Health literacy on diabetes mellitus among a working population of Mthatha, Eastern Cape Province, South Africa

Kidney Health for All: Bridging the Gap in Kidney Health Education and Literacy

BackgroundDiabetes is a significant health concern in sub-Saharan Africa, emphasizing the importance of assessing the health literacy and eHealth skills of hospitalized patients with diabetes. This study evaluated the health literacy and eHealth literacy of patients with diabetes at Donka Hospital in Guinea and Sanou Sourou Hospital in Burkina Faso, providing insights for targeted interventions and mobile health (mHealth) solutions to improve self-management and treatment outcomes.ObjectiveThe aim of this study is to evaluate the levels of health literacy and eHealth literacy among patients at Sanou Sourou Hospital in Burkina Faso and Donka Hospital in Guinea.MethodsThe study included 45 participants from Donka Hospital and 47 from Sanou Sourou Hospital. Data collection took place in May 2022, focusing on variables such as gender, age, education, income, and technology access. Health literacy and eHealth literacy were measured using the Brief Health Literacy Screen (BHLS) and the eHealth Literacy Scale (eHEALS), respectively. Statistical analysis was performed using SPSS 28.ResultsThe results indicated that 64% (64/99) of participants at Donka Hospital and 57% (57/99) at Sanou Sourou Hospital were female. The majority of participants (48/98, 49% in both hospitals) fell within the age range of 25-50 years. High rates of illiteracy were observed (62/100, 62% in Donka Hospital and 59/100, 59% in Sanou Sourou Hospital). Smartphone ownership was prevalent (62/99, 62% at Donka Hospital and 64/100, 64% at Sanou Sourou Hospital). Participants reported occasional use of technology for basic purposes and frequent internet usage for accessing health information. However, a significant proportion of participants demonstrated low health literacy (73/99, 73% at Donka Hospital; 79/101, 78% at Sanou Sourou Hospital) and inadequate eHealth literacy (57/100, 57% at Donka Hospital; 62/100, 62% at Sanou Sourou Hospital). Education was observed to positively correlate with health literacy, while age displayed a moderate negative correlation. Weak correlations were observed between gender, income, and health literacy, but these were not statistically significant. No significant correlation was found between the scores of the BHLS and the eHEALS in either hospital.ConclusionsThis study highlights the importance of targeted educational interventions and mHealth solutions aimed at enhancing health and eHealth literacy among hospitalized patients with diabetes. Addressing both health literacy and eHealth literacy is paramount for improving diabetes management and treatment outcomes in Guinea and Burkina Faso. Targeted interventions and mHealth solutions have the potential to empower patients, enabling their active involvement in health care decisions and ultimately improving overall health outcomes.

Background and objective: A large part of the control and treatment of diabetes is performed by the participation of diabetic patient through self-care. Health literacy indicates the patient's health care; therefore, the present study was aimed to determine the level of health literacy and self-care level of type II diabetic patients referred to diabetes center of Zabol city. Methods:This was a descriptive-analytic study that performed on 150 diabetic patient’s type II referred to Diabetes Control Center in Zabol in 2016 who had the inclusion criteria for the study. Samples were selected by using randomized sampling method. Data were collected through a questionnaire containing three parts of demographic information, health literacy, and self-care level in diabetes. Data were analyzed by SPSS 19 software and statistical tests (e.g.: T-test, Chi-Square, ANOVA, and Pearson's correlationcoefficient). Results: The results of this study showed that 71.3% of the participants had inadequate and cross-border health literacy and 28.7% of them had adequate health literacy. The findings also have showed that significant relationship between the level of health literacy with gender, age, and occupation. Alsofinding showed that 43% inadequate self-care؛ 35% border self-care and 22% adequate self-care level. Pearson's correlation coefficient showed that adequate health literacy in people’s old age more than others. Also by increasing age in diabetic patients was higher health literacy rate and have been adequate self-care level. Conclusion: The findings of this study showed that patients with type II diabetes had inadequate health literacy and this would cost a lot to the patients with diabetes each year. Hence, the production of media and educational materials in the local dialect of each region that have simple and comprehensible for all age groups and people with inadequate health literacy can be an effective step for improving health literacy at the individual and social levels Paper Type:Research Article.

