Academic Master

Health Care

Health Literacy and Compliance with Diabetes Treatment Therapy

Abstract

There are several chronic diseases like diabetes that require patient literacy for control of illness and to prevent further adverse effects. Patient literacy is also important to recognize the behavioral deviations vital for active participation in the handling of disease and acceptance of diagnosis. (American Diabetes Association, 2017). National Adult Literacy Survey mentioned a deficiency of appropriate reading skills among 46-51% citizens of US (Kirsch, Jungeblut, & Jenkins, 1993). It was also noticed by the physicians that 35% of the native English patients lack literacy abilities to comprehend the literature related to their disease (Williams, Parker, & Baker, 1995). The patients do not recognize the symptoms of lower glucose level as feeling sweaty, hungry and shaky due to lack of health literacy and 62% of the patients are unaware of the treatment of this condition. The problems related to the education of patients with inadequate health literacy cannot be ignored. Patients can be directly involved in the development of educational materials, and this step can empower them for improvement of their health through effective education with the help of the designed content (Rudd & Comings, 1994). This study will evaluate that how the low health literacy is causing the health issues for the diabetic patients and what interventions can be useful for such patients.

Introduction

The public health liability of chronic diseases is increasing globally and needs to be managed effectively at the universal level. A range of generic tactics had been identified that could be implemented for the management of chronic diseases like diabetes (Davis, Wagner, & Groves, 2000).These strategies included education as a first pre-requisite, with a vibrant objective of improving the dynamic contribution of patients to make them partners in the health care practice. This model arose due to the realization of health care providers that the patients are customers as well as producers of health care (Holman & Lorig, 2000). So, the model highlights the obvious role of patients in the prevention and control of chronic diseases along with the health care providers. This role can be played actively by patients if they are aware of their disease and resourceful enough to question medical findings (Ha & Longnecker, 2010). The concept of patient health literacy and empowerment is used excessively in new medical settings, throughout the world, as it can help a lot to attain control of the chronic diseases.

The control of chronic diseases is complex as in the case of diabetes; it requires a lot of treatments along with the health literacy to control the disease. It was seen that some treatments are more effective, but without health education and involvement of the patients, no treatment can produce highly efficient outcomes (Mulrow & Pugh, 1995). So, it can be said that the management of diabetes is interdependent on three main elements:

  • Education and provision for self-management (with a decrease of lifestyle risk issues).
  • Effective drug usage strategies for sustaining normal blood glucose as well as lipid levels, and normal blood pressure.
  • Operative surveillance for prompt detection and management of complications.

Health literacy

Health education means the patient’s capability to read out and comprehend curative instructions make proper choices for best health results (Ramage-Morin, 2009). Health education is quite different from regular education it consists on the instantaneous capability to read out, to completely comprehend health directions and to follow instructions regarding medicine and treatment. Nowadays, there has been a developing concentration towards health education because several people are less aware of health education (Zarcadoolas & Pleasant, 2005). There is also an increasing interest which may reduce the expenses of adults, culturally different subgroups and senior citizens of North America facing maximum frequency of less health education (Kickbusch, Pelikan, & Tsouros, 2013).

With the passage of time, the responsibility of doctor moved forwards from writing prescriptions and treatment based instructions to the patient; doctors must be able to make sure that patients can empathize all stages of health education and can keep a check on their medicines and patients can choose their medicine evenly. Nearly half of the population of North Americans consume one suggested medicine in at least, and 53% adults residing in foundations, and 13% inhabiting in societies use five or more medicines (Ernst & Grizzle, 2001). For patients at home, it is important to make sure to be well aware of curative instructions and correct medicinal schedules to be followed. Thus, good interaction among doctors and patients is essential for reliable and fruitful results of curative treatment.

Therapeutic instructions and health literacy

Usually, people with less health education have a level of reading of fifth-grade, but curative instructions are often organized in a way directed to people who can read at a level of tenth grade (Safeer & Keenan, 2005).As recent medicinal instructions are so hard to realize, less health aware people are in a great danger of misunderstanding suggested labeled information, prescribed amount, time, quantity, precautionary measures, written instructions and the doctor’s instructions to the patient (Crouch, Wills, Miller, & Abdehou, 1990).Patients who try to comprehend curative instructions are most probable to be incapable to self-control their health and make suitable choices for health. There is a great difference between the levels of ability need to realize present medicinal instructions and the certain level of realization in patients with less health awareness. Health education is important for people to completely realize, accomplish and converse own health requirements and retain health quality. Sufficient health awareness can make people able to self-control their health and to follow health instructions in their routine life (Goodall & Halford, 1991). Health education is linked with health results. Less health awareness is not only shared but also connected with bad health results, greater use of hospital services, increased death rate, and high risk of mistakes in curative treatment and less compliance regarding treatment (Crouch, Wills, Miller, & Abdehou, 1990).

Furthermore, a scientific analysis explores that less health awareness results in about 3-5% of entire health care expenditures according to an annual report. A research organized by Schillinger et. al., (2003) discovered the association among health awareness and its positive effects in patients who have type 2 diabetes. After getting a hold over different social attributes, indications of depression, support from family and friends, course of therapy and long-term diabetes, less health awareness records were automatically lead to inadequate glycemic management, and the people less literate about health were more possible to fail in controlling glycemic level as compared to those who are sufficiently aware of health education (Schillinger, 2003).

Health Literacy and Patient Awareness

There are several chronic diseases like diabetes that require patient literacy for control of illness and to prevent further adverse effects. It’s crucial for such patients to be literate enough to understand their medicinal routine and lifestyle management according to the need. The diabetic patients have educational requirements to understand the complexities of diabetic nutrition, insulin injection, and monitoring of glucose level at home. Patient literacy is also important to recognize the behavioral deviations vital for active participation in the handling of disease and acceptance of diagnosis. (American Diabetes Association, 2017). Traditional education mainly relies on the written resources of disease management and care instructions for patients, most of them have extensive information about the disease, cures, and prevention. But most of the material is of professional level and is difficult to be understood by less-educated patients. So, these efforts could not bring any improvement in patients understanding and attitudes towards the disease. So, the patients with inadequate education are not benefited from these efforts, and the patient educational programs remain unsuccessful (Crouch, Wills, Miller, & Abdehou, 1990).

National Adult Literacy Survey mentioned a deficiency of appropriate reading skills among 46-51% citizens of US (Kirsch, Jungeblut, & Jenkins, 1993). It was also noticed by the physicians that 35% of the native English patients lack literacy abilities to comprehend the literature related to their disease (Williams, Parker, & Baker, 1995). Poor health status is also related to literacy skills, and patients have a greater need for education due to worse health conditions to self-regulate their health status. The knowledge of chronic illness like diabetes is important for patients as it is prevalent disease requiring daily attention (Goodall & Halford, 1991).

Insufficient knowledge of the indications of hypoglycemia and its management is mentioned to be life-threatening in several cases. The patients do not recognize the symptoms of lower glucose level as feeling sweaty, hungry and shaky due to lack of health literacy and 62% of the patients are unaware of the treatment of this condition.

Effective knowledge is a crucial aspect of patient literacy programs, and studies had shown that inadequate functional health education was observed among patients who had attended the educational programs related to diabetes. They were not aware of the basic information and self-regulatory skills regarding their disease. So the major concern of health care agencies is an improvement of patient knowledge to increase compliance with disease therapy. This improved compliance with appointments of health care and medications is largely associated with the patient’s benefit (Brown, 1990). Adherence to the medical therapy and advice is another important aspect of these educational courses. It was mentioned by some previous studies that compliance and adherence are associated with improved results among diabetic patients (Kravitz, et al., 1993). Research done at Grady Memorial Hospital declared that along with access to complications, ineffective self-care abilities to manage diabetes were one main cause of diabetic keto acidosis among patients (Musey, et al., 1995).

The problems related to the education of patients with inadequate health literacy cannot be ignored. The Joint Commission on Accreditation of Health Care Organizations directed that health establishments and hospitals should provide education comprehensible  by patients, evaluate patients’ knowledge, and certify such educational struggles (Organizations, 1993).

Moreover, Healthy People 2000 set objectives that nonetheless 75% of individuals with diabetes get an education on diabetes (US Dept of Health and Human Services, 1991).Patients’ functional health literacy must be deliberated when trying to grasp these objectives. Though, no meek process of recognizing low-literate patients subsists, and the substantial shame allied with illiteracy repeatedly makes them conceal their incapacity (Parikh, Parker, & Baker, 1996). Patients can be directly involved in the development of educational materials, and this step can empower them for improvement of their health through effective education with the help of the designed content (Rudd & Comings, 1994). The prospect of patient instruction requires originality and assurance of essential resources to improve health effects for low-literate patients suffering from chronic diseases.

Diabetes

Diabetes Mellitus is a common health condition affecting individuals, as well as the society. Diabetes affects many communities in the U.S. as well as other parts of the world. Diabetes can be managed; however, the existing treatment options require patient’s full engagement in the treatment plan by complying to manage their blood sugar levels. According to the American Diabetes Association report (2014), as at 2012, a total of 29.1 million people or 9.3% of the American population had diabetes. Also according to the report, among the 21.0 million cases, 8.1 million people equivalent to 27.8 percent of the diabetes cases were un-diagnosed. There are significant associations between diabetes complications and other major issues such as premature death, diminished quality of life, decreased life expectancy (Chinenye & Opera, 2014), increased preventable hospital visits, high use of emergency departments, and multiple hospital readmissions. Poor health literacy according to Safeer, Cooke, and Keenan, (2006) has a significant association between treatment noncompliance and poor health status (Saffer, Cooke, & Keenan, 2006).

