Effects of Health Literacy and Knowledge on Diabetic Self-care in the Elderly with DM Living Alone

Nan Hui Kim; Youngran Yang; Myung Ha Lee

doi:10.12799/jkachn.2016.27.4.370

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Original Article
Effects of Health Literacy and Knowledge on Diabetic Self-care in the Elderly with DM Living Alone: Nan Hui Kim, Youngran Yang, Myung Ha Lee; Journal of Korean Academy of Community Health Nursing 2016;27(4):370-379.
DOI: https://doi.org/10.12799/jkachn.2016.27.4.370
Published online: December 31, 2016

¹Graduate School, College of Nursing, Chonbuk National University, Jeonju, Korea.

²College of Nursing, Research Institute of Nursing Science, Chonbuk National University, Jeonju, Korea.

• Received: October 4, 2016 • Revised: December 6, 2016 • Accepted: December 8, 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract

Abstract

Purpose
The aim of this study was to evaluate the level of self-care adherence in the elderly with diabetes mellitus (DM) who have lived alone, and to investigate the association between health literacy, diabetic knowledge and self-care adherence.
Methods
Descriptive research using the cross-sectional approach was conducted. Data was collected by using a convenience sampling of 201 participants who aged sixty-five years old or more and have lived alone. Statistical analysis was conducted by using an independent t-test, one-way ANOVA, Scheffé test, Pearson correlation coefficient and stepwise multiple regression analysis.
Results
Mean scores of health literacy, diabetic knowledge and adherence of self-care were 4.41±3.54 points out of a possible 12, 6.22±2.55 points out of a possible 15, 58.56±17.28 points out of a possible 112, respectively. Adherence of self-care showed a statistical association with health literacy (r=.26, p<.001) and diabetic knowledge (r=.30, p<.001). Statistically significant factors in the regression model were monthly income, diabetic knowledge and exercise.
Conclusion
The level of self-care adherence in the elderly with diabetes living alone was relatively low. Diabetic knowledge was an important factor to improve the level of self-care adherence for the elderly with diabetes living alone.
Key Words: Elderly; Diabetes mellitus; Health literacy; Knowledge; Self care

Table 1

General Characteristics and Diabetes-related Characteristics (N=201)

Characteristics	Categories	n (%)
Age (year)	65~<75	52 (25.9)
	75~<85	117 (58.2)
	≥85	32 (15.9)
Gender	Male	42 (20.9)
Gender	Female	159 (79.1)
Education	≤Elementary school	178 (88.6)
Education	≥Middle school	23 (11.4)
Religion	Yes	111 (55.2)
Religion	No	90 (44.8)
Occupation	Employed	20 (10.0)
Occupation	Unemployed	181 (90.0)
Monthly income (10,000 won/month)	<50	145 (72.1)
Monthly income (10,000 won/month)	≥50	56 (27.9)
Smoking	Yes	11 (5.5)
Smoking	No	190 (94.5)
Drinking	Yes	46 (22.9)
Drinking	No	155 (77.1)
Exercise	Yes	108 (53.7)
Exercise	No	93 (46.3)
Diagnosis duration (year)	<10	99 (49.3)
	10~<20	60 (29.8)
	≥20	42 (20.9)
Experiences in diabetes education	Yes	50 (24.9)
Experiences in diabetes education	No	151 (75.1)
Subjective health	Good	10 (5.0)
	Moderate	102 (50.7)
	Poor	89 (44.3)

Table 2

Health Literacy, Diabetes Knowledge and Adherence to Diabetic Self Care (N=201)

Variables and sub category	n (%)	M±SD (score)	Range	Correct (%)	Compliance (day)
Health literacy	201 (100.0)	4.41±3.54	0~12
Inadequate	145 (72.1)		0~6
Marginal	41 (20.4)		7~10
Adequate	15 (7.5)		11~12
Diabetes knowledge		6.22±2.55	0~15	22.4
Causes				57.7
Symptoms				13.9
Proper blood glucose control level				15.9
- related to 'HgbA1c and normal level'				32.8
Drug therapy				55.7
General management				91.0
Exercise				38.7
Diet
Adherence to diabetic self care		58.56±17.28	0~112
Diet					3.4
Exercise					2.9
Blood sugar test					2.9
Foot care					3.8
Drug therapy					5.9

