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

Abstract

Background Properly understanding the health information of people with type 2 diabetes mellitus (T2DM) is the basis for better risk factor management, which also positively affects their quality of life. The aim of this study was to investigate diabetes health literacy (HL), self-efficacy, and self-care behaviors associated with glycemic control among older adults with T2DM in northern Thai communities. Methods A cross-sectional study was conducted among 414 older adults over the age of 60 diagnosed with T2DM. The study was conducted in Phayao Province from January to May 2022. Simple random sampling of the patient list for the Java Health Center Information System program was used. Questionnaires were used to collect data on diabetes HL, self-efficacy, and self-care behaviors. Blood samples were tested for estimated glomerular filtration rate (eGFR) and glycemic controls, such as fasting blood sugar (FBS) and glycated hemoglobin (HbA1c). Results The mean age of participants was 67.1 years. FBS (mean ± SD = 108.5 ± 29.5 mg/dL) and HbA1c (mean ± SD = 6.6 ± 1.2%) levels were found to be abnormal in 50.5% (≥ 126 mg/dL) and 17.4% (≥ 6.5%) of the subjects, respectively. There was a strong correlation between HL and self-efficacy (r = 0.78), HL and self-care behaviors (r = 0.76), and self-efficacy and self-care behaviors (r = 0.84). The eGFR was significantly correlated with diabetes HL (r = 0.23), self-efficacy (r = 0.14), self-care behaviors (r = 0.16), and HbA1c (r = -0.16) scores. Linear regression after adjusting for sex, age, education, DM duration, smoking, and drinking alcohol showed that FBS level was inversely associated with diabetes HL (Beta = -0.21, R2 = 11.0%), self-efficacy (Beta = -0.43, R2 = 22.2%), and self-care behavior (Beta = -0.35, R2 = 17.8%), whereas HbA1C level was negatively associated with diabetes HL (Beta = -0.52, R2 = 23.8%), self-efficacy (Beta = -0.39, R2 = 19.1%), and self-care behavior (Beta = -0.42, R2 = 20.7%). Conclusion Diabetes HL was related to self-efficacy and self-care behaviors in elderly T2DM patients and was shown to influence their health, including glycemic control. These findings suggest that implementing HL programs to build competence in self-efficacy expectations is important for contributing to improvements in diabetes preventive care behaviors and HbA1c control.

Relationships Among Health Literacy, Self-Efficacy, Self-Management, and HbA1c Levels in Older Adults with Diabetes in South Korea: A Cross-Sectional Study

“…This indicates that higher health literacy is associated with higher levels of self-efficacy and selfmanagement. Moreover, similar to previous studies, [21][22][23] there was a significant negative correlation between the ability to use health literacy and HbA1c level, showing a close relationship between these two variables in patients with DM. Our results indicated that self-efficacy was associated with a level of diabetes self-management (Table 4).…”

“…16 In diabetes research, it was found that health literacy directly and indirectly affects self-management through self-efficacy among adults with DM; 17 hence, it is a major factor influencing health outcomes. [18][19][20] However, previous studies identifying the relationship between health literacy and HbA1c levels show conflicting results; that is, several studies, including research conducted on 414 patients aged 60 and above in Thailand, have reported that health literacy and HbA1c levels are significantly correlated, [21][22][23] whereas others, including a study conducted on 499 patients in Germany, 24 have shown that they are not. [25][26][27] In South Korea, the number of studies on health literacy has increased since 2012.…”

“…This supports previous studies showing that good selfmanagement 42 and better health literacy lower HbA1c levels. [21][22][23] Most older adults with DM in the community have two or more diseases but are vulnerable in terms of health literacy and self-management and belong to the representative vulnerable class with low income and education, which can further worsen their health condition. Therefore, it is necessary to secure social networks that can provide interest and comprehensive support to vulnerable groups.…”

The Effect of Health Literacy on Disease Management Self-Efficacy in Chronic Disease Patients: The Mediating Effects of Social Support and the Moderating Effects of Illness Perception

“…Both health literacy and self-efficacy can promote patients to be more active and better at managing their disease and maintaining health. 31 But health literacy plays a more foundational role in self-management, as they are necessary skills to improve one’s health, such as mastering the correct way of taking medicines, consulting doctors about exercise methods that improve symptoms, and analyzing the correctness of health information obtained. 7 , 32 Mastering these skills increases the likelihood of successfully managing one’s own disease.…”

How is family health related to health‐related quality of life among middle‐aged and older adults in rural China? A cross‐sectional study

“…Mobility is defined as the ability to change and maintain body position, walk and move purposefully; it serves as the foundation for living a healthy and independent life (Treacy et al, 2022). Self-care refers to the ability to perform activities of daily functional living, such as washing and dressing (Ong-Artborirak et al, 2023). The usual activities reflect the skills and abilities that can help a person better adapt to life and society (Gamst-Klaussen & Lamu, 2020).…”