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Wang Y, Jia Q, Wang H, Zou K, Li L, Yu B, Wang L, Wang Y. Revised Chinese resident health literacy scale for the older adults in China: simplified version and initial validity testing. Front Public Health 2023; 11:1147862. [PMID: 37265518 PMCID: PMC10231683 DOI: 10.3389/fpubh.2023.1147862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/10/2023] [Indexed: 06/03/2023] Open
Abstract
Objective This study aimed to develop a short version of the Chinese Resident Health Literacy Scale focused on older adults in China, and further assess the reliability and validity of this short version. Methods The data was from a cross-sectional community-based older adults health survey conducted in 2020. The total of 5,829 older adults were randomly divided into two parts using for the simplification and assessment of the scale, respectively. Item Response Theory (IRT) and Differential Item Functioning (DIF) were used for item analysis and scale simplification. Cronbach's alpha and McDonald's omega were used to assess the reliability and three factors Confirmatory Factor Analysis (CFA) was used to assess the validity, which were compared to the original version. Moreover, Multi-group Confirmatory Factor Analysis (MCFA) was used to test the model invariance of the short version across groups of gender, age groups, level of education, and cognitive status. Results The simplified version consisted of 27 items taken from 50 original items, of them 11 items from the dimension of knowledge and attitudes, 9 items from the dimension of behavior and lifestyle, and 7 items from the dimension of health-related skills. The overall Cronbach's alpha and McDonald's omega were both 0.87 (95%CI: 0.86-0.88). The goodness-of-fits of CFA in simplified version were still acceptable in CFI, TLI, GFI, and RMSEA, even improved in CFI, TLI, and GFI compared to those of original version. Also, the model was stable and invariant in MCFA across gender, cognitive status, and educational level groups. Conclusion In this study, we formed a simplified instrument for measuring health literacy focused on older adults in China. This short version might be more suitable for the priority recommendation in extended tracking of the dynamic changes on the levels of health literacy in the whole life cycle in public health settings. Further research might be to identify the cut-off values to distinguish the older adults with different levels of health literacy.
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Yu H, Gao Y, Tong T, Liang C, Zhang H, Yan X, Wang L, Zhang H, Dai H, Tong H. Self-management behavior, associated factors and its relationship with social support and health literacy in patients with obstructive sleep apnea–hypopnea syndrome. BMC Pulm Med 2022; 22:352. [PMID: 36115966 PMCID: PMC9482733 DOI: 10.1186/s12890-022-02153-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 09/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background The proportion of patients with obstructive sleep apnea–hypopnea syndrome (OSAHS) is increasing year by year in China, which has become a major public health problem. Self-management of OSAHS and multiple support from caregivers are key to low hospital admissions and high quality of life for patients with OSAHS. Social support and health literacy are the main promoters of self-management behavior. However, their contributions have not been adequately studied. The purpose of this study is to investigate the level of self-management among patients with OSAHS and its relationship with general demographics, social support, and health literacy. Methods A total of 280 patients with OSAHS treated in two Classiii Grade A hospitals in Jinzhou City, Liaoning Province from October 2020 to July 2021 were selected as the study subjects. Patients were investigated by General Characteristics Questionnaire, Social Support Rating Scale (SSRS), Health Literacy Scale for Chronic Patients (HLSCP), and OSAHS Self-management Behavior Questionnaire, and the influencing factors of self-management of patients with OSAHS were analyzed. Results The average score of OSAHS self-management was 74.49(SD = 8.06), SSRS and HLSCP scores were positively correlated with total scores of self-management behavior. Furthermore, we found that disease duration, SSRS, and HLSCP scores were the main predictors of self-management behavior (R2 = 0.390, P < 0.001). Conclusion This study found that OSAHS patients with a longer duration of disease and higher SSRS or HLSCP scores also had higher levels of self-management. The factors discussed in this study may be helpful in developing individualized interventions in self-management for patients with OSAHS.
