Health literacy in diabetes: psychometric properties of a new scale and effect on biochemical parameters

Authors

DOI:

https://doi.org/10.33448/rsd-v11i5.28553

Keywords:

Health Education; Health Literacy; Diabetes Mellitus; Health Promotion; Psychometrics.

Abstract

This study evaluated the health literacy (HL) competencies (access, understand/appraise and apply) using a new developed scale and the association with biochemical profile among people living with diabetes. For the diagnosis of diabetes, biochemical parameters were used. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) estimated the construct validity of the scale. Statistical models estimated the association of HL with socioeconomic, biochemical, anthropometric and cognitive parameters. This study included 341 people living with diabetes. The results showed that 91.9% received information related to diabetes. EFA demonstrated a proper factorial fit (KMO = 0.919) and the items were loaded in three factors: access, understand/appraise and apply. CFA confirmed the fit of the model (l²/df of 2.09; RMSEA of 0.061). High levels of access to information related to diabetes led to a higher apply level self-reported. However, a high apply level was not associated with better biochemical profile (p < 0.05), including the dosage of glycated hemoglobin. Moreover, regression models showed that some characteristics were associated with high HL in all its domains, such as skin color and cognitive condition. Furthermore, a higher proportion of men had high access to information related to diabetes, compared to women. These results show that different factors must be considered in the HL process to achieve proper self-management behavior to control the disease or prevent its complications. Health information for people living with diabetes should focus on specific risk factors or behaviors that modulate biochemical parameters.

References

Abdullah, A., Liew, S. M., Salim, H., Ng, C. J., & Chinna, K. (2019). Prevalence of limited health literacy among patients with type 2 diabetes mellitus: A systematic review. PLoS One, 14(5), e0216402. 10.1371/journal.pone.0216402

Al Sayah, F., Majumdar, S. R., Williams, B., Robertson, S., & Johnson, J. A. (2013). Health literacy and health outcomes in diabetes: a systematic review. J Gen Intern Med, 28(3), 444-452. 10.1007/s11606-012-2241-z

Almeida, O. P. (1998). [Mini mental state examination and the diagnosis of dementia in Brazil]. Arq Neuropsiquiatr, 56(3B), 605-612. 10.1590/s0004-282x1998000400014

American Diabetes, A. (2010). Diagnosis and classification of diabetes mellitus. Diabetes Care, 33 Suppl 1, S62-69. 10.2337/dc10-S062

American Diabetes, A. (2017). Standards of Medical Care in Diabetes-2017 Abridged for Primary Care Providers. Clin Diabetes, 35(1), 5-26. 10.2337/cd16-0067

American Diabetes, A. (2018). 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2018. Diabetes Care, 41(Suppl 1), S13-S27. 10.2337/dc18-S002

American Geriatrics Society Expert Panel on Care of Older Adults with Diabetes, M., Moreno, G., Mangione, C. M., Kimbro, L., & Vaisberg, E. (2013). Guidelines abstracted from the American Geriatrics Society Guidelines for Improving the Care of Older Adults with Diabetes Mellitus: 2013 update. J Am Geriatr Soc, 61(11), 2020-2026. 10.1111/jgs.12514

Baker, D. W., Wolf, M. S., Feinglass, J., Thompson, J. A., Gazmararian, J. A., & Huang, J. (2007). Health literacy and mortality among elderly persons. Arch Intern Med, 167(14), 1503-1509. 10.1001/archinte.167.14.1503

Cardoso, M., Santos, A. S. F., Fonseca, A. D. G., Silva-Junior, R. F. D., Carvalho, P. D., & Martins, A. (2019). Validity and reliability of the Health Literacy Assessment Scale for adherence to drug treatment among diabetics. Einstein (Sao Paulo), 17(2), eAO4405. 10.31744/einstein_journal/2019AO4405

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

Chatterjee, S., Davies, M. J., Heller, S., Speight, J., Snoek, F. J., & Khunti, K. (2018). Diabetes structured self-management education programmes: a narrative review and current innovations. Lancet Diabetes Endocrinol, 6(2), 130-142. 10.1016/S2213-8587(17)30239-5

Crespo, T. S., Andrade, J. M. O., Lelis, D. F., Ferreira, A. C., Souza, J. G. S., Martins, A., & Santos, S. H. S. (2020). Adherence to medication, physical activity and diet among older people living with diabetes mellitus: Correlation between cognitive function and health literacy. IBRO Rep, 9, 132-137. 10.1016/j.ibror.2020.07.003

De Man, J., Aweko, J., Daivadanam, M., Alvesson, H. M., Delobelle, P., Mayega, R. W., & Van Olmen, J. (2019). Diabetes self-management in three different income settings: Cross-learning of barriers and opportunities. PLoS One, 14(3), e0213530. 10.1371/journal.pone.0213530

