Assessment of health literacy and self-care in heart failure patients

Document Type : Original Article


Department of Nursing, Mahabad Branch, Islamic Azad University, Mahabad, Iran


Background and objective: Self-care is one of the most important elements of life and success in the treatment of patients with heart failure; on the other hand health literacy is the first and most effective step on self-care, so the aim of this study was to investigate the relationship between health literacy level and self-care in patients with heart failure.
Methods: This study with descriptive-correlation approach was done among 105 patients with heart failure who referred to Imam Khomeini hospital in Mahabad during1394-95 who were randomly selected. Data were collected by two standard questionnaires self-care of heart failure index (SCHFI V6.2) and Health Literacy for Iranian Adults (HELIA). Data, were analyzed by SPSS software and Pearson tests, chi- Square linear regression.
Results: The average age of participants 12/81 ± 60/74 years. Health literacy levels according to the questionnaire HELIA, 6.91 per cent at the intermediate level, 28.6 percent was inadequate and 5.9 percent was favorable. In the area of self-care, respectively, maintaining self-care subscale with an average of 5.24 ± 21.37, self- confidence in self-care with 3.78 ± 15.39 and self-care management 4.18 ± 15.01 respectively. There was a significant relationship between general health literacy and three subscales of self-care and age, education and occupation (p <0/005). Statistical analysis showed a significant positive correlation between health literacy scale and self-care subscales (p <0/001).
Conclusion: The dimension of assessment and access to health literacy were better predictors of self-care areas. With regard to the relationship between health literacy and areas of self-care in patients with heart failure, creating units in medical centers to identify factors associated with them to identify strengths and weaknesses in the way of self-care is recommended.
Paper Type: Research Article.


1.    Tehrani H, Majlessi F, Shojaeizadeh D, Sadeghi R, Kabootarkhani MH. Applying Socioecological Model to Improve Women’s Physical Activity: A Randomized Control Trial. Iranian Red Crescent Medical Journal. 2016;18(3).
2.    Salehi Tali S, Mehralian H, Imani R, Khaledi A, Hatami Pour K. Effect of continuous caring and educational intervention (home visit) on quality of life in the congestive heart failure patients. J Shahrekord Univ Med Sci. 2008; 10(1):14-19
3.    Kamrani F, Zohor A, Gahremani A. Assessing the effect of self-care education on knowledge, practice and re hospitalisation among patients with heart failure in selected hospitals of Ardebil. Abstract of 17th international congress of heart association, 2011.
4.    Mazloomy Mahmoodabad SS, Tehrani H, Gholian-aval M, Gholami H, Nematy M. The effect of social class on the amount of salt intake in patients with hypertension. Blood pressure. 2016;25(6):360-3. Haery SM, Tehrani H, Olyaeimanesh A, Nedjat S. Factors Influencing the Social Health of Employees of the Ministry of Health and Medical Education in Iran. Iranian Journal of Health Education and Health Promotion. 2016;3(4):311-8.
5.    Loghmani L, Abbaszadeh A. assessing the effect of self-care education on knowledge and practice among patients with heart failure in hospitals in Kerman City. Teb va Tazkieh. 2007; 15(64, 65): 8-13.
6.    Kato N, Kinugawa K, Ito N, Yao A, Watanabe M, Imai Y, et al. Factors associated with self-care behavior of heart failure patients assessed with the European heart failure self-care behavior Japanese version. Journal of Cardiac Failure. 2007; 13(6): 76.
7.    Bastable SB. Essentials of patient education. 1st ed. USA: Jones and Bartlett Learning; 2006.
8.    Forbes Angus, While Alison. The nursing contributing to chronic disease management. International Journal of Nursing Studies. 2009; 46(1): 120-131.
9.    Gonzalez B, Luopn J, Urrutia A, Altimir S, Coll R. Patient education by nurse: what we really do achieve? European Journal of Cardiovascular Nursing 2005; 4: 107-11
10.    Shuldham Caroline, Theaker Chris, Jaarsma Tiny, Cowie Martin R. Evaluation of the European heart failure self-care behavior scale in a United Kingdom population. Journal of Advanced Nursing. 2007; 60(1): 87-95.
11.    Cameron J Worrall-Carter L Page K Stewart S. Self-care behaviors and heart failure: Does experience with symptoms really make a difference? European Journal of Cardiovascular Nursing. 2010; 9: 92–100.
12.    Jaarsma T, Halfens R, Abu-Saad H H, Diederiks J. Self-care and quality of life in patients with advanced heart failure: The effect of a supportive educational intervention. HEART & LUNG VOL.2000; 29(5):319-30.
