Effects of a health literacy improvement program for low-income eldery with hypertension in the community

Purpose: This study was to undertaken to evaluate the effects of a health literacy improvement program on health outcomes (systolic/diastolic BP, healthy lifestyle, hypertension knowledge, self-efficacy, and medication adherence) among the low-income community dwelling elderly with hypertension. Methods: In a randomized controlled trial, a total of 153 eligible persons who were over 60 years old and diagnosed as hypertension were recruited from the visiting nurse program in a public health center in Seoul, Korea. For 5 weeks, the intervention group received an individualized and interactive education and counseling using pedagogic strategies with picture-based hypertension materials at participant's home and follow-up calls for 7 weeks. The usual care group received a standard home care service for 12 weeks. Repeated Measured ANOVAs was used to test changes in outcome variables at baseline, 5, and 12 weeks. Results: A total of 81.7% of the participants remained and completed the study: 125 persons survived (62 intervention vs 63 usual care). The health literacy improvement program did not have a significant effect on blood pressure change at 5 and 12 weeks between intervention and control groups. However, there were significant differences in hypertension knowledge (p<.001), healthy lifestyle (p<.001), self-efficacy (p<.001), medication adherence (p<.001) between the two groups. Conclusion: Although the intervention was not effective in BP changes, we still suggest that the application of health literacy improvement strategies to hypertension management in the community elderly is useful to improve their disease knowledge, health behavior, and medication adherence.