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Dijkman EM, ter Brake WWM, Drossaert CHC, Doggen CJM. Assessment Tools for Measuring Health Literacy and Digital Health Literacy in a Hospital Setting: A Scoping Review. Healthcare (Basel) 2023; 12:11. [PMID: 38200917 PMCID: PMC10778720 DOI: 10.3390/healthcare12010011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
Assessment of (digital) health literacy in the hospital can raise staff awareness and facilitate tailored communication, leading to improved health outcomes. Assessment tools should ideally address multiple domains of health literacy, fit to the complex hospital context and have a short administration time, to enable routine assessment. This review aims to create an overview of tools for measuring (digital) health literacy in hospitals. A search in Scopus, PubMed, WoS and CINAHL, following PRISMA guidelines, generated 7252 hits; 251 studies were included in which 44 assessment tools were used. Most tools (57%) were self-reported and 27% reported an administration time of <5 min. Almost all tools addressed the domain 'understanding' (98%), followed by 'access' (52%), 'apply' (50%), 'appraise' (32%), 'numeracy' (18%), and 'digital' (18%). Only four tools were frequently used: the Newest Vital Sign (NVS), the Short Test of Functional Health Literacy for Adults ((S)TOFHLA), the Brief Health Literacy Screener (BHLS), and the Health Literacy Questionnaire (HLQ). While the NVS and BHLS have a low administration time, they cover only two domains. HLQ covers the most domains: access, understanding, appraise, and apply. None of these four most frequently used tools measured digital skills. This review can guide health professionals in choosing an instrument that is feasible in their daily practice, and measures the required domains.
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Affiliation(s)
- Eline M. Dijkman
- Department of Health Technology and Services Research (HTSR), Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (E.M.D.)
- Department of Surgery, Isala Hospital, 8025 AB Zwolle, The Netherlands
| | - Wouter W. M. ter Brake
- Department of Health Technology and Services Research (HTSR), Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (E.M.D.)
| | | | - Carine J. M. Doggen
- Department of Health Technology and Services Research (HTSR), Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (E.M.D.)
- Clinical Research Center, Rijnstate Hospital, 6815 AD Arnhem, The Netherlands
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Seangpraw K, Ong-Artborirak P, Boonyathee S, Bootsikeaw S, Kantow S, Panta P, Winaiprasert P. Effect of Health Literacy Intervention on Glycemic Control and Renal Function Among Thai Older Adults at Risk of Type 2 Diabetes Mellitus. Clin Interv Aging 2023; 18:1465-1476. [PMID: 37700781 PMCID: PMC10494859 DOI: 10.2147/cia.s413456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/05/2023] [Indexed: 09/14/2023] Open
Abstract
Purpose Diabetes patients with low health literacy often have poor health and clinical outcomes. The study aimed to assess the effectiveness of a health literacy intervention on glycemic control and renal function among Thai older adults at risk of type 2 diabetes mellitus (T2DM). Methods A quasi-experimental study was carried out in rural areas of Phayao Province in northern Thailand. The participants were older adults with T2DM who recorded blood glucose levels ranging from 140 to 180 mg/dL and who were not receiving prescribed medication. The intervention lasted 12 weeks, and data were collected at three points: baseline, post-intervention, and at 3 months' follow-up. The study outcomes included the measurement of fasting blood sugar (FBS), hemoglobin A1C (HbA1c), and glomerular filtration rate (eGFR) levels after the intervention. A linear mixed model and generalized estimating equations model were used to assess the intervention effect for continuous and binary outcomes, respectively. Results From baseline to post-intervention, FBS and HbA1c decreased more in the intervention group than in the control group by 8.2 mg/dL (p < 0.001) and 0.1% (p = 0.029), respectively, whereas eGFR increased by 8.0 mL/min/1.73m2 (p < 0.001). The absolute effect of the intervention at follow-up was -9.8 units for FBS, -0.4 units for HbA1c, and 14.0 units for eGFR. Abnormal HbA1c level (≥6.5%) of the intervention group was reported as 70.3% at baseline, 31.3% at post-intervention, and 9.4% at follow-up. Compared to baseline levels, the T2DM patients who received the intervention were 0.31 times less likely to have abnormal HbA1c levels than the control subjects at follow-up (p = 0.003) who received no intervention. Conclusion Our findings suggest that this intervention may potentially improve diabetes self-management and prevention behaviors, thereby reducing the diabetes burden in rural communities in northern Thailand.
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Affiliation(s)
| | | | | | | | - Supakan Kantow
- School of Public Health, University of Phayao, Phayao, 56000, Thailand
| | - Pitakpong Panta
- School of Nursing, University of Phayao, Phayao, 56000, Thailand
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Levic M, Bogavac-Stanojevic N, Lakic D, Krajnovic D. Predictors of Inadequate Health Literacy among Patients with Type 2 Diabetes Mellitus: Assessment with Different Self-Reported Instruments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5190. [PMID: 36982101 PMCID: PMC10049631 DOI: 10.3390/ijerph20065190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Obtaining, understanding, interpreting, and acting on health information enables people with diabetes to engage and make health decisions in various contexts. Hence, inadequate health literacy (HL) could pose a problem in making self-care decisions and in self-management for diabetes. By applying multidimensional instruments to assess HL, it is possible to differentiate domains of functional, communicative, and critical HL. OBJECTIVES Primarily, this study aimed to measure the prevalence of inadequate HL among type 2 diabetes mellitus patients and to analyze the predictors influencing health literacy levels. Secondly, we analyzed if different self-reported measures, unidimensional instruments (Brief Health Literacy instruments (BRIEF-4 and abbreviated version BRIEF-3), and multidimensional instruments (Functional, Communicative and Critical health literacy instrument (FCCHL)) have the same findings. METHODS The cross-sectional study was conducted within one primary care institution in Serbia between March and September 2021. Data were collected through Serbian versions of BRIEF-4, BRIEF-3, and FCCHL-SR12. A chi-square test, Fisher's exact test, and simple logistic regression were used to measure the association between the associated factors and health literacy level. Multivariate analyses were performed with significant predictors from univariate analyses. RESULTS Overall, 350 patients participated in the study. They were primarily males (55.4%) and had a mean age of 61.5 years (SD = 10.5), ranging from 31 to 82 years. The prevalence of inadequate HL was estimated to be 42.2% (FCCHL-SR12), 36.9% (BRIEF-3) and 33.8% (BRIEF-4). There are variations in the assessment of marginal and adequate HL by different instruments. The highest association was shown between BRIEF-3 and total FCCHL-SR12 score (0.204, p < 0.01). The total FCCHL-SR12 score correlates better with the abbreviated BRIEF instrument (BRIEF-3) than with BRIEF-4 (0.190, p < 0.01). All instruments indicated the highest levels for the communicative HL domain and the lowest for the functional HL domain with significant difference in functional HL between the functional HL of FCCHL-SR12 and both BRIEF-3 and BRIEF-4 (p = 0.006 and 0.008, respectively). Depending on applied instruments, we identified several variables (sociodemographic, access to health-related information, empowerment-related indicators, type of therapy, and frequency of drug administration) that could significantly predict inadequate HL. Probability of inadequate HL increased with older age, fewer children, lower education level, and higher consumption of alcohol. Only high education was associated with a lower probability of inadequate HL for all three instruments. CONCLUSIONS The results we obtained indicate that patients in our study may have been more functionally illiterate, but differences between functional level could be observed if assessed by unidimensional and multidimensional instruments. The proportion of patients with inadequate HL is approximately similar as assessed by all three instruments. According to the association between HL and educational level in DMT2 patients we should investigate methods of further improvement.
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Affiliation(s)
- Marija Levic
- PhD Program of Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, 11221 Belgrade, Serbia
| | - Natasa Bogavac-Stanojevic
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, 11221 Belgrade, Serbia
| | - Dragana Lakic
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, 11221 Belgrade, Serbia
| | - Dusanka Krajnovic
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, 11221 Belgrade, Serbia
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Tavares VB, de Farias AL, da Silva ASA, Souza JDSE, da Silva HP, Bastos MDSCBDO, de Melo-Neto JS. Amazon Amandaba-Sociodemographic Factors, Health Literacy, Biochemical Parameters and Self-Care as Predictors in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3082. [PMID: 36833776 PMCID: PMC9966953 DOI: 10.3390/ijerph20043082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/30/2022] [Accepted: 12/30/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Health literacy (HL) and its domains (functional, critical, and communicative) appear to be related to self-care adherence in people with type 2 diabetes mellitus (DM2). This study aimed to verify if sociodemographic variables are predictors of HL, if HL and the sociodemographic factors affect biochemical parameters together, and if HL domains are predictors of self-care in DM2. METHODS We used the baseline assessment data from 199 participants ≥ 30 years in the project, "Amandaba na Amazônia: Culture Circles as a Strategy to Encourage Self-care for DM in Primary Health Care," which took place in November and December 2021. RESULTS In the HL predictor analysis, women (p = 0.024) and higher education (p = 0.005) were predictors of better functional HL. The predictors of biochemical parameters were: glycated hemoglobin control with low critical HL (p = 0.008); total cholesterol control with female sex (p = 0.004), and low critical HL (p = 0.024); low-density lipoprotein control with female sex (p = 0.027), and low critical HL (p = 0.007); high-density lipoprotein control with female sex (p = 0.001); triglyceride control with low Functional HL (p = 0.039); high levels of microalbuminuria with female sex (p = 0.014). A low critical HL was a predictor of a lower specific diet (p = 0.002) and a low total HL of low medication care (p = 0.027) in analyses of HL domains as predictors of self-care. CONCLUSION Sociodemographic factors can be used to predict HL, and HL can predict biochemical parameters and self-care.
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Affiliation(s)
- Victória Brioso Tavares
- Postgraduate Program in Health, Environment and Society in the Amazon, Institute of Health Sciences, Federal University of Pará (UFPA), Belém 66050-160, Brazil
| | - Aline Lobato de Farias
- Postgraduate Program in Health, Environment and Society in the Amazon, Institute of Health Sciences, Federal University of Pará (UFPA), Belém 66050-160, Brazil
| | - Amanda Suzane Alves da Silva
- Faculty of Physiotherapy and Occupational Therapy (FFTO), Federal University of Pará (UFPA), Belém 66075-110, Brazil
| | - Josiel de Souza e Souza
- Faculty of Physiotherapy and Occupational Therapy (FFTO), Federal University of Pará (UFPA), Belém 66075-110, Brazil
| | - Hilton Pereira da Silva
- Postgraduate Program in Health, Environment and Society in the Amazon, Institute of Health Sciences, Federal University of Pará (UFPA), Belém 66050-160, Brazil
| | | | - João Simão de Melo-Neto
- Postgraduate Program in Health, Environment and Society in the Amazon, Institute of Health Sciences, Federal University of Pará (UFPA), Belém 66050-160, Brazil
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Vassantachart A, Ragab O, Miller K, Lock D, Stal J, Bian SX, Jang J, Fossum C, Han HR, Mehta S, Cheng K, Ballas LK. Knowledge and Understanding of Radiation Therapy Among Patients With Breast Cancer From Culturally Diverse Backgrounds at a Safety-Net Hospital. Int J Radiat Oncol Biol Phys 2023; 116:176-181. [PMID: 36720316 DOI: 10.1016/j.ijrobp.2023.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Comprehensive understanding of oncologic treatment is essential for shared decision-making. However, comprehension of information in radiation oncology consults is poorly understood, particularly among Spanish-speaking patients at safetynet hospitals. The purpose of this pilot study was to examine post-consultation radiation oncology knowledge and health literacy among breast cancer patients from culturally diverse backgrounds. METHODS After consultation for curative post-operative breast radiotherapy (cT1-4N1-3M0), the Radiation Oncology Knowledge Assessment Survey (ROKAS) was administered to Spanish- and English-speaking patients ≥ 18 years old, from January 2021 to January 2022 at a safety-net hospital. Radiation knowledge was assessed using the ROKAS which included eight radiation-specific multiple-choice questions and two separate questions regarding short- and long-term side effects. Additional independent variables included validated questionnaires related to health literacy, health numeracy, acculturation, primary language, and sociodemographic factors. Bivariate Pearson correlations and T-test analyses were conducted to examine the relationship between the independent variables and post-consultation radiation knowledge. RESULTS Fifty ROKAS were obtained from 25 English- and 25 Spanish-speaking breast cancer patients (median age 57 [IQR 49.75-62.25]). When compared to Englishspeaking patients, Spanish-speaking patients had lower health literacy, health numeracy, and acculturation. There was no difference in the multiple-choice ROKAS score between English- and Spanish-speakers, or correlation with the other independent factors. Higher health numeracy correlated with a higher accuracy for identifying short-term side effects. Lower accuracy of identifying long-term side effects was seen in patients with lower education levels, health literacy, health numeracy, and acculturation, with the most missed long-term side effects being arm swelling, skin toxicity, and heart toxicity. CONCLUSIONS Patients with low health literacy, health numeracy, acculturation, and education levels as well as Spanish-speaking patients were associated with poor understanding of radiotherapy long-term side effects. Determining barriers to radiation knowledge is crucial to improve shared decision-making between patients and providers in a culturally diverse population.
