Background The prevalence of hypertension is increasing worldwide. Hypertension self-management usually involves the application and consideration of oral, written, or quantitative information. Hypertensive patients in China have limited high blood pressure health literacy (HBP-HL), which may lead to poorer clinical outcomes. This study aims to determine the feasibility and effectiveness of an interactive pictorial health education program based on behavior change wheel (BCW) theory and its effect on HBP-HL, self-efficacy, self-management ability, and health-related quality of life (HRQOL) in hypertensive patients with low HBP-HL. Methods This study is a randomized controlled trial (RCT). One of the municipal districts in Huzhou, China, will be randomly selected, and two communities with similar conditions within this district will be screened and selected. A total of 120 hypertensive patients aged 18 years and older will be recruited from these two community settings. One of the communities will be randomly allocated to an interactive pictorial health education program conducted by a comprehensive health literacy strategy that includes (i) training participants in effective health communication skills that address issues encountered in seeking medical care and (ii) the use of self-developed interactive pictorial hypertension education to improve patient understanding and behaviors versus a control group (routine community lecture health education only). The primary outcome measure is HBP-HL. Secondary outcomes are self-efficacy, self-management ability, HRQOL, social support, and improvement in blood pressure. Outcomes will be collected at 6, 9, and 12 months from trial entry. Discussion The strengths of this study are the establishment of a new health management program for hypertensive patients that closely combines BCW theory and health literacy. This trial has the potential to improve HBP-HL in hypertensive Chinese patients with low health literacy to improve the self-management of hypertension and help control blood pressure. Trial registration Clinical Trials.gov Protocol Registration and Results System ID NCT04327102. Prospectively registered on February 29, 2020

ObjectivesThe prevalence of hypertension is increasing worldwide. Hypertensive patients in China have limited high blood pressure health literacy (HBP-HL) and social support (SS), which may have an impact on health-related quality of life (HRQoL) and lead to poorer clinical outcomes. However, the potential mechanism of HBP-HL, SS and HRQoL remains unclear. The aim of this study was to investigate the association among HBP-HL, SS and HRQoL among community patients with hypertension in China.DesignA community-based cross-sectional survey.SettingThe community health service center in Huzhou, China.Participants406 community patients with hypertension were investigated from June to October 2019.Primary outcome measuresHRQoL was assessed using the Quality of Life Instruments for Chronic Diseases-Hypertension V2.0, HBP-HL was assessed with the HBP-Health Literacy Scale into Chines and SS was assessed with the Social Support Rating Scale.ResultsCompared with moderate level of HRQoL and SS, HBP-HL of community hypertensive patients was significantly deficient. Overall, 93 patients (23.2%) lacked HBP-HL, 308 patients (76.8%) had a medium level of HBP-HL, and none of them had sufficient HBP-HL. Correlation analysis showed that HBP-HL, SS and HRQoL were positively correlated (p<0.01). The significant differences in HRQoL and SS were detected in HBP-HL level (p<0.001). In multiple linear regression models, HRQoL was significantly associated with ‘Print HL’ and ‘Medication Label’ of HBP-HL (p<0.05) and all three dimensions of SS (p<0.05). In addition, The bootstrap method was used to examine the indirect effect among variables. The results showed that SS played a mediating role between HBP-HL and HRQoL (p<0.001).ConclusionThere is an association among HBP-HL, SS and HRQoL in community hypertension patients. HBP-HL can directly affect HRQoL, and through SS mediate the HRQoL. Community intervention for hypertension management should consider HBP-HL promotion and social engagement as the breakthrough points to increase the impact on patients’ HRQoL.

Aims This study aimed to evaluate the reliability and validity of the Chinese version of an instrument of health literacy competencies for health professionals. Design This study utilized a cross‐sectional design. Methods Authorization was obtained from the authors of the original scale to translate the scale and perform cross‐cultural debugging. From August 2020 to November 2020, 573 health professionals were randomly selected from primary, secondary and tertiary hospitals in Huzhou to examine the reliability and validity of the Chinese version of an instrument of health literacy competencies for health professionals. Results The Chinese version of the scale contains 49 items. The internal consistency Cronbach's α was 0.958 for the total scale and 0.791–0.956 for each dimension. The test–retest reliability was 0.973. Confirmatory factor analysis showed that the fitness degree of the model is good (χ2/df = 1.347, IFI = 0.924, TLI = 0.913, CFI = 0.922, GFI = 0.841, AGFI = 0.815, RMR = 0.011, RMSEA = 0.035). Conclusion The Chinese version of an instrument of health literacy competencies is reliable and valid, which is a credible and effective tool to assess the level of health literacy competencies in Chinese health professionals. Patient or public contribution Health professionals with good health literacy competencies can provide patient‐specific treatment and guidance to promote healthy outcomes for patients.