Korean J Adult Nurs.  2018 Aug;30(4):376-384. 10.7475/kjan.2018.30.4.376.

Health Literacy and Self-care Activities of Older Patients with Type 2 Diabetes: The Mediating Effect of Resilience

• Yoo EW
• Lee YM

• KMID: 2418980
• DOI: http://doi.org/10.7475/kjan.2018.30.4.376

Abstract

PURPOSE
The purpose of this study was to investigate the health literacy and self-care activities of elderly diabetes patients and identify the effects of mediation of resilience in the relationship between them.
METHODS
A structured self-report questionnaire measuring health literacy, resilience and self-care activities was completed by 145 elderly people aged 65 years or older, who were diagnosed with type 2 diabetes mellitus at the Pusan National University hospital in Busan city, and who visited the outpatient clinic for endocrinology. Data collection was conducted from February 10, 2017 to March 31, 2017, and the collected data were analyzed using SPSS/WIN 23.0 program.
RESULTS
The subjects' health literacy and resilience (r=.19, p=.023), health literacy and self-care activities (r=.26, p=.001), resilience and self-care activities (r=.39, p < .001) were significantly correlated. Resilience completely mediated in the relationship between health literacy and self-care activities (z=2.37, p=.017).
CONCLUSION
Resilience plays a mediating role in the association among health literacy and self-care activities. It is necessary to develop a variety of intervention programs that can improve resilience in increasing self-care activities.

MeSH Terms

Aged
Ambulatory Care Facilities
Busan
Data Collection
Diabetes Mellitus
Diabetes Mellitus, Type 2
Endocrinology
Health Literacy*
Humans
Negotiating*
Self Care*

Reference

1. Korean Diabetes Association. Diabetes fact sheet in Korea 2016 [Internet]. Seoul: Korean Diabetes Association;2016. cited 2016 October 17. Available from: http://www.diabetes.or.kr/pro/news/admin.php?category=A&code=admin&number=1428&mode=vie.

2. Won AL, Yoo SH, You MS. Factors related to perceived health status in patients with type 2 diabetes. Korean J Health Educ Promot. 2014; 31(3):1–13. DOI: 10.14367/kjhep.2014.31.3.1.

3. Yoo JH. A study on the relationship of self care behavioral compliance and perceived self-efficacy in type II diabetic patient. J Korean Acad Fundam Nurs. 2000; 7(3):453–465.

4. Mcdowell J, Courtney M, Edwards H, Shortridge-Baggett L. Validation of the Australian/English version of the diabetes management self-efficacy scale. Int J Nurs Pract. 2005; 11(4):177–184. DOI: 10.1111/j.1440-172X.2005.00518.x.

5. American Diabetes Association. Standards of medical care in diabetes-2009. Diabetes Care. 2009; 32:Supplement 1. S13–S61. DOI: 10.2337/dc09-S013.

6. Nutbeam D. The WHO health promotion glossary. Health Promot Int. 1998; 1:1–36.

7. Davis TC, Wolf MS, Bass PF, Middlebrooks M, Kennen E, Baker DW, et al. Low literacy impairs comprehension of prescription drug warning labels. J Gen Intern Med. 2006; 21(8):847–851. DOI: 10.1111/j.1525-1497.2006.00529.x.

8. Kim JE. Measuring the level of health literacy influence factors: targeting the visitors of a university hospital's outpatient clinic. J Korean Clin Nurs Res. 2011; 17(1):27–34.

9. Lee TW, Kang SJ. Health literacy in the Korean elderly and influencing factors. J Korean Gerontol Soc. 2008; 28(4):847–863.

10. Lee YM, Son YJ, Lee EJ. Health literacy, disease-related knowledge, self-efficacy and self-care behavior in patients with diabetes mellitus. J Korean Data Anal Soc. 2012; 14(6):3087–3101.

11. Kim HJ. Effects of group arts therapy on the resilience with older women of resident. Korean J Arts Ther. 2014; 4(1):255–275.

