To exam whether health literacy mediated the association between intervention and blood pressure control and to better understand the relationship between health literacy and health outcome for hypertensive.Design and Method:
A before-after designed one-year community-based intervention program including patient education and patient-centered goal support were conducted in a primary care setting. A face-to-face interview were completed among 468 hypertensives before intervention and 406 after intervention. The skill-based health literacy instrument was developed for Chinese with acceptable reliability and validity, health actions including medication compliance, monitoring of blood pressure, control of salt intake, nutrition and exercise were assessed. Blood pressure of respondents as the indicator of outcome of hypertension control was also measured. Mediational analysis was applied to test the role of literacy in explaining the relationship between intervention and blood pressure control.Results:
After intervention, improvement with statistical significance were observed in patients’ health literacy, nutrition behaviors, exercise, capacity and frequency of blood pressure monitoring, controlling salt intake and taking anti-hypertension medication. Patients exposed to intervention were likely to obtain controlled blood pressure level (OR 1.578, 95% CI 1.258–1.980). Adjusting all exogenous covariates and potential interaction effects, the standard regression coefficient between intervention and hypertension control was 0.229 (preliminary model), and between intervention and health literacy was 0.349. When health literacy entered into the preliminary model, the direct regression coefficient between intervention and hypertension control decreased to 0.174, and indirect effect mediated by health literacy was 0.05, which made up 22.32% of the total effect. All of these results were statistically significant.Conclusions:
A community-based physician service intervention including patient education and patient-centered goal support could improve patients’ healthy behaviors related hypertension and outcome of blood pressure control. The relationship between intervention and blood pressure control is partly mediated by health literacy.