Health literacy of Sesotho-speaking patients with end-stage renal disease in the Free State province
Van Rensburg, Elsabet
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Background: End-stage renal disease is a global health concern, and health literacy is essential for managing this complex disease. In South Africa, the health literacy status of Sesotho-speaking patients is unknown. Meaningful data will only be generated if health literacy is tested and local context, and cultural and dialectal diversity is taken into consideration. Aim: This study aimed to assess the health literacy of Sesotho-speaking patients with end-stage renal disease in the Free State province of South Africa. Objectives: The objectives were to establish the health literacy association between Sesotho-speaking patients with end-stage renal disease in the Free State province who received haemodialysis and peritoneal dialysis at private and public dialysis centres in this province. Methodology: The researcher followed a quantitative, descriptive, cross-sectional design. The research technique used was the culture- and context-sensitive Sesotho Health Literacy Test (SHLT). Patients receiving haemodialysis and peritoneal dialysis in the private and public healthcare sectors in four towns of the Free State province were included in the study (N=420). Convenience sampling (n=263) was used to collect data. Frequencies and percentages for categorical data and medians and percentiles for numerical data were calculated per group. Associations were calculated utilising the Chi-square or Fisher’s exact tests for categorical data and the Kruskal-Wallis test for numerical data. Results: The researcher studied 263 respondents: 57.4% (n=151) were from the public sector, 74.9% (n=197) received haemodialysis, and 25.1% (n=66) were on peritoneal dialysis. Male gender predominated, with 60.3% (n=158) men, and the median age of respondents was 49 years. The majority (58.4%) of respondents had an education level between Grade 9 and 12. Hypertension (91.3%) and diabetes mellitus (27%) were the highest reported comorbidities. Respondents had been on renal replacement therapy for a median of four years, and 46.8% reported having problems reading due to inadequate eyesight. Low health literacy levels were identified in 12.9% (n=34), moderate health literacy levels in 49.4% (n=130), and high health literacy levels in 37.6% (n=99) of the respondents. Low health literacy levels were significantly associated (p<0.01) with lower education levels. Lower health literacy levels were not associated with healthcare sector groups (p=0.58), treatment modalities (p=0.80), gender (p=0.20), age (p=0.06), years on dialysis (p=0.50) or with a higher number of comorbidities (p=0.81). However, a significant association (p<0.01) was reported between lower health literacy levels and the scores obtained in appraisal and understanding questions. Recommendations: The South African Renal Society could possibly implement context- and culture-related health literacy assessment for end-stage renal disease patients when they are diagnosed. Training institutions could integrate health literacy training into the education of healthcare workers in the dialysis field. End-stage renal disease patients could benefit if they received education and training from dialysis role players in their home language. End-stage renal disease patients’ health outcomes could improve if the staff-to-patient ratio was 1:4. Health literacy levels of end-stage renal disease patients should be considered when selection for renal replacement therapy in the public sector, and selection for transplant in both sectors take place. Education and training of end-stage renal disease patients should be related to the language, cultural and environmental context of living of the patient, education level and age of the patient, whether the patient has inadequate eyesight, and the patients’ health literacy level. Knowledge about emergencies, the influence of lifestyle, understanding of prescriptions, volume measurement, tuberculosis and hepatitis B, and the impact of nephrotoxic medications have to be reinforced during patient training. Conclusion: The health literacy of Sesotho-speaking end-stage renal disease patients was unknown. The SHLT was applicable for assessing the health literacy of these patients. Almost 50% of Sesotho-speaking end-stage renal disease patients have difficulties with measurement, possess inadequate knowledge about health, nutrition and exercise, and experience problems following medication prescriptions. This study suggests that end-stage renal disease patients’ health literacy status should be known, to improve self-management and health outcomes.