Health literacy and glycemic control in patients with diabetes: a tertiary care center study in Brazil

The relationship between health literacy and blood sugar control in rural areas among diabetes patients

Background

Although the relationship between health literacy and glycemic control has been explored in patients with diabetes, little is known about the relationship between different categories of diabetes health literacy and glycemic control in rural areas. Therefore, this study focused on the relationship between different categories of health literacy and glycemic control among diabetic patients in rural areas of Guangxi, China.

Objective

To explore the potential profiles of health literacy among rural diabetes patients in Guangxi and investigate their relationship with blood sugar control.

Methods

A health literacy questionnaire was administered to 2280 rural diabetes patients in five cities in the Guangxi Zhuang Autonomous Region. Latent profile analysis was conducted to identify potential health literacy profiles.

Results

Health literacy among rural diabetes patients in Guangxi could be categorized into high literacy-high functionality and low literacy-low criticality groups. The latent categories of health literacy were associated with blood sugar control, with diabetes patients in the high literacy-high functionality group demonstrating better blood sugar control than those in the low literacy-low criticality group (P < 0.05).

Conclusion

Health literacy among rural diabetes patients in Guangxi exhibits heterogeneity. Healthcare professionals should pay attention to patients with low literacy and low criticality in rural areas and develop interventions to enhance their health literacy, thereby improving their blood sugar control.

Diabetes Mellitus Mortality Trends in Brazil From 2000 to 2021: An In-Depth Joinpoint Analysis

Diabetes mellitus (DM) is a public health concern in Brazil, with deleterious effects on quality of life and increasing mortality rates. The prevalence of diabetes in Brazil is on the rise, and it is imperative to understand its effects on mortality rates in the last two decades in order to effectively mitigate the detrimental impact of diabetes on public health. This study aims to analyze mortality trends related to diabetes in Brazil from 2000 to 2021, encompassing both type 1 and type 2 diabetes, across sex and various age cohorts. Using joinpoint regression analysis, temporal trends in Brazil were assessed, while also incorporating findings from previous studies and considering potential influencing factors, such as government initiatives and cuts in healthcare investment. The study revealed a general upward trend in mortality rates associated with DM1 and DM2 over the study period, in both males and females, with men showing a higher AAPC (average annual percent change), which translated into significantly increased mortality difference at the end of the study. Additionally, it revealed elevated mortality values for extreme age groups in the age cohorts studied, with the exception of middle-aged cohort groups in DM2, which showed an expected higher APC (annual percent change), considering the age of highest incidence of DM2 in those age groups. This comprehensive analysis provides critical insights into the escalating impact of diabetes on mortality rates in Brazil and highlights the urgent need for healthcare strategies. It is expected that the increased prevalence of diabetes in the Brazilian population adds an additional economic burden to healthcare expenditure by the Brazilian government, further worsening the health disparities among different social groups. Unless several political decisions to reduce healthcare expenditure are reversed, greater difficulties in accessing treatments will be detrimental for vulnerable social groups in Brazil. By understanding the nuanced patterns of diabetes-related mortality, healthcare providers and policymakers can allocate resources effectively and implement tailored interventions to better address diabetes in Brazil.

Social determinants of health and glycemic control in persons with type 2 diabetes mellitus attending a tertiary hospital in Nepal: A cross-sectional study

Background

Diabetes mellitus (DM) is an emerging global public health challenge worldwide, including Nepal. Social determinants of health (SDOH) play a major role in glycemic control among persons with type 2 DM (T2DM). However, little is known about the association between SDOH and glycemic control among individuals with T2DM in Nepal.

Objective

This study aimed to identify the level of glycemic control and SDOH associated with glycemic control among Nepalese with T2DM.

Methods

This cross-sectional study was conducted at a tertiary hospital in Kathmandu, Nepal, among 135 Nepalese diagnosed with T2DM who attended follow-up appointments. Convenience sampling and inclusion criteria were utilized for participant selection. Data were collected from April to June 2021 using validated scales. Descriptive statistics, Chi-square test, and binary logistic regression were employed to analyze the data.

Results

The mean age of the participants in this study was 53.84 (SD = 11.78) years, and the average monthly household income was 567.64 (SD = 362.30) USD. The majority of the participants (77.8%) were literate and had no health insurance coverage (73.3%). Approximately 64.4% of the participants showed suboptimal glycemic control indicated by glycated hemoglobin (HbA1c) ≥7%. The significant determinants of good glycemic control included monthly household income of >850 USD (odds ratio [OR] = 12.20, 95% confident interval [CI] = 1.76-84.61, p = 0.011) and 341-600 USD (OR = 7.64, 95% CI 1.35-42.98, p = 0.021), being literate (OR = 6.37, 95% CI = 1.65-24.49, p = 0.007), having health insurance (OR = 5.82, 95% CI = 1.49-22.65, p = 0.011), sufficient health literacy (OR = 3.46, 95% CI = 1.10-10.83, p = 0.03), and high (OR = 16.17, 95% CI = 2.36-110.67, p = 0.005) and moderate (OR = 7.02, 95% CI = 1.26-39.07, p = 0.026) food availability, respectively.

