Exploring the relationships between health literacy, social support, self-efficacy and self-management in adults with multiple chronic diseases

• Published in: BMC health services research Vol. 23; no. 1; pp. 1 - 923
• Main Authors: Dinh, Thi Thuy Ha, Bonner, Ann
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 30-08-2023; BioMed Central; BMC
• Subjects: Age; Care and treatment; Chronic diseases; Chronic illnesses; Comorbidity; Data collection; Decision making; Diabetes; Evaluation; Health education; Health literacy; Health services; Kidney diseases; Medical records; Multimorbidity; Multiple chronic diseases; Patient outcomes; Questionnaires; Self-efficacy; Skills; Social support; Australia
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-023-09907-5

Abstract
Background
Self-management in chronic diseases is essential to slowing disease progression and preventing complications. However, empirical research on the associations of critical factors, such as health literacy, social support, and self-efficacy with self-management in the context of multiple chronic diseases is scarce. This study aimed to investigate these associations and provides insights for healthcare providers to develop effective educational strategies for people with multiple chronic diseases.
Methods
Using a cross-sectional survey design, adults (n = 600) diagnosed with at least two chronic diseases were conveniently recruited. To measure health literacy, social support, self-efficacy, and chronic disease self-management behaviours, the Health Literacy Questionnaire (HLQ), Medical Outcome Study - Social Support Survey, Self-efficacy in Managing Chronic Disease, and Self-management in Chronic Diseases instruments were utilized respectively. Comorbidity status was assessed using Age-adjusted Charlson Comorbidity Index (ACCI). A generalised linear regression model was used with a backward technique to identify variables associated with self-management.
Results
Participants’ mean age was 61 years (SD = 15.3), 46% were female, and most had up to 12 years of education (82.3%). Mean scores for HLQ domains 1–5 varied from 2.61 to 3.24 (possible score 1–4); domains 6–9 from 3.29 to 3.65 (possible score 1–5). The mean scores were 52.7 (SD = 10.4, possible score 0–95), 5.46 (SD = 1.9, possible score 0–10) and 82.1 (SD = 12.4, possible score 30–120) for social support, self-efficacy, and self-management, respectively. Mean ACCI was 6.7 (SD = 2.1). Eight factors (age > 65 years, being female, 4 health literacy domains, greater social support, and higher self-efficacy levels) were significantly associated with greater self-management behaviours while comorbidity status was not. The factors that showed the strongest associations with self-management were critical health literacy domains:
appraisal of health information, social support for health
, and
healthcare provider support.
Conclusions
Developing critical health literacy abilities is a more effective way to enhance self-management behaviours than relying solely on self-confidence or social support, especially for people with multiple chronic diseases. By facilitating communication and patient education, healthcare providers can help patients improve their critical health literacy, which in turn can enhance their self-management behaviours.