Disease-related knowledge, health behaviours and clinical outcomes following an educational intervention in patients with diabetes according to their health literacy level: a systematic review
Gabriela Suélen da Silva Chaves, Raquel Britto, Paul Oh, Gabriela Lima de Melo Ghisi
Resumo
Background: The effectiveness of education programs designed to improve disease-related knowledge and change behaviours in people with diabetes has been established. Low health literacy (HL) is considered a barrier to improving health outcomes in people with diabetes. The evidence of the effects of education programs considering HL levels in diabetes has not been previously systematically reviewed. Aim: This systematic review aimed to verify the impact of education on patients’ knowledge, health behaviour change and clinical outcomes in patients with diabetes with low and marginal Health Literacy (HL). Methods: A literature search of electronic databases was conducted for published articles from database inception to April 2020. Eligible articles included assessment of HL, disease-related knowledge, health behaviours (physical activity, diet, smoking cessation, medication adherence, self-care), and clinical outcomes (diabetes management based on A1C values, self-efficacy, perceived susceptibility of complications, self-reported medical care, patient activation, and diabetes-related distress) in diabetes patients that receive any type of education intervention. Results: Overall, 8 articles were included, of which 4 (50%) were RCTs. Four studies were considered “fair” quality. The most used screening instrument to assess HL was the Test of Functional Health Literacy in Adults short form (S-TOFHLA; n=5, 62.5%). All studies showed improvement in disease-related knowledge and behaviour after an education program, regardless of HL level. The overall quality of the evidence of the studies was graded as low to very low according to the GRADE scale. Included studies differed substantially in their education programs characteristics, such as mode of delivery and intervention content. Conclusion: Educational interventions can improve knowledge, change behaviour and improve clinical outcomes of diabetic patients with low or marginal health literacy.
Palavras-chave
References
1. IDF: International Diabetes Federation [Internet]. IDF Diabetes Atlas. 9th ed. Brussels, Belgium: IDF; 2019 [cited 2021 May 18]. Available from: http://www.diabetesatlas.org
2. IDF: International Diabetes Federation. International Curriculum for Diabetes Health Professional Education. Brussels, Belgium: IDF; 2008. 116 p.
3. WHO: World Health Organization. Global Report on Diabetes. Switzerland: WHO; 2016.
4. Rydén L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, et al. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J. 2013;34(39):3035-87. http://dx.doi.org/10.1093/eurheartj/eht108. PMid:23996285.
5. Koongstvedt P. The managed health care handbook. Gaithersburg: Aspen Publishers; 2001.
6. Deakin T, McShane CE, Cade JE, Williams RD. Group based training for self- management strategies in people with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2005;2(2):CD003417. http://dx.doi.org/10.1002/14651858.CD003417.pub2. PMid:15846663.
7. Snoek F, Visser A. Improving quality of life in diabetes: how effective is education? Patient Educ Couns. 2003;51(1):1-3. http://dx.doi.org/10.1016/S0738-3991(03)00204-0. PMid:12915274.
8. Beck J, Greenwood DA, Blanton L, Bollinger ST, Butcher MK, Condon JE, et al. 2017 National standards for diabetes self-management education and support. Diabetes Educ. 2017;43(5):449-64. http://dx.doi.org/10.1177/0145721717722968. PMid:28753378.
9. Tang PC, Overhage JM, Chan AS, Brown NL, Aghighi B, Entwistle MP, et al. Online disease management of diabetes: engaging and motivating patients online with enhanced resources diabetes (EMPOWER-D), a randomized controlled trial. J Am Med Inform Assoc. 2013;20(3):526-34. http://dx.doi.org/10.1136/amiajnl-2012-001263. PMid:23171659.
10. Bohanny W, Wu SFV, Liu CY, Yeh SH, Tsay SL, Wang TJ. Health literacy, self-efficacy, and self-care behaviors in patients with type 2 diabetes mellitus. J Am Assoc Nurse Pract. 2013;25(9):495-502. http://dx.doi.org/10.1111/1745-7599.12017. PMid:24170654.
11. U.S. Department of Health and Human Services [Internet]. Health Literacy in Healthy People 2030 [cited 2021 March 6]. Available from: https://health.gov/our-work/healthy-people/healthy-people-2030/health-literacy-healthy-people-2030
12. White RO, Chakkalakal RJ, Presley CA, Bian A, Schildcrout JS, Wallston KA, et al. Perceptions of Provider Communication Among Vulnerable Patients With Diabetes: Influences of Medical Mistrust and Health Literacy. J Health Commun. 2016;21(Suppl 2):127-34. http://dx.doi.org/10.1080/10810730.2016.1207116. PMid:27662442.
13. Williams MV, Baker DW, Parker MR, Nurss JR. Relationship of functional health literacy to patients’ knowledge of their chronic disease. Arch Intern Med. 1998;158(2):166-72. http://dx.doi.org/10.1001/archinte.158.2.166. PMid:9448555.
