The Association between Health Literacy and Diabetes Outcomes and Self-Management Behaviors among Older Adults in the U.S

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dc.contributor.advisorDennis Thombs
dc.contributor.committeeMemberSubhash Aryal
dc.contributor.committeeMemberEmily Spence-Almaguer
dc.creatorMontoya, Maria F.
dc.date.accessioned2019-08-22T19:30:41Z
dc.date.available2019-08-22T19:30:41Z
dc.date.issued2015-08-01
dc.date.submitted2016-10-25T08:56:20-07:00
dc.description.abstractBackground: In the United States an estimated 10.9 million people aged 65 and older are living with diabetes mellitus. Previous research has found that demographic and socioeconomic factors, health status, health behaviors, and interventions are potential determinants of diabetes outcomes. Recent studies have found that limited health literacy may be a potential new determinant of diabetes outcomes. Limited health literacy is common in underrepresented and marginalized groups such as people with low economic status, low educational attainment, new immigrants, the elderly, racial and ethnic minorities, and patients with chronic conditions. Older adults are at higher risk of developing chronic complications from improper diabetes self-management and self-care. Purpose: In this dissertation, we explore the association between health literacy and diabetes outcomes and self-management behaviors among older persons with an imputed health literacy score derived from demographic information. Methods: This study is a secondary analysis of existing cross-sectional data from the National Health & Nutrition Examination Surveys (2009-2010), in the United States. The final sample consisted of 779 participants who were ≥55 years and older and diagnosed with DM by self-report or through bio-marker laboratory testing. The predictor and outcome variables were DAHL proxy health literacy score, categorized as adequate (HL [greater than] 76), marginal (HL 63-75), and inadequate (HLp = 0.66). Proxy health literacy score contributed to the prediction of fasting blood glucose in Block 2, and made a unique contribution (β=−.392; Sig F. change: p = .028) to the full model. The fully adjusted hierarchical regression models for HbA1c showed that HL did not add any variability to the model. The fully adjusted FBG model was not statistically significant. After controlling for covariates, we found that in separate hierarchical logistic regression, health literacy level, was not associated with predicting the odds of the eight indicators of proper diabetes management. Furthermore, the R2 change attributed solely to the addition of health literacy level did not exceed 2.7% for any of the logistic regression models. Conclusion: The present study supports previous findings that found no association between HbA1c, diabetes self-management behaviors and health literacy. This study found that the characteristics of individuals who were not aware of their diabetes status was higher among subjects that were younger, more educated, higher socioeconomic status and not married. More studies are needed to examine factors associated with diabetes self-management behaviors that take into account individual health literacy, diabetes knowledge, and create targeted initiatives that decrease the risk factors associated with diabetes among the aging population.
dc.format.mimetypeapplication/pdf
dc.identifier.urihttps://hdl.handle.net/20.500.12503/26014
dc.language.isoen
dc.provenance.legacyDownloads354
dc.subjectEndocrine System Diseases
dc.subjectMedical Sciences
dc.subjectMedicine and Health Sciences
dc.subjectNutritional and Metabolic Diseases
dc.subjectPublic Health
dc.subjecthealth literacy
dc.subjectolder adults
dc.subjectdiabetes management
dc.subjectNHANES 2009-20010
dc.subjectSPSS
dc.subjectregression analysis
dc.subjectsecondary data analysis
dc.titleThe Association between Health Literacy and Diabetes Outcomes and Self-Management Behaviors among Older Adults in the U.S
dc.typeDissertation
dc.type.materialtext
thesis.degree.departmentSchool of Public Health
thesis.degree.grantorUniversity of North Texas Health Science Center at Fort Worth
thesis.degree.nameDoctor of Philosophy

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