Asian Nurs Res.  2016 Mar;10(1):82-87. 10.1016/j.anr.2016.01.005.

A Structural Equation Model Linking Health Literacy to Self-efficacy, Self-care Activities, and Health-related Quality of Life in Patients with Type 2 Diabetes

• Lee EH
• Lee YW
• Moon SH

• KMID: 2374297
• DOI: http://doi.org/10.1016/j.anr.2016.01.005

Abstract

PURPOSE
Health literacy has been attracting increasing attention because low health literacy is considered an important predictor of adverse health outcomes in many chronic conditions, including diabetes. However, it is unclear how health literacy is associated with health outcomes. The purpose of this study was to formulate a hypothetical structural equation model linking health literacy to self-efficacy, self-care activities, and health-related quality of life (HRQOL) in patients with type 2 diabetes.
METHODS
cross-sectional survey design was employed, and 459 patients with type 2 diabetes were recruited from outpatient clinics in two university hospitals. The patients completed a pack of questionnaires. The hypothetical model was tested using structural equation modeling analysis.
RESULTS
The values of multiple fit indices indicated that the proposed model provided a good fit to the data. Health literacy exerted not only a direct effect on self-care activities, but also an indirect effect on self-care activities via self-efficacy. However, health literacy exerted only an indirect effect on HRQOL. This structural model was invariant across hemoglobin-A1c-controlled and hemoglobin-A1c-uncontrolled groups. Based on R2 values, the final model accounted for 20.0% of the variance in selfefficacy, 61.0% of the variance in self-care activities, and 16.0% of the variance in HRQOL.
CONCLUSIONS
This study suggests that self-care activities are crucial to the link between health literacy and HRQOL. Both health literacy and self-efficacy need to be considered in clinical practice for enhancing self-care activities in patients with type 2 diabetes. This approach may ultimately improve HRQOL in these patients.

Keyword

diabetes mellitus, type 2; health literacy; quality of life; self care; self efficacy

MeSH Terms

Adult
Aged
Aged, 80 and over
Cross-Sectional Studies
Diabetes Mellitus, Type 2/*nursing/*psychology
Female
*Health Knowledge, Attitudes, Practice
*Health Literacy
Humans
Male
Middle Aged
Models, Theoretical
Quality of Life/*psychology
Republic of Korea
Self Care/*psychology
*Self Efficacy
Surveys and Questionnaires
Young Adult