Macabasco-O'Connell A, DeWalt DA, Broucksou KA, Hawk V, Baker DW, Schillinger D, Ruo B, Bibbins-Domingo K, Holmes GM, Erman B, Weinberger M, Pignone M, et al.
Journal of general internal medicine. Date of publication 2011 Sep 1;volume 26(9):979-86.
1. J Gen Intern Med. 2011 Sep;26(9):979-86. doi: 10.1007/s11606-011-1668-y. Epub
2011 Mar 3.
Relationship between literacy, knowledge, self-care behaviors, and heart
failure-related quality of life among patients with heart failure.
Macabasco-O'Connell A(1), DeWalt DA, Broucksou KA, Hawk V, Baker DW, Schillinger
D, Ruo B, Bibbins-Domingo K, Holmes GM, Erman B, Weinberger M, Pignone M.
Author information:
(1)UCLA School of Nursing, University of California, Olive View-UCLA Medical
Center Los Angeles, 700 Tiverton Ave., 4-242 Factor Blvd., Los Angeles, CA 90095,
USA. aoconnel@sonnet.ucla.edu
BACKGROUND: We sought to examine the relationship between literacy and heart
failure-related quality of life (HFQOL), and to explore whether literacy-related
differences in knowledge, self-efficacy and/or self-care behavior explained the
relationship.
METHODS: We recruited patients with symptomatic heart failure (HF) from four
academic medical centers. Patients completed the short version of the Test of
Functional Health Literacy in Adults (TOFHLA) and questions on HF-related
knowledge, HF-related self-efficacy, and self-care behaviors. We assessed HFQOL
with the Heart Failure Symptom Scale (HFSS) (range 0-100), with higher scores
denoting better quality of life. We used bivariate (t-tests and chi-square) and
multivariate linear regression analyses to estimate the associations between
literacy and HF knowledge, self-efficacy, self-care behaviors, and HFQOL,
controlling for demographic characteristics. Structural equation modeling was
conducted to assess whether general HF knowledge, salt knowledge, self-care
behaviors, and self-efficacy mediated the relationship between literacy and
HFQOL.
RESULTS: We enrolled 605 patients with mean age of 60.7 years; 52% were male; 38%
were African-American and 16% Latino; 26% had less than a high school education;
and 67% had annual incomes under $25,000. Overall, 37% had low literacy (marginal
or inadequate on TOFHLA). Patients with adequate literacy had higher general HF
knowledge than those with low literacy (mean 6.6 vs. 5.5, adjusted difference
0.63, p < 0.01), higher self-efficacy (5.0 vs. 4.1, adjusted difference 0.99,
p < 0.01), and higher prevalence of key self-care behaviors (p < 0.001). Those
with adequate literacy had better HFQOL scores compared to those with low
literacy (63.9 vs. 55.4, adjusted difference 7.20, p < 0.01), but differences in
knowledge, self-efficacy, and self-care did not mediate this difference in HFQOL.
CONCLUSION: Low literacy was associated with worse HFQOL and lower HF-related
knowledge, self-efficacy, and self-care behaviors, but differences in knowledge,
self-efficacy and self-care did not explain the relationship between low literacy
and worse HFQOL.
DOI: 10.1007/s11606-011-1668-y
PMCID: PMC3157534
PMID: 21369770 [Indexed for MEDLINE]
