Journal List > Korean J Adult Nurs > v.31(6) > 1139715

TOOLS
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 Ha2,

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

Copyright © 2019 Korean Society of Adult Nursing

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

REFERENCES

1. Korea Centers for Disease Control and Prevention. Korean national health and nutrition examination survey the seventh year the second year 2017 [Internet]. Cheongju: Korea Centers for Disease Control and Prevention;2019. [cited 2019 March 21]. Available from:. https://knhanes.cdc.go.kr/knhanes/sub04/sub04_03.do.
2. The Korea Society of Hypertension. Guidelines for hypertension treatment in 2018. Seoul: IMED Corporation;2018.
3. Arima H, Murakami Y, Lam TH, Kim HC, Ueshima H, Woo J, et al. Effects of prehypertension and hypertension subtype on cardiovascular disease in the asia-pacific region. Hypertension. 2012; 59(6):1118–23. https://doi.org/10.1161/HYPERTENSIONAHA.111.187252.
crossref
4. Statistics Korea. Annual report on the cause of death statistics [Internet]. Daejeon: Statistics Korea;2018. [cited 2019 March 21]. Available from:. http://www.index.go.kr/potal/main/EachDtlPageDetail.do?idx_cd=1012.
5. Son YJ, Song EK. Impact of health literacy on disease-related knowledge and adherence to self-care in patients with hypertension. The Korean Journal of Fundamentals of Nursing. 2012; 19(1):6–15. https://doi.org/10.7739/jkafn.2012.19.1.006.
crossref
6. Elmer PJ, Obarzanek E, Vollmer WM, Simons-Morton D, Stevens VJ, Young DR, et al. Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial. Annals of Internal Medicine. 2006; 144(7):485–95. https://doi.org/10.7326/0003-4819-144-7-200604040-00007.
crossref
7. Orem DE. Nursing: concepts of practice. 4th ed.St. Louis: Mos-by;1991.
8. Cho MC. New strategies in the treatment of hypertension. Korean Journal of Medicine. 2009; 76(4):409–15.
9. Ahn YH. Compliance level with therapeutic regimen of medication and life style among patients with hypertension in rural communities. Journal of Korean Public Health Nursing. 2007; 21(2):125–33.
10. Kripalani S, Robertson R, Love-Ghaffari MH, Henderson LE, Praska J, Strawder A, et al. Development of an illustrated medication schedule as a low-literacy patient education tool. Patient Education and Counseling. 2007; 66(3):368–77. https://doi.org/10.1016/j.pec.2007.01.020.
crossref
11. Berkman ND, Davis TC, MaCormack L. Health literacy: what is it? Journal of Health Communication. 2010; 15(S2):9–19. https://doi.org/10.1080/10810730.2010.499985.
crossref
12. Institute of Medicine (US) Committee on Health Literacy. Health literacy: a prescription to end confusion. Washington D.C.: The National Academic Press;2004.
13. Oh JH, Park EO. The impact of health literacy on self-care behaviors and hypertensive elderly. Korean Journal of Health Education and Promotion. 2017; 34(1):35–45. https://doi.org/10.14367/kjhep.2017.34.1.35.
14. Ahn J, Lim IS. The significant role of the national health information portal. http://health.mw.go.kr. Journal of the Korean Medical Association. 2011; 54(9):957–60. https://doi.org/10.5124/jkma.2011.54.9.957.
15. Tonsaker T, Bartlett G, Trpkov C. Health information on the internet. Gold mine or minefield? Canadian Family Physician. 2014; 60(5):407–8.
16. Norman CD, Skinner HA. eHEALS: the ehealth literacy scale. Journal of Medical Internet Research. 2006; 8(4):e27. https://doi.org/10.2196/jmir.8.4.e27.
crossref
17. Yang SC, Luo YF, Chiang CH. The Associations among individual factors, ehealth literacy, and health-promoting life-styles among college students. Journal of Medical Internet Research. 2017; 19(1):e15. https://doi.org/10.2196/jmir.5964.
crossref
18. Min ES, Hur MH. Predictors of compliance in hypertensive patients. Journal of Korean Academy of Fundamentals of Nursing. 2012; 19(4):474–82. https://doi.org/10.7739/jkafn.2012.19.4.474.
crossref
19. Glanz K, Rimer BK, Viswanath K. Health behavior and health education: theory, research and practice. 3rd ed.San Francis-co: Jossey-Bass;2002. p. 45–66.
20. Je MS, Lee SS. A Study of middle-aged women's health beliefs and their intention to practice health behaviors to prevent and improve hypertension. Korean Journal of Adult Nursing. 2007; 19(1):109–20.
21. Rosenstock IM. The health belief model and preventive health behavior. Health Education Monographs. 1974; 2(4):354–86. https://doi.org/10.1177/109019817400200405.
crossref
22. Seo MH, Lee WY, Kim SS, Kang JH, Kang JH, Kim KK, et al. 2018 Korean society for the study of obesity guideline for the management of obesity in Korea. Journal of Obesity & Metabolic Syndrome. 2019; 28(1):40–5. https://doi.org/10.7570/jomes.2019.28.1.40.
crossref
23. Lee SJ, Song MS. Compliance with low-salt diet and related factors in essential hypertension patients. Korean Journal of Adult Nursing. 1999; 11(3):605–20.
24. Chang SJ, Yang Ej, Ryu Hj, Kim HJ, Yoon JY. Cross-cultural adaptation and validation of the ehealth literacy scale in Korea. Korean Journal of Adult Nursing. 2018; 30(5):504–15. https://doi.org/10.7475/kjan.2018.30.5.504.
crossref
25. Moon JS. A study of instrument development for health belief of Korean adults [dissertation]. Seoul: Yonsei University;1990.
26. Bae MS. Related factors with health behaviors of foreign students studying in Korea [dissertation]. Daegu: Yeungnam University;;2009.
27. Lee YW. A Study of the effect of an efficacy expectation promoting program on self-efficacy and self-care. Korean Journal of Adult Nursing. 1995; 7(2):212–27.
28. Baron RM, Kenny DA. The moderator-mediator variable dis-tinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology. 1986; 51(6):1173–82.
crossref
29. Riegel B, Moser DK, Buck HG, Dickson VV, Dunbar SB, Lee CS, et al. Self care for the prevention and management of cardiovascular disease and stroke: a scientific statement for healthcare professionals from the american heart association. Jour33. Lee EJ, Park E. Predictors of self-care behaviors among elderly with hypertension using quantile regression method. Korean Journal of Adult Nursing. 2015; 27(3):273–82. https://doi.org/10.7475/kjan.2015.27.3.273.
34. Suh SR, Lee EH. A path model predicting medication adherence and self-care of low-income older adults with hypertension. Korean Journal of Adult Nursing. 2011; 23(4):374–85.
35. Rebecca KT, William BC, Kari W, Georgiann L, Andrew ME. eHealth literacy and health behaviors affecting modern college students: a pilot study of issues identified by the american college health association. Journal of Medical Internet Research. 2017; 19(12):e392. https://doi.org/10.2196/jmir.3100.

Figure 1.
The mediation effect of health belief between the disease-related knowledge and self-care behavior of patients.
kjan-31-638f1.tif
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
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
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
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
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
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.

TOOLS
Similar articles