Association Among High Blood Pressure Health Literacy, Social Support and Health-related Quality of Life Among a Community Population with Hypertension: a Community-based Cross-sectional Study in China

Overview

Journal BMJ Open

Specialty General Medicine

Date 2022 Jun 7

PMID 35672078

Authors

Yujie Wang

Ting Chen

Wei Gan

Jinyu Yin

Li Song

Huan Qi

Qinghua Zhang

Affiliations

Soon will be listed here.

Abstract

Objectives: The prevalence of hypertension is increasing worldwide. Hypertensive patients in China have limited high blood pressure health literacy (HBP-HL) and social support (SS), which may have an impact on health-related quality of life (HRQoL) and lead to poorer clinical outcomes. However, the potential mechanism of HBP-HL, SS and HRQoL remains unclear. The aim of this study was to investigate the association among HBP-HL, SS and HRQoL among community patients with hypertension in China.

Design: A community-based cross-sectional survey.

Setting: The community health service center in Huzhou, China.

Participants: 406 community patients with hypertension were investigated from June to October 2019.

Primary Outcome Measures: HRQoL was assessed using the Quality of Life Instruments for Chronic Diseases-Hypertension V2.0, HBP-HL was assessed with the HBP-Health Literacy Scale into Chines and SS was assessed with the Social Support Rating Scale.

Results: Compared with moderate level of HRQoL and SS, HBP-HL of community hypertensive patients was significantly deficient. Overall, 93 patients (23.2%) lacked HBP-HL, 308 patients (76.8%) had a medium level of HBP-HL, and none of them had sufficient HBP-HL. Correlation analysis showed that HBP-HL, SS and HRQoL were positively correlated (p<0.01). The significant differences in HRQoL and SS were detected in HBP-HL level (p<0.001). In multiple linear regression models, HRQoL was significantly associated with 'Print HL' and 'Medication Label' of HBP-HL (p<0.05) and all three dimensions of SS (p<0.05). In addition, The bootstrap method was used to examine the indirect effect among variables. The results showed that SS played a mediating role between HBP-HL and HRQoL (p<0.001).

Conclusion: There is an association among HBP-HL, SS and HRQoL in community hypertension patients. HBP-HL can directly affect HRQoL, and through SS mediate the HRQoL. Community intervention for hypertension management should consider HBP-HL promotion and social engagement as the breakthrough points to increase the impact on patients' HRQoL.

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References

. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004; 363(9403):157-63. DOI: 10.1016/S0140-6736(03)15268-3. View

. [Guideline on the assessment and management of cardiovascular risk in China]. Zhonghua Yu Fang Yi Xue Za Zhi. 2019; 53(1):13-35. DOI: 10.3760/cma.j.issn.0253-9624.2019.01.004. View

Parker R, Ratzan S . Health literacy: a second decade of distinction for Americans. J Health Commun. 2010; 15 Suppl 2:20-33. DOI: 10.1080/10810730.2010.501094. View

Lin S, Chen I, Yu W, Lee S, Tsai T . Effect of a community-based participatory health literacy program on health behaviors and health empowerment among community-dwelling older adults: A quasi-experimental study. Geriatr Nurs. 2019; 40(5):494-501. DOI: 10.1016/j.gerinurse.2019.03.013. View

Wang Z, Chen Z, Zhang L, Wang X, Hao G, Zhang Z . Status of Hypertension in China: Results From the China Hypertension Survey, 2012-2015. Circulation. 2018; 137(22):2344-2356. DOI: 10.1161/CIRCULATIONAHA.117.032380. View

Gabriel A, Bell C, Bowie J, LaVeist T, Thorpe Jr R . The Role of Social Support in Moderating the Relationship between Race and Hypertension in a Low-Income, Urban, Racially Integrated Community. J Urban Health. 2020; 97(2):250-259. PMC: 7101450. DOI: 10.1007/s11524-020-00421-1. View

Omachi T, Sarkar U, Yelin E, Blanc P, Katz P . Lower health literacy is associated with poorer health status and outcomes in chronic obstructive pulmonary disease. J Gen Intern Med. 2012; 28(1):74-81. PMC: 3539035. DOI: 10.1007/s11606-012-2177-3. View

