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This research used a mixed methods intervention design. The research aimed to:
1) study the perspectives of diabetic adults and 2) investigate the effectiveness of health literacy through transformative learning of glycemic control. In study 1, through qualitative research, the perspectives of 13 diabetic adults in Bangkok, Thailand, were examined using in-depth interviews. The findings were divided into three themes that reflected the beliefs of the patients: 1) the serious nature of the disease; 2) that made life difficult; and 3) that the glycemic control relied on patients’ sense of self-reliance and efficacy. The perspectives towards health literacy consisted of two themes: 1) information must be analyzed and evaluated before usage; and 2) hierarchical relationship influences the communication between providers and patients. The study 2 was an experimental research, in which consisted of 40 diabetic adults, divided equally into 2 groups; the experimental (20 participants) and control (20 participants) group. The instrument used were the glycemic control questionnaire, and the measurement of glycated hemoglobin (A1C). The intervention consisted of 4 sessions for 4 weeks, for two hours per session, and the final session was visiting their homes. The ANCOVA and repeated measures were applied for data analysis. The results revealed that: 1) the experimental group had more glycemic control and less A1C than the control group (p < 0.01); and 2) the experiment group had changing and maintaining in glycemic control and A1C (p < 0.01). The findings of this study could be useful for healthcare providers to develop the glycemic controlling program based on the patients’ contexts.
Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs. (1999). Health
literacy: Report of the council on scientific affairs. JAMA, 281(6), 552-557.
American Diabetes Association. (2009). Standards of medical care in diabetes–2009. Diabetes
Care, 32(Suppl 1), S13-S61.
American Diabetes Association. (2014). Standards of medical care in diabetes–2014. Diabetes Care, 37(Suppl 1), S14-S80.
Baker, D. W., Wolf, M. S., Feinglass, J., & Thompson, J. A. (2008). Health literacy, cognitive
abilities, and mortality among elderly persons. Journal of General Internal Medicine, 23(6),
Baker, D. W., Wolf, M. S., Feinglass J, Thompson, J. A., Gazmararian, J. A., & Huang, J. (2007).
Health literacy and mortality among elderly persons. Archives of Internal Medicine,
Bautista, R. E., Glen, E. T., Shetty, N. K., & Wludyka, P. (2009). The association between health
literacy and outcomes of care among epilepsy patients. Seizure, 18(6), 400-404.
Davis, T. C., & Wolf, M. S. (2004). Health literacy: Implications for family medicine. Family
Medicine, 36(8), 595-598.
Deerochanawong, C., & Ferrario, A. (2013). Diabetes management in Thailand: A literature
review of the burden, costs, and outcomes. Globalization and Health, 9, 11.
Diabetes Control and Complications Trial Research Group. (1993). The effect of intensive
treatment of diabetes on the development and progression of long-term complications in
insulin-dependent diabetes mellitus. The New England Journal of Medicine, 329(14),
Dirkx, J. M. (1998). Transformative learning theory in the practice of adult education: An
overview. PAACE Journal of Lifelong Learning, 7, 1-14.
Funnell, M. (2006). The diabetes attitudes, wishes, and needs (DAWN) study. Clinical Diabetes,
Gazmararian, J. A., Baker, D. W., Williams, M. V., Parker, R. M., Scott, T. L., Green, D. C.,
Fehrenbach, S. N., Ren, J., & Koplan, J. P. (1999). Health literacy among Medicare
enrollees in a managed care organization. JAMA, 281(6), 545–551.
Gazmararian, J. A., Williams, M. V., Peel, J., & Baker, D. W. (2003). Health literacy and
knowledge of chronic disease. Patient Education and Counseling, 51, 267-275.
Hein, S. F. (2004). Embodied reflexivity in qualitative psychological research: The disclosive capacity of the lived body. In S. P. Shohov (Ed.), Advances in Psychology Research, Volume 30 (pp. 57-74). New York: Nova Science.
Institute of Medicine (US) Committee on Health Literacy. (2004). Health literacy: A prescription
to end confusion. Washington, DC: National Academies Press.
Kalichman, S. C., Ramachandran, B., & Catz, S. (1999). Adherence to combination antiretroviral
therapies in HIV patients of low health literacy. Journal of General Internal Medicine,
Kitchenham, A. (2008). The evolution of John Mezirow's transformative learning theory.
Journal of Transformative Education, 6, 104-123.
