| ObjectiveThe present study was conducted to translate and introduce the Suitability Assessment of Materials using the Brislin translation model, and to evaluate the property of the Chinese version Suitability Assessment of Materials, and to investigate the suitability of health education text materials in China.MethodsChinese version Suitability Assessment of Materials was used to assess the suitability of 162 health education text materials. Item Response Theory was employed to analyses the property of the Chinese version Suitability Assessment of Materials.ResultsOne hundred and sixty-two health education text materials were included in this study, and the total score rate of 64.2% text materials was less than 40% while that of 12.3% text materials was ranged from 40% to 69%, and 23.5% text materials was more than 70%. Except the item C1, C3 of graphic illustration, all the other discriminability parameters were more than 1.50. Category reaction threshold of all items were ranged or approximately ranged from -3 to 3, except for the item A1 of content, the item B1 of literacy demand, the item C1, C2, C3, C4 of graphic illustration, and the item F1 of cultural appropriateness. The difference of the layout and typography scores between different health service establishments was significantly. The interaction effect of health service establishments and health education text material themes among the scores of content, literacy demand, layout and typography, learning stimulation and motivation were all statistics significantly.ConclusionChinese version Suitability Assessment of Materials could be used to assess the suitability of health education text materials and the items of graphic illustration should be considered to be revised. More than three fifths health education text materials were not suitable, and the suitability of health education text materials of community health service whose theme was related to disease prevention was better. Except the graphic illustration, learning stimulation and motivation should be particularly considered. It is suggested that problems or questions should be presented in the text materials for reader response, and complex topics be subdivided so that readers may experience small successes in understanding or problem solving, leading to self-efficacy or confidence.ObjectiveThis study was conducted to illustrate the health literacy level from clinical perspective, to discuss the effect of health literacy intervention on improving the health literacy level, treatment compliance, health service utilization and disease control among Korean-Chinese older adults with hypertension, to analysis the influencing factors and the path of health literacy intervention, and to discuss the role of health literacy in the disease management among Korean-Chinese older adults with hypertension.Methods(1) Based on the literature review and comments of health literacy concept, the triple prevention of chronic disease and the health literacy levels from public health perspective, a three-level model of health literacy from clinical perspective was proposed.(2) Intervention Mapping was employed to develop the health literacy intervention strategy, community-based participatory research methods was utilized for the intervention group patients, having received six times group education and health literacy intensive intervention or telephone follow-up intervention while the control group received usual care.(3) Health literacy level, treatment compliance, health service utilization, and blood pressure was assessed with Health Literacy Assessment Tool for Patient with HPB, Hill-Bone Compliance to High Blood Pressure, and health service utilization questionnaire before the intervention and six months, ten months after the intervention. Multivariate repeated-measures analysis of variance and Generalized Linear Models combined with qualitative research was used to estimate the results of intervention. Logistic regression was applied to illustrate the influencing factors of the health literacy intervention, and the structural equation modeling was used to explain the influencing path of the health literacy intervention.Results(1) The health literacy level from clinical perspective can be divided into basic health literacy, core health literacy, and diseased-related health literacy.(2) The baseline differences of health literacy level, treatment compliance, health service utilization and blood pressure between intervention group and control group were not statistically significant.(3) Multivariate repeated-measures analysis of variance of health literacy scores showed the time effect (F=90.98, p=0.000), group effect (F=9.79, p=0.002), and the interaction effect of time and group (F=27.60, p=0.000) were all significant.(4) The time effect (F=58.598, p=0.000), group effect (F=13.545, p=0.000), and the interaction effect of time and group (F=26.028, p=0.000) of treatment compliance and the intentional medication nonadherence were all statistically significant.(5) Generalized Linear Models indicated that the time effect of the emergency service in the six months was significant (Wald χ2=3.931, p=0.047) while the group effect and the interaction effect were not.The time effect and interaction effect of the out-patient service in the six months was significant (Wald χ2=5.970, p=0.015; Wald χ2=8.514, p=0.004) while the group effect was similar significant (Wald χ2=3.807, p=0.051). The time effect and interaction effect of the medical cost in the twelve months was significant (Wald χ2=8.396, p=0.004; Wald χ2=24.782, p=0.000) but the group effect was not significant (Wald χ2=1.597, p=0.206).(6) Multivariate repeated-measures analysis of variance of SBP and DBP showed the time effect (F=22.832, p=0.000; F=14.153, p=0.000), group effect (F=5.764, p=0.017; F=4.297, p=0.040), and the interaction effect of time and group (F=13.256, p=0.000; F=13.017, p=0.000) were all significant. The time effect and interaction effect of the standard-reaching rate of blood control was significant (Wald χ2=7.298, p=0.007; Wald χ2=7.298, p=0.007) but the group effect was not significant (Wald χ2=1.554, p=0.213).(7) Group, baseline SBP and DBP, and the emergency service utilization were the main influencing factors of the blood control after the intervention.(8) The effect of the health literacy change on medicine compliance had impact on SBP, and the change of out-patient service and medical cost either affect the change of SBP.Conclusion(1) The view of the health literacy level from clinical perspective was benefit for the aim establishment of the intervention strategy development and to improve the diversity and effectiveness of the intervention.(2) The health literacy intervention had effect on increasing the health literacy level of Korean-Chinese old adults with hypertension and the improving of comprehension ability was later than the readability and numeracy ability.(3) The health literacy intervention was effective on the improvement of treatment compliance and the intentional medication nonadherence of Korean-Chinses old adults with hypertension.(4) The health literacy intervention can increase the initiative of the self-management and the out-patient service utilization, and can control the medical cost of Korean-Chinese old adults with hypertension.(5) The baseline blood pressure was the primary influencing factors of the health literacy intervention of Korean-Chinese old adults with hypertension.(6) The effect of health literacy intervention on blood pressure was chiefly by means of the change of medication compliance and health service utilization. |
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