Low health literacy: Implications for managing cardiac patients in practice.
Kathleen T Hickey, Ruth M Masterson Creber, Meghan Reading and 4 others
PMID 30028773WHAT IT FOUND
In 91 older cardiac patients, 32% had inadequate health literacy and 35% had low health literacy.
The gap between Hispanic and White participants disappeared after education was considered. Assess comprehension routinely.
Key findings
0132% of participants had inadequate functional health literacy on the TOFHLA, and 35% had low health literacy on the SAHL.
02Hispanic participants had more inadequate TOFHLA literacy than White participants (41% versus 16%), but the difference was no longer significant when education was included.
03Quality of life scores were not related to health literacy, except in physical function, where participants with at least some college education scored higher than those with a high school education or less.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a single-center convenience sample of 91 participants, so the findings may not apply to other cardiac populations. It excluded patients with documented anxiety or depression and those who did not score 24 on the Mini-Mental State Examination, so it does not represent all older cardiac patients. The study was cross-sectional, so it cannot show that low health literacy caused poorer quality of life or worse self-care. Some participants had difficulty reading questionnaires despite larger font, and many disliked being tested, which may have affected responses. The TOFHLA and SAHL are not easily administered in clinical settings. Medication adherence was not collected, so the study cannot link health literacy to self-management. Race and ethnicity differences in health literacy were no longer significant after education was included, making education a likely confounder.
The easy way to misread this
Do not read the Hispanic and White literacy difference as proof that ethnicity causes low health literacy. When education was included in the analysis, the difference was no longer significant.