Purpose: The aim of this study is to evaluate the effect of education on rational drug use and health literacy in people with diabetes mellitus.
Materials and Methods: This pre-test and post-test control group interventional study was conducted between 24 January and 25 July 2020 in Zonguldak Diabetes Association in Turkey. The universe of the study consists of 238 diabetic people registered to the association, and the sample group consists of 154 diabetic people who were registered members of the association who had inadequate and problematic-limited health literacy according to the data collected previously and other sample criteria. Groups of 4-6 people created from the intervention group were applied face-to-face by the researcher with a power point presentations, an educational program that included basic knowledge of diabetes, rational knowledge of drug use and knowledge of health literacy. Data from the study were collected using the Rational Drug Use Scale, the Turkish Health Literacy Scale and Diagnostic Form. Intervention and control groups were established by randomization method regardless of the evaluation results. After three months, assessments of groups were repeated.
Results: In the evaluation of the intervention group in the third month after the education, statistically significant changes were determined in Rational Drug Use Scale score and Turkish Health Literacy Scale score.
Conclusion: It was found that providing group-based education on general diabetes knowledge, rational drug use and health literacy to people with diabetes was effective in increasing rational drug use and health literacy level.
This study was carried out in Zonguldak Diabetes Association in Turkey. I would like to thank the president of the association for his support in the data collection and education process and all the people who participated in the study voluntarily.
2. Guide to Diagnosis, Treatment and Follow-up of Diabetes Mellitus and Complications, 2019.
http://temd.org.tr/admin/uploads/tbl_kilavuz/201908190958542019tbl_kilavuzb48da47363.pdf. Accessed 05.02.2020.
3. World Health Organization (WHO), Promoting rational use of medicines: core components. WHO Policy Perspectives on Medicines no5.
WHO/EDM/2002.3.Geneva, WHO, 2002. Accessed 03.01.2020.
4. Chauhan I, Yasir M, Kumari M, Verma M. The pursuit of rational drug use: understanding factors and ınterventions. Pharmaspire 2018;10:48-54.
5. Pirinçci E, Bozan T. Rational drug use among nurses who work in a university hospital. Firat Med J. 2016;2:129-36.
6. Toklu HZ, Demirdamar R, Gümüşel B, Yarış E, Dülger G. Rational drug use awareness of the nurses in the Turkish Republic of Northern Cyprus Near East University
Hospital. Marmara Pharmaceutical Journal. 2012; 16: 150-54.
7. Özyurt E, Aydın İ, Aydın H, Erduran S, Uğurlu D, Akar Y, Aykutluğ M, Yörük S. Knowledge, attitude and behaviors of patients in Dışkapı Yıldırım Beyazıt Education
Research Hospital about rational drug use. Sağ Aka Derg.2018; 5:208-19.
8. Aydın B, Gelal A. Rational drug use: promotion and the role of medical education. DEÜ Journal of Faculty of Medicine. 2012; 26:57-63.
9. Ekenler Ş, Koçoğlu D. Individuals’ knowledge and practices about rational drug use. Hacettepe University Journal of Nursing Faculty. 2016; 3:44-55.
10. Çiftçi B, Aksoy M. Rational drug use in children and nurse’s responsibilities. Gümüşhane University Journal of Health Sciences. 2017; 6: 191-94.
11. Altındiş S. Systematic overview of rational drug use. Journal of BSHR. 2017; 1: 34-38.
12. Afriyie DK, Tetteh RA. Description of the pattern of rational drug use in ghana police hospital. JPP. 2014; 3: 143-48.
13. Sürmelioğlu N, Kıroğlu O, Erdoğdu T, Karataş Y. Measures to prevent irrational drug use. Archive Resource Review Journal. 2015; 24: 452-62.
14. The World Health Organization Report. (1998). Life in the 21st century: A vision for all, (Cited 2020), available at:http://www.who.int/whr/1998/en/.
15. Öncü E, Vayısoğlu SK, Güven Y, Aktaş G, Ceyhan H, Karakuş E. Evaluation of individuals with hypertension regarding chronic disease management and its
relationship with health literacy. Anatol JFM. 2018; 1:31-32.
16. Kickbusch I, Apfel F, Jürgen PM, Agis TD. Health literacy: The solid facts. 1st edition. World Health Organisation Regional Office for Europe, Copenhagen, 2013.
