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TB 2025, 24(2): 59-74 |
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Ethics code: IR.SSU.SPH.REC.1403.224
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Mousavi S M, Khaledi E, Bahariniya S, babaie zarch F, Bustani F. The Relationship between Health Literacy and Patient Satisfaction among Cardiac Patients with Staff: A Case Study at the Educational Hospital in Yazd. TB 2025; 24 (2) :59-74
URL: http://tbj.ssu.ac.ir/article-1-3742-en.html
URL: http://tbj.ssu.ac.ir/article-1-3742-en.html
Shahid Sadoughi University of Medical Sciences , elhamkhaledi76@gmail.com
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The Relationship between Health Literacy and Patient Satisfaction among Cardiac Patients with Staff: A Case Study at the Educational Hospital in Yazd
Seyed Masood Mousavi (Ph.D.)1, Elham khaledi (Ph.D.s)2, Sajjad Bahariniya (Ph.D.s)3, Fatemeh Babaei zarch (B.S.)4, Fatemeh Bustani (M.S.s)5
1. Assistant professor in Health Policy, Health Policy and Management Research Center, Department of Health Management and Economics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
2. Corresponding Author: Ph.D. Student, Student Research Committee, Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
Email: Elhamkhaledi76@gmail.com Tel: +989136941788
3. Ph.D. Student, Student Research Committee, Department of Healthcare Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
4. Bachelor Science in Healthcare Services Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
5. Master Science student in Healthcare Services Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Abstract
Introduction: Health literacy includes the ability of an individual to understand and evaluate health information in order to make the right decisions about improving their quality of life. The present study aimed to investigate the relationship between health literacy and satisfaction of heart patients with staff.
Methods: The present study was a descriptive-correlational study that was conducted cross-sectionally in 1403 on 131 cardiac patients at Afshar Hospital in Yazd. Data were collected using standard Iranian health literacy questionnaires (HELIA) and patient satisfaction questionnaires and analyzed using SPSS version 27 software.
Results: The mean patient satisfaction score was 79/96 ± 17/2 and the mean health literacy score was 61/18 ± 20/96, indicating insufficient health literacy. Among the health literacy dimensions, the highest mean score was related to the decision-making and use of health information dimension and the lowest score was related to the reading skills dimension. Among the patient satisfaction dimensions, the highest mean score was related to the medical staff dimension and the lowest score was related to the nursing staff dimension. Also, no significant relationship was observed between health literacy and patient satisfaction.
Conclusion: Although the overall relationship between health literacy and patient satisfaction was not significant, their different dimensions independently had coherent structures and were related to each other; in such a way that improving one dimension can lead to improving other dimensions. It is also recommended to hold workshops, produce simple and understandable educational content, and strengthen effective communication with patients in order to improve patient health literacy.
Keywords: Health literacy, Heart Diseases, Patient satisfaction, Afshar Hospital
Conflict of interest: The authors declared no conflict of interest.
References
1-Kazemi T, Bidokhti A, Riahi SM & et al. Cardiovascular Diseases, The Leading Cause of Death in South Khorasan Province: A two-decade study: Editorial Article. Journals of Birjand University of Medical Sciences. 2023;30(3):289-94.
2-Roth GA, Mensah GA, Johnson CO & et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. Journal of the American College of Cardiology. 2020;76(25):2982-3021.
3-Masaebi F, Salehi M, Kazemi M & et al. Trend analysis of disability adjusted life years due to cardiovascular diseases: results from the global burden of disease study 2019. BMC public health. 2021;21(1):1268.
4-Zhang NJ, Terry A, McHorney CA. Impact of health literacy on medication adherence: a systematic review and meta-analysis. Annals of Pharmacotherapy. 2014;48(6):741-51.
5-Kanejima Y, Shimogai T, Kitamura M & et al. Impact of health literacy in patients with cardiovascular diseases: A systematic review and meta-analysis. Patient education and counseling. 2022;105(7):1793-800.
6-Nutbeam D. The evolving concept of health literacy. Social science & medicine. 2008;67(12):2072-8.
7-Wu W-L, Yu L-W, Wu L. Health literacy and health outcomes in China’s floating population: mediating effects of health service. BMC Public Health. 2021;21(1):691.
8-Kanejima Y, Shimogai T, Kitamura M & et al. Impact of health literacy in patients with cardiovascular diseases: a systematic review and meta-analysis. Patient Education and Counseling. 2022;105(7):1793-800.
