Document Type : Original Article

Authors

1 Department of Environmental Health Engineering, Research Center of Health, Safety and Environment, Evaz Faculty of Health, Larestan University of Medical Sciences, Larestan, Iran

2 Department of Medical-Surgical Nursing, School of Nasibeh Nursing and Midwifery, Mazandaran University of Medical Sciences, Educational Instructor of Nasibeh Nursing and Midwifery School, Sari, Iran Department of Health in Disaster and Emergency, School of Health Management and Information Sciences, International Campus, Iran University of Medical Sciences, Tehran, Iran

3 Department of Health Services Management, Guilan University of Medical Sciences, Rasht, Iran

4 Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran

5 Deputy of Education, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

BACKGROUND: The literacy level of the elderly is predictive of health behaviors, average
hospitalization in health centers, and the type of verbal interaction with health service providers;
as the level of literacy changes, the quality of life may also change. This study aimed to determine
the relationship between health literacy level and quality of life among the elderly living in nursing
homes in 2018–2019.
MATERIALS AND METHODS: This study was of a descriptive‑analytic, correlation type that was
performed on 175 elderly of selected nursing homes in Tehran. The research tools included the
Abbreviated Mental Test; Control, Autonomy, Pleasure and Self‑realization questionnaire‑19;
and Health Literacy of Iranian Adults Questionnaire (HELIA). Data were analyzed using descriptive
and inferential statistics by SPSS 22 software.
RESULTS: The total score of health literacy and the quality of life of the elderly was 51.01 and
47.75, respectively. The literacy of most of the studied samples was “inadequate” and “not much
adequate” (0–66). The relationship between health literacy and quality of life in the elderly was
significant, and there was a direct and statistically significant relationship between them (P = 0.003).
That is, by an increase in literacy rates, the scores of quality of life of elderly people were also
increased. The correlation was equal to r = −0.28. Health literacy has the ability (31.98%) to predict
the quality of life.
CONCLUSION: The results showed a lack of enough education literacy, the average quality of life,
and the existence of a significant relationship between health literacy and quality of life in the elderly.
The wide range of inadequate literacy in the elderly reveals the importance of paying more attention
to the issue of literacy in health planning and health promotion at the national and local levels.