The frequency of DM is increasing worldwide and is regarded as the main health problem. The figures are increasing as in 2015 IDF reported, 415 million adult individuals were diagnosed with diabetes that is about one in every 11 individuals, and according to estimates, the figure will increase to 642 million until 2040 more than 50% as compared to today’s figure. It is one of the major causes of death in developing countries and resulted in 4.6 million fatalities globally in 2011. Diabetes caused about 5 million deaths in 2015, which means one death in every 6 seconds. Moreover, impaired glucose tolerance was reported in 318 million people, and about 21 million ladies developed gestational diabetes. The majority of reported cases are related to type 2 DM, and most of the people suffering from the disease are in age range of 40-59 years (International Diabetes Federation IDF, 2015).

DM is increasing globally, and the increase is related to hypertension as well as obesity. In the last few years in the US the frequency of adults 40-74 years, with BMI of ≥30 kg/m2 increased from 28-36% and the obesity problem rose due to lack of physical activity. Diabetic patients are recommended exercise, improved diet, healthier lifestyle and strong clinical schedule. In past era, DM was common in elders over 40 years of age, but now it is becoming common in adolescents, and children as well due to lack of physical activity, obesity, and unhealthy eating styles (Vivian, 2006). Many of the patients failed to control their disease with the help of diet, exercise, and pharmacotherapy. So, an appropriate level of literacy is required along with these practices to help them to prevent and control the disease. Adherence of patients to drugs, lifestyle changes and prescribed schedule and routine due to literacy programs related to disease could show better results.

Acquisition of diabetes literacy advocates for the need to establish the relationship between diabetes management and health literacy. American Association of Diabetes Educators (2013) established that literacy skills are high for most Americans living with diabetes.  According to their report, lack of health literacy has been blamed for creating a vacuum as regards to the attitude of most diabetes patients to manage the disease. Previous researchers have identified the positive correlation between health literacy and self-diabetes management. These studies include patient behavior about self-management and have concluded that adequate health literacy is central to achieving diabetic control. Comparable research carried out in Europe and established the same results (Van den Broucke, et al., 2014). The different implications of these study efforts in diabetic control, however, call for the adoption of more available techniques. One such area that needs comprehensive exploration is the design of interventions that can efficiently accommodate low health literacy that is largely represented in the 27.8 percent un-diagnosed cases. This includes identifying and determining the efficacy of techniques that can cater for the needs of patients with low health literacy, in a bid to enhance the health outcomes of diabetes therapies (Kim & Lee, 2016).

Needs of diabetic patients

A main challenge for physicians and health care providers is to address the continual needs and requirements of patients with chronic diseases like diabetes. Regular fellow-up of patients along with health care workers is important for controlling the complications which are chronic in nature. It was reported by studies that progression of problems linked with diabetes can be delayed or prevented by exacting metabolic control (Wagner, et al., 2001). Proper glycemic control is not a single need of diabetic patients but prevention of complications, infirmity limitation and reintegration is also needed. Some studies revealed that lack of adherence to treatment schedules is a result of poor health-related literacy among public. In current era, due to the introduction of blood glucose monitoring at home and extensive usage of glycosylated hemoglobin for indication of metabolic control, the main responsibility is shifted towards patients (Glasgow, et al., 2001). It was also mentioned that health care professionals have a crucial role in developing patient’s understanding of fluctuations in blood glucose level for self-regulatory actions (Peel, Douglas, & Lawton, 2007).

Self-care in diabetes

In diabetes self-management is described as a developing procedure of improvement of education by understanding to continue to exist with the complicated nature of diabetes in a social background (Cooper, Booth, & Gill, 2003). Due to the increasing familiarity of concentration towards diabetes treatment is managed by patients or their relatives, it is essential to take consistent and effective measure for self-control on diabetes (McNabb, 1997). There are seven basic self-management actions must present in patients suffering from diabetes which results in positive consequences.

These seven behaviors are: healthy eating habits, must be active in routine life, constant keep in check on blood glucose, acquiescence with treatment, abilities to deal with risk-factors, ability to follow health instructions and issue resolving skills. These suggested advises are effective for both physicians and instructors handling patients for scientists finding new strategies regarding care. Self-management is the most operative and economical attitude to self-management evaluation and thus it mostly seen unreliable. Diabetes self-management deeds are measures taken by patients to overcome the rate of diabetes by self-control, suffering from diabetes or in a great risk of diabetes (American Association of Diabetes Educators, 2008).

These seven activities seem to be effective in glycemic control, to reduce problems and progressive developments in quality of life. Moreover, it was noticed that self-management involves not only carrying out these actions but also the collaboration between them. Diabetes self-management needs various nutritional and lifestyle changes in patient accompanied by the helpful part of health care team for keeping a superior level of self-assurance directed to a positive change in performance (Shobhana, Begum, & Vijay, 1999).

Diabetes self-management instruction

As genetics serve a lot in the expansion of diabetes, different researches have exhibit the significance of environmental effects. Patients suffering from diabetes have been presented to make an intense effect on the evolution and improvement of their disease by taking care of themselves. This contribution proves fruitful only if the diabetic patients and physicians are well educated about handling this disease and taking good care of the patient.It is assumed that the people well aware about health care may well empathize different stages of the disease and have positive effects on the improvement and complexities of this disease (McNabb, 1997).

The American Association of Clinical Endocrinologists lays emphasis on the significance of patients useful and well-infirmed contribution regarding self-care. Similarly, World Health Organization also acknowledged the worth of patient’s knowledge to take their disease under control (Hendra & Sinclair, 1997). The American Diabetes Association had evaluated the principles of diabetes self-control knowledge and discover that the people not well aware of the self-management strategies are supposed to face more diabetic complexities as compare to others. A more comprehensive evaluation of self-care knowledge in adults who have type 2 diabetes discovered progress in glycemic control at early stages. But the noticed progress decreased in about three months after the termination of involvement, recommended that permanent knowledge is required for better results (Williams, Freedman, & Deci, 1998). An analysis of diabetes self-care knowledge shows that awareness is effective in decreasing glycosylated hemoglobin level.

Diabetes self-care actions

Awareness about diabetes is essential but the most, important thing is to practically follow self-care instructions to help the patient effectively. The self-care actions involve health diet plan, escaping food with high fat, routine exercise, self-check on glucose level, and taking good care of feet (Glasgow & Strycker, 2000). The most important objective of diabetes self-care is to reduce the glycosylated hemoglobin level but it can’t, be the single goal to achieve in the care of a diabetic patient. Variation in self-management deeds must be valued for development regarding conduct modification (Walker, 1999). In diabetes care self-check on glucose level is an important task which make sure the patients contribution in realizing and preserving definite goals regarding glucose level.

The main purpose of screening is the evaluation of entire glycemic management and introduction of proper moves in right time to get maximum control. Self-screening helps to be up-to-date about glycemic level, enables to suggest suitable treatment and diet plan, exercise and medicine, to take to take good control on glycemic level. Regardless of reduction in a weight, carrying out exercise on daily basis discovered to be linked to positive health results in diabetic patients (American Association of Diabetes Educators, 2008). The National Institute of Health and the American College of Sports Medicine suggested that all adults comprising those who are suffering from diabetes, must take part in exercise on daily basis (United States Department of Health and Human Service, 2008).

Compliance with self-care activities

A large number of researches had been organized in this field but accord with a cure in diabetic patients is quite important and a point of worry for health researcher and medical investigators. In people who have diabetes, patients are assumed to obey all the recommended instructions regarding their routine life to take diabetes under control. These instructions take in suitable lifestyle conduct, along with obeying a suggested diet plan and participating in proper routine exercise, taking medicines in time as suggested by the physician, checking blood sugar level, keep in check disease symptoms, taking good care of foot by following instructions and search for independent health care concerning diabetes or other health issues (Goodall & Halford, 1991). The suggested treatment is further facilitated if required to add all these behavioral actions to the routine life of a patient.

Diabetes self-management education (DSME) is an important part of care for individuals who have diabetes, and it is also essential for patient’s recovery. The National Standards of DSME are recommended to explain better self-management attentiveness about diabetes and to help diabetes trainers in different ways to spread proof-based knowledge. Due to the continuously changing elements of health care and researches concerning diabetes, these Standards are reassessed and reexamined after every five years by main establishments and governmental organizations in the diabetes awareness group. A Task Force was organized by the unison of American Association of Diabetes Educators and the American Diabetes Association in the summer time of 2016. Other groups included are the American Dietetic Association, the Veteran’s Health Administration, the Centers for Disease Control and Preventionand the American Pharmaceutical Association. Participants of the force comprised of a person who has diabetes; some health facilities scientist, registered nurses,dietitians and a chemist. They have a task of reassessing the present DSME standards for their accuracy, significance and logical basis. (Funnel, 2009).

Definitions

According to US Institute of Medicine, health literacy is the extent to which an individual can gain, process and comprehend the basic information related to health and services required to take proper health decisions (Nielsen-Bohlman, Panzer, & Kindig, 2004).

Compliance, and adherence are the terms that are commonly used to define the degree of which an individual or a patient follows the recommended medication and the aspects that can have a main effect on the treatment outcomes (WHO, 2003).

Adherence

Adherence was well-defined by WHO as the degree to which the behavior of a patient corresponds to the recommendations of the doctor, regarding diet plan, medicines, and lifestyle alterations in the case of chronic diseases (WHO, 2003).

