Elsevier

Journal of Cardiac Failure

Volume 17, Issue 11, November 2011, Pages 887-892
Journal of Cardiac Failure

Clinical Trial
Assessing Health Literacy in Heart Failure Patients

https://doi.org/10.1016/j.cardfail.2011.06.651Get rights and content

Abstract

Background

Health literacy has important implications for health interventions and clinical outcomes. The Shortened Test of Functional Health Literacy in Adults (S-TOFHLA) is a timed test used to assess health literacy in many clinical populations. However, its usefulness in heart failure (HF) patients, many of whom are elderly with compromised cognitive function, is unknown. We investigated the relationship between the S-TOFHLA total score at the recommended 7-minute limit and with no time limit (NTL).

Methods and Results

We enrolled 612 rural-dwelling adults with HF (mean age 66.0 ± 13.0 years, 58.8% male). Characteristics affecting health literacy were identified by multiple regression. Percentage of correct scores improved from 71% to 86% (mean percent change 15.1 ± 18.1%) between the 7-minute and NTL scores. Twenty-seven percent of patients improved ≥1 literacy level with NTL scores (P < .001). Demographic variables explained 24.2% and 11.1% of the variance in % correct scores in the 7-minute and the NTL scores, respectively. Female gender, younger age, higher education, and higher income were related to higher scores.

Conclusion

Patients with HF may be inaccurately categorized as having low or marginal health literacy when the S-TOFHLA time limits are enforced. New ways to assess health literacy in older adults are needed.

Section snippets

Study Design and Sample

This study was part of an ongoing randomized clinical trial titled Rural Education to Improve Outcomes in Heart Failure (REMOTE-HF) that was designed to test an education and counseling intervention to improve self-care in patients with HF. Institutional Review Board approval was obtained and each of the patients gave informed written consent to participate. Patients with HF living in rural areas were recruited from California, Kentucky, and Nevada. Criteria for recruitment in the parent study

Results

Of the 612 patients enrolled in the study, 609 had complete S-TOFHLA data. On average the patients were 66 (±13.0) years old, and the majority (58.8%) were male. The demographic characteristics of patients are presented in Table 1. Knowledge about HF, self-care behaviors, and level of emotional distress (anxiety and depression) at baseline are summarized in Table 2. In our sample, the mean score for self-care behavior was 20 (lower than the midpoint of 27); the mean and median scores for HF

Discussion

This prospective study was conducted to investigate the difference in literacy levels and the relationship of specific patient characteristics with both 7-minute and NTL health literacy scores. During the 36-item test, patients in our study answered, on average, an additional 6 items with NTL compared with the standard 7 minutes. Similarly, there was a 15% correct score improvement when patients had NTL. Finally, over one-fourth of patients improved ≥1 literacy level with NTL scores.

We

Conclusion

With cognitive decline in some HF patients, it is possible that more time may be needed to understand written information and that the 7-minute limit of the standard S-TOFHLA may underestimate true literacy levels. Although we operate in a fast-paced health information system, the time needed to provide patient education for patient populations with different needs has not been adequately assessed. This is especially true among the elderly, in whom cognitive impairment may not be detectable

Disclosures

None.

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    Funding: National Heart, Lung, and Blood Institute and the National Institute of Nursing Research: grant no. 5R01HL83176–5.

    See page 891 for disclosure information.

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