Tailoring consumer resources to enhance self-care in chronic heart failure

Actual status of pre-discharge knowledge of hospitalised patients with heart failure and measurement tools to assess said knowledge: A scoping review

BACKGROUND

Heart failure (HF) patients have high readmission rates and require continuous adherence to HF self-care. Lack of knowledge about HF has been identified as a factor that contributes to poor adherence.

OBJECTIVES

To clarify and organise existing data about measurement tools used to assess pre-discharge knowledge of hospitalised HF patients, the content and level of pre-discharge knowledge, factors associated with the level of knowledge, and the effect of knowledge levels on patients' outcomes.

METHODS

Four electronic databases were searched for articles that described the content and level of knowledge of pre-discharge HF patients.

RESULTS

Thirty-three studies were included in this review. Twenty-two measurement tools were identified used for pre-discharge knowledge assessment. 'Heart failure pathophysiology and treatment' and 'salt and fluid management' were the most common knowledge content measured. The level of knowledge of 'the nature, definition, and causes of symptoms of heart failure' and 'fluid and medication management' tended to be low. High levels of knowledge were found for 'higher educational background', 'previous heart failure hospitalisation', and 'previous heart failure education', while low levels were found for: 'high number of medications' and 'first heart failure hospitalisation'. The level of HF knowledge implies an impact on compliance and self-care.

CONCLUSION

HF patients have low level of knowledge of the nature and causes of HF and fluid management prior to hospital discharge. Some of the variables that influenced the level of patient knowledge were educational background, number of medications taken, and disease duration.

Development of Core Educational Content for Heart Failure Patients in Transition from Hospital to Home Care: A Delphi Study

Heart failure (HF) patients should be systematically educated before discharge on how to manage with standard written materials for patient self-management. However, because of the absence of readily available written materials to reinforce their learned knowledge, patients with HF feel inadequately informed in terms of the discharge information provided to them. This study aimed to develop core content to prepare patients with HF for transition from hospital to home care. The content was validated by expert panelists using Delphi methods. Nineteen draft items based on literature review were developed. We established a consensus on four core sections, including 47 categories and 128 subcategories through the Delphi survey: (1) understanding HF (five categories and 23 subcategories), (2) HF medication (19 categories and 45 subcategories), (3) HF management (20 categories and 47 subcategories), and (4) HF diary (three categories and 13 subcategories). Each section provided easy-to-understand educational contents using cartoon images and large or bold letters for older patients with HF. The developed core HF educational contents showed high consensus between the experts, along with clinical validity. The contents can be used as an educational booklet for both planning discharge education of patients with HF and for post-discharge management when transitioning from hospital to home. Based on this study, a booklet series for HF patients was first registered at the National Library of Korea. Future research should focus on delivering the core content to patients with HF in convenient and accessible format through various media.

Renal recipients' knowledge and self-efficacy during first year after implementing an evidence based educational intervention as routine care at the transplantation clinic

BACKGROUND

Following an implementation plan based on dynamic dialogue between researchers and clinicians, this study implemented an evidence-based patient education program (tested in an RCT) into routine care at a clinical transplant center. The aim of this study was to investigate renal recipients' knowledge and self-efficacy during first year the after the intervention was provided in an everyday life setting.

METHODS

The study has a longitudinal design. The sample consisted of 196 renal recipients. Measurement points were 5 days (baseline), 2 months (T1), 6 months (T2), and one-year post transplantation (T3). Outcome measures were post-transplant knowledge, self-efficacy, and self-perceived general health.

RESULTS

No statistically significant changes were found from baseline to T1, T2, and T3. Participants' levels of knowledge and self-efficacy were high prior to the education program and did not change throughout the first year post transplantation.