9-Wu JR, Reilly CM, Holland J & et al. Relationship of Health Literacy of Heart Failure Patients and Their Family Members on Heart Failure Knowledge and Self-Care. Journal of family nursing. 2017;23(1):116-37.
10-Berkman ND, Sheridan SL, Donahue KE & et al. Health literacy interventions and outcomes: an updated systematic review. Evidence report/technology assessment. 2011(199):1-941.
11-Mantwill S, Monestel-Umaña S, Schulz PJ. The Relationship between Health Literacy and Health Disparities: A Systematic Review. PloS one. 2015;10(12):e0145455.
12-Tavousi M, Mehrizi AH, Rafiefar Sh & et al. Health literacy in Iran: findings from a national study. Payesh (Health Monitor) Journal. 2016;15(1):95-102.
13-Kumar VA, Albert NM, Medado P & et al. Correlates of Health Literacy and Its Impact on Illness Beliefs for Emergency Department Patients With Acute Heart Failure. Critical pathways in cardiology. 2017;16(1):27-31.
14-Jennings CS, Astin F, Prescott E & et al. Illness perceptions and health literacy are strongly associated with health-related quality of life, anxiety, and depression in patients with coronary heart disease: results from the Euroaspire V cross-sectional survey. European Journal of Cardiovascular Nursing. 2023;22(7):719-29.
15-Al-Qerem W, Jarab A, Eberhardt J & et al. Health Literacy and Medication Adherence Among Patients with Type 2 Diabetes in Jordan: A Cross-Sectional Study. Patient preference and adherence. 2024;18:2019-26.
16-Altin SV, Stock S. The impact of health literacy, patient-centered communication and shared decision-making on patients' satisfaction with care received in German primary care practices. BMC health services research. 2016;16(1):450.
17-Oruç OA, Sener R. Multivariate analysis of the effect of health literacy levels on patient satisfaction in patients presenting to the emergency department. Medicine. 2025;104(24):e42789.
18-Hayran O, Özer O. Organizational health literacy as a determinant of patient satisfaction. Public health. 2018;163:20-6.
19-World, Health, Organization. Health literacy. Available from: https://www.who.int/news-room/fact-sheets/detail/health-literacy; 2024.
20-Magallón-Botaya R, Méndez-López F, Oliván-Blázquez B & et al. Effectiveness of health literacy interventions on anxious and depressive symptomatology in primary health care: A systematic review and meta-analysis. Frontiers in public health. 2023;11:1007238.
21-O’Neill B. Sample size determination with a pilot study. PLOS ONE. 2022;17:e0262804.
22-Montazeri A, Tavousi M, Rakhshani F & et al. Health Literacy for Iranian Adults (HELIA): development and psychometric properties. 2014.
23-Tavousi M, Haeri-Mehrizi A, Rakhshani F & et al. Development and validation of a short and easy-to-use instrument for measuring health literacy: the Health Literacy Instrument for Adults (HELIA). BMC public health. 2020;20(1):656.
24-Sahebzadeh M, Mansouri-Boroujeni F, Shaarbafchizadeh N. The Relationship Between Health Literacy and Satisfaction of Patients in Psychiatric Wards of Service Providers in Hospitals of Isfahan University of Medical Sciences, Iran. Health Information Management. 2021;18(2):60-5.
25-Ravaghi H, Salemi M, Behzadifar M & et al. Patients’ Satisfaction with Medical Emergency Services in Iran from 2000 to 2017: A Systematic Review and Meta-Analysis. Iranian Red Crescent Medical Journal (IRCMJ). 2018;20(s1):1-11.
26-Soleimanpour H, Gholipouri C, Salarilak S & et al. Emergency department patient satisfaction survey in Imam Reza Hospital, Tabriz, Iran. International journal of emergency medicine. 2011;4(6):2.
27-Shafiei MR, Haghshenas H, Shafiei N & et al. Investigating the Patients Satisfaction with Nursing Services in Imam Reza Hospital of Lar City during the Covid-19 Pandemic in 2020: A Short Report. Rums_Journal. 2022;21(2):245.
28-norouzinia r, Saeeidi N, Aghabarary M. Patient satisfaction with the medical services, hospital facilities, and the performance of the medical staff in the hospitals affiliated with Alborz University of Medical Sciences. Quarterly Journal of Nersing Management. 2023;12(2):100-8.
29-Zolhavarieh SM, Rezaei M, Karimi N & et al. Study of Patient’s Satisfaction at Urology Ward of
Shahid Beheshti Hospital, Hamadan University of Medical Sciences in the Second Half of 2018. Journal of Research in Urology. 2019;3(1):19-27.
