Journal of Health Literacy

Journal of Health Literacy

Prediction of Self-Care Behaviors among Type 2 Diabetes Patients in Tehran Based on Health Literacy in 2020: A Cross-Sectional Study

Document Type : Original Article

Authors
Azam jahangirimehr 1
Mohyeddin Azizpour 2
KHadijeh Kalanfarmanfarma 3
soudabeh Yarmohammadi 4
1 Shoushtar Faculty of Medical Sciences, Shoushtar, Iran.
2 School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
3 Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran.
4 Assistant Professor of Health Education and Promotion, Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran.
10.22038/jhl.2024.78030.1625
Abstract
Background and Objectives: Diabetes places a significant treatment responsibility on the patient. Additionally, health literacy plays a crucial role in managing chronic diseases such as diabetes. The objective of the present study is to predict self-care behaviors based on levels of health literacy in patients diagnosed with type 2 diabetes.

Materials and Methods: This study is a cross-sectional research project. It involved 250 patients with type 2 diabetes who were receiving care at hospitals affiliated with Shahid Beheshti University of Medical Sciences. The participants were chosen through cluster random sampling in 2020/2021. Data collection tool was a three-part questionnaire, having been checked for validity and reliability, including demographic information form, the Health Literacy for Iranian Adults (HELIA) questionnaire, and the Self-Care Activities of Diabetic Patients (SDSCA) questionnaire. Analysis was performed using SPSS version 16 and AMOS 20, utilizing descriptive statistics (mean and standard deviation), inferential statistics (correlation coefficient and regression), and structural equation modeling (SEM).

Results: The average age of the patients was 58.70 years, with a standard deviation of 14.69. 53.6% of the participants were female, and 46.4% had a university education. Structural equation modeling analysis revealed a strong, statistically significant positive correlation (r=0.60, p-value<0.001) between health literacy and self-care. Additionally, the assessment and decision-making aspects of health literacy were found to predict 25% of the variance in self-care behaviors.

Conclusion: The assessment of information, and decision-making to influence self-care in individuals with type 2 diabetes is paramount. According to these results, the health system can promote the public from receiving information to the level of evaluation and decision-making and application of information. This approach can enhance self-care practices for managing chronic diseases.
Keywords
Self-care
Health Literacy
Diabetes Mellitus
Type 2
Structural Equation Modeling

Acknowledgements: We express our gratitude to the diabetic patients who participated in this study.


Availability of data and materials: All data is reserved to the researchers, available upon request.


Conflicts of interests: The authors express that they have no conflicts of interests.


Consent for publication: Not applicable.


Ethics approval and consent to participate: This research pertains to project number IR.SBMU.REC.1397.088, which was approved by the Student Research Committee at Shahid Beheshti University of Medical Sciences in Tehran, Iran. Additionally, the study adhered to the principles outlined in the Declaration of Helsinki. Written informed consent was secured from all participants before their involvement in the research.


Funding: This study is funded by a research from Research Committee, Shahid Beheshti University of Medical Sciences. The funding body (SBMU) didn’t have any role in the design of the study and collection, analysis, and interpretation of data, and in the writing the manuscript.


