Health Literacy, Medications Adherence And Glycemic Control Among Diabetic Patients Attending Diabetic Center, Sana'a City, Yemen

Abstract

Background: Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin that it produces. Health literacy is recognized as a stronger predictor of a persons‟ health than age, income, employment status, education level, or race, and is associated with a wide range of adverse effects on care processes and health outcomes. Poor adherence to prescribed regimens can result in serious health consequences such as bad glycemic control.

Objectives: To assess health literacy, medication adherence, and glycemic control among diabetic patients attending the diabetic center, Sana'a city, Yemen.

Methods: A cross-sectional study was conducted among diabetic patients, who attending the national center of diabetes at Al-Thowra Hospital, Sana‟a City, Yemen. Systematic random sampling was applied to select the participants. After obtaining the official approval, 401 selected participants were interviewed, and data were collected using self-administered questionnaires. All participants were interviewed for their knowledge and medication adherence and requested to provide the last result of HbA1C. Data analysis was performed using SPSS, version 23.0, and the associations between variables were tested using Chi-square and fisher tests with the level of significance was set at ≤ 0.05.

Results: Most of the participants were above 40 years old (82.5%), (78.3%) of the participnats from urban areas, (80.3%) married, and (93.8%) had not insuance. Regarding to the characteristics of DM, most of the participants had type 2 DM (78.8%) uninsured while the mean duration of DM diagnosis was 7.99±6.66 years. Also, the main risk factor of the DM were reported as lifestyle factors (61.6%) followed by family history (24.9%). The main complications of DM were stated as hypertension among more than one-quarter (26.2%) of the participants while more than half (56.4%) reported that they had no complications. About the health literacy of the participants, the vast majority (around 98.5%) had poor health literacy which was further categorized as either inadequate (34.7%) or marginal (63.8%) while only 1.5% had adequate health literacy. The good adherents and non-adherents to their medications were 59.4% and 40.6% respectively. Only 26.2% had good glycemic control. Statistically significant association were found between age, marital status, residence, education level and health literacy (p-values = 0.004, 0.018, 0.003, and 0.000, respectively). Statistical significance association was found between health literacy and medication adherence (p = 0.000). There was statistically significant association between medication adherence and glycemic control (HbA1C) with p = 0.003.

Conclusion: Based on the results of the current study, it was found that knowledge of diabetes patients was inadequate, Adherence to medications was inadequate too and adequacy of HL and medication adherence had negative effect on glycemic control, so health care professionals have to pay special attention to patients with diabetes, especially those who are illiterate with polypharmacy and comorbidities, as this will increase the risk for non-adherence to medications, as revealed in this current study. Current study found that no reviews focused on examining and improving the adherence specifically among older adults with low health literacy. Therefore, further studies are required to better understand these issues.