30-Farajzadeh M, Karimi L, Mirjavadi S & et al. Survey of the patients’ satisfaction with services provided in an Iranian naval hospital in 2019: A cross-sectional study. Romanian Journal of Military Medicine. 2021;124:452-61.
31-Moslehpour M, Shalehah A, Rahman FF & et al. The Effect of Physician Communication on Inpatient Satisfaction. Healthcare (Basel, Switzerland). 2022;10(3).
32-Wang J, Kidd VD, Giafaglione B & et al. Improving Nurse-Physician Bedside Communication Using a Patient Experience Quality Improvement Pilot Project at an Academic Medical Center. Cureus. 2024;16(3).
33-Bahari Z, Vosoghi N, Ramazanzadeh N & et al. Patient trust in nurses: exploring the relationship with care quality and communication skills in emergency departments. BMC nursing. 2024;23(1):595.
34-Wang J, Kidd VD, Giafaglione B & et al. Improving Nurse-Physician Bedside Communication Using a Patient Experience Quality Improvement Pilot Project at an Academic Medical Center. Cureus. 2024;16(3):e55976.
35-Naz R, Khaleel S, Naz S. Evaluation Of Nurse-Patient Communication And Its Impact On Patient Satisfaction. Biological and Clinical Sciences Research Journal. 2024;2024:936.
36-Vazifeh S, Jafari N, Mehdizadeh S & et al. Health literacy of hypertensive patients and related factors: A cross sectional study. Payesh (Health Monitor) Journal. 2023;22(5):639-48.
37-Azizi Sani Dopolani SF, Shahbazi H, Lotfizadeh M & et al. The impact of educational intervention on enhancing the health literacy among middle-aged individuals at risk for cardiovascular diseases: a randomized cotrolled trial. BMC Public Health. 2025;25(1):2291.
38-Sørensen K, Levin-Zamir D, Duong TV & et al. Building health literacy system capacity: a framework for health literate systems. Health promotion international. 2021;36(Supplement_1):i13-i23.
39-Shahid R, Shoker M, Chu LM & et al. Impact of low health literacy on patients’ health outcomes: a multicenter cohort study. BMC Health Services Research. 2022;22(1):1148.
40-Altun R. The Relationship Between Health Literacy, Patient Satisfaction and Health Costs. Sabuncuoglu Serefeddin Health Sciences. 2021;3(3):29-39.
Seyed Masood Mousavi (Ph.D.)1, Elham khaledi (Ph.D.s)2, Sajjad Bahariniya (Ph.D.s)3, Fatemeh Babaei zarch (B.S.)4, Fatemeh Bustani (M.S.s)5
1. Assistant professor in Health Policy, Health Policy and Management Research Center, Department of Health Management and Economics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
2. Corresponding Author: Ph.D. Student, Student Research Committee, Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
Email: Elhamkhaledi76@gmail.com Tel: +989136941788
3. Ph.D. Student, Student Research Committee, Department of Healthcare Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
4. Bachelor Science in Healthcare Services Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
5. Master Science student in Healthcare Services Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Abstract
Introduction: Health literacy includes the ability of an individual to understand and evaluate health information in order to make the right decisions about improving their quality of life. The present study aimed to investigate the relationship between health literacy and satisfaction of heart patients with staff.
Methods: The present study was a descriptive-correlational study that was conducted cross-sectionally in 1403 on 131 cardiac patients at Afshar Hospital in Yazd. Data were collected using standard Iranian health literacy questionnaires (HELIA) and patient satisfaction questionnaires and analyzed using SPSS version 27 software.
Results: The mean patient satisfaction score was 79/96 ± 17/2 and the mean health literacy score was 61/18 ± 20/96, indicating insufficient health literacy. Among the health literacy dimensions, the highest mean score was related to the decision-making and use of health information dimension and the lowest score was related to the reading skills dimension. Among the patient satisfaction dimensions, the highest mean score was related to the medical staff dimension and the lowest score was related to the nursing staff dimension. Also, no significant relationship was observed between health literacy and patient satisfaction.
Conclusion: Although the overall relationship between health literacy and patient satisfaction was not significant, their different dimensions independently had coherent structures and were related to each other; in such a way that improving one dimension can lead to improving other dimensions. It is also recommended to hold workshops, produce simple and understandable educational content, and strengthen effective communication with patients in order to improve patient health literacy.
