Development of health literacy tool for hypertension and determinants of limited health literacy in rural Myanmar: Implications for targeted public health interventions

Abstract

Background & objectives

Health literacy (HL) is essential for managing chronic diseases like hypertension. However, limited health literacy is common in many populations leading to poor health outcomes. This study aimed to develop hypertension-specific health literacy tool and identify factors associated with limited health literacy (LHL) among individuals with and without hypertension.

Methods

A cross-sectional study was conducted in rural Karen State, Myanmar from December 2023 to November 2024. Descriptive statistics and multivariable analysis using the logistic regression were employed to investigate the associations between LHL and hypertension-related factors.

Results

Among 487 participants, the developed tool demonstrated strong reliability with Cronbach's alpha values of 0.923 (access), 0.879 (understand), 0.902 (appraise) and 0.889 (apply). The overall prevalence of LHL was 85.82 % (95 % CI: 82.02–89.08) in the no-hypertension group and 83.53 % (95 % CI: 73.91–90.69) in the hypertension group. Key factors associated with LHL in individuals with hypertension included employment in agriculture, farming, self-employment or non-government sectors (AOR: 4.85, 95 % CI: 1.18–19.91), a family history of hypertension (AOR: 5.42, 95 % CI: 1.28–22.84) and poor or average knowledge about hypertension (AOR: 5.21, 95 % CI: 1.20–22.57).

Conclusion

Four out of five individuals in rural Myanmar had LHL highlighting disparities compared to urban populations. Employment type, family history of hypertension and insufficient hypertension knowledge were significant predictors of LHL. A context-specific tool was developed to ensure accurate assessment and inform targeted interventions.