Compliance

Compliance is a term which is sometimes synonymously used with adherence, and it is measured regarding administered doses of medication as a percentage of recommended doses for a specific period (Breitscheidel, Stamenitis, & Schöffski, 2010). But it is different from adherence as do not require the agreement of the the patient to recommendations.

Statement of Problem:

In the United States, Diabetes has become the leading cause of death and also becoming the cause of other chronic diseases, such as blood pressure, obesity, and anxiety. Especially older adults have been affected by this disease more as compared to the younger. However, Diabetes has become the issue of great concern. Also, diabetes has become the leading cause of complications like blindness, nephropathy, amputations, higher rates of hospitalizations, retinopathy, and great mortality risks. Now the proper medication and great care is the only way which can help the patients to overcome these complications and to control their sugar level of the body.

Diabetic patients can control their diabetes by self-monitoring, self-caring, proper medication, monthly basis checkup, and proper exercise. The diabetes patients must also take care of their diet and must inject proper insulin to maintain the sugar level of their body. This will not only control their sugar level but also keep them healthy. For this all caring procedure, proper knowledge about diet and medicine dose is required. This means that if the diabetic patients are aware of the calories in their diet and the way of injecting insulin, then they will be able to deal with their disease in a best possible way. Also, by making them aware of the exercise schedule and self-monitoring, the disease can be controlled. It means that literacy plays a vital role in controlling diabetes. It is also observed by the research that patients with low literacy may have difficulty in learning self-care skills and in improving glycemic control. The diabetic patients must have health literacy to control their sugar level, to have a healthy diet plan, to have better exercise schedule, and have better knowledge of self-monitoring. Health literacy will make the patient able to understand the better time to check their sugar level, to avoid the food having more calories and sugar, to have better exercise and walk pattern, to have better self-care in the case of high sugar or low sugar level of the body. This study will evaluate that how the literacy compliance with diabetic treatment therapy.

Significance of Study

The significance of the present study is that it will evaluate that either health literacy is more important for the older diabetic patients than, the younger patients to have better diabetic treatment therapy or health literacy plays same role for both older diabetic patients and younger diabetic patients? It will evaluate the relationship between the health literacy and the Diabetes control. The major issue is that there is no cure for diabetes and the only solution to this problem is to control diabetes by self-monitoring, self-caring, proper medication, monthly basis checkup, and proper exercise.

Theoretical and Conceptual Perspective

Health literacy is limited among diabetic patients in US, which increases the threats of worsening of the disease due to poor health condition handling. Current study focuses on the obvious role of patients in the prevention and control of chronic diseases along with the health care providers. This role can be played actively by patients if they are aware of their disease and resourceful enough to handle their disease (Ha & Longnecker, 2010).  The primary means of information gathering enlisted are the research works found on the online libraries as well as products publically available on open sources like American Diabetes Association accumulated data, Health and Adult Literacy Survey (HALS), and articles from MEDLINE, CINAHL, Psyc INFO, PUBMED, Walden library databases and other reliable internet sources. This paper dissects the multiple layers of the impact of health literacy on the patient’s compliance with diabetic treatment and routine. It explains the importance of health awareness in patients of chronic diseases especially diabetes. The significance of health literacy related to diabetes was discussed in detail with reference to the patients of different age groups such as the younger between the age 12-18, adults, 18-30, and then the aged people between the age 30 and 60.

As diabetic patients need great self-maintenance, self-control awareness is generally suggested to increase the success ratio and reduce the expenditures of cure. Though a large number of diabetes self-management (DSM) plans are present, but the required conditions for their active employment were not described clearly. In this paper we analyze the work on implementation fidelity (IF), the extent to which these plans are presented as envisioned, as an element inspiring the efficacy of diabetes knowledge. Medical, psychological and knowledge based study records will be explored to find available researches on diabetes knowledge explaining the application method. Studies describing the intervention, compliance, fidelity, reliability were involved to evaluate the basic factors of IF were focused. From early 418 abstracts, 20 printed papers were reserved for a deep evaluation concentrating on the factors of IF. Intervention element was primarily analyzed through examination; however, intervention amount was evaluated through self-report method.

The cure for diabetes is not present, but it can be controlled through proper medication, healthy diet and some variations in everyday life. The study explores that self-control of diabetes through diet is effective for people having social and financial complications. The basic purpose of our research is to assess the theory that social and financial factors greatly affect the variation in diet after the identification of diabetes. The important factors which employ an effect on nutritional variation were the extent of knowledge of patients who have diabetes and may or may not belong to a family. The current study proves that socioeconomic elements affect the patients when there is a need of change in their eating habits after the identification of diabetes. To complete this task, the quantitative research method is employed. The method is an inquiry that investigates a contemporary phenomenon and context, which uses multiple sources of evidence (Yin 1984).

This study is about the importance of health literacy for the prevalence of diabetes. It means that if the healthy people are aware of diabetes, then they must take care of their diet, physical activities, sleeping time, sugar level, and other measures to remain safe from diabetes. Similarly, the diabetic patient may properly use technology, medicines, diet plans, and physical activity plans to control their diabetes. In this way, the study is of great importance because it provides a great knowledge that how the health literacy is important to control diabetes. With the help of this study, the health care and nursing staff will be able to make a plan to make people of the United States aware of diabetes and will take steps to increase health awareness in diabetic patients. Such plans or health care checks will make the healthcare faculty able to guide the people about the prevalence of diabetes and can aware them about diabetes and its effects on life.

Assumptions

A lot of assumptions were present about this study. The first and foremost assumption was that several elements are responsible for low literacy of diabetic patients about their health, in US. The second supposition was that this study will help to develop materials that can support to increase literacy levels of diabetic patients. The third postulation was about understanding of a relation between compliance and health literacy. The last notion was that increased health literacy can help patients to properly deal with their disease and the people using the technology instrumentations can easily control and check the diabetes level of the body.

It was assumed that the study will help the healthcare providers and nursing staff but will play an important role for the people to understand that how health literacy may help them for the prevalence of diabetes. With the help of this study, the people and the health care and nursing staff will focus on the health literacy and will make people aware about diabetes and other such chronic disease. In this way, the people will be able to understand the importance of health measures and will manage their life styles to have a healthy life.

Scope and Limitations

The scope of this study is very broad as it investigates the effects of health literacy among the diabetic patients of US in age range of 18 to 60 years. It will determine that the level of literacy can effect a patient’s health or has no effect on the health outcomes. In case of positive effects of health literacy on a patient’s health, this study will help the health organizations and health care providers to develop literary material according to the literacy level of the general population and help them to devise certain beneficial apps so that the technology can play its part to support patients in the modification of lifestyle and routine according to the requirements of their disease.

With the help of this study, the people and the health care and nursing staff can focus on the health literacy and can make people aware about diabetes and other such chronic disease. In this way, the people will be able to understand the importance of health measures and will manage their life styles to have a healthy life.

Current study has several limitations and new body of knowledge cannot be added about the patient compliance to diabetes treatment on the basis of cross-sectional data. Without using survey or questionnaire to determine the exact response of patients about the role of health literacy on the basis of provided literature and technology, direct response of a corresponding sample cannot be revealed. Non-experimental design used in the study cannot help to derive causal relationship of variables. The study cannot distinguish the effect of health literacy on the patient’s compliance to type 1 and type 2 diabetes. The study cannot describe the possible outcomes of health literacy in patients of type 1 or type 2 diabetes, with the help of technology or literature used. The study does not highlight the deficiencies present in current technology or literature according to patient perspective. Despite of the several limitations discussed, the study provides data to design new literature and technology which can increase health literacy among diabetic patients to increase compliance to treatment.

Literature Review

A lot of researches have been made to comprehend the relation of health awareness and its accordance with the diabetic cure treatment. From the 20th century, academics are struggling to assess that how health awareness affect the treatment of diabetes. Schillinger stated that diabetes of type 2 effects a person in a different context so the health awareness helps people to overcome the health imbalances and to keep diabetes under control. Particularly, there is a need for health awareness in African-Americans to comprehend how to have a hold over increasing rate of diabetes this will make easier to get better treatment and healthy diet to decrease the discrepancy hazards (Trinacty, et al., 2009).

Patient’s accordance with the advised treatment to take control over disease is assumed as the basic component which helps in managing blood sugar diabetic patients who are taking insulin, with the help of insulin amount, healthy food habits and routine exercise. Non-cooperation is attributed which differ in significance in different diabetics. Analysis consisted of ten female diabetes patients, of which two were uremic, and eight females were renal transplant receivers, was organized to evaluate their accordance with suggested shoe instructions. Witnessed accordance with using proper shoes is outlined as transpiring for the reason that matches with the life-style of patients. It was observed that three out of ten females rejected to wear suggested footwear at all, but one female changes her approval of suggested shoes. Bonds among patients and the health care panel associates are presented as a source of increasing accord customizing the health team’s care of the patient is submitted as the most important strategy (Friedman, 1988).

Insufficient useful health awareness is general, yet its effect on patients suffering from enduring diseases is not explained clearly. To observe patients who have diabetes as well as depression Williams (1998) explored the link between useful health awareness of patient and awareness of their enduring disease and cure. Awareness was evaluated by the Test of Functional Health Literacy in Adults. Understanding of their disease was measured in patients suffering from diabetes or depression by asking 21 questions related to depression and ten questions related to diabetes. Those questions were related to the basic features of common ideas generally practiced in health centers. As a whole 114 patients with diabetes were enlisted. From which 94% of individuals were well-aware of the indications of increasing diabetes level as compared to other 50% patients with insufficient knowledge. Insufficient useful health awareness plays the part of the main obstacle, so the patients should be aware of serious diseases and recent struggles to overwhelm this (Williams M. V., 1998).

