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Health Literacy: Knowledge and Experiences of Iranian Registered Nurses Open Access


Other title
Registered nurse
Health literacy
Type of item
Degree grantor
University of Alberta
Author or creator
Nesari, Maryam
Supervisor and department
Dr. Joanne Olson
Examining committee member and department
Dr. Sandra Davidson, Faculty of Nursing, University of Alberta
Dr. Caroline Porr, School of Nursing, Memorial University
Dr. Colleen Norris, Faculty of Nursing, University of Alberta
Dr. Kaysi Kushner, Faculty of Nursing, University of Alberta
Dr. Joanne Olson, Faculty of Nursing, University of Alberta
Faculty of Nursing

Date accepted
Graduation date
2017-06:Spring 2017
Doctor of Philosophy
Degree level
Background: Health literacy is a robust determinant of an individual’s health status which in turn influences population health and the healthcare system. Based on Social Cognitive Theory (SCT) limited health literacy (LHL) is a source of health disparity if healthcare providers are not able to manage it appropriately. Almost 70% of Iranian adults over 18- year old have LHL skills. Nurses make up the largest group of healthcare professionals that have the greatest potential to decrease the adverse effects related to LHL including health disparity. The purpose of this study was to examine Iranian registered nurses’ knowledge and experience of health literacy applying quantitative measures. Methods & Materials: This study applied a cross-sectional design providing a quantitative or numerical description. The target population for the study was all the registered nurses with baccalaureate nursing degrees or master’s degrees currently practicing in university hospitals and community health centers affiliated with Tehran University of Medical Science in Tehran, the capital city of Iran. Data was collected using the self-administered Health Literacy Knowledge and Experience Survey (HL-KES). The HL-KES was developed originally in the United States to examine knowledge of and experience with health literacy in the nursing profession. In this study the HL-KES was adapted and validated for the Iranian context, using the guideline on cross-cultural adaptation in health research. The adapted HL-KES was delivered through either Survey Monkey or in person to registered nurses working in hospitals and community health centers affiliated with the Tehran University of Medical Science, Tehran, Iran. In the current study, internal consistency reliability was assessed and reported using Cronbach's alpha. Findings: Total samples of 190 Iranian registered nurses were included in the final analysis. Data analysis was completed using SPSS software. Univariate analysis showed that Iranian registered nurses have limited knowledge about health literacy, most noticeably in these areas: standards for written healthcare information and common screening tools to measure health literacy. The participants also demonstrated limited experience in using health literacy screening tools, evaluating the written healthcare materials, and employing technologies in providing healthcare information. Bivariate analysis identified that there is a weak negative association between participants’ knowledge and experience with health literacy. To identify the factors which could predict Iranian registered nurses’ knowledge of health literacy, multivariate analysis was used. A multiple linear regression analysis indicated that 0.9% of the variation in Iranian registered nurses’ knowledge of health literacy was explained by the frequency of their interaction with healthcare professionals for personal reasons. Conclusion: Although the factors for limited knowledge and experience with health literacy were not assessed in this study, nurses’ limitation should not be considered as individual weakness without considering the Iranian healthcare system capacities to support healthcare professionals with health literacy activities. Some recommendations, mostly at administrative levels, were proposed to close the gap, based on the existing information; however, more investigations must be designed to shed light on barriers and facilitators for nurses to improve their knowledge and experience with health literacy.
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