Is numeracy a barrier to glycaemic control in Type 1 diabetes mellitus? A synthesis of current literature
DOI:
https://doi.org/10.1080/20573316.2016.1274556Keywords:
Health literacy, Numeracy, Type 1 diabetes mellitus, Self-care, Education, Dose adjustment, Insulin therapy, Insulin-dependent diabetesAbstract
Aims: Healthcare professionals rely on patients’ health literacy and numeracy when providing education to enable self-management of diabetes. We review existing evidence for the impact of health literacy and numeracy on self-care processes in adults with Type 1 diabetes mellitus (T1DM).
Methods: A systematic review and narrative synthesis was performed. Four electronic databases were searched from inception to October 2015. Inclusion criteria included at least 70% adults (>17 years old) T1DM population, measurement of health literacy or numeracy with validated score and measure of self-care.
Results: A total of 972 articles were identified. Three articles met the inclusion criteria. There was heterogeneity of the studies although all studies used glycaemic control as the primary outcome. Six themes were identified, in particular, the association between numeracy and glycaemic control (p = 0.004, p = 0.066) in T1DM. No association was seen with health literacy.
Conclusions: Low numeracy appears to be associated with poorer glycaemic control in adults with T1DM, likely reflecting the skills needed for conventional insulin dose adjustment in T1DM. This review calls for more work to investigate this association further, aid identification and produce strategies to overcome low numeracy.
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References
Jahanlou AS, Karami NA. The effect of literacy level on health related-quality of life, self-efficacy and self-management behaviors in diabetic patients. Acta Medica Iranica. 2011; 49: 153–8.
Bandura. A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977; 84: 191–215. doi: 10.1037/0033-295X.84.2.191
Boulos MNK. British internet-derived patient information on diabetes mellitus: is it readable? Diabetes Technol Ther. 2005; 7: 528–35. doi: 10.1089/dia.2005.7.528
The Council on Scientific Affairs AMA. Health literacy: report of the Council on Scientific Affairs. Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association. J Am Med Assoc. 1999; 281: 552–7. doi: 10.1001/jama.281.6.552
The Public Accounts Committee HoC. Skills for life: progress in improving adult literacy and numeracy. In. The Public Accounts Committee, House of Commons (UK); 2009. p. 3–6.
DeWalt DA, Boone RS, Pignone MP. Literacy and its relationship with self-efficacy, trust, and participation in medical decision making. Am J Health Behav. 2007; 31(Suppl. 1): 27–35. doi: 10.5993/AJHB.31.s1.5
Williams MV, Baker DW, Parker RM, Nurss JR. Relationship of functional health literacy to patients' knowledge of their chronic disease. Arch Intern Med. 1998; 158: 166–72. doi: 10.1001/archinte.158.2.166
Gazmararian JA, Williams MV, Peel J, Baker DW. Health literacy and knowledge of chronic disease. Patient Educ Couns. 2003; 51: 267–75. doi: 10.1016/S0738-3991(02)00239-2
Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, et al. Association of health literacy with diabetes outcomes. J Am Med Assoc. 2002; 288: 475–82. doi: 10.1001/jama.288.4.475
Kerr D, Marden S. Numeracy and insulin pump therapy. Diabet Med. 2010; 27: 730–1. doi: 10.1111/j.1464-5491.2010.02999.x
Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, et al. Association of numeracy and diabetes control. [Summary for patients in Ann Intern Med. 2008 May 20;148(10):I53; PMID: 18490670]. Ann Intern Med. 2008; 148: 737–46. doi: 10.7326/0003-4819-148-10-200805200-00006
Sacerdote C, Ricceri F, Rolandsson O, Baldi I, Chirlaque M-D, Feskens E, et al. Lower educational level is a predictor of incident type 2 diabetes in European countries: the EPIC-InterAct study. Int J Epidemiol. 2012; 41: 1162–73. doi: 10.1093/ije/dys091
Dupre ME, Silberberg M, Willis JM, Feinglos MN. Education, glucose control, and mortality risks among U.S. older adults with diabetes. Diabetes Res Clin Pract. 2015; 107: 392–9. doi: 10.1016/j.diabres.2014.12.013
Kerr D, James J, Nicholls H. Technologies as therapeutic devices. What do we expect from users of insulin pump therapy? Infusystems Int. 2008; 7: 1–4.
