Comprensione vs ipertensione: gli impatti dell’alfabetizzazione sanitaria sulla gestione dell’ipertensione arteriosa

Journal title MECOSAN
Author/s Rocco Palumbo
Publishing Year 2016 Issue 2015/95 Language Italian
Pages 27 P. 81-107 File size 20329 KB
DOI 10.3280/MESA2015-095005
DOI is like a bar code for intellectual property: to have more infomation click here

Below, you can see the article first page

If you want to buy this article in PDF format, you can do it, following the instructions to buy download credits

Article preview

FrancoAngeli is member of Publishers International Linking Association, Inc (PILA), a not-for-profit association which run the CrossRef service enabling links to and from online scholarly content.

Inadequate health literacy is generally described as a silent epidemic, which is challenging the functioning of health care systems all over the world. Health literacy is understood as the ability to obtain, process, and understand basic health information in order to effectively navigate the health system. Low health literate patients perceive poor self-efficacy, are not willing to be involved in the provision of care, show larger risks of hospitalization and mortality, and are not aware of the determinants of well-being. Moreover, limited health literacy has been associated with inadequate management of long-term conditions. This study is aimed at examining the association between health literacy and the appropriate management of hypertension. For this purpose, a narrative literature review has been performed, concerning 38 articles retrieved from the databases PubMed, Scopus-Elsevier, EBSCOhost and Web of Science. Even though the literature is not consistent dealing with this issue, inadequate health literacy is mainly conceived as a significant determinant of poor health outcomes among hypertensive patients.

Keywords: Health literacy, hypertension, appropriateness, health outcomes, health education, medication adherence

  1. Aboumatar H.J. et al. (2013). The impact of health literacy on desire for participation in healthcare, medical visit communication, and patient reported outcomes among patients with hypertension. Journal of General Internal Medicine, 28 (11):1469-1476. DOI: 10.1007/s11606-013-2466-5
  2. Adeseun G.A., Bonney C.C., Rosas S.E. (2012). Health literacy associated with blood pressure but not other cardiovascular disease risk factors among dialysis patients. American Journal of Hypertension, 25 (3): 348-353. DOI: 10.1038/ajh.2011.252
  3. Aikens J.E., Piette J.D. (2009). Diabetic patients’ medication underuse, illness outcomes, and beliefs about antihyperglycemic and antihypertensive treatments. Diabetes Care, 32 (1): 19-24. DOI: 10.2337/dc08-1533
  4. Al Sayah F., Williams B., Johnson J.A. (2013). Measuring Health Literacy in Individuals with Diabetes: A Systematic Review and Evaluation of Available Measures. Health Education and Behaviour, 40 (1): 42-55. DOI: 10.1177/1090198111436341
  5. Armin J. et al. (2014). Breast Self-Examination Beliefs and Practices, Ethnicity, and Health Literacy: Implications for Health Education to Reduce Disparities. Health Education Journal, 73 (3): 274-284. DOI: 10.1177/0017896912471048
  6. Ayotte B.J., Allaire, J.C., Bosworth H. (2009). The Associations of Patient Demographic Characteristics and Health Information Recall: The Mediating Role of Health Literacy. Aging, Neuropsychology, and Cognition: A Journal on Normal and Dysfunctional Development, 16 (4): 419-432. DOI: 10.1080/13825580902741336
  7. Baker D.W. (2006). The Meaning and the Measure of Health Literacy. Journal of General Internal Medicine, 21: 878-883. DOI: 10.1111/j.1525-1497.2006.00540.x
  8. Barrett S.E., Puryear J.S. (2006). Health Literacy: Improving Quality of Care in Primary Care Settings. Journal of Health Care for the Poor and Underserved, 17: 690-697. DOI: 10.1353/hpu.2006.0117
