Centre for Primary Health Care and Equity, UNSW, Sydney, Australia.
Forum for Health Research and Development, Dharan, Nepal.
PLoS One. 2020 May 29;15(5):e0233488. doi: 10.1371/journal.pone.0233488. eCollection 2020.
Health literacy (HL) and patient activation (PA) are necessary foundations to engage patients in self-management intervention. Each concept plays a unique role in improving access to the effective self-management of chronic disease. In this cross-sectional study, we examined the levels and determinants of HL and PA among the multi-morbid COPD patients in Nepal.
We conducted interviews with a simple random sample of 238 multi-morbid COPD people from July 2018 to January 2019. The questionnaire included sociodemographic profiles, five domains of the Health Literacy Questionnaire (HLQ), 13-item Patient Activation Measure (PAM) and patient's illness perception by Brief Illness Perception Questionnaire (BIPQ). Multivariable logistic regression was used to examine the associations.
Most people with COPD had low health levels across each of the five domains of the HLQ. The proportion of people with low literacy level across each of the domains was: (i) feeling understood and supported by healthcare providers (79.0%), (ii) having sufficient information to manage my own health (76.5%), (iii) social support for health (77.3%), (iv) ability to find the good health information (75.2%), and (v) understand the health information well enough to know what to do (74.8%), respectively. The majority of patients also reported low levels of patient activation (level 1: 81.5%; level 2: 11.8%), with only 6.7% (level 3: 5%; level 4: 1.7%) reported higher patient activation level. We found significant associations between poor HL levels in the HLQ domains and having no education, being female or from Indigenous and Dalits communities, and having a monthly family income of less than USD176. Having no education and poor illness perception were significantly associated with poor activation level on PAM scale.
A high proportion of multi-morbid COPD peoples had low levels of HL and were less activated than what would be required to self-manage COPD. These were in turn associated with socioeconomic factors and poor illness perception. The findings from this study are being used to design a COPD self-management program tailored to the low health literate population.
健康素养（HL）和患者激活（PA）是使患者参与自我管理干预的必要基础。每个概念在改善慢性病有效自我管理方面都发挥着独特的作用。在这项横断面研究中，我们检查了尼泊尔多种合并 COPD 患者的 HL 和 PA 水平及其决定因素。
我们于 2018 年 7 月至 2019 年 1 月期间对 238 名多种合并 COPD 患者进行了简单随机抽样访谈。问卷包括社会人口统计学概况、健康素养问卷（HLQ）的五个领域、13 项患者激活度量表（PAM）和患者的疾病感知通过简短的疾病感知问卷（BIPQ）。多变量逻辑回归用于检查关联。
大多数 COPD 患者在 HLQ 的五个领域中的每个领域都处于低健康水平。在每个领域中具有低文化程度的人的比例分别为：（i）感觉得到医疗保健提供者的理解和支持（79.0％），（ii）有足够的信息来管理自己的健康（76.5％），（iii）社会支持健康（77.3％），（iv）获取良好健康信息的能力（75.2％），以及（v）能够很好地理解健康信息以知道该怎么做（74.8％）。大多数患者还报告说患者的激活水平较低（水平 1：81.5％；水平 2：11.8％），只有 6.7％（水平 3：5％；水平 4：1.7％）报告了更高的患者激活水平。我们发现 HLQ 各领域 HL 水平较差与未受过教育，女性或来自土著和达利特社区以及家庭月收入低于 176 美元之间存在显著关联。未受过教育和较差的疾病感知与 PAM 量表上的低激活水平显著相关。
很大一部分多种合并 COPD 的患者 HL 水平较低，自我管理 COPD 的能力低于要求。反过来，这些又与社会经济因素和较差的疾病认知有关。这项研究的结果正被用于设计针对低健康素养人群的 COPD 自我管理计划。