To understand status of health literacy among diabetics and their health management behaviors, and analyze the relationship of health literacy and health management. A two-staged cluster randomized sampling method was used to investigate 1 130 diabetics in Beijing, Ningbo and Xiamen from October to November in 2012. All participants should be diagnosed by primary hospital and above and have lived in the community over six months. Diabetic patients who indicated that they had severely impaired vision or cognitive disorder, or had severe physical deterioration, or did not live in the address provided were excluded. A total of 1 130 questionnaires were sent out and 1 083 eligible questionnaires were taken back, accounting for 96.87%. Multivariate logistic regression was adopted to analyze the association between health literacy and health management behaviors and blood glucose level. Among those participants, 47.7% (517) were men, 52.3% (566) were women, the age was (67.0 ± 9.5). According to diabetes health literacy scores, 73.7% (798/1 083) of them were classified as poor health literacy and 26.1% (283/1 083) as essential health literacy. Health literacy was associated with health management behaviors independently, demonstrating that the probability of utilizing health education, free physical examination, lifestyle guidance, monitoring blood glucose on their own, measuring blood glucose more than once a week and taking hypoglycemic agent regularly among diabetics with essential health literacy were 1.40 (95%CI:1.03-1.91), 1.65 (95%CI: 1.19-2.28), 2.70 (95%CI:1.98-3.69), 2.05 (95%CI:1.34-3.15), 2.56 (95%CI:1.85-3.56) , 1.48 (95%CI:1.07-2.06) times of those in diabetics with poor health literacy (P < 0.05). Health literacy may affect health management behaviors among diabetics. More activities targeted on diabetics with low health literacy were suggested to improve their' health literacy and their skills about diabetes mellitus management.

Background: In spite of effective therapy, tuberculosis (TB) is still a major health problem in developing countries. In 1993, therefore, the World Health Organization declared TB a global emergency. In South Africa, TB is one of the most prevalent diseases, with an incidence of 556 per 100 000 population. In spite of free TB drugs in the public service and the directly observed treatment short course (DOTS) strategies, there is still a high prevalence of TB and a high treatment interruption rate in rural South Africa. Methods: The objectives of this study were to establish the prevalence of TB and reasons for the interruption of TB treatment by patients attending Mbekweni Health Centre in King Sabata Dalidyebo (KSD) district in the Eastern Cape province. This was a crosssectional study in which data were collected from 15 July 2004 to 15 January 2005 from patients who were on TB treatment and interrupted their treatment between 6 August 2001 and 30 December 2003. Results: Of the 255 TB patients who attended for treatment, 121 (47.5%) had interrupted their treatment. Reasons given for interruption included change of living place (18.96%), no money to go to the clinic (15.52%), feeling better (13.78%), side effects of the drug (6.90%), did not know the treatment course (5.17%), physical disability either old or too sick to collect treatment and nobody to help (5.17%), clinic too far (1.73%), drug not available in the clinic (13.83%) and no reasons (8.62%). Conclusion: The prevalence of treatment interruption was high in this study. Change of living place, lack of money for visiting the clinic to collect treatment, feeling better, and no drugs at the clinic were the major reasons given for interruption of treatment. Ensuring the availability of TB drugs at the health centre/clinic, patient education about TB and strengthening the DOTS programme, including a stipend for the DOTS supervisors, would help to reduce the prevalence of treatment interruption. This article has been peer reviewed. Full text available at www.safpj.co.za

Background and objective: Patients with diabetes need adequate knowledge of the disease due to complications of the disease and its control .The awareness is one of the effective factors on the level of health literacy. The present study aimed to determine the level of health literacy and its relation with some factors in patients with type 2 diabete. Methods:This is cross-sectional study was performed on 362 patients over 18 years of age with type 2 diabetes mellitus who referred to Diabetes Clinic in Golestan Hospital of Ahvaz. A randomized simple sampling method was used. The questionnaire included demographic and health literacy questionnaires. Data were analyzed by SPSS software version 22 using descriptive statistics and chi-square test. Results: The age of majority of samples was 48-48 years old (% 20/71), female (% 80/62), illiterate education (% 70/54), and housewife (% 60/52). Fifty (13.8%) had adequate health literacy, 169 (46.7%) border health literacy and 143 (39.5%) had inadequate health literacy. The relationship between health literacy dimensions and demographic variables did not show a significant relationship between health literacy dimensions and the history of the disease (p = 0.225) and gender (p = 0.296). But there was a significant positive correlation between dimensions of health literacy and age (p = 0.000), marital status (p = 0.000), education (p = 0.000), occupation type (p = 0.02), type of residence (p = 0.05) and kind of cure( p = 0.000). Conclusion:The research showed that the health literacy of diabetic patients is borderline. On the other hand, health professionals can provide educational resources by identifying the needs and capabilities of their audience and linking health literacy with demographic variables. As health literacy is expected to increase, health-related behaviors will also be enhance. Paper Type: research article Keywords : Health literacy, Diabet, Ahvaz