Lorig, K., Stewart, A., Ritter, P., Gonzalez, V., Laurent, D., & Lynch, J. (1996). Outcome
measures for health education and other health care interventions. Thousand Oaks, CA:
Mezirow, J. (1991). Transformative dimensions of adult learning. San Francisco: Jossey-Bass.
Mezirow, J. (1997). Transformative learning: Theory to practice. In P. Cranton (Ed.),
Transformative learning in action: Insights from practice (pp. 5-12). New Directions for
Adult and Continuing Education, No. 74. San Francisco: Jossey-Bass.
Mezirow, J. (2000). Learning to think like an adult: Core concepts of transformation theory.
In J. Mezirow (Ed.), Learning as transformation: Critical perspectives on a theory in
progress, (pp. 3-33). San Francisco: Jossey-Bass.
Murea, M., Ma, L., & Freedman, B. I. (2012). Genetic and environmental factors associated with
type 2 diabetes and diabetic vascular complications. The Review of Diabetic Studies, 9(1),
Ntiri, D. W., & Stewart, M. (2009). Transformative learning intervention: Effect on functional health literacy and diabetes knowledge in older African Americans. Gerontology & Geriatrics Education, 30(2), 100-113.
Nutbeam, D. (1999). Literacies across the lifespan: Health literacy. Literacy and Numeracy
Studies, 9(2), 47-55.
Nutbeam, D. (2008). The evolving concept of health literacy. Social Science & Medicine, 67(12), 2072-2078.
Osborn, C. Y., Bains, S. S., & Egede, L. E. (2010). Health literacy, diabetes self-care, and glycemic control in adults with type 2 diabetes. Diabetes Technology & Therapeutics, 12, 913-919.
Osborn, C. Y., Paasche-Orlow, M. K., Bailey, S. C., & Wolf, M. S. (2011). The mechanisms
linking health literacy to behavior and health status. American Journal of Health Behavior,
Osborn, C. Y., Paasche-Orlow, M. K., Davis, T. C., & Wolf, M. S. (2007). Health literacy:
An overlooked factor in understanding HIV health disparities. American Journal of
Preventive Medicine, 33(5), 374-378.
Paasche-Orlow, M. K., Wolf, M. S. (2007). The causal pathways linking health literacy to health
outcomes. American Journal of Health Behavior, 31(Suppl 1), S19-S26.
Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoagwood, K. (2015).
Purposeful sampling for qualitative data collection and analysis in mixed method
implementation research. Administration and Policy in Mental Health, 42(5), 533-544.
Peyrot, M., McMurry, J. F., Jr., & Kruger, D. F. (1999). A biopsychosocial model of glycemic
control in diabetes: Stress, coping and regimen adherence. Journal of Health and Social
Behavior, 40(2), 141-158.
Rodbard, H., Blonde, L., Braithwaite, S., Brett, E., Cobin, R., Handelsman, Y., Hellman, R.,
Jellinger, P., Jovanovic, L., Levy, P., Mechanick, J., & Zangeneh, F. (2007). American
association of clinical endocrinologists medical guidelines for clinical practice for the
management of diabetes mellitus. Endocrine Practice, 13(Suppl 1), 1-68.
Schillinger, D., Grumbach, K., Piette, J., Wang, F., Osmond, D., Daher, C., Palacios, J., Sullivan,
G. D., & Bindman, A.B. (2002). Association of health literacy with diabetes outcomes.
JAMA, 288(4), 475-482.
Skovlund, S., Peyrot, M., & on behalf of the Dawn International Advisory Panel. (2004). The
diabetes attitudes, wishes, and needs (DAWN) program: A new approach to improving
outcomes of diabetes care. Diabetes Spectrum, 18(3), 136-142.
Sridama, V. (2003). Management for diabetic patients. Bangkok: Faculty of Medicine Chulalongkorn University. (in Thai).
Susic, J. (2009). NIHSeniorHealth classes for senior citizens at a public library in Louisiana. Journal of Consumer Health on the Internet, 13(4), 417-419.
Torres, R. Y., & Marks, R. (2009). Relationships among health literacy, knowledge about
hormone therapy, self-efficacy, and decision-making among postmenopausal health.
Journal of Health Communication, 14(1), 43-55.
von Wagner, C., Steptoe, A., Wolf, M. S., & Wardle, J. (2009). Health literacy and health actions:
a review and a framework from health psychology. Health Education & Behavior, 36(5),
Wolf, M. S., Davis, T. C., Cross, J. T., Marin, E., Green, K., & Bennett, C. L. (2004). Health
literacy and patient knowledge in a Southern US HIV clinic. International Journal of STD
& AIDS, 15(11), 747-752.