The Association of Health Literacy with High-Quality Home Blood Pressure Monitoring for Hypertensive Patients in Outpatient Settings

Table 2

Summary of the selected cross-sectional studies.

Lead author [Ref], country, year	N	Level of education, health literacy, or other social factors	Any association between educational level and HBPM?	Any association between educational level and better BP control?	NOS grading
Allibe et al. [20], France, 2016	380	Education level; <A-level, A-level, >A-level hypertension knowledge	NA	Yes, knowing the correct BP target is significantly associated with normal BP	2/10 = unsatisfactory
Ayala et al. [13], USA, 2017	559	≤High school graduate, some college graduate, or more	Yes, older age, and those who believe lower BP can reduce the risk of heart attack and stroke had higher % of HBPM Educational level is not associated with HBPM use	NA	6/10 = Satisfactory
Ayala et al. [21], USA, 2008	3739	<High school graduate high School graduate; Some college; College graduate or more	neutral, regular HBPM users had an insignificantly higher educational level; Subjects who perceived HBPM helped control their BP; Measured BP more frequently	NA	7/10 = Good
Bancej et al. [22], Canada, 2010	6142	Educational attainment; Less than secondary school; Secondary school graduate; Some after secondary; Postsecondary graduate	Yes, regular HBPM was more likely among older adults; those who believed to control BP; and those who had been shown how to perform HBPM by a health professional; No, HBPM practice was not related to the level of education	NA	7/10 = Good
Breaux-Shropshire et al. [23], USA, 2012	149	NA	NA	No, HBPM was not a predictor of blood pressure control	6/10 Satisfactory
Cacciolati et al. [24], France, 2012	1,814	High: ≥12 years formal education; Low: <12 years of formal education; Cognitive level: MMSE autonomy: Lawton scale; Five basic daily activities	Yes, less HBPM in subjects age >80, with lower educational level and those had no autonomy	NA	8/10 = Good
Cai et al. [25], China, 2017	1878	Illiterate/primary or above	Yes, those with higher education were more likely to perform HBPM	NA	7/10 = Good
Cuspidi et al. [26], Italy, 2005	855	Primary/secondary/tertiary year of education	Yes, those with higher educational level used HBPM more frequently	NA	7/10 = Good
Dymek et al. [27], Poland, 2015	14	10 items patients’ knowledge score Primary, secondary, university, or above	Yes, overall subjects had fair compliance to HBPM; Results showed deficiency in both knowledge and skills	NA	3/10 = unsatisfactory
Flacco et al. [28], Italy, 2015	725	None/elementary; Middle/high school; Bachelor/higher	No, high-quality HBPM is not related to the educational level; Yes, better quality if subjects received HBPM instructions from doctors or pharmacists	NA	5/10 Satisfactory
Gohar et al. [29], UK, 2008	153	Mean years in education = 12.25 years	No, it was not associated with gender, alternative or complementary medicine use, or adherence to medication	NA	2/10 = unsatisfactory
Hu et al. [30], China, 2013	318	Years of education; ≤6 years; >6 years	Yes, older participants (>or = 65) were more likely to perform HBPM; No, educational level is not related to the practice of HBPM	NA	4/10 = unsatisfactory
Kim et al. [31], USA, 2010	377	Scoring of high BP knowledge; Cut-off at <90th percentile or ≥90th percentile	No, compliance with HBPM is not associated with HT knowledge or educational level	NA	8/10 = Good
Melnikov [32], Israel, 2019	430	Years of education; Total hypertension knowledge score	Yes, more years of education and those who performed HBPM had better knowledge of hypertension	NA	6/10 = Satisfactory
Merrick et al. [33], USA, 1997	91	Years of education; Cutoff <12 years & ≥12 years	No, the accuracy of BP measurement is not related to the factors assessed	NA	3/10 = unsatisfactory
Milot et al. [34], Canada, 2015	1010 (2010); 1005 (2014)	Received HBPM recommendations from their doctors	Only 15% of patients in 2010 and 18% in 2014 were defined as sufficiently compliant with all HBPM procedures	NA	4/10 = unsatisfactory
