Top

BMC Geriatrics

Published in:

Open Access 01-12-2023 | Care | Research

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

Authors: Parichat Ong-Artborirak, Katekaew Seangpraw, Sorawit Boonyathee, Nisarat Auttama, Prakaipetch Winaiprasert

Published in: BMC Geriatrics | Issue 1/2023

Abstract

Background

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

Methods

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

Results

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

Conclusion

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

Sun P, Wen H, Liu X, et al. Time trends in type 2 diabetes mellitus incidence across the BRICS from 1990 to 2019: an age-period-cohort analysis. BMC Public Health. 2022;22(65):1–12.

World Health Organization. Global Report on Diabetes. 2016. https://www.who.int/publications/i/item/9789241565257 Accessed 20 March 2021.

Thailand Medical Services Profile 2011–2014. Diabetes Mellitus (Thai). https://www.hiso.or.th/hiso/picture/reportHealth/report/report8_7.pdf Accessed 20 March 2021.

Ministry of Public Health. Access to Diabetes care (Thai). 2020. https://ddc.moph.go.th/brc/news.php?news=21692&deptcode=brc Accessed 20 March 2021.

Suksatan W, Prabsangob K, Choompunuch B. Association between health literacy, self-care behavior, and blood Sugar Level among older patients with type 2 diabetes in Rural Thai Communities. Ann Geriatr Med Res. 2021;4318–23. https://doi.org/10.4235/agmr.21.0117. Epub 2021 Dec 28. PMID: 34958731; PMCID: PMC8749034.

American Diabetes Association. Standards of medical care in diabetes 2010. Diabetes Care. 2010;33(Supplement1):11–S61. https://doi.org/10.2337/dc10-S011.CrossRef

Gebregziabher M, Egede LE, Lynch CP, Echols C, Zhao Y. Effect of trajectories of glycemic control on mortality in type 2 diabetes: a semiparametric joint modeling approach. Am J Epidemiol. 2010;171(10):1090–8. https://doi.org/10.1093/aje/kwq070.CrossRefPubMedPubMedCentral

Hirai FE, Moss SE, Klein BE, Klein R. Relationship of glycemic control, exogenous insulin, and C-peptide levels to ischemic heart disease mortality over a 16-year period in people with older-onset diabetes: the Wisconsin epidemiologic study of Diabetic Retinopathy (WESDR). Diabetes Care. 2008;31(3):493–7. https://doi.org/10.2337/dc07-1161.CrossRefPubMed

Williams MV, Baker DW, Parker RM, Nurss JR. Relationship of functional health literacy to patients’ knowledge of their chronic disease. A study of patients with hypertension and diabetes. Arch Intern Med. 1998;158(2):166–72. https://doi.org/10.1001/archinte.158.2.166. PMID: 9448555.CrossRefPubMed

10.

Reagan LA, Walsh SJ, Shelton D. Relationships of illness representation, diabetes knowledge, and self-care behaviour to glycemic control in incarcerated persons with diabetes. Int J Prison Health. 2016;12(3):157 – 72. https://doi.org/10.1108/IJPH-04-2015-0010. PMID: 27548018.

11.

Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, Palacios J, Sullivan GD, Bindman AB. Association of health literacy with diabetes outcomes. JAMA. 2002;288(4):475 – 82. https://doi.org/10.1001/jama.288.4.475. PMID: 12132978.

12.

Powell CK, Hill EG, Clancy DE. The relationship between health literacy and diabetes knowledge and readiness to take health actions. Diabetes Educ. 2007;33(1):144 – 51. https://doi.org/10.1177/0145721706297452. PMID: 17272800.

13.

Nutbeam D, Muscat DM, Health Promotion G. 2021. Health Promot Int. 2021;36(6):1578–1598. https://doi.org/10.1093/heapro/daaa157.

14.

World Health Organization. Health promotion: track 2: health literacy and health behaviour. https://www.who.int/teams/health-promotion/enhanced-wellbeing/seventh-global-conference/health-literacy. Accessed 20 March 2021.

15.

Wang RH, Hsu HC, Lee YJ, Shin SJ, Lin KD, An LW. Patient empowerment interacts with health literacy to associate with subsequent self-management behaviors in patients with type 2 diabetes: a prospective study in Taiwan. Patient Educ Couns. 2016;99(10):1626–31. https://doi.org/10.1016/j.pec.2016.04.001.CrossRefPubMed

16.

Reisi M, Mostafavi F, Javadzade H, Mahaki B, Tavassoli E, Sharifirad G. Impact of health literacy, Self-efficacy, and Outcome Expectations on Adherence to Self-care Behaviors in Iranians with type 2 diabetes. Oman Med J. 2016;31(1):52–9. https://doi.org/10.5001/omj.2016.10.CrossRefPubMedPubMedCentral

17.

