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

Young-Nam Park; Chul-Gyu Kim

doi:10.7475/kjan.2019.31.5.573

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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

Original Article

Korean J Adult Nurs 2019;31(5):573-583.

Published online: 21 October 2019

DOI: https://doi.org/10.7475/kjan.2019.31.5.573

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

Young-Nam Park¹, Chul-Gyu Kim^2,

¹Head Nurse, Stroke Unit, Hana Hospital, Cheongju, Korea

²Associate Professor, Department of Nursing, Chungbuk National University, Cheongju, Korea

Corresponding author: Kim, Chul-Gyu https://orcid.org/0000-0002-2512-139X Department of Nursing, Chungbuk National University, 1 Chungdae-ro, Seowon-gu, Cheongju 28644, Korea. Tel: +82-43-249-1860, Fax: +82-43-266-1719, E-mail: cgkim@cbnu.ac.kr

Received 2 August 201930 September 2019 Accepted 10 October 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 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.

Keywords: Self-care, Health literacy, Knowledge, Aged, Stroke

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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)
Gender	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)
Job status	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)
Monthly income (10,000 won)	≥100	41 (44.6)
Stroke education experience	None	71 (77.2)
Stroke education experience	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
Variables	Categories	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
Age (year)	≥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
Gender	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
Job status	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
Monthly income (10,000 won)	≥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
Stroke education experience	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
Variables	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
Living (ref.: with spouse)	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
Time since stroke (ref.:≥5 years)	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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