The Effect of Health Literacy on Health Status in Patients with Heart Failure: A Path Analysis

Managing heart failure (HF) is challenging because of its complexity and high rates of hospitalization, morbidity, and mortality. Effective management requires coordination between patients' abilities and healthcare services; however, low health literacy among patients with heart failure can adversely affect their health status. Therefore, the understanding relationship between health literacy and health status would provide the evidence for developing future intervention.

This analytical study explored multilevel factors influencing health literacy and health status in patients with heart failure (HF) who underwent health service delivery at outpatient clinics. The sample consisted of 453 patients with HF from 12 hospitals located in five regional areas (north, south, east, northeast, central, and Bangkok) in Thailand. A hypothetical model was used to test the association between comorbidity, social support, patient-centered care, health service delivery, health literacy, and health status. Path analysis was used to analyze the data.

The results indicated that 40.8% of patients with HF exhibited low or inadequate levels of health literacy, yet perceived their health status as good, with an average of 25.2±19.8 points. Health service delivery by a cardiologist and nurse case manager directly influences health literacy. Comorbidity had a direct impact on health status, whereas social support, patient-centered care, and the aforementioned health service delivery indirectly affected health status through health literacy. Importantly, health literacy status directly influences health status.

Comorbidity, social support, patient-centered care, and health service delivery were related with health literacy and high level of health literacy could influence the better health status. To increase the quality of health care services, health care providers should promote health literacy and integrate the concept of patient-centered care for HF patients at outpatient clinics. Recommendations include the training of nurses as case managers.