Keywords: Health literacy, Heart Diseases, Patient satisfaction, Afshar Hospital
Conflict of interest: The authors declared no conflict of interest.
References
1-Kazemi T, Bidokhti A, Riahi SM & et al. Cardiovascular Diseases, The Leading Cause of Death in South Khorasan Province: A two-decade study: Editorial Article. Journals of Birjand University of Medical Sciences. 2023;30(3):289-94.
2-Roth GA, Mensah GA, Johnson CO & et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. Journal of the American College of Cardiology. 2020;76(25):2982-3021.
3-Masaebi F, Salehi M, Kazemi M & et al. Trend analysis of disability adjusted life years due to cardiovascular diseases: results from the global burden of disease study 2019. BMC public health. 2021;21(1):1268.
4-Zhang NJ, Terry A, McHorney CA. Impact of health literacy on medication adherence: a systematic review and meta-analysis. Annals of Pharmacotherapy. 2014;48(6):741-51.
5-Kanejima Y, Shimogai T, Kitamura M & et al. Impact of health literacy in patients with cardiovascular diseases: A systematic review and meta-analysis. Patient education and counseling. 2022;105(7):1793-800.
6-Nutbeam D. The evolving concept of health literacy. Social science & medicine. 2008;67(12):2072-8.
7-Wu W-L, Yu L-W, Wu L. Health literacy and health outcomes in China’s floating population: mediating effects of health service. BMC Public Health. 2021;21(1):691.
8-Kanejima Y, Shimogai T, Kitamura M & et al. Impact of health literacy in patients with cardiovascular diseases: a systematic review and meta-analysis. Patient Education and Counseling. 2022;105(7):1793-800.
9-Wu JR, Reilly CM, Holland J & et al. Relationship of Health Literacy of Heart Failure Patients and Their Family Members on Heart Failure Knowledge and Self-Care. Journal of family nursing. 2017;23(1):116-37.
10-Berkman ND, Sheridan SL, Donahue KE & et al. Health literacy interventions and outcomes: an updated systematic review. Evidence report/technology assessment. 2011(199):1-941.
11-Mantwill S, Monestel-Umaña S, Schulz PJ. The Relationship between Health Literacy and Health Disparities: A Systematic Review. PloS one. 2015;10(12):e0145455.
12-Tavousi M, Mehrizi AH, Rafiefar Sh & et al. Health literacy in Iran: findings from a national study. Payesh (Health Monitor) Journal. 2016;15(1):95-102.
13-Kumar VA, Albert NM, Medado P & et al. Correlates of Health Literacy and Its Impact on Illness Beliefs for Emergency Department Patients With Acute Heart Failure. Critical pathways in cardiology. 2017;16(1):27-31.
14-Jennings CS, Astin F, Prescott E & et al. Illness perceptions and health literacy are strongly associated with health-related quality of life, anxiety, and depression in patients with coronary heart disease: results from the Euroaspire V cross-sectional survey. European Journal of Cardiovascular Nursing. 2023;22(7):719-29.
15-Al-Qerem W, Jarab A, Eberhardt J & et al. Health Literacy and Medication Adherence Among Patients with Type 2 Diabetes in Jordan: A Cross-Sectional Study. Patient preference and adherence. 2024;18:2019-26.
16-Altin SV, Stock S. The impact of health literacy, patient-centered communication and shared decision-making on patients' satisfaction with care received in German primary care practices. BMC health services research. 2016;16(1):450.
17-Oruç OA, Sener R. Multivariate analysis of the effect of health literacy levels on patient satisfaction in patients presenting to the emergency department. Medicine. 2025;104(24):e42789.
18-Hayran O, Özer O. Organizational health literacy as a determinant of patient satisfaction. Public health. 2018;163:20-6.
19-World, Health, Organization. Health literacy. Available from: https://www.who.int/news-room/fact-sheets/detail/health-literacy; 2024.
20-Magallón-Botaya R, Méndez-López F, Oliván-Blázquez B & et al. Effectiveness of health literacy interventions on anxious and depressive symptomatology in primary health care: A systematic review and meta-analysis. Frontiers in public health. 2023;11:1007238.
21-O’Neill B. Sample size determination with a pilot study. PLOS ONE. 2022;17:e0262804.
22-Montazeri A, Tavousi M, Rakhshani F & et al. Health Literacy for Iranian Adults (HELIA): development and psychometric properties. 2014.
