Document Type : Original Article

Authors

1 Department of Education and Health Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran

2 Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran

3 Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran

Abstract

BACKGROUND: Health literacy (HL) is the ability of a person to acquire the process, understand the
necessary health information, and make the health services needed for conscious health decisions.
Besides, diabetes is the most common metabolic disorder that affects patients’ quantity and quality
of life. This study focused on determining the factors that affect the HL status of patients with type 2
diabetes (T2D) through the role of the demographic variables.
MATERIALS AND METHODS: This descriptive‑analytical research survey recruited a sample
based on 280 patients with T2D at the Diabetes Research Center of Ayatollah Taleghani Hospital
in Kermanshah in 2020. This study selected patients with T2D using a simple random sampling
technique. The study applied the demographic information questionnaire and the Functional,
Communicative, and Critical HL Scale to collect data from patients with T2D. This study used the
SPSS version 23 on the received data sets to perform statistical analysis, including t‑test, analysis
of the variance, and multiple regression, to predict the factors affecting HL among diabetes patients.
RESULTS: The study results showed that the mean age of the participating patients with T2D was
55.80 ± 13.04. The results indicated the mean score and standard deviation of total HL score in patients
with T2D 2.70 ± 0.44. The findings specified a statistically significant relationship between HL, gender,
education, occupation, income, and place of residence. Results indicated that β‑coefficients of the
multiple regression analysis and the income variable (β = 0.170), age (β = 0.176), and employment
variable (β = 0.157). These are the most predictive of the HL of patients with T2D.
CONCLUSION: The results of this study specified that the HL rate of individuals with diabetes type 2
is average. The potential communicative and critical HL influence is essential for communication and
education for diabetes patients in the primary health‑care system settings. The findings indicate that
communicative and critical HL related to patients’ management and functional HL looks passable
in this study.

