A Cross-sectional Study of Factors Affecting Quality of Life of People with Type 2 Diabetes
DOI:
https://doi.org/10.60099/prijnr.2024.263621Keywords:
Health Literacy, Indonesia, Quality of Life, Self-care, Type 2 diabetesAbstract
Diabetes is a chronic illness that negatively impacts quality of life. However, the quality of life of people with type 2 diabetes could be improved with sufficient literacy and abilities to perform self-management, such as managing blood glucose, maintaining a healthy diet, and proper exercise. This descriptive cross-sectional study aimed to describe the relationships among health literacy, self-management, and quality of life and to determine the predictors of quality of life of people with type 2 diabetes. Data were collected through purposive sampling from 218 individuals with type 2 diabetes in Manado City, Indonesia, between July and October 2021. We used the European Health Literacy Survey Questionnaire, Diabetes Self-management Questionnaire, and Diabetes Quality of Life Questionnaire. Data were analyzed using descriptive statistics, Pearson’s product-moment correlation, and hierarchical regression analysis.
The study revealed that health literacy was significantly associated with self-management and quality of life. Furthermore, age, occupation, health literacy, and self-management were significant predictors and collectively explained 25.3% of the variance in quality of life. Hence, higher health literacy and improved self-management practices were linked to a higher quality of life for people with type 2 diabetes. Since the explained variance of quality of life in this study is only 25.3%, further studies should include other factors such as social and family support and communication with health care providers to predict quality of life. Nevertheless, nurses can use this study to design interventions to improve self-care management skills and health literacy levels, which may enhance quality of life. However, testing the effectiveness is needed.
References
World Health Organization. Diabetes [Internet]. 2023 April 5. [cited 2023 May.25]. Available from: https://www.who.int/news-room/fact-sheets/detail/diabetes
International Diabetes Federation. IDF Diabetes Atlas, 10th ed. [Internet]. n.d. [cited 2023 Jul.20] Available from: https://www.diabetesatlas.org
North Sulawesi Provincial Health Office. Health Profile [Internet]. [cited 2023 Jul.21]. Available from: https://dinkes.sulutprov.go.id/pages/profil-kesehatan-download (in Indonesian)
Rosyada, Trihandini. Determinates of chronic complications of diabetes mellitus. J Kesehatan Masyarakat Nasional. 2018; 7(9), 395-401. http://dx.doi.org/10.21109/kesmas.v7i9.11 (in Indonesian) DOI: https://doi.org/10.21109/kesmas.v7i9.11
Carpenter R, DiChiacchio T, Barker K. Interventions for self-management of type 2 diabetes: an integrative review. Int J Nurs Sci. 2019; 6: 70–91. doi: 10.1016/j.ijnss.2018.12.002 DOI: https://doi.org/10.1016/j.ijnss.2018.12.002
Liu C, Wang D, Liu C, Jiang J, Wang X, Chen H, et al. What is the meaning of health literacy? A systematic review and qualitative synthesis. Fam Med Community Health. 2020; 8(2), 1-8. doi:10.1136/fmch-2020-000351 DOI: https://doi.org/10.1136/fmch-2020-000351
Panahi R, Kazemi S, Juyani AK, Pishvaei M. Health literacy and self-care in patients. J Research Health. 2018; 8(5), 392-393. doi: 10.29252/jrh.8.5.392 DOI: https://doi.org/10.29252/jrh.8.5.392
Patandung VP, Kadar KS, Erika KA. Health literacy level of type 2 diabetes mellitus patients at the Tomohon City Health Center. Jurnal Ilmu Kesehatan. 2018; 7(2), 137–143. doi: 10.37341/interest.v7i2.22. (in Indonesian) DOI: https://doi.org/10.37341/interest.v7i2.22
Huang YJ, Lin GH, Lu WS, Tam KW, Chen C, Hou WH, Hsieh CL. Validation of the European health literacy survey questionnaire in women breast cancer. Cancer Nurs. 2018, 41(2), E40–E48. doi: 10.1097/NCC.0000000000000475 DOI: https://doi.org/10.1097/NCC.0000000000000475
Hickey KT, Masterson Creber RM, Reading M, Sciacca RR, Riga TC, Frulla AP, et al. Low health literacy. Nurse Pract. 2018; 43(8), 49–55. doi:10.1097/01.npr.0000541468.54290.49 DOI: https://doi.org/10.1097/01.NPR.0000541468.54290.49
Seid MA. Health-related quality of life and extent of self-care practice among heart failure patients in Ethiopia. Health Qual Life Outcomes. 2020; 18(1), 27–33. doi:10.1186/s12955-020-01290-7 DOI: https://doi.org/10.1186/s12955-020-01290-7