Sayah FA, Qiu W, Johnson JA. Health literacy and health-related quality of life in adults with type 2 diabetes: a longitudinal study. Qual Life Res. 2016;25(6):1487–94. https://doi.org/10.1007/s11136-015-1184-3.CrossRefPubMed

18.

Gazmararian JA, Kripalani S, Miller MJ, Echt KV, Ren J, Rask K. Factors associated with medication refill adherence in cardiovascular-related diseases: a focus on health literacy. J Gen Intern Med. 2006;21(12):1215–21. https://doi.org/10.1111/j.1525-1497.2006.00591.x.CrossRefPubMedPubMedCentral

19.

Baker DW, Wolf MS, Feinglass J, Thompson JA, Gazmararian JA, Huang J. Health literacy and mortality among elderly persons. Arch Intern Med. 2007;167(14):1503–9. https://doi.org/10.1001/archinte.167.14.1503.CrossRefPubMed

20.

Williams K, Bond M. The roles of self-efficacy, outcome expectancies and social support in the self-care behaviours of diabetics. Psychol Health Med. 2002;7(2):127–41.CrossRef

21.

Bandura A. Social foundations of thought and action. Englewood Cliffs, NJ. 1986. https://doi.org/10.4135/9781446221129.n6.

22.

Walker RJ, Smalls BL, Hernandez-Tejada MA, Campbell JA, Egede LE. Effect of diabetes self-efficacy on glycemic control, medication adherence, self-care behaviors, and quality of life in a predominantly low-income, minority population. Ethn Dis. 2014;24(3):349–55.PubMed

23.

Wu SF, Courtney M, Edwards H, McDowell J, Shortridge Baggett LM, Chang PJ. Self-efficacy, outcome expectations and self-care behaviour in people with type 2 diabetes in Taiwan. J Clin Nurs. 2007;16(11 C):250–7.CrossRefPubMed

24.

Breslow L. Self-care behavior. Encyclopedia of Public Health. Farmington Hills, MI: Gale Group. 2002. http://www.enotes.com/public-health-encyclopedia/self-care-behavior Accessed 20 March 2021.

25.

Bohanny W, Wu SF, Liu CY, Yeh SH, Tsay SL, Wang TJ. Health literacy, self-efficacy, and self-care behaviors in patients with type 2 diabetes mellitus. J Am Assoc Nurse Pract. 2013;25(9):495–502. https://doi.org/10.1111/1745-7599.12017.CrossRefPubMed

26.

Sigurdardóttir AK. Self-care in diabetes: model of factors affecting self-care. J Clin Nurs. 2005;14(3):301–14. https://doi.org/10.1111/j.1365-2702.2004.01043.x.CrossRefPubMed

27.

American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care. 2003;26(Suppl 1):33–50. https://doi.org/10.2337/diacare.26.2007.s33.CrossRef

28.

Davis J, Fischl AH, Beck J, Browning L, Carter A, Condon JE, Dennison M, Francis T, Hughes PJ, Jaime S, Lau KHK, McArthur T, McAvoy K, Magee M, Newby O, Ponder SW, Quraishi U, Rawlings K, Socke J, Stancil M, Uelmen S, Villalobos S. 2022 National Standards for Diabetes Self-Management Education and Support. Sci Diabetes Self Manag Care. 2022;48(1):44–59. https://doi.org/10.1177/26350106211072203.CrossRefPubMed

29.

Funnell MM, Brown TL, Childs BP, Haas LB, Hosey GM, Jensen B, Maryniuk M, Peyrot M, Piette JD, Reader D, Siminerio LM, Weinger K, Weiss MA. National Standards for diabetes self-management education. Diabetes Care. 2011;34(Suppl 1):89–96. https://doi.org/10.2337/dc11-S089.CrossRef

30.

Gaffari-Fam S, Lotfi Y, Daemi A, Babazadeh T, Sarbazi E, Dargahi-Abbasabad G, Abri H. Impact of health literacy and self-care behaviors on health-related quality of life in Iranians with type 2 diabetes: a cross-sectional study. Health Qual Life Outcomes. 2020;18(1):357. https://doi.org/10.1186/s12955-020-01613-8.CrossRefPubMedPubMedCentral

31.

Health education Division. Department of Health Service Support. Health literacy and health behaviors assessment form of village working-age people to modify health behaviors (Thai). Ministry of Public Health, Thailand. 2020. http://www.hed.go.th/linkHed/403 Accessed 20 March 2021.

32.

Auttama N, Seangpraw K. Factors Predictor Health literacy among older adults with risk hypertension disease, Phayao Province (Thai). J Health Educ. 2019;42(2):75–85.

33.

Souza JG, Apolinario D, Magaldi RM. Et alFunctional health literacy and glycaemic control in older adults with type 2 diabetes: a cross-sectional study. BMJ Open. 2014;4:e004180. https://doi.org/10.1136/bmjopen-2013-004180.CrossRefPubMedPubMedCentral

34.

