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

Article information

Res Community Public Health Nurs. 2016;27(4):370-379
Publication date (electronic) : 2016 December 31
doi : https://doi.org/10.12799/jkachn.2016.27.4.370
Nan Hui Kim1, Youngran Yang2, Myung Ha Lee2
1Graduate School, College of Nursing, Chonbuk National University, Jeonju, Korea.
2College of Nursing, Research Institute of Nursing Science, Chonbuk National University, Jeonju, Korea.
Corresponding author: Yang, Youngran. College of Nursing, Chonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju 54896, Korea. Tel: +82-63-270-3116, Fax: +82-63-270-3127, youngran13@jbnu.ac.kr
Received 2016 October 04; Revised 2016 December 06; Accepted 2016 December 08.

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.

Keywords: Elderly; Diabetes mellitus; Health literacy; Knowledge; Self care

References

1. Statistics Korea. 2015 statistics on the aged [Internet] Seoul: Statistics Korea; 2015. cite 2016 September 6. Available from: http://kostat.go.kr/smart/news/file_dn.jsp?aSeq=348565&ord=6.
2. Kim YJ. Comparison of health habits, perceived stress, depression, and suicidal thinking by gender between elders living alone and those living with others. J Korean Acad Fundam Nurs 2009;16(3):333–344.
3. Yu GS, Park HS. Comparison of health status between senior people living alone and those who live with their families. J Korea Gerontol Soc 2003;23(4):163–179.
4. Ko YM, Cho YT. Different influence of risk factors on self-rated health between the economically poor and non-poor elderly populations living alone: Based on one sub-area in Seoul. Korean J Health Educ Promot 2013;30(2):41–53.
5. Rosenstock J. Management of type 2 diabetes mellitus in the elderly: Special considerations. Drugs Aging 2001;18(1):31–44.
6. Kim JH, Chang SA. Effect of diabetes education program on glycemic control and self management for patients with type 2 diabetes mellitus. Korean Diabetes J 2009;33(6):518–525. 10.4093/kdj.2009.33.6.518.
7. Korea Centers for Disease Control and Prevention. Korea health statistics 2014: korea national health and nutrition examination survey [Internet] Sejong: Ministry of Health and Welfare; 2015. cited 2016 September 6. Available from: http://stat.mohw.go.kr/front/statData/publicationView.jsp?menuId=47&nttSeq=21894&bbsSeq=13&nttClsCd.
8. Yang NY. Knowledge, self efficacy and self care behavior regarding foot care among elderly diabetes mellitus patients. J Korean Acad Adult Nurs 2009;21(4):413–422.
9. Conn VS, Russell CL. Self-management of chronic illnesses among aging adults. J Gerontol Nurs 2005;31(5):4. 10.3928/0098-9134-20050501-03.
10. Baker DW, Wolf MS, Feinglass J, Tompso JA, Gazmararian JA, Huang J. Health literacy and mortality among elderly persons. Arch Intern Med 2007;167(14):1503–1509. 10.1001/archinte.167.14.1503.
11. Speros C. Health literacy: Concept analysis. J Adv Nurs 2005;50(6):633–640.
12. Dewalt DA, Pignone MP. The role of literacy in health and health care. Am Fam Physician 2005;72(3):387–388.
13. Kripalani S, Robertson R, Love-Ghaffari MH, Henderson LE, Praska J, Strawder A, et al. Development of an illustrated medication schedule as a low-literacy patient education tool. Patient Educ Couns 2007;66(3):368–377.
14. Kim SH, Lee EJ. The influence of functional literacy on perceived health status in Korean older adults. J Korean Acad Nurs 2008;38(2):195–203.
15. Koh EA, Park HJ. Health literacy, diabetic knowledge, and diabetic self-care among foreign diabetic patients at a hospital in South Korea. Korean J Adult Nurs 2015;27(4):397–405. 10.7475/kjan.2015.27.4.397.
16. McCleary-Jones V. Health literacy and its association with diabetes knowledge, self-efficacy and disease self-management among african Americans with diabetes mellitus. ABNF J 2011;22(2):25–32.
17. Kang HY, Gu MO. Development and effects of a motivational interviewing self-management program for elderly patients with diabetes mellitus. J Korean Acad Nurs 2015;45(4):533–543. 10.4040/jkan.2015.45.4.533.
18. Lee HL. A survey on knowledge of diabetes and self-care behavior of rural patients with diabetes mellitus. J Korean Acad Rural Health Nurs 2013;8(1):13–24.
19. Choi GA, Jang SM, Nam HW. Current status of self-management and barriers in elderly diabetic patient. Korean Diabetes J 2008;32(3):280–289.
20. Chew LD, Griffin JM, Partin MR, Noorbaloochi S, Grill JP, Snyder A, et al. Validation of screening questions for limited health literacy in a large VA outpatient population. J Gen Intern Med 2008;23(5):561–566. 10.1007/s11606-008-0520-5.
21. Son YJ, Song EK. Impact of health literacy on disease-related knowledge and adherence to self-care in patients with hypertension. J Korean Acad Fundam Nurs 2012;19(1):6–15.
22. Fitzgerald JT, Anderso RM, Funnell MM, Hiss RG, Hess GE, Barr PA, et al. The reliability and validity of a brief diabetes knowledge test. Diabetes Care 1998;21(5):706–710.
23. Choi EJ. Factors related to glycemic control in patients with type 2 diabetes mellitus [dissertation] [Seoul]: Yonsei University; 2007. 130.
24. Toobert DJ, Glasgow RE. Assessing diabetes self-management: The summary of diabetes self-care activities questionnaire. In : Bradley C, ed. Handbook of Psychology and Diabetes The Netherlands: Harwood Academic; 1994. p. 351–375.
25. Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: Results from 7 studies and a revised scale. Diabetes Care 2000;23(7):943–950.
26. Chang S, Song M. The validity and reliability of a Korean version of the summary of diabetes self-care activities questionnaire for older patients with type 2 diabetes. J Korean Acad Adult Nurs 2009;21(2):235–244.
27. Jong JH. Influence of health literacy and diabetes knowledge for diabetes self care activities in low income elderly diabetes mellitus [master's thesis] [Busan]: Inje University; 2012. 50.
28. Lee YM, Son YJ, Lee EJ. Health literacy, disease-related knowledge, self-efficacy and self-care behavior in patients with diabetes mellitus. J Korean Data Anal Soc 2012;14(6):3087–3101.
29. Zang HL, Kim HL. Compliance and barriers to self-care behaviors in patients with type 2 diabetes. J Korean Clin Nurs Res 2010;16(1):155–166.
30. Mbaezue N, Mayberry R, Gazmararian J, Quarshie A, Ivonye C, Heisler M. The impact of health literacy on self-monitoring of blood glucose in patients with diabetes receiving care in an inner-city hospital. J Natl Med Assoc 2010;102(1):5–9.