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Affiliation(s)
- April Vassantachart
- Department of Radiation Oncology, LAC+USC Medical Center, Los Angeles, California; Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California.
| | - Omar Ragab
- Department of Radiation Oncology, Washington DC VA Medical Center, Washington, District of Columbia
| | - Kimberly Miller
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Derrick Lock
- Department of Radiation Oncology, LAC+USC Medical Center, Los Angeles, California; Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Julia Stal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Shelly X Bian
- Department of Radiation Oncology, LAC+USC Medical Center, Los Angeles, California; Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Julie Jang
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Croix Fossum
- Department of Radiation Oncology, LAC+USC Medical Center, Los Angeles, California; Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Hye Ri Han
- Department of Radiation Oncology, LAC+USC Medical Center, Los Angeles, California; Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Shahil Mehta
- Department of Radiation Oncology, LAC+USC Medical Center, Los Angeles, California; Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Karen Cheng
- Department of Radiation Oncology, LAC+USC Medical Center, Los Angeles, California; Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Leslie K Ballas
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
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Prat-Luri A, López-Valenciano A, Sarabia-Cachadiña E, Liguori G, Ayala F. Sex Differences in the Glycemic Response to Structured Exercise Interventions in Adults with Type II Diabetes Mellitus: A Systematic Review. INTERNATIONAL JOURNAL OF EXERCISE SCIENCE 2022; 15:948-961. [PMID: 36158228 PMCID: PMC9458290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Despite physiological sex differences in the prevalence, pathogenesis, and responses to pharmacologic therapies of glucose metabolism in type 2 diabetes mellitus (T2DM) and the current evidence regarding the benefits of physical activity in people with T2DM, there is still a lack of information about the response to physical activity in T2DM depending on the sex. Thus, the aim of the present systematic review was to analyze the physiological sex differences response to physical activity programs in adults with T2DM. A systematic review following PRISMA guidelines was performed up to 4th January 2022 in PubMed, SportDiscus and Web of Science databases. The research protocol of this systematic review was registered in PROSPERO (CRD42020189020). The PEDro scale and Cochrane risk of bias tools were used to analyze the quality and risk of bias of the studies included. Glycaemic (blood glucose, HbA1c, AUC glycemia, metabolic clearance rate, QUICKI) insulin (HOMA-IR, insulin levels, C-peptide) and cardiovascular parameters (VO2max, body fat mass, waist circumference, cardiovascular index) were registered. 6 studies met the inclusion criteria. Physical activity showed improvements in the glycaemic and insulin profiles and cardiovascular risk parameters for both men and women, but no relevant and significant differences between sex were found. No significant differences between males and females with regard to the effects elicited by physical activity on glycaemic biomarkers and cardiorespiratory fitness in individuals with T2DM were found. These results seem to lead towards the same physical activity prescription in men and women.
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Affiliation(s)
- Amaya Prat-Luri
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University, Elche, SPAIN
| | | | - Elena Sarabia-Cachadiña
- Department of Physical Activity and Sport, Cardenal Spínola-CEU University Studies Center, Sevilla, SPAIN
| | - Gary Liguori
- College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Francisco Ayala
- Department of Physical Activity and Sport, Faculty of Sport Sciences, Regional Campus of International Excellence "Campus Mare Nostrum", University of Murcia, Murcia, SPAIN
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Delaney KZ, Santosa S. Sex differences in regional adipose tissue depots pose different threats for the development of Type 2 diabetes in males and females. Obes Rev 2022; 23:e13393. [PMID: 34985183 DOI: 10.1111/obr.13393] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 01/08/2023]
Abstract
Type 2 diabetes mellitus (T2DM) affects males and females disproportionately. In midlife, more males have T2DM than females. The sex difference in T2DM prevalence is, in part, explained by differences in regional adipose tissue characteristics. With obesity, changes to regional adipokine and cytokine release increases the risk of T2DM in both males and females with males having greater levels of TNFα and females having greater levels of leptin, CRP, and adiponectin. Regional immune cell infiltration appears to be pathogenic in both sexes via different routes as males with obesity have greater VAT ATM and a decrease in the protective Treg cells, whereas females have greater SAT ATM and T cells. Lastly, the ability of female adipose tissue to expand all regions through hyperplasia, rather than hypertrophy, protects them against the development of large insulin-resistant adipocytes that dominate male adipose tissue. The objective of this review is to discuss how sex may affect regional differences in adipose tissue characteristics and how these differences may distinguish the development of T2DM in males and females. In doing so, we will show that the origins of T2DM development differ between males and females.
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Affiliation(s)
- Kerri Z Delaney
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montréal, Québec, Canada.,Metabolism, Obesity and Nutrition Lab, PERFORM Centre, Concordia University, Montréal, Québec, Canada.,Centre de recherche - Axe maladies chroniques, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Ile-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
| | - Sylvia Santosa
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montréal, Québec, Canada.,Metabolism, Obesity and Nutrition Lab, PERFORM Centre, Concordia University, Montréal, Québec, Canada.,Centre de recherche - Axe maladies chroniques, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Ile-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
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Hsieh MH, Chen YC, Ho CH, Lin CY. Validation of Diabetes Knowledge Questionnaire (DKQ) in the Taiwanese Population - Concurrent Validity with Diabetes-Specific Quality of Life Questionnaire Module. Diabetes Metab Syndr Obes 2022; 15:2391-2403. [PMID: 35971522 PMCID: PMC9375556 DOI: 10.2147/dmso.s369552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/16/2022] [Indexed: 04/20/2023] Open
Abstract
PURPOSE Diabetes knowledge is important for people with type 2 diabetes mellitus (DM) to improve their health. Therefore, it is important to validate an instrument for assessing diabetes knowledge. The present study aimed to validate the 24-item Diabetes Knowledge Questionnaire (DKQ). PATIENTS AND METHODS The 24-item DKQ and Diabetes-specific Quality of Life Module (DMQoL) were administered to 425 patients (mean±SD age=58.4±11.6) with type 2 DM. RESULTS The 24-item DKQ was first examined for its factor structure using exploratory factor analysis (EFA). Items with low factors loadings were removed and 18 items were retained to make a DKQ-18. In DKQ-18, five factors were identified, which were named as diabetes etiology and symptoms (F1), intermediate nursing (F2), complications (F3), diet and treatment (F4), and elementary nursing (F5). The DKQ-18 had satisfactory internal consistency (Cronbach's α= 0.732 and McDonald's ω=0.748), good known-group validity (participants with a higher level of education showed better score in DKQ-18; participants with HbA1c ≤7 had better score in DKQ-18 compared to group of HbA1c level >8.5), acceptable test-retest reliability (r=0.69), adequate responsiveness (DKQ-18 can detect knowledge change), and concurrent validity with DMQoL. CONCLUSION The DKQ-18 is a valid measure for assessing diabetes knowledge. The DKQ-18 could evaluate participants' diabetes knowledge and improve their diabetes knowledge and self-care through a diabetes team and serve as a tool to evaluate the knowledge of participants with type 2 DM.
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Affiliation(s)
- Meng-Hsueh Hsieh
- Department of Industrial Design, College of Planning and Design, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Ching Chen
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Heng Ho
- Department of Industrial Design, College of Planning and Design, National Cheng Kung University, Tainan, Taiwan
- Chun-Heng Ho, Department of Industrial Design, College of Planning and Design, National Cheng Kung University, Tainan, Taiwan, Email
| | - Chung-Ying Lin
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Correspondence: Chung-Ying Lin, Institute of Allied Health Sciences, Department of Public Health, Department of Occupational Therapy, Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Email
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Xu T, Li G, Wang X, Lv C, Tian Y. Inonotus obliquus polysaccharide ameliorates serum profiling in STZ-induced diabetic mice model. BMC Chem 2021; 15:64. [PMID: 34920751 PMCID: PMC8684258 DOI: 10.1186/s13065-021-00789-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/02/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Diabetes mellitus is a systemic disease mainly caused by the disorder of metabolism, which has become huge threat to human health. Polysaccharides are the main active substance from Inonotus obliquus (I. obliquus) with hypoglycemic effect. This study aims to evaluate the hypoglycemic activity and investigate the molecular mechanism of I. obliquus polysaccharide (IOP) in streptozotocin (STZ)-induced diabetic mice using metabolomics based on UPLC-Q-Exactive-MS method. RESULTS The results showed that the oral administration of IOP in high dose (1.2 g/kg) can significantly reduce the blood glucose with 31% reduction comparing with the diabetic model and relieve dyslipidemia in diabetic mice. By UPLC-Q-Exactive-MS method and multivariate statistical analysis, a total of 15 differential metabolites were identified, including 4 up-regulated and 11 down-regulated biomarkers, of which L-tryptophan, L-leucine, uric acid, 12-HETE, arachidonic acid, PC(20:1(11Z)/14:1(9Z)) and SM(d18:0/24:1(15Z)) were exhibited an important variation, as the potential biomarkers in diabetes. Pathway analysis indicated that phenylalanine, tyrosine and tryptophan biosynthesis and arachidonic acid metabolism were prone to interference in diabetes. Moreover, leucine and proline were reversed and phytosphingosine was further reduced in diabetic mice under the intervention of IOP. CONCLUSION IOP has predominant hyperglycemic effect on STZ-induced diabetic mice via ameliorating serum profiling.
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Affiliation(s)
- Tanye Xu
- College of Food Science and Engineering, Dalian Ocean University, Dalian, 116023, Liaoning, China
- Pharmacy Department, The 967Th Hospital of PLA Joint Logistics Support Force, No. 80 Shengli Road, Xigang District, Dalian, 116021, Liaoning, China
| | - Guodao Li
- College of Food Science and Engineering, Dalian Ocean University, Dalian, 116023, Liaoning, China
| | - Xiaobo Wang
- Pharmacy Department, The 967Th Hospital of PLA Joint Logistics Support Force, No. 80 Shengli Road, Xigang District, Dalian, 116021, Liaoning, China.
| | - Chongning Lv
- Pharmacy Department, The 967Th Hospital of PLA Joint Logistics Support Force, No. 80 Shengli Road, Xigang District, Dalian, 116021, Liaoning, China
- School of Traditional Chinese Materia Medica, Shenyang Pharmaceutical University, Shenyang, 110016, Liaoning, China
| | - Yuanyong Tian
- College of Food Science and Engineering, Dalian Ocean University, Dalian, 116023, Liaoning, China
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Aljadeeah S, Nagel E, Wirtz VJ. Outpatient cardiovascular diseases and diabetes medicines dispensing in the population with government health insurance in Syria between 2018 and 2019: a retrospective analysis. BMC Health Serv Res 2021; 21:1088. [PMID: 34645430 PMCID: PMC8515648 DOI: 10.1186/s12913-021-07124-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/27/2021] [Indexed: 12/03/2022] Open
Abstract
Background Low- and middle-income countries bear the highest burden of non-communicable diseases (NCDs) mortality and morbidity. Syria has undergone an epidemiological transition from infectious diseases to NCDs in the past decades. Despite the high prevalence of cardiovascular diseases (CVDs) and diabetes in Syria, little is known about medicines utilization or prescriptions for these diseases. The aims of this study are to present the patterns and rates of dispensing medicines used for CVDs and diabetes among patients with government health insurance in Syria and examine age, sex, and regional variation in the dispensing of these medicines. Methods Outpatient data from June 2018 to May 2019 on dispensed medicines for 81,314 adults with government health insurance were obtained. The dispensing rate was expressed as the number of defined daily doses (DDDs) per 1000 beneficiaries per day (DID). The DID is a measurement that is used in drug utilization research to control for differences or changes in population size between or within countries. The number of DIDs was adjusted according to beneficiaries’ sex, age, and governorate. Results Beneficiaries received 302.09 DIDs of CVDs medicines and 35.66 DIDs of diabetes medicines, including 0.96 DID of insulin (2.99% of the total of diabetes medicines). CVDs and diabetes medicine dispensing rates were low during the study period and included very low rates of insulin dispensing compared to the dispensing rates of these medicines in other countries in East Mediterranean Region or in Europe. We found lower dispensing rates of CVDs medicines among female beneficiaries (249.59 DIDs) than male beneficiaries (388.80 DIDs). Similarly, the dispensing rates of diabetes medicines among female beneficiaries (29.42 DIDs) were lower than those among male beneficiaries (45.98 DIDs). In addition, there were lower rates of CVDs and diabetes medicines and very low to no dispensing of insulin in some governorates that were partly controlled by the Syrian government compared to other governorates that were completely or mostly controlled by the Syrian government. Conclusions Additional efforts are needed to raise awareness about the prevention and management of CVDs and diabetes especially among females in Syria and consider cultural issues that might influence access to healthcare services. There is a crucial need to address the political and geographical challenges caused by the conflict which have limited access to CVDs and diabetes medicines in some regions in Syria. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07124-6.
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Affiliation(s)
- Saleh Aljadeeah
- University of Bayreuth, Institute of Medical Management and Health Sciences, Prieserstr. 2, 95440, Bayreuth, Germany.
| | - Eckhard Nagel
- University of Bayreuth, Institute of Medical Management and Health Sciences, Prieserstr. 2, 95440, Bayreuth, Germany
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd floor, Boston, MA, 02118, USA
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11
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Tu YZ, Chang YT, Chiou HY, Lai K. The Effects of Continuous Usage of a Diabetes Management App on Glycemic Control in Real-world Clinical Practice: Retrospective Analysis. J Med Internet Res 2021; 23:e23227. [PMID: 34264192 PMCID: PMC8323018 DOI: 10.2196/23227] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/22/2020] [Accepted: 05/24/2021] [Indexed: 12/25/2022] Open
Abstract
Background The efficacy of digital technology in improving diabetes management has typically been demonstrated through studies such as randomized controlled trials, which have reported a steeper reduction in hemoglobin A1c (HbA1c) values for patients who adopted a digital solution. However, evidence from real-world clinical practice is still limited. Objective This study aimed to evaluate the effectiveness of digital interventions by tracking HbA1c improvements over 1 year in real-world clinical settings. Methods Patients used the Health2Sync mobile app to track self-measured outcomes and communicate with health care professionals (HCPs). HCPs used the web-based Patient Management Platform to monitor patient data, view test results from clinical laboratories, and communicate with patients. Patients who have been onboarded for at least 13 months and have consecutive HbA1c findings for 5 quarters were included in the analysis. They were then stratified into 3 groups (high, mid, and low retention) based on their level of use of Health2Sync in the first 6 months of onboarding. A mixed model was built to compare the slopes of the rate of reduction in HbA1c among the groups. In addition, these patients’ retention on the app from the seventh to the 12th month was verified through multiple comparisons. Results A sample of 2036 users was included in the analysis. With the mixed model coefficient estimates, we found that app users had significant HbA1c percentage reductions as the passed quarter count increased (t=–9.869; P<.001), and that effectiveness increased in the high (t=–5.173) and mid retention (t=–6.620) groups as the interaction effects were significantly negative compared to that in the low retention group (P<.001) in the passed quarter count. The low retention group also had the highest average HbA1c value at the end of 13 months (high: 7.01%, SD 1.02%; mid: 6.99%, SD 1.00%; low: 7.17%, SD 1.14%) (Bonferroni correction: high vs low, P=.07; mid vs low, P=.02; high vs mid, P>.99). The level of use of the app remained consistent in the seventh to the 12th month after onboarding (high: 5.23 [SD 1.37] months, mid: 2.43 [SD 1.68] months, low: 0.41 [SD 0.97] months) (P<.001). Conclusions Our analysis shows that continuous usage of the diabetes management app is associated with better glycemic control in real-world clinical practice. Further studies are required to reveal the efficacy for specific diabetes types and to observe effects beyond 1 year.
