Impaired perception of cardiovascular risk and health literacy in individuals with high cardiovascular diseases risk from different socioeconomic levels in Antalya, Turkey
Ayşegül Ilgaz A , Ayşe Dağistan Akgöz A * and Sebahat Gözüm AA
Abstract
This study aimed to determine how the frequency of impaired perception of cardiovascular disease (CVD) risk is correlated with health literacy in individuals with high CVD risk in two regions with different socioeconomic levels.
A descriptive study was conducted. The Systematic Coronary Risk Estimation, recommended by the European and Turkish Cardiology Societies, provides recommendations based on individuals’ actual CVD risk levels. According to the Systematic Coronary Risk Estimation, participants suffering from diseases were identified as high and very high risk. The perception of risk was determined by subjectively assessing the risk level of the individuals. The European Health Literacy Survey Questionnaire was used. The Mann–Whitney U test, Chi-squared test and Spearman’s correlation analysis were used to analyse the data. We also conducted a logistic regression analysis to identify factors contributing to impaired perception of CVD risk.
A total of 384 individuals, aged between 40 and 70 years (with a mean age of 58.35 ± 8.33 years), were included in the study. These individuals had a high risk of CVD and were registered to family health centres from two different socioeconomic levels. Out of the 384 participants, 201 individuals belonged to the lower socioeconomic level region and 183 individuals belonged to the higher socioeconomic level region. A total of 61.7% of the participants with high CVD risk had an impaired perception of CVD risk. The health literacy level of 59.9% of individuals was either inadequate or problematic. The health literacy score of participants with impaired risk perception (29.59 ± 9.07) was lower than those with correct risk perception (35.83 ± 10.94; P < 0.001). Factors that affected the perception of CVD risk included age, education level, working status, occupation, a family history of CVD, the CVD risk assessment by health professionals and the recommendation of health professionals to individuals for CVD screening.
It is necessary for health care professionals to make risk assessments and perform interventions to improve health literacy to raise the awareness of individuals with high CVD risk on their actual risk.
Keywords: cardiovascular disease (CVD): risk assessment, community health: care, community health: nursing, community health: service, health behaviour, nursing: assessment, risk perception, SCORE.
References
Akgöz A, Gözüm S (2019) Cardiovascular disease risk in Turkish family health centers. Journal of Vascular Nursing 37, 117-124.
| Crossref | Google Scholar | PubMed |
Alwan H, William J, Viswanathan B, Paccaud F, Bovet P (2009) Perception of cardiovascular risk and comparison with actual cardiovascular risk. European Journal of Cardiovascular Prevention & Rehabilitation 16, 556-561.
| Crossref | Google Scholar | PubMed |
Andrade N, Alves E, Costa AR, Moura-Ferreira P, Azevedo A, Lunet N (2018) Knowledge about cardiovascular disease in Portugal. Revista Portuguesa de Cardiologia 37, 669-677.
| Crossref | Google Scholar | PubMed |
Andsoy II, Tastan S, Iyigun E, Kopp LR (2015) Knowledge and attitudes towards cardiovascular disease in a population of North Western Turkey: a cross-sectional survey. International Journal of Caring Sciences 8, 115.
| Google Scholar |
Bakan A, Yıldız M (2019) 21-64 Yaş Grubundaki Bireylerin Sağlık Okuryazarlık Düzeylerinin Belirlenmesine İlişkin Bir Çalışma. Sağlık ve Toplum 29, 33-40 [In Turkish].
| Google Scholar |
Cioe PA, Crawford SL, Stein MD (2014) Cardiovascular risk-factor knowledge and risk perception among HIV-infected adults. Journal of the Association of Nurses in AIDS Care 25, 60-69.
| Crossref | Google Scholar | PubMed |
Cowie A, Buckley J, Doherty P, Furze G, Hayward J, Hinton S, Jones J, Speck L, Dalal H, Mills J (2019) Standards and core components for cardiovascular disease prevention and rehabilitation. Heart 105(7), 510-515.
| Crossref | Google Scholar |
Diederichs C, Jordan S, Domanska O, Neuhauser H (2018) Health literacy in men and women with cardiovascular diseases and its association with the use of health care services – results from the population-based GEDA2014/2015-EHIS survey in Germany. PLoS ONE 13, e0208303.
| Crossref | Google Scholar | PubMed |
Furuya Y, Kondo N, Yamagata Z, Hashimoto H (2015) Health literacy, socioeconomic status and self-rated health in Japan. Health Promotion International 30, 505-513.
| Crossref | Google Scholar | PubMed |
Gatulytė I, Verdiņa V, Vārpiņa Z, Lublóy Á (2022) Level of health literacy in Latvia and Lithuania: a population-based study. Archives of Public Health 80, 166.
| Crossref | Google Scholar | PubMed |
Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Judd SE, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Mackey RH, Magid DJ, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, III, Moy CS, Mussolino ME, Neumar RW, Nichol G, Pandey DK, Paynter NP, Reeves MJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Wong ND, Woo D, Turner MB (2014) Heart disease and stroke statistics – 2014 update: a report from the American Heart Association. Circulation 129, e28-e292.
| Crossref | Google Scholar | PubMed |
Ilgaz A (2021) Bir Aile Sağlığı Merkezi’ne Kayıtlı Bireylerde Sağlık Okuryazarlığı Seviyesi ve İlişkili Faktörler. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi 8, 151-159.
| Crossref | Google Scholar |
Kim C, McEwen LN, Piette JD, Goewey J, Ferrara A, Walker EA (2007) Risk perception for diabetes among women with histories of gestational diabetes mellitus. Diabetes Care 30, 2281-2286.