17. Yılmaz M, Tiraki Z. What is the health literacy? How assessment? DEUHFED. 2016; 9: 142-47.
18. Jin J, Sklar GE, Oh VMS, Li SC. Factors Affecting therapeutic compliance: A review from the patient’s perspective. Therapeutics and clinical risk management.
2008; 4: 269–86.
19. Ağralı H, Akyar I. Turkish validation and reliability of health literacy scale for diabetic patient.
ACU Sağlık Bil Derg. 2018; 9: 314-21.
20. Çakmak V. Evaluate the effects of education given by nurses on rational drug use and health literacy of patients receiving hypertension treatment, Manisa Celal
Bayar University Institute of Health Sciences, Department of Nursing, Ph. D. Thesis, 2019.
21. Erciyes Y, Çınar Pakyüz S. Evaluation of efficacy of education given by nurse to patients with hypertension about healthy life style behaviors. DOHH. 2014; 6: 46-57.
22. Demirtaş Z, Dağtekin G, Sağlan R, Alaiye M, Önsüz MF, Işıklı B, et al. Validity and reliability of rational drug use scale. ESTÜDAM Public Health Journal. 2018; 3: 37-46.
23. Okyay P, Abacıgil F. T.C. Ministry of Health, Report on reliability and validity of turkish health literacy scales. Editors, No:1025, 2016.
24. Educational Guide and Training Sets for Adult Diabetics. http://beslenme.gov.tr/index.php?lang=tr&page=527/ Accessed 12.01.2020.
25. Turkish Republic Ministry of Health Rational Drug Use. http://www.akilciilac.gov.tr/ Accessed 10.01.2020.
26. National Action Plan For Rational Drug Use. http://www.akilciilac.gov.tr/wp-content/uploads/2014/11/aik-ulusal-eylemplani.pdf. Accessed 05.01.2020.
27. Turkey Rational Drug Use Bulletin. http://www.akilciilac.gov.tr/wp-content/uploads/2015/09/aik-bltn-12-i.pdf. Accessed 06.01.2020.
28. Turkey Health Literacy. http://www.saglikokuryazarligi.org/. Accessed 11.01.2020.
29. Al Sayah F, Williams B. An integrated model of health literacy using diabetes as an exemplar. Canadian Journal of Diabetes. 2012; 36: 27-31.
30. Tanrıöver DM, Yıldırım HH, Demiray FN, Çakır B, Akalın E. Turkey health literacy survey. Health and social workers union. Sağlık-Sen Publications. 2014; 25: 14-26.
31. Hughes F. Nursing and Health Policy Perspectives: Health literacy: a key educational role for nurses and a vital tool for improving health. International Nursing
Rewiew. 2016; 63: 304-305.
32. Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, Brand H, Health literacy and public health: a systematic review and integration of definitions
and models. BMC Public Health. 2012; 12: 80.
33. Funnell M, Tammy L, Belinda P, Linda B, Gwen M, Brian J, Melinda M. National standards for diabetes self-management education. Diabetes Care. 2011;34:89–96.
34. How soon does a behavior become a habit. https://bilimgenc.tubitak.gov.tr/makale. Accessed 03.01.2020.
35. Gazmararian JA, Williams MV, Peel J, Baker DW. Health literacy and knowledge of chronic disease. PEC. 2003;51: 267- 75.
36. Fischer HH, Moore SL, Ginosar D, Davidson AJ, Rice CM, Durfee MJ, MacKenzie TD, Estacio RO, Steele AW. Care by cell phone: text messaging for chronic disease
management. AJMC. 2012;18:42-7.
37. Sayin KK, Kizilci S. Antidiabetic drugs user errors and ınfluencing factors. GÜSBD. 2017; 6:128-37.
38. Zheng F, Liu S, Liu Y, Deng L. Effects of an outpatient diabetes self-management education on patients with type 2 diabetes in china: a randomized controlled trial. J
Diabetes Res. 2019; 17:1073131.
39. Aliha JM, Asgari M, Khayeri F, Ramazani M, Farajzadegan Z, Javaheri J. Group education and nurse telephone follow-up effects on blood glucose control and
adherence to treatment in type 2 diabetes patients. Int J Prev Med. 2013; 4: 797-802.