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Wang Y, Chen T, Gan W, Yin J, Song L, Qi H, Zhang Q. Association among high blood pressure health literacy, social support and health-related quality of life among a community population with hypertension: a community-based cross-sectional study in China. BMJ Open 2022; 12:e057495. [PMID: 35672078 PMCID: PMC9174780 DOI: 10.1136/bmjopen-2021-057495] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The prevalence of hypertension is increasing worldwide. Hypertensive patients in China have limited high blood pressure health literacy (HBP-HL) and social support (SS), which may have an impact on health-related quality of life (HRQoL) and lead to poorer clinical outcomes. However, the potential mechanism of HBP-HL, SS and HRQoL remains unclear. The aim of this study was to investigate the association among HBP-HL, SS and HRQoL among community patients with hypertension in China. DESIGN A community-based cross-sectional survey. SETTING The community health service center in Huzhou, China. PARTICIPANTS 406 community patients with hypertension were investigated from June to October 2019. PRIMARY OUTCOME MEASURES HRQoL was assessed using the Quality of Life Instruments for Chronic Diseases-Hypertension V2.0, HBP-HL was assessed with the HBP-Health Literacy Scale into Chines and SS was assessed with the Social Support Rating Scale. RESULTS Compared with moderate level of HRQoL and SS, HBP-HL of community hypertensive patients was significantly deficient. Overall, 93 patients (23.2%) lacked HBP-HL, 308 patients (76.8%) had a medium level of HBP-HL, and none of them had sufficient HBP-HL. Correlation analysis showed that HBP-HL, SS and HRQoL were positively correlated (p<0.01). The significant differences in HRQoL and SS were detected in HBP-HL level (p<0.001). In multiple linear regression models, HRQoL was significantly associated with 'Print HL' and 'Medication Label' of HBP-HL (p<0.05) and all three dimensions of SS (p<0.05). In addition, The bootstrap method was used to examine the indirect effect among variables. The results showed that SS played a mediating role between HBP-HL and HRQoL (p<0.001). CONCLUSION There is an association among HBP-HL, SS and HRQoL in community hypertension patients. HBP-HL can directly affect HRQoL, and through SS mediate the HRQoL. Community intervention for hypertension management should consider HBP-HL promotion and social engagement as the breakthrough points to increase the impact on patients' HRQoL.
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Affiliation(s)
- Yujie Wang
- School of Nursing, College of Medicine, Huzhou University, Huzhou, Zhejiang, China
| | - Ting Chen
- School of Nursing, College of Medicine, Huzhou University, Huzhou, Zhejiang, China
- Department of Nursing and Optometry, Jiangxi Teacher College, Shangrao, Jiangxi, China
| | - Wei Gan
- School of Nursing, College of Medicine, Huzhou University, Huzhou, Zhejiang, China
| | - Jinyu Yin
- School of Nursing, College of Medicine, Huzhou University, Huzhou, Zhejiang, China
| | - Li Song
- School of Nursing, College of Medicine, Huzhou University, Huzhou, Zhejiang, China
| | - Huan Qi
- School of Nursing, College of Medicine, Huzhou University, Huzhou, Zhejiang, China
- School of Nursing, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Qinghua Zhang
- School of Nursing, College of Medicine, Huzhou University, Huzhou, Zhejiang, China
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Wang Z, Liu D, Zhao Y, Li M, Bai Y, Mi S, Liang X, Zhao W. Recommendations and Future Direction for Population-Based Prevention and Control of Behavioral Risk Factors for NCDs. China CDC Wkly 2022; 4:407-410. [PMID: 35685123 PMCID: PMC9167604 DOI: 10.46234/ccdcw2022.092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/28/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Zhuoqun Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, CDC China, Beijing, China,NCDs Control and Prevention Society, Chinese Preventive Medicine Association, Beijing, China
| | - Dan Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou City, Guangdong Province, China
| | - Yanfang Zhao
- National Center for Chronic and Non-communicable Disease Control and Prevention, CDC China, Beijing, China
| | - Man Li
- Department of Epidemiology and Statistic, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang City, Hebei Province, China
| | - Yamin Bai
- National Center for Chronic and Non-communicable Disease Control and Prevention, CDC China, Beijing, China
| | - Shengquan Mi
- College of Biochemical Engineering, Beijing Union University, Beijing, China
| | - Xiaofeng Liang
- Disease Control and Prevention Institute, Jinan University, Guangzhou City, Guangdong Province, China,Jinan University-BioKangtai Vaccine Institute, Jinan University, Guangzhou City, Guangdong Province, China,Wenhua Zhao,
| | - Wenhua Zhao
- NCDs Control and Prevention Society, Chinese Preventive Medicine Association, Beijing, China,National Institute for Nutrition and Health, CDC China, Beijing, China,Xiaofeng Liang,
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Yao WY, Han MG, De Vito G, Fang H, Xia Q, Chen Y, Liu X, Wei Y, Rothman RL, Xu WH. Physical Activity and Glycemic Control Status in Chinese Patients with Type 2 Diabetes: A Secondary Analysis of a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084292. [PMID: 33919529 PMCID: PMC8073010 DOI: 10.3390/ijerph18084292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 11/30/2022]
