Correlation Between Health Literacy Levels and Healthcare Behaviors in Patients With Heart Failure in Shahid Mohammadi Hospital (Bandar Abbas, Iran)

Document Type: Original Article


1 PhD Candidate of Medical Library and Information Sciences, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, IR Iran.

2 Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, IR Iran.

3 Clinical Research Development Center of Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, IR Iran.


Background: Heart failure (HF) is one of the most prevalent cardiovascular disorders. Patients with HF need self-care behaviors and, thus, need to be equipped with health literacy to make informed decisions. This study aimed to evaluate health literacy among patients with HF hospitalized in Shahid Mohammadi Hospital, Bandar Abbas, Iran, and its effect on self-care behaviors.
Methods: The present cross-sectional correlational investigation was conducted on 192 patients with HF selected via convenience sampling. The data collection instruments were HF health literacy in 3 domains and the European Heart Failure Self-care Behavior scale. The data were analyzed using SPSS, version 23, and descriptive statistics were used along with the Pearson correlation coefficient.
Results: The mean score of health literacy and self-care was 34.6 and 30, respectively. A statistically significant correlation was found between the functional dimension of health literacy and self-care. Thus, a higher health literacy rate was associated with more self-care efforts. The mean score of health literacy varied among the subjects with different education levels.
Conclusions: Considering the statistically significant relationship between health literacy and self-care, it is essential to pay attention to the promotion of the whole dimension of health literacy among patients with HF, especially those of lower education levels, in order to improve their level of self-care. Effective interventions are required to improve patients’ skills in the critical analysis of information and to promote their power of making therapeutic decisions. (Iranian Heart Journal 2020; 21(2): 57-63)


