title: Development and Validation of a Heart Failure-Specific Health Literacy Scale.
abstract: BACKGROUND
  Health literacy (HL) is an important concept for patient education and disease management with heart failure (HF). However, research on HL has predominantly focused on functional HL (ability to read and write). The World Health Organization advocates evaluating comprehensive HL, including the ability to access information (communicative HL) and critically evaluate that information (critical HL).
  
  
  OBJECTIVE
  We developed an instrument for measuring functional, communicative, and critical levels of HL in patients with HF.
  
  
  METHODS
  We evaluated the reliability and validity of those 3 HL scales in a sample of 191 outpatients with HF (mean [SD] age, 66.9 [13.9] years; 64.9% males). Sociodemographic and clinical characteristics, knowledge of HF, a well as motivation to obtain health information were assessed for each patient through a self-administered questionnaire and review of electronic medical records.
  
  
  RESULTS
  We constructed scale items to reflect directly the comprehensive World Health Organization definition of HL. We identified 3 interpretable factors by exploratory factor analysis. Internal consistency was marginally acceptable for total HL (Cronbach α = 0.71), functional HL (α = 0.73), communicative HL (α = 0.68), and critical HL (α = 0.69); the interclass correlation coefficients of the functional, communicative, and critical HL subscales were 0.882, 0.898, and 0.882, respectively. Low functional, communicative, and critical HL was characteristic of older patients, those with lower socioeconomic status, patients living alone, those without a high school education, and patients lacking HF knowledge.
  
  
  CONCLUSIONS
  Our new HL scale was demonstrated to be a reliable, valid instrument for measuring functional, communicative, and critical HL in patients with HF. Exploring a patient's HL level, including the ability to access, understand, and use health information as well as the ability to read and write, may provide better understanding of patients' potential barriers to self-care.
authors.affiliation: Shiho Matsuoka, RN, MS Doctoral Student, Section of Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan. Naoko Kato, PhD, RN Postdoctoral Fellow, Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Sweden. Takahiro Kayane, RN Nurse Manager, Department of Nursing, Edogawa Hospital, Tokyo, Japan. Michiyo Yamada, RN Department of Nursing, Edogawa Hospital, Tokyo, Japan. Masako Koizumi, RN, MSN Clinical Nurse Specialist, Department of Nursing, Tokyo Women's Medical University Hospital, Japan. Toshimi Ikegame, RN, MSN Nurse Manager, Department of Nursing, St Luke's International Hospital, Tokyo, Japan. Miyuki Tsuchihashi-Makaya, PhD, RN Associate Professor, School of Nursing, Kitasato University, Sagamihara, Japan.
authors.forename: Shiho
authors.initials: S
authors.lastname: Matsuoka
authors.forename: Naoko
authors.initials: N
authors.lastname: Kato
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kayane
authors.forename: Michiyo
authors.initials: M
authors.lastname: Yamada
authors.forename: Masako
authors.initials: M
authors.lastname: Koizumi
authors.forename: Toshimi
authors.initials: T
authors.lastname: Ikegame
authors.forename: Miyuki
authors.initials: M
authors.lastname: Tsuchihashi-Makaya
mesh_terms: D000368:Aged; D005260:Female; D057220:Health Literacy / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000592:standards*; D011594:Psychometrics / Q000592:standards; D015203:Reproducibility of Results; D020377:Self Efficacy; D011795:Surveys and Questionnaires / Q000592:standards*