Abstract
This secondary analysis was designed to evaluate the independent effect of physical activity (PA) on hemoglobin A1c (HbA1c) level in Chinese patients with type 2 diabetes mellitus (T2DM). A total of 799 T2DM patients from eight communities of Shanghai, China, were randomized into one control arm and three intervention arms receiving 1-year interventions of health literacy, exercise, or both. PA was measured using the International Physical Activity Questionnaire at baseline, 12 months, and 24 months and quantified as metabolic equivalents (Mets). A multiple level mixed regression model was applied to evaluate the associations between PA and HbA1c level. After adjusting for potential confounders including interaction of PA level with initial PA or HbA1c, a significant improved HbA1c was observed for the patients in the medium versus the lowest tertile groups of overall PA at 12 months (β: −3.47, 95%CI: −5.33, −1.60) and for those in the highest versus the lowest tertile group at 24 months (β: −0.50, 95%CI: −1.00, −0.01), resulting in a β (95%CI) of −3.49 (95%CI: −5.87, −1.11) during the whole two-year period of follow-up. The negative association was also observed when the subjects were classified according to their exercise levels using the World Health Organization (WHO) recommendation as a cut-off point. The beneficial effect of higher PA level was only observed among patients having a lower level of baseline HbA1c or PA or both (all p values for interaction <0.05). Our results provide evidence for the beneficial effect of PA and suggest that the exercise intervention should be addressed to the physically inactive patients to improve their PA level to a physiological threshold.
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Affiliation(s)
- Wei-Yuan Yao
- Key Laboratory of Public Health Safety (Ministry of Health), School of Public Health, Fudan University, Shanghai 200032, China; (W.-Y.Y.); (M.-G.H.); (X.L.); (Y.W.)
| | - Meng-Ge Han
- Key Laboratory of Public Health Safety (Ministry of Health), School of Public Health, Fudan University, Shanghai 200032, China; (W.-Y.Y.); (M.-G.H.); (X.L.); (Y.W.)
| | - Giuseppe De Vito
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy;
| | - Hong Fang
- Minhang District Center for Disease Control and Prevention, Shanghai 201102, China;
| | - Qinghua Xia
- Changning District Center for Disease Control and Prevention, Shanghai 200051, China;
| | - Yingyao Chen
- Key Laboratory of Health Technology Assessment (National Health Commission), School of Public Health, Fudan University, Shanghai 200032, China;
| | - Xiaona Liu
- Key Laboratory of Public Health Safety (Ministry of Health), School of Public Health, Fudan University, Shanghai 200032, China; (W.-Y.Y.); (M.-G.H.); (X.L.); (Y.W.)
| | - Yan Wei
- Key Laboratory of Public Health Safety (Ministry of Health), School of Public Health, Fudan University, Shanghai 200032, China; (W.-Y.Y.); (M.-G.H.); (X.L.); (Y.W.)
- Key Laboratory of Health Technology Assessment (National Health Commission), School of Public Health, Fudan University, Shanghai 200032, China;
| | - Russell L. Rothman
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA;
| | - Wang-Hong Xu
- Key Laboratory of Public Health Safety (Ministry of Health), School of Public Health, Fudan University, Shanghai 200032, China; (W.-Y.Y.); (M.-G.H.); (X.L.); (Y.W.)
- Key Laboratory of Health Technology Assessment (National Health Commission), School of Public Health, Fudan University, Shanghai 200032, China;
- Correspondence: ; Tel.: +86-21-54237679
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Song X, Chen L, Zhang T, Xiang Y, Yang X, Qiu X, Qiao Z, Yang Y, Pan H. Negative emotions, self-care activities on glycemic control in adults with type 2 diabetes: a cross-sectional study. PSYCHOL HEALTH MED 2020; 26:499-508. [PMID: 32749156 DOI: 10.1080/13548506.2020.1799042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Glycemic control has become a focus of concern among diabetic patients. However, only 26.71% of patients achieved better glycemic control in China. Given the complexity of glycemic control, it is worth investigating the potential mechanisms between negative emotions and glycemic control. A total of 428 participants were recruited from a tertiary hospital (the number of hospital beds>500). They completed questionnaires consisting of demographics, Zung Self-Assessed Anxiety Scale(SAS), Zung Self-Assessed Depression Scale(SDS), and the Summary of Diabetes Self-Care Activities (SDSCA). HbA1 c was used to measure glycemic control. Descriptive analysis, Pearson correlation analysis, and Bootstrap analysis were conducted to analyze data. A total of 428 questionnaires were distributed, with 28 invalid questionnaires (93.46% were valid). Depression and self-care activities (exercise, medication) were associated with glycemic control. At the same time, the Bootstrap analysis revealed that self-care activities (exercise: standardized coefficient β = 0.0181, p < 0.05, medication: standardized coefficient β = 0.0211, p < 0.05) mediated the relationship between depression and glycemic control.
