Health literacy (HL), a determinant of health, is defined as a patient’s ability to understand and use health information. Low HL is associated with poorer health outcomes. The purpose of this study was to identify the prevalence of, and patient factors contributing to low HL. Further, to determine whether low HL contributes to poorer disease knowledge and self-care in ambulatory patients with heart failure (HF) or recipients of advanced therapies (ventricular assist device - VAD, or heart transplant - HTx).
135 English-speaking patients were randomly selected from our ambulatory HF or post-intervention (VAD/HTx) clinics between January and August 2015. We measured HL using the Newest Vital Sign tool, disease knowledge with the validated English-version Dutch Heart Failure Knowledge Scale, and self-care with the validated Self-Care Heart Failure Index.
The sample was predominantly male (72.6%) with an average age of 56.6 years. 43 (32%) had low HL (28/90 in HF; 15/45 in VAD/HTx). Patients with low HL were significantly older (61.3 vs 54.4 years; p<0.01), had less formal education (48.8% vs 80.4% post-secondary; p<0.01), and more frequently spoke English as a second language (41.9% vs 12.0%, p<0.01). In the HF group, patients with low HL had lower HF knowledge scores (10.82 vs 12.21; p<0.01), and significantly higher B-Type natriuretic peptide (542.3 vs 255.0 pg/mL; p<0.05). Low HL was not associated with lower HF knowledge in the VAD/HTx group (11.67 vs 12.50; p>0.1). HF patients with low HL also trended towards poorer self-care maintenance (71.48% vs 78.36%, p=0.06) and self-care confidence (67.71% vs 75.42%, p=0.06) but these did not reach statistical significance. Neither self-care maintenance (79.48% vs 81.03%; p>0.5), nor confidence (75.99% vs 78.21%, p>0.5) was associated with low HL in the VAD/HTx group.
This study found that 32% of patients with HF or VAD/HTx have low HL. This population is characterized by increased age, less formal education, and English as a second language. In HF patients, low HL is associated with poorer HF knowledge and self-care, which may negatively impact outcomes. Despite this effect of low HL in the HF population, in VAD/HTx patients, low HL does not appear to correlate with HF knowledge or self-care. Low HL represents a marker for patients who may benefit from additional educational supports.
© 2016 Published by Elsevier Inc.