Effectiveness of Health Literacy through Transformative Learning on Glycemic control Behavior in Adult Diabetes Patients: A Mixed Methods Approach
Article Sidebar
Main Article Content
Abstract
This research used a mixed methods intervention design. The research aimed to:
1) study the perspectives of diabetic adults and 2) investigate the effectiveness of health literacy through transformative learning of glycemic control. In study 1, through qualitative research, the perspectives of 13 diabetic adults in Bangkok, Thailand, were examined using in-depth interviews. The findings were divided into three themes that reflected the beliefs of the patients: 1) the serious nature of the disease; 2) that made life difficult; and 3) that the glycemic control relied on patients’ sense of self-reliance and efficacy. The perspectives towards health literacy consisted of two themes: 1) information must be analyzed and evaluated before usage; and 2) hierarchical relationship influences the communication between providers and patients. The study 2 was an experimental research, in which consisted of 40 diabetic adults, divided equally into 2 groups; the experimental (20 participants) and control (20 participants) group. The instrument used were the glycemic control questionnaire, and the measurement of glycated hemoglobin (A1C). The intervention consisted of 4 sessions for 4 weeks, for two hours per session, and the final session was visiting their homes. The ANCOVA and repeated measures were applied for data analysis. The results revealed that: 1) the experimental group had more glycemic control and less A1C than the control group (p < 0.01); and 2) the experiment group had changing and maintaining in glycemic control and A1C (p < 0.01). The findings of this study could be useful for healthcare providers to develop the glycemic controlling program based on the patients’ contexts.
Downloads
Article Details
References
Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs. (1999). Health literacy: Report of the council on scientific affairs. JAMA, 281(6), 552-557. doi:10.1001/ jama.281.6.552
American Diabetes Association. (2009). Standards of medical care in diabetes–2009. Diabetes Care, 32(Suppl 1), S13-S61. doi: 10.2337/dc09-S013
American Diabetes Association. (2014). Standards of medical care in diabetes–2014. Diabetes Care, 37(Suppl 1), S14-S80. doi: 10.2337/dc14-S014
Baker, D. W., Wolf, M. S., Feinglass, J., & Thompson, J. A. (2008). Health literacy, cognitive abilities, and mortality among elderly persons. Journal of General Internal Medicine, 23(6), 723-726. doi: 10.1007/s11606-008-0566-4
Baker, D. W., Wolf, M. S., Feinglass J, Thompson, J. A., Gazmararian, J. A., & Huang, J. (2007). Health literacy and mortality among elderly persons. Archives of Internal Medicine, 167(14), 1503-1509. doi: 10.1001/archinte.167.14.1503
Bautista, R. E., Glen, E. T., Shetty, N. K., & Wludyka, P. (2009). The association between health literacy and outcomes of care among epilepsy patients. Seizure, 18(6), 400-404. doi: 10.1212/01.CPJ.0000436211.73013.ab
Creswell, J. (2015). Educational research: Planning, conducting, and evaluating quantitative and qualitative research. New York: Pearson.
Davis, T. C., & Wolf, M. S. (2004). Health literacy: Implications for family medicine. Family Medicine, 36(8), 595-598.PMID:15343422
Deerochanawong, C., & Ferrario, A. (2013). Diabetes management in Thailand: A literature review of the burden, costs, and outcomes. Globalization and Health, 9, 11.
doi: 10.1186/1744-8603-9-11
Diabetes Control and Complications Trial Research Group. (1993). The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The New England Journal of Medicine, 329(14), 977-986. doi: 10.1056/NEJM199309303291401
Dirkx, J. M. (1998). Transformative learning theory in the practice of adult education: An overview. PAACE Journal of Lifelong Learning, 7, 1-14. doi: 10.1002/ace.301
Funnell, M. (2006). The diabetes attitudes, wishes, and needs (DAWN) study. Clinical Diabetes, 24, 154-155. doi: 10.2337/diaclin.24.4.154
Gazmararian, J. A., Baker, D. W., Williams, M. V., Parker, R. M., Scott, T. L., Green, D. C., … Koplan, J. P. (1999). Health literacy among Medicare enrollees in a managed care organization. JAMA, 281(6), 545–551.doi: 10.1001/jama.281.6.545
Gazmararian, J. A., Williams, M. V., Peel, J., & Baker, D. W. (2003). Health literacy and knowledge of chronic disease. Patient Education and Counseling, 51, 267-275. doi.org/10.1016/S0738-3991(02)00239-2
Hein, S. F. (2004). Embodied reflexivity in qualitative psychological research: The disclosive capacity of the lived body. In S. P. Shohov (Ed.), Advances in Psychology Research, Volume 30 (pp. 57-74). NY: Nova Science.
