Young Whee Lee

A Structural Equation Model Linking Health Literacy to Self-efficacy, Self-care Activities, and Health-related Quality of Life in Patients with Type 2 Diabetes.

PURPOSE Health literacy has been attracting increasing attention because low health literacy is considered an important predictor of adverse health outcomes in many chronic conditions, including diabetes. However, it is unclear how health literacy is associated with health outcomes. The purpose of this study was to formulate a hypothetical structural equation model linking health literacy to self-efficacy, self-care activities, and health-related quality of life (HRQOL) in patients with type 2 diabetes. METHODS A cross-sectional survey design was employed, and 459 patients with type 2 diabetes were recruited from outpatient clinics in two university hospitals. The patients completed a pack of questionnaires. The hypothetical model was tested using structural equation modeling analysis. RESULTS The values of multiple fit indices indicated that the proposed model provided a good fit to the data. Health literacy exerted not only a direct effect on self-care activities, but also an indirect effect on self-care activities via self-efficacy. However, health literacy exerted only an indirect effect on HRQOL. This structural model was invariant across hemoglobin-A1c-controlled and hemoglobin-A1c-uncontrolled groups. Based on R(2) values, the final model accounted for 20.0% of the variance in self-efficacy, 61.0% of the variance in self-care activities, and 16.0% of the variance in HRQOL. CONCLUSIONS This study suggests that self-care activities are crucial to the link between health literacy and HRQOL. Both health literacy and self-efficacy need to be considered in clinical practice for enhancing self-care activities in patients with type 2 diabetes. This approach may ultimately improve HRQOL in these patients.

A Comparison of the Factors Influencing the Life Satisfaction of the Elderly According to their Cognitive Impairment Level

PURPOSE This study was conducted to analyze the factors that influence the life satisfaction of the elderly according to their cognitive impairment level. METHODS This study was conducted by dividing 3,012 elderly residents of a regional community into three groups based on the scores of the Korean version of the Mini-Mental State Examination: a normal group without any cognitive impairment, a suspicious group with a mild level of cognitive impairment, and a high risk group with a high level of cognitive impairment. Researchers made phone calls, house calls, and personal visits to health centers and shelters for the elderly to gather the information required for this study. RESULTS The results of this study revealed that social relationships, depression, and activities of daily living had a significant impact on life satisfaction for the normal group, while social relationships and depression had a high impact on life satisfaction for the suspicious group, and social relationships had high impact on the life satisfaction of the high risk group. CONCLUSION Based on the results of this study, we suggest that programs that promote development of the social relationship networks of the elderly should be established to promote their life satisfaction.

Development and psychometric evaluation of a diabetes-specific quality-of-life (D-QOL) scale

AIMS The aims of this study were to develop a diabetes-specific quality-of-life (D-QOL) scale and to determine its psychometric properties. METHODS An initial pool of items was generated based on a conceptual construct and attributes of health-related quality of life. The items were reviewed by experts, and a pilot test was conducted. A content-validated preliminary D-QOL scale was verified for use with psychometric tests on 402 patients who were recruited from 3 hospitals in Korea. The data were analyzed using exploratory and confirmatory factor analyses, Cronbachs alpha, generalizability coefficients, ANOVA, and Pearsons correlations. RESULTS From exploratory analyses, a total of sixteen items clustered four factors were extracted. The four-factor structure was supported by confirmatory factor analysis. Concurrent validity was established with the 36-item Short-Form Health Survey. As hypothesized, the D-QOL scores were worse in severely or moderately depressed patients than in those who were either less depressed or not depressed, implying satisfactory known-groups validity. The reliability of the D-QOL scale was supported by Cronbachs alpha and generalizability coefficients. CONCLUSIONS The D-QOL scale is a simple and brief scale, the use of which is feasible in practice. It demonstrated excellent psychometric properties, and so may also be used in clinical research.

Measurement of diabetes-related emotional distress using the Problem Areas in Diabetes scale: psychometric evaluations show that the short form is better than the full form