Diabetes Prevention Program Research, G. (2002). The Diabetes Prevention Program (DPP): description of lifestyle intervention. Diabetes Care, 25(12), 2165-2171. 10.2337/diacare.25.12.2165

El-Den, S., Schneider, C., Mirzaei, A., & Carter, S. (2020). How to measure a latent construct: Psychometric principles for the development and validation of measurement instruments. Int J Pharm Pract, 28(4), 326-336. 10.1111/ijpp.12600

Eleutério, T. P., Pereira, É. J., Farias, P. K. S., Hott, K. P. S., Paula, F. M. T. d., & Martins, A. M. E. d. B. L. (2018). Elaboração e verificação da validade e confiabilidade de um instrumento de letramento em nutrição entre pessoas com diabetes. Cadernos Saúde Coletiva, 26, 298-307.

Federation, I. D. (2019). IDF Diabetes Atlas, 9th. International Diabetes Federation.

Federman, A. D., Sano, M., Wolf, M. S., Siu, A. L., & Halm, E. A. (2009). Health literacy and cognitive performance in older adults. J Am Geriatr Soc, 57(8), 1475-1480. 10.1111/j.1532-5415.2009.02347.x

Funnell, M. M., & Anderson, R. M. (2004). Empowerment and self-management of diabetes. Clinical diabetes, 22(3), 123-127.

Ghoreishi, M. S., Vahedian-Shahroodi, M., Jafari, A., & Tehranid, H. (2019). Self-care behaviors in patients with type 2 diabetes: Education intervention base on social cognitive theory. Diabetes Metab Syndr, 13(3), 2049-2056. 10.1016/j.dsx.2019.04.045

Ishikawa, H., Takeuchi, T., & Yano, E. (2008). Measuring functional, communicative, and critical health literacy among diabetic patients. Diabetes Care, 31(5), 874-879. 10.2337/dc07-1932

Jiang, H. J., Stryer, D., Friedman, B., & Andrews, R. (2003). Multiple hospitalizations for patients with diabetes. Diabetes Care, 26(5), 1421-1426. 10.2337/diacare.26.5.1421

Jing, X., Chen, J., Dong, Y., Han, D., Zhao, H., Wang, X., & Ma, J. (2018). Related factors of quality of life of type 2 diabetes patients: a systematic review and meta-analysis. Health Qual Life Outcomes, 16(1), 189. 10.1186/s12955-018-1021-9

Kang, S. J., Sim, K. H., Song, B. R., Park, J. E., Chang, S. J., Park, C., & Lee, M. S. (2018). Validation of the health literacy scale for diabetes as a criterion-referenced test with standard setting procedures. Patient Educ Couns, 101(8), 1468-1476. 10.1016/j.pec.2018.03.013

Kautzky-Willer, A., Harreiter, J., & Pacini, G. (2016). Sex and Gender Differences in Risk, Pathophysiology and Complications of Type 2 Diabetes Mellitus. Endocr Rev, 37(3), 278-316. 10.1210/er.2015-1137

Lee, E. H., Lee, Y. W., Lee, K. W., Nam, M., & Kim, S. H. (2018). A new comprehensive diabetes health literacy scale: Development and psychometric evaluation. Int J Nurs Stud, 88, 1-8. 10.1016/j.ijnurstu.2018.08.002

Lee, Y. J., Shin, S. J., Wang, R. H., Lin, K. D., Lee, Y. L., & Wang, Y. H. (2016). Pathways of empowerment perceptions, health literacy, self-efficacy, and self-care behaviors to glycemic control in patients with type 2 diabetes mellitus. Patient Educ Couns, 99(2), 287-294. 10.1016/j.pec.2015.08.021

Martins, A. M. E. d. B. L., Bauman, C. D., Ávila, W. R. d. M. e., Farias, P. K. S., Pereira, É. J., Ferreira, F. d. N., & Cardoso, M. L. F. (2018). Elaboração de um instrumento de alfabetização em saúde quanto à prática de atividade física entre diabéticos. Revista Eletrônica Acervo Saúde/Electronic Journal Collection Health ISSN, 12, 1202-1213.

Martins, A. M. E. d. B. L., Neto, E. N., Ferreira, C. M. M., Farias, P. K. S., Freitas, C. V. d., Maia, E. L., & Silva, L. T. d. S. (2018). Criação e verificação da validade de conteúdo e das propriedades psicométricas de um instrumento para avaliação da Alfabetização em Saúde entre Diabéticos. REAS, 10 (3), 1693-1703.