14. Boren SA. A review of health literacy and diabetes: opportunities for technologies. J Diabetes Sci Technol. 2009;3(1):202-9. http://dx.doi.org/10.1177/193229680900300124. PMid:20046666.
15. Al Sayah F, Majumdar SR, Williams B, Robertson S, Johnson JA. Health Literacy and Health Outcomes in Diabetes: A Systematic Review. J Gen Intern Med. 2013;28(3):444-52. http://dx.doi.org/10.1007/s11606-012-2241-z. PMid:23065575.
16. Loveman E, Frampton GK, Clegg AJ. The clinical effectiveness of diabetes education models for Type 2 diabetes: a systematic review. Health Technol Assess. 2008;12(9):1-116, iii. http://dx.doi.org/10.3310/hta12090. PMid:18405469.
17. Steinsbekk A, Rygg LO, Lisulo M, Rise MB, Fretheim A. Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis. BMC Health Serv Res. 2012;12(1):213. http://dx.doi.org/10.1186/1472-6963-12-213. PMid:22824531.
18. Pal K, Eastwood SV, Michie S, Farmer A, Barnard ML, Peacock R, et al. Computer-based interventions to improve self-management in adults with type 2 diabetes: a systematic review and meta-analysis. Diabetes Care. 2014;37(6):1759-66. http://dx.doi.org/10.2337/dc13-1386. PMid:24855158.
19. Chrvala CA, Sherr D, Lipman RD. Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control. Patient Educ Couns. 2016;99(6):926-43. http://dx.doi.org/10.1016/j.pec.2015.11.003. PMid:26658704.
20. Mohamed A, Staite E, Ismail K, Winkley K. A systematic review of diabetes self-management education interventions for people with type 2 diabetes mellitus in the Asian Western Pacific (AWP) region. Nurs Open. 2019;6(4):1424-37. http://dx.doi.org/10.1002/nop2.340. PMid:31660170.
21. Dahal PK, Hosseinzadeh H. Association of health literacy and diabetes self-management: a systematic review. Aust J Prim Health. 2019;25(6):526-33. http://dx.doi.org/10.1071/PY19007. PMid:31710832.
22. Caruso R, Magon A, Baroni I, Dellafiore F, Arrigoni C, Pittella F, et al. Health literacy in type 2 diabetes patients: a systematic review of systematic reviews. Acta Diabetol. 2018;55(1):1-12. http://dx.doi.org/10.1007/s00592-017-1071-1. PMid:29129000.
23. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372(71):n71. http://dx.doi.org/10.1136/bmj.n71. PMid:33782057.
24. WIDER Group. [Internet]. WIDER Recommendations to Improve Reporting of the Content of Behaviour Change Interventions. WIDER Group; 2008 [cited 2020 July 1]. Available from: http://interventiondesign.co.uk/?page_id=9
25. Williams BW, Kessler HA, Williams MV. Relationship among practice change, motivation, and self-efficacy. J Contin Educ Health Prof. 2014;34(Suppl 1):S5-10. http://dx.doi.org/10.1002/chp.21235. PMid:24935884.
26. D’Souza MS, Karkada SN, Parahoo K, Venkatesaperumal R, Achora S, Cayaban ARR. Self-efficacy and self-care behaviours among adults with type 2 diabetes. Appl Nurs Res. 2017;36:25-32. http://dx.doi.org/10.1016/j.apnr.2017.05.004. PMid:28720235.
27. Dehghan H, Charkazi A, Kouchaki GM, Zadeh BP, Dehghan BA, Matlabi M, et al. General self-efficacy and diabetes management self-efficacy of diabetic patients referred to diabetes clinic of Aq Qala, North of Iran. J Diabetes Metab Disord. 2017;16(1):8. http://dx.doi.org/10.1186/s40200-016-0285-z. PMid:28239598.
28. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52(6):377-84. http://dx.doi.org/10.1136/jech.52.6.377. PMid:9764259.
29. Harris RP, Helfand W, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, et al. Current methods of the US Preventive Services Task Force: a review of the process. Am J Prev Med. 2001;20(3, Suppl):21-35. http://dx.doi.org/10.1016/S0749-3797(01)00261-6. PMid:11306229.
30. Murad MH, Mustafa RA, Schünemann HJ, Sultan S, Santesso N. Rating the certainty in evidence in the absence of a single estimate of effect. Evid Based Med. 2017;22(3):85-7. http://dx.doi.org/10.1136/ebmed-2017-110668. PMid:28320705.
31. Gerber BS, Brodsky IG, Lawless KA, Smolin LI, Arozullah AM, Smith EV, et al. Implementation and evaluation of a low-literacy diabetes education computer multimedia application. Diabetes Care. 2005;28(7):1574-80. http://dx.doi.org/10.2337/diacare.28.7.1574. PMid:15983303.
