Effects of Enhance Health Literacy through Transformative Learning Program on Self-Management and Hemoglobin A1C Level Among Adults with Uncontrolled Type 2 Diabetes: A Randomized Controlled Trial
DOI:
https://doi.org/10.60099/prijnr.2023.262041Keywords:
HbA1C, Health literacy, Randomized controlled trial, Self-management, Transformative learning, Uncontrolled type 2 diabetesAbstract
Health literacy is fundamental to people’s ability to manage their health and make appropriate health decisions. Health literacy enhancement can maximize self-management and health outcomes, especially among uncontrolled type 2 diabetes persons with chronic symptoms that can cause microvascular and macrovascular complications. This randomized controlled trial examined the effects of the Enhance Health Literacy through Transformative Learning Program on self-management and HbA1C levels among adults with uncontrolled type 2 diabetes. The sample included 64 adults with uncontrolled type 2 diabetes visiting two healthpromoting hospitals in a province in central Thailand. They were randomly allocated to either the experimental group (n = 32) receiving the 4-week transformative learning program in addition to usual care or the control group (n = 32) receiving only usual care. A demographic data questionnaire, the Self-Management Behaviors Scale, and the HbA1C record form were instruments for obtaining data. Data were analyzed using descriptive statistics, two-way repeated measures ANOVA, and independent t-tests.
Results showed that after receiving the program, the experimental group had significantly higher self-management scores than the control group and was more elevated. In addition, the experimental group had significantly lower HbA1C levels than the control group after the intervention at 12 weeks than before receiving the program. In conclusion, the Enhance Health Literacy through Transformative Learning Program can increase self-management behaviors and lower HbA1C levels. However, nurses need to further test the effectiveness of the literacy program before implementing widely in practice.
References
World Health Organization. Diabetes. 2022 Sept 16 [cited 2022 Dec 23]. Available from: https://www.who.int/ news-room/fact-sheets/detail/diabetes
Lin X, Xu Y, Pan X, Xu J, Ding Y, Sun X, et al. Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025. Sci Rep. 2020;10(1):14790. doi:10.1038/s41598-020- 71908-9.
Division of Non-communicable Diseases. Annual report 2020. Bangkok: Aksorn Graphic and Design; 2021 (in Thai).
American Diabetes Association. Classification and diagnosis of diabetes: standards of medical care in diabetes – 2021. Diabetes Care. 2021;44(Suppl 1):S15–33. doi:10.2337/ dc21-s002.
Sakboonyarat B, Pima W, Chokbumrungsuk C, Pimpak T, Khunsri S, Ukritchon S, et al. National trends in the prevalence of glycemic control among patients with type 2 diabetes receiving continuous care in Thailand from 2011 to 2018. Sci Rep. 2021;11(1):14260. doi:10.1038/s41598-021- 93733-4.
Bureau of Non-Communicable Disease, Ministry of Public Health. 5-year national NCDs prevention and control strategic and action plan (2017–2021). Bangkok: Emotion Art Co; 2017 (in Thai).
Beck J, Greenwood DA, Blanton L, Bollinger ST, Butcher MK, Condon JE, et al. 2017 national standards for diabetes self-management education and support. Diabetes Educ. 2020;46(1):46–61. doi:10.1177/0145721719897952.
Foofueng W, Anuwatnonthakate, A. Factors associated with uncontrolled of HbA1C among type 2 diabetes patients in Doi-Luang district, Chiang Rai province. Chiangrai Med J. 2019;11(2):42–51 (in Thai).
Sroisong S, Rueankon A, Apichantramethakul K, Nunta N, Sukkaseam J. Perceived self-care behavior among patients with type 2 diabetes mellitus with poor glycemic control. JPNC. 2017;28(2):93–103 (in Thai).
Nutbeam, D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int. 2000;15(3):259–67. doi:10.1093/heapro/ 15.3.259.
Rachmawati U, Sahar J, Wati DNK. The association of diabetes literacy with self-management among older people with type 2 diabetes mellitus: a cross-sectional study. BMC Nurs. 2019;18(Suppl 1):34. doi:10.1186/s12912-019-0354-y.
