Exploring the relationship between health knowledge, health literacy, self-care, self-efficacy, and glycemic control among adults with type 2 diabetes mellitus.

Abstract

Background: Adults with type 2 diabetes mellitus (T2DM) in Malaysia continue to have substantial comorbidities and struggle to achieve glycemic targets.

Aim: To comprehensively evaluate diabetes self-care and glycemic control using multiple self-reporting questionnaires.

Methods: Adults diagnosed with T2DM attending the Seremban Health Clinic were recruited in this cross-sectional study. Eligible participants were recruited based on a consecutive sampling technique, first-come-first-served-basis if they fulfilled the inclusion and exclusion criteria. In addition to the usual sociodemographic, clinical, and laboratory data, the participants answered seven specific self-reporting questionnaires. This report was focused on six key variables: Glycemic control; self-care; self-efficacy; diabetes knowledge; health literacy; and medication adherence.

Results: A total of 100 adults with T2DM participated. The proportions of participants achieving specific thresholds in the key variables were: Acceptable glycemic control 39.4%; adequate diabetes knowledge 59.6%; sufficient or higher health literacy 80.2%; and medication adherence 51.0%. The mean self-efficacy score was 110.6 (73.3% of maximum), and the mean self-care score was 30.7 (43.9% of maximum). A statistically significant linear correlation was observed for eight pairs of key variables with Pearson's correlation values varying between 0.21 to 0.55. Self-efficacy had a relatively higher correlation while glycated hemoglobin was not correlated with other key variables. Path analysis was conducted to examine the relationships among diabetes self-efficacy (Diabetes Management Self Efficacy scale score), self-care behavior (Summary of Diabetes Self-Care Activities score), and glycemic control, but the model demonstrated a poor fit (χ² = 28.1, P < 0.001).

Conclusion: We found substantial suboptimal glycemic control and low self-care practices but acceptable levels of diabetes knowledge, self-efficacy, health literacy and medication adherence among the patients with T2DM. In spite of the correlations between self-care, self-efficacy, and medication adherence, it was surprising that self-care did not correlate with glycemic control. Prospective cohort studies are needed to explore whether these factors influence diabetes outcomes.