Development of a Health Literacy Promotion Program (HeLPP) to Promote Self-Care Behaviors and Quality of Life among Rural Patients with Type 2 Diabetes: Preliminary Results

Document Type : Original Article

Authors

1 Department of Health Education & Promotion, Tabriz University of Medical Sciences, Tabriz, Iran.

2 Social Determinants of Health Research Center, Department of Health Education & Promotion, Tabriz University of Medical Sciences, Tabriz, Iran

3 Medical Education Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

4 Department of Public Health, Neyshabur University of Medical Sciences, Neyshabur, Iran.

5 Department of Public Health, Urmia University of Medical Sciences, Urmia, Iran

6 Graduate student in Psychology, Islamic Azad University-Sanandaj Branch, Sanandaj, Iran

7 Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran

8 Department of Public Health, Sarab University of Medical Sciences, Sarab, Iran.

Abstract

Background and Objective: We developed a protocol for a health literacy promotion program (HeLPP) to promote self-care behaviors and quality of life (QOL) among T2DM patients in Chaldoran County, Iran. To develop the educational program, we primarily conducted a behavioral and educational assessment on the pre-test data collected from the participants. In this paper, we report a summary of the protocol and the primary results of the pre-test findings. 

Materials and Methods: The HeLPP protocol is naturally developed for a randomized controlled trial with Solomon four-group design. Developing the HeLPP, we will conduct it for both test groups. To plan the HeLPP and to find the main predictors of self-care behaviors and QOL, we firstly conducted a cross-sectional study (as a needs assessment phase). So, applying simple random sampling, data on 160 patients were collected and analyzed. The validated scales (Health Literacy Questionnaire (HLQ), Self-care activities scale, and Diabetes QOL Brief Clinical Inventory) were used to collect data.

Results: The mean age of participants was 61.08 ± 11.35. The most significant determinants of self-care behaviors were understanding (β: 0.26), reading skills (β: 0.23), and knowledge (β: -0.19). Self-care behaviors (β: 0.29) and decision-making (β: 0.28) were significant predictors of QOL. 

Conclusion: Considering the predicting role of understanding, reading skills, and decision-making for self-care behaviors and QOL of the rural T2DM patients, the focus of HeLPP should be on clear communication, goal-setting, and teach back strategies. The developed protocol seems to be helpful in promoting the outcome variables of the study.

Keywords


Acknowledgements: The authors thank the patients who completed their participation in the study.


Availability of data and materials: The authors confirm that the data generated and analyzed during this study are available per request.


Conflicts of interests: The authors declare no conflict of interest.


Consent for publication:  All respondents have given consent for publication, provided that anonymity was ensured.


Ethical approval and consent to participate: This study was approved by the ethics committee in Tabriz University of Medical Sciences (Ethics No: IR.TBZMED.REC.1397.459). The study was performed in line with the principles of Helsinki Declaration. 


Funding: This study was funded by Tabriz University of medical Sciences (Grant No: 60587).


Author contributions: HN, HA, and TB conceptualized the main idea and designed the project. HN acquired the funding. HH, SS, SN, and BF worked on data acquisition. LZ, HH, KP, HA, and SS conducted data curation and formal analysis. KP, HN and HA wrote the original draft. HN, SS, HH, and LZ reviewed and edited the draft. All author(s) read and approved the final manuscript.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

1. Kassahun T, Gesesew H, Mwanri L, Eshetie T. Diabetes related knowledge, self-care behaviours and adherence to medications among diabetic patients in Southwest Ethiopia: A cross-sectional survey. BMC Endocrine Disorders. 2016;16(1):1-11.
https://doi.org/10.1186/s12902-016-0114-x
PMid:27381349 PMCid:PMC4933997
 
2. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380(9859):2095-128.
https://doi.org/10.1016/S0140-6736(12)61728-0
PMid:23245604
 
3. Azadnajafabad S, Ahmadi N, Rezaei N, Rashidi M-M, Saeedi Moghaddam S, Mohammadi E, et al. Evaluation of the diabetes care cascade and compliance with WHO global coverage targets in Iran based on STEPS survey 2021. Scientific Reports. 2023;13(1):13528.
https://doi.org/10.1038/s41598-023-39433-7
PMid:37598214 PMCid:PMC10439917
 
4. Ghassab-Abdollahi N, Nadrian H, Pishbin K, Shirzadi S, Sarbakhsh P, Saadati F, et al. Gender and urban-rural residency based differences in the prevalence of type-2 diabetes mellitus and its determinants among adults in Naghadeh: Results of IraPEN survey. Plos one. 2023;18(3):e0279872.
https://doi.org/10.1371/journal.pone.0279872
PMid:36881587 PMCid:PMC9990936
 
5. Raj G, Hashemi Z, Soria Contreras D, Babwik S, Maxwell D, Bell R, et al. Adherence to Diabetes Dietary Guidelines Assessed Using a Validated Questionnaire Predicts Glucose Control in Adults With Type 2 Diabetes. Canadian journal of diabetes. 2018;42(1):78-87.
https://doi.org/10.1016/j.jcjd.2017.04.006
PMid:28648765
 
