Relationship between Health Literacy, Self Care Behaviors, and Glomerular Filtration Rate Among Patients with Chronic Kidney Disease Stage 3-4

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Ketnarin Bunklai
Nirobol Kanoksuntonrat
Noppawan Phinitkhonjorndech


          This correlation research aimed to identify the relationship between health literacy of patients with chronic kidney disease stage 3 – 4 and their self-care behaviors and glomerular infiltration rates.  Theory of Health Literacy was used to guide the development of the conceptual framework of this study.  The samples were 97 patients having chronic kidney disease stage 3 – 4 and seeking medical care at an outpatient department in Nopparatrajathanee Hospital Bangkok. They were purposively selected according to the inclusion criteria set by the researcher. The data were collected from the samples during May – June, 2018, using questionnaires which consisted of three parts, namely, personal information, health literacy assessment, and self-care behaviors of the patients. Descriptive statistics, Pearson’s moment product correlation and Spearman’s Rank correlation with statistical significance level at p<.05, were used to analyse data. Results showed mostly, self-care behaviors of the samples were at moderate level . The majority of the sample had mean score of health literacy at the moderate level. Health literacy domains that  were at moderate level were at moderate level were knowledge and understanding, information accessibility, and communication skills and media literacy.Their literacies on self-care management and decision making were at high level.That the patients had inadequate health literacy in five areas.  These included water intake for patients with chronic kidney diseases stage 4, water intake for patients with chronic kidney diseases stage 3,  searching and selecting sources of information on self-care behaviors,  using herbal medicines and food supplements, and convincing others to adopt healthy practices. Health literacy of the patients was found to have a positive and significant relationship with self-care behaviors, but was negatively related to glomerular filtration rate.  The results can be used to guide the development of health literacy enhancement programs for patients with chronic kidney diseases stage 3 – 4 to practice proper self-care behaviors.  This, consequently, will delay the reduction of glomerular filtration rate and the progress of the disease into the terminal stage.


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Arammuang, S. , Sangkard, K., Kimpee, S. & Sriyuktasuth, A. (2012). Factors predicting fluid control behavior in chronic kidney disease patients receiving hemodialysis. Journal of Nursing Science , 30(3), 74-81. (in Thai)

Berkman, N.D. et al. (2011) .Low health literacy and health outcome : an update systemic review. Annals of Internal Medicine. 155(2), 97-107.

Center for disease control and prevention (CDC). (2017).Chronic kidney disease surveillance system. Retrieved (2017, March 9) from:

Cho, Y.I., Lee, S.Y.D., Arozullah, A.M., & Crittenden, K.S. (2008). Effects of health literacy on health status and health service utilization amongst the elderly. Social Science and Medicine, 66(8), 1809-1816.

Coleman, C. (2011).Teaching health care professional about health literacy. Nurse Outlook, 59(2), 70-78.

Devraj, R., Borrego, M., Vilay, A.M., Gordon, E.J., Pailden, J., & Horowit, B. (2015). Relationship between health literacy and kidney function. Nephrology (Carlton), 20(5), 360–367.

Health Education Division, Department of Health Service Support, Ministry of Public Health, (2013). Promoting and assing health literacy and health behavior (ABCDE – Health Literacy Scale of Thai Adults). Bangkok: n.d. ( in Thai)

Hlakhew, A. & Chalikheru, T. (2015). Health literacy and factors related to medication among patients with hypertension Ban Piang Luang Subdistrict health promoting hospital, Chiang Mai Province. Academic report and presentation of research results National and international level 6,national group Science, 1(6), 635-649. (in Thai)

Isaacs, B., & Kennie, A. T. (1973). The set test as an aid to the detection of dementia in old people. The British Journal of Psychiatry, 123(575), 467-470.

Ingsathit, A., Thakkinstian, A., Chaiprasert, A. Sangthawan, P., Gojaseni, P., Kiattisunthorn, K., et al. (2010). Thai-SEEK Group. Prevalence and risk factors of chronic kidney disease in the Thai adult population: Thai SEEK study. Nephrology Dialysis Transplantion, 25(5), 1567-1575.

Jitchan, P. , Masingboon, K, & Duanpaeng, S. ( 2011). Predictors of functional performance in patients with chronic kidney disease. Thai Journal of Nursing Council, 26(2), 86- 99. (in Thai)

Kidney Disease: Improving global outcomes.(2017) KDIGO 2017 Clinical practice guidelineupdate for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease–mineral and bone disorder (CKD-MBD). Kidney International Supplements. 7(1), 1- 59.

Lee, S.J., & Jeon, J .(2015). Relationship between symptom clusters and quality of life in patients at stages 2 to 4 chronic kidney disease in Korea. Apple Nursing Research, 28(4), 113 -119

Maneesri, S., Sangkard,K0 , Pongthawronsakol, K. & Terapornlaterat, K. (2011). Factors influencing Self- mangment in chronic kidney disease patients. Vajira Nursing Journal, 13(1), 14-27.(in Thai)

Nutbeam, D. (2008). The evolving concept to health literacy. Social Science and Medicine, 67, 2072 – 2078.

Tangsanga, K. (2011). Chonic kidney disease. Bangkok: Text and Journal Publication. (in Thai)

Taiwong, A., Kanogsunthornrat, N. & Chaiviboonthum, S. ( 2017). Relationship between unpleasant symptom clusters and quality of life among patients with chronic kidney disease. Journal of Nursing and Health Care, 35(3), 120-128. (in Thai)

The National Institute of Diabetes and Digestive and Kidney Diseases. (2016). Department of health and human services national institutes of health. Retrieved (2017, March 9) from:

The Office of Policy and Strategic Plan.(2015). Health Statistics Year 2014. Bangkok: The War Veterans Organization of Thailand. (in Thai)

Thummaphol, P.,Piaseu,N. & Jarupat-Maruo,S. (2018). Health literacy and clinical outcomes in people with hypertension, dyslipidemia and type 2 diabetes mellitus. Journal of Nursing and Health Care, 34(3), 176-182. (in Thai)