Iran Journal of Nursing

Background & Aims: Health literacy is defined as the degree to which an individual can obtain, communicate, process, and understand basic health information and services to make appropriate health decisions. Asthma is a common, chronic disease, which has a deep impact on life and physical, social, and mental performance, group activities, and even the economic advancement of patients, all of which are factors that affect their quality of life. On the other hand, effective management of the disease requires identifying effective factors, including health literacy. Therefore, with regard to the importance of asthma and quality of life of those with this condition, and given the effect of health literacy on this issue, the present study aimed to determine the relationship between health literacy and quality of life of asthmatic patients referring to healthcare clinics of Shahid Sadoughi University of Medical Sciences, Yazd, Iran, in 2018.
Materials & Methods: This correlational and descriptive study was performed on 300 asthmatic patients selected by simple random sampling. The inclusion criteria were the age range of 18-60 years, Farsi language proficiency, being literate, lack of malignancy and other underlying diseases, and lack of physical and psychological disabilities. On the other hand, the exclusion criteria were living in other provinces and lack of referring to the healthcare centers for several months. Data were collected using demographic characteristics questionnaire (age, gender, marital status, level of education, and occupational status), patient-reported asthma life quality questionnaire, which included 20 items in four physical, psychological, social, and health concern aspects, and patient-reported test of functional health literacy in adults (TOFHLA). Data analysis was performed in SPSS version 16 using descriptive and inferential statistics, including mean and standard deviation, absolute and relative frequency, and Kolmogorov-Smirnov test (to evaluate the normal distribution of the data). In case of a lack of normal distribution (P<0.05), we applied Spearman’s test to determine the relationship between the variables.
Results: In this study, most patients were female (52.3%) and married (87.3%) with the mean age of 43.9±11.08 years and minimum and maximum ages of 19 and 60 years, respectively. In addition, most of the subjects (73.3%) used the option of asking the physician and health care staff to receive information about asthma. The mean health literacy score of the subjects was 100.78±28.55 and the highest and lowest scores were related to the components of evaluation (68.5) and access (55.36), respectively. In addition, the majority of the participants (45%) had inadequate health literacy. Moreover, the mean life quality score of the participants was 46.91±5.32, and the lowest and highest mean scores were related to the physician (10.66±2.88) and health concern (17.41±2.88) dimensions, respectively. According to the results, there was no significant difference between the variables of health literacy and life quality with gender (P>0.05). However, there was a significant relationship between health literacy and marital status, meaning that single individuals had higher health literacy, compared to married subjects (P<0.001). However, there was no significant relationship between marital status and life quality (P=0.61). Kruskal-Wallis test results were indicative of a significant relationship between health literacy with the level of education and occupational status (P<0.001). In other words, there was a significant difference between those with MSc and BSc degrees and those with associate and below diploma degrees P<0.001). In addition, student and employed patients had a significantly different life quality, compared to housewives and retired participants (P<0.001). However, there was no significant difference between the level of education and occupational status regarding the quality of life (P>0.05). Spearman’s test results demonstrated a significant, reverse association between age and health literacy Rho=-0.76, P<0.001), which was not observed between age and life quality (Rho=-0.01, P=0.82). Moreover, no statistically significant relationship was found between health literacy and its components with quality of life and its dimensions (P>0.05).
Conclusion: According to the results of the study, the mean health literacy score of the subjects was 100.78; therefore, the overall health literacy of the subjects was below moderate. In addition, according to the ranking, the health literacy of most of the subjects was inadequate. This indicates the need to use effective strategies to improve the health literacy of asthmatic patients because adequate health literacy is essential for patient participation in health care systems and making appropriate health decisions and leads to the empowerment of people to use relevant information and instructions. It seems that due to insufficient health literacy in the present study, it should be considered by health care workers. The mean life quality score of the patients was 46.91 ± 5.32, which showed the below moderate life quality of the participants. Similar to other diseases, asthma affects the lives of patients in many ways, in a way that it becomes the main concern of patients. This condition extremely decreases the quality of life of individuals. Therefore, it is not uncommon for people with asthma to have poor living standards. Nevertheless, it is necessary to pay more attention to the quality of life of these patients and use and implement appropriate interventions to improve their quality of life. According to the results, the level of health literacy and quality of life of patients with asthma was not favorable and there was no significant relationship between health literacy and its components with quality of life and its dimensions. Therefore, it is suggested that more studies be performed to evaluate the intermediating factors that could affect these variables to better understand this condition. Moreover, it is possible to develop health literacy skills and improve the quality of life of asthmatics by developing comprehensive programs, creating simple and understandable educational materials, and effective psychological interventions. The lack of a relationship between health literacy and quality of life in this study does not mean that these variables have no effect on each other. In fact, the relationship might be indirect, and a better understanding is required to assess other intermediating simultaneously with these two variables. It is recommended that variables such as adherence to treatment be assessed in future studies as an intermediary variable between health literacy and life quality of patients with asthma.