Health Literacy in Relation to Type 2 Diabetes Mellitus Among Diabetics in South Kivu, Dr-Congo

Abstract

Background

Health literacy is viewed as the cornerstone of health promotion program; it has been applauded by all health organizations and as well evidenced as a strong predictor for the health of population. It is built through individual skills and system capabilities interactions. The relationship between health literacy level and health outcomes has been established and proven by several scholars its relevance concerning self-care management in type 2 Diabetes Mellitus.

Objectives

To ascertain the level of health literacy among diabetics attending Diabetes clinic in Nyantende and Walungu general referral hospitals, to find out the determinants of health literacy in relation to type 2 DM and to determine the relationship between health literacy an health outcomes (DM outcomes)

Methods

Sequential explanatory mixed-method consisted of quantitative part in phase 1 and qualitative drawn from phase 1 meant to explain findings of phase 1. Qualitative phase focused on individuals with limited health literacy in relation to type 2 Diabetes Mellitus. Study was carried out among type 2 diabetics, aged ≥ 35 years, diagnosed with the disease at least 2 years ago, who attend Diabetes clinic in two rural health facilities, Walungu and Nyantende general referral hospitals, located in South- Kivu province, in Democratic Republic of the Congo. Purposive sampling technique was used to determine the sample size in phase 1 and participants for qualitative phase were drawn from quantitative data. Data collection tools used semi-structured questionnaire inspired from the Information and Support for Health Actions Questionnaire (ISHA –Q) for assessment of health literacy, in depth interview and key informants interviews). People who scored marks ranged between 50-100 marks were considered to have good health literacy whereas those who scored 10-49.9 marks had limited or poor health literacy. For data analysis researcher used software such as SPSS version 20, Epi-info version 3.5.3 and 7, Medical(R) version 12.4.3 with confidence interval of 95% at the level of significance (p<0.05) for quantitative data and transcripts for qualitative part. Measurement of health literacy was assessed through an assessment tool adapted and contextualized following the ISHA-Q assessment tools comprising three dimensions of health literacy concurrently. Regarding, health literacy in relation to type 2 Diabetes Mellitus a set of 24 questions focusing on the ability to access health information and to appraise it, knowledge (perceptions, attitudes, beliefs) and ability to self-manage the degenerative condition such as type 2 Diabetes Mellitus. Twenty (20) out of these were marked, people with score ranged from ≤10-49.9 were considered having poor health literacy while those who scored from 50 up to 100 marks were considered with good health literacy regarding type 2 Diabetes Mellitus.

Main findings

The study showed that limited health literacy is common among diabetics attending these rural health facilities, only 33.3% recorded good health literacy. Educational attainment, gender and monthly income were associated with the level of health literacy and family history of DM come out as a strong predictor for health literacy in relation to type 2 Diabetes Mellitus. Health literacy was associated with health outcomes such physical exercise observance and number of hospitalizations related to type 2 Diabetes Mellitus None of these health facilities has health the minimum requirement for Diabetes medical follow up and health education and there was no health care support, limited source of health information. In one of these health rural facilities medical follow up is performed employing urine glucose test None diabetic has ever carried out required medical investigation regarding Diabetes Mellitus and only 2 out of 60 respondents owned blood sugar machine.

Conclusions

Health literacy being a strong predictor for good health of population, but it is viewed as a beneficial factor from medical perspective and an asset from public health perspective (Nutbeam, 2008) on one hand, On the other hand being associated with health outcomes in relation to type 2 Diabetes Mellitus is very paramount for self-care management, since this chronic condition requires full control over health.

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