Table 3

Differences of Health Literacy, Diabetes Knowledge, and Adherence to Self Care according to General Characteristics and Diabetes-related Characteristics (N=201)

Characteristics	category	Health literacy		Diabetes knowledge		Adherence to self care
Characteristics	category	M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p)
Age (year)	65~<75^a	6.58±3.72	16.72 (<.001) a>b, c	6.65±2.77	1.10 (.336)	61.08±17.83	0.78 (.461)
	75~<85^b	3.90±3.12		6.03±2.51		57.49±17.55
	≥85^c	2.75±3.12		6.22±2.28		58.38±15.34
Gender	Male	6.81±3.49	5.26 (<.001)	7.36±3.16	2.77† (.008)	58.33±16.86	−0.09 (.925)
Gender	Female	3.77±3.29	5.26 (<.001)	5.92±2.28	2.77† (.008)	58.62±17.44	−0.09 (.925)
Education	≤Elementary school	3.86±3.27	−6.75 (<.001)	6.07±2.52	−2.28 (.024)	57.25±16.95	−3.05 (.003)
Education	≥Middle school	8.65±2.67	−6.75 (<.001)	7.35±2.52	−2.28 (.024)	68.70±16.79	−3.05 (.003)
Religion	Yes	4.57±3.76	0.71 (.480)	6.25±2.29	0..21 (.837)	60.53±17.04	1.81 (.072)
Religion	No	4.21±3.27	0.71 (.480)	6.18±2.85	0..21 (.837)	56.12±17.36	1.81 (.072)
Occupation	Employed	7.80±3.52	4.75 (<.001)	6.70±2.27	0.89 (.375)	67.05±14.84	2.34 (.020)
Occupation	Unemployed	4.03±3.35	4.75 (<.001)	6.17±2.58	0.89 (.375)	57.62±17.31	2.34 (.020)
Monthly income (10,000 won)	<50	3.75±3.35	−4.42 (<.001)	5.89±2.50	−3.01 (.003)	55.10±16.20	−4.82 (<.001)
Monthly income (10,000 won)	≥50	6.11±3.50	−4.42 (<.001)	7.07±2.49	−3.01 (.003)	67.52±16.89	−4.82 (<.001)
Smoking	Yes	4.55±3.70	0.13 (.895)	7.36±2.58	1.53 (.126)	54.91±20.32	−0.72 (.473)
Smoking	No	4.40±3.55	0.13 (.895)	6.15±2.54	1.53 (.126)	58.77±17.13	−0.72 (.473)
Drinking	Yes	6.35±3.13	4.42 (<.001)	6.74±3.17	1.34† (.185)	55.72±17.19	−1.27 (.205)
Drinking	No	3.83±3.46	4.42 (<.001)	6.06±2.32	1.34† (.185)	59.40±17.27	−1.27 (.205)
Exercise	Yes	5.29±3.56	3.92 (<.001)	6.37±2.35	0.91 (.365)	63.49±17.48	4.57 (<.001)
Exercise	No	3.39±3.26	3.92 (<.001)	6.04±2.77	0.91 (.365)	52.83±15.24	4.57 (<.001)
Diagnosis duration (year)	<10^a	5.05±3.34	3.31 (.039)	6.53±2.61	1.54 (.217)	61.56±16.78	3.93 (.021) a>b
	10~<20^b	3.72±3.58		5.82±2.72		53.75±18.94
	≥20^c	3.89±3.76		6.07±2.06		58.36±14.54
Experience in diabetes education	Yes	5.48±3.97	2.50 (.013)	7.10±2.77	2.87 (.005)	63.90±15.67	2.56 (.011)
Experience in diabetes education	No	4.05±3.33	2.50 (.013)	5.93±2.41	2.87 (.005)	56.79±17.47	2.56 (.011)
Subjective health	Good^a	7.70±3.34	17.52 (<.001) a>b>c	5.40±1.58	12.89 (<.001) b>c	61.60±16.30	1.63 (.198)
	Moderate^b	5.33±3.57		7.07±2.64		60.39±17.24
	Poor^c	2.98±2.92		5.34±2.19		56.11±17.30

^†Not equal variance.

