Limited health literacy in CKD patients tied to poor self-care

Some patients with chronic kidney disease (CKD) appear to have limited health literacy (HL), which is associated with lower self-care, according to a Singapore study.

Additionally, self-care significantly correlates with self-efficacy and motivation and shows no association with age, race, education, CKD status, or household income.

Researchers conducted this cross-sectional, questionnaire-based study in a public primary care setting and recruited 289 participants with hypertension aged 21–80 years.

Self-care status among participants was measured using the Hypertension Self-Care Profile (HTN-SCP; range 0–240 domain range 0–80), while health literacy was assessed via the Short-Form Health Literacy Scale (HLS-SF12; range 0–50, limited literacy ≤33).

Of the participants, 31.1 percent had limited HL. The median HL score was 34.7, while their mean self-care score was 182.7. Self-care did not correlate with age, CKD status, education, and household income but was associated with gender and HL score. [Singapore Med J 2025;66:307-313]

This finding was in contrast with that of a previous study, which found better self-care behaviour among older patients and better disease knowledge among younger patients. In addition, self-care behaviour also improved in patients as their renal function deteriorated. [Sci Rep 2021;11:401]

“The lack of association found in our study could be due to the [primary care] setting and demographics of our study participants,” the researchers said. “The majority of our participants (80.3 percent) had CKD 2 or 3, while 75.7 percent of them were between 55 and 74 years old.”

Self-care domains

In the final regression model, lower HL scores (adjusted β, 1.03, 95 percent confidence interval [CI], 0.7–1.36; p<0.001) and male gender (adjusted β, –5.29, 95 percent CI, –10.56 to –0.03; p=0.049) significantly correlated with lower self-care.

“This is consistent with an Australian study, even though the male population in our study may have been over-represented,” the researchers said. [Health Expect 2017;20:1375-1384]

“Low self-care score was also significantly associated with low HL score, which suggests that HL is likely a prerequisite for patients to acquire the relevant knowledge and apply the acquired knowledge in their behaviour,” they added. [J Pers Med 2021;11:447]

Furthermore, HL scores significantly correlated with the following self-care domains: self-efficacy (β, 0.30, 95 percent CI, 0.17–0.42; p<0.001), motivation (β, 0.40, 95 percent CI, 0.26–0.53; p<0.001), and behaviour (β, 0.38, 95 percent CI, 0.26–0.50; p<0.001).

Targeted approach

“Much more can be done in clinical practice to identify the one in three patients with CKD and limited HL to improve their HL,” said the researchers, noting a targeted approach that includes greater awareness among physicians and proactive education and engagement for CKD patients with low HL. A quick screening tool for HL could also help, they added.

"Beyond physician- or clinic-level efforts, perhaps a more systematic or program-based approach towards patients with CKD to improve HL would be more effective [in improving] clinical outcomes,” the researchers said. 

“These efforts could focus beyond improving HL to also work on improving patient self-efficacy, confidence, and motivation,” they added.

“Future research could focus on more targeted approaches to improve self-care and HL among patients with CKD,” the researchers said.