Jayasinghe U, Harris M, Parker S, Litt J, van Driel M, Mazza D . The impact of health literacy and life style risk factors on health-related quality of life of Australian patients. Health Qual Life Outcomes. 2016; 14:68. PMC: 4855442. DOI: 10.1186/s12955-016-0471-1. View

Norbeck J, DeJoseph J, Smith R . A randomized trial of an empirically-derived social support intervention to prevent low birthweight among African American women. Soc Sci Med. 1996; 43(6):947-54. DOI: 10.1016/0277-9536(96)00003-2. View

10.

Xu W, Rothman R, Li R, Chen Y, Xia Q, Fang H . Improved self-management skills in Chinese diabetes patients through a comprehensive health literacy strategy: study protocol of a cluster randomized controlled trial. Trials. 2014; 15:498. PMC: 4307742. DOI: 10.1186/1745-6215-15-498. View

11.

Zhang Q, Huang F, Liu Z, Zhang N, Mahapatra T, Tang W . Cross-Cultural Validation of the High Blood Pressure Health Literacy Scale in a Chinese Community. PLoS One. 2016; 11(4):e0152182. PMC: 4846086. DOI: 10.1371/journal.pone.0152182. View

12.

Xu X, Rao Y, Shi Z, Liu L, Chen C, Zhao Y . Hypertension Impact on Health-Related Quality of Life: A Cross-Sectional Survey among Middle-Aged Adults in Chongqing, China. Int J Hypertens. 2016; 2016:7404957. PMC: 5005589. DOI: 10.1155/2016/7404957. View

13.

Kim M, Song H, Han H, Song Y, Nam S, Nguyen T . Development and validation of the high blood pressure-focused health literacy scale. Patient Educ Couns. 2011; 87(2):165-70. PMC: 3288330. DOI: 10.1016/j.pec.2011.09.005. View

14.

Adisa R, Olajide O, Fakeye T . Social Support, Treatment Adherence and Outcome among Hypertensive and Type 2 Diabetes Patients in Ambulatory Care Settings in southwestern Nigeria. Ghana Med J. 2017; 51(2):64-77. PMC: 5611909. View

15.

Matsuoka S, Kato N, Kayane T, Yamada M, Koizumi M, Ikegame T . Development and Validation of a Heart Failure-Specific Health Literacy Scale. J Cardiovasc Nurs. 2015; 31(2):131-9. DOI: 10.1097/JCN.0000000000000226. View

16.

Wang C, Lang J, Xuan L, Li X, Zhang L . The effect of health literacy and self-management efficacy on the health-related quality of life of hypertensive patients in a western rural area of China: a cross-sectional study. Int J Equity Health. 2017; 16(1):58. PMC: 5493849. DOI: 10.1186/s12939-017-0551-9. View

17.

Lee J, Kim M, Han H . Correlates of Health-Related Quality of Life Among Korean Immigrant Elders. J Appl Gerontol. 2014; 34(7):844-57. PMC: 4511715. DOI: 10.1177/0733464813490247. View

18.

Li Y, Yang L, Wang L, Zhang M, Huang Z, Deng Q . Burden of hypertension in China: A nationally representative survey of 174,621 adults. Int J Cardiol. 2016; 227:516-523. DOI: 10.1016/j.ijcard.2016.10.110. View

19.

Walther D, Curjuric I, Dratva J, Schaffner E, Quinto C, Rochat T . High blood pressure: prevalence and adherence to guidelines in a population-based cohort. Swiss Med Wkly. 2016; 146:w14323. DOI: 10.4414/smw.2016.14323. View

20.

Khayyat S, Mohamed M, Khayyat S, Hyat Alhazmi R, Korani M, Allugmani E . Association between medication adherence and quality of life of patients with diabetes and hypertension attending primary care clinics: a cross-sectional survey. Qual Life Res. 2018; 28(4):1053-1061. DOI: 10.1007/s11136-018-2060-8. View