The impact of health literacy on diabetes self-management education

Abstract

Background. Diabetes self-management education (DSME) is generally considered to be a key determinant of the treatment outcomes and related costs of diabetes mellitus. While DSME programmes generally have positive outcomes, their effects may depend on certain factors such as the type of programmes provided and patients' level of health literacy (HL). Low HL has been associated with poorer self-management behaviours and poor medication adherence in diabetic patients, but its impact on the effects of DSME has not yet been systematically investigated. This study aimed to investigate the influence of HL on the self-reported effects of DSME programmes while taking the type of programme into consideration. Method. 366 diabetic patients from nine countries completed a questionnaire measuring HL, selfmanagement behaviours, problem perception, coping, perceived general health and well-being before and after participating in a DSME programme. Results. DSME programmes were found to have positive effects on self-reported self-management behaviours and almost all psychological and health outcomes, regardless of HL level. Patients with high HL scored better on several diabetes outcomes than those with low HL, but all patients described benefiting from DSME. Individual and group-based programmes resulted in more positive effects on several diabetes outcomes than self-help groups, but no interaction with HL was found. Conclusion. Our findings confirm those of previous studies showing that DSME programmes have positive effects and that low HL is associated with lower diabetes outcomes, but do not support the assumption that the effects of DSME programmes are influenced by the patient's HL. However, due to the limitations of this study, further investigation is necessary to support these findings and improve our understanding about the impact of HL on DSME programmes' effectiveness.

Explaining variance in health literacy among people with type 2 diabetes: the association between health literacy and health behaviour and empowerment

“…Significant differences in HL were found in relation to education. People with T2DM who had completed a university-level education reported a significantly higher HL (as measured by the HLS-Q12) than those with a lower education level, which is similar to the findings of previous studies [4,12,[53][54][55][56][57]. This finding was also supported when using the FCCHL to measure HL in the same population [11].…”

“…According to the proportion of responses in each response category, over one-third marked the HL tasks as difficult or very difficult, which implies that health professionals should pay attention to the individual's HL and should adapt their health communication to the appropriate level. In contrast to van der Heide [4] and Hussein, Almajran and Albatineh [53] but in accord with Al Sayah et al [16] and Vandenbosch et al [54], no significant differences in HL with regard to age were found. However, the average age of the sample was relatively high, so differences related to age may not have been evident.…”

“…According to Field [52], variables that are already known to be predictors of the dependent variable should be entered first. As several studies have reported a link between HL and education level [4,12,[53][54][55][56][57], this variable was introduced first in Model 1. Some studies have reported a link between HL and general health, whereas the link between HL and empowerment has been investigated in people with T2DM only to a small extent.…”

Self-care activities among patients with diabetes attending a tertiary care hospital in Biratnagar, Nepal

“…To assess the effectiveness of ongoing treatment blood sugar should be regularly monitored. In our study we found that adherence to oral hypoglycemic drugs (86.52%) and insulin injections (78%) was high which is contrast with the findings of previous studies [23]. The reasons for nonadherance are multifactorial which includes age, perception, duration of disease, polutheraphy, psychological factors [24].…”

“…In our study 69.5% checked the blood sugar every 3 month which is similar were observed to a study done in [22]. The level of education appeared to play a magnificent role in medication adherence in accordance with the previous studies [23]. To assess the effectiveness of ongoing treatment blood sugar should be regularly monitored.…”