Differential Relationships Between Diabetes Knowledge Scales and Diabetes Outcomes

Instruments to assess diabetes knowledge, skills and attitudes of people living with diabetes mellitus: A COSMIN-based systematic review

AIMS

Since knowledge, skills, and attitudes influence the adherence to self-care behaviours, the purpose of this review was to identify available instruments that measure diabetes knowledge, skills or attitudes of people living with this health condition and to evaluate their measurement properties.

METHODS

A systematic search was conducted in PubMed, EMBASE, SCOPUS, Web of Science and CINAHL databases. The methodological quality of the included studies was assessed by the Consensus-based Standards for the selection of health Measurement Instruments. Risk of Bias checklist. The results of each study were rated by the updated criteria for good measurement properties and the quality of evidence was graded using a modified Grading of Recommendations Assessment, Development, and Evaluation approach.

RESULTS

This review included 38 instruments that assess diabetes knowledge (n = 26) or skills (n = 6) or attitudes (n = 5) or both three constructs (n = 1). About 40% had satisfactory results for relevance, comprehensiveness, and comprehensibility, and about 30% had unsatisfactory results for comprehensiveness, but these results were supported by very low evidence. Most studies showed indeterminate results for structural validity (50%), internal consistency (98%) and reliability (84%). Instruments that had satisfactory results for construct validity and reliability were supported by low to very low evidence. One responsiveness study was identified, and the result was satisfactory, but supported by low evidence. The Diabetes Knowledge Questionnaire is the instrument with best evidence for use.

CONCLUSIONS

To plan more assertive interventions, researchers need to follow up guidelines to develop instruments with good quality of the measurement proprieties.

LitKDM2 study: the impact of health Literacy and knowledge about the disease on the metabolic control of type 2 diabetes mellitus

AIMS

Diabetes mellitus (DM) is a common chronic disease with serious individual and socioeconomic consequences. Low health literacy (HL) has been associated with higher morbimortality. Health knowledge about DM (HK-DM) may also influence individual health. We aimed to assess HL and HK-DM in patients with type 2 DM and their associations with metabolic control.

METHODS

Our sample comprised 194 diabetic patients from a primary care health centre. We collected clinical and demographic data and applied two validated questionnaires, the Newest Vital Sign (NST) and Diabetes Knowledge Test (DKT), to assess HL and HK-DM, respectively. Metabolic control was defined as HbA1c < 7.0%. Participants were classified according to the NST as having "high likelihood of limited HL" (HLL-HL), "possibility of limited HL" (PL-HL), or "adequate HL" (A-HL) and by the DKT as having "low", "average" and "good" HK. Statistical analysis included logistic regression models, using p < 0.05 as a cut-off for statistical significance.

RESULTS

Overall, 72.7 and 34.7% of participants had HLL-HL and low HK-DM, respectively. A-HL (OR = 6.02; 95% CI: 1.691-21.450) and PL-HL (OR = 4.78; 95% CI: 1.350-16.899) were significantly associated with better metabolic control than HLL-HL. We did not find a significant association between HK-DM and metabolic control.

CONCLUSIONS

HL seems to be associated with better metabolic control. We also found a high prevalence of illiteracy and scarce knowledge about DM. Primary care physicians should promote HL to help patients achieve better metabolic control.

Diabetes knowledge, fatalism and type 2 diabetes-preventive behavior in an ethnically diverse sample of college students

Objective This study examined diabetes knowledge, health fatalism (the belief that health outcomes are outside one's control), and their interaction, as predictors of Type 2 Diabetes preventive behavior. Participants: Ethnically diverse college students (N = 345) without prior diagnosis of diabetes. Methods: Cross-sectional design using validated self-report measures. Results: Respondents answered approximately half of the diabetes knowledge items correctly. Physical activity and sedentary behavior were not predicted by diabetes knowledge, fatalism, or their interaction. Higher diabetes knowledge was associated with a healthier diet among individuals with low fatalism. Greater fatalism was associated with a poorer diet among individuals with moderate or high diabetes knowledge. Conclusions: Diabetes knowledge was moderate in this college student sample. Greater knowledge was linked with a healthier diet among those with sense of personal control over their health. College health educators may consider emphasizing modifiability of health behaviors in conjunction with Type 2 diabetes education efforts.