An ideal setting can be provided by managed health care organizations to resolve several health related issues which severely affect the health care delivery system. The researchers conducted on this subject can be used to develop interventions programs targeting specific subgroups of patients at high risk. These subgroups include low-literate and more elderly population. Some possible intervention strategies for this population could be the usage of audio or video tapes about curative instructions instead of written material. These tapes can provide instructions with the help of visual cues. These efforts can be made more successful by a partnership of these organizations with medical professionals, pharmacists, literacy councils, public groups, medical groups, hospitals and agencies of health policy. The combined efforts can cause a massive impact of health literacy on health outcomes related to chronic diseases which are extremely common like diabetes (Gazmararian, et al., 1999).

The people less aware of health care meet a large number of health issues, that’s why they are in great danger of health discrepancies. When people are familiar with diabetes and its consequences, then they make efforts to keep in check their sugar level time and again and to overcome the health discrepancies (Kim, Love, Quistberg, & Shea, 2004). Patient knowledge has increased from medically-dominated and limited sources for patient education to help patient enablement in personal, governmental and strategies regarding health issues. In this essay authors revealed both of the ancient and present situation of patient awareness in the United States and investigates the effects of enablement program based on new proposals and guidelines regarding patient awareness. By taking diabetes awareness as an example, improvements in patient’s motivation and enablement are discovered and the upcoming trends and demands of this subject were taken into consideration (Roter & Stashefsky-Margalit, 2001).

According to the records, it was revealed that about 90 million Americans are having insufficient knowledge about health measures. Nearly two million citizens of United States were not equipped with the English language, and millions other communicate in it badly. The disgrace of ignorance or lack of ability to communicate in the United States is leading patients to reveal their pain and problems. Identifying these realities is a major first step in increasing heath awareness for these disabled residents. By using teaching methodologies on patients’ basic requirements, nurses can make sure that patients self-comprehend their problems related to health and plan their scheme of self-care. Facts and figures considerably reveal the great trend of ignoring these requirements. Patients who are unable to comprehend their scheme of care cannot fulfill the suggestions and recommendations. As a result, patients face complicated problems. Physicians and the people related to health care system must equip with different languages to better help patients, less educated patient’s communication way and with the help of skilled translators significantly enhance the excellence of care and treatment for their patients and the ensuing effects (Dreger, 2002).

Review of Literature Supporting the Theoretical Framework 

Health and Retirement Research also issued their findings in 2003, that high rate of blood pressure, excessive weight gain, suffering from diabetes from a long period, taking insulin treatment, greater mental loss, and suffering from depression are the basic reasons of diabetes. If a person is familiar about all of these symptoms and also familiar with the health maintaining tips, then there are very little chances to be effected by diabetes. Thus it will be simpler for a diabetic patient to keep himself check from time to time and to take care of his self (Feil, et al., 2009). However, their research only provided the information that how the awareness can help the healthy people to prevent diabetes. Then in 2004, Kim and Rothman issued their findings, in which they conversed the link between health awareness and diabetic impacts. They made a profound exploration about people having low health awareness and face challenging problems to keep diabetes under control and thus determined that getting knowledge support them in a better way to control diabetes.

Patient’s ability to remember is a half of what a doctor delivers during checkup of a patient. To improve memory, understanding, and obedience it is suggested that doctors stimulate patients’ awareness about new perceptions and modify previous knowledge, especially in patients having less useful health knowledge. It is an unknown element that how often doctors use this communicative method of awareness, or it may have linked with better results of health. Close examination is used to evaluate the degree to which initial care doctors practicing in local hospitals evaluate patient’s memory and understanding of new perceptions during checkup of patients, by utilizing recorded tapes of visits to 38 doctors and 74 patients of English speaking suffering from diabetes and less useful health knowledge. It was observed that whether there was a link to doctor’s submission of this collaborative communicative approach and patients reduce rate of diabetes by means of knowledge from medical and managerial records.

Doctors evaluated memory and understanding of any new perception in 12 of 61 visits and for 15 from 124 new perceptions. The patients whose doctor evaluated memory or understanding were more expected to have hemoglobin A1c level less than average (≤8.6%) as compared to the patients whose doctor did not do anything for his awareness (odds ratio, 8.96; 95% confidence interval, 1.1-74.9). After evaluating a lot of logical recession, the 2 variables autonomously linked with better reduction of diabetes and improved health awareness rate. Doctors serving patients with basic treatment with diabetes and less useful health awareness evaluated patients’ memory or understanding about new perceptions. Ignoring this action in interaction reveals a neglected prospect which may have significant medical effects (Schillinger, 2003).

Though less treatment concern may lead to insufficient diabetes-management, methods to practically evaluate attention in normal medical training must be started. A research by Pladevall (2004) was organized to find whether pharmacy allegation-centered assessments of treatment carefulness are linked with medical effects on patients with diabetes. The research consisted of the people of southeastern Michigan, involved 677 patients about 18 years old with symptoms of diabetes, depression and increased cholesterol level. Non-supportive and careless patients showed dreadful results than careful patients. Thus allegation-based assessments of treatment attentiveness were linked with better results in patients facing diabetes and at last proved to be worthwhile in medical practice. Further exploration is required on technique to make people aware of allegation-based carefulness tactics in normal medical practice and the way of employing these tactics to greatly increase attentiveness and better health results in the treatment of serious diseases (Pladevall, 2004).

Shillinger D. (2006), tried to find whether awareness facilitates the association among knowledge and diabetes control in diabetic patients. They evaluated knowledge realization, knowledge experimenting the Short Test of Functional Health Literacy in Adults (s-TOFHLA), and diabetes control in 395 patients who have diabetes in a local hospital of United States. We practice pathway study to relate two comparing patterns to describe diabetic-management. The direct results pattern assessed how knowledge was associated with HbA1c; the intercession pattern evaluates the intensity of the direct association when the other means of knowledge to awareness to HbA1c were complemented. The two patterns of direct influence of knowledge on HbA1c and the pattern with awareness as a facilitator were kept up by suitable percieved facts. The intercession pattern , therefore an important development, with the supplementary way from awareness to HbA1c demoting the differences from previous data (p<0.01). After taking in this way, the direct association in knowledge and HbA1c dropped to an insignificant level (Shillinger D, 2006).

Heightened life expectations and the maturity of people collaborates with the increasing rate of obesity and idleness which results in a record rise in diabetes frequency in all over the world. The disorder and its long term effects have exceptional influences and challenges with aging. It’s most important symptom is postprandial hyperglycemia, different health issues are present, and the possibility of heart disease is greater than before. The regular examination is necessary for timely identification and suitable treatment. The method of multipurpose controlling lay emphasis on diet, exercise, awareness, good social conditions and mental health, care of metabolic problems, and cautious intake of medicines are the basis of treatment for aged persons. The cure must be personalized to the specific patient, and the support of family should be incorporated with the balanced exploitation of social resources. A proved, inclusive and practical approach is required to decrease the rate of illness and death from diabetes in aging (Rizvi, 2007).

About 50% of patients suffering from enduring disorders cannot get best medical advantage from treatment due to no fulfillment of cure schedules. Absence of accord is linked with bad health results, greater hospitalization, lower life standard and increased health care expenditures all are responsible for this issue. Though inadequate accord and stubbornness are general in various disorder conditions, they might especially inadequate in cure of diseases in which no symptoms arise like osteoporosis. Patient’s awareness has been established to greatly enhance accord with treatment in different situations and disease seriousness. In a research in which patients get knowledge resources, related to bone densitometry, and doctor consultation, 67% patients were acquiescent with cure after six months.

Patient’s gratification with treatment is associated with rehabilitation, by taking better care of patient through satisfying anticipations for regular checkups and supplying regular feedback, the person who is providing health care can affectedly increase accord. Self-control schemes concentrated on routine management of enduring disorders which results in better health conducts and health position. Irrespective of the method employed, consideration should be focused on finding the patients little most interest in treatment and to offer those help and knowledge which these patients need to stick to the treatment of the disease (Gold, 2006).

Good self-control of serious diseases in mature grownups is important for better health results. The comparative significance of two extents of doctor’s interaction, educating patients and participatory decision making (PDM) was evaluated for elderly patients with diabetes. A nationwide examination of 1588 aged persons was organized, who had diabetes. Self-made interactions were observed in patients’ evaluations of their doctor’s provision of information PCOM, and PDM with patients described self-control.

In all these elderly patients, both of their diabetes benefactors’ providing them useful knowledge and attempts to engage them in therapy decision-making effectively were linked with greatly improved diabetes self-control, and engaging aged patients in deciding goals about serious diseases and decision-making. All these measures seem to be essential in self-management fields that need more following routine modifications concerning workout, healthy food and keeping in check glucose level (Heisler, 2007).

