Poor Health Literacy is Common in Patients with a Left Ventricular Device and is Predicted by Older Age, Lower Education Levels, and Depressive Symptoms

Abstract

Health literacy is an established concept in the health care world that seeks to understand people's comprehension of various healthcare information and their ability to apply it. Health literacy has been extensively studied in the heart failure literature, and inadequate health literacy has been linked to impaired ability to assess risk versus benefit information, poorer physical and mental health, increased hospitalizations, and an inability to fully engage in treatment planning and self-care. To date, health literacy in the left ventricular assist device (LVAD) population has not been documented, and could have serious implications on outcomes, due to the demands placed on patients and caregivers of patients who have to live with the device. The purpose of this study was to describe the levels of health literacy in an LVAD population and to identify variables associated with low health literacy. A cross-sectional, correlational study design was used, with 28 LVAD patients completing the Newest Vital Sign, a measure of health literacy, along with demographic and clinical questionnaires. Of the participants in our sample, 71% had inadequate health literacy. In bivariate analyses, we found that advancing age, fewer years of education, poorer cognitive function, and worse depressive symptoms were all associated with lower levels of health literacy (p < 0.05). In a multivariate, hierarchal linear regression model, after controlling for confounding variables, such as gender and INTERMACS profile, and including variables we found were significantly associated with health literacy in the bivariate analyses, higher age, fewer years of education, and higher levels of depressive symptoms were all independently associated with lower levels of health literacy (p value < 0.001, adjusted r2 0.627). Inadequate health literacy in this population is remarkably high, and is a more common in older, less educated, and more depressed persons. It is critical we evaluate health literacy in the LVAD population regularly and in the future, we need to analyze whether health literacy may impact outcomes in the LVAD population.