College of Nursing, Kaohsiung Medical University, Department of Medical Research, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1st Road, Kaohsiung City, 807, Taiwan, ROC.
Lee's Endocrinology Clinic, No. 396, Guangdong Road, Pingtung City, 900, Taiwan, ROC.
Patient Educ Couns. 2019 Jul;102(7):1336-1341. doi: 10.1016/j.pec.2019.02.005. Epub 2019 Feb 8.
To model the pathways of patient empowerment (PE) and health literacy (HL) to glycemic control specific to insulin-treated patients by prospective design.
Insulin-treated patients with type 2 diabetes (T2DM) (N = 185) were recruited by convenience sampling. Data of personal characteristics, PE, and HL were collected by questionnaires at baseline and 9 months later. The 9-month glycosylated hemoglobin (HbA1c) levels of each participant were collected from medical records. Structural equation modeling was used to test a hypothesized model.
Baseline and 9-month communicative HL and critical HL significantly and negatively correlated with 9-month HbA1c levels. Structural equation modeling supported that baseline and 9-month PE significantly affected HL at corresponding time points. Baseline PE indirectly affected 9-month HL through 9-month PE. The 9-month HL directly affected 9-month HbA1c. Baseline HL indirectly affected 9-month HbA1c through 9-month HL.
Communicative HL and critical HL rather than functional HL were crucial in improving glycemic control. PE is essential to improve HL in insulin-treated patients.
Healthcare providers could apply the empowerment approach to educate insulin-treated patients. Through reciprocal dynamic process of PE, insulin-treated patients with T2DM might improve their communicative and critical HL; and finally, glycemic control could be improved.
通过前瞻性设计，构建针对接受胰岛素治疗的患者的患者赋权（PE）和健康素养（HL）与血糖控制的途径模型。
通过便利抽样招募了 185 名患有 2 型糖尿病（T2DM）的接受胰岛素治疗的患者。在基线和 9 个月后，通过问卷收集个人特征、PE 和 HL 的数据。从病历中收集每位参与者的 9 个月糖化血红蛋白（HbA1c）水平。采用结构方程模型检验假设模型。
基线和 9 个月的交流 HL 和批判性 HL 与 9 个月的 HbA1c 水平显著负相关。结构方程模型支持基线和 9 个月的 PE 在相应时间点显著影响 HL。基线 PE 通过 9 个月的 PE 间接影响 9 个月的 HL。9 个月的 HL 直接影响 9 个月的 HbA1c。基线 HL 通过 9 个月的 HL 间接影响 9 个月的 HbA1c。
交流 HL 和批判性 HL 而非功能性 HL 对于改善血糖控制至关重要。PE 对于改善接受胰岛素治疗的患者的 HL 至关重要。
医疗保健提供者可以应用赋权方法来教育接受胰岛素治疗的患者。通过 PE 的互惠动态过程，T2DM 接受胰岛素治疗的患者可能会提高他们的交流和批判性 HL；最终，血糖控制可以得到改善。