  9. Baumann L., Ngoc T.T. (2012). Helping patients with chronic conditions overcome barriers to selfcare.
  10. The Nurse Practitioner, 37 (3): 32-38. DOI: 10.1097/01.NPR.0000412877.80955.e0.
  11. Bourne P.A. et al. (2010). Health literacy and health seeking behaviour among older men in a middle-income nation. Patient Related Outcome Measures, 1: 39-49. DOI: 10.2147/PROM.S11141
  12. Carey G., Crammond B., Keast R. (2014). Creating change in government to address the social determinants of health: how can efforts be improved. BMC Public Health, 14 (1087). DOI: 10.1186/1471-2458-14-1087
  13. Chiang K.P., Jackson A. (2013). Health literacy and its outcomes: Application and extension of elaboration likelihood model. International Journal of Healthcare Management, 6 (3): 152-157. DOI: 10.1179/2047971913Y.0000000041
  14. Chin J. et al. (2011). The Process-Knowledge Model of Health Literacy: Evidence from a Componential Analysis of Two Commonly Used Measures. Journal of Health Communication, 16 (S3): 222-241. DOI: 10.1080/10810730.2011.604702
  15. Clark B. (2011). Using law to fight a silent epidemic: the role of health literacy in health care access, quality, & cost. Annals of Health Laws, 20 (2): 253-327.
  16. Coughlan M., Cronin P., Ryan F. (2013). Doing a Literature Review in Nursing, Health and Social Care. London: Sage Publication.
  17. Coulter A. (2012). Patient Engagement – What Works?. Journal of Ambulatory Care Management, 35 (2): 80-89. DOI: 10.1097/JAC.0b013e318249e0fd
  18. Coulter A., Ellins J. (2007). Effectiveness of strategies for informing, educating, and involving patients. British Medical Journal, 335 (7609): 24-27. DOI: 10.1136/bmj.39246.581169.80
  19. Crengle S. (2014). Cardiovascular disease medication health literacy among Indigenous peoples: design and protocol of an intervention trial in Indigenous primary care services. BMC Public Health, 14: 714-720. DOI: 10.1186/1471-2458-14-714
  20. Cunningham C.T. et al. (2014). Ethnicity and Health Literacy: A Survey on Hypertension Knowledge among Canadian Ethnic Populations. Ethnicity & Disease, 24 (3): 276-282, disponibile al sito:
  21. Davis O.I. (2011). (Re)framing Health Literacy: Transforming the Culture of Health in the Black Barbershop. Western Journal of Black Studies, 35 (3): 176-186. DOI: 10.3149/jmh.1202.138
  22. (3): 176-186. DOI: 10.3149/jmh.1202.138DevrajR.,HerndonC.M.,GriffinJ.(2013).Painawarenessandmedicationknowledge:ahealthliteracyevaluation.JournalofPainandPalliativeCarePharmacotherapy,27(1):19-27.DOI:10.3109/15360288.2012.751955
  23. Edwards M., Davies M., Edwards A. (2009). What are the external influences on information exchange and shared decision making in healthcare consultations. Patient Education and Counseling, 75 (1), pp. 37-52. DOI: 10.1016/j.pec.2008.09.025
  24. Edwards M., Wood F., Davies M., Edwards A. (2012). The development of health literacy in patients with a long-term health condition: the health literacy pathway model. BMC Public Health, 12: 130-145. DOI: 10.1186/1471-2458-12-130
  25. Evangelista L.S. et al. (2010). Health literacy and the patient with heart failure – implications for patient care and research: a consensus statement of the Heart Failure Society of America. Journal of Cardiac Failure, 16 (1): 9-16. DOI: 10.1016/j.cardfail.2009.10.026
  26. Federman A.D. et al. (2013). The association of health literacy with illness and medication beliefs among older adults with asthma. Patient Education and Counseling, 92 (2): 273-278. DOI: 10.1016/j.pec.2013.02.013
  27. Fineberg H.V. (2004). Health Literacy. Washington, DC: National Academies Press.
  28. Freedman D.A. et al. (2009). Public Health Literacy Defined. American Journal of Preventive Medicine, 36 (5): 446-451. DOI: 10.1016/j.amepre.2009.02.001
  29. Frisch A.L., Camerini L., Diviani N., Schulz P.
  30. (2012). Defining and measuring health literacy: How can we profit from other literacy domains?. Health Promotion International, 27 (1): 117-126. DOI: 10.1093/heapro/dar043
  31. Gazmararian J.A. et al. (2006). Factors Associated with Medication Refill Adherence in Cardiovascular-related. Journal of General Internal Medicine, 21 (12): 1215-1221. DOI: 10.1111/j.1525-1497.2006.00591.x
  32. Gazmararian J.A., Williams M.V., Peel J., Baker D.W. (2003). Health literacy and knowledge of chronic disease. Patient Education and Counseling, 51 (3): 267-275. DOI: 10.1016/S0738-3991(02)00239-2
  33. Gazmararian J., Jacobson K.L., Pan Y. (2010). Effect of a pharmacy-based health literacy intervention and patient characteristics on medication refill adherence in an urban health system. Annals of Pharmacotherapy, 44 (1): 80-87. DOI: 10.1345/aph.1M328
  34. Giuse N.B. et al. (2012). Using Health Literacy and Learning Style Preferences to Optimize the Delivery of Health Information. Journal of Health Communication, 17 (S3): 122-140.