13.    Mangolian Shahre Babaki P, Mohammadzadeh SH. [Assessment of educational needs of patient with heart failure]. The second biannual international heart failure summit. Tehran, Iran may 2009:15. [Persian]
14.    Krumholz H, Chen Y, Wang Y, Vaccarino V, Radford M, Horwitz R. Predictors of readmission among elderly survivors of admission with heart failure. Am Heart J 2000; 139 (1 Pt 1): 72–7.
15.    Klimm F, Campbell S, Schellberg D and Gelbrich G, Primary care-based multifaceted, interdisciplinary medical educational intervention for patients with systolic heart failure: lessons learned from a cluster randomised controlled trial. J Adv Nurs. 2009; 65(10): 2239-2248.
16.    Rafeifar SH, Attar zadeh M, Ahmad zadeh M, et al, Comprehensive system of empowerment of people to take care of their health, Tehran, Department of Community and Health Education, 3rd ,2004.
17.    Mamianloo H, Tol A, Khatibi NKH, Ahmadi Komoleleh S, Mohebbi B, Assessing the effect of small group intervention program on knowledge and health literacy among patients with heart failure, Nursing Education, 2014; 3 (3) Successive 9: 34-41
18.    Reisi M, Mostafavi F, Hasanzade A, Sharifirad GR. The relationship between health literacy, health status and healthy behaviors among elderly in Isfahan, Iran. Journal of Health System Research 2011; 7(4): 469-70.
19.    Bedworth DA, Bedworth AE. The dictionary of health education. New York: Oxford University Press; 2010; 238.
20.    Montazeri A, et al. Health Literacy for Iranian Adults (HELIA): develoment and psychometric properties. Payesh 2014; 085:31:11
21.    Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Viera A, Crotty K, et al. Health literacy interventions and outcomes: An updated systematic review. Evidence Report/Technology Assessment No. 199. Prepared by RTI International–University of North Carolina Evidence based Practice Center under contract No. 290-2007-10056- I. AHRQ Publication Number 11-E006. Rockville, MD. Agency for Healthcare Research and Quality. March 2011
22.    Paasche-Orlow M K, Wolf M S. Promoting health literacy research to reduce health disparities. Journal of Health Communication 2010; 15(1):34–41.
23.    Banihashemi S A, Amirkhani M A, Haghdoost A A, Alavian S M, Asgharifard H, Baradaran H, et al. [Health literacy and the affecting factors: a study in five provinces of Iran]. Journal of Medical Education Development Center. 2007; 4(1):1-9. (Persian)
24.    Williams MV, Baker DW, Parker RM, Nurss JR. Relationship of functional health literacy to patients’ knowledge of their chronic disease. A study of patients with hypertension and diabetes. Archives of Internal Medicine 1998; 158: 166-72
25.    Web sait: avilaible 2016/06
26.    Chew L D, Bradley K A. Brief questions to identify patients with inadequate health literacy. FAM Med 2004; 36(8):588-594.
27.    Downey La Vonne A, Zun Leslie S. Assessing adult health literacy in urban healthcare settings. Journal of the National Medical Association 2008; 100(11):1304-1308.
28.    Raphael C, Briscoe C, Davies J, Ian Whinnett Z, Manisty C, Sutton R, et al. Limitations of the New York heart association functional classification system and self-reported walking distances in chronic heart failure. Heart 2007; 93: 476-82.
29.    Riegel B, Carlson B, Moser DK, Sebern M, Hicks FD & Roland V. Psychometric testing of the selfcare of heart failure index. J Card Fail 2004; 10(4): 350-60.
30.    Moadab F, Ghanbari A, Salari A, Kazemnejad E, Sadaghi Sabet M, Pariad E. Study Status Of Self-Care Behaviors And Gender Differences In Patients With Heart Failure. Payavard. 2014; 8 (3):220-234
31.    Riegel B, Lee Ch, Dickson V, Carlson B. An Update on the Self-Care of Heart Failure Index. J Cardiovasc Nurs. 2009; 24(6): 485–497. doi:10.1097/JCN.0b013e3181b4baa0.
32.    Tung HH, Chen SC, Yin WH, et al. Self care behavior in patients with heart failure in Taiwan. Eur J Cardiovasc Nurs. 2012; 11:175–182.
33.    Macabasco-O’Connell A, DeWalt DA, Broucksou KA, Hawk V, Baker DW, Schillinger D, et al. Relationship between literacy, knowledge, selfcare behaviors, and heart failure-related quality of life among patients with heart failure. Journal of general internal medicine. 2011; 26(9):979-86.
34.    Bains SS, Egede LE. Associations between health literacy, diabetes knowledge, self-care behaviors, and glycemic control in a low income population with type 2 diabetes. Diabetes technology & therapeutics. 2011; 13(3):335-41.
35.    Paasche-Orlow MK, Parker RM, Gazmararian JA, Nielsen-Bohlman LT, Rudd RR. The prevalence of limited health literacy. J Gen Intern Med 2005; 20(2): 175-84.
