The Self-Management Activities, Health Literacy and Health-Related Quality of Life of Patients with Type 2 Diabetes: A Structural Equation Modelling in Vietnam

OBJECTIVES: Utilizing Structural Equation Modeling (SEM) to determine the relationships among socio-demographics, health literacy, self-efficacy, self-care activities, and health-related quality of life (HRQOL) in patients with type 2 diabetes (T2D)

METHODS: We conducted a cross-sectional, convenience sampling study from May 15th to June 26th, 2023. The interviews were carried out either when patients were waiting for laboratory results or medication dispensing. Participants who (1) had psychiatric disorders, (2) were pregnant, (3) were unable to respond, did not consent to participate were excluded. The HRQOL was assessed using the EQ-5D-5L (adjusted value set for Viet Nam version). Self-care activities, self-efficacy, health literacy were measured using the Summary of Diabetes Self-Care Activities, the Diabetes Management Self-Efficacy Scale, and the Health Literacy Scale, respectively. The SEM analysis utilized the maximum likelihood estimation method to evaluate the goodness of fit of the hypothesized model against multiple criteria.

RESULTS: Our study involving 218 patients, and the most common age group was 60-69 years. Patients primarily had a university-level education and received family support. Over 10 years since T2D diagnosis was seen in 40.4% of patients, while 11.5% had emergency admissions in the past year. Comorbidities were present at 89%, complications in 74.8%, and treatment mainly involved oral medications (78.4%). Patient-reported outcomes revealed high EQ-5D-5L and VAS scores. Self-care activities showed healthy eating and exercise behaviors, whereas blood glucose testing and foot care were less frequent. Patients exhibited self-efficacy in weight control, exercise, and blood glucose management. Health literacy assessment highlighted challenges, with patients needing assistance in understanding health information. SEM revealed significant relationships between variables and HRQOL, including complications, education level, gender, marriage, insulin use, self-efficacy in exercise, emergency hospitalization, living conditions, healthy eating, and body mass index.

CONCLUSIONS: Elderly patients, females, those with low education levels, singles, and lacking support need more attention when implementing T2D management.