Grinyer J. Literacy, Numeracy and the Labour Market: Further analysis of the Skills for Life Survey. In, Department for Education and Skills (UK); 2006.
Rothman RL, Housam R, Weiss H, Davis D, Gregory R, Gebretsadik T, et al. Patient understanding of food labels. Am J Prev Med. 2006; 31: 391–8. doi: 10.1016/j.amepre.2006.07.025
Al Sayah F, Williams B, Johnson JA. Measuring health literacy in individuals with diabetes: a systematic review and evaluation of available measures. Health Educ Behav. 2013; 40: 42–55. doi: 10.1177/1090198111436341
Huizinga MM, Elasy TA, Wallston KA, Cavanaugh K, Davis D, Gregory RP, et al. Development and validation of the Diabetes Numeracy Test (DNT). BMC Health Serv Res. 2008; 8: 475. doi: 10.1186/1472-6963-8-96
Aveyard H. Doing a literature review in health and social care: a practical guide. Berkshire, UK: McGraw-Hill Education; 2007.
Pope C, Mays N. Synthesising qualitative research qualitative research in health care. Oxford: Blackwell Publishing Ltd; 2007. p. 142–52.
Huang X, Lin J, Demner-Fushman D. Evaluation of PICO as a knowledge representation for clinical questions. AMIA Annu Symp Proc. 2006; 2006: 359–63.
Piatt A, Valerio A, Nwankwo R, Lucas M, Funnell M. Health literacy among insulin-taking African Americans: a need for tailored intervention in clinical practice. Diabetes Educ. 2014; 40: 240–6. doi: 10.1177/0145721713519292
Wikipedia. Compulsory schooling. 2015. Available from https://en.wikipedia.org/wiki/Compulsory_education (accessed 04 November 2015).
Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005; 5: xi, 564.
Fransen MP, Beune EJAJ, Baim-Lance AM, Bruessing RC, Essink-Bot ML. Diabetes self-management support for patients with low health literacy: perceptions of patients and providers. J Diabetes. 2015; 7: 418–25. doi: 10.1111/1753-0407.12191
Hawthorne K, Robles Y, Cannings-John R, Edwards AG. Culturally appropriate health education for type 2 diabetes mellitus in ethnic minority groups. The Cochrane database of systematic reviews: Cd006424; 2008.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6: e1000097. doi: 10.1371/journal.pmed.1000097
Greenhalgh T, Peacock R. Effectiveness and efficiency of search methods in systematic reviews of complex evidence: audit of primary sources. Br Med J. 2005; 331: 1064–5. doi: 10.1136/bmj.38636.593461.68
Guyatt GH, Sackett DL, Cook DJ. Users' guides to the medical literature. II. How to use an article about therapy or prevention. B. What were the results and will they help me in caring for my patients? Evidence-based medicine working group. J Am Med Assoc. 1994; 271: 59–63. doi: 10.1001/jama.1994.03510250075039
Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, et al. Guidance on the conduct of narrative synthesis in systematic reviews: final report. In: ESRC. MP editor. Lancaster: Lancaster University; 2006. p. 1–92.