1. Rajati F, Mostafavi, F Sharifirad Gh, Feizi A, Sadeghi M, Reisi M. Comparison of three quality of life questionnaires in heart failure patients participating in cardiac rehabilitation. J Health Syst Res 2014;10(1):85-97.
2. Testa MA, Simonson DC. Assessment of quality-of-life outcomes. New England journal of medicine. 1996;334(13):835-40.
3. Shojaei F. Quality of life in patients with heart failure. Journal of hayat. 2008;14(2):5-13.
4. Ali. A, Sedighe. F, Farzaneh A, MohammadHosein H. The effect of home walking exercise on quality of life and functional capacity of patients with heart failure. Journal of Gorgan University of Medical Sciences. 2007;19(1):49-54.
5. Heidarzadeh M, Hasani P, Rahimzadeh A, Ghahramanian A, Kolahdouzi pour J, Yousef I. Quality of life and social support in congestive heart failure patients and
healthy people. Journal Of Holistic Nursing And Midwifery 2012;23(69):49-54.
6. Borhani F, Khoshab H, Abbaszadeh A, Rashidinejad H, Mohammadi E. Study of the effect of partnership care model on the quality of life in patients with heart failure. 2012.
7. Farghadani Z, Taheri-Kharameh Z, Amiri-Mehra A, Ghajari H, Barati M. The relationship between health literacy and self-care behaviors among patients with heart failure. Hayat. 2018;24(2):186-96.
8. Khosravi A, AhmadzadehK, Ahmadzadeh Z. Advanced health literacy. Bushehr Bushehr University of Medical Sciences; 2014.
9. Macabasco-O’Connell A, DeWalt DA, Broucksou KA, Hawk V, Baker DW, Schillinger D, et al. Relationship between literacy, knowledge, self-care behaviors, and heart failure-related quality of life among patients with heart failure. Journal of general internal medicine. 2011;26(9):979-86.
10. Jovanic M, Zdravkovic M, Stanisavljevic D, Jovic Vranes A. Exploring the Importance of Health Literacy for the Quality of Life in Patients with Heart Failure. International journal of environmental research and public
health. 2018;15(8).
11. Halverson JL, Martinez-Donate AP, Palta M, Leal T, Lubner S, Walsh MC, et al. Health Literacy and Health-Related Quality of Life Among a Population-Based Sample of Cancer Patients. J Health Commun. 2015;20(11):1320-9.
12. Husson O ,Mols F, Fransen MP, van de Poll-Franse LV, Ezendam NP. Low subjective health literacy is associated with adverse health behaviors and worse health-related quality of life among colorectal cancer survivors: results from the profiles registry. Psychooncology. 2015;24(4):478-86.
13. Johnston MV, Diab ME, Kim SS, Kirshblum S. Health literacy, morbidity, and quality of life among individuals with spinal cord injury. J Spinal Cord Med. 2005;28(3):230-40.
14. Lee EH, Lee YW, Moon SH. A Structural Equation Model Linking Health Literacy to Self-efficacy, Self-care Activities, and Health-related Quality of Life in Patients with Type 2 Diabetes. Asian Nurs Res (Korean Soc Nurs Sci). 2016;10(1):82-7.
15. Kooshyar H, Shoorvazi M, Dalir Z, Hosseini M. Health literacy and its relationship with medical adherence and health-related quality of life in diabetic community-residing elderly. Journal of Mazandaran University of Medical Sciences. 2014;24(SUPPL. 1):133-43.
16. ESKANDARI S, HERAVI KM, REJEH N, EBADI A, TAHERI KZ ,MONTAZERI A. Quality of life in heart failure patients using the Minnesota Living with Heart Failure Questionnaire (MLHF). 2016.
17. Mohseni M Khanjani N, Iranpour A, Tabe R, Borhaninejad VR. . The Relationship Between Health Literacy and Health Status Among Elderly People in Kerman .sija. 2015;10(2):146-55.
18. H. I, Iraj Z. The relationship of health literacy with health status, preventive behaviors and health services utilization in Baluchistan, Iran. Journal of Education and Community Health. 2016;2(3):43-50.
19. Izadirad H, Zareban I. Assessment of health literacy and self-care in heart failure patients. Journal of Health Literacy. 2016;1(4):203-19.
20. Cajita MI, Cajita TR, Han H-R. Health literacy and heart failure: a systematic review. The Journal of cardiovascular nursing. 2016;31(2):121.
21. Tung H-H, Lu T-M, Chen L-K, Liang S-Y, Wu S-F, Chu K-H. Health literacy impact on elderly patients with heart failure in Taiwan. Journal of Clinical Gerontology and Geriatrics. 2014;5(3):72-6.
22. Carels RA. The association between disease severity, functional status, depression and daily quality of life in congestive heart failure patients. Quality of life research. 2004;13(1):63-72.
23. Hobbs F, Kenkre J, Roalfe A, Davis R, Hare R, Davies M. Impact of heart failure and left ventricular systolic dysfunction on quality of life. A cross-sectional study comparing common chronic cardiac and medical disorders and a representative adult population. European heart journal. 2002;23(23):1867-76.
24. Ambrosy AP, Fonarow GC, Butler J, Chioncel O, Greene SJ ,Vaduganathan M, et al. The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries. Journal of the American College of Cardiology. 2014;63(12):1123-33.
25. Berry C, McMurray J. A review of quality-of-life evaluations in patients with congestive heart failure. Pharmacoeconomics. 1999;16(3):247-71.
26. Ponikowski P, Anker SD, AlHabib KF, Cowie MR, Force TL, Hu S, et al. Heart failure: preventing disease and death worldwide. ESC Heart Failure. 2014;1(1):4-25.
27. Marques de Sousa M, dos Santos Oliveira J, Oliveira Soares MJG, Amorim de Araújo A, dos Santos Oliveira SH. QUALITY OF LIFE OF PATIENTS WITH HEART FAILURE: INTEGRATIVE REVIEW. Journal of Nursing UFPE/Revista de Enfermagem UFPE. 2017;11(3).
28. Meeks S, Murrell SA. Contribution of education to health and life satisfaction in older adults mediated by negative affect. Journal of Aging and Health. 2001;13(1):92-119.
29. Pooneh Y, Sakineh S, Sakineh M, AliAkbar H. Study of quality of life in heart failure hospitalized patients in Kerman medical university hospital in 2008 Nursing Research. 2011;6(21):59-67.
30. Rahnavard Z, Zolfaghari M, Kazemnejad A, Hatamipour K. An investigation of quality of life and factors affecting it in the patients with congestive heart failure. Journal of hayat. 2006;12(1):77-86.
31. Masoudi FA, Rumsfeld JS, Havranek EP, House JA, Peterson ED, Krumholz HM, et al. Age, functional capacity, and health-related quality of life in patients with heart failure. Journal of cardiac failure. 2004;10(5):368-73.
32. Raziehsadat B, Esmat N, Yunes J. Quality of Life and its Related Factors in Patients with CHF, Referring to Jiroft Imam Khomeini Hospital. . 2017; 30 (105) :23-33. IJN. 2017;30(105):23-33.