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Affiliation(s)
| | | | - Hung-Yi Chiou
- School of Public Health, Taipei Medical University, Taipei, Taiwan
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12
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Hussein SH, Albatineh AN, Almajran A, Ziyab AH. Association of health literacy and other risk factors with glycemic control among patients with type 2 diabetes in Kuwait: A cross-sectional study. Prim Care Diabetes 2021; 15:571-577. [PMID: 33573893 DOI: 10.1016/j.pcd.2021.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Poor health literacy (HL) has received much attention recently as a risk factor for poor health outcomes especially among patients with chronic diseases. The degree to which HL affects health outcomes is unknown among patients with type 2 diabetes mellitus (T2DM) in Kuwait. This study aimed to investigate the association between HL and glycated hemoglobin (HbA1c) among patients with T2DM. METHODS 356 patients with T2DM were selected from 27 primary care clinics covering the state of Kuwait. HL was measured by the Short Test of Functional Health Literacy in Adults (STOFHLA). Prevalence of uncontrolled HbA1c was estimated and its association with HL was modeled and tested using Poisson regression with log-link function and robust variance-covariance matrix, while adjusting for several confounders. RESULTS The prevalence of uncontrolled HbA1c was 77.8%. Among those with inadequate or marginal HL, about 50.7% have uncontrolled HbA1c. The prevalence of uncontrolled HbA1c among those on diet alone was 36.3% lower compared to those on mixed treatment regimen (APR = 0.637, 95% CI: 0.455-0.891, PV = 0.008). The prevalence of uncontrolled HbA1c among patients on oral hypoglycemic (OH) drugs alone was 22.3% lower compared to those on mixed treatment (OH plus Insulin) regimen (APR = 0.777, 95% CI: 0.697-0.865, PV < 0.001). For every one-year increase in age, there is 1.4% reduction in the prevalence of uncontrolled HbA1c (APR = 0.986, 95% CI: 0.978-0.994, PV < 0.001). For one STOFHLA score increase, there is 0.3% reduction in the prevalence of uncontrolled HbA1c (APR = 0.997, 95% CI: 0.994-1.00, PV = 0.055). Finally, for every year increase since T2DM onset, there is 1.1% increase in the prevalence of uncontrolled HbA1c (APR = 1.011, 95% CI: 1.003-1.019, PV = 0.008). CONCLUSIONS The prevalence of uncontrolled HbA1c among patients with T2DM in Kuwait is high. Half of T2DM with inadequate or marginal HL have uncontrolled HbA1c. Patients on diet alone or OH alone have lower prevalence of uncontrolled HbA1c compared to those on mixed treatment regimen. Older T2DM patients or those with higher STOFHLA score have lower prevalence of uncontrolled HbA1c, while those with longer T2DM onset have higher prevalence of uncontrolled HbA1c. Future interventions should focus on younger patients, improve HL, and establish better communications between physicians and patients with T2DM for better glycemic control.
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Affiliation(s)
- Shaimaa H Hussein
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait
| | - Ahmed N Albatineh
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait.
| | - Abdullah Almajran
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait
| | - Ali H Ziyab
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait
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13
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Al-Abdulrazzaq D, Al-Taiar A, Al-Haddad M, Al-Tararwa A, Al-Zanati N, Al-Yousef A, Davidsson L, Al-Kandari H. Cultural Adaptation of Health Literacy Measures: Translation Validation of the Newest Vital Sign in Arabic-Speaking Parents of Children With Type 1 Diabetes in Kuwait. Sci Diabetes Self Manag Care 2021; 47:164-172. [PMID: 34078178 DOI: 10.1177/0145721721996309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of the study was to assess the feasibility of use and reliability of the Arabic version of the Newest Vital Sign (NVS-Ar) in parents of children with type 1 diabetes (T1D). METHODS The final translated version of NVS-Ar was administered to 175 adult caregivers of children with T1D who are native Arabic speakers. The association between NVS-Ar scores for the parents/legal guardians and A1C for their children was assessed. The internal consistency was evaluated by Cronbach's α, and reliability was assessed by test-retest method. RESULTS The median (interquartile range) score was 4.0 (3-5). The internal consistency of the NVS-Ar was moderate (α = .58). The intraclass correlation coefficient was .61. There was no correlation between NVS-Ar score and A1C (Spearman's ρ = .055; P = .62). Furthermore, there was significant inverse association between adequate health literacy and optimal glycemic control among the children, which remained evident even after adjusting for the duration of T1D, age, or education of the parents/guardians. However, it lost statistical significance after adjustment for treatment regimen. CONCLUSION Study findings indicate that the NVS is unlikely to be a predictive tool for functional health literacy in Arabic settings and that there is a need to properly translate and validate other tools such as the Test of Functional Health Literacy in Adults or, alternatively, to develop a reliable tool.
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Affiliation(s)
- Dalia Al-Abdulrazzaq
- Department of Pediatrics, Faculty of Medicine, Kuwait University, Kuwait.,Population Health Unit, Dasman Diabetes Institute, Kuwait.,Mubarak Al-Kabeer Hospital, Ministry of Health, Kuwait
| | - Abdullah Al-Taiar
- School of Community & Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, Virginia
| | | | | | | | | | - Lena Davidsson
- Population Health Unit, Dasman Diabetes Institute, Kuwait
| | - Hessa Al-Kandari
- Population Health Unit, Dasman Diabetes Institute, Kuwait.,Al-Farwaniya Hospital, Ministry of Health, Kuwait
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14
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Kumah E, Abuosi AA, Ankomah SE, Anaba C. Self-management Education Program: The Case of Glycemic Control of Type 2 Diabetes. Oman Med J 2021; 36:e225. [PMID: 33585046 PMCID: PMC7868594 DOI: 10.5001/omj.2021.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 05/28/2019] [Indexed: 01/05/2023] Open
Abstract
Objectives Self-management education (SME) is recognized globally as a tool that enables patients to achieve optimal glucose control. While factors influencing the effectiveness of self-management interventions have been studied extensively, the impact of program length on clinical endpoints of patients diagnosed with diabetes is underdeveloped. This paper synthesized information from the existing literature to understand the effect of program length on glycated hemoglobin (HbA1C) in adults with type 2 diabetes mellitus. Methods We searched Web of Science, PubMed, Scopus, MEDLINE, EMBASE, PsychINFO, and the Cochrane Central Register of Controlled Trials to identify relevant English language publications on diabetes self-management education published between January 2000 and April 2019. Results The review included 25 randomized controlled trials, with 64.0% reporting significant changes in HbA1C. The studies classified as long-term (lasting one year and above) were associated with the greatest number of interventions achieving statistically significant (87.5% significant vs. 12.5% non-significant) differences in changes in HbA1C between the intervention and the control subjects, recording an overall between-group HbA1C mean difference of 0.6±0.3% (range = 0.2–1.2). Conclusions Our findings suggest that program length may change the effectiveness of educational interventions. Achieving sustained improvements in patients’ HbA1C levels will require long-term, ongoing SME, and support.
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Affiliation(s)
- Emmanuel Kumah
- Policy, Planning, Monitoring, and Evaluation Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Aaron Asibi Abuosi
- Department of Public Administration and Health Services Management, University of Ghana Business School, Accra, Ghana
| | | | - Cynthia Anaba
- Department of Administration, St. Dominic Hospital, Akwatia, Eastern Region, Ghana
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15
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Shahwan M, Hassan N, Shaheen RA, Gaili A, Jairoun AA, Shahwan M, Najjar O, Jamshed S. Diabetes Mellitus and Renal Function: Current Medical Research and Opinion. Curr Diabetes Rev 2021; 17:e011121190176. [PMID: 33430750 DOI: 10.2174/1573399817999210111205532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 11/22/2022]
Abstract
Diabetes mellitus (DM), which is defined as high blood glucose level, is a major public health issue worldwide. An enormous amount of data has been gathered regarding DM as populations have been living with it for more than a decade; however, continually updating our knowledge of DM remains important. Comorbidities are among the major challenges associated with DM. Poorly controlled DM, especially type 2 DM (T2DM), is considered a risk factor for many diseases, including but not limited to chronic kidney disease (CKD). Complications might appear over time as the aging process changes body functions; moreover, a significant number of antidiabetic medications are eventually cleared by the kidneys, thereby increasing the burden on kidney function and placing diabetic patients at risk. The significantly high number of patients with uncontrolled diabetes resulting from kidney disease shows the impact of this condition on the quality of life of patients. This review presents an overview of the pathophysiology, etiology, and prevalence of CKD and abnormal renal parameters correlated with poorly controlled T2DM, with an emphasis on clinical studies involving the association between vitamin D insufficiency/deficiency and CKD among patients with T2DM.
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Affiliation(s)
- Moyad Shahwan
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
| | - Nageeb Hassan
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
| | - Rima Ahd Shaheen
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
| | - Ahmed Gaili
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
| | | | - Monzer Shahwan
- Diabetes Clinic, Al-Swity Center for Dermatology and Chronic Diseases, Palestinian Territory, Occupied
| | - Osama Najjar
- General Directorate of Allied Health Professions, Ministry of Health, Palestinian Territory, Occupied
| | - Shazia Jamshed
- Department of Clinical Pharmacy and Practice, Faculty of Pharmacy, Universiti Sultan Zainal Abidin (UniSZA) Besut Campus, Kuala terraenganu, Malaysia
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16
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Guo XM, Zhai X, Hou BR. Adequacy of health literacy and its effect on diabetes self-management: a meta-analysis. Aust J Prim Health 2020; 26:458-465. [PMID: 33296622 DOI: 10.1071/py20079] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/28/2020] [Indexed: 11/23/2022]
Abstract
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.
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Affiliation(s)
- Xiu-Mei Guo
- Department of Outpatient, Lanzhou University Second Hospital, Lanzhou, No. 82, Cuiyingmen, Chengguan District, Gansu 730030, China
| | - Xia Zhai
- Department of Outpatient, Lanzhou University Second Hospital, Lanzhou, No. 82, Cuiyingmen, Chengguan District, Gansu 730030, China
| | - Bo-Ru Hou
- Department of Neurosurgery, Lanzhou University Second Hospital, No. 82, Cuiyingmen, Chengguan District, Lanzhou, Gansu 730030, China; and Corresponding author.
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17
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Souza JG, Farfel JM, Jaluul O, Queiroz MS, Nery M. Association between health literacy and glycemic control in elderly patients with type 2 diabetes and modifying effect of social support. EINSTEIN-SAO PAULO 2020; 18:eAO5572. [PMID: 33295425 PMCID: PMC7690930 DOI: 10.31744/einstein_journal/2020ao5572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/10/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate the association between inadequate functional health literacy, considering the Short Assessment of Health Literacy for Portuguese-speaking Adults, and glycemic control in elderly patients with type 2 diabetes, and to examine this association in low social support settings, according to Medical Outcomes Study . METHODS Cross-sectional study conducted at the diabetes referral center of a university hospital. Participants were recruited among type 2 diabetes patients aged 60 years or older, between May 2013 and November 2014. The primary outcome was the most recent glycated hemoglobin value measured within the last 6 months. RESULTS A total of 398 elderly patients with type 2 diabetes were evaluated. Of these, 232 were not eligible to participate. The final sample comprised 166 participants. Hierarchical multiple linear regression was performed. The following variables were entered in three blocks: sociodemographic characteristics, clinical variables and health literacy scores. Regression analysis of the interaction between health literacy and social support as a determinant of glycemic control was also performed. Mean age of subjects was 68.0 years (standard deviation of 5.9). Mean glycated hemoglobin value was 8.5% (standard deviation of 1.4). Short assessment of health literacy for Portuguese speaking adults score was independently associated with glycated hemoglobin (B=-0.059; p=0.043). The interaction between social support and health literacy score (p=0.003) was a determinant of glycemic control. CONCLUSION Health literacy is associated with glycemic control. Social support may modify the relation between health literacy and glycemic control.
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Affiliation(s)
- Jonas Gordilho Souza
- Universidade Federal da BahiaFaculdade de Medicina da BahiaSalvadorBABrazilFaculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, BA, Brazil.
| | - José Marcelo Farfel
- Universidade de São PauloFaculdade de MedicinaSão PauloSPBrazilFaculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Omar Jaluul
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilHospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Márcia Silva Queiroz
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilHospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Márcia Nery
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilHospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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Abdullah A, Liew SM, Ng CJ, Ambigapathy S, V Paranthaman PV. Health literacy experiences of multi-ethnic patients and their health-care providers in the management of type 2 diabetes in Malaysia: A qualitative study. Health Expect 2020; 23:1166-1176. [PMID: 32686277 PMCID: PMC7696131 DOI: 10.1111/hex.13095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/06/2020] [Accepted: 06/09/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Patients with type 2 diabetes mellitus (T2DM) require adequate health literacy to understand the disease and learn self-management skills to optimize their health. However, the prevalence of limited health literacy is high in patients with T2DM, especially in Asian countries. OBJECTIVE This study aimed to explore experiences related to health literacy in Asian patients with T2DM. DESIGN This is a qualitative study using in-depth interviews and focus group discussions. A framework analysis was used to analyse the data. SETTING AND PARTICIPANTS articipants (n = 24) were multi-ethnic patients with T2DM (n = 18) and their primary health-care providers (n = 6). This study was conducted in four primary health-care clinics in Malaysia. RESULTS Nine subthemes were identified within the four dimensions of health literacy: accessing, understanding, appraising and applying information. DISCUSSION Motivated patients actively sought information, while others passively received information shared by family members, friends or even strangers. Language and communication skills played important roles in helping patients understand this information. Information appraisal was lacking, with patients just proceeding to apply the information obtained. Patients' use of information was influenced by their self-efficacy, and internal and external barriers. CONCLUSION In conclusion, the experiences of multi-ethnic patients with T2DM regarding health literacy were varied and heavily influenced by their cultures.
