Korean J Adult Nurs.  2019 Dec;31(6):638-649. 10.7475/kjan.2019.31.6.638.

Mediating Effects of Health Belief on the Correlations among Disease-related Knowledge, eHealth Literacy, and Self-care Behaviors in Outpatients with Hypertension

  • 1Professor, Department of Nursing, Pukyong National University, Busan, Korea.
  • 2Doctoral Student, Department of Nursing, Pukyong National University, Busan, Korea. nursingcho@pknu.ac.kr


This study aimed to identify the mediating effects of health belief on the disease-related knowledge, eHealth literacy, and self-care behavior of hypertension patients. eHealth is an emerging field of medical informatics, referring to the organization and delivery of health services and information using the internet and related technologies.
A total of 156 patients who were receiving treatment for hypertension at the best internal medicine clinic in Busan City participated in the study. Data collection was conducted from May 22, to June 30, 2019. Collected data were analyzed with descriptive statistics, independent t-test, one-way analysis of variance, Pearson's correlation coefficient, and three-step mediated regression analysis using SPSS/WIN 25.0.
Significant positive correlations were observed between disease-related knowledge and eHealth literacy (r=.19, p=.016), disease-related knowledge and health belief (r=.32, p<.001), disease-related knowledge and self-care behavior (r=.16, p=.046), eHealth literacy and health belief (r=.17, p=.034), and health belief and self-care behavior (r=.27, p=.001). Health belief had a mediating effect (z=−2.47, p=.013) on the correlation between disease-related knowledge and self-care behavior.
To improve self-care behavior among hypertension patients, medical practitioners need to develop interventions that enhance health belief.

MeSH Terms

Data Collection
Health Literacy
Health Services
Internal Medicine
Medical Informatics
Self Care*


  • Figure 1. The mediation effect of health belief between the disease-related knowledge and self-care behavior of patients.

Cited by  1 articles

The Relationship Between Participating in Online Parenting Communities and Health-Promoting Behaviors for Children Among First-Time Mothers: The Mediating Effect of Parental Efficacy
Minyoung Woo, Sun-Mi Chae
J Korean Soc Matern Child Health. 2022;26(3):183-193.    doi: 10.21896/jksmch.2022.26.3.183.