| Crossref | Google Scholar | PubMed |
Ma T, Meng H, Ye Z, Jia C, Sun M, Liu D (2021) Health literacy mediates the association between socioeconomic status and productive aging among elderly Chinese adults in a newly urbanized community. Frontiers in Public Health 9, 647230.
| Crossref | Google Scholar | PubMed |
Maffei S, Meloni A, Deidda M, Sciomer S, Cugusi L, Cadeddu C, Gallina S, Franchini M, Scambia G, Mattioli AV, Surico N, Mercuro G, IGENDA Study Group (2022) Cardiovascular risk perception and knowledge among Italian women: lessons from IGENDA protocol. Journal of Clinical Medicine 11, 1695.
| Crossref | Google Scholar |
Magnani JW, Mujahid MS, Aronow HD, Cene CW, Dickson VV, Havranek E, Morgenstern LB, Paasche-Orlow MK, Pollak A, Willey JZ (2018) Health literacy and cardiovascular disease: fundamental relevance to primary and secondary prevention: a scientific statement from the American Heart Association. Circulation 138, e48-e74.
| Crossref | Google Scholar | PubMed |
Ministry of Health Turkish Public Health Institution (2015) Periodic health examinations and screening tests recommended in family medicine practice. Available at https://hsgm.saglik.gov.tr/depo/birimler/kronik-hastaliklar-ve-yasli-sagligi-db/Dokumanlar/Kitaplar/Periyodik_Muayene_Rehberi.pdf [Accessed December 2021]
Monsuez J-J, Pham T, Karam N, Amar L, Chicheportiche-Ayache C, Menasché P, Desnos M, Dardel P, Weill I (2017) Awareness of individual cardiovascular risk factors and self-perception of cardiovascular risk in women. The American Journal of the Medical Sciences 354, 240-245.
| Crossref | Google Scholar | PubMed |
Okyay P, Abacıgil F (2016) Türkiye sağlık okuryazarlığı ölçekleri güvenilirlik ve geçerlik çalışması. Available at https://ekutuphane.saglik.gov.tr/Yayin/530 [Accessed 20 July 2021]
Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney M-T, Corrà U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FDR, Løchen M-L, Löllgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, van der Worp HB, van Dis I, Verschuren WMM, Binno S, ESC Scientific Document Group (2016) 2016 European guidelines on cardiovascular disease prevention in clinical practice: the sixth joint task force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). European Heart Journal 37, 2315-2381.
| Crossref | Google Scholar |
Richards SH, Anderson L, Jenkinson CE, Whalley B, Rees K, Davies P, Bennett P, Liu Z, West R, Thompson DR, Taylor RS (2017) Psychological interventions for coronary heart disease. Cochrane Database of Systematic Reviews 4, CD002902 10.1002/14651858.CD002902.pub4.
| Google Scholar |
Stormacq C, Van den Broucke S, Wosinski J (2018) Does health literacy mediate the relationship between socioeconomic status and health disparities? Integrative review. Health Promotion International 34, e1-e17.
| Crossref | Google Scholar |
Sørensen K, Van den Broucke S, Fullam J, et al. (2012) Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health 12, 80.
| Crossref | Google Scholar |
Sørensen K, Pelikan JM, Röthlin F, Ganahl K, Slonska Z, Doyle G, Fullam J, Kondilis B, Agrafiotis D, Uiters E, Falcon M, Mensing M, Tchamov K, Broucke Svd, Brand H, on behalf of the HLS-EU Consortium (2015) Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU). The European Journal of Public Health 25, 1053-1058.
| Crossref | Google Scholar | PubMed |
Topuz I, Gözüm S (2022) A comparison of actual cardiovascular disease risks to the perceptions of middle-aged men: a cross-sectional study. Clinical and Experimental Health Sciences 12, 607-617.
| Crossref | Google Scholar |
TUİK (2018) Ölüm Nedeni İstatistikleri, 2018. Available at https://data.tuik.gov.tr/Bulten/Index?p=Olum-Nedeni-Istatistikleri-2018-30626#:~:text=%C3%96l%C3%BCm%20vakalar%C4%B1n%C4%B1n%20%38%2C4’,ile%20solunum%20sistemi%20hastal%C4%B1klar%C4%B1%20izledi.&text=%C4%B0skemik%20kalp%20hastal%C4%B1%C4%9F%C4%B1ndan%20sonra%20s%C4%B1ras%C4%B1yla,3%20ile%20hipertansif%20hastal%C4%B1klar%20g%C3%B6r%C3%BCld%C3%BC [Accessed 20 July 2020]
Turkish Society of Cardiology (TSC) (2012) European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). Archives of the Turkish Society of Cardiology 40, 1-8.
| Crossref | Google Scholar |
van der Heide I, Wang J, Droomers M, Spreeuwenberg P, Rademakers J, Uiters E (2013) The relationship between health, education, and health literacy: results from the Dutch adult literacy and life skills survey. Journal of Health Communication 18, 172-184.
| Crossref | Google Scholar | PubMed |
White S, Bissell P, Anderson C (2010) Patients’ perspectives on cardiac rehabilitation, lifestyle change and taking medicines: implications for service development. Journal of Health Services Research & Policy 15, 47-53.
| Crossref | Google Scholar | PubMed |
WHO (2016) Disease burden and mortality estimates. Available at https://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html [Accessed 20 July 2020]
Yan J, You L-M, Yang Q, Liu B, Jin S, Zhou J, Lin C, Morisky DE (2014) Translation and validation of a Chinese version of the 8-item Morisky medication adherence scale in myocardial infarction patients. Journal of Evaluation in Clinical Practice 20, 311-317.
| Crossref | Google Scholar | PubMed |