GLYCEMIC CONTROL AND BMI AMONG ETHNIC MINORITY OLDER ADULTS IN NORTHERN THAILAND: IMPACT OF HEALTH LITERACY AND SELF-MANAGEMENT

Abstract

Type 2 diabetes mellitus imposes a disproportionate health burden on older adults of ethnic minorities in northern Thailand.  These groups face a “double burden” of geographic isolation and language barrier, the latter stemming from the use of Thai in health information dissemination.  The study aimed to examine the predictive relationships of health literacy (HL), diabetes distress and self-management behaviors with clinical outcomes (fasting blood sugar [FBS] and body mass index [BMI]).  A cross-sectional predictive correlational study was conducted among 150 ethnic minority older adults recruited from five sub-district health-promoting hospitals in Chiang Rai Province, northern Thailand.  Data were collected through face-to-face interviews using the Diabetes Self-Management Questionnaire (DSMQ) and Diabetes Distress Scale (DDS-17).  Participants (66 ± 6 years of age) exhibited high vulnerability, namely 70% with no formal education and 58% obesity.  Multiple linear regression models revealed that age (β = -0.296, p-value <0.001) and HL (β = -0.263, p-value = 0.001) are significant negative predictors of FBS; whereas self-management is a significant positive predictor of FBS (β = 0.169, p-value = 0.029), suggesting a “reactive management”.  Age is the sole significant negative predictor of BMI (β = -0.166, p-value = 0.047).  HL acted as a critical determinant of glycemic control, distinct from diabetes distress.  The findings indicated that public health interventions should shift from text-based directives to visual, bilingual models to overcome any language barrier.