1. Korea Centers for Disease Control and Prevention. Korean national health and nutrition examination survey the seventh year the second year 2017 [Internet]. Cheongju: Korea Centers for Disease Control and Prevention;2019. [cited 2019 March 21]. Available from:. https://knhanes.cdc.go.kr/knhanes/sub04/sub04_03.do.
2. The Korea Society of Hypertension. Guidelines for hypertension treatment in 2018. Seoul: IMED Corporation;2018.
3. Arima H, Murakami Y, Lam TH, Kim HC, Ueshima H, Woo J, et al. Effects of prehypertension and hypertension subtype on cardiovascular disease in the asia-pacific region. Hypertension. 2012; 59(6):1118–23. https://doi.org/10.1161/HYPERTENSIONAHA.111.187252.
4. Statistics Korea. Annual report on the cause of death statistics [Internet]. Daejeon: Statistics Korea;2018. [cited 2019 March 21]. Available from:. http://www.index.go.kr/potal/main/EachDtlPageDetail.do?idx_cd=1012.
5. Son YJ, Song EK. Impact of health literacy on disease-related knowledge and adherence to self-care in patients with hypertension. The Korean Journal of Fundamentals of Nursing. 2012; 19(1):6–15. https://doi.org/10.7739/jkafn.2012.19.1.006.
6. Elmer PJ, Obarzanek E, Vollmer WM, Simons-Morton D, Stevens VJ, Young DR, et al. Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial. Annals of Internal Medicine. 2006; 144(7):485–95. https://doi.org/10.7326/0003-4819-144-7-200604040-00007.
7. Orem DE. Nursing: concepts of practice. 4th ed.St. Louis: Mos-by;1991.
8. Cho MC. New strategies in the treatment of hypertension. Korean Journal of Medicine. 2009; 76(4):409–15.
9. Ahn YH. Compliance level with therapeutic regimen of medication and life style among patients with hypertension in rural communities. Journal of Korean Public Health Nursing. 2007; 21(2):125–33.
10. Kripalani S, Robertson R, Love-Ghaffari MH, Henderson LE, Praska J, Strawder A, et al. Development of an illustrated medication schedule as a low-literacy patient education tool. Patient Education and Counseling. 2007; 66(3):368–77. https://doi.org/10.1016/j.pec.2007.01.020.
11. Berkman ND, Davis TC, MaCormack L. Health literacy: what is it? Journal of Health Communication. 2010; 15(S2):9–19. https://doi.org/10.1080/10810730.2010.499985.
12. Institute of Medicine (US) Committee on Health Literacy. Health literacy: a prescription to end confusion. Washington D.C.: The National Academic Press;2004.
13. Oh JH, Park EO. The impact of health literacy on self-care behaviors and hypertensive elderly. Korean Journal of Health Education and Promotion. 2017; 34(1):35–45. https://doi.org/10.14367/kjhep.2017.34.1.35.
14. Ahn J, Lim IS. The significant role of the national health information portal. http://health.mw.go.kr. Journal of the Korean Medical Association. 2011; 54(9):957–60. https://doi.org/10.5124/jkma.2011.54.9.957.
15. Tonsaker T, Bartlett G, Trpkov C. Health information on the internet. Gold mine or minefield? Canadian Family Physician. 2014; 60(5):407–8.
16. Norman CD, Skinner HA. eHEALS: the ehealth literacy scale. Journal of Medical Internet Research. 2006; 8(4):e27. https://doi.org/10.2196/jmir.8.4.e27.
17. Yang SC, Luo YF, Chiang CH. The Associations among individual factors, ehealth literacy, and health-promoting life-styles among college students. Journal of Medical Internet Research. 2017; 19(1):e15. https://doi.org/10.2196/jmir.5964.
18. Min ES, Hur MH. Predictors of compliance in hypertensive patients. Journal of Korean Academy of Fundamentals of Nursing. 2012; 19(4):474–82. https://doi.org/10.7739/jkafn.2012.19.4.474.
19. Glanz K, Rimer BK, Viswanath K. Health behavior and health education: theory, research and practice. 3rd ed.San Francis-co: Jossey-Bass;2002. p. 45–66.
20. Je MS, Lee SS. A Study of middle-aged women's health beliefs and their intention to practice health behaviors to prevent and improve hypertension. Korean Journal of Adult Nursing. 2007; 19(1):109–20.
21. Rosenstock IM. The health belief model and preventive health behavior. Health Education Monographs. 1974; 2(4):354–86. https://doi.org/10.1177/109019817400200405.
22. Seo MH, Lee WY, Kim SS, Kang JH, Kang JH, Kim KK, et al. 2018 Korean society for the study of obesity guideline for the management of obesity in Korea. Journal of Obesity & Metabolic Syndrome. 2019; 28(1):40–5. https://doi.org/10.7570/jomes.2019.28.1.40.
23. Lee SJ, Song MS. Compliance with low-salt diet and related factors in essential hypertension patients. Korean Journal of Adult Nursing. 1999; 11(3):605–20.
24. Chang SJ, Yang Ej, Ryu Hj, Kim HJ, Yoon JY. Cross-cultural adaptation and validation of the ehealth literacy scale in Korea. Korean Journal of Adult Nursing. 2018; 30(5):504–15. https://doi.org/10.7475/kjan.2018.30.5.504.
25. Moon JS. A study of instrument development for health belief of Korean adults [dissertation]. Seoul: Yonsei University;1990.
26. Bae MS. Related factors with health behaviors of foreign students studying in Korea [dissertation]. Daegu: Yeungnam University;;2009.
27. Lee YW. A Study of the effect of an efficacy expectation promoting program on self-efficacy and self-care. Korean Journal of Adult Nursing. 1995; 7(2):212–27.
28. Baron RM, Kenny DA. The moderator-mediator variable dis-tinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology. 1986; 51(6):1173–82.
29. Riegel B, Moser DK, Buck HG, Dickson VV, Dunbar SB, Lee CS, et al. Self care for the prevention and management of cardiovascular disease and stroke: a scientific statement for healthcare professionals from the american heart association. Jour33. Lee EJ, Park E. Predictors of self-care behaviors among elderly with hypertension using quantile regression method. Korean Journal of Adult Nursing. 2015; 27(3):273–82. https://doi.org/10.7475/kjan.2015.27.3.273.
34. Suh SR, Lee EH. A path model predicting medication adherence and self-care of low-income older adults with hypertension. Korean Journal of Adult Nursing. 2011; 23(4):374–85.
35. Rebecca KT, William BC, Kari W, Georgiann L, Andrew ME. eHealth literacy and health behaviors affecting modern college students: a pilot study of issues identified by the american college health association. Journal of Medical Internet Research. 2017; 19(12):e392. https://doi.org/10.2196/jmir.3100.
Full Text Links
  • KJAN
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr