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Does Depression and Anxiety Mediate the Relation between Limited Health Literacy and Diet Non-Adherence?

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  • Ivana Skoumalova

    (Department of Health Psychology and Research Methodology, Faculty of Medicine, P.J. Safarik University, Trieda SNP 1, 040 01 Kosice, Slovakia
    Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P.J. Safarik University in Kosice, Trieda SNP 1, 040 01 Kosice, Slovakia
    Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands)

  • Andrea Madarasova Geckova

    (Department of Health Psychology and Research Methodology, Faculty of Medicine, P.J. Safarik University, Trieda SNP 1, 040 01 Kosice, Slovakia
    Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P.J. Safarik University in Kosice, Trieda SNP 1, 040 01 Kosice, Slovakia
    Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
    Olomouc University Social Health Institute, Palacky University, Univerzitni 22, 771 11 Olomouc, Czech Republic)

  • Jaroslav Rosenberger

    (Department of Health Psychology and Research Methodology, Faculty of Medicine, P.J. Safarik University, Trieda SNP 1, 040 01 Kosice, Slovakia
    Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P.J. Safarik University in Kosice, Trieda SNP 1, 040 01 Kosice, Slovakia
    Olomouc University Social Health Institute, Palacky University, Univerzitni 22, 771 11 Olomouc, Czech Republic
    FMC-Dialysis Services Slovakia, Trieda SNP 1, 040 01 Kosice, Slovakia)

  • Maria Majernikova

    (FMC-Dialysis Services Slovakia, Trieda SNP 1, 040 01 Kosice, Slovakia)

  • Peter Kolarcik

    (Department of Health Psychology and Research Methodology, Faculty of Medicine, P.J. Safarik University, Trieda SNP 1, 040 01 Kosice, Slovakia
    Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P.J. Safarik University in Kosice, Trieda SNP 1, 040 01 Kosice, Slovakia
    Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
    Olomouc University Social Health Institute, Palacky University, Univerzitni 22, 771 11 Olomouc, Czech Republic)

  • Daniel Klein

    (Institute of Mathematics, Faculty of Science, P. J. Safarik University, Jesenna 5, 040 01 Kosice, Slovakia)

  • Andrea F. de Winter

    (Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands)

  • Jitse P. van Dijk

    (Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P.J. Safarik University in Kosice, Trieda SNP 1, 040 01 Kosice, Slovakia
    Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
    Olomouc University Social Health Institute, Palacky University, Univerzitni 22, 771 11 Olomouc, Czech Republic)

  • Sijmen A. Reijneveld

    (Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands)

Abstract

Limited health literacy (HL), depression and anxiety are common in dialyzed patients and affect health outcomes and self-management. We explored whether depression and anxiety mediate the association of HL with diet non-adherence (DN-A) in dialyzed patients. We performed a cross-sectional study in 20 dialysis clinics in Slovakia ( n = 452; mean age: 63.6 years; males: 60.7%). Hierarchical cluster analysis was performed to create three HL groups. Logistic regression adjusted for age, gender and education was used to explore whether depression and anxiety mediate the association of HL with DN-A. Patients in the moderate HL group were more likely to be non-adherent to diet (OR (Odds Ratio)/95% CI: 2.19/1.21–3.99) than patients in the high HL group. Patients in the low HL and moderate HL group more likely reported depression or anxiety. Patients reporting depression (OR/95% CI: 1.94/1.26–2.98) or anxiety (OR/95% CI: 1.81/1.22–2.69) were more likely to be non-adherent with diet. Adjustment for depression reduced the association between moderate HL and DN-A by 19.5%. Adjustment for anxiety reduced the association between moderate HL and DN-A by 11.8%. Anxiety and depression partly mediated the association of HL with DN-A. More attention should be paid to treating patients’ psychological distress to ensure adequate adherence with recommended diet.

Suggested Citation

  • Ivana Skoumalova & Andrea Madarasova Geckova & Jaroslav Rosenberger & Maria Majernikova & Peter Kolarcik & Daniel Klein & Andrea F. de Winter & Jitse P. van Dijk & Sijmen A. Reijneveld, 2020. "Does Depression and Anxiety Mediate the Relation between Limited Health Literacy and Diet Non-Adherence?," IJERPH, MDPI, vol. 17(21), pages 1-10, October.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:21:p:7913-:d:436165
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    1. Ivana Skoumalova & Peter Kolarcik & Andrea Madarasova Geckova & Jaroslav Rosenberger & Maria Majernikova & Daniel Klein & Jitse P. van Dijk & Sijmen A. Reijneveld, 2019. "Is Health Literacy of Dialyzed Patients Related to Their Adherence to Dietary and Fluid Intake Recommendations?," IJERPH, MDPI, vol. 16(21), pages 1-10, November.
    2. Peter Kolarcik & Eva Cepova & Andrea Madarasova Geckova & Gerald R. Elsworth & Roy W. Batterham & Richard H. Osborne, 2017. "Structural properties and psychometric improvements of the Health Literacy Questionnaire in a Slovak population," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 62(5), pages 591-604, June.
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    1. Ivana Skoumalova & Andrea Madarasova Geckova & Jaroslav Rosenberger & Maria Majernikova & Peter Kolarcik & Daniel Klein & Andrea F. de Winter & Jitse P. van Dijk & Sijmen A. Reijneveld, 2022. "Low Health Literacy Is Associated with Poorer Physical and Mental Health-Related Quality of Life in Dialysed Patients," IJERPH, MDPI, vol. 19(20), pages 1-9, October.
    2. Ivana Skoumalova & Andrea Madarasova Geckova & Jaroslav Rosenberger & Maria Majernikova & Peter Kolarcik & Daniel Klein & Andrea F. de Winter & Jitse P. van Dijk & Sijmen A. Reijneveld, 2022. "Health Literacy and Change in Health-Related Quality of Life in Dialysed Patients," IJERPH, MDPI, vol. 19(2), pages 1-9, January.

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