Abstract 9157: Which Patients with Heart Failure Have the Poorest Health Literacy?

Abstract

Background: Emerging interest in health literacy has resulted in appreciation of poor health literacy as a major obstacle to engaging in self-care of heart failure (HF), yet little is known about health literacy in this population. Objective: To determine predictors of health literacy in a sample of patients with HF from among relevant sociodemographic, clinical and psychosocial variables. Methods: We enrolled 612 patients with HF living in rural areas of the United States in a randomized controlled trial of a self-care intervention. This report includes baseline data from the 516 (mean age 65 ± 13 years; 41.3% female; 33.8% NYHA class III/IV) on whom we have full data on health literacy. Potential predictors were age, gender, education level, income, employment status, marital status, NYHA class, comorbidity burden, body mass index, anxiety, depression and perceived control. We measured health literacy using the Short Test of Functional Health Literacy Assessment, comorbidity burden using the Charlson comorbidity index, anxiety using the anxiety scale of the Brief Symptom Inventory, depression using the Patient Health Questionnaire-9, and perceived control using the Control Attitudes Scale-revised. Multiple hierarchical linear regression was used to determine predictors of health literacy. Results: The model explained 26% of the variance in health literacy (p < 0.001 for model). The following variables were significant independent predictors of poor health literacy: lower income (p = 0.006), education level of less than high school (p < 0.001), male gender (p < 0.001), older age (p < 0.001), and perceptions of low control related to HF (p = 0.007). None of the clinical variables and neither anxiety nor depression were significant predictors. Conclusion: A well-defined group of HF patients at risk for poor health literacy can be identified by sociodemographic variables and perceptions of control. This information can provide clinicians with information about which patients with HF may have problems with health literacy. Patients with poor health literacy often are not recognized by clinicians. When a patient possesses one or more of the characteristics identified in this study, the clinician should have a high index of suspicion for poor health literacy.