Effects of self-management program on healthy lifestyle behaviors among elderly with hypertension

© 2018, Behavioral Science Research Institute. This research aimed to evaluate whether a self-management program promoted healthy lifestyle behaviors (HLBs) and improved health outcomes among Thai elderly with hypertension. Participants were randomly allocated to either an intervention group (n=20), that received an 8-week self-management program that included home visits, or a control group (n = 20). The data were analyzed by a chi-square analysis, a mixed-model repeated measure MANOVA, and MANCOVAs. There were significant differences in the mean scores of healthy lifestyle behaviors at posttest and follow-up between the two groups (p < 0.01). Moreover, the experimental participants showed statistically significant decrease in BMI as compared to the control group participants in posttest and follow-up (p < 0.001). There was a statistically significant reduction in blood pressure in the experimental participants, compared with the control participants at follow-up (p < 0.001). Furthermore, healthy lifestyle behaviors increased significantly in the experimental participants compared with the control participants and baseline (p < 0.001). In addition, BMI and blood pressure decreased in the experimental participants compared with the control participants and baseline (p < 0.001). The self-management program resulted in improved healthy lifestyle behaviors, and health outcomes among the elderly with hypertension, and has implications for health promotion

Empirically Tested Health Literacy Frameworks

BACKGROUND: Health literacy is a significant determinant of health behaviors, but the pathways through which health literacy influences health behaviors are not completely clear nor consistent. The purpose of this systematic review is to critically appraise studies that have empirically tested the potential pathways linking health literacy to health behavior. METHODS: We performed searches of the electronic databases PubMed, Embase, and CINAHL to identify studies that proposed a conceptual framework and empirically tested the proposed mechanism through which health literacy influences certain health behaviors. Twenty eligible studies were included for analysis. KEY RESULTS: The 20 studies addressed various health behaviors: chronic disease self-management (n = 8), medication adherence (n = 2), overall health status (n = 4), oral care (n = 1), cancer screening (n = 1), shared decision-making (n = 1), health information sharing (n = 1), physical activity and eating behaviors (n = 1), and emergency department visits (n = 1). Most studies were conducted in the United States (n = 13) and used a cross-sectional design (n = 15). The Short Test of Functional Health Literacy in Adults was commonly used to assess health literacy levels. Selection of variables and their operationalization were informed by a theoretical model in 12 studies. Age, gender, race/ethnicity, and insurance status were reported antecedents to health literacy. The most commonly tested mediators were self-efficacy (n = 8) and disease knowledge (n = 4). Fit indices reported in the studies ranged from acceptable to excellent. DISCUSSION: Current evidence supports self-efficacy as a mediator between health literacy and health behavior. Further research is needed to identify how health literacy interplays with known psychosocial factors to inform people's use of preventive care services. Future studies should include more disadvantaged populations such as immigrants with high disease burden and those with low health literacy. Theory-based, empirically tested health literacy models can serve as the conceptual basis for developing effective health interventions to improve health behaviors and ultimately decrease the burden of disease in such vulnerable populations. [HLRP: Health Literacy Research and Practice. 2020;4(1):e21-e44.] PLAIN LANGUAGE SUMMARY: This review systemically compiles, and critically appraises 20 existing studies that test conceptual frameworks that propose potential pathways through which health literacy affects health behaviors. The findings from this review can help inform the development of health literacy-focused interventions to improve the health behaviors of populations with disease burdens