CONCLUSION

Renal recipients self-efficacy and insight in post-transplant aspects seem to be more robust when admitted to the hospital for transplantation compared to baseline observations in the RCT study. This may explain why the implemented educational intervention did not lead to the same positive increase in outcome measures as in the RCT. This study supports that replicating clinical interventions in real-life settings may provide different results compared to results from RCT's. In order to gain a complete picture of the impacts of an implemented intervention, it is vital also to evaluate results after implementing findings from RCT-studies into everyday practice.

Helping persons with multiple chronic conditions overcome barriers to self-management

ABSTRACT

The prevalence of multiple chronic conditions is growing dramatically, which complicates day-to-day self-management for patients. This article describes the features of multiple chronic conditions, an updated chronic care model, barriers to self-management, and strategies NPs can use to reduce or eliminate barriers to self-management in adults with multiple chronic conditions.

From Qualitative Meta-Summary to Qualitative Meta-Synthesis: Introducing a New Situation-Specific Theory of Barriers and Facilitators for Self-Care in Patients With Heart Failure

Situation-specific theories provide nurses with a vehicle to interpret situations, guide their decisions or make assumptions about factors influencing a health problem. In this article, we used meta-synthesis techniques to integrate statements of findings pertaining to barriers and facilitators to heart failure self-care that were derived previously through meta-summary techniques leading to a new situation-specific theory. According to our proposed theory, self-care behavior is the result of a patient's naturalistic decision-making process. This process is influenced by two key concepts: "self-efficacy" and the "patient's disease concept of heart failure." Numerous facilitative and inhibitive factors have been identified influencing these two key concepts as well as the decision-making process, thereby either enabling or hampering the execution of effective heart failure self-care. Further research is needed to validate the model through empirical testing. Once fully matured, the model may be useful in developing behavioral interventions aiming at enhancing adherence to self-care recommendations.

How does a new patient education programme for renal recipients become situated and adapted when implemented in the daily teaching practice in a university hospital? An ethnographic observation study

OBJECTIVE

To understand how a new patient education programme for renal recipients becomes situated and adapted when implemented in daily hospital teaching practice. The analysis focuses in particular on how principles of individual tailoring and patient involvement are adapted.

DESIGN

Ethnographic observation study. 19 teaching sessions were observed, resulting in 35 pages of data written observation notes.

SETTING

A Norwegian University hospital. The study included the transplantation (TX) post, the medical post and the outpatient clinic.

PARTICIPANTS

10 newly transplanted patients receiving the education programme, and 13 nurses trained in the new programme participated in the study.

RESULTS

We observed that the nurses attempted to implement the programme's core principles of individual tailoring and patient involvement as intended, but that patients found it difficult to formulate their knowledge needs and interest. Patients and nurses developed an approach to individual tailoring and patient involvement, which used knowledge about the patients' life and experiences as basis for translating generalised knowledge into knowledge that is individualised and meaningful for the patient. The individual tailoring was however also limited, as the nurses balanced between responsibilities for the programme's principles of individual adaption and patient involvement at the one hand, and responsibilities of safety and economy from a health systems perspective on the other hand.

CONCLUSION

Individual tailoring is observed to be a comprehensive practice which includes verbal, practical and emotional involvement with the patient's life world. This extends the notion and practice of individual tailoring as selecting among predefined, generalised knowledge based on an initial mapping of the patients' knowledge. While the adaptions to individual tailoring could have been seen as inaccurate implementation, in-depth analyses discloses that the extended approach to individual tailoring is in fact what retains the programme's core principles in the implementation context.

Implementation of a new patient education programme for renal transplant recipients

BACKGROUND

Nurses' strategies regarding patient education should be informed by the best available research evidence. Clinical nurses play an essential role in implementing new patient education programmes for renal transplant recipients.

AIM

This study investigated transplant nurse job satisfaction, competence, training and perceptions of quality of care in relation to the implementation of a new, evidence-based, patient education programme. This paper reports the results from the first part of an implementation study.

METHODS

Data were collected in the form of a survey from 50 clinical transplant nurses at a single national transplant centre in Norway in 2015, six months after the patient education programme was implemented. A descriptive, cross-sectional design was used.