Table 4

Correlation between Health Literacy, Diabetes Knowledge and Adherence to Self Care (N=201)

Variables	Health literacy	Diabetes knowledge	Adherence to self care
Variables	r (p)	r (p)	r (p)
Health literacy	1
Diabetes knowledge	.26 (<.001)	1
Adherence to self care	.26 (<.001)	.30 (<.001)	1

Table 5

Influencing Factor for Adherence to Self Care (N=201)

Variables	B	β	R²	∆R²	t	p
(Constant)	49.84
Monthly income^†	8.21	.21	.10		3.22	.001
Diabetes knowledge	1.65	.24	.16	.06	3.78	<.001
Exercise^‡	8.33	.24	.22	.05	3.71	<.001
	F=18.24, p<.001

^†Dummy coded: 1=not less than \500,000; ^‡Dummy coded: 1=currently exercise.

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Effects of Health Literacy and Knowledge on Diabetic Self-care in the Elderly with DM Living Alone

Characteristics	Categories	n (%)
Age (year)	65~<75	52 (25.9)
	75~<85	117 (58.2)
	≥85	32 (15.9)
Gender	Male	42 (20.9)
Gender	Female	159 (79.1)
Education	≤Elementary school	178 (88.6)
Education	≥Middle school	23 (11.4)
Religion	Yes	111 (55.2)
Religion	No	90 (44.8)
Occupation	Employed	20 (10.0)
Occupation	Unemployed	181 (90.0)
Monthly income (10,000 won/month)	<50	145 (72.1)
Monthly income (10,000 won/month)	≥50	56 (27.9)
Smoking	Yes	11 (5.5)
Smoking	No	190 (94.5)
Drinking	Yes	46 (22.9)
Drinking	No	155 (77.1)
Exercise	Yes	108 (53.7)
Exercise	No	93 (46.3)
Diagnosis duration (year)	<10	99 (49.3)
	10~<20	60 (29.8)
	≥20	42 (20.9)
Experiences in diabetes education	Yes	50 (24.9)
Experiences in diabetes education	No	151 (75.1)
Subjective health	Good	10 (5.0)
	Moderate	102 (50.7)
	Poor	89 (44.3)

Variables and sub category	n (%)	M±SD (score)	Range	Correct (%)	Compliance (day)
Health literacy	201 (100.0)	4.41±3.54	0~12
Inadequate	145 (72.1)		0~6
Marginal	41 (20.4)		7~10
Adequate	15 (7.5)		11~12
Diabetes knowledge		6.22±2.55	0~15	22.4
Causes				57.7
Symptoms				13.9
Proper blood glucose control level				15.9
- related to 'HgbA1c and normal level'				32.8
Drug therapy				55.7
General management				91.0
Exercise				38.7
Diet
Adherence to diabetic self care		58.56±17.28	0~112
Diet					3.4
Exercise					2.9
Blood sugar test					2.9
Foot care					3.8
Drug therapy					5.9