12. Pack MJ. A study of a resilience enhancing model to prevent depression in the elderly [dissertation]. Busan: Pusan National University;2006.

13. Yi-Frazier JP, Yaptangco M, Semana S, Buscaino E, Thompson V, Cochrane K, et al. The association of personal resilience with stress, coping, and diabetes outcomes in adolescents with type 1 diabetes: variable-and person-focused approaches. J Health Psychol. 2015; 20(9):1196–1206. DOI: 10.1177/1359105313509846.

14. Keum HS, Suh SR. HbA1c, self-efficacy and self-care activities depending on the disease duration of type 2 diabetes mellitus patients. J Korea Contents Assoc. 2014; 14(12):303–312.

15. Park SY, Oh PJ. Factors influencing diabetes educational needs in patients with diabetes mellitus. J Korea Acad Ind Coop Soc. 2014; 15(7):4301–4309. DOI: 10.5762/KAIS.2014.15.7.4301.

16. Loeb SJ, Steffensmeier D, Kassab C. Predictors of self-efficacy and self-rated health for older male inmates. J Adv Nurs. 2011; 67(4):811–820. DOI: 10.1111/j.1365-2648.2010.05542.x.

17. Fraser E, Pakenham KI. Resilience in children of parents with mental illness: relations between mental health literacy, social connectedness and coping, and both adjustment and caregiving. Psychol Health Med. 2009; 14(5):573–584. DOI: 10.1080/13548500903193820.

18. Davis TC, Long SW, Jackson RH, Mayeauk EJ, George RB, Murphy PW, et al. Rapid estimate of adult literacy in medicine: a shortened screening instrument. Fam Med. 1993; 25(6):391–395.

19. Lee SH, Choi EHR, Je MJ, Han HS, Pack BK, Kim SS. Comparison of two versions of KHLAT for improvement strategies. Korean J Health Educ Promot. 2011; 28(3):57–65.

20. Connor KM, Davidson JRT. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003; 18(2):76–82. DOI: 10.1002/da.10113.

21. Toobert DJ, Glasgow RE. Assessing diabetes self-management: the summary of diabetes self-care activities questionnaire. In : Bradley C, editor. Handbook of psychology and diabetes. The Netherlands: Harwood Academic;1994. p. 351–375.

22. Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000; 23(7):943–950. DOI: 10.2337/diacare.23.7.943.

23. Chang S, Song M. The validity and reliability of a Korean version of the summary of diabetes self-care activities questionnaire for older patients with type 2 diabetes. J Korean Acad Adult Nurs. 2009; 21(2):235–244.

24. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986; 51(6):1173–1182.

25. Barbarba HM, William F, Chestnut H. Statistical methods for health care research. 5th ed. Philadelphia: Lippincott Willams & Wilkins;2005. p. 290–300.

26. Hong IH, Eun Y. Health literacy of inpatients at general hospital. Korean J Adult Nurs. 2012; 24(5):477–488. DOI: 10.7475/kjan.2012.24.5.477.

27. Kim JI, Byeon YS. A study on the factors affecting resilience in patients with colon cancer. Asian Oncol Nurs. 2013; 13(4):256–264. DOI: 10.5388/aon.2013.13.4.256.

28. Al-Maskari F, El-Sadig M, Al-Kaabi JM, Afandi B, Nagelkerke N, Yeatts KB. Knowledge, attitude and practices of diabetic patients in the United Arab Emirates. PLoS ONE. 2013; 8(1):1–8. DOI: 10.1371/journal.pone.0052857.

29. Cheon MY, Kang J. The mediating effect of the resilience on the relationship between Type D personality and compliance in patients with coronary artery disease. Korean J Adult Nurs. 2016; 28(1):61–70. DOI: 10.7475/kjan.2016.28.1.61.

30. McCleary JV. Health literacy and its association with diabetes knowledge, self-efficacy and disease self-management among African Americans with diabetes mellitus. ABNF J. 2011; 22(2):25–32.