Matheus, A. S., Tannus, L. R., Cobas, R. A., Palma, C. C., Negrato, C. A., & Gomes, M. B. (2013). Impact of diabetes on cardiovascular disease: an update. Int J Hypertens, 2013, 653789. 10.1155/2013/653789

Merzel, C. (2000). Gender differences in health care access indicators in an urban, low-income community. Am J Public Health, 90(6), 909-916. 10.2105/ajph.90.6.909

Nathan, D. M. (2015). Diabetes: Advances in Diagnosis and Treatment. JAMA, 314(10), 1052-1062. 10.1001/jama.2015.9536

Pashaki, M. S., Eghbali, T., Niksima, S. H., Albatineh, A. N., & Gheshlagh, R. G. (2019). Health literacy among Iranian patients with type 2 diabetes: A systematic review and meta-analysis. Diabetes Metab Syndr, 13(2), 1341-1345. 10.1016/j.dsx.2019.02.020

Peek, M. E., Cargill, A., & Huang, E. S. (2007). Diabetes health disparities: a systematic review of health care interventions. Med Care Res Rev, 64(5 Suppl), 101S-156S. 10.1177/1077558707305409

Queiroz, F. A., Pace, A. E., & Santos, C. B. (2009). Cross-cultural adaptation and validation of the instrument Diabetes - 39 (D-39): brazilian version for type 2 diabetes mellitus patients - stage 1. Rev Lat Am Enfermagem, 17(5), 708-715. 10.1590/s0104-11692009000500018

Regitz-Zagrosek, V. (2012). Sex and gender differences in health. Science & Society Series on Sex and Science. EMBO Rep, 13(7), 596-603. 10.1038/embor.2012.87

Rodacki, M., Zajdenverg, L., Milech, A., & Oliveira, J. E. P. d. (2008). Dosagem do peptídeo C sérico ao acaso em adultos com diagnóstico clínico de diabetes mellitus tipo 1. Revista da Associação Médica Brasileira, 54(3), 238-241.

Schonlau, M., Martin, L., Haas, A., Derose, K. P., & Rudd, R. (2011). Patients' literacy skills: more than just reading ability. J Health Commun, 16(10), 1046-1054. 10.1080/10810730.2011.571345

Sorensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., & Consortium Health Literacy Project, E. (2012). Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health, 12, 80. 10.1186/1471-2458-12-80

Storms, H., Claes, N., Aertgeerts, B., & Van den Broucke, S. (2017). Measuring health literacy among low literate people: an exploratory feasibility study with the HLS-EU questionnaire. BMC Public Health, 17(1), 475. 10.1186/s12889-017-4391-8

Sykes, S., Wills, J., Rowlands, G., & Popple, K. (2013). Understanding critical health literacy: a concept analysis. BMC Public Health, 13, 150. 10.1186/1471-2458-13-150

Thoolen, B., De Ridder, D., Bensing, J., Maas, C., Griffin, S., Gorter, K., & Rutten, G. (2007). Effectiveness of a self-management intervention in patients with screen-detected type 2 diabetes. Diabetes Care, 30(11), 2832-2837. 10.2337/dc07-0777

Ueno, H., Ishikawa, H., Suzuki, R., Izumida, Y., Ohashi, Y., Yamauchi, T., & Kiuchi, T. (2019). The association between health literacy levels and patient-reported outcomes in Japanese type 2 diabetic patients. SAGE Open Med, 7, 2050312119865647. 10.1177/2050312119865647

van Puffelen, A. L., Rijken, M., Heijmans, M., Nijpels, G., Schellevis, F. G., & Diacourse study, g. (2019). Effectiveness of a self-management support program for type 2 diabetes patients in the first years of illness: Results from a randomized controlled trial. PLoS One, 14(6), e0218242. 10.1371/journal.pone.0218242

Wang, H., Naghavi, M., & Allen, C. (2016). Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet, 388(10053), 1459-1544. 10.1016/S0140-6736(16)31012-1

Xu, X. Y., Leung, A. Y. M., & Chau, P. H. (2018). Health Literacy, Self-Efficacy, and Associated Factors Among Patients with Diabetes. Health Lit Res Pract, 2(2), e67-e77. 10.3928/24748307-20180313-01

Published

16/04/2022

How to Cite

CRESPO, T. S.; SOUZA, J. G. S.; FERREIRA, A. C.; SANTOS, S. H. S.; MARTINS, A. M. E. de B. L. Health literacy in diabetes: psychometric properties of a new scale and effect on biochemical parameters. Research, Society and Development, [S. l.], v. 11, n. 5, p. e58511528553, 2022. DOI: 10.33448/rsd-v11i5.28553. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/28553. Acesso em: 21 nov. 2024.

Issue

Section

Health Sciences