  35. 10.1080/10810730.2012.712610. Hart C. (1998). Doing a literature review: releasing the social. London: Sage Publication.
  36. Heijmans M. et al. (2015). Functional, Communicative and Critical Health Literacy of Chronic Disease Patients and their Importance for Self-Management. Patient Education and Counseling, 98 (1):41-48. DOI: 10.1016/j.pec.2014.10.006
  37. Heinrich C. (2012). Health literacy: The sixth vital sign. Journal of the American Academy of Nurse Practitioners, 24 (4): 218-223. DOI: 10.1111/j.1745-7599.2012.00698.x
  38. Herxheimer A. (2012). Public understanding of drug therapy. British Journal of Clinical Pharmacology, 73 (6): 943-947. DOI: 10.1111/j.1365-2125.2012.04243.x
  39. Hickey K. et al. (2014). Assessing Health Literacy in Urban Patients with Implantable Cardioverter Defibrillators and Pacemakers. Journal of Cardiovascular Nursing, Pubblicato on-line prima della stampa. DOI: 10.1097/JCN.0000000000000184
  40. Hill E.K. (2005). Assessing Health Literacy. Providing Useable Health Information for Seniors at Discharge in Northern Idaho. Journal of Hospital Librarianship, 5 (4):11-24. DOI: 10.1300/J186v05n04_02
  41. Hls-Eu Consortium (2012). Comparative report of health literacy in eight EU member states. The European health literacy survey, disponibile al sito:
  42. Ingram R.. E Ivanov L.L. (2013). Examining the Association of Health Literacy and Health Behaviors in African American Older Adults: Does Health Literacy Affect Adherence to Antihypertensive Regimens? Journal of Gerontological Nursing, 39 (3): 22-32. DOI: 10.3928/00989134-20130201-01
  43. Institute of Medicine (2004). Health Literacy: A Prescription to End Confusion. Washington, DC: USA: National Academies Press.
  44. Istat (2014). Annuario Statistico Italiano 2013. Roma: ISTAT Informazioni.
  45. Jones C.A. et al. (2011). Tackling health literacy: adaptation of public hypertension educational materials for an Indo-Asian population in Canada.
  46. BMC Public Health, 11(24). DOI: 10.1186/1471-2458-11-24
  47. Joyner-Grantham J. et al. (2009). Self-Reported Influences of Hopelessness, Health Literacy, Lifestyle Action, and Patient Inertia on Blood Pressure Control in a Hypertensive Emergency Department Population. The American Journal of the Medical Sciences, 338 (5): 368-372.
  48. MAJ Keller D.L., Wright J., Pace H.A. (2008). Impact of health literacy on health outcomes in ambulatory care patients: a systematic review. Annals of Pharmacotherapy, 42 (9):1272-1281. DOI: 10.1345/aph.1L093
  49. Kim M. et al. (2013). The Effect of a Communitybased Health Literacy-enhanced Behavioral Intervention in Korean American Seniors with High Blood Pressure. Paper presentato alla Conferenza Scientific Sessions and Resuscitation Science Symposium of the American-Heart-Association, Dallas: TX, 16-17 Novembre 2013.
