Diabetes Mellitus, 17 were from previous validation studies, and two were additional categories that were mentioned as relevant. Forty-six out of the 65 categories were derived from the component body functions and structures. No agreement was reached on 82 (55.8%) categories, of which 33 were derived from the component environmental factors.Conclusions: Content validity of the ICF core set for Diabetes Mellitus was partially supported by specialized nurses. Agreement was predominantly reached on biomedical categories. Content validity of categories derived from environmental factors received little support.Relevance: The nursing profession should be aware of a gap between the current biomedical focus and the desired biopsychosocial approach; the latter of which is recommended in chronic care.IMPLICATIONS FOR REHABILITATIONThe International Classification of Functioning, Disability and Health (ICF) encourages a biopsychosocial approach in health care, and ICF core sets, such as the core set for Diabetes Mellitus, are useful in identifying the needs of patients.Content validity of the ICF core set for Diabetes Mellitus was partially supported by nurses specialized in diabetes care; agreement was predominantly reached on biomedical categories.The nursing profession should be aware of a potential gap between the current biomedical focus and a desired biopsychosocial approach, which is particularly recommended in chronic care.It is recommended that nurses take part in future revisions of ICF core sets; a multidisciplinary approach enables members to learn from each other's perspectives, including from those of patients.

Influence of Health Literacy on Effects of Patient Rating Websites: Survey Study Using a Hypothetical Situation and Fictitious Doctors

Background

Physician rating websites (PRWs) are a device people use actively and passively, although their objective capabilities are insufficient when it comes to judging the medical performance and qualification of physicians. PRWs are an innovation born of the potential of the Internet and boosted very much by the longstanding policy of improving and encouraging patient participation in medical decision-making. A mismatch is feared between patient motivations to participate and their capabilities of doing so well. Awareness of such a mismatch might contribute to some skepticism of patient-written physician reviews on PRWs.

Objective

We intend to test whether health literacy is able to dampen the effects that a patient-written review of a physician’s performance might have on physician choice.

Methods

An experiment was conducted within a survey interview. Participants were put into a fictitious decision situation in which they had to choose between two physicians on the basis of their profiles on a PRW. One of the physician profiles contained the experimental stimulus in the form of a friendly and a critical written review. The dependent variable was physician choice. An attitude differential, trust differential, and two measures of health literacy, the newest vital sign as an example of a performance-based measure and eHealth Literacy Scale as an example of a perception-based measure, were tested for roles as intermediary variables. Analysis traced the influence of the review tendency on the dependent variables and a possible moderating effect of health literacy on these influences.

Results

Reviews of a physician’s competence and medical skill affected participant choice of a physician. High health literacy dampened these effects only in the case of the perception-based measure and only for the negative review. Correspondingly, the effect of the review tendency appeared to be stronger for the positive review. Attitudes and trust only affected physician choice when included as covariants, considerably increasing the variance explained by regression models.

Conclusions

Findings sustain physician worries that even one negative PRW review can affect patient choice and damage doctors’ reputations. Hopes that health literacy might raise awareness of the poor basis of physician reviews and ratings given by patients have some foundation.

Field-Testing and Refinement of the Organisational Health Literacy Responsiveness Self-Assessment (Org-HLR) Tool and Process

Health literacy refers to the skills and knowledge that influence a person's ability to access, understand and use information to make health-related decisions, which are influenced by the complexity of their health needs and the demands health services place on them. The aim of this study was to field-test the Organisational Health Literacy Responsiveness (Org-HLR) tool and process to determine their utility in assessing health literacy responsiveness and for supporting organisations to plan health literacy-related improvement activities. Four organisations in Victoria, Australia, field-tested the Org-HLR tool. Data were collected through direct observation, participant feedback, and focus groups. Forty-three individuals participated in field-testing activities, and 20 took part in focus group meetings. Themes relating to the applicability and utility of the Org-HLR self-assessment tool and process were identified. Field-testing resulted in a number of refinements to the tool and process. Twenty-eight indicators were removed, 29 were rephrased to improve their clarity, and four new indicators were added. The revised Org-HLR self-assessment tool contains six dimensions, 22 sub-dimensions and 110 performance indicators. The Org-HLR tool and process were perceived as useful for assessing health literacy responsiveness, prioritising improvement activities, and establishing a benchmark for monitoring and evaluation of improvements over time. Testing generated an improved Org-HLR tool and assessment process that are likely to have utility across a broad range of health and social service sector organisations.

Explaining variance in health literacy among people with type 2 diabetes: the association between health literacy and health behaviour and empowerment

Background

To reflect the health literacy (HL) skills needed for managing type 2 diabetes (T2DM) in everyday life, HL in people with T2DM should be measured from a broader perspective than basic skills, such as proficiency in reading and writing. The HLS-Q12, based on the European Health Literacy Survey Questionnaire (HLS-EU-Q47), assesses four cognitive domains across three health domains. International studies on people with T2DM show inconsistent results regarding the association between HL and general health and the association between HL and glycaemic control. Moreover, knowledge is needed related to the link between HL and empowerment for those with T2DM. The aims of this study were to examine the association between i) HL and general health and diabetes outcomes, ii) HL and health behaviours and iii) HL and empowerment in people with T2DM.

Methods

During March and April 2015, 388 adults with T2DM responded to a paper-and-pencil self-administered questionnaire. A sequential multiple regression analysis was applied to explore the association between HL, as measured by the HLS-Q12, and health conditions, HbA1c, health behaviours and empowerment.

