A Causal Model of Health Literacy among Thai Older Adults with Uncontrolled Diabetes

Uncontrolled diabetes among older adults leads to acute and chronic complications that threaten health and life. Health literacy is crucial to managing health and making successful behavior changes for optimal diabetes outcomes. However, a clear understanding of multiple factors and their mechanisms to influence health literacy is lacking. This descriptive cross-sectional study aimed to test a Model of Health Literacy among Thai Older Adults with Uncontrolled Diabetes and examined the influencing pathways of cognitive function, diabetes knowledge, provider-patient communication, empowerment perception, social support, Internet use, and social engagement regarding health literacy. The sample consisted of 259 older Thai adults with uncontrolled diabetes. Data were collected using a demographic data form, the European Health Literacy Survey Questionnaire, the Diabetes Knowledge Scale, the Diabetes Empowerment Process Scale, the Provider-patient Communication Scale, the Social Support Questionnaire, the Montreal Cognitive Assessment-Basic Test, the Internet Use Questionnaire, and the Being Actively Engaged with Society Subscale of the Active Ageing Scale for Thai People. Data were analyzed using descriptive statistics and structural equation modeling with AMOS. The results showed that the model explained 76% of the quality of life variance. Diabetes knowledge and cognitive function directly affected health literacy. Health literacy was indirectly affected by provider-patient communication and empowerment perception through diabetes knowledge, social engagement through cognitive function, and Internet use through cognitive function and diabetes knowledge. Nurses can develop strategies by integrating Internet use and social engagement in empowerment communication programs to improve diabetes knowledge and cognitive function toward higher health literacy in this population.