The Relationship Between e-Health Literacy and Health Beliefs Regarding Cardiovascular Disease in Elderly Individuals with Type 2 Diabetes

Öz

Objective: Given that elderly people with diabetes are at high risk for cardiovascular complications, it is essential to understand the relationship between eHealth literacy and health beliefs regarding cardiovascular diseases. This study was conducted to examine the relationship between e-health literacy and health beliefs regarding cardiovascular disease in elderly individuals with type 2 diabetes. Methods: This study is a descriptive and cross-sectional study. The study was conducted between February 2024 and June 2024 with 326 individuals with type 2 diabetes. The study data collected descriptive characteristics form, e-Health Literacy Scale (e-HLS) and Health Beliefs Related to Cardiovascular Disease Scale (HBCVDS). Results: The mean age of the elderly individuals with type 2 diabetes included in the study was 70.21±6.18 years and 53.10% were female. The mean score on the e-HLS and HBCVDS were moderate. The factors affecting e-HLS were smoking, smartphone use, Accessing health resources from the internet, average daily internet usage time (91 minutes or more), positive effect of the internet on health. Conclusions: In this study, both the e-health literacy and the health beliefs related to heart disease of elderly individuals with diabetes were found to be at a moderate level. As the electronic health literacy of individuals with diabetes increases, their health beliefs about heart disease also improve. Therefore, educational programs aimed at enhancing electronic health literacy and the promoting use of digital tools offer an important opportunity to improve these individuals' health beliefs and behaviors related to cardiovascular diseases.

Anahtar Kelimeler

• elderly
• type 2 diabetes
• e-health literacy
• cardiovascular disease
• nursing

Tip 2 Diyabetli Yaşlılarda Kardiyovasküler Hastalığa İlişkin Sağlık İnançları ile e-Sağlık Okuryazarlığı Arasındaki İlişki

Öz

Amaç: Diyabetli yaşlı bireyler kardiyovasküler komplikasyonlar için yüksek risk altındadır, bu nedenle e-sağlık okuryazarlığı ile kardiyovasküler hastalıkla ilgili sağlık inançları arasındaki ilişkiyi anlamak önemlidir. Bu çalışma, yaşlı tip 2 diyabetli bireylerde e-sağlık okuryazarlığı ile kardiyovasküler hastalığa ilişkin sağlık inançları arasındaki ilişkinin incelenmesi amacıyla yapılmıştır. Yöntem: Çalışma tanımlayıcı ve kesitsel türdedir. Çalışma, Şubat – Haziran 2024 tarihleri arasında 326 tip 2 diyabetli bireyle gerçekleştirilmiştir. Çalışma verileri, tanımlayıcı özellikler formu, e-Sağlık Okuryazarlığı Ölçeği (e-HLS) ve Kardiyovasküler Hastalıklarla İlgili Sağlık İnançları Ölçeği (HBCVDS) ile toplanmıştır. Bulgular: Çalışmaya dahil edilen tip 2 diyabetli yaşlıların ortalama yaşı 70.21±6.18 yıl olup, %53.10’u kadındır. E-HLS ve HBCVDS ortalama puanları orta seviyedeydi. E-HLS’yi etkileyen faktörler sigara içme, akıllı telefon kullanımı, internet üzerinden sağlık kaynaklarına erişim, günlük ortalama internet kullanım süresi (91 dakika ve üzeri) ve internetin sağlık üzerindeki olumlu etkisi yer almaktadır. Sonuç: Bu çalışmada, diyabetli yaşlı bireylerin e-sağlık okuryazarlığı ve kardiyovasküler hastalığa ilişkin sağlık inançları orta seviyededir. Diyabetli bireylerin e-sağlık okuryazarlığı arttıkça, kardiyovasküler hastalıklarla ilgili sağlık inançları da artmaktadır. Bu nedenle, e-sağlık okuryazarlığını artırmaya yönelik eğitim programları ve dijital araçların kullanımının teşvik edilmesi, bu bireylerin kardiyovasküler hastalıklarla ilgili sağlık inançlarını ve davranışlarını iyileştirmek için önemli bir fırsat sunmaktadır.