Results

For people with T2DM, higher levels of HL were associated with higher levels of education, better overall health conditions and higher self-perceived empowerment. No empirical evidence strengthening either the link between HL and glycaemic control or the link between HL and health behaviours was found.

Conclusions

The independent variables education level, overall health condition and empowerment explained about one-third of the total observed variance in HL.

Functional health literacy among left-behind students in senior high schools in an ethnic minority area: A cross-sectional study

To verify the validity of functional health literacy scale and analyze what influences functional health literacy.Using convenience sampling method based on cross-sectional data to select 589 left-behind senior high-school students in an ethnic minority area, using the functional health literacy scale.The scale results were relatively strong, and the absolute fitness index, value-added fitness index, and simple fitness index reached the fitness standards. The overall functional health literacy score was (0.65 ± 0.12), which falls within the upper middle class. Gender(t = 2.40, P < .05), ethnicity (t = 4.28, P < .001), place of residence (t =  = 4.51, P < .001), mother's education level (F = 3.608, P < .05), self-assessment of grades for 1 year (F = 25.781, P < .001), and whether the participant liked the health education content (F = 9.416, P < .001) had impacts on overall functional health literacy.The study results show that relatively satisfactory reliability and validity and can be applied further analysis for improving students functional health literacy levels.

The Association of Health Literacy Level with Self-Care Behaviors and Glycemic Control in a Low Education Population with Type 2 Diabetes Mellitus: A Cross-Sectional Study in Iran

INTRODUCTION

Promoting Health Literacy (HL) can be a priority in strategic healthcare planning of the countries. Low HL is prevalent in some societies which make barriers to successful self-care of diseases. The aim of this study was to examine the association of HL with self-care behaviors and glycemic control in a low education population with type 2 diabetes mellitus.

METHODS

This cross-sectional study was conducted in Sarab city, Iran. The 192 participants were patients diagnosed as type 2 diabetes and with low level of education. Convenient sampling method was applied and the participants were chosen by their medical records in health-care centers. To collect data a valid and reliable tool was used based on HL dimensions and self-care behaviors. Using hierarchical logistic regression, the possible association of variables with self-care behaviors and glycemic control was assessed.

RESULTS

The mean age of study participants was 58.12 (±11.83) years. A 28.8% of the variation in the self-care behaviors is explained by the HL and the demographic variables (R= 0.288%; p-value<0.05). Furthermore, decision-making was the strongest predictor of self-care behaviors (β= 0.451). Approximately 80% of the variation in the HbA1c is explained by the HL, self-care behaviors, and the demographic variables (R= 0.804%; p-value<0.05).

CONCLUSION

This study revealed that the HL dimensions predicted approximately one-fourth of self-care behaviors and the self-care behaviors and HL dimensions about eight-tenths of HbA1c in this population. These findings call for the need for interventional programs on HL to improve the self-care behaviors and HbA1c control.

Health literacy and depression in women with type 2 diabetes mellitus

OBJECTIVES

The prevalence of diabetes mellitus has recently increased in Taiwan, and depression is common among these patients. Moreover, a lack of health literacy may lead to depression. In this study, we explored the correlation between health literacy and depression in diabetic women.

METHODS

In this cross-sectional study, 152 women with type 2 diabetes mellitus were recruited from the outpatient clinic of a regional teaching hospital in Taiwan. The data were collected through medical records and a self-reported structured questionnaire, which included items on basic attributes, self-rated health status, the Center for Epidemiologic Studies Depression Scale (CES-D), and Chinese Health Literacy Scale for Diabetes (CHLSD). The results were analyzed using descriptive statistical analyses, bivariate correlation tests, and linear regression analyses.

RESULTS

One hundred thirty-five valid questionnaires were obtained. Approximately 20% of the participants had a higher tendency toward depression as per their CES-D score, and the CHLSD results showed that 13.33% had poor health literacy. There was a negative correlation between health literacy and depressive tendencies after adjusting for self-rated health status, economic satisfaction status, employment status, and education level using multivariate linear regression analyses. For each 1-point rise in the CHLSD score, the CES-D score decreased by 0.17 points (z=-2.05, p=0.042).

CONCLUSIONS

A negative correlation was identified between health literacy and depression. Self-rated health status, economic satisfaction, employment status, and higher education level are factors that also affect depressive tendency among diabetic women.

Validating the Functional, Communicative, and Critical Health Literacy Scale Using Rasch Modeling and Confirmatory Factor Analysis

BACKGROUND AND PURPOSE

The functional, communicative, and critical health literacy (FCCHL) scale is widely used for assessing health literacy (HL) in people with chronic diseases, such as type 2 diabetes (T2DM). Despite related subscales, researchers continue to apply a consecutive modeling approach, treating the three subscales as independent. This article studies the psychometric characteristics of the FCCHL by applying multidimensional modeling approaches.

METHODS

Rasch modeling and confirmatory factor analyses were applied to responses (paper-and-pencil) from 386 adults with T2DM.

RESULTS

Using a six-point rating scale and a three-dimensional Rasch model, this study found that a 12-item version of the FCCHL reduced within-item bias and improved subscale reliability indexes.

CONCLUSION

This study suggests a parsimonious 12-item version of the FCCHL. The data fit a three-dimensional Rasch model best.