Organizing framework to investigate associations between diabetes knowledge, health literacy, and self-care behaviors in
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RESEARCH ARTICLE
Organizing framework to investigate associations between diabetes knowledge, health literacy, and self-care behaviors in patients with type 2 diabetes based on the extended parallel process model Seyedeh Belin Tavakoly Sany 1,2 & Afsaneh Esmaeily 3 & Elaheh Lael-Monfared 4 & Hadi Tehrani 5 & Gordon Ferns 6 & Alireza Jafari 7,8 Received: 10 June 2020 / Accepted: 18 September 2020 # Springer Nature Switzerland AG 2020
Abstract Objective The mechanisms underlying the relations between diabetes self-care behaviors, cognition, and social factors are still equivocal, and it is unclear how diabetes knowledge and health literacy is associated with self-care behaviors. Here, we tested a hypothetical path model linking diabetes self-care behaviors to knowledge, health literacy, and constructs of the extended parallel process model (EPPM) to understand potential predictors that may influence patients’ self-care behavior with type 2 diabetes. Methods A cross-sectional study was conducted, and 404 patients with type 2 diabetes were recruited from healthcare centers in Khaf, Iran. Diabetes self-care behaviors were indicated by, glucose self-control, foot care, physical activity, medications, smoking, and a healthy diet. The main data collection instruments in this study were the Health Literacy for Iranian Adults questionnaire (HELIA), diabetes knowledge, and self-care behavior based on the EPPM questionnaires. Results The results from path modeling indicated that perceived susceptibility, efficacy, self-efficacy, knowledge, and health literacy were significant (p < 0.05) predictors for diabetes self-care behaviors and path model accounted for 32% of the total variance. Conclusion Based on the results, key constructs of EPPM, diabetes knowledge, and health-related literacy are empirically supported diabetes self-care behaviors. These factors could apply to health professionals for developing educational intervention programs to facilitate a physically active lifestyle. Keywords Knowledge . Health literacy . Self-care . Path analysis . EPPM
* Alireza Jafari [email protected] Seyedeh Belin Tavakoly Sany [email protected]
2
Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
3
Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
4
School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
5
Department of Health Education and Health Promotion, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
6
Department of Medical Education Brighton and Sussex Medical School , University of Brighton Falmer campus, BN1 9PH Brighton, UK
7
Department of Public Health, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
8
Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
Afsaneh Esmaeily [email protected] Elaheh Lael-Monfared [email protected]
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