Anahtar Kelimeler

• Yaşlı
• tip 2 diyabet
• e-sağlık okuryazarlığı
• kardiyovasküler hastalık
• hemşirelik

Kaynakça

1. Ağralı, H., & Akyar, İ. (2022). The effect of health literacy-based, health belief-constructed education on glycated hemoglobin (HbA1c) in people with type 2 diabetes: A randomized controlled study. Primary care diabetes, 16(1), 173–178. https://doi.org/10.1016/j.pcd.2021.12.010
2. Al-Kaabi, J. M., Al Maskari, F., Cragg, P., Afandi, B., & Souid, A. K. (2015). Illiteracy and diabetic foot complications. Primary care diabetes, 9(6), 465–472. https://doi.org/10.1016/j.pcd.2015.04.008
3. Altaş, Z., Hıdıroğlu, S., Solmaz, C. et al. (2022). The association between electronic health literacy and self-care management in adults with Type-2 Diabetes. Progress in Health Sciences, 12(2), 14-19. https://doi.org/10.5604/01.3001.0016.1734
4. Benjamin, E. J., Muntner, P., Alonso, A., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Chang, A. R., Cheng, S., Das, S. R., Delling, F. N., Djousse, L., Elkind, M. S. V., Ferguson, J. F., Fornage, M., Jordan, L. C., Khan, S. S., Kissela, B. M., Knutson, K. L., Kwan, T. W., … American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee (2019). Heart disease and stroke statistics-2019 update: A report from the American Heart Association. Circulation, 139(10), e56–e528. https://doi.org/10.1161/CIR.0000000000000659
5. Berkman, N. D., Davis, T. C., & McCormack, L. (2010). Health literacy: what is it?. Journal of health communication, 15 Suppl 2, 9–19. https://doi.org/10.1080/10810730.2010.499985
6. Coll, P. P., Roche, V., Olsen, J. S., Voit, J. H., Bowen, E., & Kumar, M. (2020). The Prevention of Cardiovascular Disease in Older Adults. Journal of the American Geriatrics Society, 68(5), 1098–1106. https://doi.org/10.1111/jgs.16353
7. Cutilli, C. C., & Bennett, I. M. (2009). Understanding the health literacy of America: Results of the national assessment of adult literacy. Orthopedic Nursing, 28(1), 27–34. https://doi.org/10.1097/01.NOR.0000345852.22122.d6
8. Dehghani-Tafti, A., Mazloomy Mahmoodabad, S. S., Morowatisharifabad, M. A., Afkhami Ardakani, M., Rezaeipandari, H., & Lotfi, M. H. (2015). Determinants of self-care in diabetic patients based on health belief model. Global Journal of Health Science, 7(5), 33–42. https://doi.org/10.5539/gjhs.v7n5p33

