Discussion
illness, cardiovascular disease, ’, hypertensive, heart failure, hypertension
CARDIOVASCULAR DISEASE, DISEASE, AIDS, HEART FAILURE, HYPERTENSION, COMPLICATIONS
According to the findings of the present study, the intervention based on programmed instruction led to an improvement in the health literacy of patients in the areas of reading, understanding and comprehension, and decision-making. It also resulted in an increase in the average systolic blood pressure and medication adherence in the intervention group than control group.This study employed plain language, physiological and anatomical terminologies, visual aids, and interactive activities to engage patients in the learning process. The study found that the intervention improved patients’ understanding of hypertension and its management, and promoted active involvement in decision-making. Additionally, the use of M-health as a shared decision-making tool improved patients’ adherence to medication.Having reading skill in the health literacy contributes patients to read and understand the concepts and instructions written on medicine bottles, appointment slips, and other essential health related materials. Some studies defined health literacy with great focus on the domain of reading.Therefore, print literacy included reading and writing (the ability to decode letters and sound out words) has dominated the concept in health literacy so far. The focus on print literacy has yielded profound insights into difficulties and barriers linking literacy skills to health outcomes [The results of the present study are consistent with the findings of previous studies. Peyman et al. (2016) reported a significant increase in the mean score of health literacy among patients after an educational intervention [In the present study, the mean score of the comprehension of the patients improved after the intervention, representing the effect of the intervention on the health literacy of the patients. Indeed, it is expected that hypertensive patients who have a better understanding of the etiology, mechanism, and complications of the disease will be more likely to adhere to their medication and experience fewer complications. Improved health literacy can empower patients to make informed decisions about their treatment, engage in self-management strategies, and effectively communicate with healthcare providers. This can ultimately lead to better medication adherence and improved health outcomes in hypertensive patients.Adherence to healthy behaviors depends on patients’ understanding of their condition, treatment, and the benefits of lifestyle modification. The self-regulation model of illness perception suggests that the cognitive responses patients develop about their illness can influence their choice and appraisal of coping strategies [In line with the results of the present study, Inglis et al. (2016) introduced M-health as a tool for the education of heart failure patients and reported that the use of M-health to manage heart failure detects and reduces symptoms, prevents hospitalization, improves quality of life, increases patient knowledge and self-care behaviors, preventing disease exacerbation, and helps to adhere to medication [Programmed instruction is an individual educational method, dividing subject materials into small units and presenting them gradually in a sequential order. People study these materials step by step, and after completing each step and before entering the next step, they answer the test questions to assess their understanding and the health literacy of the person is improved in this way. Since hypertension with hidden nature is considered as a risk factor for cardiovascular disease and a predictor of cardiovascular disease mortality, the nature of hidden symptoms of hypertension can reduce the patients’ medication adherence, as hypertensive patients may experience few physical symptoms, leading to non-medication adherence. Mobile phone technology (M-health) can play a key role in controlling hypertensive patients’ health. Therefore, it is possible to reduce costs and the number of hospitalizations, and ultimately, empower patient without direct supervision of healthcare personnel using M-health. Programmed instruction in the electronic platform allows the patient to read the educational materials many times and benefit from the categories of reading, practice, and repetition. These findings suggest that utilizing an application and a hands-on approach can enhance health literacy and improve patient outcomes.