Low back pain (LBP) is major health issue that is experienced by
most people at some point in their life (Hoy, 2010). Some of which, experience ongoing
disability and may go on to have recurrent episodes (Walker, 2004). Estimates
of recurrence at 1 year range from 24% to 80%. Pregnant women are said to be
more susceptible to LBP than the general population (Gutke, 2008), especially
postpartum. Based on a study by Ostgaard (1992), more than 67% of 817 women experienced
back pain directly after delivery, whereas 37% said they had back pain at the
follow-up examination. Therefore,
it is important to recognize the modifiable risk factors, such as low
educational status, stress, depression and job dissatisfaction, for
chronicity and disability in relation to LBP in order to provide health
information and to increase the effectiveness of treatment methods for patients
as well as healthcare providers (Martin, 2008).
chronicity in LBP would indefinitely involve pain-related behavior which could
be caused by a number of factors. Individuals experiencing severe pain may
avoid certain actions due to fear of injury which defines fear-avoidance
beliefs have been identified as an important psychosocial variable in patients
with chronic disability due to LBP. Influences, such as low level of
education and doctors’ beliefs about LBP and physical activity contribute to
the development of fear-avoidance beliefs (Poiraudeau, 2006). Screening for
fear-avoidance beliefs may be useful for identifying patients who are at risk
of prolonged disability. Hence, behavior and attitude related to pain is
considered crucial in assessing patients with LBP.
management of chronic LBP requires the active role of patients through
behavioral and lifestyle modifications (Chou, 2007). Self-management is an
integral part of effective management of CLBP and health literacy plays an essential
role in self-management of the symptoms (Jordan, 2008). Effective communication
is crucial in delivering high quality patient-centered health care. The relationship between poor literacy skills and
health status is now well known and better understood. Interest as a result of
curiosity in this relationship has led to the emergence of the concept of
health literacy (Ha, 2010).
The Patient Protection
and Affordable Care Act of 2010 defines health literacy as the point to which
an individual has the capability to attain, communicate, process, and grasp
basic health information and services to make appropriate health choices.
Health literacy is a major component
in patients’ ability to achieve the best possible health information. There is enormous
enthusiasm for health literacy proficiency exploration and practice globally.
Health education is dependent on individual and systemic factors such as lay
person’s communication skills, health knowledge, culture, and current health
condition (Sorensen, 2012). For example, calculating cholesterol and blood
sugar levels, measuring medications, and understanding nutrition labels all
require math skills. Health literacy requires knowledge of health topics. Those
with limited health literacy often lack information and may not comprehend the
relationship between lifestyle factors such as diet and exercise and various
knowledge taught amid school years is usually overlooked or is fragmented.
Uninteresting, foreign or impractical methods of delivery deter people from
wanting to know and learn more (McKinney, 2000). Low literacy has been linked to poor health outcomes such as
higher rates of hospitalization and less frequent use of preventive services,
which would directly cause an increase in medical costs. Individuals
with poor back-related beliefs, high fear-avoidance behaviors associated with
low health literacy skills would definitely experience difficulty managing
chronic LBP disability (Briggs, 2010). Therefore, the aim of this study will be
to determine the relationship between health literacy and fear-avoidance
beliefs on disability in postpartum women with chronic low back pain.