J Korean Acad Community Health Nurs.  2014 Sep;25(3):217-224. 10.12799/jkachn.2014.25.3.217.

The Influence of Health Literacy and Diabetes Knowledge on Diabetes Self-care Activities in Korean Low-income Elders with Diabetes

• Jeong J
• Park N
• Shin SY

• KMID: 2292714
• DOI: http://doi.org/10.12799/jkachn.2014.25.3.217

Abstract

PURPOSE
This study aimed to assess the levels of and relationships among health literacy, knowledge about diabetes, and self-care activities in the Korean low-income elderly with diabetes and to identify factors influencing the self-care activities of this vulnerable population.
METHODS
This study surveyed a total of 151 low-income elderly patients with diabetes registered at 16 Visiting Health Care Services in B City, Korea. Health literacy was measured with the Newest Vital Sign. Diabetes knowledge was measured with the Diabetes Knowledge Test. The Summary of Diabetes Self-care Activities Questionnaire was used to assess diabetes self-care activities. A stepwise multiple regression analysis was conducted to identify significant factors influencing diabetes self-care activities in these patients.
RESULTS
In the regression model, diabetes knowledge (beta=.322, p<.001), exercise (beta=.337, p<.001), and experiences of diabetes education (beta=.241, p=.001) were significantly associated with increased diabetes self-care activities in low-income elderly patients with diabetes when gender, education, health literacy, and subjective health state were controlled.
CONCLUSION
To improve diabetes self-care activities in the low-income elderly with diabetes, it is important to develop a customized program considering their knowledge, exercise, and diabetes education experience.

Keyword

Health literacy; Knowledge; Self care; Diabetes mellitus; Aged

MeSH Terms

Aged
Delivery of Health Care
Diabetes Mellitus
Education
Health Education
Health Literacy*
Humans
Korea
Self Care*
Vital Signs
Vulnerable Populations
Surveys and Questionnaires

Reference

1. Korea Centers for Disease Control & Prevention. Report No.:11-1351159-000027-10. Korea health statistics 2011: The 5th Korea national health and nutrition examination survey. Policy Report. Seoul: Korea Centers for Disease Control & Prevention;2012. 12.

2. Ministry of Health and Welfare. Report No.:11-1352000-000285-13. The 3rd national health promotion strategy 2011-2020 (HP2020). Policy Report. Seoul: Ministry of Health and Welfare;2011. 06.

3. Kim HY, Yun WJ, Shin MH, Kweon SS, Ahn HR, Choi SW, et al. Management of diabetic mellitus in low-income rural patients. J Prev Med Public Health. 2009; 42(5):315–322. http://dx.doi.org/10.3961/jpmph.2009.42.5.315.

4. American Diabetes Association. Statistics about diabetes [Internet]. Alexandria VA: American Diabetes Association;2011. cited 2012 February 18. Available from: http://www.diabetes.org/diabetes-basics/diabetes-statistics/?loc=DropDownDB-stats.

5. American Diabetes Association. Standards of medical care in diabetes-2009. Diabetes Care. 2009; 32:Suppl 1. S13–S61. http://dx.doi.org/10.2337/dc09-S013.

6. Fitzgerald JT, Anderson 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. http://dx.doi.org/10.2337/diacare.21.5.706.

7. Lee HJ, Park KY, Park HS, Kim IJ. The effect of problem solving nursing counseling and intensified walking exercise on diabetes self-care, coping strategies, and glycemic control among clients with DM type 2. J Korean Acad Nurs. 2005; 35(7):1314–1324.

8. Fenwick EK, Xie J, Ress G, Finger RP, Lamoureux EL. Factors associated with knowledge of diabetes in patients with type 2 diabetes using the diabetes knowledge test validated with rasch analysis. PLoS One. 2013; 8(12):e80593. http://dx.doi.org/10.1371/journal.pone.0080593.

9. Bains SS, Eqede LE. Associations between health literacy, diabetes knowledge, self-care behaviors and glycemic control in a low income population with type 2 diabetes. Diabetes Technol Ther. 2011; 13(3):335–341. http://dx.doi.org/10.1089/dia.2010.0160.

10. Chi-Lum B. Friend or Foe? Consumers using the internet for medical information. J Med Pract Manage. 1999; 14(4):196–198.

11. Benzel Lindley JA. Exploration of factors impacting the selfcare of elders with diabetes. Arizona: Arizona University;2005. 237. [dissertation].

12. Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, et al. Association of health literacy with diabetes outcomes. JAMA. 2002; 288(4):475–482. http://dx.doi.org/10.1001/jama.288.4.475.

13. 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. http://dx.doi.org/10.4040/jkan.2008.38.2.195.

14. Kim JE. Measuring the level of health literacy and influence factors: Targeting the visitors of a university hospital's outpatient clinic. J Korean Clin Nurs Res. 2011; 17(1):27–34.

15. Lee TW, Kang SJ. Health literacy in the Korean elderly and influencing factors. J Korean Gerontol Soc. 2008; 28(4):847–863.

16. Weiss BD, Mays MZ, Martz W, Castro KM, DeWalt DA, Pignone MP, et al. Quick assessment of literacy in primary care: The Newest Vital sign. Ann Fam Med. 2005; 3(6):514–522. http://dx.doi.org/10.1370/afm.405.

17. Choi EJ. Factors related to glycemic control in patients with type 2 diabetes mellitus. Seoul: Yonsei University;2007. 131. [Dissertation].

18. Toobert DJ, Glasgow RE. Assessing diabetes self-management: The summary of diabetes self-care activities questionnaire. In : Bradley C, editor. Handbook of psychology and diabetes. Switzerland: Harwood Academic;1994. p. 351–375.

19. 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. http://dx.doi.org/10.2337/diacare.23.7.943.

20. Chang S, Song MS. 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.

21. Park JY, Lee TY, Jang KS, Oh HY. A study on blood glucose level and self management among community dwelling type II diabetes patients. J Korean Acad Adult Nurs. 2010; 22(3):271–280.

22. Park M, Kim KH. The study related to perceived stress, stress coping method, self-care behavior and hemoglobin A1c of elderly diabetic mellitus patients. J Korean Acad Fundam Nurs. 2008; 15(2):186–194.

23. Park JY. A study on self management, hemoglobin A1c (HbA1c), and perceived health status for the type II diabetes patients. J Korean Biol Nurs Sci. 2010; 12(2):106–113.

24. 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.

25. 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.

26. Zhang 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.

27. Mun YH. The effects of an exercise program on the physical, physiological and emotional status of the aged. J Korean Acad Community Health Nurs. 2006; 17(4):451–460.

28. Yoo JH. A study on the relationship of self-care behavioral compliance and perceived self-efficacy in type II diabetic patient. J Korean Acad Fundam Nurs. 2000; 7(3):453–465.

29. Karter AJ, Subramanian U, Saha C, Crosson JC, Parker MM, Swain BE, et al. Barriers to insulin initiation: The translating research into action for diabetes insulin starts project. Diabetes Care. 2010; 33(4):733–735. http://dx.doi.org/10.2337/dc09-1184.

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.