Relationships of Selected Factors, Health Literacy and Clinical Outcomes in Community Dwellers with Hypertension

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Orathai Piamsiri, RN, MNS
Chularak Kaweevivithchai, RN,PhD
Nareemarn Neelapaichit, RN,DrPH


This study was undertaken to examine the relationship among selected factors, health literacy and clinical outcomes among community dwellers with hypertension.

The samples of 360 persons with hypertension aged 20 years old and over were selected using proportional stratified random sampling with simple random sampling from 6 sub-district Health Promoting Hospitals in Muang District, Prachinburi Province. The instrument was used to screen subjects who were 60 years old and older with The Short Portable Mental Status Questionnaire (SPMSQ). Health literacy was used for hypertension questionnaires and record clinical outcomes to elicit data regarding blood pressure levels, body mass index, and waist circumference. The data were analyzed using descriptive statistics and inferential statistics including chi-square test.

The findings revealed that most participants had inadequate overall health literacy (53.1%), inadequate health literacy on functional, interactive and critical health literacy subscale (47.8%, 60.3%, 40.0% respectively) and that there was a significant correlation between selected factors and overall health literacy with statistical significance (p < 0.01) were age, educational background, income, community roles, and severity of illness whereas gender, having co-morbidity and duration of living with hypertension was not associated. In addition, there was a significant correlation between health literacy level and clinical outcomes with systolic blood pressure with statistical significance (p < 0.05) whereas diastolic blood pressure, Body mass index (BM) and waist circumference was not associated.

This study suggested that healthcare teams should provide health information and hypertension education programs focusing on target populations, particularly to persons with inadequate health literacy including the elderly, those with low education and of low income. They should communicate effectively and make health information accessible and in a language that is easy-to-understand to promote proper decision-making and lead to good clinical outcomes.


