Mediating Effects of Health Belief on the Correlations among Disease-related Knowledge, eHealth Literacy, and Self-care Behaviors in Outpatients with Hypertension

Gyoo Yeong Cho; Myung Nam Ha

doi:10.7475/kjan.2019.31.6.638

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Cho and Ha: Mediating Effects of Health Belief on the Correlations among Disease-related Knowledge, eHealth Literacy, and Self-care Behaviors in Outpatients with Hypertension

Original Article

Korean J Adult Nurs 2019;31(6):638-649.

Published online: 21 December 2019

DOI: https://doi.org/10.7475/kjan.2019.31.6.638

Mediating Effects of Health Belief on the Correlations among Disease-related Knowledge, eHealth Literacy, and Self-care Behaviors in Outpatients with Hypertension

Gyoo Yeong Cho¹, Myung Nam Ha^2,

¹Professor, Department of Nursing, Pukyong National University, Busan, Korea

²Doctoral Student, Department of Nursing, Pukyong National University, Busan, Korea

Corresponding author: Ha, Myung Nam https://orcid.org/0000-0003-3274-9983 Department of Nursing, Pukyong National University, 45 Yongso-ro, Nam-gu, Busan 48513, Korea. Tel: +82-51-629-5786, Fax: +82-51-629-5789, E-mail: nursingcho@pknu.ac.kr

Received 19 September 20198 November 2019 Accepted 29 November 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study aimed to identify the mediating effects of health belief on the disease-related knowledge, eHealth literacy, and self-care behavior of hypertension patients. eHealth is an emerging field of medical informatics, referring to the organization and delivery of health services and information using the internet and related technologies.

Methods

A total of 156 patients who were receiving treatment for hypertension at the best internal medicine clinic in Busan City participated in the study. Data collection was conducted from May 22, to June 30, 2019. Collected data were analyzed with descriptive statistics, independent t-test, one-way analysis of variance, Pearson's correlation coefficient, and three-step mediated regression analysis using SPSS/WIN 25.0.

Results

Significant positive correlations were observed between disease-related knowledge and eHealth literacy (r=.19, p=.016), disease-related knowledge and health belief (r=.32, p<.001), disease-related knowledge and self-care behavior (r=.16, p=.046), eHealth literacy and health belief (r=.17, p=.034), and health belief and self-care behavior (r=.27, p=.001). Health belief had a mediating effect (z=-2.47, p=.013) on the correlation between disease-related knowledge and self-care behavior.

Conclusion

To improve self-care behavior among hypertension patients, medical practitioners need to develop interventions that enhance health belief.

Keywords: Hypertension, Knowledge, Health literacy, Belief, Self-care

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Figure 1.

The mediation effect of health belief between the disease-related knowledge and self-care behavior of patients.

Table 1.

Disease-related Knowledge, eHealth Literacy, Health Belief and Self-care Behavior to Characteristics of Patients (N=156)

