Abstract
Objective: To investigate factors associated with Functional Health Literacy (FHL), as well as its role as a probable protective factor for treatment adherence in individuals with hypertension (SAH), attended in Primary Health Care (Atencao Primaria a Saude - APS) units. Methods: This is a cross-sectional study with APS users under antihypertensive medication in the city of Salvador, Bahia. Illiterate or functionally illiterate patients were excluded, as well as those with a history of ischemic stroke. Data were collected between November 2015 and August 2016. Sociodemographic and clinical data were accessed utilizing a structured instrument developed by the authors, and the FHL was assessed using the REALM. Descriptive analyses and logistic regression were performed. Results: The population comprised 286 individuals and it was observed that low schooling was associated with inadequate FHL, both in the gross and adjusted analysis (OR = 9.25; CI95%: 4.49 – 19.05) and with the professional activity of manual labor (OR = 9.90; CI95%: 2.08 – 46.90). In patients with schooling levels of over 8 years, it was observed that the FHL was significantly associated with non-adherence to medical treatment, even after adjustment by gender, age, civil status, physical activity, and skin color (OR = 3.0; CI95%: 1.2 – 7.9). Conclusions: Inadequate FHL was significantly associated with non-adhesion to treatment only for those with over 8 years of schooling. Improvements in health promotion actions should be reinforced to address chronic diseases such as SAH.
Highlights
Functional Health Literacy (FHL) may be understood as the ability to read, interpret, make appropriate connections, and reproduce information within the health context[1,2,3]
It was observed that low schooling was associated to inadequate FHL, both in the gross and the adjusted analyses (OR=9.25; CI95%: 4.49 – 19.05) and having a type of manual professional activity (OR=9.90; CI95%: 2.08 – 46.90)
It should be noted that patients who reported adherence to medical treatment are significantly higher proportions in the labor market (31.6%; n = 61) compared to those who did not adhere (21.5%; n = 20) (p = 0.04) and those who did not clearly understand what was informed during the medical consultation (30.1%; n = 58) compared to those who did not adhere to medical treatment (19.4%; n = 18) (p = 0.04)
Summary
Functional Health Literacy (FHL) may be understood as the ability to read, interpret, make appropriate connections, and reproduce information within the health context[1,2,3]. The FHL level can interfere in the communication processes, in the perception, and the action of the individual concerning a commitment with the treatment, in other words, adhesion to therapy[4]. It is influenced by the understanding of all of its phases and the inherent risks of the health condition[3,5]. Long-term diseases, such as chronic non-communicable diseases (CNCD) tend to challenge health professionals in the sense of keeping their patients motivated and committed to their self-care[4,5]. The knowledge of the necessary care for keeping-up the well-being, despite the existence of a CNCD, such as Systemic Arterial Hypertension (SAH), is tied to understanding the importance of the treatment[4,6,7]
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