Clinical TrialAssessing Health Literacy in Heart Failure Patients
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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Cited by (35)
Aging and Functional Health Literacy: A Population-based Study
2021, American Journal of Geriatric PsychiatryCitation Excerpt :Among them, the S-TOFHLA is a brief (7-minute) and relatively easy scale to administer. Although the standard instructions recommend cutting the test off at the 7- minute point, Robinson et al34 found that giving a group of heart failure patients more time to complete the test improved their STOFHLA scores. In our cohort, when additional time was provided, scores improved slightly among those aged 85+, and more substantially among those with less than high school education (data not shown).
Measurement of health literacy in patients with cardiovascular diseases: A systematic review
2019, Research in Social and Administrative PharmacyCitation Excerpt :Adequate health literacy is critical for patients with CVDs as they may face difficulties in comprehending complex medication regimens or following heavy treatment plans or applying restricted lifestyle interventions or even communicating with healthcare providers.39 For instance, studies have reported that chronic heart failure patients with low health literacy have poor knowledge of their illness and of their prescribed medications and have less adherence to self-care.40–45 Furthermore, inadequate health literacy could be one of the impediments for non-adherence to secondary prevention medications in CAD patients.46
Concurrent validity and acceptability of health literacy measures of adults hospitalized with heart failure
2019, Applied Nursing ResearchCitation Excerpt :In this study, the Cronbach's alpha coefficients for the six-item Newest Vital Sign was α = 0.70 and the 40 item S-TOFHLA (combined numeracy and prose items) was α = 0.88 The reporting of reliability coefficients is inconsistent in the health literacy literature (Altin, Finke, Kautz-Freimuth, & Stock, 2014). Coefficient alphas in this study were acceptable and consistent with those reported by Peterson et al. (2011) and Robinson et al. (2011) in the HF population. Both the NVS and S-TOFHLA demonstrated adequate internal consistency reliability in the hospital setting.
Health Literacy and Health Outcomes in Very Old Patients With Heart Failure
2018, Revista Espanola de CardiologiaHealth literacy is independently associated with self-care behavior in patients with heart failure
2016, Patient Education and CounselingCitation Excerpt :The results of previous research into the association between HL and self-care behavior have not been consistent. Some studies have indicated an association between HL and self-care behavior [17,28], while others found no significant association [29–31]. Most previous measurements of HL in HF patients used scales such as the Test of Functional Health Literacy in Adults (TOFHLA) and the Rapid Estimate of Adult Literacy in Medicine (REALM) [32], which apply only to the functional domain of HL.
Optimal health literacy measurement for the clinical setting: A systematic review
2015, Patient Education and Counseling
Funding: National Heart, Lung, and Blood Institute and the National Institute of Nursing Research: grant no. 5R01HL83176–5.
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