  50. Kim M.T. et al. (2012). Development and Validation of the High Blood Pressure-Focused Health Literacy Scale. Patient Education and Counseling, 87 (2):165-170. DOI: 10.1016/j.pec.2011.09.005
  51. Kim S.H. (2009). Health literacy and functional health status in Korean older adults. Journal of Clinical Nursing, 18 (16): 2337-2343. DOI: 10.1111/j.1365-2702.2008.02739.x
  52. Ko Y. et al. (2013). Health literacy and its association with disease knowledge and control in patients with hypertension in Singapore. International Journal of Cardiology, 16 (4): e116-e117. DOI: 10.1016/j.ijcard.2013.08.041
  53. Kripalani S., Gatti M.E., Jacobson T.A. (2010). Association of age, health literacy, and medication management strategies with cardiovascular medication adherence. Patient Education and Counseling, 81 (2): 177-181. DOI: 10.1016/j.pec.2010.04.030
  54. Lee T.W., Lee S.H., Kim H.H., Kang S.J. (2012). Effective Intervention Strategies to Improve Health Outcomes for Cardiovascular Disease Patients with Low Health Literacy Skills: A Systematic Review. Asian Nursing Research, 6 (4): 128-136. DOI: 10.1016/j.anr.2012.09.001
  55. Levinthal B.R. et al. (2008). Cognition and health literacy in patients with hypertension. Journal of General Internal Medicine, 23 (8): 1172-1176. DOI: 10.1007/s11606-008-0612-2
  56. Lindquist L.A. et al. (2012). Relationship of health literacy to intentional and unintentional nonadherence of hospital discharge medications. Journal of General Internal Medicine, 27 (2): 173-178. DOI: 10.1007/s11606-011-1886-3
  57. Li X. et al. (2013). Health Literacy in Rural Areas of China: Hypertension Knowledge Survey. International Journal of Environmental Research and Public Health, 10 (3): 1125-1138. DOI: 10.3390/ijerph10031125
  58. Machado et al. (2014). Instruments of health literacy used in nursing studies with hypertensive
  59. elderly. Revista Gaúcha de Enfermaghen, 35 (4):101-107. DOI: 10.1590/1983-1447.2014.04.45139
  60. Mackert M. et al. (2014). Stigma and health literacy: an agenda for advancing research and practice. American journal of health behavior, 38 (5): 690-698. DOI: 10.5993/AJHB.38.5.6
  61. Mccaffery K.J., Smith S.K., Wolf M. (2010). The challenge of shared decision making among patients with lower literacy: a framework for research and development. Medical Decision Making, 30 (1): 35-44. DOI: 10.1177/0272989X09342279
  62. McCarthy A., Jennifer L. (2002). Health literacy policy and strategy: Research report for national adult literacy agency. Dublin: National Adult Literacy Agency.
  63. McNaughton C.D. et al. (2014). Association of Health Literacy with Elevated Blood Pressure. A Cohort Study of Hospitalized Patients. Medical Care, 52 (4): 346-353. DOI: 10.1097/MLR.0000000000000101
  64. Moore K., Smith B.J., Reilly K (2013). Community understanding of the preventability of major health conditions as a measure of health literacy. Australian Journal of Rural Health, 21 (1): 35-40. DOI: 10.1111/ajr.12005
  65. Morris N.S., Maclean C.D., Littenberg B. (2013). Change in Health Literacy Over 2 Years in Older Adults with Diabetes. The Diabetes Educator, 39 (5): 638-646. DOI: 10.1177/0145721713496871.DOI:10.1080/10810730.2012.712611
  66. Mosher H.J., Kund B.C., Kripalani S., Kaboli P. (2012). Association of health literacy with medication knowledge, adherence, and adverse drug events among elderly veterans. Journal of Health Communication, 17 (3): 241-251. DOI: 10.1080/10810730.2012.712611
  67. Murray M.D. et al. (2009). Factors associated with exacerbation of heart failure include treatment adherence and health literacy skills. Clinical Pharmacology and Therapeutics, 85 (6): 651-658. DOI: 10.1038/clpt.2009.7
  68. Naik A.D., Street R.L., Castillo D., Abraham N.S. (2011). Health literacy and decision making styles for complex antithrombotic therapy among older multimorbid adults. Patient Education and Counseling, 85 (3): 499-504. DOI: 10.1016/j.pec.2010.12.015
  69. Neafsey P.J. et al. (2008). Beta Testing of a Network-Based Health Literacy Program Tailored for Older Adults with Hypertension. Computers, Informatics, Nursing: CIN, 26 (6): 311-319. DOI: 10.1097/01.NCN.0000336466.17811.e7
  70. Ngoh L.N. (2009). Health literacy: a barrier to pharmacist-patient communication and medication adherence. Journal of the American Pharmacists Association, 49 (5): e132-e149. DOI: 10.1331/JAPhA.2009.07075
  71. Noureldin M. et al. (2012). Effect of health literacy on drug adherence in patients with heart failure. Pharmacotherapy, 32 (9): 819-826. DOI: 10.1002/j.1875-9114.2012.01109.x
  72. Nutbeam D. (2008). The evolving concept of health literacy. Social Science & Medicine, 67: 2072-2078. DOI: 10.1016/j.socscimed.2008.09.050
  73. Osborn C.Y., Paasche-Orlow M.K., Cooper Bailey S., Wolf M.S. (2011). The Mechanisms Linking Health Literacy to Behavior and Health Status. American Journal of Health Behavior, 35 (1): 118-128. DOI: 10.5993/AJHB.35.1.11
  74. Paasche-Orlow M. (2011). Caring for patients with limited health literacy: a 76-year-old man with multiple medical problems. The Journal of the American Medical Association, 306 (10): 1122-1129. DOI: 10.1016/j.socscimed.2008.09.050