Among augmented distress concerning harmful significances of less health awareness, it is still unidentified that how awareness about health effects fitness conditions and health service employment. By taking 489 aged patients, Cho (2008) discovered the transitional aspects that can relate the health education to health condition and employment of health services for example hospitalization and emergency treatment. It was estimated that people with more health awareness would show better health condition and very often they utilize emergency treatments and hospital services for the reason that they have greater understanding of knowledge about their disease, much better conduct, better use of precautionary measures and a great accordance with medicinal treatment. The average results of this research revealed that health education had greatly affected health consequences and that no one of these difference of concern was an important transitional element by the help of which health knowledge have an effect on utilization of health services. It was proposed that increasing health knowledge may perhaps an operative approach make health condition better and to overcome the usage of costly services of hospitals and emergency rooms in old age patients (Cho, 2008).

A study was reported by Tang et.al., (2008), which examined the relation of health literacy with awareness of complications related to diabetes mellitus. Functional health literacy was tested among adults through a test. The prevalence of the disease is increasing rapidly throughout the world. Although the health education is improved in previous few decades especially in the area of diabetic care. So, health literacy and awareness about chronic diseases and their complications are extremely increased, but these efforts are unable to decrease the prevalence of diabetes. The study focused the diabetic control among patients, and it was concluded that effective education of patients could improve diabetic control, but it requires specific educational strategies to improve patients literacy level related to health and self-management (Tang, Pang, Chan, & Yeung, 2008).

Diabetes self-management education (DSME) is an important part of care for individuals who have diabetes, and it is also essential for patient’s recovery. The National Standards of DSNE are proposed to explain better self-management awareness about diabetes and to help diabetes trainers in different ways to spread proof-based knowledge. Due to the continuously changing elements of health care and researches concerning diabetes, these Standards are reassessed and reexamined after every five years by main establishments and federal organizations in the diabetes awareness group. A Task Force was organized by the unison of American Association of Diabetes Educators and the American Diabetes Association in the summer time of 2016.

Other groups belong to the American Dietetic Association, the Veteran’s Health Administration, the Centers for Disease Control and Prevention, the Indian Health Service, and the American Pharmaceutical Association. Participants of the Task Force comprised of a person suffering from diabetes; some health facilities scientist, registered nurses and dietitians; and a chemist. The Task Force was having the task of reassessing the modern DSME standards for their accuracy, significance and logical basis. The standards were then reassessed and reexamined according to present confirmations by professionals (Funnel, 2009).

Attentiveness to oral diabetes controlling drugs is quite useful. Variance in treatment carefulness may lead to health discrepancies regarding black diabetic patients, as well as increased micro vascular rates, increased disability, and early death risk. The research was done by Trinacty et. al., (2009) involved some black and white diabetic patients. Noteworthy white-black variance in attention levels was uniform during entire treatment of patients started from metformin cure. Cultural dissimilarity in attention regarding oral diabetes controlling therapeutic treatment carries on even with an equal approach to treatment. Initial and constant stress on treatment attention from the beginning of therapy might condense permanent cultural variance in medicinal therapy and its consequences (Trinacty, et al., 2009).

The awareness level of a patient greatly influences various aspects of treatment through medicine and also effect the evaluation of obedience from the patient. The purpose of this study is to plan and estimate an obedience level regarding medication appropriate for putting into practice in all stages of patient awareness. The Adherence to Refills and Medications Scale (ARMS) was established, initially verified and managed on 435 patients suffering from cardiac disorders. The validity of ARMS was assessed by comparing results. Patients with fewer points according to ARMS results (who show much obedience) considerably had a tendency to manage their diastolic blood pressure, and more likely to manage systolic blood pressure in a much better way. The ARMS is a useful and trustworthy medication obedience scale when utilized in people suffering from enduring disorders, along with best functioning features even in less aware patients (Kripalani, 2009).

Ethnic and semantic variations, as well as social and financial condition, participate in less awareness of health, described as the lack of ability to comprehend or follow basic recommendations for treatment. Health education is acknowledged as the main aspect of patient acquiescence, diagnosis test, and results of enduring disorders. Admirable work has been introduced by American Medical Association and other establishments to deal with less health awareness in patients. A very little work has been completed, but to present health education in the wider perspective of socioeconomic and national dissimilarities in patients and benefactors which obstruct interaction and consent. The analysis done by Shaw (2009), inspected the beneficial effects on health education, disease diagnosis and results of the enduring disorder. It was discussed that educational philosophy across health and disease greatly influence a person’s capability to comprehend and follow the suggestions of a physician. The study put forward the main factors of the connection among health education and national differences of philosophies regarding health which worth more investigation (Shaw, 2009).

A very slight awareness is present among people about hypoglycemic incidents. Patients are equipped with inadequate health literacy (HL) especially the patients with diabetes type 2, that can hinder diabetes self-control, so limited HL may result in an increase in hypoglycemia rate. To conclude the ratio of itinerant, type 2 diabetes patients having curative treatment recounting major hypoglycemic incidents in the last few months, and assess whether health literacy is linked with hypoglycemia 14,357 adult patients of type 2 diabetes getting medication treatment at KPNC were assessed. Major hypoglycemia was a common problem with this group of type 2 diabetes patients receiving treatments for hypoglycemia, and particularly the patients with inadequate health literacy were at a great risk. There is a need of strong efforts to decrease hypoglycemia and support patient wellbeing which needs self-control system especially suitable for patients with inadequate health literacy, need more attentive observation, traditional glycemic goals or keep away from medicines results in hypoglycemia (Sarkar, 2010).

Even with noteworthy developments in physical analysis and cure, the presence of insufficient metabolic control remained a problem. Inadequate diabetes control might be exposed by the insufficiency of diabetes self-control by patient’s insufficient mediation approaches by physicians. An analysis was presented by Nam (2011), the main objective of this organized analysis was to precise the present understandings about several obstacles in the way of diabetes control from patients and doctors view. An examination of previous studies discovered 1454 research papers published in English language from 1990 to 2009, focusing on type two diabetes, patient’s hurdles, physician’s hurdles, and self-control. Patient’s obedience, approach, views and awareness regarding diabetes greatly affect the diabetes self-control.

Other significant features comprised the patient’s financial condition, collective provision. Physicians approach, views and awareness regarding diabetes also effect diabetes control. Physicians may greatly affect the patient’s conception by good interaction abilities and by providing a better health care structure. Finding hurdles in the way of diabetes control is important to progress the excellence of diabetes treatment, together with the correction of metabolic rate, and diabetes self-control. Advance researches which study these hurdles are significant for developing mediations for persons with type 2 diabetes (Nam, 2011).

Diabetes is an enduring ongoing metabolic ailment indicated by hyperglycemia especially as a result of lack of insulin hormone. World Health Organization evaluated that approximately 346 million people are suffering from diabetes all over the world. It is possible that this amount will be doubled by 2030 without any intercession. The treatment of diabetic patient is not required only diabetes management is sufficient but it also needs some precautionary measures; disease control and restoration. There are seven basic self-management actions for patients having diabetes which can show positive results that is healthy food consumption, physical activity, regular check on blood glucose level, acquiescent with medicinal treatment, active issue resolving ability, good handling ability and lifesaving actions. These seven actions proved to be progressively associated with better diabetes management, decrease in health issues and positive progress in quality of life. People having diabetes have been presented to impart an intense effect on advancement and improvement of their health condition by taking interest in their own health management. Regardless of this element, acquiescence towards these behaviors is very low, particularly when focusing on enduring modifications. Along with other contributing factors, the role of physician in encouraging self-management is important and there is a need to lay emphasis on it. Understanding the multi-aspect character of disease, a scientific, and multi-purpose methodology is needed for stimulating self-management exercises in diabetic patients to avoid any enduring health issues (Shrivastava, 2013).

As diabetic patients need great self-maintenance, self-control awareness is generally suggested to increase the success ratio and reduce the expenditures of cure. Though a large number of diabetes self-management (DSM) plans are present, but the required conditions for their active employment are not described clearly. In this paper we analyze the work on implementation fidelity (IF), the extent to which these plans are presented as envisioned, as an element inspiring the efficacy if diabetes knowledge. Medical, psychological and knowledge based study records were explored to find available researches on diabetes knowledge explaining the application method. Studies describing the intervention, compliance, fidelity, reliability were involved to evaluate the basic factors of IF were focused. From early 418 abstracts, 20 printed papers were reserved for a deep evaluation concentrating on the factors of IF. Intervention element was primarily analyzed through examination; however, intervention amount was evaluated through self-report method. Only an original research discussed the link among IF and intervention efficacy. Regardless of the significance of IF to attain plans outcomes, IF of DSM plans are still need analysis and assessment. The outcomes of this analysis submit that accounts on diabetes self-management must scientifically explain that how the plan was operated. The influences of IF on plan aftereffects require more research (SChinckus, 2014).

Health knowledge is an obstruction to precisely comprehend medication knowledge. Present medication knowledge is so challenging to get familiarity with among less aware people, who are in great danger by misunderstanding the labeled directions on medicine, prescribed amount, time, precautionary measures printed information and physician advice. The main objective of this paper was to scientifically analyze the data about increasing medication awareness and compliance in less aware people. It includes less aware people, contained effect methods for education or compliance, concentrates on data regarding medication (Wali, 2016).

The cure for type 2 diabetes (T2D) is not present, but it can be controlled through proper medication, healthy diet and some variations in everyday life. It is proposed that self-control of diabetes through diet is so problematic for people having social and financial complications. The basic purpose of our research was to assess the theory that social and financial factors greatly affect the variation in diet after the identification of T2D. The important factors which employ an effect on nutritional variation were the extent of knowledge of patients who have type 2 diabetes and may or may not they had a family. The study proved that socioeconomic elements affect the patients when there is a need of change in their eating habits after the identification of T2D. Moreover, family plays an important role in nutrition self-control, most likely force a type 2 diabetes patient to follow nutrition suggestions of a physician (Mancini, 2017).

