Heart Failure and Low Health Literacy: Mitigating This Lethal Combination

Psychometric evaluation of the Arabic version of the heart failure-specific health literacy scale in a socio-politically challenged setting

INTRODUCTION

Low levels of formal education among Lebanese people with HF were reported. Additionally, limited discharge education is provided to this population. Therefore, it was necessary to evaluate the health literacy levels among this population following the translation of the heart failure-specific health literacy scale into Arabic and to evaluate its psychometric properties in the Lebanese setting.

METHODS

A cross-sectional design conducted on participants from the community with confirmed cases of heart failure. A research team was trained for data collection. Following securing participants' consents, baseline sociodemographic characteristics and the Arabic version of the heart failure-specific health literacy scale were administered. Data collection took place between June and December 2022. A pilot sample analysis was done to confirm homogeneity between the English and the Arabic versions. Exploratory and confirmatory factor analysis were performed to evaluate content and construct validity of the scale. Cronbach alpha was done to evaluate reliability.

RESULTS

The pilot analysis confirmed homogeneity of the items of the Arabic and English versions of the scale. The final sample of 343 participants was randomly divided to two parts for each of the exploratory factor analysis and confirmatory factor analysis. The mean age was 64 years with the majority being male participants. In terms of exploratory factor analysis, the three subscales of the literacy scale explained 60% of the variance. The best acceptable fit was found on 11 items of the scale after dropping the 10th item from the analysis. The Cronbach alpha of the scale was 0.68.

CONCLUSION

The Arabic version of the heart failure-specific health literacy scale was evaluated to be a valid and reliable tool. Further analysis should be done on the dropped item, and correlations should be done with significant variables such as self-care.

REPORTING METHOD

STROBE checklist.

PATIENT/PUBLIC CONTRIBUTION

No patient/public contribution.

CONTRIBUTION TO THE WIDER GLOBAL COMMUNITY

Participants with heart failure were shown to have low levels of literacy in Lebanon. Additionally, low literacy levels are also common among Lebanese older adults living in high income, Western Countries. Therefore, this valid and reliable scale can be used to evaluate health literacy among people with heart failure in Lebanon and among Lebanese and other Arabic-speaking older adults globally.

Portuguese adaptation of the Chronic Heart Failure Knowledge Questionnaire (KQCHF)

BACKGROUND

A patient's knowledge of heart failure (HF) is associated with better outcomes. The more information patients have about their illness, the less likely they are to be readmitted to the hospital. Such knowledge includes the cause, symptoms, probable duration, and expected evolution of the clinical picture. In Portugal, a tool for testing patient knowledge is an unmet need. Therefore, this study aimed to adapt and test the Chronic Heart Failure Knowledge Questionnaire (KQCHF) for the Portuguese context.

METHODS

This work includes three cross-sectional studies. In Study 1, subjects were divided between before and after receiving information about HF. In Study 2, participants answered the questionnaire before and after reading the brochure. In Study 3, KQCHF was applied to patients with HF. Studies 1 and 2 were carried out in the general population. Study 3 was carried out with HF outpatients. Convenience sampling was applied to participants in the three studies.

RESULTS

In Study 1 (n = 45), those who received information had better scores (9.2 ± 1.9) than those who did not (6.0 ± 2.3). In Study 2 (n = 21), the scores were higher after reading the brochure (10.4 ± 1.7 vs. 6.5 ± 2.9). In Study 3 (n = 169), women had better scores than men (9.1 ± 2.1 vs. 8.3 ± 2.2, overall: 8.5 ± 2.2), and knowledge was correlated with education (r = .340, p < .001) and age (r = -.170, p = .030).

CONCLUSION

The Portuguese adaptation of KQCHF captured relevant knowledge about HF and has shown promising results for clinical and research purposes. The questionnaire can be useful in assessing HF patients' knowledge of their disease and as a basis for the implementation of general and personalised educational strategies to improve HF knowledge and, therefore, promote health literacy and self-care.

Literacy critical to heart failure management: a scoping review

Heart failure is a complex clinical syndrome most commonly encountered among older adults. This complex clinical syndrome is associated with poor health outcomes such as frequent admissions and mortality. These adverse outcomes are commonly associated with poor self-care and lower health literacy. Literacy is a combination of knowledge and skills and often reflected by appropriate interaction with the community, while health literacy is the cognitive and social skills reflected by accessing and comprehending health information and making appropriate health decisions. These decisions are common and challenging to patients with heart failure. Poor outcomes are said to be reduced by adequate self-care, which is associated with health literacy among heart failure patients. Better self-care was also shown to be associated with self-efficacy and self-confidence that were in turn associated with health literacy. Hence, enhancing health literacy among patient with heart failure is critical to enable them to increase control over their disease by better understanding and participating in health care, while being empowered to take part in designing health care services and even tailoring research to serve their needs and consequently improve outcome at the individual and community level. In clinical practice, assessing health literacy, measuring health literacy, and identifying patients at risk of low nutrition literacy is important to enhance health literacy and health outcomes. Hence, developing reliable and valid methods and tools for assessment and developing tailored and targeted interventions is of critical importance.

Effectiveness of health education in the self-care and adherence of patients with heart failure: a meta-analysis

OBJECTIVE

to evaluate in the literature the effectiveness of the health education interventions in self-care and adherence to treatment of patients with Chronic Heart Failure.

