Abstract
To examine the effects of health literacy, activities of daily living, frailty and self-care on rehospitalization for older adults with chronic heart failure using a structural equation model. This was a cross-sectional study. Two hundred and seventy-one older patients with chronic heart failure were recruited using a convenience sampling method from three community healthcare centres in Guangzhou, Southern China. The data were collected using a questionnaire survey between April 2018 and October 2018 by three research assistants. The proposed model revealed a good fit to the data (χ2 /d.f.=2.39, root mean square error of approximation=0.06, goodness of fit index=0.93, comparative fit index=0.91, normed fit index=0.91). Health literacy (β=0.21), activities of daily living (β=0.43), frailty (β=0.29) and self-care (β=0.40) directly affected the rehospitalization of older patients with chronic heart failure. Health literacy (β=0.19), activities of daily living (β=0.36) and frailty (β=0.33) indirectly affected rehospitalization through self-care. Frailty (β=0.16) indirectly affected rehospitalization by activities of daily living. Activities of daily living had the highest direct and total effects on rehospitalization; the effect values were 0.43 and 0.57, respectively. Community-dwelling older adults with chronic heart failure who had limited health literacy, frailty, declined activities of daily living and lower self-care were eligible for rehospitalization. Self-care and activities of daily living were considered mediators between rehospitalization and its predictors. A future longitudinal study is required to validate the results. Tailored and targeted measures aiming to enhance self-care and activities of daily living have been developed for older patients with chronic heart failure because they are not only predictors but also mediators. Assessment of health literacy level of this population is the first step before developing health education. Frailty of patients with chronic heart failure should be reduced to a minimum level.
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