Letramento em saúde e adesão ao tratamento medicamentoso entre pessoas com diabetes : desenvolvimento e análise de um instrumento de avaliação

Abstract

Health literacy (HL) comprises the cognitive and social skills that determine the motivation and ability of individuals to access, understand and apply information in order to promote and maintain good health. LS influences the autonomy and decision-making of people assisted regarding medication adherence (MA), directly interfering with the result of therapy, with important repercussions, especially in the case of chronic diseases such as diabetes. Diabetes is a leading cause of premature and preventable death, which burdens the health system and whose progressive nature requires complex medication regimens. Given the relevance of the topic and its implications for public health in Brazil and worldwide, as well as the scarcity of reliable and valid measurement instruments, this study sought to develop a measurement in- strument capable of evaluating the LS regarding the MA among people with diabetes, consid- ering the dimensions access, understanding, evaluation and application, according to the theo- retical model proposed by Sørensen. A methodological study was conducted among people diagnosed with diabetes, registered in their medical records, who were attended by the public health service of a medium-sized city in the southeast region of Brazil. An instrument with 10 items and two questionnaires to evaluate and characterize the access and the MA were struc- tured, which went through the evaluation of the content validity and verification of reproduci- bility/reliability (Kappa). Then, the first and second order four-dimensional models were ad- justed due to the existence of a higher-order latent factor and the construct validity was ana- lyzed through the factorial validity, convergent validity and discriminant validity. The validity of concurrent criterion and composite reliability were also investigated. The instrument enti- tled “Health Literacy regarding Medication Adherence among People with Diabetes (HLMA)” presented good reproducibility, content validity, factorial validity, convergent va- lidity and discriminant validity satisfactory; internal consistency and reliability also showed satisfactory results. The HLMA showed satisfactory validity, reliability and internal con- sistency and can be used to assess health literacy regarding medication adherence among peo- ple with diabetes in clinical practice, in research and or in health care services to support dia- betes control.