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Piamsiri O, Kaweevivithchai C, Neelapaichit N. Relationships of Selected Factors, Health Literacy and Clinical Outcomes in Community Dwellers with Hypertension. BKK Med J [Internet]. 2018 Sep. 20 [cited 2023 Nov. 30];14(2):40. Available from:
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1. World Health Organization. Hypertension fact sheet, 2011. (Accessed October 30, 2015, at entity/noncommunicable_disease/ media/ non_communicable_ disease_hypertension.pdf.)
2. World Hypertension League. Healthy Heart Beat - Healthy Blood Pressure: World Hypertension Day 2013 brochure, 2013. (Accessed October 30, 2015, at https://www.worldhypertensionleague. org/Documents /WHD/2013/ WHD%20 2013%20 brochure.pdf.)
3. World Hypertension League. Hypertension Globally, 2016. (Accessed May 30, 2016, at https://www.worldhypertensionleague. org/index.php/j-stuff/ hypertension-globally.
4. Ministry of Public Health Presentation of data from the 21 health and disease prevention database. 2015. (Accessed September 15, 2015, at https://www.thaincd .com/information -statistic/non-communicable-disease-data.php.)
5. Bureau of Policy and Strategy, Office of the Permanent Secretary of the Ministry of Public Health.Death statistics of Thailand 2009-2013, 2014. (Accessed September 15, 2015, at
6. Aekpalakorn W. Thai National Health Examination survey, NHES V. Nonthaburi: Health system research; 2016.
7.  Kaewdamgerng K, Thummakul D. Health literacy promoting in aging population. J health Sci Res 2015; 9(2):1-7.
8. Health Systems Research Institute. Health literacy. Bangkok: Newthammada; 2011.
9. World Health Organization. The 10 leading causes of death in the world, 2000 and 2012, 2015. (Accessed November 1, 2015, at /factsheets/fs310/ en/.).
10. Hesse BW, Nelson DE, Kreps GL, et al. Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first Health Information National Trends Survey. Arch Intern Med 2005;22:2618-24.
11. Ko Y, Balasubramanian TD, Wong L, et al. Health literacy and its association with disease knowledge and control in patients with hypertension in Singapore. Int J Cardiol 2013:116-7.
12. Institute of Medicine. Health Literacy: A Prescription to End Confusion, 2004. (Accessed March 20, 2016, at https://www.
13. Nutbeam D. Health Literacy as a public health goal: a challenge for contemporary health education and communication strategies into health 21st century. Health Promot Int 2000;15(3):259-67.
14. Department of Health, Ministry of Public Health. 12th National Health Development plan 2017-2021. Nonthaburi: Department of Health, Ministry of Public Health; 2017.
15. Intarakamhang U. Synthesis and Development of ABCD – Health Literacy Scale of Thai Adults. Nonthaburi: Department of Health Service Support, Ministry of Public Health; 2013.
16. Thanasugarn C, Neelapaichit N. Development tools Health literacy in patients with diabetes & hypertension. Nonthaburi: Department of Health Service Support, Ministry of Public Health; 2015.
17. Prachinburi Provincial Office. Development Plan Prachinburi, 2017. (Accessed July 10, 2017 at https://www.prachinburi.
18. Division of Health Education, Department of Health Service Support, Ministry of Public Health. Health Development Program for the Elderly in Muang Si Khai District Warinchamrab Ubon Ratchathani, 2015. (Accessed October 15, 2016, at
19. Prachinburi Public Health Office. The results of the surveillance of hypertension, 2014. (Accessed at November 15, 2016, at
20. National Health Security Office. Action Plan for Disease Control NCDs 2015-2019, 2015. (Accessed April 6, 2016, at https://dmht.thaimedresnet .org/.).
21. Williams MV, Davis TC, Parker RM, et al. The Role of health literacy in Patient-Physician Communication. Fam Med 2002;34(5):383-9. 22. Bostock S, Steptoe A. Association between low function health literacy and mortality in older adults: longitudinal cohort study, 2012. (Accessed March
22. 2016 at 10.1136/bmj.el1602.).
23. Department of Health, Ministry of Public Health. The results of the Health Literacy Survey in Youth aged 12-15. Nonthaburi: Department of Health, Ministry of Public Health; 2000.
24. Suramithmaitree B. Health Literacy Research and the situation to promote health intelligence of the Thai people to support the entry into ASEAN. Foreign Affairs Executive Programme, Devawongse Varopakarn Institute of Foreign Affairs; 2013.
25. Jindawong B, Bumrerraj S, Luweela V, et al. Functional Health Literacy in Patients at Srinagarind, Khon Kaen Province[dissertation]. Master of Science Program in Community Health Development, Khon Kaen University; 2014.
26. Juntanon N, Singchai B, Worawong W. Self-Care Behavior of Hypertension Patients Who Live in Muang District, Chumphon Province. KKU Res J 2011;16(6):749-58.
27. Pansakun N, Vorayingyon A. Comparative Study and Health Literacy in the Village Health Volunteers and General Population Group in Chaing-Kham District, Phayao Province, 2014. (Accessed April 15, 2017 at cw/graduate/imagespdf.).
28. Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 1975;23(10):433-41.
29. Shi D, Li J, Wang Y, et al. Association between health literacy and hypertension management in a Chinese community: a retrospective cohort study, 2017. (Accessed July 10, 2017 at /28303441.)
30. Department of Health, Ministry of Public Health. Behavioral health surveillance system to modify risk behaviors Normal / Risk / Disease ( Diabetes & Hypertension ) in Thailand: Policy to practice For primary care .Nonthaburi:Department of Health, Ministry of Public Health; 2014.
31. Division of Health Education. The results of the assessment by province, 2011. (Accessed June 15, 2016 at https://www.
32. Kaewdamgerng K. Synthesis of knowledge about Health literacy. J Health Service Support 2010;6(3): 46-55.
33. Ministry of Public Health. Health Behavior Monitoring System to Modify Risk Behavior of Normal / Risk / Diabetic Hypertension in Thailand: A Policy for Practice For primary care. Nonthaburi: Department of Health Service Support, Ministry of Public Health; 2015.
34. Tianthavorn V. New Health Promotion Textbook. Bangkok: The War Veterans Organization of Thailand; 2012.
35. Pangjunan T, Panthuwate N. World Hypertension day 2015, 2015. (Accessed July 10, 2017 at PR/58-Hypertension.pdf.).
36. Hutchison J, Warren-findlow J, Dulin M, et al. The Association between Health literacy and Diet adherence among Primary care patient with Hypertension. J Health Dispar Res pract 2014;2:109-27.
37. Wannasirikul P, Termsirikulchai L, Sujirarat D, et al. Health Literacy, Medication adherence, and blood pressure level among hypertensive older adults treated at Primary health care centers. Southeast Asian j Trop Med Pubic Health 2016;1: 109 -20.
38. Sorensen K, Broucke S, Fullam J, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health, 2012. (Accessed November 15, 2015 at 2458/12/80 12-80.).