Institute of Medicine (US) Committee on Health Literacy. (2004). Health literacy: A prescription to end confusion. Washington, DC: National Academies Press.
doi: 10.17226/10883
Kalichman, S. C., Ramachandran, B., & Catz, S. (1999). Adherence to combination antiretroviral therapies in HIV patients of low health literacy. Journal of General Internal Medicine, 14(5), 267-273. doi: 10.1046/j.1525-1497.1999.00334.x
Kitchenham, A. (2008). The evolution of John Mezirow's transformative learning theory. Journal of Transformative Education, 6, 104-123. doi: 10.1177/1541344608322678
Lorig, K., Stewart, A., Ritter, P., Gonzalez, V., Laurent, D., & Lynch, J. (1996). Outcome measures for health education and other health care interventions. Thousand Oaks, CA: Sage.
Mezirow, J. (1991). Transformative dimensions of adult learning. San Francisco: Jossey-Bass.
Mezirow, J. (1997). Transformative learning: Theory to practice. In P. Cranton (Ed.), Transformative learning in action: Insights from practice (pp. 5-12). New Directions for Adult and Continuing Education, No. 74. San Francisco: Jossey-Bass.
Mezirow, J. (2000). Learning to think like an adult: Core concepts of transformation theory. In J. Mezirow (Ed.), Learning as transformation: Critical perspectives on a theory in progress (pp. 3-33). San Francisco: Jossey-Bass.
Murea, M., Ma, L., & Freedman, B. I. (2012). Genetic and environmental factors associated with type 2 diabetes and diabetic vascular complications. The Review of Diabetic Studies, 9(1), 6-22. doi: 10.1900/RDS.2012.9.6.
Ntiri, D. W., & Stewart, M. (2009). Transformative learning intervention: Effect on functional health literacy and diabetes knowledge in older African Americans. Gerontology & Geriatrics Education, 30(2), 100-113. doi: 10.1080/02701960902911265.
Nutbeam, D. (1999). Literacies across the lifespan: Health literacy. Literacy and Numeracy Studies, 9(2), 47-55.
Nutbeam, D. (2008). The evolving concept of health literacy. Social Science & Medicine, 67(12), 2072-2078. doi:10.1016/j.socscimed.2008.09.050
Osborn, C. Y., Paasche-Orlow, M. K., Bailey, S. C., & Wolf, M. S. (2011). The mechanisms linking health literacy to behavior and health status. American Journal of Health Behavior, 35(1), 118-128. PMID: 20950164
Osborn, C. Y., Paasche-Orlow, M. K., Davis, T. C., & Wolf, M. S. (2007). Health literacy: An overlooked factor in understanding HIV health disparities. American Journal of Preventive Medicine, 33(5), 374-378. doi: 10.1016/j.amepre.2007.07.022
Paasche-Orlow, M. K., & Wolf, M. S. (2007). The causal pathways linking health literacy to health outcomes. American Journal of Health Behavior, 31(Suppl 1), S19-S26. doi: 10.5555/ajhb.2007.31.supp.S19
Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoagwood, K. (2015). Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health, 42(5), 533-544. doi: 10.1007/s10488-013-0528-y
Peyrot, M., McMurry, J. F., Jr., & Kruger, D. F. (1999). A biopsychosocial model of glycemic control in diabetes: Stress, coping and regimen adherence. Journal of Health and Social Behavior, 40(2), 141-158. PMID: 10467761
Rodbard, H., Blonde, L., Braithwaite, S., Brett, E., Cobin, R., Handelsman, Y.,…Zangeneh, F. (2007). American association of clinical endocrinologists medical guidelines for
clinical practice for the management of diabetes mellitus. Endocrine Practice, 13
(Suppl 1), 1-68. doi: 10.4158/EP.13.S1.1
Schillinger, D., Grumbach, K., Piette, J., Wang, F., Osmond, D., Daher, C., … Bindman, A. B. (2002). Association of health literacy with diabetes outcomes. JAMA, 288(4), 475-482. doi: 10.1001/jama.288.4.475
Sherwani, S. I., Khan, H. A., Ekhzaimy, A., Masood, A., & Sakharkar, M. K. (2016). Significance of A1C test in diagnosis and prognosis of diabetic patients. Biomarker Insights, 11, 95-104. doi: 10.4137/BMI.S38440
Skovlund, S., Peyrot, M., & on behalf of the Dawn International Advisory Panel. (2004). The diabetes attitudes, wishes, and needs (DAWN) program: A new approach to improving outcomes of diabetes care. Diabetes Spectrum, 18(3), 136-142.
doi: 10.2337/diaspect.18.3.136
Susic, J. (2009). NIH Senior Health classes for senior citizens at a public library in Louisiana. Journal of Consumer Health on the Internet, 13(4), 417-419.
doi: 10.1080/ 15398280903341226
Torres, R. Y., & Marks, R. (2009). Relationships among health literacy, knowledge about hormone therapy, self-efficacy, and decision-making among postmenopausal health. Journal of Health Communication, 14(1), 43-55. doi: 10.1080/10810730802592247.
Von Wagner, C., Steptoe, A., Wolf, M. S., & Wardle, J. (2009). Health literacy and health actions: A review and a framework from health psychology. Health Education & Behavior, 36(5), 860-877. doi: 10.1177/1090198108322819.
Wolf, M. S., Davis, T. C., Cross, J. T., Marin, E., Green, K., & Bennett, C. L. (2004). Health literacy and patient knowledge in a Southern US HIV clinic. International Journal of