The association between health literacy and knowledge, and self-care in heart failure patients

Author: Katie Nesbitt

Nesbitt, Katie, 2019 The association between health literacy and knowledge, and self-care in heart failure patients, Flinders University, College of Nursing and Health Sciences

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Health literacy significantly contributes to a person’s health and wellbeing, as it affects their ability to understand and act on health information. Heart failure (HF) is a global pandemic affecting 511,000 adults within the Australian population. It is a complex condition necessitating careful symptom self-management by patients to ensure quality of life and reduce the risk of hospitalisation and premature mortality. Therefore, health literacy is fundamental to positive outcomes in heart failure.


This study was a sub-analysis of data collected as part of a prospective multi-centre randomised controlled trial which evaluated the impact of heart failure knowledge and self-care by patients who used an innovative education tool using avatars. Participants were recruited from two metropolitan HF outpatient clinics. The association between health literacy and sociodemographic and clinical outcomes were reviewed.


Thirty-six participants were recruited; the mean age was 67.5  (11.3) years. Thirty-three (89.9%) participants were classified as having adequate health literacy and the remaining four (11.1%) participants inadequate/marginal health literacy. Those with inadequate/marginal health literacy were significantly older, with a mean age of 84.7  (2.5) and those with adequate health literacy were younger, with a mean age of 65.5  (10.6). Those with a higher education level had adequate health literacy (96.6% of participants). Of the participants with inadequate/marginal health literacy, 100% had a comorbidity index score of > 3; those in the same health literacy group also had a body mass index (BMI kg/m2) > 25 (100%). Participants with adequate health literacy who also had inadequate self-care management comprised 67.7% of this group. There was a statistically significant association between health literacy and HF knowledge (p = 0.014), and literacy and self-care maintenance (p = 0.029), literacy and self-care management (p = 0.027) and literacy self-care confidence (p = 0.035). Health literacy was associated with HF knowledge, while literacy was not. No association was found between health literacy and self-care; literacy had an association across the three self-care domains.


In this study participants health literacy, were significantly associated to HF patients’ knowledge and self-care. Participants with inadequate/marginal health literacy who were older and had no schooling, had more comorbidities and a high BMI (kg/m2). Participants with adequate health literacy demonstrated inadequate self-management. Therefore, health literacy and its impact on HF patients disease specific knowledge and self-care warrants focused research and clinical innovation in many of the specific demographic, clinical and associative variables discussed in this thesis. 

Keywords: health literacy, heart failure, heart failure knowledge, self-care behaviour

Subject: Nursing thesis

Thesis type: Masters
Completed: 2019
School: College of Nursing and Health Sciences
Supervisor: Professor Robyn Clark