To investigate the health literacy about diabetes prevention and control and its influencing factors among the public in China. A multistage stratified random sampling method was applied to investigate urban and rural residents aged 18-60 years among six provinces in China during March and May, 2013. The Questionnaire of Health Literacy of Diabetes Mellitus of the Public in China was used to conduct the survey. The influencing factors of health literacy about diabetes prevention and control were analyzed by logistic regression. The results of the survey were standardized by the 6(th) national census data. A total of 4 416 persons were interviewed. A total of 4 282 valid questionnaires including 1 986 males (46.4%) and 2 296 females (53.6%) were obtained. The efficiency rate was 97.0%. The level of health literacy about diabetes prevention and control among the public in China was 32.7% (1 036/2 399). And this rate was 40.5%, 36.5% and 15.4% in east, middle and west of China, respectively. Take the west region as reference, the health literacy about diabetes prevention and control in east China was high (OR = 2.510, 95% CI: 1.931-3.263), central China was in the second place (OR = 2.083, 95% CI: 1.579-2.749). The health literacy about diabetes prevention and control among males was lower than that in females (OR = 0.488, 95% CI: 0.402-0.593). The higher education level the respondents had, the higher the health lireracy level about diabetes prevention and control. Taking the primary school and below education level as reference, the health lireracy level about diabetes prevention and control of respondents with a secondary education was higher (OR = 1.103, 95% CI: 0.812-1.499), and that of college or above degree was the highest (OR = 2.029, 95% CI: 0.460-0.870). The health literacy about diabetes prevention and control among civil servants and institution staff was high, the enterprise personnel was in the second place (OR = 0.632, 95% CI: 0.460-0.870), the literacy level among the rural residents was very low (OR = 0.339, 95% CI: 0.234-0.491). The health literacy about diabetes prevention and control among people who have a family history of diabetes was relatively higher (OR = 1.570, 95% CI: 1.222-2.018 ). The health literacy about diabetes prevention and control among people who considered that they have diabetes risk was higher than that among people who considered they didn't (OR = 1.821, 95% CI: 1.317-2.517). The east region, females, a high educational level, civil servants and public officers, having a family history of diabetes, self-assessed risk of getting diabetes were protective factors of health literacy about diabetes prevention and control.

