Heart Disease

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People with heart failure have various self-care activities they must perform such as monitoring their weight, controlling their salt and fluid intake, and assessing the effects of their medication.

For patients with limited health literacy, these critical activities can be complicated because patients may already have difficulty understanding and using health information to take care of their health.

Read the following collection of selected research articles that examine the problem of limited health literacy and its influence on the ability of adult patients to manage heart disease. Findings support the use of tailored programs to improve patients’ self-care techniques and delay or prevent re-hospitalization. Training staff to deliver tailored education to match people’s health literacy skills may produce health benefits for the patient and cost savings to the health care system.

Training and staff support make a difference in reducing hospital readmission for patients with heart problems

In two separate randomized control trials (Bell et al., 2016external iconDeWalt et al., 2006external icon) researchers conducted tailored educational sessions, including follow up phone calls, with patients. Sessions included discussion of barriers to medication adherence and a plan to address those barriers. Control group participants in both studies received usual care. Bell and colleagues used pharmacist-provided education while DeWalt and colleagues trained health educators to conduct the intervention. Results from both studies suggest patients in the intervention groups were readmitted less often than those in the usual care groups. Further, DeWalt and colleagues found that compared to the control group participants, those in the intervention group demonstrated an increase in heart failure knowledge and self-efficacy. Additionally, DeWalt and colleagues noted that significantly more participants in the intervention group reported performing daily weight measurement compared to those in the control group up to 12 months after the intervention.

Dennison and colleagues (2011)external icon surveyed 95 hospital patients who received heart failure education provided by the heart failure care coordinator. Prior to hospital admission these patients were living in the community. Researchers cited that overall, participants demonstrated lower than expected heart failure knowledge scores after receiving standardized heart failure education. However, patients with inadequate health literacy demonstrated lower scores on heart failure knowledge compared to patients with marginal or adequate health literacy. Dennison and colleagues suggest that only providing inpatient education is not enough to increase knowledge of heart failure. Unlike the previous two studies (Bell et al., 2016, DeWalt et al., 2006), researchers in this study did not find an association between health literacy level and readmission rate.

Stethoscope with red tubing folded in the shape of a heart

Assess patients’ health literacy skills and other potential barriers to self-care.


Findings from these three studies suggest that a tailored approach to heart failure education is helpful for patients of various health literacy levels.

The comprehensive approach should include adequate support such as easy-to-understand education about the patient’s condition or care regimen and an opportunity for the patient to

  • Practice skills
  • Resolve potential issues
  • Ask questions as needed
  • Receive clinical staff follow-up shortly after the sessions

Health literacy is associated with self-care behaviors related to heart disease

Matsouka and colleagues (2016)external icon surveyed 249 heart failure patients in outpatient settings to assess knowledge of heart failure and related self-care behaviors such as daily weighing, fluid restriction, medication, and contacting health care providers when they experience increased weight gain. Health literacy was assessed in three areas: functional (ability to read and write), comprehensive (ability to access information), and critical (ability to evaluate information). Overall findings suggest that patients with lower health literacy had less knowledge of heart failure and reported performing fewer self-care behaviors, compared to those with higher health literacy.

Other factors associated with lower self-care behavior included age, prior hospitalization for heart failure, chronic kidney disease, and lower heart failure knowledge. An analysis of the different types of health literacy assessed in this study found that critical health literacy, the ability to evaluate information, impacted the practice of self-care behavior more than functional or comprehensive forms of health literacy.

In a large survey study of over 1300 patients with acute heart failure, McNaughton and colleagues (2015)external icon found that patients with low health literacy had an increased risk of death compared to patients with average or above average health literacy. The researchers concluded that a heart disease patient with low health literacy will likely need more assistance from medical staff, particularly during discharge planning and after-care coordination to avoid readmission or death due to poor self-care.


These findings suggest that health literacy influences how a person manages their care. Limited health literacy can increase the likelihood of poor health outcomes. Given that patients with heart failure need to perform monitoring behaviors and evaluate when to contact a health care provider, the task of assessing barriers to self-care, including limited health literacy, among patients with heart disease is critical.