Marden S, Thomas PW, Sheppard ZA, Knott J, Lueddeke J, Kerr D. Poor numeracy skills are associated with glycaemic control in Type 1 diabetes. Diabet Med. 2012; 29: 662–9. doi: 10.1111/j.1464-5491.2011.03466.x
Zaugg SD, Dogbey G, Collins K, Reynolds S, Batista C, Brannan G, et al. Diabetes numeracy and blood glucose control: association with type of diabetes and source of care. Clin Diabetes. 2014; 32: 152–7. doi: 10.2337/diaclin.32.4.152
Trief PM, Cibula D, Rodriguez E, Akel B, Weinstock RS. Incorrect insulin administration: a problem that warrants attention. Clin Diabetes. 2016; 34: 25–33. doi: 10.2337/diaclin.34.1.25
Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011; 6: II2. doi: 10.1186/1748-5908-6-2
Kerr D. Information in diabetes care: is there a need to dumb down even more? Diabet Med. 2007; 24: 561–3. doi: 10.1111/j.1464-5491.2007.02135.x
Baker DW, Parker RM, Williams MV, Clark WS. Health literacy and the risk of hospital admission. J Gen Intern Med. 1998; 13: 791–8. doi: 10.1046/j.1525-1497.1998.00242.x
Doak CC, Doak LG, Root JH. Teaching patients with low literacy skills. Am J Nurs. 1996; 96: 16M. doi: 10.1097/00000446-199612000-00022
Braddock CH, III, Fihn SD, Levinson W, Jonsen AR, Pearlman RA. How doctors and patients discuss routine clinical decisions: informed decision making in the outpatient setting. J Gen Intern Med. 1997; 12: 339–45.
Seligman K, Wang F, Palacios L, Wilson CC, Daher CA, Piette JD, et al. Physician notification of their diabetes patients' limited health literacy: a randomized, controlled trial. J Gen Intern Med. 2005; 20. doi: 10.1111/j.1525-1497.2005.00309.x
Cavanaugh K, Wallston KA, Gebretsadik T, Shintani A, Huizinga MM, Davis D, et al. Addressing literacy and numeracy to improve diabetes care: two randomized controlled trials. Diabetes Care. 2009; 32: 2149–2155. doi: 10.2337/dc09-0563
Schwartz F, Guo A. Analysis of use of an automated bolus calculator reduces fear of hypoglycemia and improves confidence in dosage accuracy in type 1 diabetes mellitus patients treated with multiple daily insulin injections. J Diabetes Sci Technol. 2012; 6. doi: 10.1177/193229681200600118
Zisser H, Wagner R, Pleus S, Haug C, Jendrike N, Parkin C, et al. Clinical performance of three bolus calculators in subjects with type 1 diabetes mellitus: a head-to-head-to-head comparison. Diabetes Technol Ther. 2010; 12: 955–61. doi: 10.1089/dia.2010.0064
Brancato D, Scorsone A, Spano L, et al. Effectiveness of the glucometer with bolus calculator in adults with type 1 diabetes. Italian J Med. 2014; 8: 16.
Barnard K, Parkin C, Young A, Ashraf M. Use of an automated bolus calculator reduces fear of hypoglycemia and improves confidence in dosage accuracy in patients with type 1 diabetes mellitus treated with multiple daily insulin injections. J Diabetes Sci Technol. 2012; 6: 144–9. doi: 10.1177/193229681200600117
Goebel-Fabbri AE, Fikkan J, Franko DL, Pearson K, Anderson BJ, Weinger K. Insulin restriction and associated morbidity and mortality in women with type 1 diabetes. Diabetes Care. 2008; 31: 415–9. doi: 10.2337/dc07-2026
Patrakeeva EM, Romanova NN, Zalevskaya AG, Shlyakhto EV. Poor numeracy as a limiting factor for successful treatment of type 1 diabetes mellitus (T1DM) patients on continuous subcutaneous insulin infusion (CSII). Diabetes. 2013; 62.
Buysse HEC, de Moor GJE, de Maeseneer J. Introducing a telemonitoring platform for diabetic patients in primary care: will it increase the socio-digital divide? Prim Care Diabetes. 2013; 7: 119–27. doi: 10.1016/j.pcd.2012.10.085
Division of Diabetes Translation National Center for Chronic Disease Prevention and Health Promotion. Age-adjusted percentage of adults aged 18 years or older with diagnosed diabetes ever attending a diabetes self-management class, United States 2000–2010. 2014. Available from http://www.cdc.gov/diabetes/statistics/preventive/fY_class.htm (accessed 28/03/2016)
Health and Social Care Information Centre, Healthcare Quality Improvement Partnership, Diabetes UK. National Diabetes Audit – 2013–14 and 2014–15; Report 1, Care processes and treatment targets. 2016. Available from http://www.hscic.gov.uk/catalogue/PUB19900/nati-diab-rep1-audi-2013-15.pdf (accessed 26 September 2016).
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