BackgroundThe Problem Areas in Diabetes (PAID) scale is widely used for measuring diabetes-related emotional distress. There has been debate over the last 2 decades about the underlying factorial-construct validity of the PAID, with one- to four-factor structures being reported. A short form of the PAID, which comprises five items (PAID-5), was recently developed using Western patients with type 2 diabetes. This study measured the psychometric properties of the full and short forms of the PAID in Korean patients with type 2 diabetes, with the aim of determining which form is preferable.MethodsThe PAID and PAID-5 were translated into Korean (K-PAID and K-PAID-5, respectively) using a forward-and-backward translation technique. The study participants were recruited from university hospitals. The factorial-construct, convergent, and known-groups validity, and internal-consistency and test-retest reliability of both the K-PAID and K-PAID-5 were evaluated.ResultsFor the K-PAID, confirmatory factor analysis revealed a marginal fit to the one-, two-, three-, and four-factor models. The three- and four-factor models of the K-PAID partially satisfied the internal-consistency and test-retest reliability, and convergent and known-groups validity. For the K-PAID-5, confirmatory factor analysis demonstrated an excellent fit to the one-factor model, with a Cronbach’s alpha of 0.87 and an intraclass correlation coefficient of 0.89. The K-PAID-5 satisfied the convergent validity, as evaluated using the Center for Epidemiologic Studies Depression Scale and hemoglobin A1c. Known-groups validity by gender was also satisfied.ConclusionsThe K-PAID-5 demonstrated excellent psychometric properties as a one-factor scale. The brevity of the K-PAID-5 represents a major advantage in a practical context in that it may impose a minimum burden upon patients with diabetes.

A Korean version of the Appraisal of Diabetes Scale (ADS-K): psychometric evaluation with a population of Koreans with type 2 diabetes.

The purpose of this study was to evaluate the psychometric properties of the Appraisal of Diabetes Scale (ADS) in Korean patients with Type 2 diabetes. The English-language version of the ADS was translated into Korean using a forward-and-backward translation technique. The Korean version of the ADS (ADS-K) was administered to 250 patients who were recruited from two university hospitals. The data were analyzed using principal-component analysis, Cronbach’s alpha, analysis of variance, t test, and Pearson’s correlation. Six of seven items were meaningfully clustered into a two-factor structure by principal-component analysis, these factors accounting for 63.75% of the total variance. The underlying structure was consistent regardless of either gender or the presence of complications. The Cronbach’s alpha of the subscales ranged from .71 to .79, indicating an acceptable internal consistency reliability. As hypothesized, the ADS-K score was moderately correlated with the diabetes-specific quality of life and had satisfactory convergent validity. The known-groups validity of the ADS-K was established using depression groups and HbA1c control status. The ADS-K demonstrated good psychometric properties. In addition, it possessed satisfactory practical properties, such as acceptability and feasibility. Therefore, the ADS-K appears to be suitable for use in both clinical research and clinical practice.

Measurement equivalence of touch-screen computerized and paper-based diabetes-specific quality-of-life questionnaires.

Current advances in technology have enabled the development of a computer-based questionnaire that provides advantages over the paper-based mode of administration, such as automatic data entry, storage and calculations. However, before implementing a computer-based questionnaire, its equivalence with the original paper-based questionnaire must first be demonstrated. The purpose of this study was to evaluate the measurement equivalence of the computerized Diabetes-Specific Quality-of-Life questionnaire (cD-QOL) with its original paper-based counterpart. A two-period crossover design was used in this study. The measurement equivalence was evaluated using quadratic weighted kappa coefficients, intraclass correlations and Cronbachs alpha comparisons. The cD-QOL was equivalent to its original paper-based counterpart. Participants preferred the cD-QOL over the paper-based questionnaire and reported that it was easy to use.

First-order vs. second-order structural validity of the Health Literacy Scale in patients with diabetes

OBJECTIVE The purpose of this study was to determine the structural validity of the Health Literacy Scale (HLS) in Korean patients with diabetes based on the previously reported first-order three-factor and two-factor models and a newly proposed second-order model, to identify which model best represents the structure of the Korean version of the HLS (HLS-K). METHODS The HLS was translated from Japanese into Korean using a translation and back-translation technique. A secondary data analysis was used to validate the structure of the HLS. Data were obtained from a cross-sectional survey involving 459 adults with diabetes recruited from outpatient clinics at two university hospitals in South Korea. The structural validity was examined using confirmatory factor analysis. Additionally, the known-groups validity by education level and internal consistency validity were assessed. RESULTS The second-order three-factor model of the HLS-K exhibited a good fit to the data, as indicated by χ2 /df = 3.891, SRMR = 0.042, GFI = 0.924, RMSEA = 0.079 (90% CI = 0.069-0.090), and CFI = 0.962. The second-order three-factor model empirically demonstrated that both communicative and critical factors explained the variance in the overall health literacy better than did the functional factor. The HLS-K mean score was significantly lower for patients with only elementary school education than for those with higher education levels, implying the presence of known-groups validity. Cronbachs alpha for the total scale was 0.90. CONCLUSIONS This study found that the second-order three-factor model of the HLS-K is better than that the original first-order three-factor and first-order two-factor models. Further validation studies are needed to generalise the underlying structure of the instrument in diabetes populations across various cultures.

