Abstract
ABSTRACTObjective To translate, adapt and evaluate the properties of a Brazilian Portuguese version of the Spoken Knowledge in Low Literacy Patients with Diabetes, which is a questionnaire that evaluate diabetes knowledge.Methods A cross-sectional study with type 2 diabetes patients aged ≥60 years, seen at a public healthcare organization in the city of Sao Paulo (SP). After the development of the Portuguese version, we evaluated the psychometrics properties and the association with sociodemographic and clinical variables. The regression models were adjusted for sociodemographic data, functional health literacy, duration of disease, use of insulin, and glycemic control.Results We evaluated 129 type 2 diabetic patients, with mean age of 75.9 (±6.2) years, mean scholling of 5.2 (±4.4) years, mean glycosylated hemoglobin of 7.2% (±1.4), and mean score on Spoken Knowledge in Low Literacy Patients with Diabetes of 42.1% (±25.8). In the regression model, the variables independently associated to Spoken Knowledge in Low Literacy Patients with Diabetes were schooling (B=0.193; p=0.003), use of insulin (B=1.326; p=0.004), duration of diabetes (B=0.053; p=0.022) and health literacy (B=0.108; p=0.021). The determination coefficient was 0.273. The Cronbach a was 0.75, demonstrating appropriate internal consistency.Conclusion This translated version of the Spoken Knowledge in Low Literacy Patients with Diabetes showed to be adequate to evaluate diabetes knowledge in elderly patients with low schooling levels. It presented normal distribution, adequate internal consistency, with no ceiling or floor effect. The tool is easy to be used, can be quickly applied and does not depend on reading skills.
Highlights
Diabetes is a chronic degenerative disease commonly observed in elderly, and its prevalence has increased fastly in recent decades.[1]. Strong evidence demonstrated the need of appropriate glycemic control to prevent microand macrovascular complications.[2,3] Inadequate glycemic control in adults is due to cognitive impairment, sensory loss, polypharmacy, depression and poor compliance.[4,5,6]
Average duration of diabetes was 12.8 years (±9.1), and 31.8% of participants were on insulin therapy
This study did not allow evaluation of this criterion, because most tools that measure diabetes knowledge were originally described in English, and the instruments validated in Brazil have not been adjusted for low-schooling populations, for involving reading ability and complex questions on pathophysiology of disease.[25]. Neither did we evaluate reliability parameters, such as inter-examiner agreement and test-retest stability
Summary
Diabetes is a chronic degenerative disease commonly observed in elderly, and its prevalence has increased fastly in recent decades.[1]. Several tools designed to evaluate diabetes knowledge have been developed in the last decades. Most of these involve reading ability and are based on complex scales, with limited clinical applicability, especially for individuals with low schooling level.[10,11]. Rothman et al developed the Spoken Knowledge in Low Literacy Patients with Diabetes (SKILLD),(12) a tool originally designed in English to assess knowledge on this disease. The questions are written in simple language and the level of difficulty has been adapted for individuals with low schooling level. SKILLD had neither been adapted to Portuguese language nor used as a questionnaire for elderly people in Brazil, a country where the population aged over 60 years presents low schooling levels.[13]
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