| Objectives:1.Based on the theory of NUT-BEAM stratification of health literacy,combined with the research group’s understanding of the specific connotation of health literacy in Type 2 Diabetes Mellitus(T2DM),a Type 2 Diabetes health literacy questionnaire was developed.This scale can specifically and comprehensively evaluate the level of health literacy of Chinese patients with T2 DM.The aim is to provide an assessment tool for medical workers to quickly evaluate the health literacy of patients with T2 DM,and to meet the needs of fast-paced clinical work.2.Three scales were used to evaluate the status quo of health literacy,selfmanagement and emotional distress in T2 DM patients,and to explore the mediating effect of health literacy on emotional distress and self-management in T2 DM patients.The aim is to provide new ideas for medical staff,that is,to reduce the negative impact of emotional distress on self-management of T2 DM patients from the perspective of improving their health literacy.Methods:1.Through literature research,major databases at home and abroad were searched to define the definition,connotation and measurement indexes of health literacy of T2 DM patients.Based on the existing health literacy evaluation tools at home and abroad,the health literacy stratification model of NUT-BEAM was used as the theoretical framework to preliminarily construct the item pool of the health literacy scale for T2 DM patients.2.The Delphi expert consultation method was adopted to invite a total of 12 experts and scholars in the fields of endocrinology and metabolism,public health,nursing management and nursing education,etc.After two rounds of consultation by experts and scholars,the research group improved the dimension and item content of the scale based on the expert opinions.In addition,30 patients were randomly preinvestigated in the department,and their filling feelings were polished to form a survey scale.3.A total of 223 patients with T2 DM were investigated by questionnaire in 3 level-A hospitals of Zhenjiang City,and the survey data were analyzed.The item analysis method was mainly used to delete the relevant unsuitable items,and factor analysis method was used to obtain the main dimensions and related items.Cronbach’s acoefficient and the scale items were divided into two parts,and the measurement was divided into half reliability to represent the overall reliability of the scale.The scale validity mainly adopted content validity and structure validity.4.239 patients with T2 DM were investigated by using the T2 DM Health Literacy Scale,the Diabetes-related Emotional Distress Scale and the Diabetes Selfmanagement Scale.AMOS 24.0 software was used to establish a structural equation model based on Pearson correlation analysis results to verify the partial mediating effect of health literacy on emotional distress and self-management behavior in T2 DM.Results:1.The final established T2 DM health literacy scale includes 3 dimensions and 19 items.2.The content validity index of the total scale is 0.972,the content validity of each item is 0.83 to 1.00,the Cronbach’s a coefficient is 0.945,and the Cronbach’s acoefficient of each dimension is 0.894,0.909,0.877,and the half-fold reliability is0.898,test-retest reliability of 0.933,test-retest reliability of each dimension is0.717～0.937.3.The level of health literacy in T2 DM patients was 61.91±15.60 points.Pearson correlation analysis showed that there was a negative correlation between emotional distress and self-management behavior(r=-0.352,P < 0.001),and there was also a negative correlation between health literacy and emotional distress(r=-0.479,P<0.001),the higher the level of emotional distress,the lower the health literacy and the worse the self-management behavior.Health literacy was positively correlated with self-management(r=0.345,P<0.001).In the mediating test,health literacy was the mediating variable of T2 DM patients’ related emotional distress and self-management behavior,and the mediating effect accounted for 41.67% of the total effect.Conclusion:1.The T2 DM Health Literacy Survey Scale was developed,which included 19 items in three dimensions: functional,interactive and critical health literacy.2.The established T2 DM health literacy scale has good reliability and validity,and can be used to evaluate the health literacy level of T2 DM patients in clinical work.3.Health literacy had a partial mediating effect on the relationship between emotional distress and self-management in T2 DM patients.Clinical workers should pay attention to improving the health literacy of T2 DM patients with emotional distress,so as to regulate the self-management behavior of patients. |
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