Authors' Contributions: SY: Conception and design of the study, data analysis and interpretation, and manuscript writing. MA:  data collection, and writing up the manuscript. AJ and KHKFF: design of the study, data analysis and interpretation, and critical revision of the manuscript. All authors read and approved the final version of the 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. Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019. Results. Institute for Health Metrics and Evaluation. 2020 (https://vizhub.healthdata.org/gbd-results/).
  2. Carracher AM, Marathe PH, Close KL. International diabetes federation 2017. Wiley Online Library; 2018. DOI: 10.1111/1753-0407.12644. https://doi.org/10.1111/1753-0407.12644
  3. Hazar N, Jokar M, Namavari N, Hosseini S, Rahmanian V. An updated systematic review and Meta-analysis of the prevalence of type 2 diabetes in Iran, 1996-2023. Frontiers in Public Health. 2024; 12:1322072. https://doi.org/10.3389/fpubh.2024.1322072. https://doi.org/10.3389/fpubh.2024.1322072
  4. Bodke H, Wagh V, Kakar G. Diabetes mellitus and prevalence of other comorbid conditions: a systematic review. Cureus. 2023;15(11). DOI: 10.7759/cureus.49374. https://doi.org/10.7759/cureus.49374
  5. Mezil SA, Abed BA. Complication of diabetes mellitus. Annals of the Romanian Society for Cell Biology. 2021:1546-56.
  6. Jiang X, Topps AK, Suzuki R. A systematic review of self-care measures for professionals and trainees. Training and Education in Professional Psychology. 2021;15(2):126. https://doi.org/10.1037/tep0000318. https://doi.org/10.1037/tep0000318
  7. Ahmad F, Joshi SH. Self-Care Practices and Their Role in the Control of Diabetes: A Narrative Review. Cureus. 2023;15(7). DOI: 10.7759/cureus.41409. https://doi.org/10.7759/cureus.41409
  8. Ketema DB, Leshargie CT, Kibret GD, Assemie MA, Alamneh AA, Kassa GM, et al. Level of self-care practice among diabetic patients in Ethiopia: a systematic review and meta-analysis. BMC Public Health. 2020; 20:1-12. https://doi.org/10.1186/s12889-020-8425-2. https://doi.org/10.1186/s12889-020-8425-2
  9. Alhaik S, Anshasi HA, Alkhawaldeh Jf, Soh KL, Naji AM. An assessment of self-care knowledge among patients with diabetes mellitus. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2019;13(1):390-4. DOI: 10.1016/j.dsx.2018.10.010. https://doi.org/10.1016/j.dsx.2018.10.010
  10. Gökdeniz D, Akgün Şahin Z. Evaluation of knowledge levels about diabetes foot care and self-care activities in diabetic individuals. The International Journal of Lower Extremity Wounds. 2022;21(1):65-74. DOI: 10.1177/1534734620926266. https://doi.org/10.1177/1534734620926266
  11. Pourhabibi N, Mohebbi B, Sadeghi R, Shakibazadeh E, Sanjari M, Tol A, et al. Determinants of poor treatment adherence among patients with type 2 diabetes and limited health literacy: a scoping review. Journal of Diabetes Research. 2022;2022(1):2980250. DOI: 10.1155/2022/2980250 https://doi.org/10.1155/2022/2980250
  12. Butayeva J, Ratan ZA, Downie S, Hosseinzadeh H. The impact of health literacy interventions on glycemic control and self‐management outcomes among type 2 diabetes mellitus: A systematic review. Journal of diabetes. 2023;15(9):724-35. DOI: 10.1111/1753-0407.13436 https://doi.org/10.1111/1753-0407.13436
  13. Kiechle ES, Bailey SC, Hedlund LA, Viera AJ, Sheridan SL. Different measures, different outcomes? A systematic review of performance-based versus self-reported measures of health literacy and numeracy. Journal of general internal medicine. 2015; 30:1538-46. DOI: 10.1007/s11606-015-3288-4. https://doi.org/10.1007/s11606-015-3288-4
  14. Ratzan S, Parker R. Health literacy. National library of medicine current bibliographies in medicine Bethesda: National Institutes of Health, US Department of Health Human Services. 2000.
  15. Lee HY, Rhee TG, Kim NK, Ahluwalia JS. Health literacy as a social determinant of health in Asian American immigrants: findings from a population-based survey in California. Journal of general internal medicine. 2015; 30:1118-24. DOI: 10.1007/s11606-015-3217-6. https://doi.org/10.1007/s11606-015-3217-6
  16. Al Sayah F, Majumdar SR, Williams B, Robertson S, Johnson JA. Health literacy and health outcomes in diabetes: a systematic review. Journal of general internal medicine. 2013; 28:444-52. DOI: 10.1007/s11606-012-2241-z. https://doi.org/10.1007/s11606-012-2241-z
  17. Abdullah A, Liew SM, Salim H, Ng CJ, Chinna K. Prevalence of limited health literacy among patients with type 2 diabetes mellitus: A systematic review. PloS one. 2019;14(5): e0216402. https://doi.org/10.1371/journal. https://doi.org/10.1371/journal.pone.0216402
  18. PooresmaeilDorosteh A, Ghaffari M, Rakhshanderou S. Effectiveness of Interventional Studies on Type 2 Diabetes: A Decade Systematic Review. Health Scope.2022;11(2). https://doi.org/10.5812/jhealthscope-120280. https://doi.org/10.5812/jhealthscope-120280
  19. Estrella ML, Allen-Meares P. Tools to measure health literacy among US African Americans and Hispanics/Latinos with type 2 diabetes: A scoping review of the literature. Patient education counseling. 2020;103(10):2155-65. https://doi.org/10.1016/j.pec.2020.04.012. https://doi.org/10.1016/j.pec.2020.04.012
  20. ALSharit BA, Alhalal EA. Effects of health literacy on type 2 diabetic patients' glycemic control, self-management, and quality of life. Saudi medical journal. 2022;43(5):465. DOI: 10.15537/smj.2022.43.5.20210917. https://doi.org/10.15537/smj.2022.43.5.20210917
