Self-efficacy and self-management mediate the association of health literacy and quality of life among patients with TB in Tibet, China: a cross-sectional study

Abstract Background This study aimed to analyze the relationship between health literacy and quality of life in patients with TB in Tibet and explore the mediating effects of self-efficacy and self-management in the relationship between health literacy and quality of life. Methods We used a convenience sampling method to select 271 cases of patients with TB in Tibet to conduct a survey of their general information, health literacy, self-management, self-efficacy and quality of life, and to construct structural equation models. Results The total health literacy score of patients with TB in Tibet was 84.28±18.57, while the lowest score was for information acquisition ability (55.99±25.66). Scores for quality of life were generally lower than the norm (patients with chronic diseases from other cities in China) (p<0.01). Moreover, self-efficacy and self-management mediated the relationship between health literacy and quality of life (p<0.05). Conclusions In Tibet, patients with TB have a low level of health literacy and an average level of quality of life. Emphasis should be placed on improving information access literacy, role-physicals and role-emotional to improve overall quality of life. The mediating roles of self-efficacy and self-management between health literacy and quality of life may provide a basis for further interventions.

[1]  Minghuan Wang,et al.  Universal health coverage in China: a serial national cross-sectional study of surveys from 2003 to 2018. , 2022, The Lancet. Public health.

[2]  E. Tornu,et al.  Correlates of quality of life among persons living with tuberculosis: A cross-sectional study , 2022, PloS one.

[3]  Xuchao Yang,et al.  Inequalities of spatial primary healthcare accessibility in China. , 2022, Social science & medicine.

[4]  Fei Yao,et al.  Spatio-Temporal Differences in Economic Security of the Prefecture-Level Cities in Qinghai–Tibet Plateau Region of China: Based on a Triple-Dimension Analytical Framework of Economic Geography , 2022, International journal of environmental research and public health.

[5]  Huilan Xu,et al.  The Longitudinal Relationship Between eHealth Literacy, Health-Promoting Lifestyles, and Health-Related Quality of Life Among College Students: A Cross-Lagged Analysis , 2022, Frontiers in Public Health.

[6]  Yunting Chen,et al.  The relationship among social support, experienced stigma, psychological distress, and quality of life among tuberculosis patients in China , 2021, Scientific Reports.

[7]  K. Dainty,et al.  A qualitative study of perspectives on access to tuberculosis health services in Xigaze, China , 2021, Infectious Diseases of Poverty.

[8]  G. Caprara,et al.  Positivity and Self-Efficacy Beliefs Explaining Health-Related Quality of Life in Cardiovascular Patients. , 2021, Psicothema.

[9]  S. Praharaj,et al.  Psychological stress and health-related quality of life among tuberculosis patients: a prospective cohort study , 2021, ERJ Open Research.

[10]  Shi-liang Liu,et al.  Effects of the interaction among climate, terrain and human activities on biodiversity on the Qinghai-Tibet Plateau. , 2021, The Science of the total environment.

[11]  Qinghua Zhang,et al.  The effect of high blood pressure-health literacy, self-management behavior, self-efficacy and social support on the health-related quality of life of Kazakh hypertension patients in a low-income rural area of China: a structural equation model , 2021, BMC Public Health.

[12]  Stephanie Law,et al.  Acceptability, feasibility, and impact of a pilot tuberculosis literacy and treatment counselling intervention: a mixed methods study , 2021, BMC Infectious Diseases.

[13]  Z. Saleem,et al.  Association of health literacy and medication adherence with health-related quality of life (HRQoL) in patients with ischemic heart disease , 2021, Health and Quality of Life Outcomes.

[14]  K. Floyd,et al.  Epidemiology of Tuberculosis and Progress Toward Meeting Global Targets — Worldwide, 2019 , 2021, MMWR. Morbidity and mortality weekly report.

[15]  L. Santos-Martínez,et al.  Exposición crónica a la altura. Características clínicas y diagnóstico , 2021, Archivos de cardiologia de Mexico.

[16]  K. R. Amico,et al.  Dynamic needs and challenges of people with drug-resistant tuberculosis and HIV in South Africa: a qualitative study , 2021, The Lancet. Global health.

[17]  Guanghui Cui,et al.  Health-promoting behaviors mediate the relationship between eHealth literacy and health-related quality of life among Chinese older adults: a cross-sectional study , 2021, Quality of Life Research.

[18]  L. Yang,et al.  [Study on spatial clustering characteristics of tuberculosis in China, 2013-2018]. , 2020, Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi.

[19]  Pengtao Liu,et al.  Spatiotemporal characteristics and the epidemiology of tuberculosis in China from 2004 to 2017 by the nationwide surveillance system , 2020, BMC Public Health.

[20]  Ke Ju,et al.  Spatial inequality, characteristics of internal migration, and pulmonary tuberculosis in China, 2011–2017: a spatial analysis , 2020, Infectious Diseases of Poverty.

[21]  Jinjing Zhang,et al.  Factors Influencing Medication Nonadherence to Pulmonary Tuberculosis Treatment in Tibet, China: A Qualitative Study from the Patient Perspective , 2020, Patient preference and adherence.

[22]  H. Gu,et al.  Inequalities in health-related quality of life and the contribution from socioeconomic status: evidence from Tibet, China , 2020, BMC Public Health.