40. Su D, Zhou J, Kelley MS , Michaud TL, Siahpush M, Kim J, Wilson F, Stimpson JP, Pagán JA. Does telemedicine improve treatment outcomes for diabetes? A meta-
analysis of results from 55 randomize controlled trials. Diabetes Res Clin Pract. 2016; 116:136-48.
41. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155:97-107.
42. Laura M, Anne-Linda C, Peter, JS. The role of health literacy in diabetes knowledge, self-care, and glycemic control: a meta-analysis. J Gen Intern Med. 2008;23: 561–
66.
43. Williams MV, Parker RM, Baker DW, Parikh NS, Pitkin K, Coates WC, Nurss JR. Inadequate functional health literacy among patients at two public hospitals. JAMA. 1995;
274: 1677-82.
44. Özonuk E, Yılmaz M. Relationship between health literacy and compliance with the treatment among ındividuals with type 2 diabetes mellitus. HEAD. 2019;16.96-103.
45. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Viera A, Crotty K, et al. Health literacy interventions and outcomes: an updated systematic review. Evidence
Report/Technology Assesment. 2011; No:199. AHRQ publication number 11-E006.
46. Tontuş HÖ. The effects of limited health literacy on health and healthcare use. Health and Social Policy Views. 2014;19:32-35.
47. Metabolic control with diabetes mellitus. https://www.who.int/diabetes/publications/%20and%20diagnosis%20_new.pdf. Accessed 15.01.2020.
48. Yuan C, Lai CW, Chan LW, Chow M, Law HK, Ying M. The effect of diabetes self-management education on body weight, glycemic control, and other metabolic
markers in patients with type 2 diabetes mellitus. J Diabetes Res. 2014:789761.
Diyabetli bireylerde akılcı ilaç kullanımı ve sağlık okuryazarlığı üzerine uygulanan eğitimin etkisi
Year 2021,
Volume: 46 Issue: 1, 240 - 247, 31.03.2021
Amaç: Bu çalışmanın amacı, diyabetli bireylerde akılcı ilaç kullanımı ve sağlık okuryazarlığı üzerine uygulanan eğitimin etkisinin değerlendirilmesidir.
Gereç ve Yöntem: Ön test son test kontrol gruplu deneysel tasarım olan bu çalışma, 24 Ocak-25 Temmuz tarihleri arasında Zonguldak Diyabet Derneği’nde yapılmıştır. Çalışmanın evrenini derneğe kayıtlı 238 diyabetli birey oluşturmakta olup, örneklem grubunu ise derneğe kayıtlı üyelerden daha önce toplanan verilere göre yetersiz ve sorunlu-sınırlı sağlık okuryazarlığı ile diğer örneklem kriterlerine sahip 154 diyabetik birey oluşturmaktadır. Çalışmanın verileri Akılcı İlaç Kullanım Ölçeği, Türkiye Sağlık Okuryazarlığı Ölçeği ve Tanılama Formu ile toplanmıştır. Değerlendirme sonuçlarına bakılmaksızın randomizasyon yöntemi ile deney ve kontrol grupları oluşturulmuştur. Deney grubundan oluşturulan 4-6 kişilik gruplara araştırmacı tarafından temel diyabet bilgisi, akılcı ilaç kullanımı bilgisi ve sağlık okuryazarlığı bilgisini içeren eğitim programı power point sunular ile yüz yüze olarak uygulanmıştır. Üç ay sonra grupların bütün değerlendirmeleri tekrarlanmıştır.
Bulgular: Eğitim sonrası üçüncü ayda yapılan değerlendirmede Akılcı İlaç Kullanımı Ölçeği ve Türkiye Sağlık Okuryazarlığı Ölçek puanlarında istatistik olarak anlamlı değişim olduğu belirlenmiştir.
Sonuç: Diyabetli bireylere uygulanan temel diyabet bilgisi, akılcı ilaç kullanımı ve sağlık okuryazarlığı ile ilgili grup tabanlı eğitimin, bireylerin akılcı ilaç kullanımı ile sağlık okuryazarlığı seviyelerinin artırılmasında etkili olduğu bulunmuştur.
2. Guide to Diagnosis, Treatment and Follow-up of Diabetes Mellitus and Complications, 2019.
http://temd.org.tr/admin/uploads/tbl_kilavuz/201908190958542019tbl_kilavuzb48da47363.pdf. Accessed 05.02.2020.
3. World Health Organization (WHO), Promoting rational use of medicines: core components. WHO Policy Perspectives on Medicines no5.
WHO/EDM/2002.3.Geneva, WHO, 2002. Accessed 03.01.2020.
4. Chauhan I, Yasir M, Kumari M, Verma M. The pursuit of rational drug use: understanding factors and ınterventions. Pharmaspire 2018;10:48-54.
5. Pirinçci E, Bozan T. Rational drug use among nurses who work in a university hospital. Firat Med J. 2016;2:129-36.
6. Toklu HZ, Demirdamar R, Gümüşel B, Yarış E, Dülger G. Rational drug use awareness of the nurses in the Turkish Republic of Northern Cyprus Near East University
Hospital. Marmara Pharmaceutical Journal. 2012; 16: 150-54.
7. Özyurt E, Aydın İ, Aydın H, Erduran S, Uğurlu D, Akar Y, Aykutluğ M, Yörük S. Knowledge, attitude and behaviors of patients in Dışkapı Yıldırım Beyazıt Education
Research Hospital about rational drug use. Sağ Aka Derg.2018; 5:208-19.
8. Aydın B, Gelal A. Rational drug use: promotion and the role of medical education. DEÜ Journal of Faculty of Medicine. 2012; 26:57-63.
9. Ekenler Ş, Koçoğlu D. Individuals’ knowledge and practices about rational drug use. Hacettepe University Journal of Nursing Faculty. 2016; 3:44-55.
10. Çiftçi B, Aksoy M. Rational drug use in children and nurse’s responsibilities. Gümüşhane University Journal of Health Sciences. 2017; 6: 191-94.
11. Altındiş S. Systematic overview of rational drug use. Journal of BSHR. 2017; 1: 34-38.
12. Afriyie DK, Tetteh RA. Description of the pattern of rational drug use in ghana police hospital. JPP. 2014; 3: 143-48.
13. Sürmelioğlu N, Kıroğlu O, Erdoğdu T, Karataş Y. Measures to prevent irrational drug use. Archive Resource Review Journal. 2015; 24: 452-62.
14. The World Health Organization Report. (1998). Life in the 21st century: A vision for all, (Cited 2020), available at:http://www.who.int/whr/1998/en/.
15. Öncü E, Vayısoğlu SK, Güven Y, Aktaş G, Ceyhan H, Karakuş E. Evaluation of individuals with hypertension regarding chronic disease management and its
relationship with health literacy. Anatol JFM. 2018; 1:31-32.
16. Kickbusch I, Apfel F, Jürgen PM, Agis TD. Health literacy: The solid facts. 1st edition. World Health Organisation Regional Office for Europe, Copenhagen, 2013.
17. Yılmaz M, Tiraki Z. What is the health literacy? How assessment? DEUHFED. 2016; 9: 142-47.
18. Jin J, Sklar GE, Oh VMS, Li SC. Factors Affecting therapeutic compliance: A review from the patient’s perspective. Therapeutics and clinical risk management.
2008; 4: 269–86.
19. Ağralı H, Akyar I. Turkish validation and reliability of health literacy scale for diabetic patient.
ACU Sağlık Bil Derg. 2018; 9: 314-21.
20. Çakmak V. Evaluate the effects of education given by nurses on rational drug use and health literacy of patients receiving hypertension treatment, Manisa Celal
Bayar University Institute of Health Sciences, Department of Nursing, Ph. D. Thesis, 2019.
21. Erciyes Y, Çınar Pakyüz S. Evaluation of efficacy of education given by nurse to patients with hypertension about healthy life style behaviors. DOHH. 2014; 6: 46-57.
22. Demirtaş Z, Dağtekin G, Sağlan R, Alaiye M, Önsüz MF, Işıklı B, et al. Validity and reliability of rational drug use scale. ESTÜDAM Public Health Journal. 2018; 3: 37-46.
23. Okyay P, Abacıgil F. T.C. Ministry of Health, Report on reliability and validity of turkish health literacy scales. Editors, No:1025, 2016.
24. Educational Guide and Training Sets for Adult Diabetics. http://beslenme.gov.tr/index.php?lang=tr&page=527/ Accessed 12.01.2020.
25. Turkish Republic Ministry of Health Rational Drug Use. http://www.akilciilac.gov.tr/ Accessed 10.01.2020.
26. National Action Plan For Rational Drug Use. http://www.akilciilac.gov.tr/wp-content/uploads/2014/11/aik-ulusal-eylemplani.pdf. Accessed 05.01.2020.