6. Wahowiak L. National Standards for Diabetes Self-Management Education and Support: What's Changed. ADCES in Practice. 2018;6(1):20-4.
https://doi.org/10.1177/2325160317742909
 
7. Riegel B, Jaarsma T, Strömberg A. A middle-range theory of self-care of chronic illness. Advances in nursing science. 2012;35(3):194-204.
https://doi.org/10.1097/ANS.0b013e318261b1ba
PMid:22739426
 
8. Organization WH. Health promotion: track 2: health literacy and health behaviour. 2020.
 
9. Ehmann AT, Groene O, Rieger MA, Siegel A. The Relationship between Health Literacy, Quality of Life, and Subjective Health: Results of a Cross-Sectional Study in a Rural Region in Germany. International journal of environmental research and public health. 2020;17(5):1683.
https://doi.org/10.3390/ijerph17051683
PMid:32150820 PMCid:PMC7084276
 
10. Aghajanloo R, Nadrian H, Baraei B, Shirzadi S, Sarbakhsh P, Keshavarzian K, et al. Health literacy, treatment adherence, bone mass density and health-related quality of life among Iranian older adults with osteoporosis. International Journal of Health Promotion and Education. 2022:1-16.
https://doi.org/10.1080/14635240.2022.2052145
 
11. Heizomi H IZ, Vaezi R, Bhalla D, Morisky DE, Nadrian H. . Gender differences in the associations between health literacy and medication adherence in hypertension: a population-based survey in Heris county, Iran. . Vascular health and risk management. 2020 Apr;23:157-66.
https://doi.org/10.2147/VHRM.S245052
PMid:32368074 PMCid:PMC7186197
 
12. Pleasant A. Health literacy: an opportunity to improve individual, community, and global health in adult education for health and wellness. In: Imel S, Jovita M, Gordon R, editors. 2011. 1302011. p. 43-53.
https://doi.org/10.1002/ace.409
 
13. 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 medical journal. 2016;31(1):52-9.
https://doi.org/10.5001/omj.2016.10
PMid:26813680 PMCid:PMC4720937
 
14. Sayah F, Qiu W, Johnson J. Health literacy and health-related quality of life in adults with type 2 diabetes: a longitudinal study. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 2016;25(6):1487-94.
https://doi.org/10.1007/s11136-015-1184-3
PMid:26603739
 
15. Vasan R, Larson M, Leip E, Kannel W, Levy D. Assessment of frequency of progression to hypertension in non-hypertensive participants in the Framingham Heart Study: a cohort study. Lancet. 2001;358(9294):1682-6.
https://doi.org/10.1016/S0140-6736(01)06710-1
PMid:11728544
 
16. Nijland N, Gemert-Pijnen J, Kelders S, Brandenburg B, Seydel E. Factors influencing the use of a Web-based application for supporting the self-care of patients with type 2 diabetes: a longitudinal study. Journal of medical Internet research. 2011;13(3):e71.
https://doi.org/10.2196/jmir.1603
PMid:21959968 PMCid:PMC3222177
 
17. Vigneshwaran E, Padmanabhareddy Y, Devanna N, Alvarez-Uria G. Gender Differences in Health Related Quality of Life of People Living with HIV/AIDS in the Era of Highly Active Antiretroviral Therapy. North American journal of medical sciences. 2013;5(2):102-7.
https://doi.org/10.4103/1947-2714.107526
PMid:23641370 PMCid:PMC3624709
 
18. Williams M, Baker D, Parker R, Nurss J. Relationship of functional health literacy to patients' knowledge of their chronic disease. A study of patients with hypertension and diabetes. Archives of internal medicine. 1998;158(2):166-72.
https://doi.org/10.1001/archinte.158.2.166
PMid:9448555
 
19. Momeni M, Mirmohammadkhani M, Ziari A. Health Literacy in the Population of Diabetic Patients in Iran: A Systematic Review and Meta-Analysis. Iranian journal of public health. 2020;49(4):617-27.
https://doi.org/10.18502/ijph.v49i4.3167
PMid:32548041 PMCid:PMC7283175
 
20. Gyawali B, Neupane D, Vaidya A, Sandbæk A, Kallestrup P. Community-based intervention for management of diabetes in Nepal (COBIN-D trial): study protocol for a cluster-randomized controlled trial. Trials. 2018;19(1):579.
https://doi.org/10.1186/s13063-018-2954-3
PMid:30348188 PMCid:PMC6196417
 
21. Kheradmand A, Ranjbarzade A, Hassanpour K, Bidi F. Effectiveness of educational program on knowledge, attitude, self care and life style in patients with type II diabetes. Journal of Sabzevar University of Medical Sciences. 2013;19(4):336-44.
 
