Effectiveness of a Health Literacy Development Program for Patients with Hypertension at Risk of Cardiovascular Disease in Mueang Trang District, Trang Province

Abstract

Introduction Hypertension is a non-communicable disease that leads to complications in cardiovascular disease. Research indicates a significant correlation between self-care behaviors and health literacy in patients with hypertension. Therefore, promoting health literacy fosters improved self-care behaviors and the prevention of cardiovascular diseases. 

Objective This study aimed to investigate the effects of a health literacy development program on health literacy, self-care behaviors, and the risk of cardiovascular diseases in patients with hypertension at risk of cardiovascular disease. 

Design A quasi-experimental design with two-group pretest and posttest. 

Methods Through stratified random sampling, the participants consisted of patients with uncontrolled hypertension residing in Mueang Trang District, Trang Province and met the following inclusion criteria: 1) having systolic blood pressure levels ranging from 140 to 179 mmHg or diastolic blood pressure levels ranging from 90 to 109 mmHg, and 2) being at risk of cardiovascular disease. They were assigned to experimental and comparison groups, each comprising 35 patients. The research instruments included: 1) a 12-week health literacy development program, consisting of training sessions to enhance processing capacity, general verbal knowledge, specific health knowledge, and followed up by community health volunteers; 2) a health literacy handbook for patients with hypertension at risk of cardiovascular disease; 3) a health literacy questionnaire; 4) a self-care behavior questionnaire; and 5) a 10-year cardiovascular disease risk score recording form. The content validity of instrument parts 1-4 was examined, revealing the content validity indices of 1.00, 1.00, .86, and 1.00 respectively. The reliability of the instrument parts 3-4 was tested, revealing a Kuder-Richardson 20 coefficient of .82 for the health literacy questionnaire, and Cronbach’s alpha coefficients of .90 for the self-care behavior questionnaire. Data analysis employed descriptive statistics, Independent t-test, Paired t-test, Mann Whitney U test, and Wilcoxon Signed Ranks test. 

Results The experimental and comparison groups had similar characteristics, including average ages of 59.31 years (SD 7.38) and 59.63 years (SD 6.64) respectively, as well as educational attainment levels (74.29% and 68.57% respectively) at the primary education. After participating in the program, patients with hypertension at risk of cardiovascular disease in the experimental group demonstrated significantly higher overall health literacy (M 125.63, SD 4.33) and self-care behaviors (M 4.63, SD 0.23) compared to before participating in the program (M 84.71, SD 14.12, p<.001; M 3.50, SD 0.46, p<.001, respectively), and the comparison group (M 87.63, SD 13.91, p<.001; M 3.44, SD 0.37, p<.001, respectively). Additionally, risk of cardiovascular disease (M 7.26, SD 3.39) was significantly lower than before the program (M 9.92, SD 5.03, p<.001) and the comparison group (M 10.50, SD 6.28, p = .031). 

Recommendation Registered nurses and healthcare teams can effectively implement health literacy development programs for patients with hypertension at risk of cardiovascular disease in the community thereby contributing to cardiovascular disease prevention.