32. Kandula NR, Nsiah-Kumi PA, Makoul G, Sager J, Zei CP, Glass S, et al. The relationship between health literacy and knowledge improvement after a multimedia type 2 diabetes education program. Patient Educ Couns. 2009;75(3):321-7. http://dx.doi.org/10.1016/j.pec.2009.04.001. PMid:19395223.
33. Koonce TY, Giuse NB, Kusnoor SV, Hurley S, Ye F. A personalized approach to deliver health care information to diabetic patients in community care clinics. J Med Libr Assoc. 2015;103(3):123-30. http://dx.doi.org/10.3163/1536-5050.103.3.004. PMid:26213503.
34. Muller I, Rowsell A, Stuart B, Hayter V, Little P, Ganahl K, et al. Effects on engagement and health literacy outcomes of web-based materials promoting physical activity in people with diabetes: an international randomized trial. J Med Internet Res. 2017;19(1):e21. http://dx.doi.org/10.2196/jmir.6601. PMid:28115299.
35. Negarandeh R, Mahmoodi H, Noktehdan H, Heshmat R, Shakibazadeh E. Teach back and pictorial image educational strategies on knowledge about diabetes and medication/dietary adherence among low health literate patients with type 2 diabetes. Prim Care Diabetes. 2013;7(2):111-8. http://dx.doi.org/10.1016/j.pcd.2012.11.001. PMid:23195913.
36. Ntiri DW, Stewart M. Transformative learning intervention: effect on functional health literacy and diabetes knowledge in older African Americans. Gerontol Geriatr Educ. 2009;30(2):100-13. http://dx.doi.org/10.1080/02701960902911265. PMid:19440898.
37. Swavely D, Vorderstrasse A, Maldonado E, Eid S, Etchason J. Implementation and evaluation of a low health literacy and culturally sensitive diabetes education program. J Healthc Qual. 2013;36(6):16-23. http://dx.doi.org/10.1111/jhq.12021. PMid:23799918.
38. Wallace AS, Seligman HK, Davis TC, Schillinger D, Arnold CL, Bryant-Shilliday B, et al. Literacy-appropriate educational materials and brief counseling improve diabetes self-management. Patient Educ Couns. 2009;75(3):328-33. http://dx.doi.org/10.1016/j.pec.2008.12.017. PMid:19167857.
39. Baker DW, Williams MV, Parker RM, Gazmararian JA, Nurss J. Development of a brief test to measure functional health literacy. Patient Educ Couns. 1999;38(1):33-42. http://dx.doi.org/10.1016/S0738-3991(98)00116-5. PMid:14528569.
40. Chew LD, Griffin JM, Partin MR, Noorbaloochi S, Grill JP, Snyder A, et al. Validation of screening questions for limited health literacy in a large VA outpatient population. J Gen Intern Med. 2008;23(5):561-6. http://dx.doi.org/10.1007/s11606-008-0520-5. PMid:18335281.
41. Chew LD, Bradley KA, Boyko EJ. Brief questions to identify patients with inadequate health literacy. Fam Med. 2004;36(8):588-94. PMid:15343421.
42. Nath CR, Sylvester ST, Yasek V, Gunel E. Development and validation of a literacy assessment tool for persons with diabetes. Diabetes Educ. 2001;27(6):857-64. http://dx.doi.org/10.1177/014572170102700611. PMid:12211925.
43. Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Hess Fischl A, et al. Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. J Acad Nutr Diet. 2015;115(8):1323-34. http://dx.doi.org/10.1016/j.jand.2015.05.012. PMid:26054423.
44. Duke SAS, Colagiuri S, Colagiuri R. Individual patient education for people with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2009;1(1):CD005268. http://dx.doi.org/10.1002/14651858.CD005268. pub2. PMid:19160249.
45. Tankova T, Dakovska G, Koev D. Education and quality of life in diabetic patients. Patient Educ Couns. 2004;53(3):285-90. http://dx.doi.org/10.1016/j.pec.2003.09.013. PMid:15186865.
46. Rashed OA, Sabbah HA, Younis MZ, Kisa A, Parkash J. Diabetes education program for people with type 2 diabetes: an international perspective. Eval Program Plann. 2016;56:64-8. http://dx.doi.org/10.1016/j.evalprogplan.2016.02.002. PMid:27060766.
47. Attridge M, Creamer J, Ramsden M, Cannings-John R, Hawthorne K. Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2014;9(9):CD006424. http://dx.doi.org/10.1002/14651858.CD006424. pub3. PMid:25188210.
48. Lepard MG, Joseph AL, Agne AA, Cherrington AL. Diabetes selfmanagement interventions for adults with type 2 diabetes living in rural areas: a systematic literature review. Curr Diab Rep. 2015;15(6):608. http://dx.doi.org/10.1007/s11892-015-0608-3. PMid:25948497.
Submitted date:
03/06/2021
Accepted date:
08/04/2021