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Korean J Adult Nurs : Korean Journal of Adult Nursing

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Original Article

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

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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

Copyright © 2015 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.

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  • 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)
M±SD M±SD M±SD
Gender Male 75 (62.0) 39.24±20.40 5.02 8.04±4.85 4.55 64.17±15.57 2.31
Female 46 (38.0) 20.80±18.14 (＜.001) 4.02±4.46 (＜.001) 57.57±14.73 (.022)
Age (year) ≤49a 13 (10.7) 40.38±20.52 4.42 11.54±2.33 10.27 59.15±13.35 1.34
50~59b 23 (19.0) 38.35±19.34 (.002) 9.13±4.78 (＜.001) 61.30±13.72 (.257)
60~69c 42 (34.7) 36.40±19.35 a, b, c＞e† 6.29±4.79 a, b＞d, e† 65.17±15.14  
70~79d 33 (27.3) 24.67±22.93   4.09±4.39   60.91±17.39  
≥80e 10 (8.3) 15.00±16.65   2.90±4.28   53.50±15.99  
Education Ineducationa 8 (6.7) 6.12±7.33 16.21 0.50±0.92 28.85 43.75±8.54 12.19
Elementary schoolb 24 (19.8) 15.00±11.97 (＜.001) 2.29±2.67 (＜.001) 50.50±10.87 (＜.001)
Middle schoolc 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 schoold 42 (34.7) 39.93±21.77   7.81±4.09   68.29±12.52  
≥Collegee 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) Nonea 53 (43.8) 19.81±18.02 21.36 3.45±4.17 32.19 56.32±14.14 6.10
＜200b 24 (19.9) 39.87±21.03 (＜.001) 6.50±4.46 (＜.001) 66.67±15.20 (.003)
≥200c 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
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
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
With family 95 (78.5) 30.11±22.67 (.001) 7.69±4.94 (＜.001) 59.54±15.82 (.238)
Family support Lowa 65 (53.7) 25.68±20.27 15.02 4.54±4.39 14.34 55.72±13.48 16.36
Moderateb 26 (21.5) 29.50±21.57 (＜.001) 7.69±5.35 (＜.001) 63.31±13.27 (＜.001)
Highc 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 Poora 66 (54.5) 25.26±20.71 9.63 5.42±5.17 5.86 58.79±15.15 4.55
Fairb 37 (30.6) 38.11±20.62 (＜.001) 6.84±4.97 (.004) 62.32±13.08 (.012)
Goodc 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
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
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
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    Health Literacy and Health Behavior Compliance in Patients with Coronary Artery Disease
    Health Literacy and Health Behavior Compliance in Patients with Coronary Artery Disease

    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)
    M±SD M±SD M±SD
    Gender Male 75 (62.0) 39.24±20.40 5.02 8.04±4.85 4.55 64.17±15.57 2.31
    Female 46 (38.0) 20.80±18.14 (＜.001) 4.02±4.46 (＜.001) 57.57±14.73 (.022)
    Age (year) ≤49a 13 (10.7) 40.38±20.52 4.42 11.54±2.33 10.27 59.15±13.35 1.34
    50~59b 23 (19.0) 38.35±19.34 (.002) 9.13±4.78 (＜.001) 61.30±13.72 (.257)
    60~69c 42 (34.7) 36.40±19.35 a, b, c＞e† 6.29±4.79 a, b＞d, e† 65.17±15.14  
    70~79d 33 (27.3) 24.67±22.93   4.09±4.39   60.91±17.39  
    ≥80e 10 (8.3) 15.00±16.65   2.90±4.28   53.50±15.99  
    Education Ineducationa 8 (6.7) 6.12±7.33 16.21 0.50±0.92 28.85 43.75±8.54 12.19
    Elementary schoolb 24 (19.8) 15.00±11.97 (＜.001) 2.29±2.67 (＜.001) 50.50±10.87 (＜.001)
    Middle schoolc 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 schoold 42 (34.7) 39.93±21.77   7.81±4.09   68.29±12.52  
    ≥Collegee 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) Nonea 53 (43.8) 19.81±18.02 21.36 3.45±4.17 32.19 56.32±14.14 6.10
    ＜200b 24 (19.9) 39.87±21.03 (＜.001) 6.50±4.46 (＜.001) 66.67±15.20 (.003)
    ≥200c 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
    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
    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
    With family 95 (78.5) 30.11±22.67 (.001) 7.69±4.94 (＜.001) 59.54±15.82 (.238)
    Family support Lowa 65 (53.7) 25.68±20.27 15.02 4.54±4.39 14.34 55.72±13.48 16.36
    Moderateb 26 (21.5) 29.50±21.57 (＜.001) 7.69±5.35 (＜.001) 63.31±13.27 (＜.001)
    Highc 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 Poora 66 (54.5) 25.26±20.71 9.63 5.42±5.17 5.86 58.79±15.15 4.55
    Fairb 37 (30.6) 38.11±20.62 (＜.001) 6.84±4.97 (.004) 62.32±13.08 (.012)
    Goodc 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.

    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.

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

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

    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  

    Related Factors to Health Behavior Compliance (N=121)

    Variables Step 1 Step 2
    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)

    Table 5. Related Factors to Health Behavior Compliance (N=121)

    Table 1.

    Table 2.

    Table 3.

    Table 4.

    Table 5.

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