Ueno Haruka, Ishikawa Hirono, Suzuki Ryo, Izumida Yoshihiko, Ohashi Yumiko, Yamauchi Toshimasa, Kadowaki Takashi, Kiuchi Takahiro
Department of Health Communication, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Graduate School of Public Health, Teikyo University, Tokyo, Japan.
SAGE Open Med. 2019 Jul 23;7:2050312119865647. doi: 10.1177/2050312119865647. eCollection 2019.
The aim of this study is to empirically examine a full pathway model of health literacy, and health and well-being outcomes among patients with type 2 diabetes.
A three-wave longitudinal survey was administered to 148 patients with diabetes. Covariance structure analysis was conducted to create a path diagram, with health literacy and burden of medical expenses included as independent variables and with psychosocial factors, behaviors, and health and well-being outcomes included as dependent variables.
The model fit indices showed a comparative fit index of 0.985 at baseline, 0.959 after 3 months, and 0.948 after 6 months, with a root mean square error of approximation of 0.040 at baseline, 0.079 after 3 months, and 0.085 after 6 months. There were 14 significant paths across the three time points between health literacy and understanding of diabetes care, self-efficacy, communication with doctors, and medication adherence.
The model fitness index showed an adequate result. Health literacy was significantly positively associated with understanding of diabetes care, self-efficacy, communication with doctors, and medication adherence. Health literacy had a direct positive influence on medication adherence and possibly an indirect positive influence on exercise/diet via self-efficacy. The results were generally consistent across the three time points, suggesting good reliability of the models. Improving health literacy may lead to better self-management of diabetes and favorable health outcomes.
本研究旨在实证检验2型糖尿病患者的健康素养、健康及幸福状况的完整路径模型。
对148名糖尿病患者进行了三轮纵向调查。进行协方差结构分析以创建路径图，将健康素养和医疗费用负担作为自变量，将心理社会因素、行为以及健康和幸福状况作为因变量。
模型拟合指数显示，基线时比较拟合指数为0.985，3个月后为0.959，6个月后为0.948，基线时近似均方根误差为0.040，3个月后为0.079，6个月后为0.085。在三个时间点上，健康素养与糖尿病护理理解、自我效能感、与医生沟通及药物依从性之间共有14条显著路径。
模型拟合指数显示结果良好。健康素养与糖尿病护理理解、自我效能感、与医生沟通及药物依从性显著正相关。健康素养对药物依从性有直接正向影响，可能通过自我效能感对运动/饮食有间接正向影响。结果在三个时间点上总体一致，表明模型具有良好的可靠性。提高健康素养可能会带来更好的糖尿病自我管理和良好的健康结果。
