Health Literacy and Knowledge of Chronic Diseases in Nepal

Abstract

Background: Understanding of risk factors and developing healthy lifestyles is a way of tackling the surging burden of chronic diseases in low-to-middle income countries such as Nepal. Health literacy (HL) has a pivotal role in prevention, adherence to treatment, self-care, and better use of health care; therefore, factors associated with HL need to be studied in the context of Nepal. Objective: This study was conducted to assess the level of HL and explore disease-specific knowledge among patients with chronic diseases. Methods: A cross-sectional study was conducted among 426 respondents with hypertension, diabetes mellitus, or chronic obstructive pulmonary disease from a tertiary care hospital and primary care clinics using face-to-face interviews. HL was measured using a translated and pretested HL questionnaire (the Europe-Asia Health Literacy Survey Questionnaire). Disease-related knowledge was assessed using a validated questionnaire. Key Results: The study found that 27% of the respondents had sufficient HL, 19% had marginal HL, and 54% had inadequate HL. Factors associated with inadequate HL included being older and female, and having lower or no education, unemployment or retired status, poverty, and having a history of smoking or a history of consuming alcohol. HL was a strong predictor of knowledge regarding hypertension (β = 0.32; p < .05), diabetes mellitus (β = 0.41; p < .05), and chronic obstructive pulmonary disease (β = 0.37; p < .05) in multiple regression analyses after adjusting for age, gender, education, marriage, family history of disease, attendance at follow-up clinics at recommended intervals, information received regarding disease at clinics, smoking, and alcohol intake. Conclusions: A sufficient level of HL was uncommon among participants in our study. People with sufficient HL knew significantly more about their diseases or conditions than those with inadequate HL. [ HLRP: Health Literacy Research and Practice . 2018;2(4):e221–e230.] Plain Language Summary: Very little is known about health literacy in Nepal. We conducted a study to learn how much people in Nepal with hypertension, diabetes, or chronic obstructive pulmonary disease knew about their condition and sought to check its association with health literacy. We found that more than one-half of the participants did not have adequate health literacy levels. Participants who were older, female, uneducated, retired from work, or poor had lower levels of health literacy. We also found that those with high levels of health literacy had better knowledge of their disease. Therefore, we recommend that in Nepal health literacy should be measured for each patient and support regarding management of his or her condition should be provided if necessary. ...

Self-management practice, associated factors and its relationship with health literacy and patient activation among multi-morbid COPD patients from rural Nepal

“…In this community-based study, we identified that being uneducated, with a low level of family income (β = − 5.22, p = .002), and having one co-morbidity were all significantly associated with SMPs among the multi-morbid COPD patients of Nepal. Our finding is consistent with observations from a previous Nepalese study that concluded lack of education among the COPD patients contributed to poor SMPs such as incorrect use of inhalers [5], knowledge on self-care [6] and knowledge on COPD [7]. Patients with no education have poor functional health literacy and thus are more likely to have a poorer understanding of self-management skills including information management, symptoms management, daily lifestyle management, emotional management, and selfefficacy, in turn resulting in poor SMPs.…”

“…COPD self-management primarily involves self-recognition and management of symptoms, taking medication, having a healthy diet, coping with breathlessness, quitting smoking and engaging in regular physical exercise to maintain good health [4]. Evidence shows that various factors such as educational status [5][6][7], family history of COPD [6], lack of social support [8] and low socioeconomic status of family [9] are associated with poor SMPs.…”

Levels and determinants of health literacy and patient activation among multi-morbid COPD people in rural Nepal: Findings from a cross-sectional study

“…Thus, an approach that is gender based may be required to improve patient health literacy. Another study from Nepal supports our finding that being female was associated with poor health literacy [18,50]. In contrast, evidence from China did not find a relationship between gender and HL while a study from the US, showed females had higher HL, possible due the difference in socio-demographic profiles of the studied populations [11,51].…”

“…A recently published study from Nepal conducted among chronic disease patients recruited from tertiary level hospital and a community hospital using Europe-Asia Health Literacy Survey Questionnaire showed 19% had marginal HL and 54% had inadequate HL [18]. Overall, a higher proportion of patients had low literacy in our study population when compared with studies from India [35] and Bangladesh [36].…”

The potential of health literacy to address the health related UN sustainable development goal 3 (SDG3) in Nepal: a rapid review

“…While Nepal still faces a burden of infectious diseases struggling with inadequate basic hygiene and sanitation along with deep rooted cultural beliefs, the burden of non-communicable diseases is also on the rise [18, 19]. Limited research has been found mentioning health literacy in Nepal [20–22] and level of health literacy of the people of Nepal is not known.…”