Conclusion

The study revealed suboptimal glycemic control in Nepalese with T2DM. This study presents essential social determinants of glycemic control in this population. Therefore, healthcare providers, particularly nurses, should pay more attention to assessing social determinants and provide targeted interventions to patients with T2DM who have low income, are illiterate, have no health insurance coverage, have insufficient health literacy, and have low resources for food availability.

Health literacy, illness perception, depression, and self-management among African Americans with type 2 diabetes

BACKGROUND

Type 2 diabetes mellitus (T2DM) causes significant morbidity and mortality. Compared with non-Hispanic Whites, African Americans are more likely to suffer and die from T2DM.

PURPOSE

This study examines the associations between health literacy, illness perception, depression, working memory, executive function, and self-management among African Americans (18-65 years) with T2DM.

METHODOLOGY

A descriptive cross-sectional design was used. Data were collected through Research Electronic Data Capture and transferred to the Statistical Package for the Social Sciences software version 26 for statistical analysis. Fifty-three participants met study eligibility criteria.

RESULTS

Health literacy was associated with depression ( r = -0.433, p = .003), more concerns about illness ( r = -0.357, p = .02), and better medication adherence ( r = 0.487, p = .001). Higher levels of depression were inversely associated with medication adherence ( r = -0.449, p = .002; r = 0.449, p = .003). Higher concern about illness was associated with lower medication adherence ( r = -0.414, p = .005).

CONCLUSIONS

Lower health literacy coupled with illness perception and depression is associated with lower self-management behaviors among African Americans which can lead to complications of T2DM. More studies are needed to examine the association of cognitive factors with self-management activities among African Americans with T2DM.

IMPLICATIONS

Limited health literacy is associated with lower medication adherence among African Americans with T2DM. Illness perception is a significant factor that influences self-management of T2DM among African Americans. Using screening tools that assess health literacy and illness perception may address underlying concerns regarding adherence to T2DM treatment regimens in African Americans.

Cocreation of Massive Open Online Courses to Improve Digital Health Literacy in Diabetes: Pilot Mixed Methods Study

Background

Self-management education is a fundamental aspect in the health care of people with diabetes to develop the necessary skills for the improvement of health outcomes. Patients are required to have the competencies to manage electronic information resources—that is, an appropriate level of digital health literacy. The European project IC-Health aimed to improve digital health literacy among people with diabetes through the cocreation of massive open online courses (MOOCs).

Objective

We report the preliminary results obtained in 3 participating countries in the IC-Health project (Italy, Spain, and Sweden) regarding (1) experience of the participants during the cocreation process of MOOCs, (2) perceived changes in their digital health literacy level after using MOOCs, and (3) a preliminary assessment of the acceptability of MOOCs.

Methods

The cocreation of the MOOCs included focus groups with adults and adolescents with diabetes and the creation of independent communities of practice for type 1 diabetes and type 2 diabetes participants aimed to co-design the MOOCs. Quantitative measures of the acceptability of MOOCs, experience in the cocreation process, and increase in digital health literacy (dimensions of finding, understanding, and appraisal) were assessed.

Results

A total of 28 participants with diabetes participated in focus groups. Adults and adolescents agreed that the internet is a secondary source of health-related information. A total of 149 participants comprised the diabetes communities of practice. A total of 9 MOOCs were developed. Acceptability of the MOOCs and the cocreation experience were positively valued. There was a significant improvement in digital health literacy in both adults and adolescents after using MOOCs (P<.001).

Conclusions

Although the results presented on self-perceived digital health literacy are preliminary and exploratory, this pilot study suggests that IC-Health MOOCs represent a promising tool for the medical care of diabetes, being able to help reduce the limitations associated with low digital health literacy and other communication barriers in the diabetes population.

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

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

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

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

Association of Health Literacy and Nutritional Status Assessment with Glycemic Control in Adults with Type 2 Diabetes Mellitus

While the role of medical and nutrition factors on glycemic control among adults with type 2 diabetes mellitus (T2DM) has been well-established, the association between health literacy (H.L.) and glycemic control is inconsistent. This study aims to determine the association of H.L. and nutritional status assessments with glycemic control in adults with type 2 diabetes mellitus. A total of 280 T2DM respondents (mean (SD) age = 49.7 (10.3) years, Glycated hemoglobin (HbA1c) = 9.9 (2.6) %, and Body Mass Index = 32.7 (15.1) kg/m²) were included in this study. A short-form Test of Functional Health Literacy in Adults (S-TOFHLA) assessed the H.L. levels. Nutritional status assessments included client history, glycemic control, anthropometric, and biochemical data. The mean (S.D.) H.L. score was 45.7 (24.6), with 56% of the respondents had inadequate H.L. Inadequate H.L. was more common among those females; housewives, low education, received oral antidiabetic therapy, and shorter diabetes duration. Respondents with inadequate H.L. were significantly older and had higher HbA1c than those with marginal and adequate H.L. Meanwhile, respondents with inadequate and marginal H.L. levels had significantly higher total cholesterol, LDL-cholesterol, and systolic blood pressure than the respondents with adequate H.L. Low H.L. scores, self-employment status, received dual antidiabetic therapy (insulin with oral agents), received insulin alone, and had higher fasting blood glucose explained about 21% of the total variation in HbA1c (adjusted R² = 0.21; p < 0.001). Respondents with inadequate H.L. had poor glycemic control. The H.L. scores, together with nutritional status assessments, were the factors that predicted poor glycemic control among adults with T2DM.