Health Literacy and Health Behavior Compliance in Patients with Coronary Artery Disease

Eun-Young Jung; Sun-Kyung Hwang

doi:10.7475/kjan.2015.27.3.251

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Health Literacy and Health Behavior Compliance in Patients with Coronary Artery Disease

Eun-Young Jung¹, Sun-Kyung Hwang²

Korean Journal of Adult Nursing 2015;27(3):251-261.
Published online: June 30, 2015

DOI: https://doi.org/10.7475/kjan.2015.27.3.251

¹Respiratory Center, Pusan National University Hospital, Busan

²College of Nursing, Pusan National University, Yangsan, Korea

Corresponding author: Hwang, Sun-Kyung College of Nursing, Pusan National University, 49 Busandaehak-ro, Mulgeum-eup, Yangsan 626-870, Korea. Tel: +82-51-510-8340, Fax: +82-51-510-8348, E-mail: skhwang@pusan.ac.kr

• Received: March 5, 2015 • Accepted: May 25, 2015

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.

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Abstract
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Abstract

Purpose
The aim of this study was to identify the levels of and the related factors to health literacy and health behavior compliance in patients with coronary artery disease.
Methods
A cross-sectional survey was conducted with a convenience sample of 121 hospitalized patients with coronary artery disease. The structured questionnaires were used to measure the levels of health literacy and health behavior compliance.
Results
The average linguistic health literacy score was 32.23±21.46, the functional health literacy score was 6.51±5.08, and the health behavior compliance score was 61.66±15.53. The levels of education (β=.35), income (β=.27), and perceived health status (β=.21) were found significant, explaining 41.8% of the variance in linguistic health literacy. The levels of education (β=.23), income (β=.27), age (β=-.24), and family support (β=.22) were found to be significant, explaining 50.9% of the variance in functional health literacy. The levels of education (β=.27), family support (β=.20), and linguistic health literacy (β=.40) were found to be the significant factors, which explained 45.1% of the variance in health behavior compliance. Linguistic health literacy specifically explained 9.5% of health behavior compliance.
Conclusion
Health literacy was associated with health behavior compliance, influencing the factors of health behavior compliance. These findings suggest that the interventions for improving health literacy are necessary to enhance health behavior compliance in patients with coronary artery disease.
Key Words: Coronary artery disease; Health literacy; Health behavior; Patient compliance

Table 1.

Linguistic and Functional Health Literacy, Health Behavior Compliance according to the General Characteristics (N=121)

