Validation of the health literacy scale for diabetes as a criterion-referenced test with standard setting procedures.

OBJECTIVE: To develop and examine the psychometric properties of the Korean Health Literacy Scale for Diabetes Mellitus (KHLS-DM), and to establish reasonable cutoff scores. METHODS: Initially, 299 items were generated to measure diabetes-related words, numeracy, and information utilization. Content validity assessment and preliminary tests were conducted. After exploratory factor analysis (EFA) and Rasch analysis, the remaining 65 items were administered to a quota sample of 500 diabetic patients aged 40-74 years. The items were narrowed down to 58 items based on an item fit index. To obtain cutoff scores, Jaeger's method and the Bookmark method were employed. RESULTS: A confirmatory factor analysis (CFA) was performed, and a three-factor model was supported (χ2/df = 3.891, CFI = 0.92, TLI = 0.91, RMSEA = 0.04). The overall scores ranged from 0 to 58, and two cutoff points were established. The scale exhibited good internal consistency (Cronbach's α = 0.83). CONCLUSIONS: The KHLS-DM is a reliable and valid measure with cutoff points to classify individuals into three groups (adequate, marginal, and inadequate). PRACTICE IMPLICATIONS: The standard setting may be useful for researchers to validate health literacy measures in other countries and populations.

Current Status of Management in Type 2 Diabetes Mellitus at General Hospitals in South Korea.

BACKGROUND: In Korea, the prevalence, complications, and mortality rate of diabetes are rapidly increasing. However, investigations on the actual condition of diabetes management are very limited due to lack of nation-wide research or multicenter study. Hence, we have minutely inquired the current status of diabetes management and achievement of glucose target goal in general hospital offering education program. That way, we are able to furnish data for policy making of diabetes education and draw up guideline which may allow us to reduce the morbidity and mortality of diabetes. METHODS: The subjects consisted of 2,610 patients with type 2 diabetes who visited the 13 general hospital in Seoul or Gyeonggi region from March 19 to May 29, 2013. General characteristics, associated diseases, complications, and management status were investigated. RESULTS: The mean age was 61.0±11.6 years, body mass index was 25.0±3.3 kg/m(2), and family history of diabetes was 50.5%. The mean duration of diabetes was 10.7±7.9 years and 53% received education about diabetes. The prevalence of hypertension and dyslipidemia were 59.2% and 65.5%, respectively, and 18.3% of the subjects were accompanied by liver disease. Diabetic retinopathy appeared in 31.6%, nephropathy in 28.1%, and neuropathy in 19.9% of the subjects. The mean glycosylated hemoglobin (HbA1c) level was 7.3%±1.3% and the achieving rate based on Korean Diabetes Association guideline (HbA1c <6.5%) was 24.8%, blood pressure (130/80 mm Hg or less) was 49.4%, and low density lipoprotein cholesterol (<100 mg/dL) was 63.6%. The reaching rate to the target level in four parameters (blood glucose, blood pressure, lipids, and body weight) was 7.8%. CONCLUSION: The blood glucose control rate was lower than other parameters, and the implementation rate of diabetes education was only 53%. Thus more appropriate glucose control and systematic diabetes education are imperative.