title: Health literacy is independently associated with self-care behavior in patients with heart failure.
abstract: Health literacy (HL) has been recognized as an important concept in patient education and disease management for heart failure (HF). However, previous studies on HL have focused predominantly on the relationships between functional HL (the ability to read and write), comprehensive HL including the ability to access information (communicative HL), and the ability to critically evaluate information (critical HL). Self-care behavior has not been evaluated. This study determined the relationship between functional, communicative, and critical HL and self-care behavior in HF patients.
  
  
  
  Cross-sectional analysis of the data was completed for HL, HF-related knowledge, and HF-related self-care behaviors. Sociodemographic and clinical characteristics were also assessed. Multivariate linear regression analysis was used to estimate the associations between literacy and self-care behavior.
  
  
  
  249 patients with HF were assessed (mean age, 67.7±13.9years). Patients with low HL had poorer knowledge and self-care behavior than those with high HL. Critical HL was an independent determinant of self-care behavior (sβ=-0.154, P=0.027).
  
  
  
  Critical HL was independently associated with self-care behavior in HF patients.
  
  
  
  Effective intervention should be developed to improve patient skills for critically analyzing information and making decisions.
authors.affiliation: Section of Liaison Psychiatry & Palliative Medicine, Graduate School of Medical & Dental Sciences, Tokyo Medical & Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan. Electronic address: matsuoka.shiho.cp@gmail.com.
authors.forename: Shiho
authors.initials: S
authors.lastname: Matsuoka
authors.affiliation: School of Nursing, Kitasato University, 2-1-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan. Electronic address: miyuki-m@nrs.kitasato-u.ac.jp.
authors.forename: Miyuki
authors.initials: M
authors.lastname: Tsuchihashi-Makaya
authors.affiliation: Department of Nursing, Edogawa Hospital, 2-24-18 Higashikoiwa, Edogawa-ku, Tokyo 133-0052, Japan. Electronic address: kayanen@tnk-kyn.com.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kayane
authors.affiliation: Department of Nursing, Edogawa Hospital, 2-24-18 Higashikoiwa, Edogawa-ku, Tokyo 133-0052, Japan. Electronic address: puu_michi@yahoo.co.jp.
authors.forename: Michiyo
authors.initials: M
authors.lastname: Yamada
authors.affiliation: Department of Nursing, Tokyo Women's Medical University Hospital, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo 162-8666, Japan. Electronic address: rumi-waka@hotmail.co.jp.
authors.forename: Rumi
authors.initials: R
authors.lastname: Wakabayashi
authors.affiliation: Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, 581 83 Linköping, Sweden. Electronic address: naoko.kato@liu.se.
authors.forename: Naoko P
authors.initials: NP
authors.lastname: Kato
authors.affiliation: Department of Cardiology, Saiseikai Karatsu Hospital, 817 Motohatamachi, Karatsu-shi, Saga 847-0852, Japan. Electronic address: miyukiyaza@yahoo.co.jp.
authors.forename: Miyuki
authors.initials: M
authors.lastname: Yazawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006333:Heart Failure / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009518:New York; D012424:Rural Population; D012648:Self Care / Q000379:methods*; D011795:Surveys and Questionnaires