[Health literacy in patients with heart failure treated in primary care]

[Education interventions in heart failure using m-Health: Systematic review]

OBJECTIVE

To provide the best scientific evidence available on the effectiveness of therapeutic education programs through digital health in patients with heart failure.

DESIGN

Systematic review of randomized clinical trials.

DATA SOURCES

Six databases were included due to their relevance in Health Sciences: PubMed, EMBASE, Scielo, Cochrane, CINAHL, and Web of Science.

SELECTION OF STUDIES

In English and Spanish, studies carried out between 2018 and 2023 were selected. After evaluating the methodological quality of the studies, the Jadad tool was used to discriminate those that did not meet said quality. In total, 8 articles from 6 different countries were included.

DATA EXTRACTION

The review and analysis of the documents were carried out by independent pairs. The Cochrane tool for RoB 2 randomized clinical trials was used to assess the risk of bias.

RESULTS

All the applications had therapeutic education, it was also assessed that they had monitoring, evaluation of signs and symptoms, drug titration, and professional follow-up through the application.

CONCLUSION

This review reveals the significant impact of therapeutic education in increasing patient knowledge, reducing hospital readmissions, and improving functional status and self-care. This makes digital health a valuable tool to complement nursing care in patients with heart failure.

[Protocolo para la evaluación de una intervención de alfabetización en salud sobre morbimortalidad y calidad de vida en pacientes con insuficiencia cardíaca.]

OBJECTIVE

Heart failure (HF) is a complex clinical syndrome that impairs the ability to achieve proper filling or ejection, in which patients have typical symptoms and signs. It is a major Public Health problem with a high incidence and prevalence associated with high morbidity and mortality. The management of the patient with HF is complex, requiring in its treatment the work of specialized multidisciplinary teams in which the management of cardiac-healthy habits and self-care will play a leading role. Knowing the health literacy (HL) level of patients is a fundamental piece that will help us to provide a holistic attention, based on individual needs, promoting in this way the empowerment of the patient. Our aim will be to evaluate the effectiveness of an HL intervention for improving quality of life and decreasing morbidity/mortality.

METHODS

A two-arm randomized controlled clinical trial will be conducted, with concealment of randomization. Patients with diagnosis of HF attended in cardiology and internal medicine consultations of 5 hospitals in Spain will be included.

Health literacy of patients on oral anticoagulation treatment- individual and social determinants and effect on health and treatment outcomes

Background

Assessment health literacy in people with cardiovascular health problems would facilitate the development of appropriate health strategies for the care and reduction of complications associated with oral anticoagulation therapy. Aim: To evaluate the relationship between health literacy and health and treatment outcomes (concordance with oral anticoagulants, Normalized Ratio control and occurrence of complications) in patients with cardiovascular pathology.

Methods

Observational, analytic and cross-sectional study carried out on 252 patients with cardiovascular pathology (atrial fibrillation, flutter or valve prosthesis), aged 50–85 years, accessing primary care services in Valencia (Spain) in 2018–2019. Variables referring to anticoagulant treatment with vitamin K antagonists (years of treatment, adequate control, polypharmacy and occurrence of complications, among others) and health literacy (Health Literacy Questionnaire) were analysed.

Results

All dimensions of health literacy were significantly related to the level of education (p < 0.02), social class (p < 0.02), an adequate control of acenocoumarol (p < 0.001), frequentation of health services (p < 0.001), information by patients to health professionals about anticoagulant treatment (p < 0.03), emergency care visits (p < 0.001) and unscheduled hospital admissions (p < 0.001).

Conclusion

Health literacy has a relevant influence on the adequate self-management of anticoagulation treatment and the frequency of complications. The different dimensions that comprise health literacy play an important role, but the “social health support” dimension seems to be essential for such optimal self-management.

Trial registration

ACC-ACE-2016-01. Registration date: December 2015.

Grado de incumplimiento terapéutico en función del nivel de alfabetización en salud en pacientes en hemodiálisis

Introducción: El paciente en hemodiálisis está sometido a un régimen terapéutico cuya adherencia contribuye a disminuir la aparición de complicaciones asociadas mejorando la morbimortalidad. El incumplimiento terapéutico es un problema prevalente en la práctica clínica. Bajos niveles de alfabetización en salud se relacionan con falta de autocuidados, errores en la toma de medicaciones y dificultad para entender instrucciones, lo que trae consigo una mayor tasa de incumplimiento terapéutico. Objetivo:  Conocer el grado de incumplimiento terapéutico en función del grado de alfabetización en salud de los pacientes sometidos a hemodiálisis. Material y Método: Estudio prospectivo en 35 pacientes en programa de hemodiálisis.  La alfabetización en salud se valoró con el cuestionario Health Literacy Survey European Union y el grado de incumplimiento terapéutico mediante la ganancia de peso interdialítica e indicadores analíticos, según recomendaciones de guías clínicas. Resultados: Los pacientes con nivel de alfabetización adecuada (≥34 puntos) presentaron menor incumplimiento terapéutico que pacientes con alfabetización inadecuada en relación a ganancia de peso interdialítica (78%vs 70%), potasio (67%vs56%), albúmina (83%vs72%) pero mayor IT con el fósforo (83,33%vs51,44%) – p<0,05 en todos los casos-. Conclusiones: Los pacientes con mayor nivel de alfabetización en salud tienen un menor grado de incumplimiento terapéutico, a excepción del fósforo, que es el parámetro con peor tasa de adherencia.