Yarmohammadi S, Momenyan S, Ghaffari M, Ali R, Azizpour M. Impact of functional, communicative and critical health literacy on glycemic control among patients with type 2 diabetes, and the mediating role of self-care. Psychol Res Behav Manag. 2019;12:427–35. doi:10. 2147/prbm.s207466.
Madican K, Oba N, Supametaporn P. Factors related to health literacy in patients with uncontrolled type 2 diabetes. Journal of Nursing and Health Sciences. 2020;14(1): 38–53 (in Thai).
Sykes S, Wills J, Rowlands G, Popple K. Understanding critical health literacy: a concept analysis. BMC Public Health. 2013;13:150. doi:10.1186/1471-2458- 13-150.
Mezirow J. Transformative dimensions of adult learning. 1st ed. Hoboken, New Jersey: Jossey-Bass; 1991.
Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003;26(1):1-7. doi:10.1207/S15324796ABM 260 1_01.
Nutbeam D. The evolving concept of health literacy. Soc Sci Med. 2008;67(12):2072–8. doi:10.1016/j.socscimed. 2008.09.050.
Emara RA, Hamed M, Awad M, Zeid W. Effect of diabetes self-management education program on glycemic control in diabetic patients attending the family medicine outpatient clinic, Suez Canal University Hospital, Ismailia, Egypt. Egypt J Intern Med. 2021;33:30. doi:10.1186/s43162 -021-00058-9.
Hung JY, Chen PF, Livneh H, Chen YY, Guo HR, Tsai TY. Long-term effectiveness of the diabetes conversation map program. Medicine. 2017;96(36):e7912. doi:10.1097/ md.0000000000007912.
Intarakamhang U, Macaskill A. Effectiveness of a health literacy intervention based on transformative learning and incorporating positive psychology on health behavior and well-being of Thai families with NCDs risk. J Public Health Res. 2021;11(2):1935. doi:10.4081/jphr.2021.1935.
Chiangkhong A, Intarakamhang U, Duangchan P, Macaskill A. Effectiveness of health literacy through transformative learning of glycemic control in diabetic adults. TJBS. 2019;14(3):49–61.
Polit DF, Beck CT. Nursing research: generating and assessing evidence for nursing practice. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2008.
Noppakraw J, Chintanawat R, Khampolsiri T. Health literacy and self-management in older persons with type 2 diabetes mellitus. Nurs J. 2020;47(2):251–61 (in Thai).
Ishikawa H, Takeuchi T, Yano E. Measuring functional, communicative, and critical health literacy among diabetic patients. Diabetes Care. 2008;31(5):874-9. doi: 10.2337/ dc07-1932.
Angboonta P, Pothiban L, Kosachunhanun N. Effects of a self-management supporting program on self-management behaviors and hemoglobin A1C level among elders with diabetes type 2. Nurs J. 2012;39(3):93–103 (in Thai).
Suparak S, Pratumvinit B, Ngueanchanthong K, Unpol P, Thanomsakyuth A, Setthaudom C, et al. External quality assessment scheme for HbA1c assays in Thailand: a 5-year experience. Pract Lab Med. 2022;31:e00288.doi: 10.1016/j.plabm.2022.e00288.
Adu MD, Malabu UH, Malau-Aduli AEO, Malau-Aduli BS. Enablers and barriers to effective diabetes self-management: a multi-national investigation. PLOS ONE. 2019;14(6): e0217771. doi:10.1371/journal.pone.0217771.
Santiparp P. Health promotion program via social media for hypertension and diabetes mellitus patients. Adv Pub Health Com Trop Med. 2021;131. doi:10.37722/ aphctm.2021302.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Pacific Rim International Journal of Nursing Research
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright: The Pacific Rim International Journal of Nursing Research, Thailand Nursing & Midwifery Council has exclusive rights to publish, reproduce and distribute the manuscript and all contents therein.