Variables	Categories	n (%) or Mean±SD	Disease-related knowledge		eHealth literacy		Health belief		Self-care behavior
Variables	Categories	n (%) or Mean±SD	Mean± SD	t or F (p)	) Mean± SD	t or F (p)	Mean± SD t	t or F (p)	Mean± SD t	or F (p)
Gender	Men	76 (48.7)	70.00±14.80	-0.32	3.17±0.86	2.35	3.66±0.41	-0.28	3.49±0.53	-2.39
Gender	Women	80 (51.3)	70.00±11.80	(.743)	2.83±0.94	(.020)	3.68±0.40	(.777)	3.69±0.53	(.018)
Age (year)	≤59 ^a	46 (29.5)	70.00±15.50	0.38	3.50±0.73	8.65	3.65±0.40	1.59	3.47±0.47	1.51
	60~69 ^b	49 (31.4)	69.00±12.90	(.764)	2.92±0.93	(＜.001)	3.62±0.41	(.193)	3.61±0.58	(.212)
	70~79 ^c	48 (30.8)	71.00±11.80		2.75±0.86	a＞ b, c, d^†	3.69±0.39		3.65±0.55
	≥80 ^d	13 (8.3)	72.00±12.50		2.42±0.88		3.89±0.46		3.78±0.48
		64.68±11.80
Spouse	No	39 (25.0)	66.00±15.80	2.15	2.79±1.07	0.16	3.66±0.48	1.65	3.57±0.50	0.34
Spouse	Yes	117 (75.0)	72.00±12.10	(.036)	3.07±0.85	(.873)	3.67±0.38	(.100)	3.60±0.55	(.762)
Education	≤ Primary ^a	43 (27.6)	67.00±11.10	3.01^‡	2.41±0.86	14.00	3.62±0.44	0.53	3.66±0.39	0.88
	Middle school ^b	31 (19.8)	67.00±15.00	(.036)	2.82±0.69	(＜.001)	3.64±0.43	(.659)	3.64±0.69	(.448)
	High school ^c	58 (37.2)	73.00±9.90	a＜ c^§	3.32±0.83	a＜ c, d^†	3.71±0.40		3.58±0.53
	≥ College ^d	24 (15.4)	72.00±19.30		3.52±0.83		3.70±0.35		3.58±0.53
Monthly income (10,000 won)	≤200 ^a	93 (59.6)	68.00±12.80	1.64	2.75±0.93	6.74	3.68±0.43	1.02	3.63±0.52	5.26
	201~300 ^b	31 (19.9)	73.00±9.60	(.180)	3.28±0.76	(＜.001)	3.75±0.38	(.383)	3.81±0.55	(.002)
	301~400 ^c	13 (8.3)	73.00±17.10		3.59±0.62	a＜ b, c^†	3.60±0.35		3.36±0.39	b＞ d^†
	≥401 ^d	19 (12.2)	72.00±16.90		3.35±0.82		3.56±0.36		3.27±0.49
Smoking	No	132 (84.6)	70.00±13.20	0.04	2.93±0.92	2.20	3.68±0.39	-0.70	3.63±0.54	-1.90
Smoking	Yes	24 (15.4)	70.00±14.30	(.964)	3.37±0.81	(.029)	3.60±0.51	(.485)	3.40±0.51	(.059)
Alcohol intake	No ^a	90 (57.7)	69.00±13.00	0.92	2.79±0.92	7.18	3.68±0.45	0.17	3.70±0.58	3.10
	Once a month ^b	24 (15.4)	72.00±16.00	(.431)	3.28±0.55	(＜.001)	3.62±0.38	(.914)	3.40±0.46	(.029)
	1~2 times a week ^c	23 (14.7)	73.00±11.00		3.65±0.72	a＜ b, c^†	3.68±0.32		3.43±0.46	a＞ c^†
	≥3 times a week ^d	19 (12.2)	69.00±13.00		2.85±1.03		3.65±0.31		3.54±0.40
Salt diet	Low ^a	37 (23.7)	74.00±11.30	1.58	2.97±1.05	1.35	3.79±0.43	1.48	3.73±0.62	4.03
	Medium ^b	70 (44.9)	68.00±14.30	(.196)	3.03±0.90	(.258)	3.63±0.41	(.221)	3.66±0.53	(.009)
	More than medium ^c	45 (28.8)	71.00±13.20		3.04±0.75		3.64±0.36		3.43±0.42	b＞ c^†
	High ^d	4 (2.6)	65.00±7.10		2.11±1.29		3.66±0.43		3.08±0.43
Exercise (times/week)	No	35 (22.4)	70.00±11.60	0.14	3.04±0.78	0.38	3.66±0.40	0.98	3.54±0.57	0.54
	1~2	39 (25.0)	71.00±16.00	(.866)	3.08±0.74	(.680)	3.65±0.46	(.906)	3.55±0.55	(.581)
	≥3	82 (52.6)	70.00±12.70		2.94±1.03		3.68±0.39		3.64±0.52
Degree of health worry	No ^a	13 (8.5)	70.00±12.80	0.50	2.35±0.93	3.34	3.59±0.33	3.82	3.75±0.40	3.51
	Sometimes ^b	66 (42.2)	69.00±12.70	(.680)	3.01±0.97	(.021)	3.60±0.34	(.011)	3.45±0.55	(.017)
	Often ^c	35 (22.4)	69.00±18.00		3.27±0.71	a＜ c^†	3.61±0.47	a＜ d^†	3.61±0.50	b＜ d^†
	Always ^d	42 (26.9)	72.00±9.40		2.95±0.89		3.85±0.42		3.77±0.53
Number of health information searches	None ^a	72 (46.1)	69.00±13.60	1.06	2.64±0.75	15.44	3.61±0.39	2.64	3.64±0.51	0.87
	1/month ^b	36 (23.1)	68.00±12.40	(.368)	2.84±0.92	(＜.001)	3.61±0.47	(.052)	3.49±0.63	(.456)
	2~3/weeks ^c	26 (16.7)	74.00±12.00		3.58±0.75	a＜ c, d^†	3.78±0.32		3.55±0.49
	Everyday ^d	22 (14.1)	72.00±15.00		3.72±0.84		3.83±0.40		3.69±0.53
Internet using time (hours/day)	≤1 ^a	111 (71.2)	69.00±12.80	1.91	2.72±0.88	14.61	3.64±0.42	1.90	3.63±0.54	1.04
	2~3 ^b	30 (19.2)	75.00±14.20	(.129)	3.70±0.58	(＜.001)	3.75±0.28	(.132)	3.53±0.49	(.375)
	4~5 ^c	7 (4.5)	67.00±13.20		3.67±0.71	a＜ b, c, d^†	3.52±0.52		3.29±0.72
	＞5 ^d	8 (5.1)	73.00±14.60		3.57±0.63		3.92±0.41		3.56±0.50
BMI (kg/m²)	Normal	43 (27.6)	73.00±11.80	1.13	2.94±0.95	0.75	3.63±0.36	1.26	3.59±0.68	0.15
	Overweight	54 (34.6)	69.00±12.80	(.324)	3.12±0.91	(.473)	3.74±0.44	(.285)	3.63±0.54	(.858)
	Obesity	59 (37.8)	69.00±14.60		2.92±0.89		3.63±0.40		3.57±0.40
Duration of hypertension medication (year)	≤5	56 (35.9)	72.00±14.70	0.97	3.18±0.88	2.21	3.66±0.37	0.33	3.50±0.63	1.66
	6~10	54 (34.6)	70.00±11.10	(.408)	2.99±0.93	(.089)	3.70±0.38	(.798)	3.71±0.42	(.177)
	11~15	20 (12.8)	69.00±15.80		2.99±0.94		3.60±0.48		3.52±0.52
	≥16	26 (16.7)	67.00±12.20		2.63±0.86		3.70±0.47		3.62±0.53
The number of times forget to take a medicine (month)	No ^a	122 (78.2)	69.00±13.00	0.99	2.89±0.96	4.31^‡	3.66±0.42	0.81	3.65±0.53	8.88
	1~2 ^b	19 (12.2)	74.00±14.00	(.373)	3.39±0.64	(.015)	3.78±0.35	(.447)	3.63±0.43	(.001)
	≥3 ^c	15 (9.6)	72.00±14.70		3.41±0.40	a＜ b, c^§	3.62±0.32		3.06±0.41	a,
										b＞ c^†