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Affiliation(s)
- Adina Abdullah
- Department of Primary Care Medicine, University Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Su May Liew
- Department of Primary Care Medicine, University Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, University Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Wei Y, Chen Y, Zhao Y, Rothman R, Ming J, Wang L, Liu X, Shi L, Xu W. Health literacy and exercise interventions on clinical outcomes in Chinese patients with diabetes: a propensity score-matched comparison. BMJ Open Diabetes Res Care 2020; 8:e001179. [PMID: 32487594 PMCID: PMC7264995 DOI: 10.1136/bmjdrc-2020-001179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 03/19/2020] [Accepted: 04/10/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Patients with diabetes in China have low health literacy, which likely leads to poor clinical outcomes. This study aimed to assess the effectiveness of health literacy and exercise interventions on clinical measurements in Chinese adults with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS A cluster randomized controlled trial was conducted from February 2015 through April 2017 in Shanghai, China. 799 patients with T2DM aged 18 years or older recruited from eight Community Healthcare Centers were randomized into one control arm and three intervention arms receiving 1-year health literacy intervention, exercise intervention or both as the comprehensive intervention. Propensity score matching was employed to minimize potential imbalance in randomization. The intervention-attributable effects on main clinical outcomes were estimated using a difference-in-difference regression approach. RESULTS After propensity score matching, 634 patients were included in the analysis. The three intervention groups had decreased hemoglobin A1c (A1c) level after 12 months of intervention. The largest adjusted decrease was observed in the health literacy group (-0.95%, 95% CI: -1.30 to -0.59), followed by the exercise group (-0.81%, 95% CI: -1.17 to -0.45). However, A1c was observed to increase in the health literacy and the comprehensive groups from 12 to 24 months. No obvious changes were observed for other measurements including high-density and low-density lipoprotein cholesterols, and systolic and diastolic blood pressures. CONCLUSIONS Health literacy and exercise-focused interventions improve glycemic control in Chinese patients with diabetes after 12 months of intervention, and the health literacy intervention shows the greatest effect. Our results suggest that the interventions may have the potential to improve diabetes self-management and reduce diabetes burden in China. TRIAL REGISTRATION NUMBER ISRCTN76130594.
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Affiliation(s)
- Yan Wei
- Key Lab of Health Technology Assessment (National Health Commission), School of Public Health, Fudan University, Shanghai, China
| | - Yingyao Chen
- Key Lab of Health Technology Assessment (National Health Commission), School of Public Health, Fudan University, Shanghai, China
| | - Yingnan Zhao
- Division of Clinical and Administrative Science, College of Pharmacy, Xavier University of Louisiana, Louisiana, New Orleans, USA
| | - Russell Rothman
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jian Ming
- Key Lab of Health Technology Assessment (National Health Commission), School of Public Health, Fudan University, Shanghai, China
| | - Lei Wang
- Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety (National Ministry of Education), Fudan University, Shanghai, China
| | - Xiaona Liu
- Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety (National Ministry of Education), Fudan University, Shanghai, China
| | - Lizheng Shi
- Department of Global Health Management and Policy, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Wanghong Xu
- Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety (National Ministry of Education), Fudan University, Shanghai, China
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Almigbal TH, Almutairi KM, Vinluan JM, Batais MA, Alodhayani A, Alonazi WB, Sheshah E, Alhoqail RI. Association of health literacy and self-management practices and psychological factor among patients with type 2 diabetes mellitus in Saudi Arabia. Saudi Med J 2020; 40:1158-1166. [PMID: 31707414 PMCID: PMC6901769 DOI: 10.15537/smj.2019.11.24585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objectives: To determine the association between sociodemographic, clinical, and health literacy and the presence of depressed mood and their relationships to diabetes self-management among type 2 diabetes mellitus (T2DM) patients in Saudi Arabia. Methods: A total of 352 T2DM patients from 2 public tertiary hospitals in Saudi Arabia participated in this descriptive cross-sectional study between December 2016 and February 2017. All respondents answered a 4-part questionnaire, which includes demographic data, Diabetes Self-Management Questionnaire (DSMQ), 36-item test based Short Test of Functional Health Literacy in Adults, and a 2-item Patient Health Questionnaire (PHQ-2). The Chi-square test and logistic regression analysis were conducted to determine the relationship and significant predictors for self-management among T2DM patients. Results: The analysis showed that majority of the participants had low to marginal functional health literacy. The overall DSM-16 score was good, indicating more effective self-care, while 20% of the participants had a score of 2 or more in the PHQ-2 indicating presence of depressed mood. No significant association was found between DSM and health literacy among the study participants while age, gender, educational level, employment status, and level of the depressive symptom were significantly associated with differences in the level of functional literacy of the participants. Conclusion: The study shows that nearly half of the T2DM patients that exhibited low level of functional health literacy had low diabetes self-management. Our findings also show that gender significantly affects diabetes self-management in which odds are a lot higher among females than males with diabetes self-management. This study underscores the importance of proper counselling and education about diabetes control on both patients and family members.
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Affiliation(s)
- Turky H. Almigbal
- From the Department of Medicine (Almigbal, Batais, Alhoqail), Department of Community Health Science, College of Applied Medical Science (Almutairi, Vinluan), Department of Family and Community Medicine (Alodhayani), College of Medicine; from the College of Business Administration (Alonazi); and from the Department of Diabetes Center (Sheshah), King Salman Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Address correspondence and reprint request to: Jason M. Vinluan, Department of Community Health Science, College of Applied Medical Science, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0001-8670-3580
| | - Khalid M. Almutairi
- From the Department of Medicine (Almigbal, Batais, Alhoqail), Department of Community Health Science, College of Applied Medical Science (Almutairi, Vinluan), Department of Family and Community Medicine (Alodhayani), College of Medicine; from the College of Business Administration (Alonazi); and from the Department of Diabetes Center (Sheshah), King Salman Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Jason M. Vinluan
- From the Department of Medicine (Almigbal, Batais, Alhoqail), Department of Community Health Science, College of Applied Medical Science (Almutairi, Vinluan), Department of Family and Community Medicine (Alodhayani), College of Medicine; from the College of Business Administration (Alonazi); and from the Department of Diabetes Center (Sheshah), King Salman Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Address correspondence and reprint request to: Jason M. Vinluan, Department of Community Health Science, College of Applied Medical Science, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0001-8670-3580
| | - Mohammed A. Batais
- Address correspondence and reprint request to: Jason M. Vinluan, Department of Community Health Science, College of Applied Medical Science, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0001-8670-3580
| | - Abdulaziz Alodhayani
- From the Department of Medicine (Almigbal, Batais, Alhoqail), Department of Community Health Science, College of Applied Medical Science (Almutairi, Vinluan), Department of Family and Community Medicine (Alodhayani), College of Medicine; from the College of Business Administration (Alonazi); and from the Department of Diabetes Center (Sheshah), King Salman Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Wadi B. Alonazi
- From the Department of Medicine (Almigbal, Batais, Alhoqail), Department of Community Health Science, College of Applied Medical Science (Almutairi, Vinluan), Department of Family and Community Medicine (Alodhayani), College of Medicine; from the College of Business Administration (Alonazi); and from the Department of Diabetes Center (Sheshah), King Salman Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Eman Sheshah
- From the Department of Medicine (Almigbal, Batais, Alhoqail), Department of Community Health Science, College of Applied Medical Science (Almutairi, Vinluan), Department of Family and Community Medicine (Alodhayani), College of Medicine; from the College of Business Administration (Alonazi); and from the Department of Diabetes Center (Sheshah), King Salman Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Razan I. Alhoqail
- From the Department of Medicine (Almigbal, Batais, Alhoqail), Department of Community Health Science, College of Applied Medical Science (Almutairi, Vinluan), Department of Family and Community Medicine (Alodhayani), College of Medicine; from the College of Business Administration (Alonazi); and from the Department of Diabetes Center (Sheshah), King Salman Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
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21
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Liu S, Zhang R, Shang X, Li W. Analysis for warning factors of type 2 diabetes mellitus complications with Markov blanket based on a Bayesian network model. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 188:105302. [PMID: 31923820 DOI: 10.1016/j.cmpb.2019.105302] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 12/05/2019] [Accepted: 12/24/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Type 2 diabetes mellitus (T2DM) complications seriously affect the quality of life and could not be cured completely. Actions should be taken for prevention and self-management. Analysis of warning factors is beneficial for patients, on which some previous studies focused. They generally used the professional medical test factors or complete factors to predict and prevent, but it was inconvenient and impractical for patients to self-manage. With this in mind, this study built a Bayesian network (BN) model, from the perspective of diabetic patients' self-management and prevention, to predict six complications of T2DM using the selected warning factors which patients could have access from medical examination. Furthermore, the model was analyzed to explore the relationships between physiological variables and T2DM complications, as well as the complications themselves. The model aims to help patients with T2DM self-manage and prevent themselves from complications. METHODS The dataset was collected from a well-known data center called the National Health Clinical Center between 1st January 2009 and 31st December 2009. After preprocess and impute the data, a BN model merging expert knowledge was built with Bootstrap and Tabu search algorithm. Markov Blanket (MB) was used to select the warning factors and predict T2DM complications. Moreover, a Bayesian network without prior information (BN-wopi) model learned using 10-fold cross-validation both in structure and in parameters was added to compare with other classifiers learned using 10-fold cross-validation fairly. The warning factors were selected according the structure learned in each fold and were used to predict. Finally, the performance of two BN models using warning features were compared with Naïve Bayes model, Random Forest model, and C5.0 Decision Tree model, which used all features to predict. Besides, the validation parameters of the proposed model were also compared with those in existing studies using some other variables in clinical data or biomedical data to predict T2DM complications. RESULTS Experimental results indicated that the BN models using warning factors performed statistically better than their counterparts using all other variables in predicting T2DM complications. In addition, the proposed BN model were effective and significant in predicting diabetic nephropathy (DN) (AUC: 0.831), diabetic foot (DF) (AUC: 0.905), diabetic macrovascular complications (DMV) (AUC: 0.753) and diabetic ketoacidosis (DK) (AUC: 0.877) with the selected warning factors compared with other experiments. CONCLUSIONS The warning factors of DN, DF, DMV, and DK selected by MB in this research might be able to help predict certain T2DM complications effectively, and the proposed BN model might be used as a general tool for prevention, monitoring, and self-management.
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Affiliation(s)
- Siying Liu
- School of Economics and Management, Beijing Jiaotong University, Beijing 100044, PR China
| | - Runtong Zhang
- School of Economics and Management, Beijing Jiaotong University, Beijing 100044, PR China.
| | - Xiaopu Shang
- School of Economics and Management, Beijing Jiaotong University, Beijing 100044, PR China
| | - Weizi Li
- Informatics Research Center, University of Reading, Berkshire RG6 6AH, United Kingdom
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22
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López-Entrambasaguas OM, Martínez-Linares JM, Sola-García M, García-Redecillas C, Díaz-Meco-Niño AM. Economic Problems and Loneliness as Factors Related to Subjective Unmet Health Needs in People with Chronic Diseases and Dependency. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082924. [PMID: 32340277 PMCID: PMC7216074 DOI: 10.3390/ijerph17082924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 11/17/2022]
Abstract
Background: The continuous increase of people with chronic diseases is one of the greatest challenges for healthcare systems worldwide. Population growth and life expectancy means that an increasing number of people with chronic diseases and dependency need some kind of assistance to meet their needs. Determining these subjective unmet needs helps to understand the situation of these people. The aim of this study was to explore the perceptions of chronic patients over 65 years of age from the day-care center toward subjective health needs that are not being met by the socio-health system. Methods: Qualitative exploratory-descriptive study. Through convenience sampling, we selected people with chronic diseases and dependency who used day-care centers and met the inclusion criteria. Focus groups were performed. The data were transcribed and a thematic analysis was carried out using Atlas.ti software. Results: The topics resulting from the analysis were classified into dissatisfaction of biological/physiological needs, psychological needs, social needs, and other issues that arose in both groups of participants which referred to the types of needs previously indicated. The issues related to social and psycho-social needs stood out. Conclusions: People with chronic diseases and dependency have their physiological needs covered with the help they receive, but their situation of dependency generates additional costs that worsen their economic situation. However, their greatest need is due to the loneliness they feel and the feeling they have of “being a burden” on their families.
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Affiliation(s)
| | | | - Miguel Sola-García
- Complejo Hospitalario de Jaén, Servicio Andaluz de Salud, 23007 Jaén, Spain; (M.S.-G.); (C.G.-R.); (A.M.D.-M.-N.)
| | - Carmen García-Redecillas
- Complejo Hospitalario de Jaén, Servicio Andaluz de Salud, 23007 Jaén, Spain; (M.S.-G.); (C.G.-R.); (A.M.D.-M.-N.)
| | - Ana María Díaz-Meco-Niño
- Complejo Hospitalario de Jaén, Servicio Andaluz de Salud, 23007 Jaén, Spain; (M.S.-G.); (C.G.-R.); (A.M.D.-M.-N.)
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23
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Pirdehghan A, Eslahchi M, Esna-Ashari F, Borzouei S. Health literacy and diabetes control in pregnant women. J Family Med Prim Care 2020; 9:1048-1052. [PMID: 32318465 PMCID: PMC7114019 DOI: 10.4103/jfmpc.jfmpc_891_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/23/2019] [Accepted: 12/31/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Low health literacy (HL) is associated with an extensive range of health outcomes. Objective: The present study was performed to inquire about the relationship between HL and glycemic control in gestational diabetes in order to design interventional future preventing programs. Methods: This cross-sectional study was performed on 104 Iranian pregnant women with gestational diabetes mellitus (GDM) referred from urban and rural areas to endocrinology clinic of Hamadan Beheshti Hospital, in 2017. Iranian Health Literacy Questionnaire (IHLQ) and a sociodemographic checklist were distributed among women. Correlation between HL and glycemic control was examined using SPSS. The significance level was set at P < 0.05. Results: Among women, 48.1% (50) were affected by uncontrolled diabetes and only 22% (11) had an adequate level of HL. An adequate level of HL were 50% and 22% in glycemic controlled and uncontrolled women, respectively. In univariate analysis, there was a significant relationship between diabetes control and adequate HL. So, problematic HL could increase the chance of uncontrolled diabetes more than three times (odds ratio: 3.5; CI: 1.5–8.3; P value: 0.004). Among all related variables, education and being housewife were considered as protective and risk factors for problematic HL, respectively. Conclusion: In conclusion, this study has provided evidence of limited HL and its relationship with low glycemic control in pregnant women with GDM. The problem was more serious in low educated, rural, housekeepers, and older-aged women. This deficit needs to be addressed by health planners and policymakers who are responsible for promoting the health of people and decreasing health inequalities community.