RESULTS

Seventy-two percent of the respondents reported that they had sufficient knowledge about the new programme; 54.4 % stated that the new programme resulted in renal transplant recipients being better educated. The new programme was found to be more structured, patient-centered and visible for the nurses across the wards, as compared with their previous practice. Nurses with less nursing experience were significantly more motivated about the new patient education programme, than the more experienced nurses (p = 0.05).

CONCLUSIONS

Nurses were generally satisfied with their new patient education practice. Knowledge derived from the research evidence on patient education was found to be valuable and transferable to everyday clinical nursing practice.

Self-Care for the Prevention and Management of Cardiovascular Disease and Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association

Self-care is defined as a naturalistic decision-making process addressing both the prevention and management of chronic illness, with core elements of self-care maintenance, self-care monitoring, and self-care management. In this scientific statement, we describe the importance of self-care in the American Heart Association mission and vision of building healthier lives, free of cardiovascular diseases and stroke. The evidence supporting specific self-care behaviors such as diet and exercise, barriers to self-care, and the effectiveness of self-care in improving outcomes is reviewed, as is the evidence supporting various individual, family-based, and community-based approaches to improving self-care. Although there are many nuances to the relationships between self-care and outcomes, there is strong evidence that self-care is effective in achieving the goals of the treatment plan and cannot be ignored. As such, greater emphasis should be placed on self-care in evidence-based guidelines.

Changing Landscape for Peritoneal Dialysis: Optimizing Utilization

The future growth of peritoneal dialysis (PD) will be directly linked to the shift in US healthcare to a value-based payment model due to PD's lower yearly cost, early survival advantage over in-center hemodialysis, and improved quality of life for patients treating their kidney disease in the home. Under this model, nephrology practices will need an increased focus on managing the transition from chronic kidney disease to end-stage renal disease (ESRD), providing patient education with the aim of accomplishing modality selection and access placement ahead of dialysis initiation. Physicians must expand their knowledge base in home therapies and work toward increased technique survival through implementation of specific practice initiatives that highlight PD catheter placement success, preservation of residual renal function, consideration of incremental PD, and competence in urgent start PD. Avoidance of both early and late PD technique failures is also critical to PD program growth. Large dialysis organizations must continue to measure and improve quality metrics for PD, expand their focus beyond the sole provision of PD to holistic patient care, and initiate programs to reduce PD hospitalization rates and encourage physicians to consider the benefits of PD as an initial modality for appropriate patients. New and innovative strategies are needed to address the main reasons for PD technique failure, improve the connectivity of the patient in the home, leverage home biometric data to improve overall outcomes, and develop PD cycler devices that lower patient treatment burden and reduce both treatment fatigue and treatment-dependent complications.

The effectiveness of individual rehabilitation on health status in patients with heart failure: A quasi-experimental study

Patients with heart failure (HF) live with a serious disease, and need long-term rehabilitation care. Elements in rehabilitation for patients with HF are based on the recommendations from the European Society of Cardiology and focuses on self-care and adherence in general. The aim of this study is to test the effect of individually prepared rehabilitation plans measured on health status (HS). The study design is quasi-experimental. Patients in the control group follow the conventional rehabilitation. For the patients in the intervention group. an individual rehabilitation plan was prepared and followed up by telephone after 4 and 12 weeks. For all patients, HS was measured with Short Form-36. One hundred sixty-two patients are included in the study, of which 137 (84.6%) consented. There were no differences in HS before and after the intervention. There are no significant differences by use of a systematically prepared intervention compared with usual care for patients with HF measured on HS 3 months after discharge from the outpatient clinic.