Characteristics	Categories	n (%)	Linguistic health literacy	t or F (p)	Functional health literacy	t or F (p)	Health behavior compliance	t or F (p)
Characteristics	Categories	n (%)	M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p)
Gender	Male	75 (62.0)	39.24±20.40	5.02	8.04±4.85	4.55	64.17±15.57	2.31
Gender	Female	46 (38.0)	20.80±18.14	(＜.001)	4.02±4.46	(＜.001)	57.57±14.73	(.022)
Age (year)	≤49^a	13 (10.7)	40.38±20.52	4.42	11.54±2.33	10.27	59.15±13.35	1.34
	50~59^b	23 (19.0)	38.35±19.34	(.002)	9.13±4.78	(＜.001)	61.30±13.72	(.257)
	60~69^c	42 (34.7)	36.40±19.35	a, b, c＞e^†	6.29±4.79	a, b＞d, e^†	65.17±15.14
	70~79^d	33 (27.3)	24.67±22.93		4.09±4.39		60.91±17.39
	≥80^e	10 (8.3)	15.00±16.65		2.90±4.28		53.50±15.99
Education	Ineducation^a	8 (6.7)	6.12±7.33	16.21	0.50±0.92	28.85	43.75±8.54	12.19
	Elementary school^b	24 (19.8)	15.00±11.97	(＜.001)	2.29±2.67	(＜.001)	50.50±10.87	(＜.001)
	Middle school^c	24 (19.8)	30.96±17.40 a	a, b＜c, d, e^†	5.13±4.57	a, b＜d, e^†	60.46±14.85	a, b＜d, e^†
	High school^d	42 (34.7)	39.93±21.77		7.81±4.09		68.29±12.52
	≥College^e	23 (19.0)	46.57±15.61		12.09±3.14		68.70±16.02
Diagnosis	Stable AP	27 (22.3)	29.37±22.47	0.36	6.52±5.39	0.61	60.37±13.51	1.00
	Unstable AP	49 (40.5)	34.76±21.12	(.833)	6.10±4.84	(.654)	63.24±17.13	(.407)
	NSTEMI	23 (19.0)	32.26±22.86		5.96±5.43		64.74±15.47
	STEMI	11 (9.1)	31.64±19.19		7.91±5.30		56.55±16.35
	Variant AP	11 (9.1)	28.55±22.06		8.09±4.74		56.45±10.92
Monthly income (10,000 won)	None^a	53 (43.8)	19.81±18.02	21.36	3.45±4.17	32.19	56.32±14.14	6.10
	＜200^b	24 (19.9)	39.87±21.03	(＜.001)	6.50±4.46	(＜.001)	66.67±15.20	(.003)
	≥200^c	44 (36.3)	43.02±17.74	a＜b, c^†	10.20±3.86	a＜b＜c^†	65.36±15.63	a＜b, c^†
Job	Yes	71 (58.7)	39.15±18.95	-4.56	8.56±4.78	-6.20	65.14±15.17	-3.03
Job	No	50 (41.3)	22.40±21.14	(＜.001)	3.60±3.98	(＜.001)	56.72±14.82	(.003)
Marital status	Married	97 (80.2)	34.31±21.94	2.17	6.62±5.09	0.46	62.33±15.3	0.95
Marital status	Single	24 (19.8)	23.83±17.40	(.032)	6.08±5.14	(.646)	58.96±15.57	(.343)
Living	Alone	26 (21.5)	20.38±18.71	4.83	4.31±4.86	6.67	57.35±16.41	1.40
Living	With family	95 (78.5)	30.11±22.67	(.001)	7.69±4.94	(＜.001)	59.54±15.82	(.238)
Family support	Low^a	65 (53.7)	25.68±20.27	15.02	4.54±4.39	14.34	55.72±13.48	16.36
	Moderate^b	26 (21.5)	29.50±21.57	(＜.001)	7.69±5.35	(＜.001)	63.31±13.27	(＜.001)
	High^c	30 (24.8)	48.80±14.54	a, b＜c^†	9.77±4.32	a＜b, c^†	73.10±15.10	a, b＜c^†
Perceived health status	Poor^a	66 (54.5)	25.26±20.71	9.63	5.42±5.17	5.86	58.79±15.15	4.55
	Fair^b	37 (30.6)	38.11±20.62	(＜.001)	6.84±4.97	(.004)	62.32±13.08	(.012)
	Good^c	18 (14.9)	45.72±15.96	a＜b, c^†	9.83±3.38	a＜c^†	70.83±18.45	a＜c^†

AP=angia pectoris, NSTEMI=non-ST elevation myocardial infarction, STEMI=ST elevation myocardial infarction;

^†Scheffé test.

Table 2.

Descriptive Statistics of Health Literacy and Health Behavior Compliance (N=121)

Variables	Range	Min	Max	M±SD
Linguistic health literacy	0~66	0	66	32.23±21.46
Functional health literacy	0~15	0	15	6.51±5.08
Health behavior compliance	25~100	32	100	61.66±15.53
REALM	Grade	Range		n (%)
	0~3	0~18		44 (36.4)
	4~6	19~44		34 (28.1)
	7~8	45~60		31 (25.6)
	≥9	61~66		12 (9.9)

REALM=rapid estimate of adult literacy in medicine.

Table 3.

Correlations between Health Literacy and Health Behavior Compliance (N=121)

Variables	Linguistic health literacy	Functional health literacy	Health behavior compliance
Variables	r (p)	r (p)	r (p)
Linguistic health literacy	1
Functional health literacy	.57 (＜.001)	1
Health behavior compliance	.58 (＜.001)	.43 (＜.001)	1

Table 4.

Related Factors to Health literacy in Patients with Coronary Artery Disease (N=121)

Variables		B	SE	_β	t	p
Linguistic health literacy	(Constant)	27.34	8.43		3.24	.002
	Education level	16.99	3.92	.35	4.33	＜.001
	Monthly income	2.78	0.84	.27	3.33	.001
	Perceived health status	4.61	1.79	.21	2.58	.011
			R²=.418, Adj. R²=.403, F=27.98, p＜.001
Functional health literacy	(Constant)	6.40	2.99		2.14	.034
	Education level	2.62	0.94	.23	2.78	.006
	Monthly income	0.67	0.21	.27	3.24	.002
	Age	-0.11	0.04	-.24	-2.81	.006
	Family support	1.12	0.38	.22	2.94	.004
			R²=.509, Adj. R² =.492, F=30.03, p＜.001

Table 5.

