Health literacy, negative emotional status, and self-care behaviors in dialysis

Introduction: renal failure patients with low health literacy are at an increased risk for poor self-care and negativehealth outcome. the purpose of the present study was to examine the prevalence of low health literacy, differences innegative emotional status and self-care behaviors by health literacy levels, and the mediating role of negative emotions onthe relationship between health literacy and self-care among patients undergoing dialysis.materials and methods: in the cross-sectional study, we recruited 240 consecutive patients diagnosed with end stagerenal disease (esrd) who had scheduled appointments at tehran university of medical sciences-affiliated dialysisunits from march 2014 until june 2014 based on the inclusion criteria. instrument include: mini mental state exam,short test of health literacy for adults, depression, anxiety and stress scale-21 and self-management scale.results: the findings indicated that health literacy was inadequate in 25%, marginal in 9.8%, and adequate in 65.2% ofthe cases. depression, anxiety, stress and self-care scores differed significantly by health literacy levels (p<0.001,p<0.02, p<0.004, p<0.001 respectively). post-hoc pairwise comparisons indicated that those with inadequate healthliteracy had higher depression, anxiety and stress scores, and lower self-care compared to those with marginal or adequatehealth literacy. regression analyses indicated that, after controlling for education, health literacy was significantlyassociated with depression, anxiety, stress and self-care. in addition, depression, anxiety and stress were mediators ofhealth literacy and self care relationship.conclusion: these findings demonstrate the high prevalence of low health literacy. it also shows that health literacy is animportant consideration in promoting mental health and self-care behaviors among patients under dialysis