Keywords

1. Zarei F, Mohammadi M, Gatabi KA, Ghanbari Moghaddam A.
General health and its related factors among elderly in Sabzevar
2016. J Gerontol 2017;2:26‑33.
2. Shankar A, McMunn A, Steptoe A. Health‑related behaviors in
older adult’s relationships with socioeconomic status. Am J Prev
Med 2010; 38:39‑46.
3. Ghanbari Moghadam A, Mohammadi Shahbolaghi F, Dalvandi A,Hoseinzade S. Relationship between lifestyle and general health
among elderly people in Tehran. Salmand: Iran J Ageing.
2015;10:90‑9.
4. Reisi M, Mostafavi F, Hasanzadeh A, Sharifirad G. The
relationship between health literacy, health status and healthy
behaviors among elderly in Isfahan, Iran. J Health Syst Res
2011;7:469‑79.
5. Tehrani H, Rahmani M, Jafari A. Health literacy and its
relationship with general health of women referring to health
care centers. J Health Lit 2017;3:191‑8.
6. Singh S, Acharya SD, Kamath A, Ullal SD, Urval RP. Health
literacy status and understanding of the prescription instructions
in diabetic patients. J Diabetes Res 2018; 4517243. doi.
org/10.1155/2018/4517243.
7. Borji M, Tarjoman A, Otaghi M, Salimi E, Naseri A. Health literacy
level and its related factors among the elderlies in Ilam in 2015.
Iran J Nurs 2017;30:33‑43.
8. Higgins JW, Begoray D, MacDonald M. A social ecological
conceptual framework for understanding adolescent health
literacy in the health education classroom. Am J Community
Psychol 2009;44:350‑62.
9. Ann MR. “Associations among Health Literacy Levels and
Health Outcomes in Pregnant Women with Presentational and
Gestational Diabetes in an Urban Setting”; 2009. Theses and
Dissertations (ETD). Paper, No. 173.
10. Tung HH, Lu T, Chen LK, Liang S, Wu S, Chu K. Health literacy
impact on elderly patients with heart failure in Taiwan. J Clin
Gerontol Geriatr 2014;5:72‑6.
11. Nakayama K, Osaka W, Togari T, Ishikawa Y, Yonekura Y,
Sekido A, et al. Comprehensive health literacy in Japan is lower
than in Europe: A validated Japanese‑language assessment of
health literacy. BMC Public Health 2015;15:1‑12.
12. Paasche‑Orlow MK, Parker RM, Gazmararian JA,
Nielsen‑Bohlman LT, Rudd RR. The prevalence of limited health
literacy. J Gen Intern Med 2005;20:175‑84.
13. Mohseni M, Khanjani N, Iranpour A, Tabe R, Borhaninejad VR.
The relationship between health literacy and health status among
elderly people in Kerman, Iran. Iran J Ageing 2015;10:146‑55.
14. Panahi R, Osmani F, Sahraei M, Ebrahimi S, Nehadghashti MS,
Javanmardi E. Relationship of health literacy and quality of
life in adults residing in Karaj, Iran. J Educ Community Health
2018;4:13‑9.
15. Baernholdt M, Hinton I, Yan G, Rose K, Mattos M. Factors
associated with quality of life in older adults in the United States.
Qual Life Res 2012;21:527‑34.
16. Esmaeili R, Esmaeili M. Quality of life in the elderly:
A meta‑synthesis. J Res Relig Health 2018;4:105‑16.
17. Lee SY, Tsai TI, Tsai YW, Kuo KN. Health literacy, health status,
and healthcare utilization of Taiwanese adults: Results from a
national survey. BMC Public Health 2010;10:614.
18. Bakhtiyari F, Foroughan M, Fakhrzadeh H, Nazari N, Najafi B,
Alizadeh M, et al. Validation of the Persian version of abbreviated
mental test (AMT) in elderly residents of Kahrizak Charity
Foundation. Iran J Diabetes Metab 2014;13:487‑94.
19. Montazeri A, Tavousi M, Rakhshani F, Azin A, Jahangiri K,
Ebadi M, et al. Health literacy for Iranian adults (HELIA):
Development and psychometric properties. Payesh 2014;13:589‑99.
20. Heravi‑Karimooi M, Rejeh N, Garshasbi A, Montazeri A,
Bandari R. Psychometric properties of the Persian version of the
quality of life in early old age (CASP‑ 19). Iran J Psychiatry Behav
Sci 2018;12:e8378.
21. Fahim F, Sofi MR. The relationship between health literacy and
physical activity level of elderly women in the city of Urmia.
J Health Lit 2017;2:12‑21.
22. Kooshyar H, ShoorvaziM, DalirZ, HosseiniM. Health literacy and
its relationship with medical adherence and health‑related quality
of life in diabetic community‑residing elderly. J Mazandaran Univ
Med Sci 2014;23:134‑43.
23. Smith KH. Aging and health literacy. J Consum Health Internet
2014;18:94‑100.
24. Kutner M, Greenberg E, Jin Y, Paulsen C. The Health Literacy of
America’s Adults: Results from the 2003 National Assessment of
Adult Literacy (NCES 2006–483). U.S. Department of Education.
Washington, DC: National Center for Education Statistics; 2006.
25. von Wagner C, Knight K, Steptoe A, Wardle J. Functional health
literacy and health‑promoting behaviour in a national sample of
British adults. J Epidemiol Community Health 2007;61:1086‑90.
26. Matthews LA, Shine AL, Currie L, Chan CV, Kaufman DR.
A nurse’s eye‑view on health literacy in older adults. NI
2012 (2012) 2012;2012:204.
27. Azadi A, Taghineghad H, Azizi M, Mahmodi Y, Jamalaldin H.
Scrutiny the quality of life elderly in Ilam and its related factors
in 2015. Sci J Nurs Midwifery Paramed Fac 2016;2:29‑37.
28. Izadi S, Khamehvar A, Aram SS, Nozari AY. Social support and
quality of life of elderly people admitted to rehabilitation centers.
J Mazandaran Univ Med Sci 2013;23:101‑9.
29. Alipour F, Sajadi H, Foruzan A, Biglarian A, Jalilian A. Elderly
quality of life in Tehran’s district two. Salman Iran J Ageing
2008;3:75‑83.
30. Babak A, Daneshpajouhnejad P, Davari S, Aghdak P, Pirhaji O,
Jahangiri P. Quality of life among the elderly under the protection
of health and treatment centers in Isfahan Province, Iran, and its
relationship with depression and body mass index. J Isfahan Med
Sch 2016;34:885‑92.
31. Wu TY, Chie WC, Kuo KL, Wong WK, Liu JP, Chiu ST, et al.
Quality of life (QOL) among community dwelling older people
in Taiwan measured by the CASP‑19, an index to capture QOL
in old age. Arch Gerontol Geriatr 2013;57:143‑50.
32. Knesebeck OV, Wahrendorf M, Hyde M, Siegrist J.
Socio‑economic position and quality of life among older people
in 10 European countries: Results of the SHARE study. Ageing
Soc 2007;27:269‑84.
33. Bowling A, Hankins M, Windle G, Bilotta C, Grant R. A short
measure of quality of life in older age: The performance of the
brief older people’s quality of life questionnaire (OPQOL‑brief).
Arch Gerontol Geriatr 2013;56:181‑7.
34. Hyde M, Wiggins RD, Higgs P, Blane DB. A measure of quality
of life in early old age: The theory, development and properties
of a needs satisfaction model (CASP‑19). Aging Ment Health
2003;7:186‑94.
35. Wiggins R, Netuveli G, Hyde M, Higgs P, Blane D. The evaluation
of a self‑enumerated scale of quality of life (CASP‑19) in the
context of research on ageing: A combination of exploratory and
confirmatory approaches. Soc Indic Res 2008;89:61‑77.
36. Lima FM, Hyde M, Chungkham HS, Correia C ,
Campos AS, Campos M, et al. Quality of life amongst older
Brazilians: A cross‑cultural validation of the CASP‑19 into
Brazilian‑Portuguese. PLoS One 2014;9:e94289.
37. Sexton E, King‑Kallimanis BL, Conroy RM, Hickey A.
Psychometric evaluation of the CASP‑19 quality of life scale in
an older Irish cohort. Qual Life Res 2013;22:2549‑59.
38. Miranda LC, Soares SM, Silva PA. Quality of life and associated
factors in elderly people at a reference center. Cien Saude Colet
2016;21:3533‑44.
39. Bornet MA, Truchard ER, Rochat E, Pasquier J, Monod S. Factors
associated with quality of life in elderly hospitalised patients
undergoing post‑acute rehabilitation: A cross‑sectional analytical
study in Switzerland. BMJ Open 2017;7:e018600.
40. Soosova MS. Determinants of quality of life in the elderly. Cent
Eur J Nurs Midwifery 2016;7:484‑93.
41. Hosieni F, Mirzaei T, Ravari A, Akbary A. The relationship
between health literacy and quality of life in retirement Rafsanjan
University of medical sciences. J Health Lit 2016;1:92‑9.
42. Song L, Mishel M, Bensen JT, Chen RC, Knafl GJ, Blackard B, et al How does health literacy affect quality of life among men with
newly diagnosed clinically localized prostate cancer? Findings
from the North Carolina‑Louisiana prostate cancer project(PCaP).
Cancer 2012;118:3842‑51.
43. Macabasco‑O’Connell A, DeWalt DA, Broucksou KA, Hawk V,
Baker DW, Schillinger D, et al. Relationship between literacy,
knowledge, self‑care behaviors, and heart failure‑related quality of life
among patients with heart failure. J Gen Intern Med 2011;26:979‑86.
44. Wallace LS, Rogers ES, Weiss BD. Relationship between health
literacy and health‑related quality of life among Tennesseans.
Tenn Med 2008;101:35‑9.
45. Howard DH, Sentell T, Gazmararian JA. Impact of health literacy
on socioeconomic and racial differences in health in an elderly
population. J Gen Intern Med 2006;21:857‑61.