1. Discussion & Conclusion
Health Literacy and Physical Activity among Soon-to-be-aged and Older Patients with
Type II Diabetes: A Systematic Review
Leung AYM, Lam MHS, Chan SSC
School of Nursing, The University of Hong Kong, Hong Kong SAR, China.
Results
Background
1) A total of 11 studies (5 interventional studies and 6 cross-sectional studies) which met the inclusion criteria were identified.
2) HL intervention is effective to arouse STBA and older adults with T2DM to do PA. Though no direct relationship between HL and PA was found in the cross-sectional study, factors like self-efficacy (SE) and social support (SS) which affect the relationship of HL and PA were identified (refer to Figure 2).
Physical activity (PA), an effective but the least compliant self-management behavior on soon-to-be-aged (STBA) and older adults with type 2 diabetes mellitus (T2DM) was under-investigated. Different strategies were used to maintain the persistency of patients to do PA; however, the effects were inconsistent. Health literacy (HL) has been considered by the Office of Surgeon General of United States Department of Health and Human Services as one of the four public health priorities. It is defined as the ability to obtain process and understand the basic information needed to make appropriate health decisions. Though HL was regarded as the first step in self-management behaviors and ultimately affecting the glycemic control of T2DM, studies on HL and PA were scarce.
Discussion & Conclusion
The relationship between HL and PA
1) HL was not associated with PA in cross-sectional studies and;
2) The effects of HL intervention on PA was confirmed. People with higher HL performed better in PA behaviors while HL education was supported to be an effective tool to boost up the HL and the PA especially for the patients with lower HL levels and such PA behavioral changes accelerated with the duration of HL interventions (refer to Figure 2).
Self Efficacy
SE was the most frequently investigated factor between HL and health behaviors including PA no matter in cross-sectional studies or interventional studies. Studies showed that the association between SE and PA was consistent across different HL levels (refer to Figure 2).
Social Support
The role of SS on the relationship between HL and self-management behaviors was confirmed with the cross-sectional structural equation modeling. Different from the other ten studies located, this is the only study which excluded PA as one of the self-management behaviors, as PA was not strong enough to be included in the specific population of this study. Future studies should focus more on the effect of SS on the relationship between HL and PA (refer to Figure 2).
Limitation
1) limited to the “full text” articles published in English in eight academic databases.
2) The generalizability of the findings was limited by few defects.
Firstly, ten out of eleven studies were from USA.
Secondly, some studies were conducted in local site with non-representative samples.
Thirdly, though validated, reliable and comparable instruments were used to measure different outcomes, different studies and different countries used similar but not the same instruments, for example, when measuring health literacy, REALM, REALM –R, C-S-TOFHLA , DNT, S-TOFHLA were used in different studies and countries; when measuring self efficacy, IMDSES, DSES, PDSMS were utilized and; when measuring knowledge, DKQ, Patients’ knowledge of diabetes were utilized.
3) As the relationship between HL and self-management behaviors was under-investigated, low number of studies with PA and HL were identified.
Conclusion
Evidence of interventional studies suggested that HL would be effective to intervene the behavior of PA of STBA and older adults with T2DM. Factors affecting the association between HL and PA were identified, so that the future studies should take these factors into consideration when designing the cross-sectional or interventional studies.
Objective
The aim of this study is to identify the relationship between HL and PA on STBA and older adults with T2DM
Methodology
Study Design
Systematic Review
Methods
Studies published between 1990 and 2010 and written in English were identified in Medline, PubMed, CINAHL, PsycINFO, Proquest, SportDISCUS, ISI Web of Science and ERIC. Key search terms included health literacy, literacy, numeracy, reading ability, Rapid Estimate of Adult Literacy in Medicine, Test of Functional Health Literacy in Adults Wide Range Achievement Test, Diabetes Numeracy Test , type 2 diabetes mellitus, T2DM, older adult, older people, senior, elderly, elder, geriatric, aged, soon-to-be-aged, middle aged, physical activity, exercise, physical exercise, Tai Chi, walking, brisk walking, strength training, aerobic exercise, running, aquatic exercise, self management, self care, compliance and Summary of Diabetes Self-Care Activities . The inclusion and exclusion criteria is stated in Table 1. For the process of screening, please refer to Figure 1. The systematic review was conducted from November, 2010 to Feburary, 2011 and was updated in March 2011.
Significances
This study provides a foundation for the implementation of a new diabetes management approach on STBA and older Chinese adults with T2DM, specifically, improving the least compliant self-care behaviour of T2DM, PA, through understanding the relationship between HL and PA and the factors affecting this relationship.