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

Pharmacotherapy literacy level and predictors of low literacy among diabetes mellitus type 2 patients in Serbia

BACKGROUND

Pharmacotherapy literacy (PTHL) is a specific ability to safely access, appraise and understand the available information concerning medication and to calculate and act accordingly. The concept of PTHL is mostly unknown for the majority of diabetes mellitus type 2 (DMT2) patients in Serbia. With diabetes being one of the major public health problems in Serbia with a prevalence of 9.1%, this two-study research aims at constructing performance-based instrument and estimating the prevalence of PTHL levels and identification of predictors of low PTHL scores in patients with DMT2.

METHODS

Multistage study was performed to adapt the existing performance-based instrument (PTHL-SR) into specific questionnaire for DMT2 population (PTHL-DM instrument). PTHL levels were assessed through cross-sectional study categorising patients into groups of low, medium, and high PTHL levels. We considered 19 predictors for low PTHL scores, from sociodemographic characteristics, health behaviours and health characteristics, access to health-related information and empowerment-related indicators. Univariate and multivariate logistic regression analyses were used to determine independent predictors of low PTHL.

RESULTS

The final 15-item PTHL-DM instrument proved to have satisfactory reliability (KR20 = 0.475) and internal reliability [ICC for the whole instrument was 0.97 with 95% confidence intervals (0.95-0.99)]. Positive correlation (rho = 0.69) between PTHL-DM score (15 questions) and the total PTHL-SR score (14 questions) was also observed. It was demonstrated that the majority of 350 patients had low PTHL (62%), and only 5% high PTHL level. Mean score on PTHL-DM was 7.8 ± 2.3. Probability of low PTHL increased among smokers, patients with low interest in health and those who estimated their health as bad. Patients who used pharmacists as sourse of information were less likely to be pharmacotherapy illiterate. Combined therapy with insulin and Oral Hypoglycemic Agents was associated with higher PTHL.

CONCLUSIONS

Our data indicate that specific PTHL-DM tool is objective, valid, and reliable. It was found that low level of PTHL prevailed among DMT2 patients. Medication literacy is influenced by age, residence, education, and family status. Patients with better health literacy also reported better health behaviours. Different patient empowerment programs and approaches aimed at raising PTHL would be essential to improve self-management and control of this widespread chronic disease in Serbia.

'Feta is obviously very dangerous stuff looking at all those reds': Can nutrition labelling help people living with type 2 diabetes to self-manage their condition?

BACKGROUND

The consumption of a healthy balanced diet is the cornerstone of treatment for people living with type 2 diabetes (PLWT2DM). The United Kingdom recommends a standardised voluntary front-of-pack food labelling system which uses the green-amber-red colour coding to indicate the presence of nutrients in a food item. Research with PLWT2DM suggests that they may find it challenging to interpret the information on food labels. This paper draws from a larger study exploring nutrition information practices for PLWT2DM. The aim of this paper is to explore the experiences of using nutrition information found on food labels among PLWT2DM and their partners/carers.

METHODS

This study used a qualitative and mixed methods design, using a solicited 4-week unstructured diary followed by a qualitative interview with each participant. The theoretical framework drew on practice theory. Data were analysed using thematic analysis.

RESULTS

Nineteen PLWT2DM and one partner took part. Data consisted of 19 diaries and interviews. Almost all participants used food labels to help manage their condition; however, the colour-coding link with traffic lights appeared to overemphasise the need to avoid foods with red labels. Participants' beliefs about sugar influenced their food choices which in turn could impact on their nutritional intake. Highly developed mathematical skills were needed to interpret information about portion sizes.

CONCLUSIONS

Healthcare professionals and patient support groups should focus more on educating PLWT2DM about how to interpret food labels so that they are able to apply these to their own food choices. Future research and development of subsequent versions of the food labelling system should include PLWT2DM to ensure that labels are both clear and relevant to them.

Factors affecting the health literacy status of patients with type 2 diabetes through demographic variables: A cross-sectional study

BACKGROUND

Health literacy (HL) is the ability of a person to acquire the process, understand the necessary health information, and make the health services needed for conscious health decisions. Besides, diabetes is the most common metabolic disorder that affects patients' quantity and quality of life. This study focused on determining the factors that affect the HL status of patients with type 2 diabetes (T2D) through the role of the demographic variables.

MATERIALS AND METHODS

This descriptive-analytical research survey recruited a sample based on 280 patients with T2D at the Diabetes Research Center of Ayatollah Taleghani Hospital in Kermanshah in 2020. This study selected patients with T2D using a simple random sampling technique. The study applied the demographic information questionnaire and the Functional, Communicative, and Critical HL Scale to collect data from patients with T2D. This study used the SPSS version 23 on the received data sets to perform statistical analysis, including t-test, analysis of the variance, and multiple regression, to predict the factors affecting HL among diabetes patients.