Keywords

1. Anbarasan S, Gurtoo A, Srinivaasan M, Musafir Khan AP. Level
of health literacy among type 2 diabetic persons and its relation to
glyc emic control. J Assoc Physicians India 2019;67:59‑62.
2. Smith BJ, Tang KC, Nutbeam D. WHO Health Promotion
Glossary: New terms. Health Promot Int 2006;21:340‑5.
3. Hussein SH, Almajran A, Albatineh AN. Prevalence of health
literacy and its correlates among patients with type II diabetes
in Kuwait: A population based study. Diabetes Res Clin Pract
2018;141:118‑25.
4. Nutbeam D. Health literacy as a public health goal: A challenge
for contemporary health education and communication strategies
into the 21st century. Health Promot Int 2000;15:259‑67.
5. Kaboudi M, Dehghan F, Ziapour A. The effect of acceptance and
commitment therapy on the mental health of women patients
with type II diabetes. Ann Trop Med Public Health Nurs
2017;10:1709‑13.
6. Huang YM, Shiyanbola OO. Investigation of barriers and
facilitators to medication adherence in patients with type 2
diabetes across different health literacy levels: An explanatory
sequential mixed methods study. Front Pharmacol 2021;12:745749.
7. Sabouri M, Shakibazadeh E, Mohebbi B, Tol A, Yaseri M, Babaee S.
Effectiveness of an educational intervention using theory of
planned behavior on health care empowerment among married
reproductive‑age women: A randomized controlled trial. J Educ
Health Promot 2020;9:293.
8. Hussein SH, Albatineh AN, Almajran A, Ziyab AH. Association
of health literacy and other risk factors with glycemic control
among patients with type 2 diabetes in Kuwait: A cross‑sectional
study. Prim Care Diabetes 2021;15:571‑7.
9. Klinovszky A, Papp‑Zipernovszky O, Buzás N. Building a house
of skills – A study of functional health literacy and numeracy
among patients with type 2 diabetes in hungary. Int J Environ
Res Public Health 2021;18:1547.
10. Tefera YG, Gebresillassie BM, Emiru YK, Yilma R, Hafiz F,
Akalu H, et al. Diabetic health literacy and its association with
glycemic control among adult patients with type 2 diabetes
mellitus attending the outpatient clinic of a university hospital
in Ethiopia. PLoS One 2020;15:e0231291.
11. Pourmirza Kalhori R, Ziapour A, Kianipour N, Foroughinia A.
A study of the relationship between lifestyle and happiness of
students at Kermanshah University of Medical Sciences over
2015–2016. Ann Trop Med Public Health. 2017;10:1004-9.
12. Lael‑Monfared E, Tehrani H, Moghaddam ZE, Ferns GA, TatariM,
Jafari A. Health literacy, knowledge and self‑care behaviors to
take care of diabetic foot in low‑income individuals: Application
of extended parallel process model. Diabetes Metab Syndr
2019;13:1535‑41.
13. Abdullah A, Ng CJ, Liew SM, Ambigapathy S, Paranthaman V,
Chinna K. Prevalence of limited health literacy and its associated
factors in patients with type 2 diabetes mellitus in Perak, Malaysia:
A cross‑sectional study. BMJ Open 2020;10:e039864.
14. Barati S, Sadeghipour P, Ghaemmaghami Z, Mohebbi B, Baay M,
Alemzadeh‑Ansari MJ, et al. Warning signals of elevated
prediabetes prevalence in the modern Iranian urban population.
Prim Care Diabetes 2021;15:472‑9.
15. Mohammadi M, Esfandnia A, Rezaei S, Ziapour A. Performance
evaluation of hospitals under supervision of kermanshah medical
sciences using pabonlasoty diagram of a five-year period (20082012). Life Sci J. 2014;11:77-81.
16. Logan R, Siegel E. Health literacy: Insights and issues. Health Lit
2017;240:60‑78.
17. Bailey SC, Brega AG, Crutchfield TM, Elasy T, Herr H,
Kaphingst K, et al. Update on health literacy and diabetes.
Diabetes Educ 2014;40:581‑604.
18. Mashi AH, Aleid D, Almutairi S, Khattab F, AlMuqawed AN,
Khan S, et al. The association of health literacy with glycemic
control in Saudi patients with type 2 diabetes. Saudi Med J
2019;40:675‑80.
19. Hashemi SM, Bouya S. Treatment adherence in diabetic patients:
An important but forgotten issue. J Diabetes Nurs 2018;6:341‑51.
20. Abdullah A, Liew SM, Salim H, Ng CJ, Chinna K. Prevalence
of limited health literacy among patients with type 2 diabetes
mellitus: A systematic review. PLoS One 2019;14:e0216402.
21. Fadaiyan Arani E, Amin Shokravi F, Tavakoli Ghouchani H.
The relationship between health literacy and knowledge in rural
patients with type 2 diabetes mellitus in 2016. Health Educ Health
Promot 2017;5:32‑19.
22. Zokaei A, Ziapour A, Khanghahi ME, Lebni JY, Irandoost SF,
Toghroli R, et al. Investigating high blood pressure, type‑2
diabetes, dislipidemia, and body mass index to determine the
health status of people over 30 years. J Educ Health Promot
2020;9:333.
23. Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C,
et al. Association of health literacy with diabetes outcomes. JAMA
2002;288:475‑82.
24. Khiyali Z, Ghasemi A, Toghroli R, Ziapour A, Shahabi N,
Dehghan A, et al. The effect of peer group on self‑care behaviors
and glycemic index in elders with type II diabetes. J Educ Health
Promot 2021;10:197.
25. Squellati R. Health literacy: Understanding basic health
information. Creat Nurs 2010;16:110‑4.
26. Zhao H, Wang F, Luo GH, Lei H, Peng F, Ren QP, et al. Assessment
of structural brain changes in patients with type 2 diabetes
mellitus using the MRI‑based brain atrophy and lesion index.
Neural Regen Res 2022;17:618‑24.
27. Osborn CY, Bains SS, Egede LE. Health literacy, diabetes self‑care,
and glycemic control in adults with type 2 diabetes. Diabetes
Technol Ther 2010;12:913‑9.
28. Ishikawa H, Yano E. The relationship of patient participation and
diabetes outcomes for patients with high vs. low health literacy.
Patient Educ Couns 2011;84:393‑7.
29. Reisi M, Mostafavi F, Javadzade H, Mahaki B, Tavassoli E,
Sharifirad G. Communicative and critical health literacy and
