Patient perception of understanding health education and instructions has moderating effect on glycemic control.

Gin-Den Chen,Chien-Ning Huang,Yi-Sun Yang,Chin-Yin Lew-Ting

doi:10.1186/1471-2458-14-683

Abstract

BackgroundWhether health literacy is independently associated with processes or outcomes of diabetes-related care is controversial. We tried to demonstrate the interaction of health literacy and understanding of health education and instructions in achieving glycemic control.MethodsFive hundred and one consecutive patients with type 2 diabetes mellitus (DM) in the outpatient clinic of the metabolism department were recruited into this pilot study. The demographic data were collected from patients’ self-reports. The clinical background information was collected through electronic medical records. A questionnaire derived from part of the Mandarin Health Literacy Scale was used to measure numeracy and functional health literacy of people with diabetes. Health literacy levels were categorized into inadequate, marginal and adequate. Patient self-ratings of their perceived understanding of the health education information and instructions provided by their case manager in the past were categorized into two subgroups: better and poor. Patients with an HbA1c level equal to or below 7% were considered to have good glycemic control. Multivariate logistic regression was used to find associated factors of health literacy and understanding of health education and instructions. GENMOD procedures were used to analyze repeated outcome measurements of glycemic control.ResultsHigher educational attainment and higher household income (odds ratios were 2.23 and 2.22, respectively) were significantly associated with patients who had adequate health literacy. Higher educational attainment and patients with a family history of DM (odds ratios were 4.99 and 1.85, respectively) were significantly associated with better understanding of health education and instructions. Adequate health literacy is not the only factor associated with good glycemic control. The effect of adequate health literacy in achieving good glycemic control might be masked by patients with better understanding of health education and instructions.ConclusionsOur results revealed that not only were patients with adequate health literacy associated with good glycemic control but patients with marginal health literacy were also able to achieve good glycemic control. Adequate health literacy and better understanding of health education is highly correlated. The role of adequate health literacy on glycemic control could be suppressed if variables are over-controlled during analysis.

Highlights

Whether health literacy is independently associated with processes or outcomes of diabetes-related care is controversial
Forty-four (9.4%) patients who were illiterate or had poor literacy completed two portions of the questionnaire with the help of the research assistant were included in the data analysis. They were categorized as having inadequate health literacy because they could not answer the diabetesrelated reading comprehension sheets
In model 2, we found that patients with marginal health literacy and better perceived understanding of health education and instructions were significantly associated with good glycemic outcomes

Summary

Introduction

Whether health literacy is independently associated with processes or outcomes of diabetes-related care is controversial. Health literacy is a set of skills, including functional, interactive, numeracy and critical skills, which people need to function effectively in the health care system These skills include the ability to read and understand written text, locate and interpret information in documents, write or complete forms; speak and listen effectively and communicate about health-related information; navigate the health care system and make appropriate health decisions; and use numeric information for tasks, such as interpreting medication dosages, food labels, and blood glucose measurements [2]. “Inadequate health literacy poses a major barrier to caring for or educating patients with chronic diseases” such as hypertension or diabetes (i.e. lack knowledge of their disease, important lifestyle modifications, interpreting medication dosages, food labels, blood glucose measurements and essential self-management) [3]. There is little sufficient or consistent evidence suggesting that health literacy is independently associated with processes or outcomes of diabetes-related care. They concluded that “it may be premature to routinely screen for low health literacy as a means for improving diabetesrelated outcomes” [4]

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