RESULTS

The study results showed that the mean age of the participating patients with T2D was 55.80 ± 13.04. The results indicated the mean score and standard deviation of total HL score in patients with T2D 2.70 ± 0.44. The findings specified a statistically significant relationship between HL, gender, education, occupation, income, and place of residence. Results indicated that β-coefficients of the multiple regression analysis and the income variable (β = 0.170), age (β = 0.176), and employment variable (β = 0.157). These are the most predictive of the HL of patients with T2D.

CONCLUSION

The results of this study specified that the HL rate of individuals with diabetes type 2 is average. The potential communicative and critical HL influence is essential for communication and education for diabetes patients in the primary health-care system settings. The findings indicate that communicative and critical HL related to patients' management and functional HL looks passable in this study.

Levels and Correlates of Numeracy Skills in Lebanese Adults with Diabetes: A Cross-Sectional Study

Diabetes numeracy skills are required in the interpretation of food labels, insulin pump dosage, the interpretation of blood glucose meter data, and the determination of carbohydrate intake. This study assessed the levels and correlates of numeracy skills in Lebanese adults with diabetes to identify those most at risk of uncontrolled diabetes. In total, 299 adults with diabetes, mean age 47.4 ± 19.8 years, took the questionnaire. It consisted of self-developed items on sociodemographic and health-related factors, in addition to the Diabetes Numeracy Test-15 (DNT-15) and the Single Item Literacy Screener. Many participants (62%) scored < 10 on the DNT-15 indicating insufficient numeracy skills. DNT-15 scores were positively associated with literacy, exercise, healthy diet, perceived diabetes control, frequency of glycaemia measurement, ability to afford treatment, and ease of understanding information related to diabetes. Age, BMI, and complications were negatively correlated with DNT-15 score. Numeracy skills were higher in males, single individuals, and in people with type 1 diabetes, fewer complications, controlled HbA1c, higher income, higher education, a prior visit to a dietician, and ability to maintain personal care despite COVID-19. Interventions to strengthen numeracy skills would empower individuals with diabetes, lead to appropriate self-management behaviors, and prevent health complications in at-risk individuals.

Cultural Adaptation and Validity Testing of the Portuguese Version of the Health Literacy Questionnaire (HLQ)

Background: Health literacy is considered a determinant of self-management behaviors and health outcomes among people with diabetes. The assessment of health literacy is central to understanding the health needs of a population. This study aimed to adapt the Health Literacy Questionnaire (HLQ) to the Portuguese context and to examine the psychometric properties of a population of people with diabetes. Methods: Data were collected using a self-administrated questionnaire from 453 people with diabetes in a specialized diabetes care unit. Analysis included item difficulty level, composite scale reliability, and confirmatory factor analysis (CFA). Results: The HLQ showed that the items were easily understood by participants. Composite reliability ranged from 0.74 to 0.83. A nine-factor CFA model was fitted to the 44 items. Given the very restricted model, the fit was quite satisfactory [χ²_wlsmv = 2147.3 (df = 866), p = 0.001; CFI = 0.931, TLI = 0.925, RMSEA = 0.057 (90% C.I. 0.054–0.060), and WRMR = 1.528]. Conclusion: The Portuguese version of the HLQ has shown satisfactory psychometric properties across its nine separate scales in people with diabetes. Given the strong observed properties of the HLQ across cultures, languages, and diseases, the HLQ is likely to be a useful tool in a range of Portuguese settings.

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.

The Sociodemographic Determinants of Health Literacy in the Ethnic Hungarian Mothers of Young Children in Eastern Europe

Parental health literacy is a decisive factor for child health and quality of life. Children of parents with limited health literacy are at increased risk of illness and longer recovery periods. The research at the Quality of Life Research Centre is aimed at studying the health literacy of ethnic Hungarian mothers in Eastern Europe (Hungary, Slovakia, Romania) as well as at assessing its socioeconomic and demographic antecedents. The sample size is 894 mothers. Our standardized online questionnaire includes the HLS-EU-16 and the BHLS questions, with the latter intended to screen for inadequate health literacy. Predictors of health literacy in mothers are socioeconomic status, age and partnership status. A key finding is the improvement of health literacy with age. Assessing the association of partnership status and health literacy is a novelty in this region. Our analysis reinforces the role of socioeconomic capital, widely recognized to be associated with health literacy in general and with parental health literacy in particular. Results indicate the necessity of improving caregiver health literacy with a range of health promotional activities in Eastern Europe, especially among mothers with low socioeconomic status. The hardships of young mothers and single mothers should also be considered in this respect.