  75. Palumbo R. (2012). Health literacy: una review della dottrina internazionale. Mecosan, 84: 27-50.
  76. Palumbo R. (2014). The Dark Side of Health Care Coproduction. Health literacy as a requisite for the coproduction of care. Zuerich, Institute of Research Engineers and Doctors: 15-19. DOI: 10.15224/978-1-63248-032-3-105
  77. Parker R.M., Baker D.W., Williams M.V., Nurss J.R. (1995). The test of functional health literacy in adults. Journal of General Internal Medicine, 10 (10): 537-541. DOI: 10.1007/bf02640361
  78. Parker R.M., Ratzen S.C., Lurie N. (2003). Health Literacy: a policy challenge for advancing high quality health care. Health Affairs, 22 (4): 147-153. DOI: 10.1377/hlthaff.22.4.147
  79. Parker R.M., Wolf M.S., Kirsh I. (2008). Preparing for an epidemic of limited health literacy: weathering. Journal of General Internal Medicine, 23 (8): 1273-1276. DOI: 10.1007/s11606-008-0621-1.PeersonA.,SaundersM.(2009).Healthliteracyrevisited:whatdowemeanandwhydoesitmatter?.HealthPromotionInternational,24(3):285-296.DOI:10.1093/heapro/dap014
  80. Perez A. (2015). Acculturation, Health Literacy, and Illness Perceptions of Hypertension among Hispanic Adults. Journal of Transcultural Nursing, 26 (4): 386-394. DOI: 10.1177/1043659614524785
  81. Persell S.D. et al. (2007). Limited Health Literacy is a Barrier to Medication Reconciliation in Ambulatory Care. Journal of General Internal Medicine, 22 (11): 1523-1526. DOI: 10.1007/s11606-007-0334-x
  82. Peters E., Hibbard J., Slovic P., Dieckmann N. (2007). Numeracy skill and the communication, comprehension, and use of risk-benefit information. Health Affairs, 26 (3): 741-748. DOI: 10.1377/hlthaff.26.3.741
  83. Pleasant A. (2012). Health literacy around the world: Part 1. Health literacy efforts outside of the United States. Washington, DC: Institute of Medicine.
  84. Ratzan S.C. (2001). Health Literacy: Communication for the Public Good. Health Promotion International, 16 (2): 207-214. DOI: 10.1093/heapro/16.2.207
  85. Ratzan S.C., Weinberger M.B., Apfel F., Kocharian G. (2013). The Digital Health Scorecard: A New Health Literacy Metric for NCD Prevention and Care. Global Heart, 8 (2): 171-179. DOI: 10.1016/j.gheart.2013.05.006
  86. Raynor D.K. (2012). Health literacy. British Medical Journal, 344:2188. DOI: 10.1136/bmj.e2188.RechelB.etal.(2013).AgeingintheEuropeanUnion.TheLancet,381(9874):1312-1322.DOI:10.1016/S0140-6736(12)62087-X
  87. Rodriguez K.M. (2013). Intrinsic and extrinsic factors affecting patient engagement in diabetes selfmanagement: perspectives of a certified diabetes educator. Clinical Therapeutics, 35 (2): 170-178. DOI: 10.1016/j.clinthera.2013.01.002.RuddR.E.(2007).HealthliteracyskillsofU.S.adults.AmericanJournalofHealthBehaviour,31(1):8-18.DOI:10.5555/ajhb.2007.31.supp.S8
  88. Safeerm R.S., Cooke C.E., Keenan J. (2006). The impact of health literacy on cardiovascular disease. Vascular Health and Risk Management, 2 (4): 457-464. DOI: 10.2147/vhrm.2006.2.4.45
  89. Shaw S.J. et al. (2012). Chronic Disease Self-Management and Health Literacy in Four Ethnic Groups. Journal of Health Communication, 17 (S3): 67-81. DOI: 10.1080/10810730.2012.712623
  90. Shaw S.J. et al. (2009). The Role of Culture in Health Literacy and Chronic Disease Screening and Management. Journal of Immigrant and Minority Health, 11 (6): 460-467. DOI: 10.1007/s10903-008-9135-5
  91. Shibuya A. et al. (2011). The Relation between Health Literacy, Hypertension Knowledge, and Blood Pressure among Middle-Aged Japanese Adults. Blood Pressure Monitoring, 16 (5): 224-230.