Health information needs are predominantly addressed by means of broad health promotion interventions. These interventions’ view health needs from the individual, interpersonal, community, environmental and political perspectives. Usually these materials come in a written form known as Information, Education &amp; communication (IEC) materials Researchers and programme developers realise that successful health promotion interventions should be informed by epidemiological studies which take into account the social, cultural and economic influences and programme evaluations It is believed that the combination of all these sources of data contributes to the development of effective health promotion interventions which carry the potential of addressing a variety of health needs. These health needs include addressing health literacy for different audiences, health conditions education levels. With the enhanced attention on prevention of lifestyle illness, self-care and management, health promotion, as a strategy becomes too broad and ineffective as an intervention strategy. Thus, researchers and clinicians are now interested in understanding why and how individuals seek , obtain and use health information, rather than providing general information at a society level. This translated to a much-needed focus on health information which may enable individuals to make informed decisions about their health. Health literacy and low health literacy has received increased attention due to its association with poor understanding of health information, and consequently negative health outcomes. Although much research discusses health literacy and its role; there are gaps in explaining the relationship between health literacy and low literacy; as well as various determinants of health (i.e., social, cultural, political, etc.). This relationship is particularly significant for lower- and middle-income countries where most clients might not even speak English as a first language; or the same language of the health care providers. This book aims to shares content views not only of the scholars, researchers, developers and policy makers; but also, those of the recipients of the health interventions. Such a book has the potential to appraise a different angle of health information and literacy which has rarely been made available in discussions about the phenomenon within the health care setting, since these sources are usually biased to the views of persons with adequate literacy. Therefore, this book will highlight key considerations for stakeholders who desire to improve the delivery of health information to persons with lower literacy levels. The book sums up important literature, procedures and findings from investigations with indigenous people within the South African health setting and also offers relevant summaries and recommendations in a user-friendly manner whose readability level can reach a wider audience. This is useful since the objectives of this book is to enhance the work of public health and community workers who could be researchers and scholars and health care providers at different levels i.e., both clinical and non-clinical. This book is distinctive from others on the similar subject because most books on health communication, literacy and promotion have predominantly focused on online resources and their credibility. These books are also published on case studies from the high-income countries such as the US; targeting literacy in babies, infants, or school going young people. Whereas, this book focuses on the adult population, those with low literacy, and its attendant effects on the effective dissemination and understanding of health information on living with chronic illness such as HIV/AIDS. Moreover, through literature on the theories of information processing, the book unpacks insights on the dual information processing of both written text and visual aids, and why this is significant for the dissemination of health information to the low literate adults. This approach breaks away from traditional understandings of health interventions based on theories of social behavioural changes; ecological theories. Overall, the book also outlines the advantages of involving persons with low literacy in the development of health education materials and the selection of culturally appropriate visual aids.

This study investigates the interplay between family support, health literacy, and self-management behaviors in newly diagnosed patients with type 2 diabetes mellitus (T2DM). A cohort of 354 newly diagnosed patients with T2DM participated in this longitudinal study. Health literacy, self-management behavior, and family support were assessed using the Health Literacy Scale, Diabetes Self-Management Behavior Scale, and Family Support Scale at baseline, 3 months, and 6 months post-diagnosis. Health literacy and self-management abilities demonstrated significant correlations at both 0-3 months (β = 0.32; β = 0.23) and 3-6 months (β = 0.37; β = 0.28). Family support was a significant predictor of health literacy during the 0-3 month period (β = 0.23), with a reduced effect size at 3-6 months (β = 0.18). Health literacy and self-management abilities in newly diagnosed patients with T2DM follow a co-evolutionary spiral model, with family support serving as a key driver in the initial phase. Clinical interventions should establish a dual-core "education-behavior" linkage system, focusing on enhancing family empowerment in the early stage (0-3 months) and transitioning to a cognitive improvement model driven by behavioral feedback in the later stages (3-6 months).

Background and Aims: The management of chronic inflammatory bowel diseases in youth is challenging. We aimed to determine health literacy (HL), quality of life (QoL) and clinical outcomes in young adults from the BELgian CROhn's disease registry (BELCRO) in comparison to type 1 diabetes mellitus (DM) as a control.Methods: In this prospective and observational study, young adults with Crohn's disease (CD) diagnosed < 18 years and with > 5 years disease duration and a comparable group of patients with DM completed validated HL, QoL and work productivity and activity impairment questionnaires (HLS-EU-Q16, EQ-5D-5L and WPAI). HL was scored as sufficient (13–16), problematic (9–12) or inadequate (0–8). QoL was dichotomized into “no problems” (EQ-5D level 1) or “problems” (EQ-5D levels 2 to 5). Non-parametric (Mann-Whitney U) analyses and Spearman correlations were performed.Results: A total of 52 CD (median [IQR] age of 25.0 [23.8-27.0], 64% male) and 50 DM (age 20.0 [19.0-22.0], 50% male) patients were included. HL was 14.0 [11.0-16.0] for CD and 14.0 [11.3-14.8] for DM (p = 0.6) with similar proportions of sufficient (60 vs. 68%, p = 0.4), problematic (34 vs. 26%, p = 0.3) and inadequate HL (both 6%, p = 1). Although QoL was comparable for CD and DM (77.0 [68.8-82.0] vs. 75.0 [65.0-80.0] %, p =0.4), CD had a trend for higher pain/discomfort (50 vs. 32%, p = 0.06). HL and QoL correlated in CD (r = 0.6, p < 0.001) and DM patients (r = 0.6, p < 0.001). Fewer CD patients with recent hospitalization/surgery had sufficient HL (31 vs. 69%, p = 0.01) and had lower QoL (70.0 [60.0-77.0] vs. 80.0 [70.0-85.0], p = 0.04) compared to those without.Conclusions: Selected young Belgian adults suffering from CD for >5 years have similar and sufficient HL compared to DM patients. However, CD patients requiring hospitalization/surgery have lower HL, which indicates the need for targeted educational programs.

