The Relationship Between Health Literacy And Compliance Behavior In Patients With Pulmonary Tuberculosis And The Mediating Effect Of Stigma

ObjectiveTo explore the effects of health literacy,stigma,and demographic characteristics on compliance behavior among patients with Pumonary tuberculosis(PTB)in a hospital in Shenyang,Liaoning province and a hospital in Taiyuan,Shanxi Province,and to analyze the mediating effects of stigma on compliance behavior and health literacy,to provide reference for improving the level of compliance behavior of patients.MethodsIn this study,382 pulmonary tuberculosis patients admitted to a specialized hospital in Shenyang,Liaoning Province and Taiyuan,Shanxi Province from October 2021 to October 2022 were collected for an anonymous questionnaire survey.Patients were measured in the form of questionnaires,including the general Information questionnaire,the Chinese Health Literacy Scale for Tuberculosis(CHLS-TB),the Tuberculosis-related Stigma Scale(TSS),and the Eight-Item Morisky Medication Adherence Scale(MMAS-8).The data conform to normal distribution.The measurement data are described by mean±standard deviation((?)),and the counting data are described by frequency(N)and percentage(%).Independent samples t-test or single factor ANONA and LSD were used to compare the mean values.Pearson correlation analysis was used to analyze the correlations among health literacy,stigma and compliance behavior in patients with tuberculosis.Multiple stepwise regression method was used to analyze the influencing factors of compliance behavior.PROCESSV4.0 plug-in was used to explore the mediating effect of stigma on health literacy and compliance behavior.P<0.05 was considered statistically significant.Results1.382 patients with tuberculosis had an average health literacy of 38.87±7.88 points,among which 30.89%had low health literacy,45.55%had basic health literacy and 23.56%had good health literacy.2.The average stigma of tuberculosis patients was 60.43±8.57 points.In the two dimensions,the mean value of others’ demeaning was 31.30±5.16 points,and the mean value of self-negative feeling was 29.30±5.35 points.3.The score of compliance behavior of pulmonary tuberculosis patients was 3.63±1.77 points,81.68%of hospitalized pulmonary tuberculosis patients had low compliance,16.49%of hospitalized pulmonary tuberculosis patients had medium compliance,1.83%of hospitalized pulmonary tuberculosis patients had good compliance,and the number of patients with low compliance was the largest.4.In univariate analysis,age(years),place of residence,education level,marriage,medical insurance,per capita monthly household income(yuan),smoking,treatment principle,treatment time(month),destination of initial diagnosis and the presence of other diseases were statistically significant differences in health literacy(P<0.05);Age(years),medical insurance,treatment principle,drug resistance,destination of initial diagnosis and the presence of other diseases were statistically significant differences in stigma(P<0.05).Age(years),residence,education level,occupation,marriage,medical insurance,per capita monthly household income(yuan),initial treatment,treatment time(month),destination of initial diagnosis and the presence of other diseases were statistically significant differences in compliance behavior(P<0.05).5.Pearson correlation analysis showed a negative correlation between health literacy and stigma(r=-0.415,P<0.05),a positive correlation between health literacy and compliance behavior(r=0.568,P<0.01),and a negative correlation between stigma and compliance behavior(r=-0.578,P<0.01).6.Compliance behavior of pulmonary tuberculosis patients was affected by multiple factors,and compliance behavior of pulmonary tuberculosis patients aged 40～49 years old(β=-1.523),50～59 years old(β=-1.525)and ≥60 years old(β=-1.731)was lower than that of patients<30 years old;The compliance behavior of pulmonary tuberculosis patients with high school/vocational high school/technical secondary school(β=0.495)was higher than that of patients with illiteracy/semi-illiteracy;The compliance behavior of pulmonary tuberculosis patients with medical insurance for urban workers(β=0.763)was higher than that of patients with medical insurance for new rural cooperative medical system.The compliance behavior of pulmonary tuberculosis patients whose family per capita monthly income was 3000～3999 yuan(β=-0.695),4000～4999 yuan(β=-0.977),5000～5999 yuan(β=-1.101),≥ 6000 yuan(β=-1.492)was lower than that of patients whose family per capita monthly income was<2000 yuan;Compliance behavior of pulmonary tuberculosis patients with treatment time ≥6 months(β=-0.845)was lower than that of patients with treatment time≤2 months;The compliance behavior of pulmonary tuberculosis patients who first went to municipal or above Grade A hospitals(β=0.871)was higher than that of patients who first went to township health centers/community health service centers.Health literacy(β=0.037)positively predicted the level of compliance behavior;Stigma(β=-0.873)had a negative effect on compliance behavior.7.The analysis of mediating effect showed that when stigma was used as a mediating variable,the interval value of 95%CI did not include 0(0.003,0.015),and the mediating effect was established.The mediating effect accounted for 25.81%of the total effect,which was a partial mediator.When the two dimensions of stigma,namely negative self-perception,were used as mediating variables,the 95%CI confidence interval of Bootstrap test did not include 0(0.011,0.027),and the mediating effect was established,accounting for 16.13%of the total effect.When others deprecated as a mediator variable,the 95%CI confidence interval of Bootstrap test did not include 0(0.013,0.035),the mediator was established,and the mediator effect accounted for 19.35%of the total effect.Conclusions1.In this study,compliance behavior of patients with pulmonary tuberculosis was low,which needs to be improved.Compliance behavior was significantly correlated with patients’ health literacy,stigma,age(years),education level,medical insurance,family per capita monthly income(yuan),treatment time(month),initial visit and the presence of other diseases.2.After controlling confounding factors,health literacy of patients with tuberculosis can directly have a positive impact on compliance behavior,and can also be indirectly affected compliance behavior through stigma,which has an intermediary effect between the two.Both dimensions of stigma,namely,the demeaning of others and negative self-feelings,play a mediating role.It is necessary to include stigma reduction in national pulmonary nuclear response strategies.