Effects of Health Literacy, Self-Efficacy, and Depression on Self Care Adherence in Patients with Ischemic Stroke

Abstract

Purpose: This study aimed to assess health literacy, self-efficacy, depression, and self-care adherence among patients with ischemic stroke and to identify factors associated with self-care adherence. Methods: This crosssectional survey included 192 patients with ischemic stroke who were receiving outpatient care after hospitalization at P University Hospital in B City. Data were collected from April 22 to September 3, 2024, using structured questionnaires. The data were analyzed using SPSS/WIN 28.0 with descriptive statistics, the independent t-test, one-way analysis of variance, Pearson's correlation coefficient, and multiple linear regression. Results: The mean scores were 61.46±8.48 for health literacy, 95.65±10.17 for self-efficacy, 12.40±9.35 for depression, and 87.81±10.03 for self-care adherence. Self-care adherence differed significantly according to age (F=9.56, p<.001), religion (t=-2.65, p=.009), monthly income (F=4.78, p=.009), and the presence of sequelae (t=3.51, p<.001). Self-care adherence was positively correlated with health literacy (r=.38, p<.001) and self-efficacy (r=.22, p=.003) and negatively correlated with depression (r=-.38, p<.001). Factors associated with self-care adherence were depression (β=-.36, p<.001), health literacy (β=.30, p<.001), age (β=.23, p=.001), monthly income of≥3 million KRW (β=-.23, p<.001), and monthly income of 2 million to <3 million KRW (β=-.15, p=.016). The model explained 36.0% of the variance in self-care adherence (F=14.41, p<.001). Conclusion: Self-care adherence among patients with ischemic stroke was interpreted as low in this study. Lower depression scores and higher health literacy were associated with higher self-care adherence. Nursing interventions and educational programs aimed at reducing depression and improving health literacy may help improve self-care adherence in patients with ischemic stroke.