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Affiliation(s)
- Azar Pirdehghan
- Department of Community and Preventive Medicine, School of Public Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Eslahchi
- Medical Student, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farzaneh Esna-Ashari
- Department of Community and Preventive Medicine, School of Public Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shiva Borzouei
- Department of Internal Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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24
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Yu K, Wu S, Lee PJ, Wu DA, Hsiao HY, Tseng YC, Wang YW, Cheng CF, Wang YH, Lee SP, Chi I. Longitudinal Effects of an Intergenerational mHealth Program for Older Type 2 Diabetes Patients in Rural Taiwan. DIABETES EDUCATOR 2020; 46:206-216. [PMID: 32216585 DOI: 10.1177/0145721720907301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE The purpose of the study is to test the longitudinal efficacy of a mHealth intervention (Intergenerational Mobile Technology Opportunities Program, IMTOP) for older type 2 diabetes mellitus (T2DM) patients in rural Taiwan. Few mHealth programs targeted rural older adults and the longitudinal effects are unknown. METHODS Ninety-seven T2DM patients aged 55+ were recruited from an outpatient in Hualien, Taiwan. The intervention comprised 8-week technology and diabetes self-management training and 4-week technical support. College student tutors facilitated T2DM patients to learn technology. Participants used a diabetes self-management app to track health behaviors. Outcomes measured at baseline and at 4 and 8 months including patient-reported self-care behaviors, T2DM symptoms, clinical outcomes, health resource utilization, and medical expenditure. Linear mixed-effect regressions of repeated measures were conducted for each outcome. RESULTS At 4 months, improvements in self-care behaviors were reported in diet, exercise, smoking, and blood glucose testing. Patients paid less endocrinology clinic visits, spent less on endocrinology medications, and improvements in fasting blood glucose and total cholesterol were observed. At 8 months, the statistical significance of improvements in diet and smoking were maintained, and the averaged endocrinology clinic visits remained less than baseline. However, more frequent occurrence of diabetes symptoms were reported at both follow-ups. CONCLUSIONS IMTOP had lasting effects on diet and decreased smoking behavior, clinic visits, and medication costs over 8 months. Self-monitoring through an app increased awareness and may explain the increased reporting of diabetes symptoms. IMTOP is a promising model for promoting T2DM self-management in rural areas.
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Affiliation(s)
- Kexin Yu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California.,Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, California
| | - Shinyi Wu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California.,Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, California.,Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, California.,Division of Endocrinology and Metabolism, Hualien Tzu Chi Hospital, Hualien (Dr Wu, Ms. Wang)
| | - Pey-Jiuan Lee
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Du-An Wu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Hsin-Yi Hsiao
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Yi-Chuan Tseng
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Ying-Wei Wang
- Division of Endocrinology and Metabolism, Hualien Tzu Chi Hospital, Hualien
| | | | - Yi-Hsuan Wang
- Ministry of Health and Welfare, Director-General, Health Promotion Administration, Taipei.,School of Medicine, Tzu Chi University, Hualien.,Division of Family Medicine, Hualien Tzu Chi Hospital, Hualien
| | - Szu-Pei Lee
- Sports Medical Center, Hualien Tzu Chi Hospital, Hualien
| | - Iris Chi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
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25
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Finbråten HS, Guttersrud Ø, Nordström G, Pettersen KS, Trollvik A, Wilde-Larsson B. Explaining variance in health literacy among people with type 2 diabetes: the association between health literacy and health behaviour and empowerment. BMC Public Health 2020; 20:161. [PMID: 32013897 PMCID: PMC6998369 DOI: 10.1186/s12889-020-8274-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/24/2020] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Hanne Søberg Finbråten
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, PO Box 400, N-2418, Elverum, Norway. .,Department of Health Sciences, Faculty of Health, Science and Technology, Nursing science, Karlstad University, SE-65188, Karlstad, Sweden.
| | - Øystein Guttersrud
- Norwegian Centre for Science Education, Faculty of Mathematics and Natural Sciences, University of Oslo, PO Box 1106, Blindern, N-0317, Oslo, Norway
| | - Gun Nordström
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, PO Box 400, N-2418, Elverum, Norway
| | - Kjell Sverre Pettersen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, PO Box 4, St Olavs plass, N-0130, Oslo, Norway
| | - Anne Trollvik
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, PO Box 400, N-2418, Elverum, Norway
| | - Bodil Wilde-Larsson
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, PO Box 400, N-2418, Elverum, Norway.,Department of Health Sciences, Faculty of Health, Science and Technology, Nursing science, Karlstad University, SE-65188, Karlstad, Sweden
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26
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Wang L, Fang H, Xia Q, Liu X, Chen Y, Zhou P, Yan Y, Yao B, Wei Y, Jiang Y, Rothman RL, Xu W. Health literacy and exercise-focused interventions on clinical measurements in Chinese diabetes patients: A cluster randomized controlled trial. EClinicalMedicine 2019; 17:100211. [PMID: 31891144 PMCID: PMC6933227 DOI: 10.1016/j.eclinm.2019.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/07/2019] [Accepted: 11/07/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The diabetes patients in China have low health literacy and low levels of physical activities which may result in the poor glycemic control and other clinical outcomes. This study is designed to evaluate the effectiveness of health literacy and exercise-focused interventions on clinical outcomes among Chinese patients with type 2 diabetes (T2DM). METHODS In this cluster randomized controlled trial, 799 T2DM patients with the most recent A1c ≥ 7·5% (58 mmol/mol, or fasting glucose level ≥10 mmol/L) were recruited from 35 clinics in 8 communities in Shanghai, China, and randomized into one standard care (control) arm and three intervention arms receiving interventions focused on health literacy, exercise or both. A1c (primary outcome), blood pressure and lipids (secondary outcomes) were measured at baseline, 3-, 6-, 12-months of intervention period and 12-months after completion of the interventions. This trial is registered with the International Standard RCT Number Register, number ISRCTN76130594. FINDINGS The three intervention groups had more reductions in A1c than the control group, with 0·90% reduction in the health literacy, 0·83% in the exercise and 0·54% in the comprehensive group at 12-months (p<0·001) and these improvements remained even after a 1-year follow-up period post intervention. The risk of suboptimal A1c (≥7·0% or 53 mmol/mol) was also significantly lower in three intervention groups than control group at each follow-up visit, with adjusted risk ratios (RR) ranging from 0.06 to 0.16. However, the control group has greater reductions in low-density lipoprotein (LDL) than the health literacy group from baseline to 12-months (β=0·55, p<0·0001) and from baseline to 24-months (β=0·62, p<0·0001). A higher risk of abnormal LDL was also observed for the health literacy group at 12-months [adjusted risk ratio (RR): 2·22, 95%CI: 1·11-4·44] and 24-months [adjusted risk ratio (RR): 2·37, 95%CI: 1·16-4·87] compared to the control group. No significant benefits in systolic blood pressure (SBP), diastolic blood pressure (DBP) and low-density lipoprotein (HDL) were observed from the interventions compared to the usual care. INTERPRETATION The health literacy and exercise interventions result in significant improvements in A1c. However, no significant benefits in blood pressure and lipids control were observed. These effective interventions may have potential of scaling up in China and other countries to help diabetes patients manage their blood glucose levels. FUNDING This Study was supported by the China Medical Board (CMB) Open Competition Project (No.13-159) and the Social Science Fund of China National Ministry of Education (No.14YJAZH092).
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Affiliation(s)
- Lei Wang
- School of Public Health and Key Laboratory of Public Health Safety, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China
| | - Hong Fang
- Minhang District Center for Disease Control and Prevention, 962 Zhong Yi Road, Shanghai, China
| | - Qinghua Xia
- Changning District Center for Disease Control and Prevention, 39 Yun Wu Shan Road, Shanghai, China
| | - Xiaona Liu
- School of Public Health and Key Laboratory of Public Health Safety, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China
| | - Yingyao Chen
- School of Public Health and Key Laboratory of Public Health Safety, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China
| | - Peng Zhou
- Changning District Center for Disease Control and Prevention, 39 Yun Wu Shan Road, Shanghai, China
| | - Yujie Yan
- Minhang District Center for Disease Control and Prevention, 962 Zhong Yi Road, Shanghai, China
| | - Baodong Yao
- Minhang District Center for Disease Control and Prevention, 962 Zhong Yi Road, Shanghai, China
| | - Yan Wei
- School of Public Health and Key Laboratory of Public Health Safety, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China
| | - Yu Jiang
- Changning District Center for Disease Control and Prevention, 39 Yun Wu Shan Road, Shanghai, China
| | - Russell L. Rothman
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wanghong Xu
- School of Public Health and Key Laboratory of Public Health Safety, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China
- Corresponding author.
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27
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Finbråten HS, Guttersrud Ø, Nordström G, Pettersen KS, Trollvik A, Wilde-Larsson B. Validating the Functional, Communicative, and Critical Health Literacy Scale Using Rasch Modeling and Confirmatory Factor Analysis. J Nurs Meas 2019; 26:341-363. [PMID: 30567948 DOI: 10.1891/1061-3749.26.2.341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Hanne Søberg Finbråten
- Inland Norway University of Applied Sciences, Elverum, Norway .,Karlstad University, Karlstad, Sweden
| | - Øystein Guttersrud
- Norwegian Centre for Science Education, University of Oslo, Oslo, Norway
| | - Gun Nordström
- Inland Norway University of Applied Sciences, Elverum, Norway
| | | | - Anne Trollvik
- Inland Norway University of Applied Sciences, Elverum, Norway
| | - Bodil Wilde-Larsson
- Karlstad University, Karlstad, Sweden.,Inland Norway University of Applied Sciences, Elverum, Norway
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28
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Belsti Y, Akalu Y, Fekadu H, Animut Y. Awareness of complications of diabetes mellitus and its associated factors among type 2 diabetic patients at Addis Zemen District Hospital, northwest Ethiopia. BMC Res Notes 2019; 12:602. [PMID: 31533856 PMCID: PMC6751640 DOI: 10.1186/s13104-019-4637-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 09/11/2019] [Indexed: 01/24/2023] Open
Abstract
Objectives Awareness about complications is important to reduce diabetes related morbidity and mortality. This study aimed to assess awareness of diabetes complications and associated factors among type 2 diabetic patients. Institution based cross sectional study was conducted from April to June, 2019, using simple random sampling technique, and interviewer administered questionnaires. Results The mean age was 41 ± 1.46 years and 56% were females. Awareness regarding diabetic complications was 48.5% with 95% CI (43.3, 52.7%). Male sex (AOR: 4.67, 95% CI (2.53, 8.61)), age of 31–45 years (AOR: 7.30, 95% CI (3.10, 17.17)), 46–70 years old (AOR: 15.02, 95% CI (6.11, 36.92)), read and write (AOR: 3.79, 95% CI (1.78, 8.06)), primary school (AOR: 9.58, 95% CI (3.26, 28.18)), high school and above (AOR: 7.46, 95% CI (3.02, 18.44)), NGO employee (AOR: 7.24, 95% CI (2.68, 19.53)), having a family history of DM (AOR: 5.55, 95% CI (2.53, 12.20)); income of 1001–1500 (AOR: 3.22, 95% CI (1.28, 8.10)), 1501–2500 (AOR: 11.73, 95% CI (4.32, 31.81)) and > 2500 Ethiopian birr (AOR: 7.18, 95% CI (1.70, 30.28)) ≥ 2500 ETB (AOR: 7.18, 95% CI (1.70, 30.28)) were significantly associated with good awareness. To improve patient’s awareness on DM complications providing health education for type 2 diabetic patients is crucial.
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Affiliation(s)
- Yitayeh Belsti
- Department of Physiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Yonas Akalu
- Department of Physiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Haileab Fekadu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yaregal Animut
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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White BM, Rochell JK, Warren JR. Promoting Cardiovascular Health for African American Women: An Integrative Review of Interventions. J Womens Health (Larchmt) 2019; 29:952-970. [PMID: 31502905 DOI: 10.1089/jwh.2018.7580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: African American (AA) women bear a disproportionate burden of cardiovascular disease. Promoting ideal cardiovascular health is one strategy to promote health equity for this disparate population. The goal of this integrative review was to summarize and evaluate the research evidence for cardiovascular risk reduction interventions specifically targeting, tailored, or adapted for AA women. Materials and Methods: A review of the literature was conducted using the EBSCOHost platform. Study elements from articles in the final analysis were extracted. Results: Fourteen interventions were included in the final analysis (16 peer-reviewed articles). Most studies targeted two or more areas of cardiovascular health with the most common areas being physical activity and diet. Primary and secondary outcome measures varied; the most common measures were self-reported dietary intake, physical activity, and knowledge-related measures. Eleven studies reported health outcomes; only five reported long-term intervention effects. Most studies employed at least one cultural tailoring or adaptation strategy for AA women. The most common strategies included incorporating feedback from the target population before implementation and tailoring intervention material to reflect the target population. Conclusions: There is a need to develop and evaluate tailored or adapted evidence-based interventions for AA women. Additional research is needed to design interventions for subgroups of the population such as low-income or rural AA women.
