Study On The Relationship Between Health Literacy And Disease Activity And Medication Compliance Among The Patients With Systemic Lupus Erythematous

Objective To assess the health literacy level and investigate its related influencing factors among the patients with systemic lupus erythematous(SLE)and analyze the impact of health literacy on disease activity and medication compliance.It is expected to provide references for future researches.Methods Convenience sampling method was used to recruit patients with SLE from December 2016 to October 2017 from the department of rheumatology and immunology in two tertiary hospitals in Anhui province.All of the participants were investigated by General Demographic Information Questionnaire,Health Literacy Scale for Patients with Chronic Disease,Medication Compliance Scale for Patients with Chronic Disease,Self-rating Depression Scale(SDS),Social Support Rating Scale(SSRS).Systemic Lupus Erythematous Disease Activity Index 2000(SLEDAI-2000)was used to assess the patients' disease activity.Binary logistic regression analysis was used to analyze the influencing factors of health literacy and the effect of health literacy on disease activity in SLE patients.Multiple linear regression analysis was used to analyze the effect of health literacy on medication compliance in SLE patients.Bootstrap method was used to examine the intermediary effect of medication compliance in health literacy and disease activity.Results The mean score of health literacy in the patients with SLE was(92.18 ± 12.08).55.0%(n = 213)of the sample presented insufficient health literacy.In the four dimensions of health literacy,the average score of information acquisition ability ranked first and the average score of communicative interaction ability ranked last.According to the binary regression analysis,SLE patients who were more than 40 years old had the highest percentage of inadequate health literacy.Patients with education lower than junior middle school(including junior middle school)presented lower health literacy than those with education in secondary school or high school or above.Patients who were unemployed and earning less than 2000 yuan per capita monthly household income were more likely to have lower health literacy.The median score of the disease activity in SLE patients was 7(4,12).65.4%(n = 253)of the patients had different degrees of disease activity.Spearman correlation analysis showed that the score of health literacy in SLE patients was negatively correlated with the score of disease activity(r =-0.373,P < 0.001).Binary logistic regression analysis showed that race(OR = 0.063,95% CI = 0.007 ~ 0.595,P = 0.016),duration of SLE(OR = 1.714,95% CI = 1.227 ~ 2.394,P = 0.002),health literacy(OR = 0.938,95% CI = 0.909 ~ 0.968,P < 0.001)were the influencing factors of disease activity.The mean score of medication compliance in patients with SLE was(55.40 ± 3.56).6.5%(n = 25)of the sample did not have good medication compliance.Pearson correlation analysis showed that the score of health literacy in SLE patients was positively correlated with the score of medication compliance(r = 0.216,P < 0.001).The results of multiple linear regression analysis showed that gender(? =-0.144,P = 0.004)and health literacy(? = 0.199,P = 0.002)were the influencing factors of medication compliance(F = 9.411,P < 0.001).Intermediary effect analysis presented that medication compliance didn't mediate the effect of health literacy on disease activity.Conclusion The overall health literacy level in SLE patients in China is low.The main influencing factors of health literacy include age,education level,occupation,and per capita monthly household income after adjusting for the confounding factors.The health literacy level of SLE patients not only affects disease activity but also affects medication compliance.Lower health literacy level can lead to poor health outcomes.Screening health literacy of SLE patients during regular work may be considered by clinical health care providers.Patients who are more than 40 years old,with education level lower than junior middle school,unemployed and earning less than 2000 yuan per capita monthly household income should be paid more attention in disease management.The intervention programs in health literacy should also be developed in the future in order to improve the health outcomes of SLE patients.