Introduction:
Inadequate health literacy may be a barrier during traditional clinic-based heart failure (HF) education. The influence of health literacy on gains over time in knowledge, self-efficacy and self-care is unknown. The purpose of this study was to examine health literacy, knowledge, self-efficacy, and self-care longitudinally in HF.
Hypotheses:
Patient health literacy level will be associated with differential gains in knowledge, self-efficacy, and self-care after completion of traditional clinic-based education.
Methods:
First-time patients at 3 HF clinics (N=51, age: 64.7±13.04 years) completed assessments of health literacy (Short-Form Test of Functional Health Literacy in Adults), knowledge (HF Knowledge Questionnaire), and self-care/self-efficacy (Self-Care of HF Index v.6) prior to HF education (baseline), 2 months (education completion), and 4 months post-baseline. Repeated measures Analysis of Variance was used to analyze longitudinal associations, and post-hoc tests with Bonferroni-adjusted alpha-levels were used for comparison.
Results:
Higher health literacy was associated with greater HF knowledge at 2 and 4 months (p<0.001), but there were no associations between health literacy and self-care or self-efficacy. In post-hoc analyses (Figure 1), patients with inadequate health literacy had less knowledge than those with marginal (p=0.024) or adequate (p<0.001) health literacy at 2 months. At 4 months, patients with inadequate health literacy continued to have less knowledge compared to adequate (p<0.001).
Conclusions:
Health literacy level is associated with attaining and retaining HF knowledge; however, it is not associated with self-care confidence or adherence. Tailoring HF education to health literacy level may aid in grasping concepts taught. It is unknown if a better grasp of concepts would enhance self-care adherence and promote improved health. Future research is needed to more fully understand the consequences of inadequate health literacy on self-care.
Critical health literacy as an important determinant of self-care behavior among patients with heart failure