Mitchell et al. [35], USA, 2015	193	College graduate/some college/< high school	No, HBPM is not associated with BP levels, age, sex, race, or education level	NA	3/10 = unsatisfactory
Naik et al. [36], USA, 2008	212	Older adults, some college education; Self-management behaviors; Communication factors	Yes, patients’ endorsement of a shared decision-making style is associated with more HBPM	Yes, proactive communication with one’s clinician about abnormal HBPM is associated with better BP control	9/10 = very good
Ragot et al. [37], France, 2005	104 pharmacists; 1015 patients	Patients’ knowledge for lifestyle change for HT, equipped with an automatic HBPM device, knew the name of drugs, treatment-related side effects, and drug compliance	Yes, 90% reported using the device without any rule. In all, 10% of the patients followed doctor’s or pharmacist’s recommendations	No, those had higher educational level had better hypertension knowledge, but were not better BP controlled	4/10 = unsatisfactory
Rao et al. [38], USA, 2015	409	Some high school, high school graduate, some college, college graduate; Rapid estimate of adult literacy in medicine-short form (REALM-SF) numeracy: 3-item numeracy measure	Yes, adequate numeracy, but not high literacy is associated with more complete reporting of HBPM	NA	8/10 = Good
Seidlerová et al. [39], Czech, 2014	449	Primary, secondary, university	Yes, older age, university education, married, and longer duration of HT were more likely to have HBPM device; Regular HBPM is associated with the no. of HT drugs	No, BP control is not associated with frequency of HBPM	6/10 = Satisfactory
Shi et al. [40], China, 2017	523	Primary, middle, high school, higher education; Chinese Health Literacy Scale for Hypertension	Yes, higher HL was more compliant with HBPM	NA	= 6/10 Satisfactory
Tan et al. [41], Singapore, 2005	224	None and primary; Secondary; Tertiary/poly/graduate	Yes, HBPM use was associated with higher-income status; Nonusers were associated with failure to recognize benefits, HBPM awareness, understanding of device operation, and perception of HBPM inaccuracy	NA	7/10 = Good
Tirabassi et al. [42], USA, 2013	1254	Different primary care providers (PCPs)	Yes, PCPs were less likely to recommend HBPM to their patients if they were from poor to the lower middle class than those PCPs with most patients from higher economic classes	NA	7/10 = Good
Tekin et al. [43], Turkey, 2012	2747	Illiterate; Literate/primary school Graduate; Middle school graduate; High school graduate; University graduate	Yes, higher educational level and higher-income level are associated with possession of HBPM	NA	8/10 = Good
Tyson and Mcelduff [44], UK, 2003	222	College or university	Yes, subjects who had further education were more likely to own HBPM and participate in monitoring	NA	6/10 = Satisfactory
Uzun et al. [45], Turkey, 2009	150	Illiterate; Literate but no graduation; Graduated from elementary school; Junior high school; High school; License program	Yes, informed about HT & CVD risk factors informed is better and education level (higher is better)	NA	6/10 Satisfactory
Viera et al. [46], USA, 2008	530	<High school graduate; High school graduate; Some college or more	Yes, 35.2% of patients report that their physicians had recommended HBPM to them	NA	9/10 = very good
Wang et al. [47], China, 2014	1915	Junior high school; Senior high school; College	Yes, subjects with college education used HBPM more frequently than those with middle school education	NA	5/10 Satisfactory

CSS = cross-sectional study, CVD = cardiovascular disease, Ref = reference number, N = number of hypertensive subject, NA = not available, HBPM = home blood pressure monitoring, HT = hypertension, BP = blood pressure, HL = health literacy, NOS = Newcastle-Ottawa score for cross-sectional studies, S = selection, C = comparability, O = outcome, OR = odds ratio.