23-Tavousi M, Haeri-Mehrizi A, Rakhshani F & et al. Development and validation of a short and easy-to-use instrument for measuring health literacy: the Health Literacy Instrument for Adults (HELIA). BMC public health. 2020;20(1):656.
24-Sahebzadeh M, Mansouri-Boroujeni F, Shaarbafchizadeh N. The Relationship Between Health Literacy and Satisfaction of Patients in Psychiatric Wards of Service Providers in Hospitals of Isfahan University of Medical Sciences, Iran. Health Information Management. 2021;18(2):60-5.
25-Ravaghi H, Salemi M, Behzadifar M & et al. Patients’ Satisfaction with Medical Emergency Services in Iran from 2000 to 2017: A Systematic Review and Meta-Analysis. Iranian Red Crescent Medical Journal (IRCMJ). 2018;20(s1):1-11.
26-Soleimanpour H, Gholipouri C, Salarilak S & et al. Emergency department patient satisfaction survey in Imam Reza Hospital, Tabriz, Iran. International journal of emergency medicine. 2011;4(6):2.
27-Shafiei MR, Haghshenas H, Shafiei N & et al. Investigating the Patients Satisfaction with Nursing Services in Imam Reza Hospital of Lar City during the Covid-19 Pandemic in 2020: A Short Report. Rums_Journal. 2022;21(2):245.
28-norouzinia r, Saeeidi N, Aghabarary M. Patient satisfaction with the medical services, hospital facilities, and the performance of the medical staff in the hospitals affiliated with Alborz University of Medical Sciences. Quarterly Journal of Nersing Management. 2023;12(2):100-8.
29-Zolhavarieh SM, Rezaei M, Karimi N & et al. Study of Patient’s Satisfaction at Urology Ward of
Shahid Beheshti Hospital, Hamadan University of Medical Sciences in the Second Half of 2018. Journal of Research in Urology. 2019;3(1):19-27.
30-Farajzadeh M, Karimi L, Mirjavadi S & et al. Survey of the patients’ satisfaction with services provided in an Iranian naval hospital in 2019: A cross-sectional study. Romanian Journal of Military Medicine. 2021;124:452-61.
31-Moslehpour M, Shalehah A, Rahman FF & et al. The Effect of Physician Communication on Inpatient Satisfaction. Healthcare (Basel, Switzerland). 2022;10(3).
32-Wang J, Kidd VD, Giafaglione B & et al. Improving Nurse-Physician Bedside Communication Using a Patient Experience Quality Improvement Pilot Project at an Academic Medical Center. Cureus. 2024;16(3).
33-Bahari Z, Vosoghi N, Ramazanzadeh N & et al. Patient trust in nurses: exploring the relationship with care quality and communication skills in emergency departments. BMC nursing. 2024;23(1):595.
34-Wang J, Kidd VD, Giafaglione B & et al. Improving Nurse-Physician Bedside Communication Using a Patient Experience Quality Improvement Pilot Project at an Academic Medical Center. Cureus. 2024;16(3):e55976.
35-Naz R, Khaleel S, Naz S. Evaluation Of Nurse-Patient Communication And Its Impact On Patient Satisfaction. Biological and Clinical Sciences Research Journal. 2024;2024:936.
36-Vazifeh S, Jafari N, Mehdizadeh S & et al. Health literacy of hypertensive patients and related factors: A cross sectional study. Payesh (Health Monitor) Journal. 2023;22(5):639-48.
37-Azizi Sani Dopolani SF, Shahbazi H, Lotfizadeh M & et al. The impact of educational intervention on enhancing the health literacy among middle-aged individuals at risk for cardiovascular diseases: a randomized cotrolled trial. BMC Public Health. 2025;25(1):2291.
38-Sørensen K, Levin-Zamir D, Duong TV & et al. Building health literacy system capacity: a framework for health literate systems. Health promotion international. 2021;36(Supplement_1):i13-i23.
39-Shahid R, Shoker M, Chu LM & et al. Impact of low health literacy on patients’ health outcomes: a multicenter cohort study. BMC Health Services Research. 2022;22(1):1148.
40-Altun R. The Relationship Between Health Literacy, Patient Satisfaction and Health Costs. Sabuncuoglu Serefeddin Health Sciences. 2021;3(3):29-39.
Type of Study: Research |
Subject:
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Received: 2025/03/17 | Accepted: 2025/06/7 | Published: 2025/09/11
Received: 2025/03/17 | Accepted: 2025/06/7 | Published: 2025/09/11
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