Research was conducted by Grammatikopoulou (2017), to measure food quality and awareness about the disease in patients with type 2 diabetes. An inclusive analysis was controlled, with data from 75 patients having signs of type 2 diabetes. Awareness about the disease was evaluated with the help of Diabetes Knowledge Test (DKT), and food quality was tested with the Healthy Eating Index (HEI), estimated from last day memories of diet. The study exposed a less popularity of proper eating habits and disease awareness in patients having type 2 diabetes, with different factors influencing food quality and diabetes awareness in both males and females (Grammatikopoulou, 2017).

Diabetes self-management education (DSME) and Medical nutrition therapy (MNT) recover patient’s results, bad refund limits approach to carefulness. In the study done by Marincic (2017), a system was established for observing patient’s recovery according to registered nutritionist diet plan. A random sample of about hundred was selected from electronic medical records of patients who have type 2 diabetes fulfilling DSME and customized medical nutrition therapy from June 2013 to 2014. Statistics were obtained from body mass (measured as kg/m2), weight, hemoglobin level, blood sugar, and fats. Reconsidering chart examine offers an effective pattern for extracting present result of the patient following diet plan of a registered nutritionist. In assistance of collective compensations and patients approach to diabetes self-management education other customized medical nutrition therapy, the clear drop was examined in primary results of weight, body mass hemoglobin and triglycerides (Marincic, 2017).

However, these all researches either provided information about the importance of awareness of diabetes for the prevalence of diabetes or the level of awareness and unawareness amongst the people about diabetes. No research could provide any positive information about how the health literacy leaves an impact on the prevalence and control of diabetes. If the research was conducted to evaluate its impact, then most of the time the results were not positive. However, this study will show that how the health literacy leaves a positive impact on the prevalence and control of diabetes in people of United States.

Review of Literature Using Proposed Methodology 

Researchers evaluated that low health literacy is a major factor which if dealt properly can help to reduce the disease burden in case of chronic diseases, by appropriate skills of self-management. Several studies were done to on the subject of health literacy and its impact on diabetes compliance using different methods. The quantitative methodology was used along with meta-analysis in some studies, as done by Montoya (2015). Cross-sectional data was used for secondary analysis from 2009-2010 surveys of National Health & Nutrition Examination.  The study focused on the self-managing behaviors of diabetic patients of age groups ≥55 years and more than 55 years of age as adults, with the help of a quantitative methodology. Four main demographic factors were considered for the study as age, gender, marital status and education. It was evaluated in the study that young people who were single with strong financial status were more unaware of their disease status. (Montoya, 2015) .

Another study conducted by Berkman et. al. (2011), which was based on previous researches on the topic of health literacy and its outcomes. The study was focused on English articles from 2003 to February 2011, from Medline, ERIC, PsycINFO. They selected the articles particularly focusing health literacy according to patient health outcomes. It was evaluated that low health literacy is related to poor health outcomes and high rates of mortality. As low literacy levels resulted in poor handling of chronic diseases by patients which was associated to higher rate of hospitalization, poor medication routine and health status (Berkman, Sheridan, Donahue, Halpern, & Crotty, 2011).

An analysis was done by Easton et. al., (2010) with a population of low literate people who had difficulty in understanding the medical literature related to their disease. These difficulties cannot be easy recognized by the physicians and cost the health care system. Previous reviews and researches were used in this study to extract data related to low HL and health status. 24 reviews were analyzed and it was evaluated that poor health is based on low literacy levels up to some extent, as it resulted in poor health management by the patients (Easton, Entwistle, & Williams, 2010).

A study done by Wolf, Gazmararian & Baker (2005), surveyed 2923 individuals to check the effect of health literacy on self-management of diseases. It was evaluated on the basis of survey that low HL results in poor health conditions and affects the normal working of a person. Poor health results in mental health problems like stress and anxiety, decreasing the quality of life of individuals. So, it is important to provide proper health literacy to patients to increase the life span of population suffering from chronic diseases (Wolf, Gazmararian, & Baker, 2005).

A research by Pladevall (2004) was organized to check assessments of treatment carefulness are linked with medical effects on patients with diabetes. The quantitative research consisted of the people of southeastern Michigan, involved 677 patients about 18 years old with symptoms of diabetes, depression and increased cholesterol level. Non-supportive and careless patients showed dreadful results than careful patients (Pladevall, 2004). Shillinger D. (2006), found whether awareness facilitates the association among knowledge and diabetes control in diabetic patients. He evaluated knowledge realization, knowledge experimenting the Short Test of Functional Health Literacy in Adults (s-TOFHLA), and diabetes control in 395 patients who have diabetes in a local hospital of United States (Shillinger D, 2006).

 METHODOLOGY

The purpose of this study is to evaluate the relationship between the health literacy and the Diabetes control. In U.S. diabetes has become the major leading cause of death and every one in four people is the victim of this disease. Diabetes is not only the leading cause of death but also causes so many other chronic diseases in the patients due to which the life of patient becomes the curse. Also, it is found that the older people are facing this disease more than the adults. However, now, diabetes has also become the common disease in adults and younger.

The major issue is that there is no cure for diabetes and the only solution to this problem is to control diabetes by self-monitoring, self-caring, proper medication, monthly basis checkup, and proper exercise This all can only be done by having knowledge about diabetes and its preventive methods. The diabetes patients must also take care of their diet and must inject proper insulin to maintain the sugar level of their body. This will not only control their sugar level but also keep them healthy. For this all caring procedure, proper knowledge about diet and medicine dose is required. This means that if the diabetic patients are aware of the calories in their diet and the way of injecting insulin, then they will be able to deal with their disease in a best possible way. Also, by making them aware of the exercise schedule and self-monitoring, the disease can be controlled. It means that literacy plays a vital role in controlling diabetes.

When it becomes clear that the health literacy is of great importance in preventing and controlling diabetes than in this research, we will find a relationship between the health literacy and the preventive measures of diabetes. For this purpose, the research design of the study will be the quantitative methodology. This research methodology will be based on the researched material from different resources to understand that how in different times the literacy has played a positive role in helping the diabetic patients. The major focus of the research is to evaluate that either the literacy leaves a positive impact on the prevalence of diabetes or it leaves no impact on it.

Initiative Design/Methods

The initial design of the research is a meta-analysis approach in which the data was collected via different sources, and then a filter was applied to analyze the useful data, and remaining was ignored. The researched data was based on four approaches. How is health literacy helping the diabetic patients in controlling their body sugar and insulin level? What should be the methodologies for the people with low literacy level to control diabetes? How may the health literacy help the aged people to control their diabetes? How modern technology and its awareness may help the diabetic patients to control their diabetes.

Initially, the research design will be separately analyzed for the younger, adults, and the old people separately. The purpose of this separate analysis is to examine that what is the ratio of diabetes in younger, adults, and old aged people. Moreover, it will help to understand that how the literacy helps these people in the prevalence of diabetes. It means that the sample design will be consisting of the younger between the age 12-18, adults, 18-30, and then the aged people between the age 30 and 60.

The various studies reviewed indicated that lifestyle or behaviors play an essential role in the prevalence of diabetes among younger, adults, and aged people. Therefore, the use of the detailed design must be highly efficacious for both descriptions, as well as the acquisition of pertinent information on informational resources, personal factors, awareness, health promoting behaviors, the knowledge regarding the disease, and to facilitate the collection of huge amount of unique data. Thus by reviewing the data from different resources, it was evaluated that how the literacy can help the diabetic patients to control their sugar level and what hurdles can be faced during this research or in future.

Population and Sampling

The initiative population for this proposed initiative includes younger between the age 12 and18, adults between the age 18 and 30, and then the aged people between the age 30 and 60. The population of United States has been considered in the research because the purpose of the research is to evaluate that how health literacy is helping the public of United States for the prevalence of diabetes. With the help of this population and sample it became easier to evaluate the impact of health literacy on different people of United Stated belonging to different age groups, and finally, a general conclusion can be drawn that how the health literacy is impacting the prevalence of diabetes.

Variables

In this research, the major variables are the health literacy and diabetes treatment therapy. The variable health literacy is an independent variable because health literacy can be provided to younger, old, and adults too and it does not depend on anything. The people will be guided to use the information technology tools for the prevalence of diabetes, better physical activities, better diet plans, proper care, and medication to control diabetes. It is on patient’s wish that either he wants to learn from the literacy or is not interested. However the second variable is the prevalence of diabetes, which depends on the health literacy, is a dependent variable. With the help of this variable, the study will evaluate that either the health literacy helped the patients to control their diabetes level or it was useless to literate the people about diabetes and its prevention. Thus with the help of this variable, the study will conclude the impact of health literacy on the prevalence of diabetes in younger, adults, and old people.

Data Collection

The research design of the study was a quantitative analysis of secondary data. The research question will be examined by analyzing the correlation between the two variables, existing variance as well as a chi-square test for homogeneity with regards to previous studies. The independent variable is health literacy, and the dependent variable is the diabetes treatment therapy. SPSS was also computed to generate logistic regression which will be used to interpret the p-values. The data was collected from the following resources;

  • American Diabetes Association accumulated data.
  • Articles are from MEDLINE, CINAHL, Psyc INFO, PUBMED, Walden library databases and other reliable internet sources.
  • Health and Adult Literacy Survey (HALS).
  • Others.