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Affiliation(s)
- Xuejia Song
- Department of Medical Psychology, Public Health Institute of Harbin Medical University, Harbin, China
| | - Lu Chen
- Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China
| | - Tianyu Zhang
- Department of Medical Psychology, Public Health Institute of Harbin Medical University, Harbin, China
| | - Ying Xiang
- The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiuxian Yang
- Department of Medical Psychology, Public Health Institute of Harbin Medical University, Harbin, China
| | - Xiaohui Qiu
- Department of Medical Psychology, Public Health Institute of Harbin Medical University, Harbin, China
| | - Zhengxue Qiao
- Department of Medical Psychology, Public Health Institute of Harbin Medical University, Harbin, China
| | - Yanjie Yang
- Department of Medical Psychology, Public Health Institute of Harbin Medical University, Harbin, China
| | - Hui Pan
- Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China
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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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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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Effect of health literacy on quality of life among patients with chronic heart failure in China. Qual Life Res 2019; 29:453-461. [DOI: 10.1007/s11136-019-02332-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
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Bukhsh A, Nawaz MS, Ahmed HS, Khan TM. A randomized controlled study to evaluate the effect of pharmacist-led educational intervention on glycemic control, self-care activities and disease knowledge among type 2 diabetes patients: A consort compliant study protocol. Medicine (Baltimore) 2018; 97:e9847. [PMID: 29561461 PMCID: PMC5895327 DOI: 10.1097/md.0000000000009847] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Diabetes self-care activities, like, healthy diet, regular exercise, self-monitoring of blood glucose, and rational use of medicines are considered to play a vital role in establishing euglycemia. Health literacy among type 2 diabetes mellitus (T2DM) patients in Pakistan is very low, which is the most likely cause for poor clinical outcomes. This study is designed to investigate the impact of pharmacist-led educational intervention on glycemic control, self-care activities and disease knowledge among T2DM patients in Pakistan. METHODS In this randomized controlled trail, effectiveness of a 6-month pharmacist-led educational intervention will be examined on glycemic control, diabetes self-care activities and disease knowledge of 80 adult T2DM patients (age >30 years) with poorly controlled T2DM (HbA1c> 7%), after randomizing them into intervention and control groups, at diabetes care clinic of Capital Hospital Islamabad, Pakistan. RESULTS The primary outcome is change in patients' HbA1c, whereas, changes in self-care activities and patients' disease knowledge are the secondary outcomes. After baseline assessment of their self-care activities and disease knowledge by using validated Urdu versions of Diabetes Self-management Questionnaire (DSMQ) and Diabetes Knowledge Questionnaire (DKQ), respectively, interventional group patients will be supplemented with a face-to-face pharmacist-led educational intervention, whereas, the control group will receive usual care. Intervention arm patients will be educated successively at their first follow-up visit (12th week) and telephonically after every 4 weeks. All assessments will be made at baseline and end of trail for both intervention and control groups. Multivariate general linear model will be applied to analyze the effects of the intervention. CONCLUSION Glycemic control in T2DM patients requires optimum self-care activities. This study is an attempt to improve self-care behaviors among poorly controlled T2DM patients who are at higher risk of diabetes-associated late complications.
