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Health literacy and its influence on self-care in heart failure patients: a literature review

Session Moderated poster session - Heart Failure

Speaker Karin Hinterbuchner

Congress : EuroHeartCare 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure - Treatment
  • Session type : Moderated Posters
  • FP Number : 214

Authors : K Hinterbuchner (Graz,AT), F Grossschaedl (Graz,AT)

K Hinterbuchner1 , F Grossschaedl1 , 1Medical University of Graz, Institute of Nursing Science - Graz - Austria ,


Background: Heart failure is a major public health concern leading to increased morbidity, mortality and health care costs. Successes for heart failure management were identified by high self-care skills of concerned patients. However, there are many challenging factors of self-care to be considered. Self-care is a naturalistic decision-making process, with the intertwined factors being self-care management, self-care maintenance and self-care confidence. A barrier to follow through with self-care regimes is low health literacy, which healthcare providers need to recognize to adopt strategies to provide better health outcomes. Therefore, it is essential to find appropriate approaches and interventions to improve self-care of heart failure patients, especially among those with low health literacy. To our knowledge, no review has been performed investigating health literacy and its influence on self-care behavior in heart failure patients.

Aim: This review aims to determine the effects of health literacy on self-care of patients with heart failure.

Method: A literature review was conducted using the databases CINAHL and PUBMED. A well-defined search strategy with selected keywords and MeSH-terms was used. Articles in English and German published in the last ten years were searched in the databases. Further eligibility criteria for inclusion in the review was decided using the PICOS framework. A total of 164 studies were found in the databases. Title and abstract screening were performed together to avoid exclusion of potential articles. A total of 23 full-text articles were assessed for quality using the Hawker criteria instrument. 

Results: The criteria for the review were met by 11 articles. Most of the studies reviewed had a cross-sectional design and used the Test of Functional Health Literacy in Adults (S-TOFHLA) short-form for measuring health literacy. Different scales were used to measure self-care behaviors, most using a version of The Self-Care Heart Failure Index (SCHFI). The results showed that low health literacy may influence self-care behaviors with a trend towards poorer self-care adherence. Furthermore, patients were more likely to perform fewer self-care interventions and confidence was an influencer in the self-care process. Intensive self-care intervention can be of benefit for low literacy patients. 

Conclusion: Based on this literature review are inconsistent on what effect low health literacy has on self-care. Most of the studies do not allow the investigation of causal associations due to their cross-sectional design. Furthermore, the results are hard to compare since the studies used different instruments for measuring the patient’s literacy and self-care behavior. It is recommended to design self-care interventions related to the patient’s previous knowledge, skills and level of self-care training regardless of literacy level, to be certain to provide the best outcome for the patient.

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