A new comprehensive diabetes health literacy scale: Development and psychometric evaluation

BACKGROUND The prevalence of diabetes is close to reaching an epidemic level, and health literacy has recently emerged as a concept that can influence the health outcomes of patients with diabetes. Health literacy was once defined from the perspective of basic reading and understanding skills, but this has now become more comprehensive to include the abilities and skills to assess, understand, appraise, communicate, and use health information. Nevertheless, there is no instrument reflecting the comprehensive health literacy relevant to diabetes. OBJECTIVES The aims of this study were to develop a comprehensive Diabetes Health Literacy Scale and to evaluate its psychometric properties. DESIGN An instrument-development study was applied that comprised three steps: conceptualization, item generation and content validity, and field testing of the psychometric properties. SETTINGS A convenience sample of 462 participants was recruited from December 2016 to September of 2017 at outpatient clinics in 2 Korean university hospitals. PARTICIPANTS The inclusion criteria for participants were being aged at least 19 years, articulate in the Korean language, and diagnosed with diabetes, while the presence of gestational diabetes was applied as an exclusion criterion. Approximately half of the participants were female (51.1%). The participants were aged 54.5 (SD, 11.0) years, 67.1% of them were taking an oral hypoglycemic agent, and 21.9% of them had well-controlled blood-glucose levels. METHODS The content validity, factorial structure validity, convergent validity, criterion validity, internal consistent reliability, and test-retest reliability of the Diabetes Health Literacy Scale were evaluated. Data were analyzed using exploratory and confirmatory factor analyses, Pearsons correlation, Cronbachs alpha, and the intraclass correlation coefficient. RESULTS The content validity was assessed by five experts. Exploratory and confirmatory factor analyses yielded a three-factor solution. Convergent validity was demonstrated using measures of diabetes knowledge and self-efficacy. Criterion validity was demonstrated with generic health-literacy questions. Internal consistency reliability and test-retest reliability were found to be acceptable, as indicated by a Cronbachs alpha of 0.91 and an intraclass correlation coefficient of 0.89, respectively. CONCLUSIONS The Diabetes Health Literacy Scale is a new instrument that measures comprehensive aspects of informational, numeracy, and communicative health literacy. It is a short instrument, comprising only 14 items scored on a 5-point Likert scale. The instrument exhibits good psychometric properties for four validity metrics (content, structural, convergent, and criterion validity) and two reliability metrics (internal consistency and test-retest reliability). These findings indicate that the instrument can be applied in both research and clinical practice.

Identifying Perceptions of Health Professionals Regarding Deathbed Visions and Spiritual Care in End-of-Life Care: A Delphi Consensus Study

The final hours before death can be the most significant time for the dying. Adequate preparation for death can help reduce patients’ fears. Research on end-of-life experiences suggests that deathbed visions are not uncommon, but many doctors and nurses find this a difficult subject to approach. A 2-round Delphi method was used to gain a reliable consensus on deathbed visions from experts in end-of-life care. A purposive sample of nurses (n = 18) and doctors (n = 13) was invited from across hospitals and nursing homes to participate in this study. In this Delphi evaluation, the health professionals’ perceptions of the deathbed visions experienced by patients were identified, as well as how these phenomena should be integrated into spiritual care. The research found that healthcare professionals who are experts in end-of-life care tend to remain at the end-of-life care setting while acknowledging human spirituality as part of a peaceful death. However, they tend to not make conclusions about how death visions should be classified. This Delphi study was an attempt to identify a consensus on spiritual care including deathbed visions in end-of-life care among healthcare professionals.

Knowledge, health-promoting behaviors, and biological risks of recurrent stroke among stroke patients in Korea

AIM The study was undertaken to explore stroke knowledge, health-promoting behaviors, and predictors for biological risk profiles of stroke recurrence among stroke patients in Korea. METHODS This study was a cross-sectional descriptive study. Seventy-five stroke patients were recruited from a university medical center. Stroke knowledge, physical functioning, health-promoting life profile (HPLP), and five biological risk factors for stroke recurrence (i.e. systolic and diastolic blood pressure, total cholesterol, blood glucose, and body mass index) were measured. RESULTS The results indicated that 70.0% of the patients selected correct answers in most of the knowledge questions. The mean score for HPLP was 3.08 ± 0.45 (range, 1-4). Twenty-seven percent of patients had their five biological risk factors under control. Education level of 9 years or less and duration of stroke diagnosis within a year were predictors for biological risk profiles of stroke recurrence (F=6.94, P<0.01). CONCLUSION Stroke patients exhibited appropriate stroke knowledge and performed moderate to high levels of health-promoting behaviors. However, 73.2% of patients had uncontrolled risk factor(s) in one or more of the five biological risk factors for stroke recurrence. Nurses should be aware that stroke patients seeking treatments from clinics and hospitals are still at risk of stroke recurrence.