Self-care in hypertension is one of the most significant strategies in order to control the disease; moreover, health literacy and social support are regarded as effective factors in this case. Therefore, considering the necessity and need of society in promoting the level of health literacy and social support, as well as the role and importance of self-care in hypertension, the aim of the present study was to determine the relationship between self-care behavior and health literacy and social support in patients suffering from hypertension.

 

The descriptive-analytical study was cross-sectional and was conducted on 400 patients with hypertension referring to the specialized heart clinic of Tohid Hospital in Sanandaj, Iran, using the convenience sampling method. The Four-part Demographic Questionnaire, the Self-Care Behavior Assessment Questionnaire, the Health Literacy for Iranian Adults Questionnaire and Social Support Questionnaire were used so as to collect the data. To analyze the data, SPSS software version 21 (SPSS Inc., Chicago, Ill., USA) and parametric tests of Pearson correlation coefficient and non-parametric Kruskal-Wallis analysis were used.

Based on the results of this study, the mean and standard deviation of general self-care behavior (38.64 ± 8.83) was evaluated at a weak level, which was reported by the results of the study of Shabibi et al. in which the mean score of self-care behaviors was 31.34 ± 8.89 [19]. The results of the present study are completely consistent with the study of Rahimi et al. [20], Firooz et al. [21], and Allahyari et al. [22]. The results of Newell et al.'s study also reported unsatisfactory self-care behaviors in patients with hypertension [23], which is consistent with the results of the present study. However, the findings of the present study differ from the results of Peyman et al.'s study, which might be due to the statistical population and the dominant culture [24].
According to the researcher, the existence of cultural and economic issues in society and the resulting psychological pressures and lack of awareness about the effects of non-compliance with the principles of treatment and care has caused a low percentage of self-care behaviors in society. In the present study, the mean and standard deviation of the health literacy score was 63.10 ±11.16, indicating the community's low level of health literacy.
Based on the results of the present study, social support in society was assessed at the desired level (91.54 ± 6.93), which indicates the high level of social support in society, which is in line with the results of one study [30], but different from the studies by Mirzaei, Moghimbeigi and Arabi and Mardanian Dehkordi and Kahangi that had moderate to low levels of social support. That could be due to differences in the research community [31, 32].
The present study results indicate a significant relationship between self-care behavior and health literacy; in other words, those who have higher health literacy are committed more to self-care. Chen et al. also reported a positive relationship between health literacy and self-care adherence [34].
The results of the present study show that there is a significant relationship between self-care behavior and social support. In other words, increasing adherence to self-care behaviors is a factor that will increase the demand for social support, which is consistent with the results of Taher et al. [32]. Also, in the study of Alizadeh et al., a positive and significant correlation was reported between social support and adherence to self-care behaviors in patients with heart failure [33].
There is evidence that social support has protective effects on patients. Lack of social support is an important predictor of hospital readmission and patient mortality; therefore, it is suggested that due to the effective presence of family members, especially the spouse in the course of treatment, which is the most crucial supportive factor, by increasing attention and love for patients, the ability to adapt to the disease can be increased and the risk of recurrence can be significantly reduced. In fact, people who receive good social support from family, friends and medical staff experience happiness and life satisfaction. In other words, social support is the key to increasing self-esteem, reducing self-blame, and being less threatening. It leads to a better understanding of illness and problems and adaptation.
In other words, health promotion is the process of enabling people to control their health and the factors that affect it. People with inadequate health literacy are less able to evaluate information, understand the quality of information and trust it, and have less information about their health status, and may reduce treatment success by misusing their health information, misusing medications, disobeying their doctor, and participating less in treatment decisions. Therefore, in order to strive to increase people's health literacy, in addition to increasing their access to educational content, it is essential to ensure that people understand these issues and have the necessary ability to make decisions based on them. Because without sufficient understanding of health information, decision making will lead to adverse health consequences and rejection of related responsibilities. This is possible when the individual goes through this process with the support of family and community. Overall, health literacy and social support have a positive and significant correlation with health-promoting behaviors, and both can predict health-promoting behaviors. 

 

The results of the present study showed that having health literacy and social support would influence the individual and the occurrence of self-care behaviors, and since these cases are highly effective in preventing and controlling hypertension, it is necessary to train and promote them in the health system. 

 

This article is the result of a research project approved by the Kurdistan University of Medical Sciences. We would like to thank the Vice-Chancellor for Research and Technology of the University for his financial support, as well as all the loved ones who have cooperated with us and helped us in this research.
 
 

The authors declared no conflict of interest.