Shiho Matsuoka

Health literacy is independently associated with self-care behavior in patients with heart failure

OBJECTIVE Health literacy (HL) has been recognized as an important concept in patient education and disease management for heart failure (HF). However, previous studies on HL have focused predominantly on the relationships between functional HL (the ability to read and write), comprehensive HL including the ability to access information (communicative HL), and the ability to critically evaluate information (critical HL). Self-care behavior has not been evaluated. This study determined the relationship between functional, communicative, and critical HL and self-care behavior in HF patients. METHODS Cross-sectional analysis of the data was completed for HL, HF-related knowledge, and HF-related self-care behaviors. Sociodemographic and clinical characteristics were also assessed. Multivariate linear regression analysis was used to estimate the associations between literacy and self-care behavior. RESULTS 249 patients with HF were assessed (mean age, 67.7±13.9years). Patients with low HL had poorer knowledge and self-care behavior than those with high HL. Critical HL was an independent determinant of self-care behavior (sβ=-0.154, P=0.027). CONCLUSIONS Critical HL was independently associated with self-care behavior in HF patients. PRACTICE IMPLICATIONS Effective intervention should be developed to improve patient skills for critically analyzing information and making decisions.

Development and Validation of a Heart Failure-Specific Health Literacy Scale.

Background:Health literacy (HL) is an important concept for patient education and disease management with heart failure (HF). However, research on HL has predominantly focused on functional HL (ability to read and write). The World Health Organization advocates evaluating comprehensive HL, including the ability to access information (communicative HL) and critically evaluate that information (critical HL). Objective:We developed an instrument for measuring functional, communicative, and critical levels of HL in patients with HF. Methods:We evaluated the reliability and validity of those 3 HL scales in a sample of 191 outpatients with HF (mean [SD] age, 66.9 [13.9] years; 64.9% males). Sociodemographic and clinical characteristics, knowledge of HF, a well as motivation to obtain health information were assessed for each patient through a self-administered questionnaire and review of electronic medical records. Results:We constructed scale items to reflect directly the comprehensive World Health Organization definition of HL. We identified 3 interpretable factors by exploratory factor analysis. Internal consistency was marginally acceptable for total HL (Cronbach &agr; = 0.71), functional HL (&agr; = 0.73), communicative HL (&agr; = 0.68), and critical HL (&agr; = 0.69); the interclass correlation coefficients of the functional, communicative, and critical HL subscales were 0.882, 0.898, and 0.882, respectively. Low functional, communicative, and critical HL was characteristic of older patients, those with lower socioeconomic status, patients living alone, those without a high school education, and patients lacking HF knowledge. Conclusions:Our new HL scale was demonstrated to be a reliable, valid instrument for measuring functional, communicative, and critical HL in patients with HF. Exploring a patient’s HL level, including the ability to access, understand, and use health information as well as the ability to read and write, may provide better understanding of patients’ potential barriers to self-care.

Avoidance behavior associated with depressive symptoms in patients with implantable cardioverter defibrillators

Objective: Many patients with implantable cardioverter defibrillators experience depressive symptoms. In addition, avoidance behavior is a common problem among patients with implantable cardioverter defibrillators. We examined the association between avoidance behaviors and depressive symptoms in patients with implantable cardioverter defibrillators. Method: We conducted a single-center, cross-sectional study with self-completed questionnaires between May 2010 and March 2011. We measured avoidance behaviors (avoidance of places, avoidance of objects, and avoidance of situations) and depressive symptoms (using the Beck Depression Inventory, Version II) in 119 participants. An avoidance behaviors instrument was developed for this study and we confirmed its internal consistency reliability. Results: Ninety-two (77.3%) patients were aged older than 50 years, and 86 (72.3%) were men. Fifty-one (42.9%) patients reported “avoidance of places”, 34 (28.6%) reported “avoidance of objects”, and 63 (52.9%) reported “avoidance of activity”. Avoidance behavior was associated with increased odds for the presence of depressive symptoms (OR 1.31; 95% CI 1.06–1.62). Conclusions: This was the first study to identify the relationship between avoidance behavior and depressive symptoms among patients with implantable cardioverter defibrillators; however, there are a few methodological limitations.

Insomnia in Heart Failure

Insomnia is a mental condition that has a profound and well-documented effect on overall health and quality of life (QOL) in the general population (Figure). In a study of a community-dwelling population, insomnia was shown to be associated with depression and dementia.3,4 Insomnia can also lead to an unhealthy lifestyle and an abnormal autonomic nervous system and neuroendocrine system,5 and these changes increase the risk of obesity, arteriosclerosis, hypertension, diabetes, and heart failure (HF). The mechanism of the effect of insomnia on these lifestyle-related diseases is unclear, but it is possible that treatment of insomnia will prevent these diseases. Insomnia is also more prevalent in patients with chronic nsomnia is highly prevalent in patients with chronic conditions. In the International Classification of Sleep Disorders, insomnia is defined as “a repeated difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity and circumstances for sleep, and results in some form of daytime impairment”.1 Thus, insomnia has 3 general traits: persistent sleep difficulty, adequate sleep opportunity, and associated daytime dysfunction. Insomnia is also classified into chronic, short-term, and other types.1,2