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Nursing Research and Practice
Volume 2013, Article ID 353290, 8 pages
Research Article

Health Literacy Influences Heart Failure Knowledge Attainment but Not Self-Efficacy for Self-Care or Adherence to Self-Care over Time

1Assistant Professor of Pharmacy Practice, School of Pharmacy, Cedarville University, 251 N. Main Street, Cedarville, OH 45314, USA
2School of Nursing, Purdue University, 502 N. University Street, JNSN 238, West Lafayette, IN 47907, USA
3Center on Aging and the Life Course, Purdue University, West Lafayette, IN 47907, USA
4Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN 47907, USA
5Office of Research & Innovation, Nursing Institute and CNS, Kaufman Center for Heart Failure, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J3-4, Cleveland, OH 44195, USA
6Distinguished Professor of Sociology, Purdue University, Bill and Sally Hanley Hall, 1202 W. State Street, West Lafayette, IN 47907, USA
7Pharmacy Administration, College of Pharmacy, Purdue University, Heine Pharmacy Building, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA
8Pharmacy Practice, College of Pharmacy, Purdue University, Heine Pharmacy Building, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA

Received 1 May 2013; Accepted 30 June 2013

Academic Editor: Victoria Vaughan Dickson

Copyright © 2013 Aleda M. H. Chen et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Inadequate health literacy may be a barrier to gaining knowledge about heart failure (HF) self-care expectations, strengthening self-efficacy for self-care behaviors, and adhering to self-care behaviors over time. Objective. To examine if health literacy is associated with HF knowledge, self-efficacy, and self-care adherence longitudinally. Methods. Prior to education, newly referred patients at three HF clinics ( , age: years) completed assessments of health literacy, HF knowledge, self-efficacy, and adherence to self-care at baseline, 2, and 4 months. Repeated measures analysis of variance with Bonferroni-adjusted alpha levels was used to test longitudinal outcomes. Results. Health literacy was associated with HF knowledge longitudinally ( ) but was not associated with self-efficacy self-care adherence. In posthoc analyses, participants with inadequate health literacy had less HF knowledge than participants with adequate ( ) but not marginal ( ) health literacy. Conclusions. Adequate health literacy was associated with greater HF knowledge but not self-efficacy or adherence to self-care expectations over time. If nurses understand patients’ health literacy level, they may educate patients using methods that promote understanding of concepts. Since interventions that promote self-efficacy and adherence to self-care were not associated with health literacy level, new approaches must be examined.