| BackgroundWith the acceleration of aging and urbanization,unhealthy lifestyles are prevalent,the risk factors of coronary heart disease(CHD)continue increasing.After the attack of coronary heart disease,we cannot only rely on revascularization therapy,but more importantly,we should adopt an entire and standardized secondary prevention strategy.As the new field of chronic disease management,health literacy has a prominent role in the secondary prevention of coronary heart disease,previous studies have pointed health literacy is the predictor of medication adherence,but few researchers focus on the mechanism between health literacy and medication adherence,some scholars pointed that determinants of adherence play mediating effects between health literacy and medication adherence,and points out the future research should explore the mediation or other factors.ObjectivesTo investigate the status of health literacy,illness perception and medication adherence among patients with CHD,to analyze the influencing factors of health literacy in patients with CHD,to explore the relationship between health literacy and illness perception in patients with CHD,to explore the mediating effect of illness perception between health literacy and medication adherence among patients with CHD.MethodsTaking CHD patients who were in the cardiology department of 4 hospitals in Xinxiang City as the research object,using the chronic diseases health literacy scale,the Chinese revised illness perception questionnaire and Morisky medication adherence scale as the survey tool.SPSS22.0 software was used for descriptive analysis,independent sample non-parametric test,Logistic regression analysis,independent sample t test,single sample t test and Spearman correlation analysis.AMOS23.0 software was used for test mediating effect of illness perception between health literacy and medication adherence.Results1.The health literacy level of CHD patients was 39.44%,and the total score was(87.27±15.90);the information acquisition ability level was 43.16%,the score was(32.87±8.05);the communicative interaction ability level was 23.67%,the score was(31.19±5.16);the health improvement willingness level was 66.13%,the score was(15.62±2.60);the economic support willingness level was 59.63%,the score was(7.59±1.84).2.Among the 12 common symptoms of CHD,on average 4.47 were recognized;the average score of timeline was(3.56±0.49),timeline cyclical was(3.06±0.57),consequence was(2.96±0.66),emotional representation was(2.82±0.71),personal control was(2.70±0.63),treatment control was(3.46±0.58),illness coherence was(2.86±0.74);among six factors,the highest score was behavior factors,then was immune factors and physical factors.3.The medication adherence score was 6.00(5.00,8.00),139 patients(32.25%)had low medication adherence level,184 patients(42.69%)had medium medication adherence level,and 108 patients(25.06%)had high medication adherence level.4.Logistic regression analysis showed that age,residence and education level were independent influencing factors of health literacy and the communicative interaction ability among CHD patients;age,education level,professional,residence and therapy method were independent influencing factors of the information acquisition ability;age,education level,living situation,family history and therapy method were independent influencing factors of the health improvement willingness;age,education level and family history were independent influencing factors of the economic support willingness(P<0.05).5.There were statistically significant differences between illness perception and medication adherence scores in patients with and without health literacy(P<0.05);The total score of health literacy and its four dimensions were positively correlated with personal control,treatment control,illness coherence and medication adherence,negatively correlated with timeline,timeline cyclical,consequence and emotional representation(r=-0.539~0.652,P<0.05).6.Personal control,illness coherence and emotional representation have mediating effects between health literacy and medication adherence.Health literacy's mediating effect accounting for 47.29% in the total effect.The mediating effect of personal control,illness coherence and emotional representation accounted for 27.92%,11.34% and 13.44%.Conclusions1.The level of health literacy in patients with CHD is at the middle level,among which the communicative interaction ability is the worst;medication adherence is at a low level,and positive illness perception needs to be improved.2.Health literacy was the key factors affecting illness perception and medication adherence of CHD patients.Health literacy can not only directly affect medication adherence,but also indirectly affect medication adherence through personal control,illness coherence and emotional representation. |
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