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Affiliation(s)
- Brandi M White
- Department of Health and Clinical Sciences, College of Health Sciences, University of Kentucky, Lexington, Kentucky
| | - Jahsleighe K Rochell
- Department of Health and Clinical Sciences, College of Health Sciences, University of Kentucky, Lexington, Kentucky
| | - Jennifer R Warren
- Center for African American Health Disparities Education and Research, Trenton, New Jersey
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Adinan J, Manongi R, Temu GA, Kapologwe N, Marandu A, Wajanga B, Dika H, Maongezi S, Laizer S, Manyuti R, Nassir RA, Renju J, Todd J. Preparedness of health facilities in managing hypertension & diabetes mellitus in Kilimanjaro, Tanzania: a cross sectional study. BMC Health Serv Res 2019; 19:537. [PMID: 31366384 PMCID: PMC6670222 DOI: 10.1186/s12913-019-4316-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background Hypertension and Diabetes mellitus are risk factors for cardiovascular diseases that cause 17 million deaths globally. Many of these deaths could have been prevented if hypertensive and diabetic patients had their blood pressure and glucose controlled. Less than 30% of hypertensive and diabetic patients on management have controlled their blood pressure and glucose respectively. This study aimed to determine the preparedness of health facilities in managing hypertensive and diabetic patients in terms of personnel; laboratory services provision, and local use of routinely collected data, and shows differences in preparedness between the levels of facilities. Methods We conducted a cross-sectional study in Government, faith-based and private health facilities in two districts in Kilimanjaro region in Tanzania from March to July 2017. We collected data through interviews and observations on the preparedness of the facilities for managing hypertension and DM. Results Forty-three (43) health facilities and 62 healthcare workers (HCW) participated in the survey. Services for hypertension and DM were available in 37 (86%) and 34 (79%) health facilities respectively. Eighteen (53%) and five (15%) facilities had HCW trained on hypertension and DM management respectively within two years preceding the survey. Regular adherence to treatment guideline was reported in 18 (53%) of the health facilities. More than third of health facilities were without basic equipment for managing hypertension and DM. All the recommended laboratory tests were only available in four (15%) hospitals and one health center. Valid first line medicines for both hypertension and DM were available in six (50%) health centers, four (24%) dispensaries and in four (80.0%) hospitals. Health data collection, analysis and local use for planning were reported in all hospitals, nine (75%) health centers and four (24%) dispensaries. Conclusions Health facilities are not fully prepared to manage hypertension and DM. Health centers and dispensaries are mostly affected levels of health facilities. Government interventions to improve facility factors and collaborative approaches to build capacity to HCW are needed to enable health facilities be responsive to these diseases.
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Affiliation(s)
- Juma Adinan
- School of AMO KCMC, 3010, Moshi, Kilimanjaro, Tanzania. .,Kilimanjaro Christian Medical University College, 2240, Moshi, Kilimanjaro, Tanzania. .,Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania.
| | - Rachel Manongi
- Kilimanjaro Christian Medical University College, 2240, Moshi, Kilimanjaro, Tanzania
| | - Gloria August Temu
- Kilimanjaro Christian Medical University College, 2240, Moshi, Kilimanjaro, Tanzania
| | - Ntuli Kapologwe
- Kilimanjaro Christian Medical University College, 2240, Moshi, Kilimanjaro, Tanzania.,President's Office - Regional Administration and Local Government (PORALG), Dodoma, Tanzania
| | - Annette Marandu
- Mawenzi Regional Referral Hospital, Moshi, Kilimanjaro, Tanzania
| | - Bahati Wajanga
- Catholic University of Health and Allied Sciences, 1464, Mwanza, Tanzania
| | - Haruna Dika
- Catholic University of Health and Allied Sciences, 1464, Mwanza, Tanzania
| | - Sarah Maongezi
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Sweetness Laizer
- Kilimanjaro Christian Medical University College, 2240, Moshi, Kilimanjaro, Tanzania
| | - Ridhiwani Manyuti
- Kilimanjaro Christian Medical University College, 2240, Moshi, Kilimanjaro, Tanzania
| | | | - Jenny Renju
- Kilimanjaro Christian Medical University College, 2240, Moshi, Kilimanjaro, Tanzania.,Department of Population Health, LSHTM, London, UK
| | - Jim Todd
- Kilimanjaro Christian Medical University College, 2240, Moshi, Kilimanjaro, Tanzania.,Department of Population Health, LSHTM, London, UK
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The role of support and sustainability elements in the adoption of an online self-management support system for chronic illnesses. J Biomed Inform 2019; 95:103215. [DOI: 10.1016/j.jbi.2019.103215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 05/01/2019] [Accepted: 05/17/2019] [Indexed: 12/26/2022]
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Yarmohammadi S, Momenyan S, Ghaffari M, Ali R, Azizpour M. Impact of functional, communicative and critical health literacy on glycemic control among patients with type 2 diabetes, and the mediating role of self-care. Psychol Res Behav Manag 2019; 12:427-435. [PMID: 31417324 PMCID: PMC6592064 DOI: 10.2147/prbm.s207466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/07/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Health literacy (HL) could influence self-care behaviors and further affect HbA1c values. Understanding the mechanism relationships between HL, self-care behaviors and HbA1c could provide the valuable knowledge for developing evidence-based interventions in diabetic patients. In this study, we hypothesized that HL and its subscales would be related to self-care behaviors and that HL would be indirectly related to glycemic control (HbA1c) via relations with self-care behaviors among diabetes patients. Methods: This cross-sectional study was performed on 300 patients with type 2 diabetes referred to five educational hospitals affiliated to Shahid Beheshti University of Medical Sciences in 2018. The Persian version of Functional, Communicative, and Critical Health Literacy (FCCHL) questionnaire and the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire were used. Also, recent HbA1c values were extracted from patients’ medical records. Structural equation modeling (SEM) was also used to investigate the relationships between the variables. Results: The SEM results showed the direct standardized path of the total HL score, functional HL, communicative HL and critical HL on HbA1c were nonsignificant in the model with mediator. While the indirect effect of the total HL score (β = −0.24, P=0.042), functional HL (β = −0.15, P=0.01), communicative HL (β = −0.16, P=0.01) and critical HL (β = −0.22, P=0.03) on HbA1c through the mediation of self-care behaviors were significant. Conclusion: The results of this study indicated that HL and particularly critical HL are significant factors in reducing HbA1c in patients with type 2 diabetes through the mediation of self-care behaviors.
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Affiliation(s)
- Soudabeh Yarmohammadi
- Research Center for Environmental Determinants of Health (RCEDH), Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Somayeh Momenyan
- Department of Biostatistics, Faculty of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohtasham Ghaffari
- Health Education & Health Promotion, Environmental and Occupational Hazards Control Research Center, School of Public Health & Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramezankhani Ali
- Department of Public Health, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohyeddin Azizpour
- School of Public Health & Safety, Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Marciano L, Camerini AL, Schulz PJ. The Role of Health Literacy in Diabetes Knowledge, Self-Care, and Glycemic Control: a Meta-analysis. J Gen Intern Med 2019; 34:1007-1017. [PMID: 30877457 PMCID: PMC6544696 DOI: 10.1007/s11606-019-04832-y] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/25/2018] [Accepted: 01/08/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Empirical evidence on how health literacy affects diabetes outcomes is inconsistent. The purpose of this meta-analysis was to quantitatively summarize the findings on the associations between health literacy and diabetes knowledge, self-care activities, and glycemic control as disease-related outcomes, with specific focus on the type of health literacy assessment. DATA SOURCES Nine databases (MEDLINE, CINAHL, Communication and Mass Media Complete, PsychInfo, PsychArticles, Psychology and Behavioral Sciences Collection, ERIC, Sociology, Embase) were searched for peer-reviewed original research articles published until 31 March 2018. METHODS Studies with type 1 and/or type 2 diabetes patients aged 18 or older, providing a calculable baseline effect size for functional health literacy and diabetes knowledge, self-care activities, or HbA1C were included. RESULTS The meta-analysis includes 61 studies with a total of 18,905 patients. The majority were conducted in the USA, on type 2 diabetes patients, and used the S-TOFHLA as a performance-based or the BHLS as a perception-based measure of functional health literacy. Meta-analytic results show that all three outcomes are related to health literacy. Diabetes knowledge was best predicted by performance-based health literacy measures, self-care by self-report measures, and glycemic control equally by both types of health literacy assessment. DISCUSSION Health literacy plays a substantial role in diabetes knowledge. Findings for the role of health literacy in self-care and glycemic control remain heterogeneous, partly due to the type of health literacy assessment (performance- vs. perception-based). This has implications for the use of health literacy measures in clinical settings and original research. This meta-analysis was limited to functional health literacy and, due to the paucity of studies, did not investigate the role of other dimensions including communicative and critical health literacy.
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Affiliation(s)
- Laura Marciano
- Faculty of Communication Sciences, Institute of Communication and Health, Università della Svizzera italiana, Via Giuseppe Buffi 13, 6904, Lugano, Switzerland.
| | - Anne-Linda Camerini
- Faculty of Communication Sciences, Institute of Communication and Health, Università della Svizzera italiana, Via Giuseppe Buffi 13, 6904, Lugano, Switzerland
| | - Peter J Schulz
- Faculty of Communication Sciences, Institute of Communication and Health, Università della Svizzera italiana, Via Giuseppe Buffi 13, 6904, Lugano, Switzerland
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Moura NDS, Lopes BB, Teixeira JJD, Oriá MOB, Vieira NFC, Guedes MVC. Literacy in health and self-care in people with type 2 diabetes mellitus. Rev Bras Enferm 2019; 72:700-706. [DOI: 10.1590/0034-7167-2018-0291] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 01/15/2019] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To evaluate the effect of educational intervention in the adherence to self-care activities and functional health literacy and numeracy in people with type 2 diabetes mellitus. Methods: This was a quasi-experimental study conducted in two units of the Brazilian Family Health Strategy, involving people with diabetes. Educational interventions occurred in three meetings, weekly, lasting 60 minutes on average. Data were collected using the Questionário de Autocuidado com o Diabetes, before and after the interventions. Results: 55 people participated in the study. After the interventions, the greatest difference for a better adherence to self-care was the item “inspecting the inside of the shoes before putting them on”, with 3.29 days in the week delta at analytical level. The worst was “taking insulin shots as recommended”, with 0.00 days a week delta at basic level. Conclusion: Educational interventions had a positive effect on adherence to self-care and functional literacy in health.
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G Duarte F, da Silva Moreira S, Almeida MDCC, de Souza Teles CA, Andrade CS, Reingold AL, Moreira Jr ED. Sex differences and correlates of poor glycaemic control in type 2 diabetes: a cross-sectional study in Brazil and Venezuela. BMJ Open 2019; 9:e023401. [PMID: 30842107 PMCID: PMC6429715 DOI: 10.1136/bmjopen-2018-023401] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Examine whether glycaemic control varies according to sex and whether the latter plays a role in modifying factors associated with inadequate glycaemic control in patients with type 2 diabetes (T2D) in Brazil and Venezuela. DESIGN, SETTING AND PARTICIPANTS This was a cross-sectional, nationwide survey conducted in Brazil and Venezuela from February 2006 to June 2007 to obtain information about glycaemic control and its determinants in patients with diabetes mellitus attending outpatient clinics. MAIN OUTCOME MEASURES Haemoglobin A1c (HbA1c) level was measured by liquid chromatography, and patients with HbA1c ≥7.0% (53 mmol/mol) were considered to have inadequate glycaemic control. The association of selected variables with glycaemic control was analysed by multivariate linear regression, using HbA1c as the dependent variable. RESULTS A total of 9418 patients with T2D were enrolled in Brazil (n=5692) and in Venezuela (n=3726). They included 6214 (66%) women and 3204 (34%) men. On average, HbA1c levels in women were 0.13 (95% CI 0.03 to 0.24; p=0.015) higher than in men, after adjusting for age, marital status, education, race, country, body mass index, duration of disease, complications, type of healthcare, adherence to diet, adherence to treatment and previous measurement of HbA1c. Sex modified the effect of some factors associated with glycaemic control in patients with T2D in our study, but had no noteworthy effect in others. CONCLUSIONS Women with T2D had worse glycaemic control than men. Possible causes for poorer glycaemic control in women compared with men include differences in glucose homeostasis, treatment response and psychological factors. In addition, sex modified factors associated with glycaemic control, suggesting the need to develop specific treatment guidelines for men and women.
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Affiliation(s)
- Fernanda G Duarte
- Department of Epidemiology, School of Public Health, University of California, Berkeley, California, USA
| | - Sandra da Silva Moreira
- Associação Obras Sociais Irmã Dulce, Salvador, Bahia, Brazil
- Laboratório de Epidemiologia Molecular e Bioestatística, Instituto Gonçalo Moniz, FIOCRUZ-BA, Salvador, BA, Brazil
| | - Maria da Conceição C Almeida
- Laboratório de Epidemiologia Molecular e Bioestatística, Instituto Gonçalo Moniz, FIOCRUZ-BA, Salvador, BA, Brazil
| | - Carlos A de Souza Teles
- Laboratório de Epidemiologia Molecular e Bioestatística, Instituto Gonçalo Moniz, FIOCRUZ-BA, Salvador, BA, Brazil
| | - Carine S Andrade
- Laboratório de Epidemiologia Molecular e Bioestatística, Instituto Gonçalo Moniz, FIOCRUZ-BA, Salvador, BA, Brazil
- Escola de Nutrição, Departamento Ciências da Nutrição, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Art L Reingold
- Department of Epidemiology, School of Public Health, University of California, Berkeley, California, USA
| | - Edson D Moreira Jr
- Associação Obras Sociais Irmã Dulce, Salvador, Bahia, Brazil
- Laboratório de Epidemiologia Molecular e Bioestatística, Instituto Gonçalo Moniz, FIOCRUZ-BA, Salvador, BA, Brazil
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Kaneko R, Ono S. Exploratory analysis of comparative clinical trials used for marketing approval in patients with type 2 diabetes in Japan. SAGE Open Med 2019; 7:2050312118823407. [PMID: 30671243 PMCID: PMC6329034 DOI: 10.1177/2050312118823407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/10/2018] [Indexed: 01/02/2023] Open
Abstract
Background/objectives: The results of phase 2 and 3 clinical trials, which justify decisions regarding marketing approval for new drugs, are used for comparison of drugs in the post-marketing phase. A number of meta-analyses of approved antidiabetics have been performed, but the heterogeneity of trials has not been fully examined. The aim of this study was to explore factors that may influence baseline HbA1c in trial samples and treatment outcomes (i.e. HbA1c reductions and effect sizes), with the goal of providing unbiased and fair retrospective comparisons between different antidiabetics. Method: We conducted three meta-regression analyses using 78 randomized or non-randomized comparative phase 2 or 3 trials of 24 approved antidiabetics in Japan, conducted from 1987 to 2012. Results: Baseline HbA1c of each arm was higher in phase 2 trials, trials with a greater number of subjects, trials with a lower proportion of male subjects, trials of combination therapy, or trials with longer subject disease duration. Entry criteria were different among drug classes and caused variations in baseline HbA1c. HbA1c reductions were larger in non-randomized trials, trials with a shorter treatment period, or trials with a lower proportion of male subjects. Effect sizes were larger in phase 2 trials, or trials of combination therapy. Larger effect sizes were observed in drugs with later market entry for alpha-glucosidase inhibitors and glinides. Conclusion: Baseline HbA1c, an important characteristic of subjects enrolled in trials of antidiabetics, differed significantly across trials. Differences in features of study subjects were caused by explicit stipulations in eligibility criteria of HbA1c and also by other conditions (e.g. trial design, regulatory guidance, treatment guideline) and/or interventions of investigators and pharmaceutical companies that were specific to drugs and trials. Healthcare professionals should carefully consider these heterogeneities in trials used for marketing approval review when making a retrospective comparison to select the best treatment option for patients.