Characteristics	category	Health literacy		Diabetes knowledge		Adherence to self care
Characteristics	category	M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p)
Age (year)	65~<75^a	6.58±3.72	16.72 (<.001) a>b, c	6.65±2.77	1.10 (.336)	61.08±17.83	0.78 (.461)
	75~<85^b	3.90±3.12		6.03±2.51		57.49±17.55
	≥85^c	2.75±3.12		6.22±2.28		58.38±15.34
Gender	Male	6.81±3.49	5.26 (<.001)	7.36±3.16	2.77† (.008)	58.33±16.86	−0.09 (.925)
Gender	Female	3.77±3.29	5.26 (<.001)	5.92±2.28	2.77† (.008)	58.62±17.44	−0.09 (.925)
Education	≤Elementary school	3.86±3.27	−6.75 (<.001)	6.07±2.52	−2.28 (.024)	57.25±16.95	−3.05 (.003)
Education	≥Middle school	8.65±2.67	−6.75 (<.001)	7.35±2.52	−2.28 (.024)	68.70±16.79	−3.05 (.003)
Religion	Yes	4.57±3.76	0.71 (.480)	6.25±2.29	0..21 (.837)	60.53±17.04	1.81 (.072)
Religion	No	4.21±3.27	0.71 (.480)	6.18±2.85	0..21 (.837)	56.12±17.36	1.81 (.072)
Occupation	Employed	7.80±3.52	4.75 (<.001)	6.70±2.27	0.89 (.375)	67.05±14.84	2.34 (.020)
Occupation	Unemployed	4.03±3.35	4.75 (<.001)	6.17±2.58	0.89 (.375)	57.62±17.31	2.34 (.020)
Monthly income (10,000 won)	<50	3.75±3.35	−4.42 (<.001)	5.89±2.50	−3.01 (.003)	55.10±16.20	−4.82 (<.001)
Monthly income (10,000 won)	≥50	6.11±3.50	−4.42 (<.001)	7.07±2.49	−3.01 (.003)	67.52±16.89	−4.82 (<.001)
Smoking	Yes	4.55±3.70	0.13 (.895)	7.36±2.58	1.53 (.126)	54.91±20.32	−0.72 (.473)
Smoking	No	4.40±3.55	0.13 (.895)	6.15±2.54	1.53 (.126)	58.77±17.13	−0.72 (.473)
Drinking	Yes	6.35±3.13	4.42 (<.001)	6.74±3.17	1.34† (.185)	55.72±17.19	−1.27 (.205)
Drinking	No	3.83±3.46	4.42 (<.001)	6.06±2.32	1.34† (.185)	59.40±17.27	−1.27 (.205)
Exercise	Yes	5.29±3.56	3.92 (<.001)	6.37±2.35	0.91 (.365)	63.49±17.48	4.57 (<.001)
Exercise	No	3.39±3.26	3.92 (<.001)	6.04±2.77	0.91 (.365)	52.83±15.24	4.57 (<.001)
Diagnosis duration (year)	<10^a	5.05±3.34	3.31 (.039)	6.53±2.61	1.54 (.217)	61.56±16.78	3.93 (.021) a>b
	10~<20^b	3.72±3.58		5.82±2.72		53.75±18.94
	≥20^c	3.89±3.76		6.07±2.06		58.36±14.54
Experience in diabetes education	Yes	5.48±3.97	2.50 (.013)	7.10±2.77	2.87 (.005)	63.90±15.67	2.56 (.011)
Experience in diabetes education	No	4.05±3.33	2.50 (.013)	5.93±2.41	2.87 (.005)	56.79±17.47	2.56 (.011)
Subjective health	Good^a	7.70±3.34	17.52 (<.001) a>b>c	5.40±1.58	12.89 (<.001) b>c	61.60±16.30	1.63 (.198)
	Moderate^b	5.33±3.57		7.07±2.64		60.39±17.24
	Poor^c	2.98±2.92		5.34±2.19		56.11±17.30

Variables	Health literacy	Diabetes knowledge	Adherence to self care
Variables	r (p)	r (p)	r (p)
Health literacy	1
Diabetes knowledge	.26 (<.001)	1
Adherence to self care	.26 (<.001)	.30 (<.001)	1

Variables	B	β	R²	∆R²	t	p
(Constant)	49.84
Monthly income^†	8.21	.21	.10		3.22	.001
Diabetes knowledge	1.65	.24	.16	.06	3.78	<.001
Exercise^‡	8.33	.24	.22	.05	3.71	<.001
	F=18.24, p<.001

Table 1 General Characteristics and Diabetes-related Characteristics (N=201)

Table 2 Health Literacy, Diabetes Knowledge and Adherence to Diabetic Self Care (N=201)

Table 3 Differences of Health Literacy, Diabetes Knowledge, and Adherence to Self Care according to General Characteristics and Diabetes-related Characteristics (N=201)

^†Not equal variance.

Table 4 Correlation between Health Literacy, Diabetes Knowledge and Adherence to Self Care (N=201)

Table 5 Influencing Factor for Adherence to Self Care (N=201)

^†Dummy coded: 1=not less than \500,000; ^‡Dummy coded: 1=currently exercise.