self‑care behaviors in patients with type 2 diabetes. Iran J Diabetes
Metabol 2015;14:199‑208.
30. Ansari H, Almasi Z, Ansari‑Moghaddam A, Mohammadi M,
Peyvand M, Hajmohammadi M, et al. Health literacy in older
adults and its related factors: A cross‑sectional study in Southeast
Iran. Health Scope 2016;5:e37453.
31. Tahery N. The association of health literacy with self‑efficacy
and self‑care, in type 2 diabetes patients. Iran J Endocrinol Metab
2018;20:135‑41.
32. LaiAY, IshikawaH, KiuchiT, MooppilN, GrivaK. Communicative
and critical health literacy, and self‑management behaviors in
end‑stage renal disease patients with diabetes on hemodialysis.
Patient Educ Couns 2013;91:221‑7.
33. Maleki S, Rakhshani F, Masoudi G, Ansari‑Moghaddam A.
Health literacy, knowledge and relevant factors in patients with type 2 diabetes presenting to a diabetes clinic in Zahedan in 2014.
Caspian J Health Res 2016;2030:9‑17.
34. van der Vaart R, Drossaert CH, Taal E, van de Laar MA. Patient
preferences for a hospital‑based rheumatology Interactive Health
Communication Application and factors associated with these
preferences. Rheumatology (Oxford) 2011;50:1618‑26.
35. Zerovnik S, Kos M, Locatelli I. Initiation of insulin therapy in
patients with type 2 diabetes: An observational study. Acta Pharm
2022;72:147‑57.
36. Lee YJ, Shin SJ, Wang RH, Lin KD, Lee YL, Wang YH. Pathways
of empowerment perceptions, health literacy, self‑efficacy, and
self‑care behaviors to glycemic control in patients with type 2
diabetes mellitus. Patient Educ Couns 2016;99:287‑94.
37. Yeh JZ, Wei CJ, Weng SF, Tsai CY, Shih JH, Shih CL, et al.
Disease‑specific health literacy, disease knowledge, and
adherence behavior among patients with type 2 diabetes in
Taiwan. BMC Public Health 2018;18:1062.
38. Pooryaghob M, Abdollahi F, Mobadery T, Haji Shabanha N,
Bajalan Z. Assesse the health literacy in multiple sclerosis patients.
J Health Lit 2018;2:266‑74.
39. Noroozi M, Madmoli Y, Derikvand M, Saki M. Investigating
health literacy level and its relation with some factors in patients
with type 2 diabetes in Ahvaz‑2018. J Health Lit 2019;4:43‑52.
40. von Wagner C, Knight K, Steptoe A, Wardle J. Functional health
literacy and health‑promoting behaviour in a national sample of
British adults. J Epidemiol Community Health 2007;61:1086‑90.
41. Khosravi A, Ahmadzadeh K, Arastoopoor S, Tahmasbi R. Health
literacy levels of diabetic patients referred to Shiraz health centers
and its effective factors. Health Inf Manage 2015;12:194‑205.
42. Charoghchian Khorasani E, Peyman N, Sahebkar M, Moghzi M.
Investigating health literacy in patients with type 2 diabets
referring to the health houses of Chenaran in 2016. J North
Khorasan Univ Med Sci 2017;9:183‑91.
43. Alidosti M, Tavassoli E. Investigating health literacy, knowledge
and self‑efficacy in patients with type 2 diabetes referring to health
centers in Shahrekord. J Health Lit 2019;3:36‑45.
44. Sahrayi M, Panahi R, Kazemi SS, Goli Rostami Z, Rezaie H,
Jorvand R. The study of health literacy of adults in Karaj. J Health
Lit 2017;1:230‑8.
45. Izadirad H, Zareban I. The relationship of health literacy with
health status, preventive behaviors and health services utilization
in Baluchistan, Iran. J Educ Community Health 2015;2:43‑50.
46. Rezaee Esfahrood Z, Haerian Ardekani A, Rahmanian M,
Ghaffari Targhi M. A survey on health literacy of referred
diabetic patients to Yazd diabetes research center. Tolooebehdasht
2016;15:176‑86.
47. Tehrani Banihashemi S, Amir Khani A, Haghdoust A, Alavian M,
Asghari Fard H, Baradaran H. Health literacy in five province and
relative effective factors. Strides Dev Med Educ 2007;4:1‑9.
48. Kooshyar H, ShoorvaziM, DalirZ, HosseiniM. Health literacy and
its relationship with medical adherence and health‑related quality
of life in diabetic community‑residing elderly. J Mazandaran Univ
Med Sci 2014;23:134‑43.
49. SeyedoshohadaeeM, Barasteh S, Jalalinia F, EghbaliM, NezamiM.
The relationship between health literacy and self‑care behaviors
in patients with type 2 diabetes. Iran J Nurs Res 2016;10:43‑51.
50. Noureldin M, Plake KS, Morrow DG, Tu W, Wu J, Murray MD.
Effect of health literacy on drug adherence in patients with heart
failure. Pharmacotherapy 2012;32:819‑26.
51. Aminuddin HB, Jiao N, Jiang Y, Hong J, Wang W. Effectiveness
of smartphone‑based self‑management interventions on
self‑efficacy, self‑care activities, health‑related quality of life and
clinical outcomes in patients with type 2 diabetes: A systematic
review and meta‑analysis. Int J Nurs Stud 2021;116:103286.
52. Souza JG, Apolinario D, Magaldi RM, Busse AL, Campora F,
Jacob‑Filho W. Functional health literacy and glycaemic control
in older adults with type 2 diabetes: A cross‑sectional study. BMJ
Open 2014;4:e004180.
53. Tol A, Pourreza A, Foroshani R, Tavassoli E. Assessing the effect
of educational program based on small group on promoting
knowledge and health literacy among women with type 2 diabetes
referring to selected hospitals affiliated to Tehran University of
Medical Sciences. Razi J Med Sci 2013;19:10‑9.
54. RahimiM, Reshadat S, Farid MarandiB, ZakieiA. Factors associated
with sexual function and sexual satisfaction in male patients with
diabetes type 2. J Mazandaran Univ Med Sci 2018;28:164‑9.
55. Mohammadpour M, Zarifinezhad E, Armand R. A study of
correlation between applied health literacy and self‑care behaviors
in hypertensive patients of Gachsaran City, 2016 (Iran). Qom Univ
Med Sci J 2018;12:55‑65.
56. Friis K, Vind BD, Simmons RK, Maindal HT. The relationship
between health literacy and health behaviour in people with
diabetes: A Danish population‑based study. J Diabetes Res
2016;2016:7823130.