Effect of Health Literacy on Quality of Life amongst Patients with Ischaemic Heart Disease in Australian General Practice

Abstract

BackgroundAppropriate understanding of health information by patients with cardiovascular disease (CVD) is fundamental for better management of risk factors and improved morbidity, which can also benefit their quality of life.ObjectivesTo assess the relationship between health literacy and health-related quality of life (HRQoL) in patients with ischaemic heart disease (IHD), and to investigate the role of sociodemographic and clinical variables as possible confounders.MethodsCross-sectional study of patients with IHD recruited from a stratified sample of general practices in two Australian states (Queensland and South Australia) between 2007 and 2009. Health literacy was measured using a validated questionnaire and classified as inadequate, marginal, or adequate. Physical and mental components of HRQoL were assessed using the Medical Outcomes Study Short Form (SF12) questionnaire. Analyses were adjusted for confounders (sociodemographic variables, clinical history of IHD, number of CVD comorbidities, and CVD risk factors) using multiple linear regression.ResultsA total sample of 587 patients with IHD (mean age 72.0±8.4 years) was evaluated: 76.8% males, 84.2% retired or pensioner, and 51.4% with up to secondary educational level. Health literacy showed a mean of 39.6±6.7 points, with 14.3% (95%CI 11.8–17.3) classified as inadequate. Scores of the physical component of HRQoL were 39.6 (95%CI 37.1–42.1), 42.1 (95%CI 40.8–43.3) and 44.8 (95%CI 43.3–46.2) for inadequate, marginal, and adequate health literacy, respectively (p-value for trend = 0.001). This association persisted after adjustment for confounders. Health literacy was not associated with the mental component of HRQoL (p-value = 0.482). Advanced age, lower educational level, disadvantaged socioeconomic position, and a larger number of CVD comorbidities adversely affected both, health literacy and HRQoL.ConclusionInadequate health literacy is a contributing factor to poor physical functioning in patients with IHD. Increasing health literacy may improve HRQoL and reduce the impact of IHD among patients with this chronic CVD.

Health Literacy among People in Cardiac Rehabilitation: Associations with Participation and Health-Related Quality of Life in the Heart Skills Study in Denmark

“…Our results on the positive association between health literacy and physical HRQoL (PCS) most likely reflect the complex reality of many people with extensive physical health problems, where the demands placed on their health literacy may be multiple. These findings are consistent with several other studies in people with cardiac disease [13,19,42]. Strong associations were found in relation to actively engaging with healthcare providers and navigating the healthcare system (scales 6 and 7), that is, "executive capacities", which may reflect the many players and services that are often involved in the care of people with physical health challenges.…”

“…In line with our results, literature on general populations confirms strong associations between health literacy and mental HRQoL (MCS) [9,43]. Studies based on populations with cardiac disease are less conclusive [13,19]. However, none of these studies includes very comprehensive health literacy measures.…”

“…In relation to cardiac conditions, low health literacy has been associated with higher prevalence [12], poorer cardio-protective health behaviors [13,14], less disease knowledge and poorer self-management [14,15], higher hospital readmission rates [16][17][18], and higher mortality [17,18]. In addition, low health literacy has been associated with low health-related quality of life (HRQoL) [13,16,[19][20][21], particularly in relation to the physical components of HLQoL [19,20]. Improved HRQoL is an important and well-supported outcome of cardiac rehabilitation programs [1].…”

Socioeconomic status and health literacy as the important predictors of general health in Iran: A structural equation modeling approach

“…The results of our study were in the line of a study in the US, which confirmed the effect of HL on the health status and health services utilization among elderly people (30). The result of inadequate HL on a poor physical function dimension of quality of life among patient with ischemic heart disease is shown in a study in Queensland and South Australia (31). HL may lead to a better lifestyle (32,33), more use of preventive care (34), and adherence to medical treatment (35).…”

Communication skills training for physicians improves health literacy and medical outcomes among patients with hypertension: a randomized controlled trial

“…Despite the importance of communication skills training, little experimental research has linked skilled physician communication with patient HL and medical outcomes. Further, the interaction between HL skills development and health education interventions has not been well investigated [9,16] because it is unclear how/where physicians' communication skills can influence patient HL skills and medication adherence to control blood pressure targets [17,18]. Thus, there is an increasing need for assessments of strategies, which improve physician-patient communication quality, patient HL and health outcomes in the medical care context [11,19].…”