Heart failure study: Health-literate patients not always adept at managing care

December 14, 2011

WEST LAFAYETTE, Ind. - A patient's education level is not a fail-safe predictor of how well they will manage symptoms related to complicated chronic diseases, such as heart failure, according to a Purdue University study.

"Our research indicates that some of the better-educated heart failure patients in our sample did not manage their symptoms as well as those who were less educated," said Karen S. Yehle, an assistant professor of nursing who specializes in cardiovascular conditions. "We're not sure why this is. It could be that heart failure patients with lower health literacy experience symptoms more often and, therefore, know how to manage them better. No matter the reason, it's a reminder to doctors, nurses and pharmacists to communicate clearly and thoroughly to all patients, regardless of how much information or guidance they might believe a particular patient needs."

The researchers evaluated the adherence of 49 heart failure patients' daily self-care, which includes eating a low-sodium diet and taking medications, as well as the patients' self-management, which was required when they developed a symptom such as weight gain, leg swelling or shortness of breath.

"This is a small sample size, but what was especially telling is that many of the people in this sample had advanced degrees, so we feel it's an important message to remind practitioners to not make assumptions based on education," said Aleda M.H. Chen, a recent Purdue pharmacy and gerontology graduate who is now an assistant professor of pharmacy practice at Ohio's Cedarville University, who led the study. "We also are working to expand the study to a larger sample size and follow heart failure patients' care and behaviors for the long-term."

The study is published in the current issue of the Journal of Cardiovascular Nursing. The research was supported by the Regenstrief Center for Healthcare Engineering at Purdue, and Chen received a fellowship to support her research from the National Institute on Aging and Purdue's Center on Aging and the Life Course.

"Overall, we found that health literacy - a patient's ability to read and understand health information - was associated with proper daily care and management for heart failure patients," Chen said. "But there was a statistically significant negative relationship with self-care management, or when patients respond to heart failure symptoms. When patients with higher health literacy did not have symptoms, they were better at adhering to the day-to-day care of the condition in comparison to those with lower health literacy. However, when symptomatic, they appeared to have more difficulty in addressing the condition-related problems."

There are approximately 5.8 million Americans diagnosed with heart failure, and most of them are older than 65. In 2010 the direct health cost related to heart failure was $39.2 billion, according to the American Heart Association. During that same year, heart failure contributed to 1.1 million hospitalizations and nearly 3.4 million emergency room visits.

"Heart failure is a very complicated condition in that the daily behaviors must be followed or the patient will develop symptoms, and if the symptoms are triggered and the patient does not manage them well, they are often hospitalized," said Kimberly S. Plake, an associate professor of pharmacy who specializes in patient behavior and adherence.

"It's critical that providers have better insight into how to communicate with their patients or follow up with them about their self-care," Plake said. "From a practitioner viewpoint, you can't assume that the information delivered to a patient is interpreted the way you want it to be. We can't make the assumption that if someone is highly educated they are more likely to take better care of themselves."

Purdue's Matthew M. Murawski, an associate professor of pharmacy practice, and Holly L. Mason, professor of pharmacy, also co-authored the study.

Writer: Amy Patterson Neubert, 765-494-9723, apatterson@purdue.edu

Sources:   Karen S. Yehle, 765-494-4011, kyehle@purdue.edu

                  Kimberly S. Plake, 765-494-5966, kplake@purdue.edu

                  Aleda M. H. Chen, 937-766-7454, amchen@cedarville.edu


Health Literacy and Self-Care of Patients with Heart Failure

Aleda M.H. Chen, Karen S. Yehle, Kimberly S. Plake,
Matthew M. Murawski, Holly L. Mason

Background and research objective: Today's complex health-care system relies heavily on sophisticated self-care regimens. To navigate the system and follow self-care protocols, patients must be able to understand and use health information, which requires health literacy. However, nearly 90 million Americans lack the necessary health literacy skills to adequately care for themselves in the face of a complex health-care system and self-care regimens. Understanding how to effectively care for one's self is thought to improve heart failure symptoms and patient outcomes, but little is actually known about how health literacy influences self-care in patients with heart failure. The purpose of this pilot study was to examine the relationship between health literacy and self-care of patients with heart failure.

Subjects and Methods: Patients with a diagnosis of heart failure were recruited from a variety of community settings. Participants completed the Short-Form Test of Functional Health Literacy (measured health literacy), the Self-care Index of Heart Failure (measured self-care maintenance, management, and confidence), and a demographic questionnaire. Spearman rho ρ correlations were used to assess the strength of relationship between health literacy level and self-care scores.

Results and Conclusions: Among the 49 participants recruited, health literacy was positively related to self-care maintenance (Rs = 0.357, P = .006). Health literacy had a negative relationship with self-care management (Rs = 0.573, P = .001). There was no association between health literacy and self-care confidence (Rs = 0.201, P = 0.083). This project provides preliminary data regarding the association between health literacy and self-care in heart failure, showing support for higher health-literate patients performing more self-care maintenance, which has been shown to improve patient outcomes in heart failure. Patients with higher health literacy trended toward having greater self-care confidence, which can increase the likelihood of performing self-care, but this finding was not statistically significant. It was unexpected to find that lower health-literate patients performed more self-care management.