36.    Baker DW, Parker RM, Williams MV, et al. Health literacy and the risk of hospital admission. Journal of General Internal Medicine 1998; 13(12):791-8.
37.    von Wagner C, Knight K, Steptoe A, Wardle J. Functional health literacy and health-promoting behaviour in a national sample of British adults. J Epidemiol Community Health.2007; 61(12):1086-90.
38.    Javadzade H, Sharifirad Gh, Reisi M, Tavassoli E, Rajati F. Health Literacy among Adults of Isfahan, Iran. J Health Syst Res 2013; 9(5): 540-9.
39.    Ghanbari S, Majlessi F, Ghafari M, Mahmoudi-Majdabadi M. [Evaluation of health literacy of pregnant women in urban health centers of Sha-hid Beheshti Medical University]. Daneshvar Medicine.2011; 19(97):1-13. (Persian)
40.    Afshari M, Khazaei S, Bahrami M, Merati H. [Investigating Adult Health Literacy in Tuyserkan City]. Journal of Education and Community Health.2014; 1(2):48-55.
41.    Kandula NR1, Nsiah-Kumi PA, Makoul G, Sager J, Zei CP, Glass S, et al.The relationship between health literacy and knowledge improvement after a multimedia type 2 diabetes education program. Patient Education and Counseling. 2009; 75(3): 321-7.
42.    Powell CK, Hill EG, Clancy DE. The relationship between health literacy and diabetes knowledge and readiness to take health actions. Diabetes Educ. 2007 Jan-Feb;33(1):144-51.
43.    Lee SY, Tsai TI, Tsai YW, Kuo KN. Health literacy, health status, and healthcare utilization of Taiwanese adults: results from a national survey. BMC Public Health 2010; 10: 614.
44.    Abootalebi Daryasari Gh, and et al, Study of the self-care agency in patients with heart failure, Iranian Journal of Critical Care Nursing Vol. 4. No. 4, winter 2012, Pages: 203 – 208
45.    Ghahramani A, Kamrani F, Mohamadzadeh Sh, Namadi M, Effect of self-care education on knowledge, performance and readmission of heart failure patients admitted in city hospitals of Ardabil, J nursig research, 2013, 8(29), 65-72.
46.    Baker DW, Gazmararian JA, Williams MV, Scott T, Parker RM, Green D, et al. Functional health literacy and the risk of hospital admission among Medicare managed care enrollees. American Journal of Public Health 2002; 92(8): 1278-83
47.    Rafeifar SH, ahmadzadehasl M, sharifi MH and et al. Systematic health education to patients in Iran, Community Health Education Department and Health Department, Ministry of Health and Medical Education. 2005.
48.    Khoshtarash M, Momeni M, Ghanbari A, Salehzadeh AH, Rahmatpour P. Self-care behaviors and related factors in patients with heart failure reffering to ‎medical & educational center of heart in Rasht.‎. Holist Nurs Midwifery. 2013; 23 (1):22-29 URL:
49.    Cho YI, Lee SYD, Arozullah AM, et al. Effects of health literacy on health status and health service utilization amongst the elderly. Social Science & Medicine 2008; 66(8):1809-16.
50.    Arozullah AM, Lee SY, Khan T, Kurup S, Ryan J, Bonner M, et al. The roles of low literacy and social supportin predicting the preventability of hospital admission. J Gen Intern Med 2006; 21(2): 140-5.
51.    Azarbad M. The survey of the relationship between self –care behaviors and self – care needs in patient with heart failure referred to Shahid Rajaee’s medical - educational and research center of cardiovascular 2005. MSc thesis. Nursing and midwifery faculty, Iran University of Medical Sciences [Persian]
52.    Oksel E, AkbiyIk A,Kocak G. Self-care behavior analysis of patients with chronic heart failure. European journal of cardiovascular nursing. 2009; 31(8):p s22
53.    Artinian NT, Magnan M, Christian W, Lange MP. What do patient know about their heart failure? Applied Nursing research. 2002; 15(4): 80-200.
54.    Akyol AD, Cetinkaya Y, Bakan G, Yarah S,Akkus S. Self– care agency and factors related to this agency among patients with hypertension. Jornal of clinical nursing. 2007; 687: (4) 16.
55.    Dashiff CJ,Mccaleb A,Cull V. Self-care of young adolescents with type 1 diabetes. Journal of pediatric nursing. 2006; 21(3):222-232
56.    Riegel B, Carlson B. Facilitators and barriers to heart failure self-care. Patient Educ Couns 2002; 46(4): 287-95.
57.    Lai AY, Ishikawa H, Kiuchi T, Mooppil N, Griva K. Communicative and critical health literacy, and self-management behaviors in end-stage renal disease patients with diabetes on hemodialysis. Patient education and counseling. 2013; 91(2):221-7