Journal List > Korean J Adult Nurs > v.31(5) > 1135930

Park and Kim: Effects of the Health Literacy and Knowledge on Adherence to Self-care Behavior among Elderly with Ischemic Stroke Visiting Local General Hospitals

Abstract

Purpose

This study aims to identify the effects of health literacy and stroke knowledge on adherence to self-care behavior among the elderly with ischemic stroke.

Methods

The participants were 92 outpatients aged 65 or older with ischemic stroke, who were visiting the neurology or neurosurgery departments of two general hospitals in Chungcheongbuk-do between November 20, 2018, and April 9, 2019. The SPSS/WIN 23.0 program was used to analyze descriptive statistics, independent t-tests, and one-way ANOVA, and multiple regression.

Results

The mean age of participants was 73.25±5.72 and the proportion of men was 71.7%. The average score for health literacy, stroke knowledge, and adherence to self-care behavior were 9.26±2.32, 10.34±2.53, and 81.67±14.72, respectively. There were statistically significant differences in adherence to self-care behavior according to living and time since stroke. Adherence to self-care behavior and health literacy showed a statistically significant positive correlation with stroke knowledge. Stroke knowledge, living alone, and time since stroke(less than one year) were significantly related to the adherence to self-care behavior. This regression model explained 24.0% of the variance in the adherence to self-care behavior.

Conclusion

To improve the adherence to self-care behavior in the elderly with ischemic stroke, it is necessary to develop and implement educational program for those who live alone and who have experienced stroke less than one year previously.

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Table 1.
General Characteristics of the Participants (N=92)
Characteristics Categories n (%) or M± SD
Age (year) 75 55 (59.8)
≥75 37 (40.2)
73.3±5.72
Gender Men 66 (71.7)
Women 26 (28.3)
Education ≤ Elementary school 40 (43.5)
Middle school 20 (21.7)
High school 22 (23.9)
≥ College 10 (10.9)
Job status Unemployed 59 (64.1)
Employed 33 (35.9)
Living Alone 18 (19.6)
With spouse 47 (51.1)
With family 27 (29.3)
Monthly income (10,000 won) 100 51 (55.4)
≥100 41 (44.6)
Stroke education experience None 71 (77.2)
Yes 21 (22.8)
Time since stroke (year) 1 19 (20.6)
1~<5 48 (52.2)
≥5 25 (27.2)
Comorbidity (number) None 16 (17.4)
1 35 (38.0)
≥2 41 (44.6)
1.48±1.09
Hypertension 61 (66.3)
Diabetes mellitus 29 (31.5)
Ophthalmologic disease 11 (12.0)
Prostate disease 9 (9.8)
MI or angina 7 (7.6)
Arthritis 6 (6.5)
Cancer 5 (5.4)
Arrythmia 3 (3.3)
kidney disease 3 (3.3)
Thyroid disease 2 (2.2)

Multiple response; MI=myocardial infarction.

Table 2.
Level of Health Literacy, Stroke Knowledge and Adherence to Self-care Behavior (N=92)
Variables Categories n (%) Min Max Range M± SD
Health literacy Total 4.0 12.0 0~12 9.26±2.32
Low health literacy (≤7) 21 (22.8) 5.90±0.83
High health literacy (>7) 71 (77.2) 10.25±1.56
Term related health 3.0 5.0 0~5 4.45±0.72
Understanding and calculation field 1.0 7.0 0~7 4.82±1.92
Stroke knowledge 4.0 14.0 0~15 10.34±2.53
Adherence to self-care behavior 40.0 105.0 21~105 81.67±14.72
Table 3.
Differences in Health Literacy, Stroke Knowledge and Adherence to Self-care Behavior by General Characteristics (N=92)
Variables Categories Health literacy Stroke knowledge Self-care behavior
M± SD t or F (p) Scheffé M± SD t or F (p) Scheffé M± SD t or F (p) Scheffé
Age (year) 75 9.96±1.93 3.79 10.84±2.10 2.22 85.15±14.04 0.38
≥75 8.21±2.48 (<.001) 9.59±2.94 (.030) 80.95±15.85 (.704)
Gender Men 9.47±2.19 1.28 10.30±2.55 -0.20 81.33±14.34 -0.34
Women 8.73±2.62 (.210) 10.42±2.53 (.839) 82.50±15.90 (.734)
Education ≤ Elementary school a 8.30±2.11 6.43 9.95±2.64 2.43 80.15±16.39 1.28
Middle school b 9.45±2.39 (<.001) 9.95±2.39 (.070) 78.55±15.66 (.285)
High school c 9.91±2.29 a< d 10.55±2.36 84.50±12.01
≥ College d 11.30±1.06 12.20±2.10 87.70±9.03
Job status Unemployed 8.95±2.44 -1.83 10.00±2.54 -1.73 81.36±15.93 -0.26
Employed 9.82±2.02 (.071) 10.93±2.42 (0.88) 82.21±12.49 (.791)
Living Alone a 8.61±2.75 1.03 8.61±2.62 5.92 71.22±18.22 6.85
With spouse b 9.53±2.02 (.362) 10.87±2.29 (.004) 85.43±13.68 (.002)
With family c 9.22±2.52 10.55±2.53 a< b, c 81.66±14.72 a< b, c
Monthly income (10,000 won) 100 8.58±2.48 -3.25 9.71±2.58 -2.80 79.96±15.57 -1.24
≥100 10.10±1.81 (.002) 11.12±2.24 (.006) 83.78±13.48 (.218)
Stroke education experience None 9.20±2.28 -0.46 10.13±2.58 -1.58 80.87±15.26 -0.95
Yes 9.48±2.50 (.350) 11.04±0.49 (.122) 84.33±12.70 (.347)
Time since stroke (year) 1 a 8.84±2.24 2.33 9.00±3.27 4.39 73.11±19.08 4.41
1~<5 b 9.75±2.30 (.103) 10.94±2.13 (.016) 84.29±13.70 (.015)
≥5 c 8.64±2.30 10.20±2.30 b> a, c 83.12±10.37 a< b, c
Comorbidity (number) None 9.75±2.08 0.44 10.88±2.42 0.67 86.63±12.62 1.15
1 9.11±2.36 (.649) 10.03±2.64 (.537) 78.80±15.41 (.322)
≥2 9.19±2.41 10.39±2.46 82.95±14.72
Table 4.
Correlations among Health Literacy, Stroke Knowledge, and Adherence to Self-care Behavior (N=92)
Variables Health literacy Stroke knowledge
r (p) r (p)
Stroke knowledge .50 (<.001) 1
Adherence to self-care behavior .06 (.122) .44 (<.001)
Table 5.
Factors affecting Adherence to Self-care Behavior (N=92)
Variables Categories B SE β t p 95% CI
(Constants) 70.52 7.61 9.26 .001 55.38~85.66
Living (ref.: with spouse) Alone -10.43 3.87 -.28 -2.69 .008 -18.14~-2.72
With family -2.47 3.14 -.07 -0.79 .434 -8.73~3.78
Time since stroke (ref.:≥5 years) 1 year -8.76 4.05 -.24 -2.16 .033 -16.81~-0.71
1~<5 years -2.12 3.32 -.07 -0.64 .524 -8.73~4.48
Health literacy -0.26 0.67 -.04 -0.38 .706 -1.60~1.09
Stroke knowledge 1.86 0.66 .32 2.78 .006 0.53~3.18
Adj. R2=.24, F=5.79, p<.001

CI=confidence interval; SE=standard error.

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