| BackgroundThe incidence of diabetes has been rising all over the world in recent years,China has the largest number of diabetic patients in the world.Diabetes mellitus was characterized by long course,difficult to cure and many complications,which not only brings harm to patients' quality of life,but also increases patients' medical expenses.With the increasing number of patients,it also brings heavy medical costs to the society.Therefore,it was necessary to have a further study on how to improve the quality of life of diabetic patients and reduce their direct medical costs.Health literacy has been proved to be closely related to individual quality of life and the efficiency of medical service utilization by previous studies.However,the research on health literacy in China is relatively late,and the research on health literacy of diabetic patients is mostly from the clinical perspective,such as influencing factors or the correlation with complications.Further research about The correlation between health literacy and quality of life,direct medical costs,and related policy recommendations for type 2 diabetes mellitus in community was needed.ObjectivesBased on the quantitative measurement of health literacy,quality of life and direct medical cost of type 2 diabetic patients in community,the status of health literacy,quality of life and direct medical cost of diabetic patients were discovered,and the impact of patients' health literacy on their quality of life and direct medical cost were analyzed.To provide theoretical and evidential support for formulating intervention plans to improve the health literacy of patients with type 2 diabetes mellitus,improve their quality of life,and further reduce the economic burden of patients and social diseases.MethodsA cross-sectional survey was conducted.Two-stage sampling method was used to randomly select 300 patients with type 2 diabetes mellitus from two community health service centers in a city.Survey tools include diabetic general situation questionnaire,family concern index questionnaire,health literacy management scale,EQ-5D scale and direct medical cost questionnaire.Descriptive statistical analysis,independent sample t test,non-parametric test,one-way ANOVA,optimal scale regression and correlation test were used to analyze the data.Results1.Health literacy includes four dimensions: information acquisition ability,communication and interaction ability,willingness to improve health and willingness to pay.If the total score of patients or each dimension exceeds 80% of the total score or the total score of that dimension,patients have health literacy and the ability of corresponding dimensions.The total score of health literacy of 300 patients with type 2 diabetes mellitus in the investigated community was 94.39±14.94.Among them,162 people had health literacy,accounting for 54% of the total number,indicating that the overall level of health literacy of patients was low.The dimension with the highest possession rate of patients was the dimension of improving health willingness(72.7% of patients possessed),and the dimension with the lowest possession rate was the dimension of information acquisition ability(52.3% of patients possessed).2.The total score of quality of life of type 2 diabetes mellitus in the community was 0.850±0.14.Quality of life included five dimensions: action ability,self-care,daily activities,pain/discomfort and anxiety/depression.Most patients in the study had no difficulty in five dimensions.Patients with difficulty were mostly concentrated in the two dimensions:action ability(40.3% of patients had difficulty)and anxiety/depression(34.3% of patients had difficulty),while the patients with difficulty in the "self-care" dimension were the least(11% of patients had difficulty).The self-rating score of patients' quality of life(VAS)was 76.93±12.16.3.The direct medical cost of type 2 diabetes mellitus in community was 3482.5(1603,7625.75)yuan,including outpatient expenses522.5(202.5,1019)yuan,hospitalization expenses1600(0,6000)yuan,self-paid drug expenses400(0,920)yuan and equipment expenses187.5(0,200)yuan.4.There were significant differences in the scores of quality of life among patients with different ages,marital status,educational level,current or pre-retirement work,family care,diagnostic approach,blood sugar detection methods,the number of other diseases and the community medical consortium cooperation.There were significant differences in health self-assessment scores among patients with different gender,age,marital status,education level,current or pre-retirement work,family care,family history of diabetes,diagnostic approaches,blood glucose detection methods,frequency of blood glucose detection,number of other diseases and community medical consortium cooperation.There were significant differences in direct medical costs among patients of different nationalities,ages,educational levels,current or pre-retirement work,family care,family history of diabetes mellitus,diagnostic approaches,blood glucose detection methods,blood glucose detection frequency and community medical consortium cooperation.5.The level of health literacy was positively correlated with the quality of life(r = 0.681,P < 0.001)and the score of self-assessment of health(r = 0.700,P < 0.001),All dimensions of health literacy were positively correlated with quality of life and self-rating scores of health;The level of health literacy was negatively correlated with the direct medical cost(r=-0.423,P < 0.001),and the level of health literacy was positively correlated with outpatient expenses(r=0.416,P < 0.001),while the level of health literacy was negatively correlated with hospitalization expenses(r=-0.510,P < 0.001).6.The influencing factors of patients' quality of life were health literacy score,age,marital status,educational level,current or previous occupation,family care,community medical consortium cooperation.The influencing factors of health self-assessment scores were health literacy score,sex,age,marital status,educational level,current or previous occupation,family care,diagnostic approach,community medical consortium cooperation.The independent influencing factors of patients' direct medical cost were health literacy score,Ethnicity,Occupation,Frequency of Blood Glucose Detection and community medical consortium cooperation.Conclusions1.The overall level of quality of life of patients with type 2 diabetes in community was low,and the direct medical cost of diseases is mainly composed of hospitalization fees.2.There was a significant positive correlation between patients' health literacy and quality of life,There is a strong correlation between dimension of information acquisition ability,dimension of communication and interaction ability and quality of life.3.There was a significant negative correlation between health literacy and direct medical cost in community type 2 diabetes mellitus patients.4.Health literacy of type 2 diabetes mellitus patients in community is an important factor influencing both quality of life and direct medical cost.Implication1.Pay attention to improving patients' health literacy and formulate personalized health promotion strategies2.Improving the utilization efficiency of patients' health information3.Emphasis on the impact of community medical cooperation on patients' quality of life and direct medical costs4.Focus on health promotion for patients with low health literacy5.Popularize patients' health literacy assessment... |
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