Article information Continued

© 2016 Korean Academy of Community Health Nursing

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.

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)
Female 159 (79.1)
Education ≤Elementary school 178 (88.6)
≥Middle school 23 (11.4)
Religion Yes 111 (55.2)
No 90 (44.8)
Occupation Employed 20 (10.0)
Unemployed 181 (90.0)
Monthly income (10,000 won/month) <50 145 (72.1)
≥50 56 (27.9)
Smoking Yes 11 (5.5)
No 190 (94.5)
Drinking Yes 46 (22.9)
No 155 (77.1)
Exercise Yes 108 (53.7)
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)
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
M±SD t or F (p) M±SD t or F (p) M±SD t or F (p)
Age (year) 65~<75a 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~<85b 3.90±3.12 6.03±2.51 57.49±17.55
≥85c 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)
Female 3.77±3.29 5.92±2.28 58.62±17.44
Education ≤Elementary school 3.86±3.27 −6.75
(<.001)		 6.07±2.52 −2.28
(.024)		 57.25±16.95 −3.05
(.003)
≥Middle school 8.65±2.67 7.35±2.52 68.70±16.79
Religion Yes 4.57±3.76 0.71
(.480)		 6.25±2.29 0..21
(.837)		 60.53±17.04 1.81
(.072)
No 4.21±3.27 6.18±2.85 56.12±17.36
Occupation Employed 7.80±3.52 4.75
(<.001)		 6.70±2.27 0.89
(.375)		 67.05±14.84 2.34
(.020)
Unemployed 4.03±3.35 6.17±2.58 57.62±17.31
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)
≥50 6.11±3.50 7.07±2.49 67.52±16.89
Smoking Yes 4.55±3.70 0.13
(.895)		 7.36±2.58 1.53
(.126)		 54.91±20.32 −0.72
(.473)
No 4.40±3.55 6.15±2.54 58.77±17.13
Drinking Yes 6.35±3.13 4.42
(<.001)		 6.74±3.17 1.34†
(.185)		 55.72±17.19 −1.27
(.205)
No 3.83±3.46 6.06±2.32 59.40±17.27
Exercise Yes 5.29±3.56 3.92
(<.001)		 6.37±2.35 0.91
(.365)		 63.49±17.48 4.57
(<.001)
No 3.39±3.26 6.04±2.77 52.83±15.24
Diagnosis duration (year) <10a 5.05±3.34 3.31
(.039)		 6.53±2.61 1.54
(.217)		 61.56±16.78 3.93
(.021)
a>b
10~<20b 3.72±3.58 5.82±2.72 53.75±18.94
≥20c 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)
No 4.05±3.33 5.93±2.41 56.79±17.47
Subjective health Gooda 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)
Moderateb 5.33±3.57 7.07±2.64 60.39±17.24
Poorc 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
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.