DIRECTED ACYCLIC GRAPH-BASED PATIENT EDUCATION SYSTEM FOR CARDIOVASCULAR PATIENTS IN TAIWAN

Background: Cardiovascular disease is the leading global cause of death and the number of patients is expected to grow yearly. Pertinent patient education materials provide adequate medical information to cardiovascular patients to change their behaviors, improve their health status, and reduce medical costs. However, systematic and patient-oriented education materials for cardiovascular disease are currently not available to the public, especially in Chinese. Methods: A directed acyclic graph (DAG) database structure is proposed for storing all created low-demand medical illustrations and video clips. Further, all designed medical media elements are evaluated according to the Patient Education Materials Assessment Tool (PEMAT) to assure the quality of the medical information content. Each media element is automatically annotated by calculating representative keywords; relationships between different media elements are constructed according to keyword associations. Results: A total of 222 video clips and 45 printable medical documents in Chinese were created in the proposed patient education system. This contains fundamental knowledge of diseases, causes of diseases, medical and surgical treatments, and a prognosis of the medical care for the majority of types of cardiovascular disease. It is the first constructive and intelligent patient education system for cardiovascular patients in Taiwan.

The effect of a supportive educational intervention developed based on the Orem's self-care theory on the self-care ability of patients with myocardial infarction: a randomised controlled trial

AIMS AND OBJECTIVES

The aim of this study was to assess the effect of a supportive educational intervention developed based on the Orem's self-care theory on the self-care ability of patients with myocardial infarction.

BACKGROUND

Patients with cardiovascular disease suffer from the lack of knowledge about the disease and consequently are not able to fulfil their own self-care needs.

DESIGN

This was a randomised controlled trial conducted in 2012.

METHODS

We recruited a random sample of 66 patients with myocardial infarction who had been recently discharged from coronary care unit. The study setting was two university hospitals located in Khorasan, Iran. Patients were randomly allocated to either the experimental or the control groups. Patients in the experimental group received education, support, and counselling while patients in the control group received no intervention. We employed a demographic questionnaire and the Myocardial Infarction Self-Care Ability Questionnaire for data collection and spss version 16.00 for data analysis.

FINDINGS

After the study, patients in the experimental group had higher levels of self-care knowledge, motivation and skills compared to the prestudy readings and the control group.

CONCLUSION

The supportive educational intervention developed based on the Orem's self-care theory can improve nonhospitalised patients' self-care ability and positively affect public health outcomes. Consequently, using the developed programme for providing follow-up care to nonhospitalised patients is recommended.

RELEVANCE TO CLINICAL PRACTICE

Having the ability to develop caring systems based on the nursing theories is a prerequisite to standard nursing practice. Identifying patients' educational needs is a fundamental prerequisite to patient education. Our findings revealed that the supportive educational intervention developed based on the Orem's self-care theory can help health care providers identify and fulfil patients' self-care needs.

A systematic approach to chronic heart failure care: a consensus statement

The National Heart Foundation of Australia assembled an expert panel to provide guidance on policy and system changes to improve the quality of care for people with chronic heart failure (CHF). The recommendations have the potential to reduce emergency presentations, hospitalisations and premature death among patients with CHF. Best-practice management of CHF involves evidence-based, multidisciplinary, patient-centred care, which leads to better health outcomes. A CHF care model is required to achieve this. Although CHF management programs exist, ensuring access for everyone remains a challenge. This is particularly so for Aboriginal and Torres Strait Islander peoples, those from non-metropolitan areas and lower socioeconomic backgrounds, and culturally and linguistically diverse populations. Lack of data and inadequate identification of people with CHF prevents efficient patient monitoring, limiting information to improve or optimise care. This leads to ineffectiveness in measuring outcomes and evaluating the CHF care provided. Expanding current cardiac registries to include patients with CHF and developing mechanisms to promote data linkage across care transitions are essential. As the prevalence of CHF rises, the demand for multidisciplinary workforce support will increase. Workforce planning should provide access to services outside of large cities, one of the main challenges it is currently facing. To enhance community-based management of CHF, general practitioners should be empowered to lead care. Incentive arrangements should favour provision of care for Aboriginal and Torres Strait Islander peoples, those from lower socioeconomic backgrounds and rural areas, and culturally and linguistically diverse populations. Ongoing research is vital to improving systems of care for people with CHF. Future research activity needs to ensure the translation of valuable knowledge and high-quality evidence into practice.