Related Factors to Health Behavior Compliance (N=121)

Variables	Step 1		Step 2
Variables	β	t (p)	β	t (p)
Gender	.17	1.68 (.097)	.17	1.74 (.085)
Monthly income	.04	0.43 (.671)	-.08	-0.81 (.422)
Education level	.41	4.11 (＜.001)	.27	2.66 (.009)
Perceived health status	.15	1.65 (.103)	.08	0.92 (.358)
Family support	.26	2.98 (.003)	.20	2.43 (.017)
Linguistic health literacy			.40	4.16 (＜.001)
Functional health literacy			.05	0.45 (.655)
R² (△R²)	.356		.451 (.095)
Adjusted R²	.328		.417
F (p)	12.74 (＜.001)		13.28 (＜.001)

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Health Literacy and Health Behavior Compliance in Patients with Coronary Artery Disease

Korean J Adult Nurs. 2015;27(3):251-261. Published online June 30, 2015

DOI: https://doi.org/10.7475/kjan.2015.27.3.251

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Health Literacy and Health Behavior Compliance in Patients with Coronary Artery Disease

Korean J Adult Nurs. 2015;27(3):251-261. Published online June 30, 2015

DOI: https://doi.org/10.7475/kjan.2015.27.3.251

Health Literacy and Health Behavior Compliance in Patients with Coronary Artery Disease

Table 1.

Linguistic and Functional Health Literacy, Health Behavior Compliance according to the General Characteristics (N=121)

Characteristics	Categories	n (%)	Linguistic health literacy	t or F (p)	Functional health literacy	t or F (p)	Health behavior compliance	t or F (p)
Characteristics	Categories	n (%)	M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p)
Gender	Male	75 (62.0)	39.24±20.40	5.02	8.04±4.85	4.55	64.17±15.57	2.31
Gender	Female	46 (38.0)	20.80±18.14	(＜.001)	4.02±4.46	(＜.001)	57.57±14.73	(.022)
Age (year)	≤49^a	13 (10.7)	40.38±20.52	4.42	11.54±2.33	10.27	59.15±13.35	1.34
	50~59^b	23 (19.0)	38.35±19.34	(.002)	9.13±4.78	(＜.001)	61.30±13.72	(.257)
	60~69^c	42 (34.7)	36.40±19.35	a, b, c＞e^†	6.29±4.79	a, b＞d, e^†	65.17±15.14
	70~79^d	33 (27.3)	24.67±22.93		4.09±4.39		60.91±17.39
	≥80^e	10 (8.3)	15.00±16.65		2.90±4.28		53.50±15.99
Education	Ineducation^a	8 (6.7)	6.12±7.33	16.21	0.50±0.92	28.85	43.75±8.54	12.19
	Elementary school^b	24 (19.8)	15.00±11.97	(＜.001)	2.29±2.67	(＜.001)	50.50±10.87	(＜.001)
	Middle school^c	24 (19.8)	30.96±17.40 a	a, b＜c, d, e^†	5.13±4.57	a, b＜d, e^†	60.46±14.85	a, b＜d, e^†
	High school^d	42 (34.7)	39.93±21.77		7.81±4.09		68.29±12.52
	≥College^e	23 (19.0)	46.57±15.61		12.09±3.14		68.70±16.02
Diagnosis	Stable AP	27 (22.3)	29.37±22.47	0.36	6.52±5.39	0.61	60.37±13.51	1.00
	Unstable AP	49 (40.5)	34.76±21.12	(.833)	6.10±4.84	(.654)	63.24±17.13	(.407)
	NSTEMI	23 (19.0)	32.26±22.86		5.96±5.43		64.74±15.47
	STEMI	11 (9.1)	31.64±19.19		7.91±5.30		56.55±16.35
	Variant AP	11 (9.1)	28.55±22.06		8.09±4.74		56.45±10.92
Monthly income (10,000 won)	None^a	53 (43.8)	19.81±18.02	21.36	3.45±4.17	32.19	56.32±14.14	6.10
	＜200^b	24 (19.9)	39.87±21.03	(＜.001)	6.50±4.46	(＜.001)	66.67±15.20	(.003)
	≥200^c	44 (36.3)	43.02±17.74	a＜b, c^†	10.20±3.86	a＜b＜c^†	65.36±15.63	a＜b, c^†
Job	Yes	71 (58.7)	39.15±18.95	-4.56	8.56±4.78	-6.20	65.14±15.17	-3.03
Job	No	50 (41.3)	22.40±21.14	(＜.001)	3.60±3.98	(＜.001)	56.72±14.82	(.003)
Marital status	Married	97 (80.2)	34.31±21.94	2.17	6.62±5.09	0.46	62.33±15.3	0.95
Marital status	Single	24 (19.8)	23.83±17.40	(.032)	6.08±5.14	(.646)	58.96±15.57	(.343)
Living	Alone	26 (21.5)	20.38±18.71	4.83	4.31±4.86	6.67	57.35±16.41	1.40
Living	With family	95 (78.5)	30.11±22.67	(.001)	7.69±4.94	(＜.001)	59.54±15.82	(.238)
Family support	Low^a	65 (53.7)	25.68±20.27	15.02	4.54±4.39	14.34	55.72±13.48	16.36
	Moderate^b	26 (21.5)	29.50±21.57	(＜.001)	7.69±5.35	(＜.001)	63.31±13.27	(＜.001)
	High^c	30 (24.8)	48.80±14.54	a, b＜c^†	9.77±4.32	a＜b, c^†	73.10±15.10	a, b＜c^†
Perceived health status	Poor^a	66 (54.5)	25.26±20.71	9.63	5.42±5.17	5.86	58.79±15.15	4.55
	Fair^b	37 (30.6)	38.11±20.62	(＜.001)	6.84±4.97	(.004)	62.32±13.08	(.012)
	Good^c	18 (14.9)	45.72±15.96	a＜b, c^†	9.83±3.38	a＜c^†	70.83±18.45	a＜c^†

