Factors Associated with Health Literacy and Self-care Behaviors among Patients with Type 2 Diabetes: A Mixed Method Study in Ko Kha District, Lampang Province, Northern Thailand

Abstract

Background: A key component for better risk factor management in improving the quality of life of type 2 diabetes mellitus (T2DM) patients is having a comprehensive understanding of the relevant health information. This study examined diabetes health literacy (HL), self-care behaviors and associated factors among T2DM patients in a community in Lampang Province, Northern Thailand. Methods: A cross-sectional study was conducted among 183 T2DM patients. Data on sociodemographic variables, diabetes HL and self-care behavior were collected using questionnaires and in-depth interviews. In order to identify factors significantly associated with HL and self-care practices, an ordinal logistic regression analysis was employed. For qualitative data analysis, the data was analyzed using thematic analysis. Results: Twenty three percent of the participants had high levels of overall HL, while 85.8 % had high levels of self-care practice. There was an association between HL and education (AOR ¼ 6.5; 95 % CI ¼ 2.8e15.3; p < 0.001) and being a member of village health volunteers (AOR ¼ 3.0; 95 % CI ¼ 1.1e8.0; p ¼ 0.029). Self-care behaviors were associated with age (AOR ¼ 4.4; 95 % CI ¼ 1.6e11.6; p ¼ 0.003). Barriers regarding self-care behavioral practices included lack of self-control, physical condition and culture. Diabetes HL was not directly affected by self-care behaviors. Conclusion: The findings revealed that only one fourth of the T2DM patients had high levels of overall diabetes HL, but most of them had high levels of self-care behavioral practices. Healthcare providers should conduct specialized HL, self-efficacy and social support promotion programs that have been designed to develop self-care behaviors in patients with T2DM.