Association between Health Literacy, Self-care Behavior, and Blood Sugar Level among Older Patients with Type 2 Diabetes in Rural Thai Communities

Pathways linking health literacy to self-care in diabetic patients with physical disabilities: A moderated mediation model

INTRODUCTION

Health literacy is widely considered to be a determinant of self-care behavior in people with diabetes. However, the mechanisms underlying how health literacy is linked to self-care behaviors have not been clearly elucidated. The aim of the present study was to explore the mediating roles of access to healthcare, provider-patient interaction, motivation, self-efficacy in the effect of health literacy on diabetes self-care behaviors among diabetic patients with physical disabilities and investigate the moderating effect of age in a moderated mediation model.

METHODS

The online survey was participated by a total of 214 diabetic patients with physical disabilities from November to December 2021. The moderated mediation analysis was examined using the Hayes' PROCESS macro modeling tool based on the bias-corrected bootstrapping method.

RESULTS

After controlling for education, the results yielded a significant indirect effect of health literacy on diabetes self-care through motivation and self-efficacy. A partially mediating relationship also was confirmed, as there is a positive direct effect of health literacy on diabetes self-care. Furthermore, age groups (i.e., age <40 and ≥ 40) functioned as a moderator of the mediating effects of motivation and self-efficacy between health literacy and diabetes self-care.

CONCLUSION

This study emphasized the important role of motivation and self-efficacy which play in linking health literacy and self-care behavior, especially for younger diabetic patients with physical disabilities. In the light of these findings, a health-literacy tailored motivation and self-efficacy enhancing program may be key targets for interventions promoting diabetes self-care behaviors in people with physical disabilities.

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

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.

Quality of Life of Older Adults with Physical and Mobility Disabilities during the COVID-19 Pandemic: A Cross-Sectional Study in Thailand

Suffering during events such as the COVID-19 pandemic threatens the quality of life (QoL) of older adults with physical and mobility disabilities. This study aims to determine the QoL of older Thai adults with such disabilities during the COVID-19 pandemic and its predictor. A cross-sectional study was conducted among 360 older adults with physical and mobility disabilities. Data were collected by structured interview questionnaires. Data analyses comprised Pearson’s correlation coefficient and multiple regression analysis. The mean age of the participants was 73.52 years; a total of 58.6% of them were female and 97.8% had completed only primary education. More than half of them had a moderate QoL (63.3%). Self-esteem, age, and perception of the benefits of disability were found to be associated with the participants’ QoL (p < 0.05) and capable of predicting it with 54.7% accuracy. As self-esteem and the perception of the benefits of disability were found to be indicators of the QoL of older adults with physical and mobility disabilities, the healthcare providers of such older adults should organize activities that could enhance their self-esteem and the perception of the benefits of disability to improve their QoL, particularly during the COVID-19 pandemic.

Factors Associated with a Health-promoting Lifestyle among Adults and Older Adults in the Era of COVID-19: An Integrative Review

AIM: To identify the factors associated with a health-promoting lifestyle (HPL) among adults or older adults during the COVID-19 pandemic. METHODS: On the basis of the PRISMA guidelines, primary articles published in English within the period from December 2019 to December 2021 were searched for on five databases: PubMed, Cochrane Library, Scopus, Web of Science, and CINAHL Plus with Full Text. RESULTS: The current review identified nine relevant studies with a total of 4,509 adults and older adults. We found that sociodemographic were associated with HPL among both adults and older adults in the COVID-19 era. The findings also asserted that a nurse-led lifestyle intervention is an effective program for improving the self-efficacy and HPL of older adults with chronic illnesses. CONCLUSION: According to this review’s findings, individuals and healthcare professionals should consider the sociodemographic and social factors associated with HPL among adults and older adults, it is important to improve and standardize the guidelines for home-based services so that they can be used properly to help them deal with the COVID-19 pandemic and similar health crises.

Influence of Self-esteem and Preparation for Aging on the Happiness of Older Thai Adults: A Cross-sectional Study

Background: Happiness is necessary for older adults’ physical and psychological well-being. The objective of this study was to examine the associations of self-esteem and preparation for aging with happiness and to determine the predictive factors of the happiness of older Thai adults. Methods: The study had a cross-sectional predictive correlational design and included 225 older Thai adults aged 60–69 years selected using multi-stage random sampling. Data were collected through self-administered questionnaires, and the collected data were analyzed using frequency, percentage, Pearson’s product moment correlation coefficient, and multiple regression analysis. Results: The study results showed that 64.9% of the study participants were moderately happy. The factors that significantly influenced their happiness were self–esteem and preparation for aging (p < 0.05), meaning their self–esteem and preparation for aging were able to predict their happiness, accounting for approximately 67.0% of the variance of such happiness. Conclusion: Older adults’ healthcare providers should organize activities for enhancing older adults’ self-esteem and for helping them prepare well for old age.