[23]  P. Hong,et al.  Illness prevalence rate in Tibet, China: data from the 2018 National Health Service Survey , 2020, BMC Public Health.

[24]  A. Aggarwal.  Quality of life with tuberculosis , 2019, Journal of clinical tuberculosis and other mycobacterial diseases.

[25]  Wang Jing,et al.  Spatial distribution of tuberculosis and its socioeconomic influencing factors in mainland China 2013–2016 , 2019, Tropical medicine & international health : TM & IH.

[26]  J. Assmus,et al.  Self-management and health related quality of life in persons with chronic obstructive pulmonary disease , 2019, Quality of Life Research.

[27]  F. Tzelepis,et al.  Barriers to diabetic self-care: A qualitative study of patients' and healthcare providers' perspectives. , 2019, Journal of clinical nursing.

[28]  R. Fitzpatrick,et al.  Self-efficacy and health-related quality of life: a cross-sectional study of primary care patients with multi-morbidity , 2019, Health and Quality of Life Outcomes.

[29]  Xiaoning Li,et al.  The relationship between health literacy and quality of life: a systematic review and meta-analysis , 2018, Health and Quality of Life Outcomes.

[30]  Samantha R. Paige,et al.  Association Between Health Literacy, Electronic Health Literacy, Disease-Specific Knowledge, and Health-Related Quality of Life Among Adults With Chronic Obstructive Pulmonary Disease: Cross-Sectional Study , 2018, Journal of medical Internet research.

[31]  R. Dowse,et al.  An illustrated booklet for reinforcing community health worker knowledge of tuberculosis and facilitating patient counselling , 2018, African journal of primary health care & family medicine.

[32]  Y. Tong,et al.  Status of tuberculosis‐related stigma and associated factors: a cross‐sectional study in central China , 2018, Tropical medicine & international health : TM & IH.

[33]  Shengshou Hu,et al.  The primary health-care system in China , 2017, The Lancet.

[34]  Huanhuan Chen,et al.  Patient characteristics and perceived health status of individuals with HIV and tuberculosis coinfection in Guangxi, China , 2017, Medicine.

[35]  P. Yang,et al.  Infectious disease-specific health literacy in Tibet, China , 2016, Health promotion international.

[36]  Richard J. K. Taylor,et al.  The impact of health literacy and life style risk factors on health-related quality of life of Australian patients , 2016, Health and Quality of Life Outcomes.

[37]  Eun-Hyun Lee,et al.  A Structural Equation Model Linking Health Literacy to Self-efficacy, Self-care Activities, and Health-related Quality of Life in Patients with Type 2 Diabetes. , 2016, Asian nursing research.

[38]  S. Nicholas,et al.  Primary Care Quality among Different Health Care Structures in Tibet, China , 2015, BioMed research international.

[39]  P. Hill,et al.  Prevalence of tuberculosis in China , 2015, The Lancet.

[40]  X-F Gao,et al.  Quality of life of a migrant population with tuberculosis in West China. , 2015, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[41]  Abdoul Nasser Ibrahim,et al.  A Spatial, Social and Environmental Study of Tuberculosis in China Using Statistical and GIS Technology , 2015, International journal of environmental research and public health.

[42]  R. Buchbinder,et al.  The health literacy management scale (HeLMS): a measure of an individual's capacity to seek, understand and use health information within the healthcare setting. , 2013, Patient education and counseling.

[43]  Rick H. Hoyle,et al.  Three Approaches to Using Lengthy Ordinal Scales in Structural Equation Models , 2010, Applied psychological measurement.

[44]  Andrew Steptoe,et al.  Health Literacy and Health Actions: A Review and a Framework From Health Psychology , 2009, Health education & behavior : the official publication of the Society for Public Health Education.

[45]  K. Zulkosky.  Self‐Efficacy: A Concept Analysis , 2009 .

[46]  Kun Chen,et al.  [Reliability and validity of a Short-Form Health Survey Scale (SF-36), Chinese version used in an elderly population of Zhejiang province in China]. , 2008, Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi.

[47]  D. Nutbeam.  The evolving concept of health literacy. , 2008, Social science & medicine.

[48]  James H. Steiger,et al.  Understanding the limitations of global fit assessment in structural equation modeling , 2007 .

[49]  R. Gómez,et al.  The importance of being mature: the effect of demographic maturation on global per capita GDP , 2006 .

[50]  J. E. Cohen,et al.  Hypsographic demography: the distribution of human population by altitude. , 1998, Proceedings of the National Academy of Sciences of the United States of America.

[51]  K. Lorig.  Outcome measures for health education and other health care interventions , 1996 .

[52]  Keith F. Widaman,et al.  Unidimensional Versus Domain Representative Parceling of Questionnaire Items: An Empirical Example , 1994 .

[53]  M. Browne,et al.  Alternative Ways of Assessing Model Fit , 1992 .

[54]  Daniel D. Lee.  The Prevalence of Tuberculosis , 1891, The Journal of comparative medicine and veterinary archives.

[55]  Yongming Ding,et al.  Implementation and quantitative evaluation of chronic disease self-management programme in Shanghai, China: randomized controlled trial. , 2003, Bulletin of the World Health Organization.

[56]  E. L. Werner,et al.  Self-Management Skills in Chronic Disease Management: What Role Does Health Literacy Have? , 2022 .