BMI=body mass index; SD=standard deviation;

^† Scheffé test;

^‡ Welch's F test;

^§ Games-Howell test.

Table 2.

Level of Disease-related Knowledge, eHealth Literacy, Health Belief and Self-care Behavior of Patients (N=156)

Variables	Number of item	Range	Min	Max	Mean± SD
Disease-related knowledge	20	0~5	30.00	100.00	70.00±13.30
eHealth literacy	8	1~5	2.75	3.16	3.00±0.91
Health belief	14	1~5	2.18	4.17	3.67±0.41
Self-care behavior	16	1~5	2.61	4.43	3.59±0.54

Table 3.

Correlation among Disease-related Knowledge, eHealth Literacy, Health Belief and Self-care Behavior of Patients (N=156)

Variables	Disease-related knowledge	eHealth literacy	Health belief
Variables	r (p)	r (p)	r (p)
Disease-related knowledge	1
eHealth literacy	.19 (.016)	1
Health belief	.32 (＜.001)	.17 (.034)	1
Self-care behavior	.16 (.046)	.14 (.865)	.27 (.001)

Table 4.

Mediating Effect of Health Belief among the Knowledge, eHealth Literacy and Self-care Behavior of Patients (N=156)

	Independent variables	Dependent variables	B	SE	β	t (p)	95% CI	Adjusted R²	F (p)
Step I	1 Knowledge	Health belief	1.00	0.23	.32	4.26 (＜.001)	0.01~0.72	.10	18.18 (＜.001)
	2 Knowledge	Self-care behavior	0.65	0.32	.16	2.00 (.046)		.01	4.03 (.046)
	3 Knowledge	Self-care behavior	0.32	0.33	.07	0.96 (.338)		.06	6.75 (.003)
	Health belief		0.32	0.10	.24	3.04 (.003)
						Sobel test: z=-2.47, p=.013
Step II	1 eHealth literacy	Health belief	0.07	0.36	.17	2.14 (.034)	-0.00~0.06	.02	4.59 (.034)
	2 eHealth literacy	Self-care behavior	0.01	0.04	.01	0.17 (.865)		.01	0.02 (.865)
	3 eHealth literacy	Self-care behavior	-0.02	0.04	-.03	-0.43 (.667)		.06	6.35 (.002)
	Health belief		0.36	0.10	.28	3.56 (＜.001)

B=unstandardized estimates; CI=confidence interval; Knowledge=disease-related knowledge; SE=standardized error; β=standardized estimates.

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