ECHO: A Pilot Health Literacy Intervention to Improve Hypertension Self-Care

Abstract

Background: Medication adherence and diet and weight control are essential contributors to blood pressure management. Low health literacy is also associated with poor health behaviors and outcomes among adults with hypertension.

Objective: This study aims to pilot test the acceptability and feasibility of a brief health literacy intervention focused on hypertension self-care and to assess changes in self-care activities.

Methods: We recruited patients with hypertension who were treated at a low-cost clinic. A 2-hour evidence-based class was delivered in Spanish and English, and a telephone follow-up survey was conducted 1 month later. Intervention content included health literacy activities, nutrition education, and medication use. Participants engaged in reading, writing, a group activity, and critical discussion. Health literacy was measured using the Newest Vital Sign and the Test of Functional Health Literacy in Adults.

Key results: The intervention was delivered to 52 English- (52%) and Spanish-speaking adults (48%) with a mean age of 52.3 years (SD 7.9). More than one-half had Stage 1 or 2 hypertension (54%), and 56% had inadequate health literacy. At 1-month follow-up, participants showed improvement on all self-care measures with significant mean differences (p < .05) on diet adherence and weight management activities. These improvements were largely among Hispanics and those with low health literacy.

Conclusions: Results suggest that teaching targeted self-care skills in a brief health literacy intervention can be effective in improving self-care activities relating to diet and weight management among vulnerable populations. [HLRP: Health Literacy Research and Practice. 2019;3(4):e259-e267.].

Plain language summary: This study explored the effects of a 2-hour health education class on self-care behaviors. At the follow-up, participants reported better self-care behaviors. Effects were more pronounced among those with low health literacy, suggesting brief exposure to health education may improve high blood pressure in this population.