World Health Organization. WHOQOL: measuring quality of life. [Internet]. 1997. [cited 2023 May.25]. Available from: https://apps.who.int/iris/handle/10665/63482
Babazadeh T, Dianatinasab M, Daemi A, Nikbakht HA, Moradi F, Ghaffari-Fam S. Association of self-care behaviors and quality of life among patients with type 2 diabetes mellitus: Chaldoran County, Iran. Diabetes Metab J. 2017, 41(6), 449–456. doi: 10.4093/dmj.2017.41.6.449 DOI: https://doi.org/10.4093/dmj.2017.41.6.449
Prihatin Putri D. Relationship between self-management and quality of life of patients with type 2 diabetes mellitus. JKKH [Internet]. 2019 Sept [cited 2023 Aug.6]; 7(2): 230-4. Available from: https://jurnal.poltekkeskhjogja.ac.id/index.php/jkkh/article/view/234 (in Indonesian) DOI: https://doi.org/10.36577/jkkh.v7i2.234
Sabil F. Relationship between health literacy and self-efficacy towards self-care management of type 2 diabetes mellitus patients in Makassar City health center. [Internet]. Makassar (ID): Hasanuddin University; 2018. [cited 2023 Jul.19]. Available from: http://digilib.unhas.ac.id/uploaded_files/temporary/DigitalCollection/OTJkNGNmMmQzN2E3MDRjYzI2MDE4NGRjYTI3NTJkMGU4M2JlZjJjOQ==.pdf (in Indonesian)
Sahroni, Dien A, Tri K. Social determinants of health literacy level in patients with hypertension at Cilegon City health center. Faletehan Health J. [Internet]. 2019. [cited 2023 Aug.14]; 6(3): 111-117. Available from: https://journal.lppm-stikesfa.ac.id/index.php/FHJ (in Indonesian) DOI: https://doi.org/10.33746/fhj.v6i3.94
Nutbeam D. Health promotion glossary. Health Promot. Int. 1998; 13(4), 349-64. doi: 10.1093/heapro/13.4.349 DOI: https://doi.org/10.1093/heapro/13.4.349
Nielsen-Bohlman L, Panzer AM, Kindig DA. What is health literacy? Nih.gov. National Academies Press. [Internet]. 2010. [cited 2023 Sept.26]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK216035/
Xie Y, Ma M, Zhang Y, Tan X. Factors associated with health literacy in rural areas of Central China: structural equation model. BMC Health Serv Res. 2019;19(1):300. doi: 10.1186/s12913-019-4094-1 DOI: https://doi.org/10.1186/s12913-019-4094-1
Van der Heide I, Poureslami I, Mitic W, Shum J, Rootman I, FitzGerald JM. Health Literacy in chronic disease management: a matter of interaction. J Clin Epidemiol. 2018;102:134–8. doi:10.1016/j.jclinepi.2018.05.010 DOI: https://doi.org/10.1016/j.jclinepi.2018.05.010
Wang C, Lang J, Xuan L, Li X, Zhang L. The effect of health literacy and self-management efficacy on the health-related quality of life of hypertensive patients in a western rural area of China: a cross-sectional study. Int J Equity Health. 2017;16:58. doi: 10.1186/s12939-017-0551-9 DOI: https://doi.org/10.1186/s12939-017-0551-9
Poureslami I, Nimmon L, Rootman I, Fitzgerald MJ. Health literacy and chronic disease management: drawing from expert knowledge to set an agenda. Health Promot Int. 2017;32(4):743-754. doi: 10.1093/heapro/daw003 DOI: https://doi.org/10.1093/heapro/daw003
RobatSarpooshi D, Mahdizadeh M, Alizadeh Siuki H, Haddadi M, Robatsarpooshi H, Peyman N. The relationship between health literacy level and self-care behaviors in patients with diabetes. Patient Relat Outcome Meas. 2020;11:129-135. doi: 10.2147/PROM.S243678 DOI: https://doi.org/10.2147/PROM.S243678
Kim S, Love F, Quistberg DA, Shea JA. Association of health literacy with self-management behavior in patients with diabetes. Diabetes Care. 2004;27(12):2980–2. doi:10.2337/diacare.27.12.2980 DOI: https://doi.org/10.2337/diacare.27.12.2980
Adams K, Greiner AC, Corrigan JM. The 1st Annual Crossing the Quality Chasm Summit: A Focus on Communities. National Academies Press. [Internet]. 2004. [cited 2023 Sept 23]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK215507/ DOI: https://doi.org/10.1037/e305932005-001
Aweko J, De Man J, Absetz P, Östenson CG, Peterson SS, Alvesson HM, et al. Patient and provider dilemmas of type 2 diabetes self-management: a qualitative study in socioeconomically disadvantaged communities in Stockholm. Int J Environ Res Public Health. 2018;15(9):1810. doi: 10.3390/ijerph15091810 DOI: https://doi.org/10.3390/ijerph15091810