Pilot program to improve self-management of patients with heart failure by redesigning care coordination

Objectives. We tested both an educational and a care coordination element of health care to examine if better disease-specific knowledge leads to successful self-management of heart failure (HF). Background. The high utilization of health care resources and poor patient outcomes associated with HF justify tests of change to improve self-management of HF. Methods. This prospective study tested two components of the Chronic Care Model (clinical information systems and self-management support) to improve outcomes in the self-management of HF among patients who received intensive education and care coordination during their acute care stay. A postdischarge follow-up phone call assessed their knowledge of HF self-management compared to usual care patients. Results. There were 20 patients each in the intervention and usual care groups. Intervention patients were more likely to have a scale at home, write down their weight, and practice new or different health behaviors. Conclusion. Patients receiving more intensive education knew more about their disease and were better able to self-manage their weight compared to patients receiving standard care.

Northern Territory Heart Failure Initiative-Clinical Audit (NTHFI-CA)-a prospective database on the quality of care and outcomes for acute decompensated heart failure admission in the Northern Territory: study design and rationale

INTRODUCTION

Congestive heart failure is a significant cause of morbidity and mortality in Australia. Accurate data for the Northern Territory and Indigenous Australians are not presently available. The economic burden of this chronic cardiovascular disease is felt by all funding bodies and it still remains unclear what impact current measures have on preventing the ongoing disease burden and how much of this filters down to more remote areas. Clear differentials also exist in rural areas including a larger Indigenous community, greater disease burden, differing aetiologies for heart failure as well as service and infrastructure discrepancies. It is becoming increasingly clear that urban solutions will not affect regional outcomes. To understand regional issues relevant to heart failure management, an understanding of the key performance indicators in that setting is critical.

METHODS AND ANALYSIS

The Northern Territory Heart Failure Initiative-Clinical Audit (NTHFI-CA) is a prospective registry of acute heart failure admissions over a 12-month period across the two main Northern Territory tertiary hospitals. The study collects information across six domains and five dimensions of healthcare. The study aims to set in place an evidenced and reproducible audit system for heart failure and inform the developing heart failure disease management programme. The findings, is believed, will assist the development of solutions to narrow the outcomes divide between remote and urban Australia and between Indigenous and Non-Indigenous Australians, in case they exist. A combination of descriptive statistics and mixed effects modelling will be used to analyse the data.

ETHICS AND DISSEMINATION

This study has been approved by respective ethics committees of both the admitting institutions. All participants will be provided a written informed consent which will be completed prior to enrolment in the study. The study results will be disseminated through local and international health conferences and peer reviewed manuscripts.

Implementing guideline based heart failure care in the Northern Territory: challenges and solutions

The Northern Territory of Australia is a vast area serviced by two major tertiary hospitals. It has both a unique demography and geography, which pose challenges for delivering optimal heart failure services. The prevalence of congestive heart failure continues to increase, imposing a significant burden on health infrastructure and health care costs. Specific patient groups suffer disproportionately from increased disease severity or service related issues often represented as a "health care gap". The syndrome itself is characterised by ongoing symptoms interspersed with acute decompensation requiring lifelong therapy and is rarely reversible. For the individual client the overwhelming attention to heart failure care and the impact of health care gaps can be devastating. This gap may also contribute to widening socio-economic differentials for families and communities as they seek to take on some of the care responsibilities. This review explores the challenges of heart failure best practice in the Northern Territory and the opportunities to improve on service delivery. The discussions highlighted could have implications for health service delivery throughout regional centres in Australia and health systems in other countries.

