title: "Teach to goal": theory and design principles of an intervention to improve heart failure self-management skills of patients with low health literacy.
abstract: Self-management is vital for achieving optimal health outcomes for patients with heart failure (HF). We sought to develop an intervention to improve self-management skills and behaviors for patients with HF, especially those with low health literacy. Individuals with low health literacy have difficulty reading and understanding written information and comprehending numerical information and performing calculations, and they tend to have worse baseline knowledge, short-term memory, and working memory compared with individuals with higher health literacy. This paper describes theoretical models that suggest methods to improve the design of educational curricula and programs for low literate audiences, including cognitive load theory and learning mastery theory. We also outline the practical guiding principles for designing our intervention, which includes a multisession educational strategy that teaches patients self-care skills until they reach behavioral goals ("Teach to Goal"). Our intervention strategy is being tested in a randomized controlled trial to determine if it is superior to a single-session brief educational intervention for reducing hospitalization and death. If this trial shows that the "Teach to Goal" approach is superior, it would support the value of incorporating these design principles into educational interventions for other diseases.
authors.affiliation: Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Baker
authors.forename: Darren A
authors.initials: DA
authors.lastname: DeWalt
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
authors.forename: Victoria
authors.initials: V
authors.lastname: Hawk
authors.forename: Bernice
authors.initials: B
authors.lastname: Ruo
authors.forename: Kirsten
authors.initials: K
authors.lastname: Bibbins-Domingo
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
authors.forename: Aurelia
authors.initials: A
authors.lastname: Macabasco-O'Connell
authors.forename: Michael
authors.initials: M
authors.lastname: Pignone
mesh_terms: D004522:Educational Status; D057220:Health Literacy; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D007858:Learning; D010353:Patient Education as Topic / Q000379:methods*; D011582:Psychological Theory; D012648:Self Care; D013663:Teaching / Q000379:methods*