Musekamp, G., Schuler, M., Seekatz, B, et al. Does improvement in self-management skills predict improvement in quality of life and depressive symptoms? A prospective study in patients with heart failure up to one year after self-management education. BMC Cardiovasc Disord. 2017;17(51). https://doi.org/10.1186/s12872-017-0486-5 DOI: https://doi.org/10.1186/s12872-017-0486-5
Al-Khaledi M, Al-Dousari H, Al-Dhufairi S, Al-Mousawi T, Al-Azemi R, Al-Azimi F, Badr HE. Diabetes self-management: A key to better health-related quality of life in patients with diabetes. Med Princ Pract. 2018;27(4):323-331. doi: 10.1159/000489310 DOI: https://doi.org/10.1159/000489310
Gaffari-Fam S, Lotfi Y, Daemi A, Babazadeh T, Sarbazi E, Dargahi-Abbasabad G, Abri H. Impact of health literacy and self-care behaviors on health-related quality of life in Iranians with type 2 diabetes: a cross-sectional study. Health Quality Life Outcomes. 2020; 18(1), 357–365. doi: 10.1186/s12955-020-01613-8 DOI: https://doi.org/10.1186/s12955-020-01613-8
Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behav Res Methods. 2009; 41:1149-60 DOI: https://doi.org/10.3758/BRM.41.4.1149
Nurjanah N, Rachmani E, Soenaryati S. Demography and social determinants of health literacy Semarang. 2nd international conference on health literacy and health promotion [Internet]. 2014 Oct.08 [cited 2023 Aug.14]. Available from: https://www.researchgate.net/publication/334002278_Demography_and_Social_Determinants_of_Health_Literacy_Semarang
Schmitt A, Gahr A, Hermanns N, Kulzer B, Huber J, Haak T. The Diabetes Self-Management Questionnaire (DSMQ): development and evaluation of an instrument to assess diabetes self-care activities associated with glycaemic control. Health Qual Life Outcomes. 2013; 11:138. doi:10.1186/1477-7525-11-138 DOI: https://doi.org/10.1186/1477-7525-11-138
Burroughs TE, Radhika D, Brian W, Debra G, Janet M. Development and validation of the diabetes quality of life brief clinical inventory. Diabetes Spectr. 2004 January 1; 17 (1): 41–49. doi: 10.2337/diaspect.17.1.41 DOI: https://doi.org/10.2337/diaspect.17.1.41
Purwansyah D. Self-stigma and quality of life in type 2 diabetes mellitus patients at internal medicine polyclinic level iii Baladhika Husada Hospital in Jember regency. [Internet]. Jember (ID): University of Jember; 2019. [cited 2023 Jul.20]. Available from: https://repository.unej.ac.id/handle/123456789/93614 (in Indonesian)
Chusmeywati V. Family support and quality of life of patients with diabetes mellitus at unit ii PKU Muhammadiyah Hospital Yogyakarta. [Internet]. Yogyakarta (ID): University of Muhammadiyah Yogyakarta; 2016. [cited 2023 Jul.20]. Available from: https://etd.umy.ac.id/id/eprint/27998 (in Indonesian)
Lee YJ, Shin SJ, Wang RH, Lin KD, Lee YL, Wang YH. Pathways of empowerment perceptions, health literacy, self-efficacy, and self-care behaviors to glycemic control in patients with type 2 diabetes mellitus. Patient Educ Couns. 2016; 99(2): 287–94. doi:10.1016/j.pec.2015.08.021 DOI: https://doi.org/10.1016/j.pec.2015.08.021
Xia J, Wu P, Deng Q, Yan R, Yang R, Lv B, et al. Relationship between health literacy and quality of life among cancer survivors in China: a cross-sectional study. BMJ Open. 2019; 9(12): 1–9. doi:10.1136/bmjopen-2018-028458 DOI: https://doi.org/10.1136/bmjopen-2018-028458
Diriba DC, Leung DY, Suen LK. Factors predicted quality of life of people with type 2 diabetes in western Ethiopia. PLOS ONE. 2023; 18(2): 1–15 doi:10.1371/journal.pone.0281716 DOI: https://doi.org/10.1371/journal.pone.0281716
Son YJ, Yu HY. Influence of health literacy on HRQoL in patients after PCI. West. J. Nurs. Res. 2016; 38(12): 1611–1626 DOI: https://doi.org/10.1177/0193945916653104
Domínguez-Domínguez A, Martínez-Guardado I, Domínguez-Muñoz FJ, Barrios-Fernandez S, Morenas-Martín J, Garcia-Gordillo MA, Carlos-Vivas J. Association between the level of physical activity and health-related quality of life in type 1 diabetes mellitus: a preliminary study. J. Clin. Med. 2021;10(24):5829. doi:10.3390/jcm10245829 DOI: https://doi.org/10.3390/jcm10245829
Tan FCJH, Oka P, Dambha-Miller H, Tan NC. The association between self-efficacy and self-care in essential hypertension: a systematic review. BMC Fam Pract. 2021;22(1):44. doi: 10.1186/s12875-021-01391-2 DOI: https://doi.org/10.1186/s12875-021-01391-2
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