AUStralian Indigenous Chronic Disease Optimisation Study (AUSI-CDS) prospective observational cohort study to determine if an established chronic disease health care model can be used to deliver better heart failure care among remote Indigenous Australians: Proof of concept-study rationale and protocol

BACKGROUND

The congestive heart failure syndrome has increased to epidemic proportions and is cause for significant morbidity and mortality. Indigenous patients suffer a greater prevalence with greater severity. Upon diagnosis patients require regular follow-up with medical and allied health services. Patients are prescribed life saving, disease modifying and symptom relieving therapies. This can be an overwhelming experience for patients. To compound this, remoteness, differentials in conventional health care and services pose special problems for Indigenous clients in accessing care. Additional barriers of language, culture, socio-economic disadvantage, negative attitudes towards establishment, social stereotyping, stigma and discrimination act as barriers to improved care. Recent focus supported by clinical evidence support the role of chronic disease self-management programs. A patient focused, problem identification, goal setting and psychosocial modification based program should in principal highlight these issues and help tailor a patient focused comprehensive care plan to complement guideline based care. At present there are no Indigenous focused chronic disease self-management programs. There is a need for research on ways to provide chronic disease management to this group. We therefore designed a study to assess a model of patient focussed comprehensive care for Indigenous Australians with heart failure.

STUDY DESIGN

AUSI-CDS is a prospective, cohort, observational study to evaluate the efficacy of the standard "Flinders Program of Chronic Condition Management" for Indigenous patients with chronic heart failure. Eligible patients will be Indigenous, suffering from chronic heart failure, in the Northern Territory. The primary end-point is the satisfaction score based on the PACIC. The study will recruit 20 patients and is expected to last 12 months.

SUMMARY

The rationale and design of the AUSI-CDS using the Flinders Model is described.

The effect of an educational intervention for renal recipients: a randomized controlled trial

AIM

The purpose of this randomized controlled trial was to test the efficacy of an educational intervention on renal recipient's knowledge, compliance, self-efficacy, and quality of life.

METHODS

In total, 159 renal recipients were randomized to the intervention (N = 77) or control group (N = 82). A total of 139 participants reached second measure point (7-8 wk post-Tx), and 120 participants reached third measure point (six months post-Tx). The intervention consisted of five tailored one-to-one sessions. Primary outcome was measured by a knowledge questionnaire. Secondary outcomes were measured by "The General- Self-efficacy Scale," SF-12 and by number of patient observations (Compliance).

RESULTS

Significantly higher levels of knowledge were found in the experimental group compared with the control group at both measure points (p = 0.002 and p = 0.004). Compliance was significantly higher in the experimental group at second measure point (p = 0.000). At third measure point, the experimental group reported significantly better scores on self-efficacy (p = 0.036) and mental score of quality of life (p = 0.001).

CONCLUSIONS

This structured, tailored educational intervention, applied in a 7-8 wk post-transplant period, increased renal recipients' levels of knowledge on both short and long terms. Furthermore, the intervention was beneficial for patients' compliance, self-efficacy, and mental quality of life.

Effect of health literacy on drug adherence in patients with heart failure

STUDY OBJECTIVE

To assess the effect of health literacy on drug adherence in the context of a pharmacist-based intervention for patients with heart failure.

DESIGN

Post hoc analysis of a randomized controlled trial.

SETTING

Inner-city ambulatory care practice affiliated with an academic medical center.

PATIENTS

The original trial enrolled 314 patients with heart failure who were aged 50 years or older and were taking at least one cardiovascular drug for heart failure; 122 patients received the pharmacist intervention (patient education, therapeutic monitoring, and communication with primary care providers), and 192 patients received usual care (regular follow-up with primary care providers). We analyzed the results of 281 patients who had available health literacy and adherence data.

