Critical health literacy as an important determinant of self-care behavior among patients with heart failure

Abstract

Purpose: Health literacy (HL) has been recognized as an important concept in patient education and disease management for heart failure (HF). However, previous studies on HL has focused predominantly on the functional HL (the ability to read and write), the relationship between comprehensive HL including the ability to access to information (communicative HL) and the ability to evaluate critically (critical HL) and self-care behavior has not been evaluated. This study aimed to determine the relationship between the functional, communicative, and critical HL and self-care behavior on HF patients. Methods: Cross-sectional analysis of data were completed the HL (the comprehensive HL scale), HF-related self-care behaviors (The European Heart Failure Self-Care Behavior Scale) and HF-related knowledge. Socio-demographic (age, gender, education level) and clinical characteristics (etiology, risk factors, comorbidity and severity of HF) were also assessed. We used the analyses of covariance and multivariate linear regression to estimate the associations between three levels of HL and self-care behavior. Results: 189 out of 201 patients with HF were assessed (mean age 66.8±13.9 years; 64.6% males; 46.6% NYHA function classII). Patients with low HL had poor HF-related knowledge and self-care behavior than those with high HL (Knowledge: 9.2 versus. 11.8, P<0.00, Self-care: 35.5 versus. 32.4, P=0.03). Out of the three components of HL, patients with low critical HL had poor self-care behavior than those with high critical HL (35.82 versus 32.70, P=0.03). Functional and communicative HL were not associated with self-care behavior (functional HL: low 33.45 versus high 33.96, P=0.71, communicative HL: low 35.66 versus high 32.91, P=0.80). Multivariate linear regression analysis revealed that critical HL (β= −0.25, P=0.02), HF-related knowledge (β= − 0.21, P=0.03), age (β= −0.01, P < 0.03), and occupation (β= −0.27, P<0.04) were independently associated with self-care behavior. Conclusions: Critical HL was independent associated with self-care behavior in patients with HF. We should develop the effective intervention to improve patient's skills for analyzing critically information and using it to making decisions.