Propriedades psicométricas e interpretabilidade de instrumento de avaliação da literacia em saúde entre pessoas com diabetes assistidas na atenção primária à saúde e sua associação com cognição e parâmetros bioquímicos

Abstract

Diabetes is a progressive metabolic disease, being part of the noncommunicable diseases, which according to the World Health Organization, comprise seven of the ten main death causes worldwide. According to the Diabetes International Federation, the estimates for 2045 is that the number of people with diabetes may reach 693 million, with impacts on the social, and economic scenarios, especially in low and middle-income countries. The metabolic control in diabetes relies not only on the medication’s use but also on the diet and physical activity lifestyles. Therefore, the self-care is fundamental in the disease management to minimize the associated morbimortality. In this perspective, diabetes is an eligible model of chronic disease for the study of health literacy (HL) on the clinical outcomes, and for the formulation of public policies aimed to promote health equity. The HL embraces the knowledge, the motivation, and the competence to access, comprehend, evaluate, and apply the health information to encourage judgments and decision-making regarding self-care, being extended to the community, social, cultural, economic, and political scope. In an inclusive and integrative way, HL emerges as an essential measure to meet the challenging health demands in modern society. Despite the relevance, scientific evidence on HL and its applicability remains scarce and faulty, mainly among the elderly, and low-income population subgroups. In the elderly, diabetes interacts and predisposes to dementia processes as resulting from vascular disease, and Alzheimer’s disease, accelerating the cognitive decline. Therefore, the development and validation of instruments that comprehensively contemplate the HL domains, are necessary. In clinical and research scenarios, valid and reliable instruments may contribute to the identification of modifiable risk factors that, by acting bidirectionally, feedback the limitation of literacy, from which complexity needs to be the target of studies that support public health policies. The present study is an excerpt from the “Health Literacy Project”, and included a population with diabetes assisted by professionals from the Family Health Strategy in Montes Claros – MG. It comprises a construct validation (structural validity and hypothesis test), as well as the “Health Literacy for Diabetics” (HLD) instrument interpretability, which is designated to assess the health literacy (HL) among individuals with diabetes assisted in the Health Primary Care. The statistical analysis demonstrated the instrument construct reliability and validity in the studied population, inferring suitability for application in research, and health services that assist patients with diabetes. It was also evidenced that a greater accessibility to information on diabetes tends to improve other literacy skills, which is related to cognitive conditions, condition, and HL of elderly with diabetes and their relation with medication adherence, physical activity, nutrition, sociodemographic, and biochemical factors were evaluated by using the Mini-Mental State Examination and diabetes-specific HL instruments. In this subgroup, HL was correlated with cognition and sociodemographic conditions (age, income, and educational level). Therefore, the use of instruments to evaluate HL and cognitive condition may contribute to the improvement of measures based on the comprehensive care of elderly with diabetes, enriching the disease management effectiveness. In this perspective, the HLD psychometric properties evaluation in individuals with diabetes, in addition to correlations with the cognition and sociodemographic conditions collaborates to emphasize the importance of using instruments as tools for the elaboration of strategies for disease prevention, minimization of complications, and health promotion.