Lee Eun-Hyun, Lee Young Whee, Moon Seung Hei
Graduate School of Public Health, Ajou University, Suwon, South Korea.
Department of Nursing, Inha University, Incheon, South Korea.
Asian Nurs Res (Korean Soc Nurs Sci). 2016 Mar;10(1):82-7. doi: 10.1016/j.anr.2016.01.005. Epub 2016 Feb 27.
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.
A 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.
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 R(2) values, the final model accounted for 20.0% of the variance in self-efficacy, 61.0% of the variance in self-care activities, and 16.0% of the variance in HRQOL.
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.
健康素养一直备受关注，因为低健康素养被认为是包括糖尿病在内的许多慢性病不良健康结局的重要预测因素。然而，健康素养与健康结局之间的关联尚不清楚。本研究的目的是构建一个假设的结构方程模型，将2型糖尿病患者的健康素养与自我效能感、自我护理活动及健康相关生活质量（HRQOL）联系起来。
采用横断面调查设计，从两家大学医院的门诊招募了459例2型糖尿病患者。患者完成了一组问卷。使用结构方程模型分析对假设模型进行检验。
多个拟合指数的值表明所提出的模型与数据拟合良好。健康素养不仅对自我护理活动有直接影响，还通过自我效能感对自我护理活动产生间接影响。然而，健康素养仅对HRQOL有间接影响。该结构模型在糖化血红蛋白控制组和糖化血红蛋白未控制组中是不变的。根据R²值，最终模型解释了自我效能感方差的20.0%、自我护理活动方差的61.0%以及HRQOL方差的16.0%。
本研究表明自我护理活动对于健康素养与HRQOL之间的联系至关重要。在临床实践中，为增强2型糖尿病患者的自我护理活动，需要同时考虑健康素养和自我效能感。这种方法最终可能改善这些患者的HRQOL。
