关键词: 高血压, 健康素养, 自我管理行为, 影响因素分析

Abstract: Background　According to the guideline for high blood pressure updated in 2017 by the American Heart Association，more people may be diagnosed with hypertension.High self-management level can better delay the progression of hypertension and prevent hypertension-related complications.Health literacy，an important factor involving in self-management，but its effect on self-management behaviors in hypertension patients has not come to a conclusion.Objective　To explore the effect of health literacy on self-management behaviors in patients with hypertension.Methods　By use of convenience sampling，hypertension patients were recruited from 3 grade A tertiary general hospitals（Beichen District Hospital of TCM，Tianjin Third Central Hospital，The Second Hospital of Tianjin Medical University），and 4 community health institutions（Wenchang Community Health Center，Sixindao Community Health Station，Machangdao Community Health Center and Xinxing Community Health Center） from July to August 2018.A self-designed general information questionnaire was used to collect the basic data of the patients，including gender，age，height，body weight，place of residence，marital status，household size，course of hypertension，medication treatment，first diagnosis institution，first healthcare-seeking behavior，adherence to drug treatment，main reasons for adjusting drug treatment，drug adjustment following the advice from healthcare workers）.The Chinese version of the Health Literacy Management Scale（HeLMS-C），translated and adapted by SUN Haolin based on the HeLMS-C originally developed by Professor Jordan and others from The University of Melbourne，was used to assess the health literary level.Hypertension Patients Self-Management Behavior Rating Scale（HPSMBRS） was used to evaluate self-management behaviors.The relationships of HeLMS-C and its domains with self-management level were analyzed.And the impact of impact of health literacy on self-management behaviors was explored.Results　A total of 250 patients participated in the survey，and 248 of them（99.2%） responded effectively.The mean total score of the HeLMS-C was（90.8±10.1）.And the mean scores for 4 domains from high to low were（93.6±12.3） for patient attitudes towards their health，（90.5±11.2） for being proactive and using health information，（90.2±15.4） for socioeconomic considerations，and（89.9±13.3） for communication with health professionals，respectively.The mean total score of HPSMBRS was（73.7±14.2）.And the mean scores for 6 domains from high to low were（78.4±22.1） for medication management，（77.6±16.7） for emotional management，（74.6±17.3） for rest and work management，（73.7±15.6） for diet management，（67.4±20.9） for condition monitoring，and（64.9±21.9） for exercise management，respectively.The mean total score of HPSMBRS differed significantly by age，place of residence，household size，occupation，prevalence of drinking，history of hypertension，diagnostic institution，first healthcare-seeking behavior，adherence to drug treatment，main reasons for adjusting drug treatment，and drug adjustment status following the advice from healthcare workers（P<0.05）.The self-management level was positively associated with the total score of HeLMS-C，and the scores of domains of communication with health professionals，patient attitudes towards their health，and socioeconomic considerations（P<0.05），but had no linear association with being proactive and using health information（P>0.05）.Hierarchical multiple regression analysis found that health literacy level contributed 12.7% to the changes in self-management behaviors，in particular，patient attitudes towards their health，and socioeconomic considerations were associated with the changes in self-management behaviors（P<0.05）.Conclusion　The self-management level of patients with hypertension in Tianjin is moderate.The overall level is mainly affected by factors such as the place of residence，household size，adherence to drug treatment，patient attitudes towards their health，and socioeconomic considerations.To improve the self-management level in such patients，attention should be paid to the improvement of health literacy.

Key words: Hypertension, Health literacy, Self-management behavior, Root cause analysis