Low health literacy in older patients with uncontrolled blood pressure at secondary care

Abstract

Background: Low health literacy (LHL) is common among patients with chronic diseases. Studies on the association between LHL and uncontrolled blood pressure are limited to primary and tertiary levels of healthcare. Objective: We evaluated the prevalence and association between LHL and uncontrolled blood pressure in hypertensive patients in a secondary healthcare in Brazil. Material and methods: Our study had a cross-sectional design and included 485 patients, between August/2014 to March/2016. We evaluated health literacy, by Short Assessment of Health Literacy for Portuguese-Speaking Adults (SAHLPA-18), and the blood pressure control. Individuals with a score ≤14 in SAHLPA-18 were considered as LHL, and individuals with blood pressure ≥140/90 (or ≥130/80 in diabetic patients) were considered as having uncontrolled blood pressure. Results: A total of 56.0% female, with mean age 62.0±12.6 years. Illiterate participants were 61.6%, and 65.4% earned up to one reference wage. Both uncontrolled blood pressure and LHL were highly prevalent (75.1% and 70.9%, respectively), but there was no association between these two parameters. In multivariate analysis, uncontrolled blood pressure was associated with age (OR:0.96, CI:0.94-0.98, p<0.001), diabetes mellitus (OR:4.36, CI:2.54-7.51; p<0.001) and number of pills (OR:1.16, CI:1.08-1.25, p<0.001). Conclusion: Even we found a high prevalence of LHL, the lack of association between LHL and uncontrolled blood pressure may be due to demographic characteristics of the sample, i.e., elderly people with low income and low schooling. HL assessment provides important information that supports actions to improve hypertension control and treatment.

The low health literacy in Latin America and the Caribbean: a systematic review and meta-analysis

“…Four studies ( n = 729; 3.0%) [ 41 , 46 , 68 , 85 ] evaluated a population under 30 years of age, and 35 studies ( n = 8,315; 34.8%) [ 12 , 14 , 16 , 25 , 26 , 29 , 31 , 32 , 35 , 40 , 44 , 45 , 48 , 50 , 51 , 53 , 54 , 56 , 57 , 60 , 62 – 64 , 66 , 67 , 69 , 71 , 79 , 82 , 86 , 89 , 90 , 92 , 93 , 95 ] assessed HL in adults with an average age between 30 and 60 years of age. 25 studies had a population with an average age above 60 years ( n = 5,870; 24.5%) [ 13 , 15 , 17 , 21 , 24 , 28 , 33 , 37 – 39 , 42 , 49 , 55 , 59 , 61 , 65 , 70 , 75 – 77 , 81 , 83 , 84 , 88 , 91 ]. In the mean years of formal education, 1,849 (7.7%) [ 13 , 16 , 26 , 29 ,…”

“…25 studies had a population with an average age above 60 years ( n = 5,870; 24.5%) [ 13 , 15 , 17 , 21 , 24 , 28 , 33 , 37 – 39 , 42 , 49 , 55 , 59 , 61 , 65 , 70 , 75 – 77 , 81 , 83 , 84 , 88 , 91 ]. In the mean years of formal education, 1,849 (7.7%) [ 13 , 16 , 26 , 29 , 40 , 54 , 69 , 85 ] participants had eight years or more of schooling, and 1,247 (5.2%) [ 15 , 55 , 65 , 81 ] had less than eight years of schooling. The table with the individual characteristics of the included studies is in Additional file 3 .…”

“…For standardization, we used the S-TOFHLA nomenclature. Regarding the tools’ validation, most were validated in the country of origin (47 studies; n = 9,483; 39.7%) [ 13 , 14 , 16 , 17 , 19 , 22 , 23 , 26 – 28 , 31 – 34 , 38 , 39 , 41 , 46 , 49 , 50 , 54 , 55 , 58 – 60 , 62 , 65 – 68 , 70 , 74 – 81 , 83 , 84 , 86 , 88 , 91 – 94 ]. The predominant language was Portuguese (57 studies; n = 11,445; 47.9%) [ 14 – 19 , 22 , 23 , 25 – 34 , 41 , 42 , 45 , 49 , 50 , 52 – 55 , 58 – 62 , 64 – 66 , 68 – 71 , 74 – 81 , 83 , 86 – 94 ] and Spanish (22 studies; n = 11,593; 48.5%) [ 12 , 13 , 20 , 21 , 36 – 39 , 44 , 46 – 48 , ...…”

“…The overall prevalence of low HL varied considerably from 16.64 to 100%, with a pooled of 50.62% (95%CI:41.82–59.39; 95%PI:12.45–88.08; I 2 = 97%) [ 13 , 15 , 17 , 21 , 28 , 30 , 33 , 35 , 38 – 41 , 47 , 51 , 54 , 55 , 57 , 63 , 65 , 66 , 73 , 77 , 81 , 82 , 84 – 86 , 92 , 95 ] (Fig. 4 ).…”

Fatores associados ao letramento funcional em saúde da pessoa idosa em tratamento pré-dialítico

“…From the perspective of social determinants, it is observed that individuals belonging to ethnic groups who are victims of social adversity and with low schooling are more likely to have low levels of FHL and, consequently, are predisposed to worse health status 21 . In this sense, a study conducted with North American adults observed that non-white individuals were more likely to have low or limited FHL 22 .…”