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

Journal List > J Korean Acad Community Health Nurs > v.27(4) > 1058438

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Yang, and Lee: Effects of Health Literacy and Knowledge on Diabetic Self-care in the Elderly with DM Living Alone

Original Article

Journal of Korean Academy of Community Health Nursing 2016; 27(4): 370-379.

Published online: 31 December 2016

DOI: https://doi.org/10.12799/jkachn.2016.27.4.370

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

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 4 October 2016 Revised 6 December 2016 Accepted 8 December 2016

(open-access):

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.

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

Figures and Tables

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.

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. DOI: 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. DOI: 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. DOI: 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. DOI: 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. DOI: 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. DOI: 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, editor. 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.

TOOLS

Similar articles