Association of health literacy and medication adherence with health-related quality of life (HRQoL) in patients with ischemic heart disease

BACKGROUND

Medication Adherence (MA) and Health Related Quality of Life (HRQoL) are two inter-connected concepts, co-influenced by Health Literacy (HL), with significant impact on patient management and care. Thus, we aimed to estimate the association of HL and MA with HRQoL in IHD patients.

METHODS

Cross-sectional study of 251 IHD patients recruited from Lahore over 6 months period. HL, MA and HRQoL was assessed using validated questionnaires; 16-items of HL, Morisky Green Levine Scale (MGLS) and SF-12, respectively. Chi-square for significance, logistic-regression for association and linear regression for predictions were used.

RESULTS

IHD patients; males (p = 0.0001), having secondary-higher education (p = 0.0001), middle/upper class (p = 0.0001) and employed (p = 0.005) had adequate HL, and were more likely to be adherent (OR; 4.3, p = 0.014). Both physical (PCS-12) and mental (MCS-12) component scores of HRQoL for age, gender, education, area of residence, employment and MA were significantly higher in patients with adequate HL. In multinomial regression, improved PCS-12 scores tend to be higher in subjects having secondary-higher education (OR; 3.5, p = 0.067), employed (OR; 6.1, p = 0.002) and adherent (OR; 2.95, p = 0.218), while MCS-12 scores tend to be higher in patients < 65 years (OR; 2.2, p = 0.032), employed (OR; 3, p = 0.002) and adherent (OR; 4, p = 0.004). In adjusted model, HL (β;0.383, p = 0.0001) and MA (β; - 0.133, p = 0.018) were significantly associated with PCS-12, and MCS-12 with MA (β; - 0.161, p = 0.009) only.

CONCLUSION

Data suggested that adequate HL was significantly associated with adherence and both physical and mental dimensions of HRQoL were higher in IHD patients with adequate HL. Besides, HL and MA are independent predictors of HRQoL in IHD patients.

What is the Prevalence of Low Health Literacy in European Union Member States? A Systematic Review and Meta-analysis

BACKGROUND

Many studies have shown that low health literacy (HL) is associated with several adverse outcomes. In this study, we systematically reviewed the prevalence of low HL in Europe.

METHODS

PubMed, Embase, and Scopus were searched. Cross-sectional studies conducted in the European Union (EU), published from 2000, investigating the prevalence of low HL in adults using a reliable tool, were included. Quality was assessed with the Newcastle-Ottawa Scale. Inverse-variance random effects methods were used to produce pooled prevalence estimates. A meta-regression analysis was performed to assess the association between low HL and the characteristics of the studies.

RESULTS

The pooled prevalence of low HL ranged from of 27% (95% CI: 18-38%) to 48% (95% CI: 41-55%), depending on the literacy assessment method applied. Southern, Western, and Eastern EU countries had lower HL compared to northern Europe (β: 0.87, 95% CI: 0.40-1.35; β: 0.59, 95% CI: 0.25-0.93; and β: 0.72, 95% CI: 0.06-1.37, respectively). The assessment method significantly influenced the pooled estimate: compared to word recognition items, using self-reported comprehensions items (β: 0.61, 95% CI: 0.15-1.08), reading or numeracy comprehensions items (β: 0.77, 95% CI: 0.24-1.31), or a mixed method (β: 0.66, 95% CI: 0.01-1.33) found higher rates of low HL. Refugees had the lowest HL (β: 1.59, 95% CI: 0.26-2.92). Finally, lower quality studies reported higher rates of low HL (β: 0.56, 95% CI: 0.06-1.07).

DISCUSSION

We found that low HL is a public health challenge throughout Europe, where one in every three to almost one in every two Europeans may not be able to understand essential health-related material. Additional research is needed to investigate the underlying causes and to develop remedies.

PROSPERO REGISTRATION

CRD42019133377.

Development and psychometric study of a simple instrument to assess patient communication and comprehension skills: the AsCkS

BACKGROUND

Instruments to examine patients' communication skills are impractical for daily clinical practice in primary health care, and it is assumed that health care professionals are always aware of the communication and comprehension status of patients.

OBJECTIVE

To design and examine the psychometric properties of a new questionnaire (AsCkS) to screen patients' risk of low communication and comprehension skills.

