Health Literacy among the Older Adults with Coexisting Type 2 Diabetes Mellitus and Hypertension in Primary Care Cluster, Saraburi Province

Abstract

This mixed-method research aimed to 1) study health literacy among the older adults with coexisting type 2 diabetes mellitus and hypertension and 2) compare the differences of personal factors including age, educational level, and income toward health literacy. The quantitative method employed survey research. The samples were older adults with coexisting type 2 diabetes mellitus and hypertension visiting the primary care cluster Saraburi province. A sample size of 336 older adults was calculated and selected according to the inclusion criteria. The instrument used to collect data was Health Literacy Questionnaire which presented IOC at 0.85 and demonstrated reliability at 0.87. Data were analyzed by using descriptive statistics One Way ANOVA and Scheffe. The qualitative method collected data from 34 representatives 1) the health care providers who are responsible for caring for diabetic patients consist of 10 of the followings; doctors, nurses, nutritionists, and public health volunteers. and 2) the 24 older adults with diabetes and high blood pressure were selected by purposeful random sampling. The researchers conducted group discussions and in-depth interviews with structured interview questionnaire. Data were analyzed by content analysis. Data were collected from January to April, 2020.

The results showed that 1) participants had overall health literacy at inadequate HL of 54.76%, followed by 28.27% problematic HL and 16.96% adequate HL. In terms of access, assessment, and information application for decision-making were inadequate HL level of 76.49%, 75.60%, and 41.07%, respectively, while 48.51% of participants had understanding at problematic HL. The participants had accessed and believed health information from health care providers or the distributed publications. Communication would help clients apply information to decide to take care of their health
2) there were significant differences of health literacy mean score among the participant with different age group (F = 6.826, p < 0.05), educational level (F = 33.552, p < 0.001), and income (F = 26.314, p < 0.001). The results of Scheffe revealed that there were significant differences of health literacy mean score among the ages 60-69 and 70-79 including educational level and income for each pair (p < .05).

conclusion: Most older adults had health literacy at inadequate HL level, especially in terms of access, assessment, and information application for decision-making. Nurses or health care providers who work in diabetic clinics should early assess and enhance health literacy in the beginning stage of old age by taking educational level, and income among older adults into account.