27. Turkey Rational Drug Use Bulletin. http://www.akilciilac.gov.tr/wp-content/uploads/2015/09/aik-bltn-12-i.pdf. Accessed 06.01.2020.
28. Turkey Health Literacy. http://www.saglikokuryazarligi.org/. Accessed 11.01.2020.
29. Al Sayah F, Williams B. An integrated model of health literacy using diabetes as an exemplar. Canadian Journal of Diabetes. 2012; 36: 27-31.
30. Tanrıöver DM, Yıldırım HH, Demiray FN, Çakır B, Akalın E. Turkey health literacy survey. Health and social workers union. Sağlık-Sen Publications. 2014; 25: 14-26.
31. Hughes F. Nursing and Health Policy Perspectives: Health literacy: a key educational role for nurses and a vital tool for improving health. International Nursing
Rewiew. 2016; 63: 304-305.
32. Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, Brand H, Health literacy and public health: a systematic review and integration of definitions
and models. BMC Public Health. 2012; 12: 80.
33. Funnell M, Tammy L, Belinda P, Linda B, Gwen M, Brian J, Melinda M. National standards for diabetes self-management education. Diabetes Care. 2011;34:89–96.
34. How soon does a behavior become a habit. https://bilimgenc.tubitak.gov.tr/makale. Accessed 03.01.2020.
35. Gazmararian JA, Williams MV, Peel J, Baker DW. Health literacy and knowledge of chronic disease. PEC. 2003;51: 267- 75.
36. Fischer HH, Moore SL, Ginosar D, Davidson AJ, Rice CM, Durfee MJ, MacKenzie TD, Estacio RO, Steele AW. Care by cell phone: text messaging for chronic disease
management. AJMC. 2012;18:42-7.
37. Sayin KK, Kizilci S. Antidiabetic drugs user errors and ınfluencing factors. GÜSBD. 2017; 6:128-37.
38. Zheng F, Liu S, Liu Y, Deng L. Effects of an outpatient diabetes self-management education on patients with type 2 diabetes in china: a randomized controlled trial. J
Diabetes Res. 2019; 17:1073131.
39. Aliha JM, Asgari M, Khayeri F, Ramazani M, Farajzadegan Z, Javaheri J. Group education and nurse telephone follow-up effects on blood glucose control and
adherence to treatment in type 2 diabetes patients. Int J Prev Med. 2013; 4: 797-802.
40. Su D, Zhou J, Kelley MS , Michaud TL, Siahpush M, Kim J, Wilson F, Stimpson JP, Pagán JA. Does telemedicine improve treatment outcomes for diabetes? A meta-
analysis of results from 55 randomize controlled trials. Diabetes Res Clin Pract. 2016; 116:136-48.
41. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155:97-107.
42. Laura M, Anne-Linda C, Peter, JS. The role of health literacy in diabetes knowledge, self-care, and glycemic control: a meta-analysis. J Gen Intern Med. 2008;23: 561–
66.
43. Williams MV, Parker RM, Baker DW, Parikh NS, Pitkin K, Coates WC, Nurss JR. Inadequate functional health literacy among patients at two public hospitals. JAMA. 1995;
274: 1677-82.
44. Özonuk E, Yılmaz M. Relationship between health literacy and compliance with the treatment among ındividuals with type 2 diabetes mellitus. HEAD. 2019;16.96-103.
45. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Viera A, Crotty K, et al. Health literacy interventions and outcomes: an updated systematic review. Evidence
Report/Technology Assesment. 2011; No:199. AHRQ publication number 11-E006.
46. Tontuş HÖ. The effects of limited health literacy on health and healthcare use. Health and Social Policy Views. 2014;19:32-35.
47. Metabolic control with diabetes mellitus. https://www.who.int/diabetes/publications/%20and%20diagnosis%20_new.pdf. Accessed 15.01.2020.
48. Yuan C, Lai CW, Chan LW, Chow M, Law HK, Ying M. The effect of diabetes self-management education on body weight, glycemic control, and other metabolic
markers in patients with type 2 diabetes mellitus. J Diabetes Res. 2014:789761.
Akyol Güner, Türkan. “Effect of Education on Rational Drug Use and Health Literacy in People With Diabetes Mellitus”. Cukurova Medical Journal, vol. 46, no. 1, 2021, pp. 240-7.