METHODS

Designing the new questionnaire involved: (i) a content validity study to generate a set of items, (ii) administration of a questionnaire in a sample of patients and (iii) study of the psychometric properties using a Rasch probabilistic model. The test probability function was used to detect patients at risk of having low communication and comprehension skills, and the associated factors were studied using multivariate logistic regression.

RESULTS

Five items were generated and 369 patients screened. In the Rasch analysis, one item was removed due to a lack of goodness-of-fit (Outfit = 3.64). The final set of four items showed good reliability (person separation index = 0.90). Convergent validity was moderate for the health literacy construct (r = 0.53) and low for the patient activation (r = 0.38): 77 patients (20.86%) were at risk of having low communication and comprehension skills. After adjustment, the associated factors were age (p < 0.001) and lower educational level (p < 0.001).

CONCLUSION

The AsCkS is a reliable and valid instrument and may be used to detect patients requiring a greater effort by the physician to communicate health care messages.

Relationship between Determinants of Health, Equity, and Dimensions of Health Literacy in Patients with Cardiovascular Disease

Background: Health literacy (HL) has been linked to empowerment, use of health services, and equity. Evaluating HL in people with cardiovascular health problems would facilitate the development of suitable health strategies care and reduce inequity. Aim: To investigate the relationship between different dimensions that make up HL and social determinants in patients with cardiovascular disease. Methods: Observational, descriptive, cross-sectional study in patients with cardiovascular disease, aged 50–85 years, accessing primary care services in Valencia (Spain) in 2018–2019. The Health Literacy Questionnaire was used. Results: 252 patients. Age was significantly related with the ability to participate with healthcare providers (p = 0.043), ability to find information (p = 0.022), and understanding information correctly to know what to do (p = 0.046). Level of education was significant for all HL dimensions. Patients without studies scored lower in all dimensions. The low- versus middle-class social relationship showed significant results in all dimensions. Conclusions: In patients with cardiovascular disease, level of education and social class were social determinants associated with HL scores. Whilst interventions at individual level might address some HL deficits, inequities in access to cardiovascular care and health outcomes would remain unjustly balanced unless structural determinants of HL are taken into account.

Exploring the Importance of Health Literacy for the Quality of Life in Patients with Heart Failure

As with all other chronic noncommunicable diseases, adequate health literacy plays a key role in making the right decisions in the treatment of heart failure. Patients with heart failure and a lower health literacy have a reduced quality of life. A cross-sectional study among 200 patients with heart failure was conducted at a state university hospital in Belgrade, Serbia. The European Health Literacy Questionnaire, HLS-EU-Q47, was used to assess health literacy. Quality of life was measured with the generic SF-36 and the Minnesota Living with Heart Failure Questionnaire. Descriptive and analytical statistical analysis was applied. More than half of the respondents (64%) had limited health literacy. The lowest mean health literacy index (28.01 ± 9.34) was within the disease prevention dimension, where the largest number of respondents showed limited health literacy (70%). Our patients had a poorer quality of life in the physical dimension, and the best scores were identified in the emotional role and social functioning. Health literacy was highly statistically significant and an independent predictor of quality of life (physical, mental, and total quality of life). Improving health literacy can lead to better decisions in the treatment of disease and quality of life in heart failure patients.

[Heart failure in primary care: Attitudes, knowledge and self-care]

OBJECTIVE

To determine the attitudes, knowledge, and self-care practices in patients with heart failure (HF) in Primary Care, as well as to identify factors associated with better self-care.

DESIGN

Cross-sectional and multicentre study.

SETTING

Primary Care.

PARTICIPANTS

Subjects over 18 years old with HF diagnosis, attended in 10 Primary Health Care Centres in the Metropolitan Area of Barcelona.

MAIN MEASUREMENTS

Self-care was measured using the European Heart Failure Self-Care Behaviour Scale. Sociodemographic and clinical characteristics, tests on attitudes (Self-efficacy Managing Chronic Disease Scale), knowledge (Patient Knowledge Questionnaire), level of autonomy (Barthel), and anxiety and depression screening (Goldberg Test), were also gathered in an interview. A multivariate mixed model stratified by centre was used to analyse the adjusted association of covariates with self-care.

RESULTS

A total of 295 subjects (77.6%) agreed to participate, with a mean age of 75.6 years (SD: 11), 56.6% women, and 62% with no primary education. The mean self-care score was 28.65 (SD: 8.22), with 25% of patients scoring lower than 21 points. In the final stratified multivariate model (n=282; R2 conditional=0.3382), better self-care was associated with higher knowledge (coefficient, 95% confidence interval: -1.37; -1.85 to -0.90), and coronary heart disease diagnosis (-2.41; -4.36: -0.46).

CONCLUSION

Self-care was moderate. The correlation of better self-care with higher knowledge highlights the opportunity to implement strategies to improve self-care, which should consider the characteristics of heart failure patients attended in Primary Care.