Salmanpour Nastaran, Salehi Alireza, Nemati Sadaf, Rahmanian Mahdi, Zakeri Alireza, Drissi Hamed Bazrafshan, Shadzi Mohammad Reza
Department of MPH, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Cardiovascular Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
BMC Public Health. 2025 Aug 2;25(1):2630. doi: 10.1186/s12889-025-23914-7.
Hypertension is a common chronic disease that negatively affects health-related quality of life (HRQOL). Identifying modifiable factors influencing HRQOL is essential to improve patient outcomes. This study focuses on self-care, self-efficacy, and health literacy due to their established role in chronic disease management and their potential to be enhanced through targeted interventions. These variables were selected based on Social Cognitive Theory and the Health Literacy Skills Framework, which highlight the roles of self-efficacy and health literacy in promoting effective self-care and improving health outcomes.
In this cross-sectional study, data on HRQOL, self-care, self-efficacy, and health literacy were collected from 427 patients selected through systematic random sampling between March 2023 and March 2024 in community and private sector clinics affiliated with Shiraz University of Medical Sciences, Shiraz, Iran. Data were obtained via interviews using validated questionnaires, including WHOQOL-BREF, Hill-Bone, HBP-SCP, and HELIA-SF, along with patients' demographic, anthropometric, and physiological information. A multiple linear regression model was used for data analysis. Additionally, logistic regression was performed to estimate odds ratios (ORs) for categorized HRQOL outcomes.
The mean (SD) age of participants was 60.1 (11.1) years, with the majority (68.4%) being women. The mean (SD) scores for total HRQOL, self-care, self-efficacy, and health literacy were 62.5 (15.8), 87.1 (10.8), 68.7 (14.9), and 81.2 (17.2), respectively. Bivariate analysis revealed that male gender (p = 0.009), being employed (p < 0.001), and having a higher income (p < 0.001) were significantly associated with better HRQOL, whereas participants with diabetes mellitus (p = 0.001) and renal disease (p = 0.002) exhibited reduced considerably HRQOL. In the linear regression model, better self-care (β = - 0.34, 95% CI: - 0.67 to 0.00), higher self-efficacy (β = 0.28, 95% CI: 0.10-0.45), and greater health literacy (β = 0.37, 95% CI: 0.29-0.44) were significantly associated with higher HRQOL scores. Effect sizes were small for self-care (η² = 0.02), moderate for self-efficacy (η² = 0.03), and large for health literacy (η² = 0.13). Presence of diabetes (β = 3.8, 95% CI: 1.1-6.5) and renal disease (β = 3.2, 95% CI: 0.08-6.3) was significantly linked to lower HRQOL scores, though effect sizes were minimal (η² = 0.005 and 0.003). In the logistic regression model, higher self-efficacy (OR = 1.05, 95% CI: 1.01-1.08) and health literacy (OR = 1.04, 95% CI: 1.03-1.06) were associated with greater odds of reporting good HRQOL. Absence of diabetes (OR = 1.57) and renal disease (OR = 1.34) was also favorably associated with HRQOL. Gender and education were not significant predictors.
Although health literacy, self-care, and self-efficacy are associated with HRQOL in patients with hypertension, only health literacy demonstrated a sizeable effect size. Therefore, interventions aimed at enhancing these factors, particularly health literacy, should be prioritized in public health strategies to improve the quality of life in this population.
高血压是一种常见的慢性病，会对健康相关生活质量（HRQOL）产生负面影响。识别影响HRQOL的可改变因素对于改善患者预后至关重要。本研究聚焦于自我护理、自我效能感和健康素养，因为它们在慢性病管理中已确立作用，且有可能通过有针对性的干预得到增强。这些变量是根据社会认知理论和健康素养技能框架选取的，该框架强调自我效能感和健康素养在促进有效自我护理和改善健康结局方面的作用。
在这项横断面研究中，于2023年3月至2024年3月期间，通过系统随机抽样从伊朗设拉子医科大学附属社区和私立诊所的427例患者中收集了有关HRQOL、自我护理、自我效能感和健康素养的数据。数据通过使用经过验证的问卷进行访谈获得，这些问卷包括世界卫生组织生活质量简表（WHOQOL - BREF）、希尔 - 博恩问卷（Hill - Bone）、高血压自我护理量表（HBP - SCP）和健康素养自评量表（HELIA - SF），以及患者的人口统计学、人体测量学和生理学信息。采用多元线性回归模型进行数据分析。此外，进行逻辑回归以估计分类HRQOL结局的比值比（OR）。
参与者的平均（标准差）年龄为60.1（11.1）岁，大多数（68.4%）为女性。HRQOL总分、自我护理、自我效能感和健康素养的平均（标准差）得分分别为62.5（15.8）、87.1（10.8）、68.7（14.9）和81.2（17.2）。双变量分析显示，男性（p = 0.009）、就业（p < 0.001）和较高收入（p < 0.001）与更好的HRQOL显著相关，而患有糖尿病（p = 0.001）和肾病（p = 0.002）的参与者HRQOL明显降低。在多元线性回归模型中，更好的自我护理（β = - 0.34，95%置信区间：- 0.67至0.00）、更高的自我效能感（β = 0.28，95%置信区间：0.10 - 0.45）和更高的健康素养（β = 0.37，95%置信区间：0.29 - 0.44）与更高的HRQOL得分显著相关。自我护理的效应量较小（η² = 0.02），自我效能感适中（η² = 0.03），健康素养较大（η² = 0.13）。患有糖尿病（β = 3.8，95%置信区间：1.1 - 6.5）和肾病（β = 3.2，95%置信区间：0.08 - 6.3）与较低的HRQOL得分显著相关，尽管效应量极小（η² = 0.005和0.003）。在逻辑回归模型中，更高的自我效能感（OR = 1.05，95%置信区间：1.01 - 1.08）和健康素养（OR = 1.04，95%置信区间：1.03 - 1.06）与报告良好HRQOL的更高几率相关。没有糖尿病（OR = 1.57）和肾病（OR = 1.34）也与HRQOL呈有利关联。性别和教育程度不是显著的预测因素。
虽然健康素养、自我护理和自我效能感与高血压患者的HRQOL相关，但只有健康素养显示出较大的效应量。因此，在公共卫生策略中应优先考虑旨在增强这些因素，特别是健康素养的干预措施，以改善该人群的生活质量。
