지역사회 노인 고혈압 환자의 건강정보이해능력과 고혈압 관련 지식, 자기효능감 및 자가관리 행위에 관한 연구

Abstract

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.