Also, it was evaluated that how the health literacy impacts the patient’s care, diet plan, physical fitness, and medication to control diabetes. Diabetic treatment therapy consists of the following objectives.

Patient’s Care

Secondary data was approached to understand that how the patient’s care can be affected by the health literacy? Patient’s care is different for different age groups because the younger cannot care themselves, adults are sensible enough to take care of themselves by their own, and old age people also cannot take care of their medication and diet and need someone who can look after them. That is why the research data for different stage groups was different. The younger needs extra care because they don’t understand how to have control on a diet and what is good and what is bad for them. In this condition, the patients and family members play a vital role by guiding them about their disease and by taking care of their diet and other physical activities. Moreover, the younger does not know the importance of medication thus the parents need more attention and care to take care of the proper medication of younger so that the dosage of insulin must not be disturbed.

Secondly, the secondary data was searched to understand how the literacy impacts the prevalence of diabetes in adults. It is easier to guide adults because they understand the importance of care, medicine, and diet care for their health and prevalence of diabetes. Just a little guidance can help them to control their diabetes.

The secondary data was collected to understand that how the old aged people need extra care? The old aged people cannot understand the things as early as the adults can that are why the health literacy leaves a very little impact on their prevalence of diabetes. Moreover, they are reluctant to their routines and tradition, and that is why it is quite difficult to make them agree with changing their lifestyle to control diabetes. Moreover, the data was searched that how the family support can help them in the prevalence of diabetes.

Patient’s Diet Plan

It is quite difficult to plan the diet plan for younger because they are in growing age and need extra nutrition than the others. Moreover, the younger cannot understand the importance of diet plan for the prevalence of diabetes, and that is why they need extra guidance and care to be careful in eating sweets and chocolates and other diets having more sugar. The secondary data was collected to understand that what diet plan can be the best for the younger having diabetes which must be essential for their growth and should be helpful in control their diabetic level too.

The adults and the old age people are well aware of health issues, and thus a little guidance of their diet plan can help them in the prevalence of diabetes. The secondary data was collected to understand how the diet plan can be helpful for them to control their diabetes as well as to have a normal healthy life like others

Physical Exercise

Proper physical exertion can help the patient to control the diabetic level. In fact, a proper physical fitness plan is also helpful or the healthy people because it helps in disease prevention, such as obesity, hypertension, diabetes, and others. However, there must be a proper physical fitness plan because the diabetic patients cannot exert due to unstable sugar level of their bodies. The secondary data was collected to understand that how the physical fitness plan can help the adults to control their diabetes. The younger players in grounds so there must be proper guidance for the to exert in limitation. If the younger feel that their sugar level is going down, then they must be aware of taking and sweet immediately. This all can be done by health literacy and awareness about the prevalence of diabetes.

The old people also face a lot of difficulties in physical exertions because of their joints issues and addiction of rest. It is quite difficult to make old people agree with changing their lifestyle and thus the data was collected to understand that what physical fitness plan can be better for them in the prevalence of diabetes.

Awareness of the Technology

Nowadays the younger and adults are very quick in understanding the information technology. Moreover, they enjoy using the technology devices. In this way, the use of technology devices is not only easier for them but will also be helpful in the prevalence of diabetes. The technology instruments, such as a glucometer, can be used to check the diabetes level of the body with the help of which the patient can understand the better preventive methods. However, the old age people are addicted of their manual routines, and thus they don’t understand the use of technology easily.

In this way, the secondary data was collected to analyze that how the health literacy can guide the people to use the technology instrumentation to control and check the diabetes level of the body. The use of technology can help the diabetic patients to count their calories per day, check glucose level of the patients’ body, and manage the physical fitness plan schedule, and the meal and medication timing management

Data Analysis

Initially, so much data was collected from the secondary sources to understand the health literacy impact on the diabetes treatment therapy of younger, adults, and old aged people. However, after the collection of data, the data was filtered on several bases. Initially, the data was filtered by publication year, and only the data was selected which had published in recent years. Secondly, the data was filtered by diabetes, and the data was selected which was only for the health literacy impact for the diabetic treatment of United States’ population. Then data was divided into age groups and the patient’s care, medication, physical fitness, and use of technology. After completing the investigation and the useful data from the secondary sources, the data was processed for the Statistical results, and the graphs and charts were designed by using the Excel. The data were double checked for the accuracy because there must not be any chance of negligence or any mistake in the collection of data.

Results and Discussion

Intervention Techniques for the Low Health Literate Patients

According to the statistics, the U.S. population has very limited health literacy, and that is why there must be some interventions for the diabetic patients with low health literacy. These interventions will help the low literate people to understand the basic health services required for the prevalence of diabetes, and to manage their daily care.  The most important thing for the diabetic patient is to be able to inject insulin properly, to read the dosage on the insulin scale, to be able to understand the schedule of checking glucose level of body, the diet plan, and physical exertions required to maintain the sugar level of the body.

Different intervention techniques can be used to guide the diabetic patients about their health care. Some interventions are patient communication technique, confirmation of understanding, guiding the care process via information technology, reinforcement of the guidance (Sudore, 2009). It means that the initial point is that the health care staff must first ask the patient that what does he know about diabetes? In this way, the health care staff will understand that how much guidance is required to the patient for the prevalence of diabetes. The initial question of the clinician to the patient must be, “What do you know about diabetes prevalence?”

Kripalani and Weiss suggested that in this way the health care staff will be able to develop a communication plan via which they will be able to guide several things to the patients. The very first step is to guide the patient about his conditions when the sugar level of the body is higher or lower. Secondly, the health care staff guides the patient about taking proper medicines on time or the use of insulin and set of dosage on insulin pen. Thirdly health care staff must guide the patients that what can they eat normally and what is not good for their health. For this purpose, the guidance chart can be used. Finally, a physical exertion plan can be given to the patients to guide them about their physical exertion plan (Kripalani S, 2006).

Figure 1 Guidance Chart for the Diabetic Patients.

Figure 1 shows the guidance chart for the diabetic patients. In this way, the clinician will guide the patients about how to care for the sugar level in the body. With the help of this chart the patient will understand that how to use insulin, how to use glucometer to check the sugar level in the body, when should the patient check sugar level of the body on daily basis, when should the patient consult with the doctor, and when should the patient go for complete checkup of the blood pressure and sugar level.

Figure 2 Food Chart for the Diabetic Patients.

 

Figure 2 shows the guidance chart for the diet control. The diabetic patients can have the guidance of calories intake from the above chart and in this way they can plan a proper diet plan to maintain the calories and sugar level of their body. However, the chart with pictures can be designed for the people who are completely illiterate and cannot read English. Moreover, for the younger patients of diabetes, the charts can be drawn to attract them. In this way, the children get impressed from the diet plan chart and follow that. One of such chart is shown in the figure below;

Figure 3 Food chart for the Younger.

Figure 3 is a food chart for the younger patients of diabetes. However, the health care staff also provides an exercise plan to the patients via which they can understand that how much exercise they need to do on a daily basis and how many doses of insulin should they take every day. The following figure shows the charts for the exercise plan and insulin dose plan.

Figure 4 Exercise Plan and Insulin Dose Plan for the Diabetic Patients.

With the help of such communication via the charts, emails, of free messages the health care staff can make the patients able to understand the caring and checking process of diabetes prevalence. Such communication plans are really helpful and the best intervention for the illiterate diabetic patients. Once the health care staff hand over these charts to the patients then the staff must make sure that the patient has completely understood the instructions provided in the charts. In the case of any confusion, the staff must guide the patient about the instructions and the plan suggested by the doctor.

Table 1 Intervention Techniques for the Diabetic Patients with Low Health Literacy.

Clinician- Patient Level
Patient-Centered Communication Clear Health Communication Confirmation of understanding. Reinforcement Numeracy and Risk Medication Reconciliation
What does patient know? Slow Down and use plain language Ask the questions from the patient. Use different modalities for better understanding. Use of consistent denominator. Dose Schedule must be provided
What does patient need to know? Keep matching the patient’s vocabulary. Teach back Use better-written information. Use absolute risks and a time span of ten years. Make follow up appointments plan via computer.

Impact of Low Health Literacy on the Diabetic Patients

The major issue of the U.S. is the low health literacy, due to which the patients become unable to understand the preventive methodologies for the chronic diseases. When the patients are illiterate, then they don’t understand that what health care staff has guided them. They don’t understand their appointment schedule, dose intake, and other care and prevention methods. This causes the either increase or decrease in diabetes, and that is why patients can either become the victim of other chronic disease or may die due to the instability of sugar level in the body.

Moreover, the people who are healthy but illiterate, they also don’t understand the importance of physical activities and diet control or other preventive measures for diabetes. Especially the people who have diabetic genetic issues in the families must be careful about their diet and lifestyle and must adopt the preventive measures of diabetes.

Figure 5 Low health Literacy and Its Impact on Diabetic Patients.

Figure 5 shows that how the low health literacy leaves a negative impact on the treatment of diabetic patients. 26% of the patients have no idea about the appointment schedule, 65% of the patients have no knowledge of medication timing, and 75% of the patients have no idea of how to get the financial, medical aids for the diabetic treatment. Due to this all negligence the patients become unable to control their sugar level and thus it causes the high sugar level in bodies or causes the death of the patients.

Figure 6 Literacy Level and Sugar Level awareness.

Figure 6 shows the information about the knowledge of low sugar level and hypoglycemic symptoms to the people with low literacy, marginally health literacy, and complete health literate. The people with low literacy level face a lot of difficulties because they have no idea of the symptoms and preventive methods of unstable sugar level of bodies. Thus this causes the increase in another chronic disease in diabetic patients which then leads towards death.

