title: Health literacy in heart transplantation: Prevalence, correlates and associations with health behaviors-Findings from the international BRIGHT study.
abstract: Health literacy (HL) is a major determinant of health outcomes; however, there are few studies exploring the role of HL among heart transplant recipients. The objectives of this study were to: (1) explore and compare the prevalence of inadequate HL among heart transplant recipients internationally; (2) determine the correlates of HL; and (3) assess the relationship between HL and health-related behaviors.
  
  
  
  A secondary analysis was conducted using data of the 1,365 adult patients from the BRIGHT study, an international multicenter, cross-sectional study that surveyed heart transplant recipients across 11 countries and 4 continents. Using the Subjective Health Literacy Screener, inadequate HL was operationalized as being confident in filling out medical forms none/a little/some of the time (HL score of 0 to 2). Correlates of HL were determined using backward stepwise logistic regression. The relationship between HL and the health-related behaviors were examined using hierarchical logistic regression.
  
  
  
  Overall, 33.1% of the heart transplant recipients had inadequate HL. Lower education level (adjusted odds ratio [AOR] 0.24, p < 0.001), unemployment (AOR 0.69, p = 0.012) and country (residing in Brazil, AOR 0.25, p < 0.001) were shown to be associated with inadequate HL. Heart transplant recipients with adequate HL had higher odds of engaging in sufficient physical activity (AOR 1.6, p = 0.016). HL was not significantly associated with the other health behaviors.
  
  
  
  Clinicians should recognize that almost one third of heart transplant participants have inadequate health literacy. Furthermore, they should adopt communication strategies that could mitigate the potential negative impact of inadequate HL.
authors: School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.
authors: Maan Isabella
authors: MI
authors: Cajita
authors: Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland.
authors: Kris
authors: K
authors: Denhaerynck
authors: Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
authors: Fabienne
authors: F
authors: Dobbels
authors: Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland.
authors: Lut
authors: L
authors: Berben
authors: School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri, USA.
authors: Cynthia L
authors: CL
authors: Russell
authors: School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.
authors: Patricia M
authors: PM
authors: Davidson
authors: Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland; Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium. Electronic address: sabina.degeest@unibas.ch.
authors: Sabina
authors: S
authors: De Geest
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D006084:Graft Rejection / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D015438:Health Behavior; D057220:Health Literacy; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D038622:Internationality; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010349:Patient Compliance; D015995:Prevalence; D011379:Prognosis; D012737:Sex Factors; D015996:Survival Rate; D014181:Transplantation Immunology
chemical_list: D007166:Immunosuppressive Agents
keywords: health behaviors; health literacy; heart transplantation; multicenter; physical activity; survey