Basic Determinants of Disease Knowledge in COPD Patients: Results from COSYCONET

INTRODUCTION

In many chronic diseases, including COPD, the patients' basic knowledge of the disorder has been shown to be relevant for the course of the disease. We studied which clinical and functional characteristics were related to this knowledge as well as the patients' satisfaction with their knowledge about COPD.

METHODS

The study population comprised 645 patients of GOLD grades 1-4 who participated in Visit 6 of the COSYCONET cohort (COPD and Systemic Consequences - Comorbidities Network). The assessments covered a broad panel of clinical and functional characteristics, including generic and disease-specific quality of life and the COPD Assessment Test (CAT). The study aim was addressed by two questions, referring to patients' knowledge of the meaning of FEV₁ and the overall satisfaction with their knowledge of COPD.

RESULTS

Knowledge of FEV₁ was higher in patients of higher spirometric GOLD grades or exacerbation risk, in males, with higher educational level, and after participation in a prior educational training on COPD. Patients with more detailed knowledge showed a higher satisfaction with their knowledge. Satisfaction was associated with higher generic quality of life and a lower CAT score. Furthermore, satisfaction was higher in patients with a treatment plan but lower in patients with cardiac comorbidities. It appeared that females with basic education, high burden from COPD and low quality of life had the greatest knowledge deficits.

DISCUSSION

The results suggest room for education programs adapted to the educational level of the participants. They also emphasize the major role of a disease management plan for the patients.

Type 2 diabetes self-management schemas across diverse health literacy levels: a qualitative investigation

OBJECTIVE

The aim of this study was to explore how people with diabetes and diverse health literacy levels conceptualise their experience and efforts to engage in self-management behaviours (their self-management 'schemas').

DESIGN

A qualitative design was applied.

METHODS

Twenty-six people in Sydney, Australia, took part in semi-structured interviews, which were audio-recorded and coded using Framework analysis.

RESULTS

Half the participants (54%) had limited health literacy, whereas 38% adequate health literacy (using Newest Vital Sign). Regardless of health literacy, people described how monitoring increased self-management awareness and signalled periods of low self-management ('lulls'). Accounts of monitoring to sustain motivation were more apparent for participants with adequate health literacy. Most participants described simple and flexible rules (e.g. use artificial sweeteners; eat in moderation). Two schemas related to 'lulls': a 'problem-solving orientation' depicted lulls as inevitable and was associated with varied coping strategies; a 'willpower orientation' attributed lulls to lack of 'willpower,' and described willpower as a main coping strategy.

CONCLUSION

There is considerable variation in how people think about their diabetes self-management and the strategies they use. Health literacy may contribute to some of this variation. Self-management interventions could benefit from depicting motivation as fluctuating and challenging ideas about willpower and self-blame.

Level of diabetes knowledge among adult patients with diabetes using diabetes knowledge test

Objectives:

To determine the level of diabetes knowledge and to identify the main knowledge gaps among patients with diabetes (both types 1 and 2) as there is a high prevalence of diabetes in Saudi Arabia.

Methods:

A cross-sectional study was conducted in Makkah city, Kingdom of Saudi Arabia and included governmental primary healthcare centers and hospitals from November 2016 until February 2017. A self-administrated Diabetes Knowledge Test 2 (DKT2) was used to determine the level of diabetes knowledge. It consisted of two parts: general knowledge and insulin use with a global score out of 23.

Results:

A total of 942 patients with diabetes were enrolled in this study. Male to female ratio was 55.1:44.9, with mean global DKT2 score of 13.3±3.2 (57.8%±13.3%). The majority of patients (66.1%) had average diabetes knowledge while 29.2% had low knowledge, and 4.7% had high knowledge. Better knowledge and significant associations were found with younger ages, high educational levels, longer duration of diabetes, and positive family history of diabetes.

Conclusion:

Patients’ knowledge regarding diabetes was found poor in this study. Hence healthcare providers should pay more attention to diabetes education, especially with respect to dietary concepts. We are strongly advising researchers and physicians in Saudi Arabia to do similar research to determine the level of diabetes knowledge in their fields to get a more comprehensive picture of their patients’ knowledge of diabetes.