AP=angia pectoris, NSTEMI=non-ST elevation myocardial infarction, STEMI=ST elevation myocardial infarction;

^†Scheffé test.

Table 2.

Descriptive Statistics of Health Literacy and Health Behavior Compliance (N=121)

Variables	Range	Min	Max	M±SD
Linguistic health literacy	0~66	0	66	32.23±21.46
Functional health literacy	0~15	0	15	6.51±5.08
Health behavior compliance	25~100	32	100	61.66±15.53
REALM	Grade	Range		n (%)
	0~3	0~18		44 (36.4)
	4~6	19~44		34 (28.1)
	7~8	45~60		31 (25.6)
	≥9	61~66		12 (9.9)

REALM=rapid estimate of adult literacy in medicine.

Table 3.

Correlations between Health Literacy and Health Behavior Compliance (N=121)

Variables	Linguistic health literacy	Functional health literacy	Health behavior compliance
Variables	r (p)	r (p)	r (p)
Linguistic health literacy	1
Functional health literacy	.57 (＜.001)	1
Health behavior compliance	.58 (＜.001)	.43 (＜.001)	1

Table 4.

Related Factors to Health literacy in Patients with Coronary Artery Disease (N=121)

Variables		B	SE	_β	t	p
Linguistic health literacy	(Constant)	27.34	8.43		3.24	.002
	Education level	16.99	3.92	.35	4.33	＜.001
	Monthly income	2.78	0.84	.27	3.33	.001
	Perceived health status	4.61	1.79	.21	2.58	.011
			R²=.418, Adj. R²=.403, F=27.98, p＜.001
Functional health literacy	(Constant)	6.40	2.99		2.14	.034
	Education level	2.62	0.94	.23	2.78	.006
	Monthly income	0.67	0.21	.27	3.24	.002
	Age	-0.11	0.04	-.24	-2.81	.006
	Family support	1.12	0.38	.22	2.94	.004
			R²=.509, Adj. R² =.492, F=30.03, p＜.001

Table 5.

Related Factors to Health Behavior Compliance (N=121)

Variables	Step 1		Step 2
Variables	β	t (p)	β	t (p)
Gender	.17	1.68 (.097)	.17	1.74 (.085)
Monthly income	.04	0.43 (.671)	-.08	-0.81 (.422)
Education level	.41	4.11 (＜.001)	.27	2.66 (.009)
Perceived health status	.15	1.65 (.103)	.08	0.92 (.358)
Family support	.26	2.98 (.003)	.20	2.43 (.017)
Linguistic health literacy			.40	4.16 (＜.001)
Functional health literacy			.05	0.45 (.655)
R² (△R²)	.356		.451 (.095)
Adjusted R²	.328		.417
F (p)	12.74 (＜.001)		13.28 (＜.001)

Table 1. Linguistic and Functional Health Literacy, Health Behavior Compliance according to the General Characteristics (N=121)

AP=angia pectoris, NSTEMI=non-ST elevation myocardial infarction, STEMI=ST elevation myocardial infarction;

†

Scheffé test.

Table 2. Descriptive Statistics of Health Literacy and Health Behavior Compliance (N=121)

REALM=rapid estimate of adult literacy in medicine.

Table 3. Correlations between Health Literacy and Health Behavior Compliance (N=121)

Table 4. Related Factors to Health literacy in Patients with Coronary Artery Disease (N=121)

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