Tajdar D, Lühmann D, Fertmann R, Steinberg T, van den Bussche H, Scherer M, Schäfer I. Low health literacy is associated with higher risk of type 2 diabetes: a cross-sectional study in Germany. BMC Public Health. 2021;21(1):510. https://doi.org/10.1186/s12889-021-10508-2.CrossRefPubMedPubMedCentral

35.

Maleki Chollou K, Gaffari-Fam S, Babazadeh T, Daemi A, Bahadori A, Heidari S. The Association of Health literacy level with Self-Care Behaviors and Glycemic Control in a Low Education Population with type 2 diabetes Mellitus: a cross-sectional study in Iran. Diabetes Metab Syndr Obes. 2020;13:1685–93. https://doi.org/10.2147/DMSO.S253607.CrossRefPubMedPubMedCentral

36.

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(6):1007–17. https://doi.org/10.1007/s11606-019-04832-y.CrossRefPubMedPubMedCentral

37.

van der Heide I, Uiters E, Rademakers J, Struijs JN, Schuit AJ, Baan CA. Associations among health literacy, diabetes knowledge, and self-management behavior in adults with diabetes: results of a dutch cross-sectional study. J Health Commun. 2014;19(Suppl 2):115–31. https://doi.org/10.1080/10810730.2014.936989.CrossRefPubMed

38.

Saeed H, Saleem Z, Naeem R, Shahzadi I, Islam M. Impact of health literacy on diabetes outcomes: a cross-sectional study from Lahore. Pakistan Public Health. 2018;156:8–14. https://doi.org/10.1016/j.puhe.2017.12.005.CrossRefPubMed

39.

Caruso R, Magon A, Baroni I, Dellafiore F, Arrigoni C, Pittella F, Ausili D. Health literacy in type 2 diabetes patients: a systematic review of systematic reviews. Acta Diabetol. 2018;55(1):1–12. https://doi.org/10.1007/s00592-017-1071-1.CrossRefPubMed

40.

Pender NJ. Health Promotion Model Manual. University of Michigan. Available from: https://deepblue.lib.umich.edu/bitstream/handle/2027.42/85350/HEALTH_PROMOTION_MANUAL_Rev_5-2011.pdf. Accessed 20 March 2021.

41.

Clemens KK, O’Regan N, Rhee JJ. Diabetes Management in older adults with chronic kidney disease. Curr Diab Rep. 2019;19(3):11. https://doi.org/10.1007/s11892-019-1128-3.CrossRefPubMedPubMedCentral

42.

Quality of life in. Type 2 diabetic patients is affected by complications but not by intensive policies to improve blood glucose or blood pressure control (UKPDS 37). U.K. prospective diabetes Study Group. Diabetes Care. 1999;22(7):1125–36. https://doi.org/10.2337/diacare.22.7.1125.CrossRef

43.

Rossing K, Christensen PK, Hovind P, Tarnow L, Rossing P, Parving HH. Progression of nephropathy in type 2 diabetic patients. Kidney Int. 2004;66(4):1596–605. https://doi.org/10.1111/j.1523-1755.2004.00925.x.CrossRefPubMed

44.

Wagner EH, Sandhu N, Newton KM, McCulloch DK, Ramsey SD, Grothaus LC. Effect of improved glycemic control on health care costs and utilization. JAMA. 2001;285(2):182–9. https://doi.org/10.1001/jama.285.2.182.CrossRefPubMed

45.

Zhang Y, Gu S, Wang C, et al. Association between fasting blood glucose levels and stroke events: a large-scale community-based cohort study from China. BMJ Open. 2021;11:e050234. https://doi.org/10.1136/bmjopen-2021-050234.CrossRefPubMedPubMedCentral

Title: Health literacy, self-efficacy, self-care behaviors, and glycemic control among older adults with type 2 diabetes mellitus: a cross-sectional study in Thai communities
Authors: Parichat Ong-Artborirak
Katekaew Seangpraw
Sorawit Boonyathee
Nisarat Auttama
Prakaipetch Winaiprasert
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Care
Diabetes
Type 2 Diabetes
Published in: BMC Geriatrics / Issue 1/2023
Electronic ISSN: 1471-2318
DOI: https://doi.org/10.1186/s12877-023-04010-0

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2023

Physical performance and compensation strategies of older adults to maintain physical fitness and well-being during the COVID-19 pandemic in Germany

“They want you to know who they really are inside of the old visage”—biographical storytelling as a methodological tool to explore emotional challenges in old age

Systematic review of research barriers, facilitators, and stakeholders in long-term care and geriatric settings, and a conceptual mapping framework to build research capacity

Implication of different frailty criteria in older people with atrial fibrillation: a prospective cohort study

Association between BMI trajectories in late-middle age and subsequent dementia risk in older age: a 26-year population-based cohort study

Developing and validating the Taiwan version of the meaningful activity participation assessment (T-MAPA) with Rasch analysis

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials