Assessment of the relationship of health literacy with the quality of life and treatment efficiency using the health literacy scale developed for hemodialized patients

Introduction: A great portion of patients diagnosed with end stage renal disease are under hemodialysis as renal replacement therapy. It is known that in this group, nonadherence to tthe treatment is associated with increased mortality rates, whereas patients health outcomes are known to get better with development of health literacy level. In this study we aimed to develop a specific health literacy assesment tool and evaluate the relationship between health literacy, quality of life and treatment adequacy with it. Material and Method: This is a cross sectional, methodological study. In this study we included 110 patients meeting our inclusion criterias that applied to the Department of Adult Neprology, Gazi University Health Research and Practice Center between March 02.2020 and October 15.2020. The inclusion criteria for our study were; patients older than 18 years old, patients who are undergoing minimum 6 months of dialysis, not having other health problems that may cause any blockage for reading and writing skills, and having no cognitive dysfunction. The study form we used to evaluate these patients in this study consisted of; a questionnaire assessing demographical informations, Short Form 36 Quality of life assesment tool, Turkey Helath Literacy Assesment Tool-32 and the draft form of health literacy assesment tool for hemodialysis patients. Items of the draft tool were determined according to expert opinion. The 22 item tool was applied to 110 patients. After statistical analyses non of the items were excluded and the final form of 22 item SOY-HD was developed. Results: 37,3% of patients were female. Mean age of all study population was 54,4 ± 15,9. Of all patients, 7,3% were literate, 33,6% were graduated from primary school, 13,6% were graduated from middle school, 27,3% were graduate from high school, 18,2% were graduated from a university. While 15,5% of patients were doing regular physical examination, 22,7% of study population were smoker. Of all patients, 54,5% started planned hemodialysis through follow up. 11,8% of patients had return to hemodialysis after transplantation rejection. In this study it's found that, SOY-HD scores had positive correlation of all domains of SF-36. Among demographic assesment, SOY-HD had negative correlation with age (r= - 0,290, p=0,002). There was a statistically significant difference between SOY-HD scores of the patients who were literate and patients who had any level of formal education (p=0,046). On the other hand, patients who had renal transplatation history seemed to have higher scores of SOY-HD than those who didn't (p=0,046). Patients with diabetes mellitus had lower SOY-HD scores than those who were without diabetes mellitus (p=0,027). Of those who started hemodialysis planned, those who had arteriovenous fistula/graft were seemed to have higher scores of SOY-HD than those who had central venous cathater (p=0,012). SOY-HD scores of the patients who had PTH level ≥ 350 pg/ml were significantly higher than those who had PTH levels < 350 pg/ml. Conclusion: SOY-HD is a reliable and validated tool for assesment of health literacy among Turkish hemodialysis patients. Among hemodialysis population, older age, having less formal education level and having diabetes mellitus are related to lower health literacy levels. Having renal transplantation history and arteriovenous fistula/graft are associated with higher SOY-HD scores. Higher health literacy levels are associated with better quality of life in all domains of SF-36.