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Affiliation(s)
- Allah Bukhsh
- School of Pharmacy, Monash University, Jalan Lagoon, Selatan, Selangor, Malaysia
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore
| | | | | | - Tahir Mehmood Khan
- School of Pharmacy, Monash University, Jalan Lagoon, Selatan, Selangor, Malaysia
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
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Wang C, Lang J, Xuan L, Li X, Zhang L. The effect of health literacy and self-management efficacy on the health-related quality of life of hypertensive patients in a western rural area of China: a cross-sectional study. Int J Equity Health 2017; 16:58. [PMID: 28666443 PMCID: PMC5493849 DOI: 10.1186/s12939-017-0551-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 03/15/2017] [Indexed: 11/29/2022] Open
Abstract
Background Hypertension is a common and frequently occurring chronic disease of the cardiovascular system. Besides the pathological factors, the occurrence and exacerbation of hypertension are also associated with many factors of lifestyle and behaviors. Thus hypertensive patients’ Health-related quality of life (HRQL) is not only influenced by the disease itself but also by many subjective factors such as health literacy and self-management efficacy, especially in the deeper part of southwestern China and thus is less developed compared to the other places. The purpose of this study was to examine the association between the HRQL of hypertensive patients and health literacy and self-management efficacy as well as how they affect the HRQL, so as to provide a theoretical reference for improving the HRQL of patients with hypertension in less developed areas. Methods This was a cross-sectional study of baseline data from a clustered randomized controlled trial. The study design had passed a cross-national peer review and accepted grants by the China Medical Board. It was also registered in the Chinese Clinical Trial Registry (ChiCTR-OOR-14005563). A standardized questionnaire adapted from a previous validated WHO questionnaire was used for the survey which included detailed questions about patient’s socio-demographic characteristics and self-reported information. Patients’ HRQL was measured by the Mandarin version of the 36-item Short Form. We used the validated Mandarin version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale to assess patients’ self-management efficacy. The validated three-item Brief Health Literacy Screening (BHLS) was used to measure the patients’ health literacy. A structural equation model was constructed, and p ≤ 0.05 was taken as significant. Results Demographic characteristics, health literacy and self-management efficacy have all significant effects on HRQL. Age, education level, self-management efficacy and health literacy were significantly related to the HRQL. The constructed model had a good fit for the data according to the model fit indices. Based on the model, health literacy (r = 0.604, p = 0.029) and Self-management efficacy (r = 0.714, p = 0.018) have a significant impact on HRQL. Demographic characteristics were inversely related to HRQL (r = −0.419, p = 0.007), but have a significant impact on health literacy (r = 0.675, p = 0.029) and self-management efficacy (r = 0.379, p = 0.029). At the same time, self-management efficacy was positively correlated to health literacy (r = 0.413, p < 0.01). Conclusions Age, education level, self-management efficacy and health literacy were all related to the HRQL of patient with hypertension, which means that patients who are more elderly and have lower education level, low self-management efficacy and poor health literacy get worse HRQL. This may imply the necessary to introduce routine assessment of health literacy and self-management efficacy into assessment procedures for hypertensive patients’ health management. Such assessment can help professionals to identify the population at greatest risk for poor health outcomes and low well-being in the future. In clinical practice, effective interventions such as direct guidance and education to raise the self-management efficacy and enhance health literacy might improve the HRQL of patients with hypertension. Trial registration Retrospectively registered Chinese Clinical Trial Registry (ChiCTR-OOR-14005563). Name of registry: Effects of the integrated delivery system and payment system of community-based intervention on rural patients of chronic diseases in Qianjiang District, China Date of registration: Retrospectively registered 23 November 2014. Date of enrolment of the first participant to the trial: 5 July 2012
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Affiliation(s)
- Chenli Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Juntao Lang
- ZhongShan Hospital Fudan University, Shanghai, China
| | - Lixia Xuan
- Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Xuemei Li
- Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Liang Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China.
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Shen M, Hu M, Liu S, Chang Y, Sun Z. Assessment of the Chinese Resident Health Literacy Scale in a population-based sample in South China. BMC Public Health 2015; 15:637. [PMID: 26163383 PMCID: PMC4498512 DOI: 10.1186/s12889-015-1958-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/22/2015] [Indexed: 11/10/2022] Open
Abstract
Background A national health literacy scale was developed in China in 2012, though no studies have validated it. In this investigation, we assessed the reliability, construct validity, and measurement invariance of that scale. Methods A population-based sample of 3731 participants in Hunan Province was used to validate the Chinese Resident Health Literacy Scale based on item response theory and classical test theory (including split-half coefficient, Cronbach’s alpha, and confirmatory factor analysis). Measurement invariance was examined by differential item functioning. Results The overall Cronbach’s alpha of the scale was 0.95 and Spearman-Brown coefficient 0.94. Confirmatory factor analysis showed that the test measured a unidimensional construct with three highly correlated factors. Highest discrimination was found among participants with limited to moderate health literacy. In all, 64 items were selected from the original scale based on factor loading, Pearson’s correlation coefficient, and discrimination and difficulty parameters in item response theory. Measurement invariance was significant but slight. According to the two-level linear model, health literacy was associated with education level, occupation, and income. Conclusions The 2012 national health literacy scale was validated, and 64 items were selected based on classical test theory and item response theory. The revised version of the scale has strong psychometric properties with minor measurement invariance.
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Affiliation(s)
- Minxue Shen
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China. .,Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, K1G 8L6, ON, Canada.
| | - Ming Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China.
| | - Siyun Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China.
| | - Yan Chang
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China.
| | - Zhenqiu Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China.
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