Development and pilot testing of a disease management program for low literacy patients with heart failure.
Development and pilot testing of a disease management program for low literacy patients with heart failure.


BACKGROUND
Randomized trials have shown that disease management programs can reduce hospitalizations and improve symptoms for patients with congestive heart failure. We sought to create and pilot test such a program for patients with low literacy skills.


METHODS
We used focus groups and individual cognitive response interviews (CRIs) to develop an educational booklet for low literacy patients with heart failure. We incorporated the booklet into a disease management intervention that also included an initial individualized 1-h educational session and scheduled supportive phone calls that were tapered over 6 weeks. We then conducted a 3-month before-after study on patients with low literacy skills (<9th grade literacy level) in a university internal medicine clinic to test the acceptability and efficacy of our program. Outcomes of interest included heart failure-related knowledge, self-care behavior and heart failure-related symptoms measured on the Minnesota Living with Heart Failure (MLwHF) scale.


RESULTS
Twenty-five patients were enrolled and 23 (92%) completed 3-month follow-up. Mean age was 60 years (range 35-74), 60% were men, 60% were African-American, and 74% had household income under $15,000 per year. The median reading level was fifth grade with 32% reading at or below the third grade level. Mean knowledge score at baseline was 67% and did not improve after the intervention. The proportion of patients reporting weighing themselves daily increased from 32% at baseline to 100% at 12 weeks. Mean improvement on the MLwHF scale was 9.9 points over the 3-month trial (95% CI: 0.5, 19.2), which corresponds to an improvement in one class on the New York Heart Association heart failure scale.


CONCLUSIONS
A heart failure disease management program designed specifically for patients with low literacy skills is acceptable and is associated with improvement in self-care behavior and heart failure related symptoms.
Robert Wood Johnson Clinical Scholars Program, Departments of Medicine and Pediatrics, University of North Carolina, 5034 Old Clinic Building, CB#7105, Chapel Hill, NC 27599, USA.
Darren A
DA
DeWalt
Michael
M
Pignone
Robb
R
Malone
Cathy
C
Rawls
Margaret C
MC
Kosnar
Geeta
G
George
Betsy
B
Bryant
Russell L
RL
Rothman
Bonnie
B
Angel
D000328:Adult; D000368:Aged; D019468:Disease Management; D004522:Educational Status; D005260:Female; D017144:Focus Groups; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000517:prevention & control* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D017063:Outcome Assessment, Health Care; D010174:Pamphlets; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000379:methods* / Q000592:standards; D010865:Pilot Projects; D016730:Program Development; D015397:Program Evaluation; D012648:Self Care / Q000379:methods / Q000523:psychology; D020377:Self Efficacy; D012720:Severity of Illness Index; D012944:Social Support; D011795:Surveys and Questionnaires; D013664:Teaching Materials / Q000592:standards; D013689:Telephone