Strategies to Enhance Health Literacy amomg Diabetes Patients


  • Somchit Sinthuchai -
  • Suda Dejpitaksirikul
  • Siriporn Sawangchit


Health literacy, Diabetes mellitus


Diabetes Mellitus is a chronic disease that cause major public health problems globally. Uncontrolled diabetes can accelerate the onset of complications of microvascular and macrovascular complications which eventually will results in the increate in morbidity and mortality. Health literacy, defined as an individual's capacity to access, understand, and interpret health information and make appropriate health decisions, is one of the key factor which have an influence on diabetes self-management and controlling HbA1c. This article purposes strategies to enhance the health literacy among diabetes patients, by providing strategies to health care provider regarding patient’s care, which includes motivation interview, self-management education, teaching back, communication for decision making, goal setting, perceiving life experience from stories telling and tele-nursing.


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Aekplakorn, W. (2021). Report of the survey of the

Thai people by physical examination 6th,

-2020. Bangkok: Faculty of Medicine

Ramathibodi Hospital. [In Thai].

American Diabetes Association. (2019). Standards

of medical care in diabetes 2019. Diabetes

Care, 42, (Suppl.1).

Bailey, S. C., Brega, A. G., Crutchfield, T. M., Elasy,

T., Herr, H., Kaphingst, K., … Schillinger, D.

(2014). Update on health literacy and dia

betes. The Diabetes Educator, 40(5), 581604.


Campbell, T., Dumt, D., Fitzgera, J. L., & Gordon,

I. (2013). The impact of patient narratives

on self-efficacy and self-care in Australians

with type 2 diabetes: stage 1 results of a

randomized trial. Health Promotion Interna

tional, 30(3), 438-448. doi:10.1093/heapro/


Chatterjee, S., Davies, M. J., Heller, S., Speight, J.,

Snoek, F. J., & K hunti, K. (2018). Diabetes

structured self-management education

programmes: A narrative review and current

innovations. Lancet Diabetes Endocrinology,

(2), 130-142.

Dahal, P. K., &Hosseinzadeh, H. (2019). Association

of health literacy and diabetes self-manage

ment: A systematic review. Australian Journal

of Primary Health, 25, 526533.


Dogru, A., Ovayolu, N., & Ovayolu, O. (2019).

The effect of motivational interview persons

with diabetes on self-management and

metabolic variables. Journal of Pakistan

Medical Association, 69(3), 294-300.

Dunn, P. & Conard, S. (2018). Improving health

literacy in patients with chronic conditions:

A call to action. International Journal of Car

diology, 273, 249251.

Fredrix, M., McSharry, J., Flannery, C., Dinneen,S.,

& Byrne, M. (2018). Goal-setting in diabetes

self-management: A systematic review and

meta-analysis examining content and

effectiveness of goal-setting interventions.

Psychology & Health, 33(8), 955977. https://

Goddu, A.P.,Raffel, K.E., & Peek, M.E. (2015). A

story of change: The influence of narrative on

African-Americans with diabetes. Patient

Education and Counseling, 98, 10171024.

Harada, M., Fujihara, K., Osawa, T., Yamamoto, M.,

Kaneko, M., Matsubayashi,Y., ... Sone, H.

(2018). Effects of treatment-achieved HbA1c

on incidence of micro-/macrovascular

complications in patients with diabetes

mellitus. Diabetes, 67, 444.

Hong, Y. R., Huo, J., Jo, A., Cardel, M., &Mainous,

A. G. (2020). Association of patient-provider

teach-back communication with diabetic

outcomes: A cohort study. Journal of the

American Board of Family Medicine, 33(6),


Hong, Y. R, Jo, A., Cardel, M, Huo, J., & Mainous,

A. G. (2020). Patient-provider communica

tion with teach-back, patient-centered dia

betes care, and diabetes care education.

Patient Education and Counseling, 103,


Inoue, M., Takahashi, M., & Kai, I. (2013). Impact

of communicative and critical health literacy

on understanding ofdiabetes care and selfefficacy in diabetes management: acrosssectional study of primary care in Japan.

BMC Family Practice, 14, 40. http://www.


International Health Policy Program. (2021). Report

on the burden of diseases and injuries of the

Thai population 2017-2019. Nonthaburi: The

graphicosystems company limited. [In Thai].

Kim, S.H., & Lee, A. (2016). Health-literacy-sensitive

diabetes self-management interventions:

A systematic review and meta-analysis.

Worldviews on Evidence-Based Nursing,

(4), 324333.

KotsaniVasiliki, K., Antonopoulou, V., Kountouri, A.,

Grammatiki, M., Rapti, E., Karras, S.,…Kotsa,

K. (2018). The role of telenursing in the

management of diabetes type 1:

A randomized controlled trial. International

Journal of Nursing Studies, 80, 29-35.

Lee, E. H., Lee, Y. W., & Moon, S. H. (2016).

A structural equation model linking health

literacy to self-efficacy, self-care activities,

and health-related quality of life in patients

with type 2 diabetes. Asian Nursing

Research, 10(1), 82-87.

Marciano, L., Camerini, A.-L., & Schulz, P. J. (2019).

The role of health literacy in diabetes

knowledge,self-care, and glycemic control:

Ameta-analysis. Journal of General Internal

Medicine, 34(6), 1007-1017.

