سواد سلامت، وضعيت هيجاني منفي و رفتارهاي خودمراقبتي در بيماران دياليزي

Health literacy, negative emotional status, and self-care behaviors in dialysis

مقدمه: بيماران مبتلا به نارسايي كليه كه سواد سلامت پايين دارند در معرض خطر بيشتري براي رفتارهاي خودمراقبتي نامطلوب و نتايج منفي سلامت هستند. هدف پژوهش حاضر برآورد شيوع سواد سلامت پايين، تفاوت در حالات هيجاني منفي و رفتارهاي خودمراقبتي بر حسب سطوح سواد سلامت و آزمون نقش واسطه‌اي هيجان‌هاي منفي در رابطه‌ي بين سواد سلامت و خودمراقبتي در بيماران تحت درمان دياليز بود. روش‌كار: در اين مطالعه‌ي مقطعي، 240 بيمار با تشخيص مراحل انتهايي نارسايي كليه در مراكز دياليز وابسته به دانشگاه علوم پزشكي تهران به روش نمونه‌گيري هدفمند از اسفند 1392 تا خرداد 1393 انتخاب شدند. ابزار پژوهش شامل معاينه‌ي مختصر وضعيت رواني، فرم كوتاه پرسش‌نامه‌ي سواد سلامت بزرگسالان و مقياس افسردگي، اضطراب و استرس 21 آيتمي و زيرمقياس خودمراقبتي رفتارهاي خودمديريتي بود. يافته‌ها: ميزان 25 درصد آزمودني‌ها سواد سلامت پايين، 2/65 درصد سواد سلامت كافي و 8/9 درصد سواد سلامت مرزي داشتند. افسردگي، اضطراب، استرس و رفتارهاي خودمراقبتي از لحاظ سطوح سواد سلامت تفاوت معني‌داري داشتند

Introduction: Renal failure patients with low health literacy are at an increased risk for poor self-care and negative health outcome. The purpose of the present study was to examine the prevalence of low health literacy, differences in negative emotional status and self-care behaviors by health literacy levels, and the mediating role of negative emotions on the relationship between health literacy and self-care among patients undergoing dialysis. Materials and Methods: In the cross-sectional study, we recruited 240 consecutive patients diagnosed with End Stage Renal Disease (ESRD) who had scheduled appointments at Tehran University of Medical Sciences-affiliated dialysis units from March 2014 until June 2014 based on the inclusion criteria. Instrument include: Mini Mental State Exam, Short test of Health Literacy for Adults, Depression, Anxiety and Stress Scale-21 and Self-Management Scale. Results: The findings indicated that health literacy was inadequate in 25%, marginal in 9.8%, and adequate in 65.2% of the cases. Depression, anxiety, stress and self-care scores differed significantly by health literacy levels (P<0.001, P<0.02, P<0.004, P<0.001 respectively). Post-hoc pairwise comparisons indicated that those with inadequate health literacy had higher depression, anxiety and stress scores, and lower self-care compared to those with marginal or adequate health literacy. Regression analyses indicated that, after controlling for education, health literacy was significantly associated with depression, anxiety, stress and self-care. In addition, depression, anxiety and stress were mediators of health literacy and self care relationship. Conclusion: These findings demonstrate the high prevalence of low health literacy. It also shows that health literacy is an important consideration in promoting mental health and self-care behaviors among patients under dialysis.