Relationship among Health Literacy, Knowledge about Hypertension Control, and Health Behavior in Older Persons with Hypertension

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Kannika Kareesun
Porntip Malathum
Nuchanad Sutti


This study aimed to investigate the relationship among health literacy, knowledge about hypertension control, and health behavior in older persons with hypertension. Nutbeam’s conceptual framework of health literacy was used to guide this study. The sample consisted of 70 older persons with hypertension who were at least 80 years old in subdistrict health promoting hospitals, Chonburi Province. The sample was recruited according to the inclusion criteria and proportional stratified sampling. Data were collected by interviews using the questionnaires, including the Demographic Questionnaire, the Functional Communication and Critical Health Literacy Scales Questionnaire, the Hypertensive Knowledge Questionnaire, and the Self-Care Behavior in Hypertension Questionnaire. The data were analyzed using descriptive statistics, and Spearman’s Rho correlation coefficient. The sample had a mean score of health literacy at a moderate to high level. The mean score of knowledge about hypertension control and the mean score of total health behavior were at a moderate level. The analysis showed a significant positive relationship of health literacy to knowledge about hypertension control and health behavior, but knowledge about hypertension control was not statistically correlated with health behavior. The results showed that health literacy is essential to promote health behavior of older persons. Therefore, health care providers should find strategies to develop health literacy of older persons to critically use their knowledge for desirable health behavior to control hypertension appropriately


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Kareesun K, Malathum P, Sutti N. Relationship among Health Literacy, Knowledge about Hypertension Control, and Health Behavior in Older Persons with Hypertension. Rama Nurs J [Internet]. 2020 Jan. 7 [cited 2022 Oct. 1];25(3):280-95. Available from:


1. Zhou B, Bentham J, Di Cesare M, Bixby H, Danaei G,Cowan MJ, et al. Worldwide trends in blood pressure from
1975 to 2015: a pooled analysis of 1479 populationbased measurement studies with 19·1 million participants.
Lancet. 2017;389(10064):37-55.

2. Aekplakorn W. Report the 4th Thai Health Survey Physical Examination in 2008-9. Nonthaburi: The Graphic Go
System; 2009. (in Thai)

3. Aekplakorn W. Report the 5th Thai Health Survey Physical Examination, 2014. Nonthaburi: Health Systems Research
Institute; 2014. (in Thai)

4. Bureau of Non-Communicable Diseases, Ministry of Public Health. Annual report 2015. Bangkok: War Veterans Organization of Thailand; 2016. (in Thai)

5. Thai Hypertension Society. The guidelines on the treatment of hypertension 2012: update 2015. Bangkok: Thai
Hypertension Society; 2015. (in Thai).

6. Thianthawon V. Hypertension; 2017. [Cited 2017 June 8]. Available from:
columnists/news_557604. (in Thai).

7. Rakchanyaban U, Vapattanawong P, Prasartkul P,Porapakkham Y, Aekplakorn W. Disability and risk factors of disability among the Thai older population. Rama Nurs J. 2009;15(1):111-26. (in Thai).

8. Promsena Y. Self-care behavior among hypertensive patients at hypertension clinic, Nakornping Hospital,Chiangmai Province [thesis]. Chiang Mai: Chiang Mai University; 2007. (in Thai)

9. Nutbeam D. The evolving concept of health literacy. Social Science & Medicine. 2008;67(12):2072-78.

10. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ,Crotty K. Low health literacy and health outcomes: an
updated systematic review. Ann Intern Med.2011;155(2):97-107.

11. Friis K, Vind BD, Simmons RK, Maindal HT. The relationship between health literacy and health behaviour in people with diabetes: a Danish population-based study.J Diabetes Res, 2016;1-7.

12. Almas A, Godil SS, Lalani S, Samani ZA, Khan AH. Good knowledge about hypertension is linked to better control
of hypertension: a multicentre cross-sectional study in Karachi, Pakistan. BMC research notes. 2012;5(1):1-8.

13. National Statistical Office Ministry of Information and Communication Technology. The 2014 survey of the older
persons in Thailand. Bangkok: Text and Journal Publication; 2014. (in Thai)

14. Olowe OA, Ross AJ. Knowledge, adherence and control among patients with hypertension attending a peri-urban
primary health care clinic, KwaZulu-Natal. Afr J Prm Health Care Fam Med. 2017;9(1):1-5.

15. Ginggeaw S, Prasertsri N. The relationship between health literacy and health behaviors among older adults who have multi-morbidity. Nursing Journal of Ministry of Public Health. 2015;25(3):43-54. (in Thai)

16. Bains SS, Egede LE. Associations between health literacy,diabetes knowledge, self-care behaviors, and glycemic
control in a low income population with type 2 diabetes.Diabetes Technol Ther. 2011;13(3):335-41.

17. Osborn CY, Paasche-Orlow MK, Bailey SC, Wolf MS.The mechanisms linking health literacy to behavior and health status. Am J Health Behav. 2011;35(1):118-28.