22. Baur C, Prue C. The CDC Clear Communication Index is a new evidence-based tool to prepare and review health information. Health promotion practice. 2014;15(5):629-37.
https://doi.org/10.1177/1524839914538969
PMid:24951489
 
23. Porter KJ, Alexander R, Perzynski KM, Kruzliakova N, Zoellner JM. Using the Clear Communication Index to improve materials for a behavioral intervention. Health communication. 2019;34(7):782-8.
https://doi.org/10.1080/10410236.2018.1436383
PMid:29419320 PMCid:PMC6384153
 
24. Montazeri A, Tavousi M, Rakhshani F, Azin S, Jahangiri K, Ebadi M, et al. Health literacy for Iranian adults (HELIA): Development and psychometric properties. Payesh. 2014;13(5):589-99.
 
25. Toobert D, Hampson S, Glasgow R. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000;23(7):943-50.
https://doi.org/10.2337/diacare.23.7.943
PMid:10895844
 
26. Didarloo A, Shojaeizadeh D, Gharaaghaji Asl R, Habibzadeh H, Niknami S, Pourali R. Prediction of Self-Management Behavior among Iranian Women with Type 2 Diabetes: Application of the Theory of Reasoned Action along with Self-Efficacy (ETRA). Iranian Red Crescent medical journal. 2012;14(2):86-95.
 
27. Burroughs T, Desikan R, Waterman B, Gilin D, McGill J. Development and validation of the diabetes quality of life brief clinical inventory. Diabetes Spectrum. 2004;17(1):41-9.
https://doi.org/10.2337/diaspect.17.1.41
 
28. Nasihatkon A. Determining the reliability and validity of the clinical quality of life questionnaire for diabetic patients in Persian. Iranian Journal of Diabetes and Lipids. 2012;11(5):487-3.
 
29. Mirfeizi M, Jafarabadi M, Toorzani Z, Mohammadi S, Azad M, Mohammadi A, et al. Feasibility, reliability and validity of the Iranian version of the Diabetes Quality of Life Brief Clinical Inventory (IDQOL-BCI). Diabetes research and clinical practice. 2012;96(2):237-47.
https://doi.org/10.1016/j.diabres.2011.12.030
PMid:22306060
 
30. Yeh J, Wei C, Weng S, Tsai C, Shih J, Shih C, et al. Disease-specific health literacy, disease knowledge, and adherence behavior among patients with type 2 diabetes in Taiwan. BMC Public Health. 2018;18(1):1062.
https://doi.org/10.1186/s12889-018-5972-x
PMid:30143020 PMCid:PMC6108149
 
31. Kefale B, Alebachew M, Tadesse Y, Engidawork E. Quality of life and its predictors among patients with chronic kidney disease: A hospital-based cross sectional study. Public Library of Science one. 2019;14(2):e0212184.
https://doi.org/10.1371/journal.pone.0212184
PMid:30811447 PMCid:PMC6392259
 
32. Gobbens R, Remmen R. The effects of sociodemographic factors on quality of life among people aged 50 years or older are not unequivocal: comparing SF-12, WHOQOL-BREF, and WHOQOL-OLD. Clinical interventions in aging. 2019;14:231-9.
https://doi.org/10.2147/CIA.S189560
PMid:30787599 PMCid:PMC6363394
 
33. Manun'Ebo M, Masonga M, Ndombe D, Tshiala L, Ngoie C, Llanga W, et al. Assessment of the quality of life of people living with HIV/AIDS in the city of Lubumbashi, the Democratic Republic of the Congo. African Journal of Medical and Health Sciences. 2020;19(7):110-9.
 
34. Al Sayah F, Majumdar S, Williams B, Robertson S, Johnson J. Health literacy and health outcomes in diabetes: a systematic review. Journal of general internal medicine. 2013;28(3):444-52.
https://doi.org/10.1007/s11606-012-2241-z
PMid:23065575 PMCid:PMC3579965
 
35. Lee Y, Shin S, Wang R, Lin K, Lee Y, Wang Y. Pathways of empowerment perceptions, health literacy, self-efficacy, and self-care behaviors to glycemic control in patients with type 2 diabetes mellitus. Patient education and counseling. 2016;99(2):287-94.
https://doi.org/10.1016/j.pec.2015.08.021
PMid:26341940
 
36. Harsch S, Jawid A, Jawid M, Saboga Nunes L, Sahrai D, Bittlingmayer U. The relationship of health literacy, wellbeing and religious beliefs in neglected and unequal contexts-Results of a survey study in central Afghanistan. Health promotion journal of Australia 2021.
https://doi.org/10.1002/hpja.419
PMid:32949096
 
37. Gaffari-Fam S, Lotfi Y, Daemi A, Babazadeh T, Sarbazi E, Dargahi-Abbasabad G, et al. 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 and quality of life outcomes. 2020;18(1):357.
https://doi.org/10.1186/s12955-020-01613-8
PMid:33148266 PMCid:PMC7640476
 
38. Zeidi I, Morshedi H, Alizadeh Otaghvar H. A theory of planned behavior-enhanced intervention to promote health literacy and self-care behaviors of type 2 diabetic patients. Journal of preventive medicine and hygiene. 2021;61(4):E601-E13.