Pharmacy Practice Faculty Publications


Health Literacy and Self-Care of Patients with Heart Failure

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Journal of the American Pharmacists Association





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Objective: To examine the association between patient health literacy level and self-care maintenance, management, and confidence in patients with heart failure.

Methods: Participants were recruited from a variety of community settings, such as heart failure clinics, cardiology offices, and continuing care retirement centers. A nonprobability convenience sample of individuals who met the inclusion criteria (at least 18 years of age, diagnosis of heart failure, could read English, and no cognitive impairment) was used. Participants were asked to complete three questionnaires: the Short-Form Test of Functional Health Literacy (S-TOFHLA), the Self-Care of Heart Failure Index (SCHFI), and a demographics questionnaire. The S-TOFHLA was used to measure health literacy and has 36 reading comprehension items, containing examples of commonly used materials in the health care system. The SCHFI was used to measure different components of self-care in heart failure with three subscales: maintenance, management, and confidence. The demographic instrument administered was a modified version of a demographic instrument utilized in other self-care research. Pearson correlations were used to determine the association between S-TOFHLA score and SCHFI subscale score.

Results: A total of 41 participants were recruited over 12 months. S-TOFHLA scores were positively correlated with self-care maintenance (0.385, P < 0.01) and self-care confidence (0.380, P < 0.01) and negatively correlated with self-care management (−0.360, P < 0.01). A square-root transformation was done to normalize the data. After transformation, S-TOFHLA scores continued to be positively and significantly correlated with self-care maintenance (0.434, P = 0.003) and self-care confidence (0.404,P = 0.004) and were negatively correlated with self-care management (−0.374, P = 0.057).

Conclusion: Higher health literacy is associated with better self-care maintenance and self-care confidence but poorer self-care management. Limitations of this study include small sample size, lack of participants with inadequate and marginal health literacy, and the variance of time since diagnosis among participants.


Health literacy, heart failure