The hypertension prevalence rate among the population aged 65 years or
older in South Korea showed an upward trend, increasing from 55.3% in 2007
to 58.6% in 2013. There are two important factors in hypertension
management: hypertension-related knowledge and self-efficacy to properly
manage it. These factors have increased interest in health literacy. It has
been reported that higher health literacy leads to higher health-related
knowledge and self-efficacy, but there not many studies have analyzed the
effects of health literacy, diseases-related knowledge, and self-efficacy on
self-care behavior among hypertension patients.
This study thus set out to examine the health literacy, hypertension-related
knowledge, self-efficacy, and self-care behavior of community-dwelling
elderly patients with hypertension and investigate their relations and
influential factors, thus providing basic data to develop a nursing intervention
program to promote self-care behavior among hypertension patients.
The subjects include 180 hypertension patients using community health
centers, public senior centers, and welfare centers in J area. Data were
collected using a self-report questionnaire between November 4 and 11, 2015.
Health literacy was measured using 15 of the Health Literacy screening
items developed by Chew, Bradley, and Byoko (2004) and translated and used
by Kim Su Hyun (2010). Hypertension-related knowledge was measured
using a questionnaire developed by Park Young Im (1994) and revised and
supplemented by the investigator based on the hypertension management
guidelines (2013) of the Korean Society of Hypertension. Self-efficacy was
measured using a questionnaire developed by Park Young Im (1994) and the
self-care and self-efficacy items used under Case Management for
Hypertension (2008) in the Visiting Health Care Program Manual after a
revision and supplementation process. Self-care behavior was measured using
a scale developed by Lee Young Whee (1995) and the self-care behavior
items for hypertension patients used by Min Eun Sil (2011) and Ko Yeong Ju
(2012) after a revision and supplementation process.
A descriptive statistical analysis, t-test, ANOVA, Scheffe’s test, Pearson’s
correlation coefficient, and stepwise multiple regression analysis with the
SPSS Win 18.0 program were conducted on the collected data.
The findings were as follows.
1. The subjects scored a mean of 49.8 (±12.4) points on health literacy, 9.0
(±2.4) points on hypertension-related knowledge, 31.1 (±3.8) points on
self-efficacy, and 55.8 (±6.7) points on self-care behavior.
2. Differences in the health literacy, hypertension-related knowledge,
self-efficacy, and self-care behavior of the subjects according to their
general characteristics were as follows.
1) There were significant differences in their health literacy according to
gender (t=3.83, p=<.001), age (t=3.09, p=.002), education level (t=17.73, p<.001), marital status (t=-4.25, p<.001), number of family members
(t=4.65, p=.004), monthly income of family members (t=8.52, p<.001), and
occupation (t=-2.52, p=.013).
2) There were significant differences in their hypertension-related
knowledge according to age (t=4.85, p<.001), educational level (t=6.22,
p<.001), marital status (t=-4.07, p<.001), number of family members
(t=3.96, p=.009), and occupation (t=-5.31, p<.001).
3) Significant differences were also found in their self-efficacy according to
BMI (t=4.33, p=.006).
4) There were significant differences in their self-care behavior according
to BMI (t=2.79, p=.042) and duration of hypertension diagnosis (t=4.16,
p=.017).
3. The study analyzed correlations among health literacy, hypertension-related
knowledge, self-efficacy, and self-care behavior of the subjects and found
that health literacy had significant positive correlations with
hypertension-related knowledge (r=.27, p<.001), self-efficacy (r=.26, p=.001),
and self-care behavior (r=.31, p<.001), and that self-care behavior had
significant positive correlations with self-efficacy (r=.71, p<.001).
4. Major factors having significant impacts on health literacy were educational
level (β=.37, p<.001) and monthly income of family members (β=.27,
p<.001). The two variables explained 23.7% of health literacy (F=28.73,
p<.001).
5. Major factors having significant influences on self-care behavior were
self-efficacy (β=.68, p<.001) and health literacy (β=.14, p=.010). The two
variables explained 52.3% of self-care behavior (F=99.21, p<.001).
Based on those findings, the following proposals were made in this study.
1. There is a need to provide programs to promote self-efficacy among
community-dwelling elderly patients with hypertension by considering the characteristics of the elderly.
2. An appropriate tool needs to be developed for the evaluation of literacy
among the community-dwellings elderly.
3. It is necessary to understand the health literacy of elderly patients with
hypertension before providing them with educational intervention and
information and to develop appropriate educational materials and
intervention programs.
4. Since random sampling was used in the present study to select subjects,
repetitive studies will need to be conducted with elderly patients with
hypertension in diverse areas to render the findings generalizable.