9. De Melo, M., de Sa, E., & Gucciardi, E. (2013). Exploring differences in Canadian adult men and women with diabetes management: results from the Canadian community health survey. BMC Public Health, 13, 1089. https://doi.org/10.1186/1471-2458-13-1089
10. Ernsting, C., Stühmann, L. M., Dombrowski, S. U., Voigt-Antons, J. N., Kuhlmey, A., & Gellert, P. (2019). Associations of health app use and perceived effectiveness in people with cardiovascular diseases and diabetes: Population-based survey. JMIR mHealth and uHealth, 7(3), e12179. https://doi.org/10.2196/12179
11. Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191. https://doi.org/10.3758/bf03193146
12. Friis, K., Lasgaard, M., Osborne, R. H., & Maindal, H. T. (2016). Gaps in understanding health and engagement with healthcare providers across common long-term conditions: A population survey of health literacy in 29,473 Danish citizens. BMJ Open, 6(1), e009627. https://doi.org/10.1136/bmjopen-2015-009627
13. Guo, S. H., Lin, J. L., Hsing, H. C., Lee, C. C., & Chuang, S. M. (2023). The effect of mobile ehealth education to improve knowledge, skills, self-care, and mobile ehealth literacies among patients with diabetes: Development and evaluation study. Journal of Medical Internet Research, 25, e42497. https://doi.org/10.2196/42497
14. Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., Ostolaza, H., & Martín, C. (2020). Pathophysiology of Type 2 Diabetes Mellitus. International Journal of Molecular Sciences, 21(17), 6275. https://doi.org/10.3390/ijms21176275
15. George, D., Mallery, P. (2019). IBM SPSS Statistics 26 step by step: A simple guide and reference. https://doi.org/10.4324/9780429056765
16. Guo, S. H., Hsing, H. C., Lin, J. L., & Lee, C. C. (2021). Relationships between mobile ehealth literacy, diabetes self-care, and glycemic outcomes in taiwanese patients with type 2 diabetes: Cross-sectional study. JMIR mHealth and uHealth, 9(2), e18404. https://doi.org/10.2196/18404
17. Harvey, J. N., & Lawson, V. L. (2009). The importance of health belief models in determining self-care behaviour in diabetes. Diabetic Medicine, 26(1), 5–13. https://doi.org/10.1111/j.1464-5491.2008.02628.x
18. Jalilian, F., Motlagh, F. Z., Solhi, M., & Gharibnavaz, H. (2014). Effectiveness of self-management promotion educational program among diabetic patients based on health belief model. Journal of education and health promotion, 3, 14. https://doi.org/10.4103/2277-9531.127580
19. Joseph, J. J., Deedwania, P., Acharya, T., Aguilar, D., Bhatt, D. L., Chyun, D. A., Di Palo, K. E., Golden, S. H., Sperling, L. S., & American Heart Association Diabetes Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Clinical Cardiology; and Council on Hypertension (2022). Comprehensive management of cardiovascular risk factors for adults with type 2 diabetes: A scientific statement from the American heart association. Circulation, 145(9), e722–e759. https://doi.org/10.1161/CIR.0000000000001040
20. Karahan Okuroglu, G., & Ercan Toptaner, N. (2018). Adaptation of the Cardiovascular Disease-Related Health Beliefs Scale to Turkish in Turkish patients with type 2 diabetes; validity and reliability. Hemşirelikte Araştırma Geliştirme Dergisi, 20(2/3), 1-12. https://doi.org/10.69487/hemarge.696127 (in Turkish)
21. Karimy, M., Montazeri, A., Araban, M. (2012). The effect of an educational program based on health belief model on the empowerment of rural women in prevention of brucellosis. Arak Medical University Journal, 14,85–94.
22. Kasparian, N. A., Lieu, N., Winlaw, D. S., Cole, A., Kirk, E., & Sholler, G. F. (2017). eHealth literacy and preferences for eHealth resources in parents of children with complex CHD. Cardiology in the Young, 27(4), 722–730. https://doi.org/10.1017/S1047951116001177
23. Kim, K., Shin, S., Kim, S., & Lee, E. (2023). The Relation between ehealth literacy and health-related behaviors: Systematic review and meta-analysis. Journal of Medical Internet Research, 25, e40778. https://doi.org/10.2196/40778
