Study On Current Status Of Health Literacy And Its Impact On Quality Of Life Among Chronic Heart Failure Patients

Objective(1)To investigate the current status of health literacy among chronic heart failure patients(CHF)and analyze its influencing factors;(2)To explore the mechanism linking health literacy to quality of life in chronic heart failure patients.Methods With convenience sampling method,223 CHF patients who met the inclusion and exclusion criteria were recruited from an outpatient department in a tertiary general hospital in Shanghai from Ooctober,2017 to Sepmtember,2018.Questionaires included: Self-designed demographic and health status questionnaire,Social Support Rating Scale,the Chinese version of Heart Failure-Specific Health literacy scale,the scale of physicianpatient communication quality,the Chinese version of the European Heart Failure Self-care Behavior Scale,the Healthcare utilization scale and Minnesota Living With Heart Failure Questionnaire.Stastical analysis methods include:(1)descriptive stastical methods: mean ± SE and frequencies;(2)Single-factor analysis and multiple hierarchical regression analysis were used to analyze the infunencing factors of health literacy among CHF patients;(3)Pearson or Spearman analysis was used for correlation analysis;(4)Structural equation modeling was used to test the hypothetical model;(5)Bootstrap analysis(n=1000)was used to examine the mediating effects of physician-patient communication,healthcare utilization and self-care behavior on health literacy and quality of life in CHF patients.Results:(1)The mean score of health literacy was 29.29±9.22,the dimension with the lowest score was critical health literacy(8.54±3.40);(2)Multiple hierarchical regression analysis suggested: age,education,NYHA class and utilization of social support were the influencing factors of health literacy in CHF patients,accounting for 53.4% of the variance in health literacy;(3)Spearman analysis showed that health literacy had a positive effect on quality of physician-patient communication and self-care behavior and it also had a negative effect on healthcare utilization in CHF patients;Meanwhile the quality of physician-patient communication and self care had a positive effect on quality of life and healthcare utilization had a negative effect on quality of life in CHF patients;(4)Bootstrap analysis suggested: the mediating effects of physician-patient communication and healthcare utilization on health literacy and quality of life among CHF patients are significant;while the mediating effect of self-care behavior was not significant;(5)Fitness indices of the adjusted model were: ?2/df=1.238?GFI=0.955?AGFI=0.930?NFI=0.966?CFI=0.930?RMSEA=0.033;which indicated a good model fit;Conclusion:(1)In this study,The current status of health literacy among CHF patients was relatively poor,the dimension of critical health literacy was at the worst;(2)In this study,The current status of quality of life among CHF patients was at a moderate to low level;(3)The influencing factors of health literacy among CHF patients were age,education,cardiac function and utilization of social support.Medical staff should focus on CHF patients who are older,less educated and have a poor cardiac function and help patients to strive for more social support resources;(4)Health literacy could exert an indirect effect on quality of life via physician-patient communication and healthcare utilization,therefore quality of life of CHF patients can be improved by developing strategies on the quality of physician-patient communication and healthcare utilization;(5)In this study,no mediating effect of self-care behavior on health literacy and quality of life was found.Therefore,it is suggested to choose properer measurement tools,expand the sample size and conduct multicenter research for further confirmation.