Pharmacy Practice Faculty Publications


A Proposed Model of the Relationships Between Health Literacy, Self-Care, Self-Efficacy, and Knowledge in Heart Failure

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Suppl 21

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Introduction: Inadequate health literacy may be a barrier in heart failure (HF) education. Prior research suggests that health literacy may influence HF knowledge, self-efficacy and self-care, but this has not been fully examined. The purpose of this study is to model the relationship between health literacy, formal education, knowledge, self-efficacy, and self-care in HF.

Hypotheses: H1: Health literacy will be positively associated with HF knowledge and self-efficacy. H2: Health literacy will have indirect effects on self-care through knowledge and self-efficacy. It also will indirectly affect self-efficacy through knowledge. H3: Education will be associated with health literacy and have a direct effect on knowledge.

Methods: New patient referrals (N=81, age 62.68 ± 13.55 years) to three HF clinics completed assessments of health literacy (Short-Form Test of Functional Health Literacy in Adults), knowledge (HF Knowledge Questionnaire), self-care and self-efficacy (Self-Care of HF Index v.6), and formal education prior to clinic HF education. Structural equation modeling was used to assess the variable relationships.

Results: A total of 63 participants with complete data were analyzed. The model demonstrated good fit (Figure 1), with a comparative fit index of 1.000. Although health literacy was associated with more years of formal education, there was an independent effect of health literacy on HF knowledge. Health literacy was not directly- or indirectly-related to self-care. Self-efficacy independently affected self-care. Nearly 34% of the variance in knowledge and 28% of the variance in self-care were explained by the model.

Conclusions: Health literacy may influence knowledge attainment in HF. However, health literacy, knowledge, and self-efficacy may not fully explain why patients perform self-care. Future research should examine additional factors that may influence HF self-care, such as motivation to perform self-care and social support.


Health literacy, self-care, heart failure