  21. Yarmohammadi S, Momenyan S, Ghaffari M, Ali R, Azizpour M. Impact of functional, communicative and critical health literacy on glycemic control among patients with type 2 diabetes, and the mediating role of self-care. Psychology research behavior management.2019:427-35. https://doi.org/10.2147/PRBM.S207466. https://doi.org/10.2147/PRBM.S207466
  22. Marciano L, Camerini A-L, Schulz PJ. The role of health literacy in diabetes knowledge, self-care, and glycemic control: a meta-analysis. Journal of general internal medicine. 2019; 34:1007-17. DOI: 10.1007/s11606-019-04832-y. https://doi.org/10.1007/s11606-019-04832-y
  23. 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, Metabolic Syndrome and Obesity. 2020:1685-93. DOI: 10.2147/DMSO.S253607. https://doi.org/10.2147/DMSO.S253607
  24. Heijmans M, Waverijn G, Rademakers J, van der Vaart R, Rijken M. Functional, communicative and critical health literacy of chronic disease patients and their importance for self-management. Patient education counseling. 2015;98(1):41-8. https://doi.org/10.1016/j.pec.2014.10.006. https://doi.org/10.1016/j.pec.2014.10.006
  25. Bukhsh A, Khan TM, Nawaz MS, Ahmed HS, Chan KG, Lee L-H, et al. Association of diabetes-related self-care activities with glycemic control of patients with type 2 diabetes in Pakistan. Patient preference adherence. 2018:2377-85. https://doi.org/10.2147/PPA.S177314. https://doi.org/10.2147/PPA.S177314
  26. Xu Y, Pan W, Liu H. Self‐management practices of Chinese Americans with type 2 diabetes. Nursing health sciences. 2010;12(2):228-34. https://doi.org/10.1111/j.1442-2018.2010.00524.x. https://doi.org/10.1111/j.1442-2018.2010.00524.x
  27. Almomani MH, Al-Tawalbeh S. Glycemic control and its relationship with diabetes self-care behaviors among patients with type 2 diabetes in northern Jordan: A Cross-Sectional Study. Patient preference and adherence. 2022:449-65. DOI: 10.2147/PPA.S343214. https://doi.org/10.2147/PPA.S343214
  28. Reisi M, Mostafavi F, Javadzade H, Mahaki B, Tavassoli E, Sharifirad G. Communicative and critical health literacy and self-care behaviors in patients with type 2 diabetes. Iranian journal of Diabetes Metabolism. 2015;14(3):199-208.
  29. Montazeri A, Tavousi M, Rakhshani F, Azin SA, Jahangiri K, Ebadi M, et al. Health Literacy for Iranian Adults (HELIA): development and psychometric properties. Payesh. 2014;13(5):589-99.
  30. VOSOGHI KN, ABOOTALEBI DG, Farahani B, Mohammadnezhad E, Sajjadi A. The study of self-care agency in patients with diabetes (Ardabil). Modern Care Journal. 2012;4(8):204-197.
  31. Shin KS, Lee EH. Relationships of health literacy to self‐care behaviors in people with diabetes aged 60 and above: Empowerment as a mediator. Journal of advanced nursing. 2018;74(10):2363-72. DOI: 10.1111/jan.13738. https://doi.org/10.1111/jan.13738
  32. Barratt A. Evidence based medicine and shared decision making: the challenge of getting both evidence and preferences into health care. Patient education counseling. 2008;73(3):407-12. https://doi.org/10.1016/j.pec.2008.07.054. https://doi.org/10.1016/j.pec.2008.07.054
  33. Nakayama K, Yonekura Y, Danya H, Hagiwara K. Associations between health literacy and information-evaluation and decision-making skills in Japanese adults. BMC Public Health. 2022;22(1):1-13. https://doi.org/10.1186/s12889-022-13892-5. https://doi.org/10.1186/s12889-022-13892-5
  34. Zahedi R, Baghaei M, Yeganehfarzand MR, Kazemnezhad Leili E. The relationship of health literacy and adherence to self-care behaviors in patients with metabolic syndrome. Journal of Holistic Nursing Midwifery. 2019;29(4):218-27. https://doi.org/10.32598/JHNM.29.4.218. https://doi.org/10.32598/JHNM.29.4.218
  35. Ong-Artborirak P, Seangpraw K, Boonyathee S, Auttama N, Winaiprasert P. 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. BMC geriatrics. 2023;23(1):297. DOI: 10.1186/s12877-023-04010-0. https://doi.org/10.1186/s12877-023-04010-0
  36. Bijlsma-Rutte A, Rutters F, Elders PJ, Bot SD, Nijpels G. Socio‐economic status and HbA1c in type 2 diabetes: a systematic review and meta‐analysis. Diabetes/metabolism research reviews. 2018;34(6): e3008. DOI: 10.1002/dmrr.3008. https://doi.org/10.1002/dmrr.3008
  37. Martinell M, Pingel R, Hallqvist J, Dorkhan M, Groop L, Rosengren A, et al. Education, immigration and income as risk factors for hemoglobin A1c> 70 mmol/mol when diagnosed with type 2 diabetes or latent autoimmune diabetes in adult: A population-based cohort study. BMJ Open Diabetes Research Care. 2017;5(1). DOI: 10.1136/bmjdrc-2016-000346. https://doi.org/10.1136/bmjdrc-2016-000346
  38. Montazeri N, Bakhshi S, Malekzadeh R, Ziapour A, Chaboksavar F, Yazdi F, et al. Investigating the factors affecting the self-care behaviors of patients with type II diabetes and the role of demographic variables: A case study in Iran. Journal of Education and Health Promotion. 2023;12(1):291. DOI: 10.4103/jehp.jehp_1307_22. https://doi.org/10.4103/jehp.jehp_1307_22
  39. Asadi P, Ahmadi S, Abdi A, Shareef OH, Mohamadyari T, Miri J. Relationship between self-care behaviors and quality of life in patients with heart failure. Heliyon. 2019;5(9). DOI: 10.1016/j.heliyon. 2019.e02493. https://doi.org/10.1016/j.heliyon.2019.e02493