Development of a Hypertension Health Literacy Assessment Tool for use in primary healthcare clinics in South Africa, Gauteng

Abstract

BackgroundHypertension is a universal risk factor for cardiovascular morbidity and mortality in both the ageing and obese populations and patients must be literate in hypertension health issues to participate actively in the management of their disease. Little research has been done to investigate hypertension health literacy levels among South Africans.AimTo develop a Hypertension Heath Literacy Assessment Tool to establish patients’ comprehension of the health education they receive in primary healthcare (PHC) clinics in Tshwane, Gauteng, South Africa.SettingPHC clinics in Tshwane, Gauteng, South Africa.MethodsThe design was quantitative, descriptive and contextual in nature. The study population comprised health promoters who were experts in the field of health, documents containing hypertension health education content and individuals with hypertension. Participants were conveniently and purposefully selected. A modified Delphi technique was used to develop and validate the Hypertension Health Literacy Assessment Tool (HHLAT). To ensure validity and reliability of the HHLAT, the tool was administered to 195 participants concurrently with the Learning Ability Battery (LAB).ResultsThere was a strong positive (F = 76.0, p < 0.0001, R2 = 28.25%) correlation between the LAB and the HHLAT. The HHLAT indicated that only 37 (19%) of the patients with hypertension had poor hypertension health literacy levels.ConclusionThe HHLAT is a valid tool that can be used in busy PHC clinics as it takes less than two minutes to administer. This tool can inform the healthcare worker on the depth of hypertension health education to be given to the patient, empowering the patient and saving time in PHC facilities.

Assessment Tools for Health Literacy among the General Population: A Systematic Review

“…Third, we found that two measuring tools [ 32 , 33 ] were aimed separately at one field of health literacy. The fields areas of health literacy had been explored as follows: Digital Health Literacy Instrument [ 16 ], Hypertension Health Literacy Assessment Tool [ 19 ], and Oral Health Literacy Instrument [ 44 ]. Given that these measurement modes may serve as one component of a complete measure of health literacy, measurement scales for health literacy may also be further developed and validated in other areas, such as nutrition and environment.…”

“…A World Health Organization (WHO) report on the roles for stakeholders in advancing health literacy mentioned that assessment tools for health literacy should be developed and improved by the research institutions [ 14 ]. To date, various frameworks or scales are available for assessing and measuring health literacy based on different subjects, diseases, or theoretical foundations, such as the development of the health literacy instrument for female marriage immigrants [ 15 ], development of the digital health literacy instrument [ 16 ], conceptualizing a new approach to adolescent health literacy [ 17 ], health literacy tools in the outpatient setting [ 18 ], and the development of a hypertension health literacy instrument [ 19 ]. However, no reliable, definitive, and comparable health literacy scale exists for a global population.…”

Functional health literacy: protective role in adherence to treatment for hypertensive patients

“…This acts as a gap in the communication process and the information provided may be perceived in a different way than the original or may not even be obtained. As a result, misinterpretations in understanding may occur and affect the application of such information during self-care (7,17) . Therefore, this causes low adherence to therapy, resulting in a lack of blood pressure control and greater exposure to complications and comorbidities (6,17) .…”

Conveying hypertension message: An investigation into the language and content used in primary health clinics in South Africa

“…This list of words, phrases and concepts was presented to the first panel of experts following the Modified Delphi Technique, selected the most common words, phrases and concepts used during health education on hypertension in order to develop a Hypertension Health Literacy Assessment Tools. 16 Another challenge with language use was that immigrants who might not understand any of the 11 languages and even the sign language could miss valuable information provided by health promoters when they switched to native language, which was mostly Setswana as the commonly spoken language in Tshwane. In addition, health promoters might not speak all 12 official languages, meaning that some patients who spoke other South African language might miss important information because of language barrier.…”