Use of Technology for the Diabetic Patients

With the progress of information technology now it is also possible for the patients to control their diabetes by using the technology. Different mobile apps or alarming digital systems have been introduced which help the patients to manage their diet schedule and to set the reminders for their medicine time, meal time, and glucose check time.

Figure 7 Technology Use to Maintain Diabetes.

With the help of technology the patients can now measure the use of calories per day, can manage their exercise schedule per day, and can keep records of their sugar level and medication intake of every day.

Figure 8 Dose adjustment via Technology.

Figure 8 has shown that how the mobile apps or alarms can be used to adjust the insulin dose timing and their records. The technology will alert the patient at the timing of meal, medication, or insulin dose and then the patient will never forget the intake of insulin dose or timely meal, or medication. In this way, the patient will be able to control the diabetic level of the body appropriately.

With the help of technology, the health care staff can also guide the risk factors for the diabetes to the diabetic patients as well as to the healthy people. For this purpose, the health care staff can design a chart or alert diagram, which can be emailed to the people or can be sent to social networking websites to alert the people about the risk factors of diabetes. A sample has been shared in figure 9.

Figure 9 Diabetes Risk Factors.

The technology will help the patients to control their diabetes. Moreover, it will also guide the exercise schedule and proper diet intake to the patients. With such technology, the adults and younger can have benefited and can manage their diabetes. It is found that with the proper use of technology the diabetic patients can control the sugar level in their bodies within 90 days. The results have also shown in figure 10.

Figure 10 Sugar Level Controlled by using Technology.

The figure shows that how the use of technology made the diabetic patients able to control their sugar level of the body within 90 days. The sugar level was initially at 10.5 A1C, and then it decreased to 6.3 in 90 days, which is a normal A1C level of the human body.

Conclusion

The control of chronic diseases is complex as in the case of diabetes; it requires a lot of treatments along with the health literacy to control the disease. It was seen that some treatments are more effective, but without health education and involvement of the patients, no treatment can produce highly efficient outcomes (Mulrow & Pugh, 1995). Health education means the patient’s capability to read out and comprehend curative instructions make proper choices for best health results (Ramage-Morin, 2009). Nowadays, there has been a developing concentration towards health education because several people are less aware of health education (Zarcadoolas & Pleasant, 2005).

For patients at home, it is important to make sure to be well aware of curative instructions and correct medicinal schedules to be followed. Thus, good interaction among doctors and patients is essential for reliable and fruitful results of curative treatment. Usually, people with less health education have a level of reading of fifth-grade, but curative instructions are often organized in a way directed to people who can read at a level of tenth grade (Safeer & Keenan, 2005). There is a great difference between the levels of ability need to realize present medicinal instructions and the certain level of realization in patients with less health awareness. Health education is important for people to completely realize, accomplish and converse own health requirements and retain health quality. Furthermore, a scientific analysis explores that less health awareness results in about 3-5% of entire health care expenditures according to an annual report.

There are several chronic diseases like diabetes that require patient literacy for control of illness and to prevent further adverse effects. Patient literacy is also important to recognize the behavioral deviations vital for active participation in the handling of disease and acceptance of diagnosis. (American Diabetes Association, 2017).National Adult Literacy Survey mentioned a deficiency of appropriate reading skills among 46-51% citizens of US (Kirsch, Jungeblut, & Jenkins, 1993). It was also noticed by the physicians that 35% of the native English patients lack literacy abilities to comprehend the literature related to their disease (Williams, Parker, & Baker, 1995). The patients do not recognize the symptoms of lower glucose level as feeling sweaty, hungry and shaky due to lack of health literacy and 62% of the patients are unaware of the treatment of this condition.

The problems related to the education of patients with inadequate health literacy cannot be ignored. Patients can be directly involved in the development of educational materials, and this step can empower them for improvement of their health through effective education with the help of the designed content (Rudd & Comings, 1994).

American Association of Diabetes Educators (2013) established that literacy skills are high for most Americans living with diabetes.  According to their report, lack of health literacy has been blamed for creating a vacuum as regards to the attitude of most diabetes patients to manage the disease. Previous researchers have identified the positive correlation between health literacy and self-diabetes management. These studies include patient behavior about self-management and have concluded that adequate health literacy is central to achieving diabetic control.

As genetics serve a lot in the expansion of diabetes, different researches have exhibit the significance of environmental effects. Patients suffering from diabetes have been presented to make an intense effect on the evolution and improvement of their disease by taking care of themselves. This contribution proves fruitful only if the diabetic patients and physicians are well educated about handling this disease and taking good care of the patient. The American Diabetes Association had evaluated the principles of diabetes self-control knowledge and discover that the people not well aware of the self-management strategies are supposed to face more diabetic complexities as compare to others.

Awareness about diabetes is essential but the most, important thing is to practically follow self-care instructions to help the patient effectively. The self-care actions involve health diet plan, escaping food with high fat, routine exercise, self-check on glucose level, and taking good care of feet (Glasgow & Strycker, 2000).

The purpose of this study is to evaluate the relationship between the health literacy and the Diabetes control. The major issue is that there is no cure for diabetes and the only solution to this problem is to control diabetes by self-monitoring, self-caring, proper medication, monthly basis checkup, and proper exercise This all can only be done by having knowledge about diabetes and its preventive methods. This means that there is a deep relationship between the health literacy and diabetes treatment therapy. For this purpose, the research design of the study will be the quantitative methodology. This research methodology will be based on the researched material from different resources to understand that how in different times the literacy has played a positive role in helping the diabetic patients. The major focus of the research is to evaluate that either the literacy leaves a positive impact on the prevalence of diabetes or it leaves no impact on it.

The researched data was based on four approaches. How is health literacy helping the diabetic patients in controlling their body sugar and insulin level? What should be the methodologies for the people with low literacy level to control diabetes? How may the health literacy help the aged people to control their diabetes? How modern technology and its awareness may help the diabetic patients to control their diabetes. Also the research data was based on two variables. The variable health literacy is an independent variable because health literacy can be provided to younger, old, and adults too and it does not depend on anything. The people will be guided to use the information technology tools for the prevalence of diabetes, better physical activities, better diet plans, proper care, and medication to control diabetes. However the second variable is the prevalence of diabetes, which depends on the health literacy, is a dependent variable.

According to the results of the research, the U.S. population has very limited health literacy, and that is why there must be some interventions for the diabetic patients with low health literacy. Different intervention techniques can be used to guide the diabetic patients about their health care. Some interventions are patient communication technique, confirmation of understanding, guiding the care process via information technology, reinforcement of the guidance (Sudore, 2009).

The result showed that by using the intervention techniques, such as instruction charts and tables, the clinician can guide the patients about how to care for the sugar level in the body in an efficient way. Thus the use of intervention of techniques is really helpful to guide the diabetic patients, with low health literacy, about their care and treatment of disease.

The results of this study also showed that low health literacy leaves a negative impact on the treatment of diabetic patients. 26% of the patients have no idea about the appointment schedule, 65% of the patients have no knowledge of medication timing, and 75% of the patients have no idea of how to get the financial, medical aids for the diabetic treatment. Due to this all negligence the patients become unable to control their sugar level and thus it causes the high sugar level in bodies or causes the death of the patients. However with the help of intervention techniques, proper guidance, and use of technology, now it is also possible for the patients to control their diabetes by using the technology. Different mobile apps or alarming digital systems have been introduced which help the patients to manage their diet schedule and to set the reminders for their medicine time, meal time, and glucose check time.

The mobile apps or alarms can be used to adjust the insulin dose timing and their records. The technology will alert the patient at the timing of meal, medication, or insulin dose and then the patient will never forget the intake of insulin dose or timely meal, or medication. In this way, the patient will be able to control the diabetic level of the body appropriately. Moreover, it will also guide the exercise schedule and proper diet intake to the patients. With such technology, the adults and younger can have benefited and can manage their diabetes. It is found that with the proper use of technology the diabetic patients can control the sugar level in their bodies within 90 days.

Conclusively, the research shows that the health literacy is an essential element for the better treatment of the chronic disease. Without having knowledge about the medication, and other intervention techniques, the patient can never take care of himself in better way. That is why the healthcare staff must take some strategies to make the people literate about health issues. In this way the people will begin to understand the importance of health and treatment of chronic diseases.

Potential Social Change Implications of study:

This study is about the importance of health literacy for the prevalence of diabetes. It means that if the healthy people are aware of diabetes, then they must take care of their diet, physical activities, sleeping time, sugar level, and other measures to remain safe from diabetes. Similarly, the diabetic patient may properly use technology, medicines, diet plans, and physical activity plans to control their diabetes. In this way, the study is of great importance because it provides a great knowledge that how the health literacy is important to control diabetes. With the help of this study, the health care and nursing staff will be able to make a plan to make people of the United States aware of diabetes and may take a survey to check that how many diabetic patients are still not aware of their diabetes. Such survey plans or health care checks will make the healthcare faculty able to guide the people about the prevalence of diabetes and can aware them about diabetes and its effects on life.

This study is not only important for the healthcare and nursing staff but also is important for the people to understand that how health literacy may help them for the prevalence of diabetes. With the help of this study, the people and the health care and nursing staff will focus on the health literacy and will make people aware about diabetes and other such chronic disease. In this way, the people will be able to understand the importance of health measure and will manage their life styles to have a healthy life.

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