Anthelmintic drugs are readily accessible to farmers and have been widely used to control gastrointestinal nematode (GIN) infections in communally reared sheep in the Eastern Cape Province (ECP), South Africa. Indiscriminate and prolonged use of these drugs has inevitably contributed to the selection of resistant GIN populations. This study aimed to assess the anthelmintic resistance status of GINs in communally reared sheep farms in King Sabata Dalindyebo Local Municipality, ECP. A semi-structured questionnaire was used to collect data on farm characteristics and helminth control practices. Faecal egg count reduction tests were performed on 259 lambs selected from eight communal farms. Lambs with egg per gram count > 150 were treated with anthelmintics (co-formulation of albendazole + closantel, and levamisole) currently used on the farms as well as an alternative anthelmintic from a different drug class (ivermectin, and a co-formulation of levamisole + praziquantel). Several suboptimal helminth control practices were identified that may have compromised the accurate administration of anthelmintics and effective management of deworming. These include the advanced age (> 65 years) of farmers: failure to weigh sheep prior to drug administration, use of syringes (5 ml/10 ml) instead of drench guns, and absence of a drenching and shifting approach. Helminths eggs from the genera Moniezia, Strongyloides, Trichuris, and Haemonchus were identified in both pre-and post-treatment faecal samples. Coprological culture of post-treatment samples, followed by morphological and molecular identification of larvae, confirmed the presence of Haemonchus contortus. This GIN species exhibited resistance to all the anthelmintic formulations assessed in this study. These findings highlight the urgent need for improved management strategies to mitigate resistance and promote sustainable worm control in communal sheep farming areas of ECP.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00436-025-08532-x.

While the role of medical and nutrition factors on glycemic control among adults with type 2 diabetes mellitus (T2DM) has been well-established, the association between health literacy (H.L.) and glycemic control is inconsistent. This study aims to determine the association of H.L. and nutritional status assessments with glycemic control in adults with type 2 diabetes mellitus. A total of 280 T2DM respondents (mean (SD) age = 49.7 (10.3) years, Glycated hemoglobin (HbA1c) = 9.9 (2.6) %, and Body Mass Index = 32.7 (15.1) kg/m2) were included in this study. A short-form Test of Functional Health Literacy in Adults (S-TOFHLA) assessed the H.L. levels. Nutritional status assessments included client history, glycemic control, anthropometric, and biochemical data. The mean (S.D.) H.L. score was 45.7 (24.6), with 56% of the respondents had inadequate H.L. Inadequate H.L. was more common among those females; housewives, low education, received oral antidiabetic therapy, and shorter diabetes duration. Respondents with inadequate H.L. were significantly older and had higher HbA1c than those with marginal and adequate H.L. Meanwhile, respondents with inadequate and marginal H.L. levels had significantly higher total cholesterol, LDL-cholesterol, and systolic blood pressure than the respondents with adequate H.L. Low H.L. scores, self-employment status, received dual antidiabetic therapy (insulin with oral agents), received insulin alone, and had higher fasting blood glucose explained about 21% of the total variation in HbA1c (adjusted R2 = 0.21; p < 0.001). Respondents with inadequate H.L. had poor glycemic control. The H.L. scores, together with nutritional status assessments, were the factors that predicted poor glycemic control among adults with T2DM.