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Affiliation(s)
- Reina Kaneko
- Laboratory of Pharmaceutical Regulation and Sciences, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Shunsuke Ono
- Laboratory of Pharmaceutical Regulation and Sciences, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
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Griva K, Rajeswari M, Nandakumar M, Khoo EYH, Lee VYW, Chua CG, Goh ZS, Choong YTD, Newman SP. The combined diabetes and renal control trial (C-DIRECT) - a feasibility randomised controlled trial to evaluate outcomes in multi-morbid patients with diabetes and on dialysis using a mixed methods approach. BMC Nephrol 2019; 20:2. [PMID: 30606135 PMCID: PMC6318946 DOI: 10.1186/s12882-018-1183-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 12/11/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND This cluster randomised controlled trial set out to investigate the feasibility and acceptability of the "Combined Diabetes and Renal Control Trial" (C-DIRECT) intervention, a nurse-led intervention based on motivational interviewing and self-management in patients with coexisting end stage renal diseases and diabetes mellitus (DM ESRD). Its efficacy to improve glycaemic control, as well as psychosocial and self-care outcomes were also evaluated as secondary outcomes. METHODS An assessor-blinded, clustered randomised-controlled trial was conducted with 44 haemodialysis patients with DM ESRD and ≥ 8% glycated haemoglobin (HbA1c), in dialysis centres across Singapore. Patients were randomised according to dialysis shifts. 20 patients were assigned to intervention and 24 were in usual care. The C-DIRECT intervention consisted of three weekly chair-side sessions delivered by diabetes specialist nurses. Data on recruitment, randomisation, and retention, and secondary outcomes such as clinical endpoints, emotional distress, adherence, and self-management skills measures were obtained at baseline and at 12 weeks follow-up. A qualitative evaluation using interviews was conducted at the end of the trial. RESULTS Of the 44 recruited at baseline, 42 patients were evaluated at follow-up. One patient died, and one discontinued the study due to deteriorating health. Recruitment, retention, and acceptability rates of C-DIRECT were generally satisfactory HbA1c levels decreased in both groups, but C-DIRECT had more participants with HbA1c < 8% at follow up compared to usual care. Significant improvements in role limitations due to physical health were noted for C-DIRECT whereas levels remained stable in usual care. No statistically significant differences between groups were observed for other clinical markers and other patient-reported outcomes. There were no adverse effects. CONCLUSIONS The trial demonstrated satisfactory feasibility. A brief intervention delivered on bedside as part of routine dialysis care showed some benefits in glycaemic control and on QOL domain compared with usual care, although no effect was observed in other secondary outcomes. Further research is needed to design and assess interventions to promote diabetes self-management in socially vulnerable patients. TRIAL REGISTRATION NUMBER Trial registered with the International Standard Randomised Controlled Trial (ISRCTN10546597). Registered 12 September 2016 (Retrospectively registered).
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Affiliation(s)
- K. Griva
- Centre for Population Health Sciences, Clinical Sciences Building, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232 Singapore
- Department of Psychology, National University of Singapore, 9 Arts Link AS4, Singapore, 117570 Singapore
| | - M. Rajeswari
- National Kidney Foundation, 81 Kim Keat Road, Singapore, 328836 Singapore
| | - M. Nandakumar
- National Kidney Foundation, 81 Kim Keat Road, Singapore, 328836 Singapore
| | - E. Y. H. Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Division of Endocrinology, University Medicine Cluster, National University Health System, Singapore, Singapore
| | - V. Y. W. Lee
- Department of Psychology, National University of Singapore, 9 Arts Link AS4, Singapore, 117570 Singapore
| | - C. G. Chua
- National Kidney Foundation, 81 Kim Keat Road, Singapore, 328836 Singapore
| | - Z. S. Goh
- Centre for Population Health Sciences, Clinical Sciences Building, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232 Singapore
| | - Y. T. D. Choong
- Department of Psychology, National University of Singapore, 9 Arts Link AS4, Singapore, 117570 Singapore
| | - S. P. Newman
- School of Health Sciences, City University of London, Northampton Square, London, UK
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Neter E, Brainin E. Association Between Health Literacy, eHealth Literacy, and Health Outcomes Among Patients With Long-Term Conditions. EUROPEAN PSYCHOLOGIST 2019. [DOI: 10.1027/1016-9040/a000350] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abstract. The objective of this paper is to synthesize and update findings from systematic review on health literacy and health outcomes among patients with long-term conditions, and extend the review to the digital domain. Health outcomes include clinical outcomes, processes of care, and health service use. Data sources are the following: (1) studies which appeared in two previous systematic reviews in 2004 and 2011 whose participants were people with long-term conditions or elderly ( n = 54); (2) articles on health literacy and health outcomes identified in an updated 2011–2016 search ( n = 26); (3) articles on eHealth literacy and its association with health outcomes ( n = 8). Strength of evidence was determined by a qualitative assessment of risk of bias, consistency, and directness. There was a lack of consistent evidence on the relationship between health literacy and clinical outcomes despite the consistent evidence on the association with mortality. There was low to insufficient evidence on the association between health literacy and self-rated health/function and emotional states of anxiety and depression, alongside high evidence on lack of association with quality of life. There was insufficient to low evidence on the association between health literacy and behavioral outcomes (medication adherence, other health behaviors) and finally also low to moderate evidence on the association between health literacy and use of health services such as hospitalization and emergency department. In the eHealth literacy domain, there were few studies reporting association with health behaviors and self-rated health with inconsistent results. In conclusion, it is advocated to examine performed heath literacy and eHealth literacy in large longitudinal studies.
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Affiliation(s)
- Efrat Neter
- Department of Behavioral Sciences, Ruppin Academic Center, Emeq Hefer, Israel
| | - Esther Brainin
- Department of Behavioral Sciences, Ruppin Academic Center, Emeq Hefer, Israel
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Does patient education improve compliance to routine diabetic retinopathy screening? J Telemed Telecare 2018; 26:161-173. [DOI: 10.1177/1357633x18804749] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Introduction Diabetic retinopathy (DR) screening relies on adherence to follow-up eye care. This article assesses if a model of patient education and tele-retina screening among high-risk patients with DR can achieve increased rates of compliance within a one-year follow-up. Methods Between May 2014 and May 2016, DR screening was conducted in a cohort of 101 patients with diabetes in Southern Ontario. Optical coherence tomography and fundus photography images were used to visualize the retina remotely. Enrolled patients participated in an educational seminar at the screening site with the expressed purpose of enhancing patient understanding of DR. A chi-squared test was used to assess patient compliance to follow-up examinations within 6–12 months, while pre-to post-screening HbA1c levels were compared using a dependent t-test. Results Of 101 patients who completed the study, 33 patients (32.6%) have never previously been screened for DR. Baseline compliance to annual screening increased from 36 patients (35.6%) to 51 patients (50.5%) after the tele-retina programme ( p = 0.03). Eighty-nine patients (88%) were referred to an optometrist for ongoing care compared with 12 patients (11.9%) to an ophthalmologist for management of DR. Overall, 100 patients (99.0%) were satisfied with the tele-retina screening. There was no significant change in pre- to-post screening HbA1c levels ( p = 0.91). Discussion Patient education-focused tele-retina screening for DR significantly increased compliance to follow-up in a high-risk, non-compliant patient population. Management of diabetes as captured by HbA1c levels remain unchanged in the cohort indicating a need for ongoing inter-professional collaboration in education and vision screening.
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Association of Electronic Health Literacy With Health-Promoting Behaviors in Patients With Type 2 Diabetes: A Cross-sectional Study. Comput Inform Nurs 2018; 36:438-447. [PMID: 29742548 DOI: 10.1097/cin.0000000000000438] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
It is important to know how well patients with type 2 diabetes understand and use health information available online in relation to health-promoting behaviors. Thus, the purposes of this study were to examine the association among electronic health literacy, perceived benefits, self-efficacy, and health-promoting behaviors in patients with type 2 diabetes, and to identify factors that affect health-promoting behaviors. A cross-sectional survey was conducted in a diabetes center in Seoul, South Korea. It was found that health-promoting behaviors were significantly correlated with electronic health literacy (r = 0.15, P < .05), perceived benefits (r = 0.15, P < .05), and self-efficacy (r = 0.47, P < .01). In the multiple linear regression analysis to identify the factors influencing health-promoting behaviors, electronic health literacy (β = .13, P = .040) and self-efficacy (β = .38, P < .001) were found to be significant factors, even after adjusting for general and disease-related characteristics. Strategies to improve health-promoting behaviors in patients with type 2 diabetes should focus on analyzing levels of electronic health literacy and deepening their understanding of online information accordingly.
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Alramadan MJ, Magliano DJ, Almigbal TH, Batais MA, Afroz A, Alramadhan HJ, Mahfoud WF, Alragas AM, Billah B. Glycaemic control for people with type 2 diabetes in Saudi Arabia - an urgent need for a review of management plan. BMC Endocr Disord 2018; 18:62. [PMID: 30200959 PMCID: PMC6131885 DOI: 10.1186/s12902-018-0292-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/29/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The aim of this study was to assess inadequate glycaemic control and its associated factors among people with type 2 diabetes in Saudi Arabia. METHODS A cross-sectional study design was used. Adults with type 2 diabetes attending diabetes centres in Riyadh, Hofuf and Jeddah cities were interviewed and their anthropometrics were measured. Their medical records were also reviewed to collect information related to recent lab tests, medications, and documented comorbidities. Multivariable logistic regression were used for data analysis. RESULTS A total of 1111 participants were recruited in the study. Mean age was 57.6 (±11.1) years, 65.2% of the participants were females, and mean HbA1c was 8.5 ± 1.9%. About three-fourths of participants had inadequate glycaemic control (≥ 7%). Multivariable analysis showed that age ≤ 60 years, longer duration of diabetes, living in a remote location, low household income, low intake of fruits and vegetable, low level of physical activity, lack of knowledge about haemoglobin A1c, high waist-hip ratio, low adherence to medication, and using injectable medications were independent risk factors for inadequate glycaemic control. CONCLUSIONS Inadequate glycaemic control is prevalent among people with type 2 diabetes in Saudi Arabia. In order to improve glycaemic control diabetes management plan should aim at controlling the modifiable risk factors which include low intake of fruits and vegetable, low level of physical activity, lack of knowledge about haemoglobin A1c, high waist-hip ratio, and low adherence to medications.
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Affiliation(s)
- Mohammed J. Alramadan
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Dianna J. Magliano
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC Australia
| | | | | | - Afsana Afroz
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | | | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Bijlsma-Rutte A, Rutters F, Elders PJM, Bot SDM, Nijpels G. Socio-economic status and HbA 1c in type 2 diabetes: A systematic review and meta-analysis. Diabetes Metab Res Rev 2018; 34:e3008. [PMID: 29633475 DOI: 10.1002/dmrr.3008] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 03/14/2018] [Accepted: 03/22/2018] [Indexed: 01/12/2023]
Abstract
Up until now, differences in HbA1c levels by socio-economic status (SES) have been identified, but not yet quantified in people with type 2 diabetes. The aim of this study was therefore to assess the difference in HbA1c levels between people with type 2 diabetes of different SES in a systematic review and meta-analysis. A systematic literature search was conducted in MEDLINE, Embase, Ebsco, and the Cochrane Library until January 14, 2018. Included studies described adults with type 2 diabetes in whom the association between SES and HbA1c levels was studied. Studies were rated for methodological quality and data were synthesized quantitatively (meta-analysis) and qualitatively (levels of evidence), stratified for type of SES variable, i.e., education, income, deprivation, and employment. Fifty-one studies were included: 15 high, 27 moderate, and 9 of low methodological quality. Strong evidence was provided that people of low SES have higher HbA1c levels than people of high SES, for deprivation, education, and employment status. The pooled mean difference in HbA1c levels between people of low and high SES was 0.26% (95% CI, 0.09-0.43) or 3.12 mmol/mol (95% CI, 1.21-5.04) for education and 0.20% (95% CI, -0.05 to 0.46) or 2.36 mmol/mol (95%CI, -0.61 to 5.33) for income. In conclusion, our systematic review and meta-analysis showed that there was an inverse association between SES and HbA1c levels in people with type 2 diabetes. Future research should focus on finding SES-sensitive strategies to reduce HbA1c levels in people with type 2 diabetes.
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Affiliation(s)
- Anne Bijlsma-Rutte
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Femke Rutters
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Petra J M Elders
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Sandra D M Bot
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Giel Nijpels
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
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A Theory-Based Self-Care Intervention with the Application of Health Literacy Strategies in Patients with High Blood Pressure and Limited Health Literacy: A Protocol Study. Int J Hypertens 2018; 2018:4068538. [PMID: 30112196 PMCID: PMC6077648 DOI: 10.1155/2018/4068538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 04/26/2018] [Accepted: 06/12/2018] [Indexed: 01/24/2023] Open
Abstract
The purpose of this study is to assess the effectiveness of a theory-based self-care intervention with the application of health literacy strategies in patients with high blood pressure and limited health literacy. This is a randomized controlled trial, with measurements at baseline and 1 and 3 months follow-up. 100 patients with high blood pressure and limited health literacy will be randomly allocated to either an intervention group or a usual care control group. We will mainly establish the intervention model based on the principal health belief model components. Patients randomized to the intervention group will receive four educational sessions during four weeks. Considering the limited health literacy level of the patients of the study, health literacy strategies will be used in educational material design for enhancing the quality of the intervention. In order to cover these strategies, we will design four standard animated comics and fact sheets with illustrations and photos consistent with the health belief model constructs and educational sessions' topics. Data will be collected using some questionnaires and will be analyzed using the SPSS software. The findings of this study may assist with the development of a theoretical model for self-care intervention in patients with high blood pressure and limited health literacy.
