Health literacy of patients with heart failure in a dutch population
Authors: Van Driel A G , Maghroudi E , Klis A M T , Hooft S M , Staa A L , Jaarsma T 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Dutch Research Council (NWO)

Background
Limited Health Literacy affects about 3 in 10 persons in the Netherlands. Especially for people with chronic conditions like heart failure, adequate health literacy is needed to maintain, monitor and manage their health and their chronic condition. While nurses are expected to meet the specific support needs of their patients, many find it difficult to recognize and assess the level of health literacy of their patients.

Purpose
To examine and compare health literacy in patients with heart failure patients from the nurses’ perspective against two health literacy measurement tools.

Methods
Patients with heart failure were recruited in the outpatient cardiology departments of four different hospitals in the Netherlands. Information about health literacy of the patients was collected with a self-reported questionnaire (Set of Brief Screening Questions - SBSQ) and with the Newest Vital Sign-Dutch (NVS-D). Finally, nurses and nurse practitioners assessed health literacy of the patients on a visual analogue scale from 0-6. Additionally, demographic data (gender, age, level of education and native language) and clinical data (NYHA class and medication use) were collected.

Results
61 patients with heart failure were recruited during 2022. Mean age was 68.5 (±14.6), 66% were men, 61% had a lower educational level. Most patients (86%) were native Dutch speakers and had a NYHA classification between II-III (46%). The mean number of used cardiac medication was 5.8 (±1.7).
55 patients completed the SBSQ, fifteen (27%) scored an average ≤ 2, indicating inadequate health literacy. The NVS-D was completed by 53 patients. Twenty-seven patients (51%) scored 0-1, suggesting limited health literacy. Fourteen patients (26%) scored 2-3, indicating possible limited health literacy.
The nurses’ assessments (using &gt;3 on the visual analogue scale as adequate health literacy), indicated 35 patients (63%) as having adequate health literacy. There was only poor to slight agreement with the results of the SBSQ (Kappa: 0.198).
For comparison with the NVS-D, the visual analogue scale was divided into three groups (limited health literacy (&lt;2), possibly limited health literacy (2-4) and adequate health literacy (&gt;4). This resulted in 10 patients (18%) with limited health literacy according to nurses, 23 (41%) with possibly limited health literacy and 23 (41%) with adequate health literacy. There was also poor agreement between the nurses’ assessment and the NVS-D results (Kappa: 0.133).

Conclusion(s)
Health literacy is vital for patients with heart failure to process and apply health related information. Alhough there is no gold standard measuring health literacy yet, this study shows that nurses’ assessment does not agree with the SBSQ and the NVS-D. To take health literacy into account during communication, nurses can use the SBSQ, noting that the SBSQ seems to underestimate limited health literacy, while the NVS-D seems to overestimate it.Table 1:Characteristics of patientsTable 2:HL of heart failure patients