MEASUREMENTS AND MAIN RESULTS

Drug adherence was assessed over 9 months using electronic prescription container monitors on cardiovascular drugs. Health literacy was assessed using the Short Test of Functional Health Literacy in Adults (scores range from 0-36, with an adequate literacy score defined as ≥ 23). Taking adherence, defined as the percentage of prescribed drug doses taken by the patient compared with the number of doses prescribed by the physician, was assessed for each group. Patients were a mean ± SD of 63 ± 9 years old, 51% had less than 12 years of education, 29% had inadequate health literacy, and they received a mean ± SD of 11 ± 4 drugs. In the usual care group, taking adherence was greater among patients with adequate (69.4%) than those with inadequate (54.2%) health literacy (p=0.001). In the intervention group, the difference in taking adherence among patients with adequate (77.3%) and inadequate (65.3%) health literacy was not statistically significant (p=0.06). Among patients with inadequate health literacy, the intervention increased adherence (65%, 95% confidence interval [CI] 54-77%) by an order of magnitude similar to that of the baseline adherence of patients with adequate health literacy (69%, 95% CI 65-74%). Multivariable analysis supported the association between health literacy and adherence.

CONCLUSION

In patients with heart failure, those with adequate health literacy have better adherence to cardiovascular drugs than those with inadequate health literacy. The pharmacist intervention improved adherence in patients with adequate and inadequate health literacy. Health literacy may be an important consideration in drug adherence interventions.

Renal recipients' educational experiences in the early post-operative phase--a qualitative study

Renal recipients need to acquire significant amount of knowledge for their life post-transplantation. More knowledge on kidney recipients' experiences after transplantation with regard to the patient education provided is needed. Sixteen renal recipients were interviewed 4-6 weeks post-transplantation about content and methods in the patient education programme. Data were analysed in the hermeneutic tradition. The patients experienced barriers towards learning in the early post-operative phase. Kidney transplantation was expressed as a 'turning point in life', causing learning difficulties because of both physical and mental stress. Survival knowledge was the label for topics concerning medication and rejection as they were experienced as essential for life. Situational knowledge, that is, knowledge related to recipients' individual life situations, requires further details in the main topics provided. The difference between knowing and practising what was taught was experienced as troublesome. The recipients expressed that a supportive learning atmosphere characterized by patience, respect, continuity and active participation was essential. This study revealed new knowledge about renal recipients' need for individual application of the educational content, as well as cognitive difficulties, and other factors impacting on learning in the early post-operative phase. The patients' perspective is an important and useful aid in creating effective interventions in this field.

Adequate health literacy is associated with higher heart failure knowledge and self-care confidence in hospitalized patients

Heart failure (HF) patients with inadequate health literacy are at increased risk for poor self-care and negative health outcomes such as hospital readmission. The purpose of the present study was to examine the prevalence of inadequate health literacy, the reliability of the Dutch HF Knowledge Scale (DHFKS) and the Self-care of Heart Failure Index (SCHFI), and the differences in HF knowledge, HF self-care, and 30-day readmission rate by health literacy level among patients hospitalized with HF. The convenience sample included adults (n = 95) admitted to a large, urban, teaching hospital whose primary diagnosis was HF. Measures included the Short Test of Functional Health Literacy in Adults, the DHFKS, the SCHFI, and readmission at 30 days after discharge. The sample was 59 ± 14 years in age, 51% male, and 67% African American; 35% had less than a high school education, 35% were employed, 73% lived with someone who helps with their HF care, and 16% were readmitted within 30 days of index admission. Health literacy was inadequate for 42%, marginal for 19%, and adequate for 39%. Reliability of the DHFKS and SCHFI scales was comparable to prior reports. Mean knowledge score was 11.43 ± 2.26; SCHFI subscale scores were 56.82 ± 17.12 for maintenance, 63.64 ± 18.29 for management, and 65.02 ± 16.34 for confidence. Those with adequate health literacy were younger and had higher education level, HF knowledge scores, and HF self-care confidence compared with those with marginal or inadequate health literacy. Self-care maintenance and management scores and 30-day readmission rate did not differ by health literacy level. These findings demonstrate the high prevalence of inadequate and marginal health literacy and that health literacy is an important consideration in promoting HF knowledge and confidence in self-care behaviors, particularly among older adults and those with less than a high school education.