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Cheng YL, Shu JH, Hsu HC, Liang Y, Chou RH, Hsu PF, Wang YJ, Ding YZ, Liou TL, Wang YW, Huang SS, Lin CC, Lu TM, Leu HB, Lin SJ, Chan WL. High health literacy is associated with less obesity and lower Framingham risk score: Sub-study of the VGH-HEALTHCARE trial. PLoS One 2018; 13:e0194813. [PMID: 29590183 PMCID: PMC5874050 DOI: 10.1371/journal.pone.0194813] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 03/09/2018] [Indexed: 02/06/2023] Open
Abstract
Backgrounds Lower health literacy (HL) is associated with several cardiovascular disease (CVD) risk factors such as diabetes, hypertension, and metabolic syndrome (MS). The aim of our study was to investigate the association between HL and the Framingham 10-year risk score of CVD. Methods From 2015–2016, 1010 subjects aged 23 to 88 years receiving health check-up in Taipei Veterans General Hospital had complete clinical evaluations and laboratory examinations. Fatty liver was diagnosed by ultrasonography. The short form questionnaire adapted from the Mandarin Health Literacy Scale was used to assess HL. The Framingham risk score was calculated by patient characteristics. Results Subjects with higher BMIs were associated with lower HL scores. The proportion of subjects with MS was higher in the lower health literacy score group (≤ 9) at 28.8%; further analysis found that lower HL was significantly associated with MS in women but not in men. The Spearman’s rho demonstrated that the HL score was significantly associated with the BMI-based (rho = -0.11; P < 0.001) or lipid-based (rho = -0.09; P < 0.004) Framingham risk score. Conclusions Higher HL scores were associated with less CVD risk such as lower BMIs, less MS in women, and less fatty liver disease. Furthermore, HL had an inverse association with the Framingham risk score as expected. Therefore, HL in patients with CVD risk should be improved and considered as an important issue in terms of CVD reduction.
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Affiliation(s)
- Yuan-Lung Cheng
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan
| | - Jiah-Hwang Shu
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiu-Chuan Hsu
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ying Liang
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
- * E-mail: (YJW); (YL)
| | - Ruey-Hsing Chou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Cardiovascular research center, National Yang-Ming University, Taipei, Taiwan
| | - Pai-Feng Hsu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Cardiovascular research center, National Yang-Ming University, Taipei, Taiwan
| | - Yuan-Jen Wang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
- * E-mail: (YJW); (YL)
| | - Yaw-Zon Ding
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Teh-Ling Liou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ying-Wen Wang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shao-Sung Huang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Cardiovascular research center, National Yang-Ming University, Taipei, Taiwan
| | - Chung-Chi Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of public health, National Yang-Ming University, Taipei, Taiwan
| | - Tse-Min Lu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Cardiovascular research center, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-Bang Leu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Cardiovascular research center, National Yang-Ming University, Taipei, Taiwan
| | - Shing-Jong Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Cardiovascular research center, National Yang-Ming University, Taipei, Taiwan
| | - Wan-Leong Chan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Cardiovascular research center, National Yang-Ming University, Taipei, Taiwan
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Uthman RT, Sutton AJ, Jackson LJ, Uthman OA. Does directly administered antiretroviral therapy represent good value for money in sub-Saharan Africa? A cost-utility and value of information analysis. PLoS One 2018; 13:e0191465. [PMID: 29360841 PMCID: PMC5779662 DOI: 10.1371/journal.pone.0191465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 01/07/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Successful antiretroviral therapy (ART) relies on the optimal level of ART adherence to achieve reliable viral suppression, avert HIV drug resistance, and prevent avoidable deaths. It has been shown that there are various groups of people living with HIV at high-risk of non-adherence to ART in sub-Saharan Africa. The objective of this study was to examine the cost effectiveness and value-of-information of directly administered antiretroviral therapy (DAART) versus self-administered ART among people living with HIV, at high risk of non-adherence to ART in sub-Saharan Africa. METHODS AND FINDINGS A Markov model was developed that describes the transition between HIV stages based on the CD4 count, along with direct costs, quality of life and the mortality rate associated with DAART in comparison with self-administered ART. Data used in the model were derived from the published literature. A health system perspective was employed using a life-time time horizon. Probabilistic sensitivity analysis was performed to determine the impact of parameter uncertainty. Value of information analysis was also conducted. The expected cost of self-administered ART and DAART were $5,200 and $15,500 and the expected QALYs gained were 8.52 and 9.75 respectively, giving an incremental cost effectiveness ratio of $8,400 per QALY gained. The analysis demonstrated that the annual cost DAART needs to be priced below $200 per patient to be cost-effective. The probability that DAART was cost-effective was 1% for a willingness to pay threshold of $5,096 for sub-Saharan Africa. The value of information associated with the cost of DAART and its effectiveness was substantial. CONCLUSIONS From the perspective of the health care payer in sub-Saharan Africa, DAART cannot be regarded as cost-effective based on current information. The value of information analysis showed that further research will be worthwhile and potentially cost-effective in resolving the uncertainty about whether or not to adopt DAART.
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Affiliation(s)
- Rashidah T. Uthman
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Andrew J. Sutton
- Health Economics Unit, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Louise J. Jackson
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Olalekan A. Uthman
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, United Kingdom
- * E-mail:
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Wang X, Zhou X, Leesa L, Mantwill S. The Effect of Vaccine Literacy on Parental Trust and Intention to Vaccinate after a Major Vaccine Scandal. JOURNAL OF HEALTH COMMUNICATION 2018; 23:413-421. [PMID: 29589807 DOI: 10.1080/10810730.2018.1455771] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Health literacy, and more specifically vaccine literacy, might be an important factor in reducing the negative effects of exposure to misleading reports on vaccination. This study explores the association between vaccine literacy and vaccination-related outcomes after misleading reports on a scandal concerning locally produced childhood vaccines had emerged in 2016 in China. Data for this study came from a cross-sectional survey, which was conducted in April 2016 in Hangzhou, China. Data were collected in kindergartens and community health centers among parents of children up to 6 years of age. Data were analyzed for 1864 participants. Binary logistic regression models showed that, after controlling for socio-demographics and children's age, parents who had better vaccine literacy (<0.05) were more likely to trust and choose domestically produced vaccines, which account for about 95% of the total vaccinations in China. This study provides evidence on a still largely understudied relationship between vaccine literacy and vaccination-related outcomes. Findings might suggest that higher literacy levels could reduce some of the negative effects of being exposed to misleading information on vaccination, eventually leading to less vaccination hesitancy.
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Affiliation(s)
- Xiaomin Wang
- a Institute for Social Medicine , Zhejiang University , Hangzhou , Zhejiang , China
- b Department of Social and Behavioral Sciences , Harvard T.H. Chan School of Public Health , Boston , Massachusetts , USA
- c Center for Community-Based Research , Dana-Farber Cancer Institute , Boston , Massachusetts , USA
| | - Xudong Zhou
- a Institute for Social Medicine , Zhejiang University , Hangzhou , Zhejiang , China
| | - Lin Leesa
- b Department of Social and Behavioral Sciences , Harvard T.H. Chan School of Public Health , Boston , Massachusetts , USA
- c Center for Community-Based Research , Dana-Farber Cancer Institute , Boston , Massachusetts , USA
- d Division of Policy Translation and Leadership Development , Harvard T.H. Chan School of Public Health , Boston , Massachusetts , USA
| | - Sarah Mantwill
- e Department of Health Sciences and Health Policy , University of Lucerne , Lucerne , Switzerland
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Shanmukappa SM, Nadig P, Puttannavar R, Ambareen Z, Gowda TM, Mehta DS. Knowledge, Attitude, and Awareness among Diabetic Patients in Davangere about the Association between Diabetes and Periodontal Disease. J Int Soc Prev Community Dent 2017; 7:381-388. [PMID: 29387625 PMCID: PMC5774062 DOI: 10.4103/jispcd.jispcd_390_17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 12/11/2017] [Indexed: 01/24/2023] Open
Abstract
Objective: Diabetes mellitus (DM) is one of the major public health problems. Association of diabetes and periodontitis is widely proven and can influence each other in the development and progression of the disease and its complications, which are largely preventable. Hence, if data could be collected on the knowledge and awareness about the association between DM and periodontal disease, the results could be applied in creating public health campaigns and can bring about lifestyle modification among people. The aim of the present study is to assess the awareness, attitude, and practices of diabetic patients regarding their periodontal health in Davangere city with the objective of enhancing dental health education for this population, which would upgrade their knowledge and awareness. Materials and Methods: The present cross-sectional survey was carried out on 600 diabetic patients from various clinics. A time limit of 3 months was set for the data collection which was then subjected to statistical software SAS 9.2, SPSS 15.0, Stata 10.1, MedCalc 9.0.1, Systat 12.0, and R environment version 2.11.1 for statistical analysis. Results: On correlation of gender and education with overall knowledge of association between periodontal disease and DM, females and participants below secondary school education and lower duration of DM were significantly associated with lack of knowledge. Other questions revealed limited awareness, sources, and need for more information about this association and depicted poor knowledge and attitude toward the oral health. Conclusion: Dental professionals need to create awareness about the importance of maintaining good oral health influencing overall general health in diabetic patients. Oral screening and referral by health professionals to dentists may benefit diabetic patients by improving access to dental care.
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Affiliation(s)
| | - Priyadarshini Nadig
- Department of Periodontics, Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India
| | - Rekha Puttannavar
- Department of Periodontics, Guru Nanak Institute of Dental Sciences and Research, Kolkata, West Bengal, India
| | - Zeenath Ambareen
- Department of Periodontics, Sharavathi Dental College and Hospital, Shimoga, India
| | | | - Dhoom Singh Mehta
- Department of Periodontics, Bapuji Dental College and Hospital, Davangere, Karnataka, India
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Nie R, Han Y, Xu J, Huang Q, Mao J. Illness perception, risk perception and health promotion self-care behaviors among Chinese patient with type 2 diabetes: A cross-sectional survey. Appl Nurs Res 2017; 39:89-96. [PMID: 29422183 DOI: 10.1016/j.apnr.2017.11.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 06/26/2017] [Accepted: 11/02/2017] [Indexed: 01/19/2023]
Abstract
AIM To explore illness perception and perceived risk of developing diabetes complications in relation to health-promoting self-care behaviors among Chinese patients with type 2 diabetes. BACKGROUND Illness and risk perceptions are important determinants of various health behaviors. However, few studies have simultaneously examined the impacts of these two constructs on self-care among diabetic patients. METHODS Data were collected on participants' characteristics, illness perception, risk perception, and health-promoting self-care behaviors over 6months among 304 subjects from three general hospitals. RESULTS Significant associations between illness perception and risk perception were observed. Illness perception and/or risk perception explained an independent, small but significant proportion of the variance in each health-promoting self-care behavior. CONCLUSION One's perceptions of illness and future risk might be influential in understanding health-promoting self-care among diabetic patients. It may be useful to improve self-management by tailoring intervention content to individuals' illness-related perceptions.
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Affiliation(s)
- Rong Nie
- School of Nursing, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei 430030, China; School of Health Science & Nursing, Wuhan Polytechnic University, Wuhan, Hubei 430023, China
| | - Yanhong Han
- Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei 430022, China
| | - Jiaqi Xu
- School of Nursing, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei 430030, China
| | - Qiao Huang
- School of Nursing, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei 430030, China
| | - Jing Mao
- School of Nursing, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei 430030, China.
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Umeh AE, Nkombua L. A study of the knowledge and practice of lifestyle modification in patients with type 2 diabetes mellitus in Middelburg sub-district of Mpumalanga. S Afr Fam Pract (2004) 2017. [DOI: 10.1080/20786190.2017.1364012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- AE Umeh
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - L Nkombua
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
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Finbråten HS, Pettersen KS, Wilde-Larsson B, Nordström G, Trollvik A, Guttersrud Ø. Validating the European Health Literacy Survey Questionnaire in people with type 2 diabetes: Latent trait analyses applying multidimensional Rasch modelling and confirmatory factor analysis. J Adv Nurs 2017; 73:2730-2744. [PMID: 28543754 DOI: 10.1111/jan.13342] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2017] [Indexed: 11/29/2022]
Abstract
AIM To validate the European Health Literacy Survey Questionnaire (HLS-EU-Q47) in people with type 2 diabetes mellitus. BACKGROUND The HLS-EU-Q47 latent variable is outlined in a framework with four cognitive domains integrated in three health domains, implying 12 theoretically defined subscales. Valid and reliable health literacy measurers are crucial to effectively adapt health communication and education to individuals and groups of patients. DESIGN Cross-sectional study applying confirmatory latent trait analyses. METHODS Using a paper-and-pencil self-administered approach, 388 adults responded in March 2015. The data were analysed using the Rasch methodology and confirmatory factor analysis. RESULTS Response violation (response dependency) and trait violation (multidimensionality) of local independence were identified. Fitting the "multidimensional random coefficients multinomial logit" model, 1-, 3- and 12-dimensional Rasch models were applied and compared. Poor model fit and differential item functioning were present in some items, and several subscales suffered from poor targeting and low reliability. Despite multidimensional data, we did not observe any unordered response categories. CONCLUSION Interpreting the domains as distinct but related latent dimensions, the data fit a 12-dimensional Rasch model and a 12-factor confirmatory factor model best. Therefore, the analyses did not support the estimation of one overall "health literacy score." To support the plausibility of claims based on the HLS-EU score(s), we suggest: removing the health care aspect to reduce the magnitude of multidimensionality; rejecting redundant items to avoid response dependency; adding "harder" items and applying a six-point rating scale to improve subscale targeting and reliability; and revising items to improve model fit and avoid bias owing to person factors.
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Affiliation(s)
- Hanne Søberg Finbråten
- Faculty of Public Health, Department of Dental Care and Public Health, Inland Norway University of Applied Sciences, Elverum, Norway.,Faculty of Health, Science, and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden
| | - Kjell Sverre Pettersen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Bodil Wilde-Larsson
- Faculty of Public Health, Department of Dental Care and Public Health, Inland Norway University of Applied Sciences, Elverum, Norway.,Faculty of Health, Science, and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden
| | - Gun Nordström
- Faculty of Public Health, Department of Nursing, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Anne Trollvik
- Faculty of Public Health, Department of Nursing, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Øystein Guttersrud
- Faculty of Mathematics and Natural Sciences, Norwegian Centre for Science Education, University of Oslo, Oslo, Norway
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