What is the clinical evidence from this study?

Study design: Cohort. Population: Intermittent claudication (n=158). Intervention: Standard care (Best medical therapy and lifestyle advice) vs. Baseline. Primary outcome: Quality of life (VQ6 score) (p=0.003).

May 17, 2023Open Access

Illness perception, health literacy, self-efficacy, adherence and quality of life in patients with intermittent claudication – a longitudinal cohort study

Key Result

In patients with intermittent claudication, quality of life significantly increased from a median of 13 at baseline to 16 at 12 months, while sufficient health literacy was associated with higher self-efficacy and quality of life.

Study Design

Type

Cohort (n=158)

Multicenter

Yes

Structured PICO

How do health literacy and illness perception affect self-efficacy and quality of life in patients with intermittent claudication?

Population

128 patients with intermittent claudication recruited from vascular units in southern Sweden

Outcome

Illness perception, health literacy, self-efficacy, adherence to treatment, and quality of lifepatient reported

Sufficient health literacy is associated with better illness perception, higher self-efficacy, and improved quality of life in patients with intermittent claudication.

Main Result

Absolute Event Rate: 16% vs 13%

p-value: p=0.003

Limitations

All data from the questionnaires were self-reported, which can be inaccurate due to social desirability or failure to recollect adherence behavior.
Potential ceiling effect in the adherence questionnaire.
No power calculation was performed.
Recruitment had to stop earlier than planned due to the COVID-19 pandemic.

Abstract

BACKGROUND: Patients with intermittent claudication need lifelong treatment with secondary prevention to prevent cardiovascular events and progression of atherosclerotic disease. Illness perception, health literacy, self-efficacy, adherence to medication treatment, and quality of life are factors influencing patients' self-management. Knowledge of these factors could be important when planning for secondary prevention in patients with intermittent claudication. AIM: to compare illness perception, health literacy, self-efficacy, adherence to treatment, and quality of life in in patients with intermittent claudication. METHODS: A longitudinal cohort study was conducted with 128 participants recruited from vascular units in southern Sweden. Data were collected through medical records and questionnaires regarding illness perception, health literacy, self-efficacy, adherence to treatment, and quality of life. RESULTS: In the subscales in illness perception, patients with sufficient health literacy reported less consequences and lower emotional representations of the intermittent claudication. They also reported higher self-efficacy and higher quality of life than patients with insufficient health literacy. In comparison between men and women in illness perception, women reported higher illness coherence and emotional representations associated with intermittent claudication compared to men. A multiple regression showed that both consequences and adherence were negative predictors of quality of life. When examining changes over time, a significant increase in quality of life was seen between baseline and 12 months, but there were no significant differences in self-efficacy.. CONCLUSION: Illness perception differs in relation to level of health literacy and between men and women. Further, the level of health literacy seems to be of importance for patients' self-efficacy and quality of life. This illuminates the need for new strategies for improving health literacy, illness perception, and self-efficacy over time. For example, more tailored information regarding secondary prevention could be provided to strengthen self-management to further improve quality of life in patients with intermittent claudication.

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