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Milad Borji et al.
INTRODUCTION
Health literacy is individual’s capacity for process,
obtain and understand basic about health information &
services and is necessary for good health (Kindig, Panzer
et al. 2004). Health literacy includes reading, listening,
analysis, and decision-making skills and the ability to
apply these skills in health positions, which is not neces-
sarily associated with education level or general reading
inability (Sihota and Lennard 2004). Inadequate health
literacy correlates with poorer individual health status
report, misuse of drugs and failure to comply with phy-
sician’s orders, poorer blood sugar control and increased
prevalence of individual reports of problems induced by
poor control, lower health knowledge, lower contribu-
tion in deciding on treatment, less expression of health
concerns, and worse relationship with physicians(Kindig,
Panzer et al. 2004; Javadzade, Shari rad et al. 2012) .
Individuals with low health literacy are less aware of
their health status, receive fewer preventive services, are
under less control for chronic diseases, have poorer phys-
ical and mental health performance, and make greater
use of the emergency department and hospital services
(Peerson and Saunders 2009). Despite the critical impor-
tance of identifying individuals with inadequate health
literacy, healthcare systems’ employees are often less
concerned about this issue. In contributing patients with
inadequate health literacy, particular methods should be
used, including using simple and understandable words
and expressions, using images, getting feedback from
individuals after providing information to them, and
limiting the information provided to the individual at
any meeting (Chew, Bradley et al. 2004).
Low level of health literacy is more common among
the elderly, illiterate individuals, immigrants, individu-
als with low mental health, and those with hyperten-
sion and type II diabetes. Low health literacy also causes
increased mortality, decisions on certain health risk
behaviors, and failure to perform preventive behaviors
such as screening tests and, thus, poor physical health
(Williams, Baker et al. 1998; Kalichman, Benotsch et al.
2000; Kalichman and Rompa 2000; Schillinger, Grum-
bach et al. 2002; Kindig, Panzer et al. 2004). Health lit-
eracy in chronic patients such as patients with diabetes
who require self-care plays an essential role, which is
why attention to the issue of health literacy in patients
with diabetes has been growing in importance (Khosravi,
Ahmadzadeh et al. 2015).
Chronic diseases affect patients for many years. For
this reason, as long as these conditions are not properly
managed and controlled, no further healthcare services
are received, which leads to reduced quality of life and
health (Esmaeili Shahmirzadi, Shojaeizadeh et al. 2012).
Psychological aspects of diabetes have attracted atten-
tion of many experts in this area as this disease leads
to many behavioral problems in patients. Psychological
factors associated with quality of life can have a great
impact on the quality of patients’ lives. Accordingly,
the results of previous studies in this area indicate that
mood factors are involved in the prevention of diabe-
tes in patients with diabetic retinopathy (McDarbyc and
Acerinie 2014; Moayedi, Zare et al. 2015; Seyedoshoha-
daee, Kaghanizade et al. 2016).
Given the increasing prevalence of diabetes (Mohan,
Sandeep et al. 2007; Seyedoshohadaee, Kaghanizade
et al. 2016; Varvani Farahani, Rezvanfar et al. 2016), the
present study was conducted in 2015 with the aim to
determine the relationship between health literacy and
general health status of patients with type II diabetes in
Ilam City.
MATERIAL AND METHODS
In this descriptive-correlational study, according to pre-
vious studies conducted in the eld (Seyedoshohadaee,
Kaghanizade et al. 2016), 250 individuals with diabetes
in Ilam City participated in the study. The inclusion cri-
teria were residence in the city of Ilam, ability to read
and write, having type II diabetes, and lack of known
mental disorders. In this study, the participants were
selected using convenience sampling; accordingly, the
researcher went to the Shahid Mostafa Khomeini and
Imam Khomeini hospitals in Ilam City every morning
and gave the questionnaire to diabetes patients who
met the inclusion criteria. The questionnaires were com-
pleted through self-report.
To collect the health literacy data, the Persian version
of the Test about Functional Health Literacy in Adults
(TOFHLA) was used, which was previously validated
by Tehrani Bani Hashemi et al. (Tehrani Banihashemi,
Amirkhani et al. 2007). The questionnaire consists of
two parts of computation and reading comprehension.
The reading comprehension part has 50 items and exam-
ines patients’ ability in reading authentic healthcare
texts. The computation part evaluates patients’ ability
to understand and act based on the recommendations
given to them by physicians and healthcare educators,
which require computation. This part contains 10 health
instructions or orders on prescribed drugs, time to go
to the doctor, stages of use of grants, and an example
of the result of a medical test. Each item in the read-
ing comprehension part was given 1 point (a total of
50 points), and the items (a total of 17) in the computa-
tion part were given a total of 50 points by multiplying
coef cients for an overall of 100 points for the items
in the questionnaire. Based on the point of separation
of 59 and 74, the participants’ health literacy level was
BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS THE RELATIONSHIP BETWEEN HEALTH LITERACY AND GENERAL HEALTH STATUS OF PATIENTS 139