  92. DOI: 10.1097/MBP.0b013e32834af7ba.
  93. Simonds S.K. (1974). Health Education as Social Policy. Health Education Monographs, 2 (1s): 1-25.
  94. DOI: 10.1177/10901981740020S102
  95. Sorensen K. et al. (2012). Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health, 80 (12). DOI: 10.1186/1471-2458-12-80
  96. Sykes S., Wills J., Rowlands G., Popple K. (2013). Understanding critical health literacy: a concept analysis. BMC Public Health, 13 (150).
  97. 10.1186/1471-2458-13-150. Tokuda Y., Doba N. Butler J.P., Paasche-Orlow M.K. (2009). Health Literacy and Physical and Psychological Wellbeing in Japanese Adults. Patient Education and Counseling, 75 (3): 411-417. DOI: 10.1016/j.pec.2009.03.031
  98. Tones K. (2002). Health literacy: new wine in old bottles?. Health Education Research, 17(3): 287-290. DOI: 10.1093/her/17.3.287
  99. Warren-Findlow J. et al. (2014). Assessing health literacy of hypertensive patients in a primary care setting using a self-administered questionnaire. Journal of Health Care for the Poor and Underserved, 4 (1833-1843): 25. DOI: 10.1353/hpu.2014.0187
  100. Willens D.E. et al. (2013). Association of Brief Health Literacy Screening and Blood Pressure in Primary Care. Journal of Health Communication, 18 (S1): 129-142. DOI: 10.1080/10810730.2013.825663
  101. Williams M.V., Baker D.W., Parker R.M., Nurss J.R. (1998). Relationship of Functional Health Literacy to Patients’ Knowledge of Their Chronic Disease. A Study of Patients with Hypertension and Diabetes. Archives of Internal Medicine, 158 (2): 166-172. DOI: 10.1001/archinte.158.2.166
  102. Woodard L.D. et al. (2014). Interaction between functional health literacy, patient activation, and glycemic control. Patient Prefer Adherence, 8: 1019-1024. DOI: 10.2147/PPA.S63954
  103. Xu W.H. et al. (2014). Improved self-management skills in Chinese diabetes patients through a comprehensive health literacy strategy: study protocol of a cluster randomized controlled trial. Trials, 15 (1): 498-505. DOI: 10.1186/1745-6215-15-498
  104. Yin H.S. et al. (2010). Parents’ medication administration errors: role of dosing instruments and health literacy. Archives of Pediatrics and Adolescent Medicine, 164 (2): 181-186. DOI: 10.1001/archpediatrics.2009.269
  105. Devraj R., Herndon C. M., Griffin J. (2013). Pain awareness and medication knowledge: ahealth literacy evaluation. Journal of Pain and Palliative Care Pharmacotherapy,27 (1):19-27. DOI: 10.3109/15360288.2012.751955

  • La riorganizzazione delle prestazioni sanitarie in ottica di appropriatezza: l'esperienza dell'AOU "San Giovanni di Dio e Ruggi d'Aragona" nella gestione del DRG 127 - Insufficienza cardiaca e shock Lucia Soriente, Silvio Cigolari, Alberto Gigantino, Chiara Aliberti, Pasquale Ardovino, Paola Adinolfi, Rocco Palumbo, in MECOSAN 115/2021 pp.7
    DOI: 10.3280/MESA2020-115002

Rocco Palumbo, Comprensione vs ipertensione: gli impatti dell’alfabetizzazione sanitaria sulla gestione dell’ipertensione arteriosa in "MECOSAN" 95/2015, pp 81-107, DOI: 10.3280/MESA2015-095005