Background : Type 2 diabetes mellitus (DM2) is the most common metabolic disorder with complex treatment, and adherence to its treatment requires sophisticated cognition, which includes health literacy. This study aimed to spread health literacy among patients with DM2 in northeast Iran. Methods : A cross-sectional survey was conducted among diabetic patients in Shahroud city of Iran in 2016. Multistaged cluster random sampling was used for 450 individuals with diabetes who were interviewed using two standard questionnaires on diabetes health literacy (TOFHLA and DNT15). Participants were enquired about their personal information (age, gender, level of education, etc.). Binary logistic regression analysis was used to identify risk factors for poor health literacy concerning diabetes prevention and control among patients with prediabetes. Results : The mean diabetes health literacy score was 44.0 (18.0–92.0). This score was higher among men than women (OR=1.623), and lowest literacy score was observed in respondents with less than 1 year of education (OR=13.041). The literacy score among diabetic patients with a family history of diabetes was higher than among those with no family history (OR=2.523). Conclusions : This study showed that health literacy related to diabetes prevention and control among diabetic individuals was rather low in Shahroud city. Appropriate health education for diabetic patients with low literacy should be incorporated into diabetes prevention efforts.

Background and Objective: Type 2 diabetes is one of the most important public health problems. Health literacy, self-efficacy and knowledge are important factors influencing self-care behaviors in diabetic patients. The aim of this study was to determine the health literacy, knowledge and self-efficacy of diabetic patients referring to health centers in Shahrekord. Materials and Methods: This cross-sectional descriptive study was performed on 138 diabetic patients referring to Shahrekord health centers in 2017. Patients were selected via convenience random sampling from five health centers and entered the study. The data were collected using demographic variables, health literacy questionnaire (TOHFLA), knowledge and self-efficacy. In this study, SPSS 18 and descriptive and inferential statistical tests (linear regression analysis and Pearson and analysis of variance) was used to analyze data. Results: The results showed that 52.9% of the patients had inadequate health literacy. The mean score of health literacy in diabetic patients was 45.23 ± 21.43, the mean score of knowledge was 66.39±23.37 and the mean score of self-efficacy was obtained 31.09±34.21. There were significant relationships between health literacy, self-efficacy and knowledge (P = 0.001); the results of multiple regression analysis indicated that knowledge is the main predictors of health literacy. Conclusion: Regarding the low level of health literacy and self-efficacy of diabetic patients, it is necessary to implement interventions using health education models to enhance their health literacy and self-efficacy for improving quality of their lives Paper Type: Research Article

Adults with diabetes mellitus (DM) living in rural areas often face limited access to medical and specialist care, minimal exposure to diabetes education, and transportation challenges. Rural residents also tend to be older, poorer, less educated, under-insured and have lower health literacy compared to their urban counterparts. We tested the effectiveness of the American College of Physicians (ACP) diabetes health literacy intervention in rural community clinics to improve a range of diabetes-related patient outcomes and determine whether the intervention reduces disparities by health literacy. We recruited 756 English-speaking adults with uncontrolled Type 2 DM from rural clinics in Arkansas. Trained health coaches reviewed the ACP Diabetes Guide and conducted counseling and action-planning monthly to participants randomized to the intervention. The enhanced usual care (EUC) arm received an American Diabetes Association workbook and was followed as usual. Interviews were conducted at baseline, 3 and 6 months, and clinical outcomes, including hemoglobin A1C and blood pressure values, were extracted from charts through 12 months post-baseline. Health literacy was measured at baseline using the Newest Vital Sign (NVS). Our primary outcome was A1C at 6 months, with other clinical values and self-reported diabetes-related knowledge, self-efficacy, distress, and self-care behaviors examined as secondary outcomes. Participants had a mean age of 55.8 (SD=11.7), 68% were female, two-thirds had an annual household income <$15,000, and 52% had limited health literacy. Overall, the intervention had little effect on outcomes at 6 and 12 months, including our primary outcome of A1C at 6 months (Intervention Least Squared Means (LSM) 8.28, 95% CI 8.11, 8.46; EUC LSM 8.44, 95% CI 8.26, 8.61). Diabetes knowledge was greater in those with adequate (LSM 9.46, 95% CI 9.25, 9.67) compared to those with limited health literacy (LSM 8.11, 95% CI 7.91, 8.23, p<0.001) at baseline. This disparity remained in the EUC arm after 6 months but disparities were mitigated in the intervention arm (interaction p<0.001). Our intensive intervention was well received, but insufficient to improve outcomes. Strategies may need to attend to other barriers faced by rural patients beyond health literacy to improve health behaviors and outcomes.