24. Kim, K. A., Kim, Y. J., & Choi, M. (2018). Association of electronic health literacy with health-promoting behaviors in patients with type 2 diabetes: A cross-sectional study. Computers Informatics Nursing, 36(9), 438–447. https://doi.org/10.1097/CIN.0000000000000438
25. Lee, M., & Shim, J. (2025). Effects of diabetes knowledge and attitudes toward internet health information on e-health literacy in middle-aged patients with diabetes. Healthcare ,13 (5), 512.
26. Lei, G.Q. (2017). A comparative study of health action research and classical behavior change theories. Chinese Journal of Health Education, 33,764–767.
27. Nagori, A., Keshvani, N., Patel, L., Dhruve, R., & Sumarsono, A. (2024). Electronic health literacy gaps among adults with diabetes in the United States: Role of socioeconomic and demographic factors. Preventive Medicine Reports, 47, 102895. https://doi.org/10.1016/j.pmedr.2024.102895
28. Norman, C. D., & Skinner, H. A. (2006). eHealth literacy: Essential skills for consumer health in a networked world. Journal of Medical Internet Research, 8(2), e9. https://doi.org/10.2196/jmir.8.2.e9
29. Norman, C. D., & Skinner, H. A. (2006). eHEALS: The eHealth Literacy Scale. Journal of Medical Internet Research, 8(4), e27. https://doi.org/10.2196/jmir.8.4.e27
30. Poureslami, I., Nimmon, L., Rootman, I., & Fitzgerald, M. J. (2017). Health literacy and chronic disease management: Drawing from expert knowledge to set an agenda. Health Promotion International, 32(4), 743–754. https://doi.org/10.1093/heapro/daw003
31. Sarkar, U., Fisher, L., & Schillinger, D. (2006). Is self-efficacy associated with diabetes self-management across race/ethnicity and health literacy? Diabetes Care, 29(4), 823–829. https://doi.org/10.2337/diacare.29.04.06.dc05-1615
32. Shukhratovna,, N.G., Erkinovna, S.D., Suxrobovna,, X.M., Ikromovna, A.Z. (2022) Diabetes mellitus, ischemic heart disease and arterial hypertension. Pedagog, 5(5), 381-386.
33. Simons-Morton, B.G., McLeroy, K.R., Wendel, M.L. (2012). Behavior theory in health promotion practice and research Sudbury, Mass.: Jones & Bartlett Learning
34. Sun, H., Saeedi, P., Karuranga, S., Pinkepank, M., Ogurtsova, K., Duncan, B. B., Stein, C., Basit, A., Chan, J. C. N., Mbanya, J. C., Pavkov, M. E., Ramachandaran, A., Wild, S. H., James, S., Herman, W. H., Zhang, P., Bommer, C., Kuo, S., Boyko, E. J., & Magliano, D. J. (2022). IDF Diabetes atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Research and Clinical Practice, 183, 109119. https://doi.org/10.1016/j.diabres.2021.109119
35. Tovar, E. G., Rayens, M. K., Clark, M., & Nguyen, H. (2010). Development and psychometric testing of the Health Beliefs Related to Cardiovascular Disease Scale: preliminary findings. Journal of Advanced Nursing, 66(12), 2772–2784. https://doi.org/10.1111/j.1365-2648.2010.05443.x
36. Uskun, E., Doğan, E., Önal, Ö., Kişioğlu, A.N. (2022). e-Health literacy scale: Turkish validity and reliability study for adults over 45. Türk Hijyen ve Deneysel Biyoloji Dergisi, 79(4), 674 – 689. https://doi.org/10.5505/TurkHijyen.2022.75608 (in Turkish)
37. Wang, X., & Luan, W. (2022). Research progress on digital health literacy of older adults: A scoping review, Frontiers in Public Health, 10, 906089. https://doi.org/10.3389/fpubh.2022.906089
38. World Health Organisation. Ageing and health. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health. Accessed date: 14th November 2024
39. World Health Organisation, 2021. https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds).
40. Yekaninejad, M.S., Hajiheidari, A., Alijanzadeh, M. et al. Exploring health literacy categories among an Iranian adult sample: A latent class analysis. Scientific Reports, 14, Article 776. https://doi.org/10.1038/s41598-023-49850-3
41. Yun, J. S., & Ko, S. H. (2021). Current trends in epidemiology of cardiovascular disease and cardiovascular risk management in type 2 diabetes. Metabolism: Clinical and Experimental, 123, 154838. https://doi.org/10.1016/j.metabol.2021.154838