METHOD

a systematic review with meta-analysis. Studies were selected that compared health education interventions with the usual care to assess the outcomes of adherence and self-care. The quality of the methodological evidence was assessed by the Grading of Recommendations, Assessment, Development and Evaluation system.

RESULTS

the educational interventions were more effective in relation to the usual care in the outcome of adherence (fixed effect=0-3841; p-value <0.001). There was no statistical difference in the outcome of self-care (fixed effect=0.0063; p-value=0.898).

CONCLUSION

the educational interventions improved the outcome of adherence, though not self-care in the patient with Heart Failure.

Navigating Symptom Management in Heart Failure: The Crucial Role of the Critical Care Nurse

High-acuity, progressive care, and critical care nurses often provide care for patients with heart failure during an exacerbation of acute disease or at the end of life. Identifying and managing heart failure symptoms is complex and requires early recognition and early intervention. Because symptoms of heart failure are not disease specific, patients may not respond to them appropriately, resulting in treatment delays. This article reviews the complexities and issues surrounding the patient's ability to recognize heart failure symptoms and the critical care nurse's role in facilitating early intervention. It outlines the many barriers to symptom recognition and response, including multimorbidities, age, symptom intensity, symptom escalation, and health literacy. The influence of self-care on heart failure management is also described. The critical care nurse plays a crucial role in teaching heart failure patients to identify and respond appropriately to their symptoms, thus promoting early intervention.

Health Literacy and Cardiovascular Disease: Fundamental Relevance to Primary and Secondary Prevention: A Scientific Statement From the American Heart Association

Health literacy is the degree to which individuals are able to access and process basic health information and services and thereby participate in health-related decisions. Limited health literacy is highly prevalent in the United States and is strongly associated with patient morbidity, mortality, healthcare use, and costs. The objectives of this American Heart Association scientific statement are (1) to summarize the relevance of health literacy to cardiovascular health; (2) to present the adverse associations of health literacy with cardiovascular risk factors, conditions, and treatments; (3) to suggest strategies that address barriers imposed by limited health literacy on the management and prevention of cardiovascular disease; (4) to demonstrate the contributions of health literacy to health disparities, given its association with social determinants of health; and (5) to propose future directions for how health literacy can be integrated into the American Heart Association's mandate to advance cardiovascular treatment and research, thereby improving patient care and public health. Inadequate health literacy is a barrier to the American Heart Association meeting its 2020 Impact Goals, and this statement articulates the rationale to anticipate and address the adverse cardiovascular effects associated with health literacy.

Health Literacy and Health Status in People With Chronic Heart Failure

PURPOSE/AIM

The aim of this study was to investigate whether health literacy, self-efficacy, and medication adherence can explain or predict the variance in health outcomes (measured as perceived physical or mental health status [HS]) in persons with chronic heart failure (HF).

DESIGN

A nonexperimental cross-sectional survey study used data gathered from 175 patients with chronic HF from urban cardiology practices in the northeast United States.

METHODS

The Paasche-Orlow and Wolf Causal Pathways conceptual model and Bandura's self-efficacy theory were used to select and test variables in the study. A demographic questionnaire, the Short Test of Functional Health Literacy, the Self-Efficacy for Appropriate Medication Use Scale, the Morisky Medication Adherence Scale, and the Short Form-12 version 2 assessing perceived physical and mental HS were completed. Multiple hierarchical regression analyses were used to analyze relationships among the variables.

RESULTS

Significant associations between health literacy and self-efficacy and between health literacy and perceived mental HS were found (P < .05). High self-efficacy was the strongest predictor of physical HS (P < .01). The strongest predictor of mental HS was medication adherence (P < .01).

CONCLUSIONS

Support of self-efficacy and medication adherence may improve HS. Including health literacy strategies in clinical practice may support improvements in HS in people with chronic HF.

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

OBJECTIVES

The level of health literacy is examined, as well as its conditioning factors in patients with heart failure who are seen routinely in a Primary Health Care Area.

DESIGN

A multicentre cross-sectional study.

SETTING

10 Primary care centres from the metropolitan area of Barcelona.

PARTICIPANTS

Patients diagnosed with heart failure.

INCLUSION CRITERIA

to have visited the Primary Health Care centre in the last year, being able to arrive at the primary care setting independently, and voluntarily participation.

MAIN MEASUREMENTS

Health Literacy Survey-European Union - Questionnaire (HLS-EU-Q) and Spanish version of the European Heart Failure Self-care Behaviour Scale. An analysis was made of the relationships between health literacy, self-care practices, sociodemographic, and clinical variables using ANOVA test and a multiple linear regression model.

RESULTS

The study included 318 patients (51.2% women) with a mean age of 77.9±8.7 years. The index of health literacy of 79.6% (n=253) of the participants indicated problems in understanding healthcare information. Health literacy level was explained by academic level (P<.001), the extent of heart failure (P=.032), self-care, and age (P<.04).The academic level explained 61.6% of the health of literacy (95% bootstrap: 44.58%; 46.75%).

CONCLUSIONS

In patients with stable heart failure, it is important to consider all factors that help patients to understand the healthcare information. Health literacy explains patient self-care attitude in heart failure.