Journal of Preventive Medicine

Introduction
Heart diseases was the main cause of death in 2020. The World Health Organization (WHO) reported that in 2019, 8.9 million people worldwide died due to heart diseases [1]. In this regard, the effective role of health literacy in the management of chronic diseases has been reported. Low health literacy is a predictor of unhealthy behaviors, high rate of hospitalization, difficulty in communicating verbally with health service providers, and low health status [2]. In Kanejima et al.’s meta-analysis of 16 studies, the heath literacy of 32.8% of heart patients was low [7]. In Iran, based on a study in five provinces, only 28.1% of participants had adequate health literacy and 56.6% had low health literacy [8]. One of the important factors in the health literacy of patients with heart diseases is general health [10]. Due to the conflicting results of studies in this field and the fact that health literacy has not been measured in patients with heart diseases in Iran, this study aims to determine the relationship between the level of health literacy and general health in Iranian patients with heart diseases.

Methods
This is a descriptive-analytical study. The study population consists of all cardiac patients hospitalized in the coronary care unit (CCU) of Khatam-al-Anbiya hospital in Shushtar county, Iran, during 2022-2023. Of these, 284 patients were selected based on inclusion criteria (age >18 years, being literate, having heart disease, no diseases difficult to treat such as cancer, no cognitive disorders based on the short test of mental status score, ability to communicate, and no absence of mental illness) and exclusion criteria (incomplete questionnaires and unwillingness to continue participation). The data collection tools included a demographic form (surveying age, sex, education level, occupation, family history of chronic diseases, and heart disease), the health literacy instrument for adults (HELIA), and the general health questionnaire (GHQ). The questionnaires were completed in the evening shift after explaining the study objectives to the participants and obtaining their written consent. The collected data were analyzed in SPSS software, version 20 and AMOS software, version 18 using independent t-test, analysis of variance, Pearson correlation test, and structural equation modeling (SEM).

Results
The mean age of the participants was 45.27±16.47 years. Of 254 patients, 131(51.6%) were male, 101(39.76%) had a history of heart disease, and 181(71.25 %) had a history of chronic diseases. Regarding health literacy, 101 patients (41%) were at a good and sufficient level, and the highest score was related to the dimension of decision-making (44.79±10.21) and the lowest score was related to the dimension of access to information (21.6±6.64). Regarding general health, 100 patients (39.37%) were at the moderate level and the highest score was related to the social dysfunction (10.66±4.65). The results of the Pearson correlation test showed a significant and negative relationship between age and health literacy (r=-0.434, P<0.001), indicating that as the age of patients increases, their health literacy decreases. There was a significant difference in health literacy among patients with different educational levels (F=51.62, P<0.001). Patients who were illiterate had the lowest health literacy score (95.83±23.48), while patients with university education had the highest health literacy score (122.71±20.65). The general health score was also significantly different among patients with different educational levels (F=4.54, P=0.004). Illiterate patients had the highest general health score (58.72±15.59) while patients with university education had the lowest general health score (51.25±12.72).
Using the regression model, the understanding subscale of HELIA had the highest standard coefficient, while the decision-making subscale had the lowest coefficient. The anxiety and insomnia subscale of GHQ had the highest coefficient, and the subscale of social dysfunction had the lowest standard coefficient. To examine the difference between the observed values and the expected values using the graphical model and according to the acceptable level, the study SEM model had a favorable fit.

Conclusion
The health literacy of the patients with heart diseases admitted to the study hospital is sufficient, and their general health is moderate. With the increase in health literacy, their general health can be improved. Understanding the relationship between health literacy and general health in cardiac patients can provide useful information to policymakers and health planners in Iran to promote the patient’s health literacy and general health.

Ethical Considerations

Compliance with ethical guidelines
This study was approved by the Shoushtar Faculty of Medical Sciences (Code: IR.SHOUSHTAR.REC.1399.001).

Funding
This article was done with the financial support of Shoushtar Faculty of Medical Sciences.

Authors' contributions
Study design: Elham Abdolahi and Azam Hoonarmandpour; Data collection: Sohrab Asadi and Zahr Mehri; Statistical analysis: Azam Jahangirimehr; Drafting the manuscript: Akram Hemmatipour; Review and editing: Elham Abdolahi.

Conflicts of interest
The authors declared no conflict of interest


 

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