Miller, C. K., & Bauman, J. (2014). Goal-setting:

An integral component of effective diabetes

care. Current Diabetes Reports, 14(8), 18.


Miller, W. R., &Rollnick, S. (2012). Motivational

interview helping people change (3rded.).

New York: Guilford press.

Nas, M. A., Cayir. Y., & Bilen, A. (2021). The impact

of teach-back educational method on

diabetes knowledge level and clinical

parameters in type 2 diabetes patients

undergoing insulin therapy. TheInternational

Journal of Clinical Practice, 75e13921. https://

Negarandeha, R., Mahmoodib, H., Noktehdanb, H.,

Heshmatc, R., &Shakibazadeh, E.(2013).

Teach back and pictorial image educational

strategies on knowledge about diabetes and

medication/dietary adherence among low

health literate patients with type 2 diabetes.

Primary Care Diabetes, 7(2), 111-118.

Nutbeam, D. (2000). Health literacy as a public health

goal: a challenge for contemporary health

education and communication strategies into

the 21st century. Health Promotion

International, 15, 259267.

Nutbeam, D. (2015). Defining, measuring and

improving health literacy. HEP, 42(4), 450-455.

O'Donnell, M., Carey, M. E., Horne, R., AlvarezIglesias, A., Davies, M. J., Byrne, M., ...

Dinneen, F. S. (2018). Assessing the

effectiveness of a goal-setting session as

part of a structured group self-management

education programme for people with type

diabetes. Patient Education and Counseling,

(12), 21252133.

Raznahan, R., Farahaninia, M., Jalal, E.J., & Haghan,

H. (2018). The effect of teach-back method

on health promotinglifestyle of patients with

type 2 diabetes. Client-Centered Nursing

Care, 4(2). 88-95.

Saeed, H., Saleem, Z., Naeem, R., Shahzadi, I., &

Islam, M. (2018). Impact of health literacy

on diabetes outcomes:A cross-sectional

study from Lahore, Pakistan. Public Health,

, 8-14.

Soliman, H. M. M., & Mohamed, W. G. (2016).

Educational intervention and tele-nursing

effects on glycemic control, metabolic

parameters and adherence in adults with

type II Diabetes Mellitus. International Journal

of Nursing Didactics, 6(2)


Srensen, K., Van den Broucke, S., Fullam, J., Doyle,

G., Pelikan, J., Slonska, Z., ... (HLS-EU)

Consortium Health Literacy Project

European. (2012). Health literacy and public

health: A systematic review and integration

of definitions and models. BMC Public

Health, 12, 80.

Steffen, P. L. S., Mendonca, C. S., Meyer, E., &

Faustino-Silva, D. D. (2021). Motivational

Interviewing in the management of type 2

diabetes mellitus and arterial hypertension

in primary health care: An RCT. American

Journal of Preventive Medicine, 60(5), e203-


Shiyanbola, O. O., Unni, E., Huang, Y. M., & Lanier,

C. (2018).The association of health literacy

with illness perceptions, medication beliefs,

and medication adherence among individuals

with type 2. Research in Social and

Administrative Pharmacy, 14(9), 824830.

Tahmasebi, R., Noroozi, A., & Tavafian, S. S. (2013).

Determinants of self-managementamong

diabetic patients: A path analysis.

Asia-Pacific Journal of Public Health, 27(2),

NP524-NP534. doi:10.1177=1010539513475652.

Tanasugarn, C & Neelapaichit, N. (2016). Survey of

health literacy of diabetes mellitus and

hypertension patients. Bangkok: Health

Education Division Department of Health

Service support Ministry of Public Health.

[In Thai].

Tefera, Y. G., Gebresillassie, B. M., Emiru, Y. K.,

Yilma, R., Hafiz, F., Akalu, H., & Ayele, A. A.

(2020). Diabetic health literacy and its

associationwith glycemic control among

adult patientswith type 2 diabetes mellitus

attending theoutpatient clinic of a university

hospital in Ethiopia, PlOS ONE, 15(4),



Thailand Development Research Institute: Case

study report. (2018). Estimated public health

expenditures over the 15 next year. Retrieved

August 2022 from




expenditure. [In Thai].

Thepwongsa, I., Muthukumar, R., & Kessomboon, P.

(2017). Motivational interviewing by general

practitioners for type 2 diabetes patients: A

systematic review. Family Practice, 34(4),


Wallace, A. S., Perkhounkova, Y., Sussman, A. L.,

Hein, M., Chung, S. J., & Tripp-Reimer, T.

(2016). Implementation of collaborative goal

setting for diabetes in community primary

care. Translational Behavioral Medicine, 6(2),

-211. doi: 10.1007/s13142-016-0389-5.

Wongnisanatakul, K. (2018). Health literacy among

diabetic patients at the family practice center

of Phra Nakhon Si Ayutthaya Hospital.

Journal of Preventive Medicine Association

of Thailand, 8(1), 50-61. [In Thai].




How to Cite

Sinthuchai, S. ., Dejpitaksirikul, S. ., & Sawangchit, S. . (2022). Strategies to Enhance Health Literacy amomg Diabetes Patients. NU Journal of Nursing and Health Sciences, 16(3), 20–32. Retrieved from