Linking Health Literacy to Self-Care in Hypertensive Patients with Physical Disabilities: A Path Analysis Using a Multi-Mediation Model.

Hye Jin Nam,Ju Young Yoon

doi:10.3390/ijerph18073363

Abstract

Hypertension has been identified as the most prevalent chronic disease, accounting for the majority of premature deaths in people with physical disability in South Korea. Self-care is vital in controlling high blood pressure. Health literacy has been implicated in self-care behaviors; however, the mechanisms behind this relationship remain unclear. Therefore, the present study aimed to test a hypothetical path model estimating the association between health literacy and hypertension self-care behaviors and to verify the mediating effects of access to healthcare, provider–patient interactions, hypertension knowledge, and hypertension control self-efficacy in hypertensive people with physical disability. In total, 211 hypertensive adults with physical disability completed an online survey. A path analysis using a multi-mediation model was performed using AMOS 17.0 (IBM SPSS Inc., Chicago, IL, USA), and indirect effects were estimated using phantom variables. As a result, the model fit indices were deemed excellent. Significant indirect pathways were determined from health literacy to hypertension self-care behavior via provider–patient interactions, knowledge, and self-efficacy, although no direct association was found between health literacy and self-care behaviors. The study findings supported the importance of provider–patient interactions, knowledge, and self-efficacy, which play a role in linking health literacy and self-care behavior in hypertensive patients with physical disability.

Highlights

Published: 24 March 2021An estimated 1 billion people live with disabilities worldwide, and health disparities for this population have increasingly been recognized recently [1]
We sought to validate the applicability of Paasche-Orlow and Wolf’s pathway model in predicting the linkage between health literacy and self-care that goes beyond previous research by including four mediators, i.e., access and use of healthcare; provider–patient interactions; hypertension knowledge; and hypertension control self-efficacy, in hypertensive adults with physical disability. The aim of this present study was to test a hypothetical path model that estimated the influence of health literacy on hypertension self-care behavior and to verify the mediating effects of access to healthcare, provider–patient interactions, hypertension knowledge, and hypertension control self-efficacy between health literacy and hypertension self-care in hypertensive people with physical disability based on the Paasche-Orlow and Wolf’s pathway model [20]
This study used a multi-mediation path analytic model to identify the effects of health literacy on self-care, mediated by factors at the individual, interactive, and systematic levels in hypertensive patients with physical disabilities

Summary

Introduction

An estimated 1 billion people live with disabilities worldwide, and health disparities for this population have increasingly been recognized recently [1]. They are more likely to experience poor health than people without disabilities, as they tend to engage in un-healthy behaviors, such as smoking cigarettes, and have inadequate physical activity, putting them at risk of chronic diseases [2]. The mortality rates caused by cerebrovascular disease and hypertension were 7.3 times and 5.0 times higher in the population with disability, respectively [5]. Considering that one of the leading causes of cerebrovascular disease is hypertension, hypertension has been determined to account for a large part of premature death in the population with disabilities

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