18. Ko Y, Balasubramanian TD, Wong L, Tan ML, Lee E,Tang WE, et al. Health literacy and its association with disease knowledge and control in patients with hypertension in Singapore. Int J Cardiol. 2013; 168(4): 116-7.

19. Peamnoom C. Self-care behaviors among hypertensive patients of sub-district Khao Kitcha Kood, Chanthaburi
Province [thesis]. Bangkok: Kasetsart University; 2007.(in Thai)

20. Kummak P, Kummak S, Kagmmunee M. Factors related to self-care behaviors among patients with hypertension.
The Sounthern College Network Journal of Nursing and Public Health. 2015;2(3): 74-90. (in Thai)

21. Laloon P, Madhyamankura N, Malarat A. Self–care behavior of hypertensive patients at outpatient department
of HRH Princess Maha Chakri Sirindhorn Medical Center.J Med Health Sci.2011;18(3): 160-9. (in Thai)

22. Jenjob J, Chomson S. Factors related to blood pressure control behaviors of patients with essential hypertension
of Ban Keskasorn subdistrict health promotion hospital Lankrabue District, Kamphaeng Phet. Province. 2016. In
Proceedings of the 12th National Conference (p.721-34). (in Thai)

23. Poolperm S. Factors affecting self-care behaviors among hypertensive patients at Tambon Keelek, Amphoe Mueang,
Changwat Ubon Ratchathani. Journal of Nakhonratchasima College. 2011;5(2): 49-54. (in Thai)

24. Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and
communication strategies into the 21st century. Health Promot Int. 2000;15(3):259-67.

25. Brooke P, Bullock R. Validation of a 6 item cognitive impairment test with a view to primary care usage. Int J
Geriatr Psychiatry. 1999;14(1):936-40.

26. Jitapunkul S, Kamolratanakul P, Ebrahim S. The meaning of activities of daily living in a Thai elderly population:
development of a new index. Age Ageing. 1994;23(2):97-101.

27. Cohen J. Statistical power analysis for the behavior sciences (2nded). Hillsdale, NJ: Lawrence Erlbaum; 1988. p.75-105.

28. Malathum P. The Six Item Cognitive Impairment Test:6CIT. Unpublished paper. Ramathibodi School of Nursing,
Faculty of Medicine Ramathibodi Hospital, Mahidol University; 2017. (in Thai).

29. Ishikawa H, Takeuchi T, Yano E. Measuring functional,communicative, and critical health literacy among diabetic
patients. Diabetes Care. 2008;31(5):874-9.

30. Chontichachalalauk, J. Translation and evaluation of the version of the Diabetes Numeracy Test for older adults with
type 2 diabetes. 2015. (Unpublished doctoral dissertation).The University of Texas at Austin, the United States.

31. Krirkgulthorn, T. Effects of self-care promotion program on knowledge, self-care practices and blood pressure in
hypertensive elderly women (dissertation). Nakhon Pathom: Mahidol University; 2001. (in Thai)

32. Lakiew A, Chaleekrua C. Health literacy and factors related to medication among patients with hypertension Ban Piang Luang Subdistrict Health Promoting Hospital, Chiangmai Province. In: 6th Nationaland International Conference
and Research Presentation “Moving Towards World Class Research”; 28-29 April 2015; Suan Sunandha Rajabhat
University. Bangkok: Suan Sunandha Rajabhat University;2015. p.635-49. (in Thai)

33. Sarkar U, Karter AJ, Liu JY, Adler NE, Nguyen R, Lopez A, Schillinger D. The literacy divide: health literacy and
the use of an internet-based patient portal in an integrated health system—results from the Diabetes Study of Northern
California (DISTANCE). J Health Commun. 2010;15(S2):183-96.

34. Tajfard M, Esmaily H, Peyman N, Ghasemi AN, Tehrani H, & Sharifzadeh G. The relationship of health literacy
with Hypertension Self-Efficacy and General Self-Efficacy among schoolteachers. Mod Care J,2018;15(4):1-6.

35. Wungthanakorn S, Phatidumrongkul C, Khomchan P.Factors affecting medication taking behaviors in hypertensive patients. Songkla Med J. 2008;26(6):539-47. (in Thai)

36. Rosenstock IM. Historical origins of the health belief model. Health Education Monographs. 1974;2(4):328-35.

37. Lo SH, Chau JP, Woo J, Thompson DR, Choi KC.Adherence to antihypertensive medication in older adults with hypertension. J Cardiovasc Nurs. 2016;31(4):296-303.

38. Siwanna T. Factors affecting on non-exercising of the elderly in Kanchanaburi Demographic Surveillance System. [thesis]. Nakhon Pathom: Mahidol University;2012. (in Thai)

39. Whaley MH, Brubaker PH, Otto RM, Armstrong LE,American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2006.

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