Assessing Health Literacy in Patients With HF

Study Questions:

What is the reliability and validity of a new tool measuring multiple domains of health literacy in patients with chronic heart failure (HF)?


The authors used a process of concept analysis, expert consensus, and focus groups to develop a 14-item survey measuring health literacy in patients with New York Heart Association Class I-III HF. The final survey was administered to 203 patients in the greater Tokyo area. The survey was re-administered by mail 2 weeks after initial administration for test-retest analysis.


The three domains of health literacy are functional, communicative, and critical health literacy. A limitation of prior literature is that the tools used encompassed only one domain. The initial administration of the survey involved 191 patients (12 excluded for missing data). One hundred thirty-six patients responded to the retest. This study documented the validity and reliability of the survey, which demonstrated good correlation with each of the three domains as well as the concepts of HF self-care. The study revealed that lower health literacy was associated with advanced age, lower education, and living alone. The patient’s motivation to obtain information and explore more sources of information was positively associated with higher communicative and critical health literacy.


A new tool to assess all domains of health literacy, specifically in patients with HF, is valid and reliable. The results of this study are consistent with the direction of association between HF and health literacy while expanding upon the impact that all three domains of health literacy have on self-care efficacy of patients with HF.


There is growing recognition of the impact of health literacy on the efficacy of self-care in many populations. As the population of patients with HF continues to grow, it is essential that we, as a cardiovascular team, understand our patients’ health literacy in order to individualize our interventions. This tool has the potential to improve our ability to assess our patients and promote truly patient-centered care.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Congenital Heart Disease, CHD & Pediatrics and Prevention, CHD & Pediatrics and Quality Improvement, Acute Heart Failure

Keywords: Geriatrics, Health Literacy, Health Surveys, Heart Defects, Congenital, Heart Failure, Patient-Centered Care, Questionnaires, Self Care

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