Health Literacy and Risk Factors for Coronary Artery Disease (From the CONCARDPCI Study)

Relationship Between Perceived Social Support and Physical Frailty Among Older Patients with Coronary Artery Disease: A Dual Mediation Model

Background: Physical frailty is common among older patients with coronary artery disease (CAD) and is influenced by perceived social support, health literacy, and a sedentary lifestyle. This study examined the dual mediating roles of health literacy and a sedentary lifestyle in the relationship between perceived social support and physical frailty in older patients with CAD. Methods: This cross-sectional study included data collected from 182 older patients with CAD at a general hospital in Korea between June 2022 and January 2023. Participants completed self-reported questionnaires measuring the main variables and demographic information. Clinical data were obtained from electronic medical records. Results: The mediation hypothesis was tested using a dual mediation model with the PROCESS macro (Model 6) and 95% bias-corrected bootstrap confidence intervals. Perceived social support indirectly influenced physical frailty through three pathways: health literacy alone, sedentary lifestyle alone, and a sequential process in which health literacy influenced sedentary lifestyle and ultimately physical frailty. Conclusions: This study identified a strong mediating effect of health literacy and a sedentary lifestyle on the relationship between perceived social support and physical frailty. A built environment of perceived social support among older patients with CAD improves health literacy, modifies sedentary lifestyles, and helps prevent physical frailty. Thus, healthcare professionals should evaluate the perceived social support, health literacy, and sedentary lifestyle of older patients when developing physical frailty prevention programs.

The effects of maternal health literacy, family functioning and self-efficacy on antepartum depression in pregnant women in China: a moderated mediation model

BACKGROUND

Antepartum depression (AD) is associated with a greater risk of adverse outcomes for both mothers and fetuses. Maternal health literacy (MHL), family functioning (FF), and self-efficacy (SE) are important factors affecting antepartum depression (AD) in pregnant women. Therefore, this study aimed to explore the associations between these factors and whether MHL and SE mediate the relationship between FF and AD.

METHODS

This cross-sectional study included 1392 pregnant women from 6 hospitals in Chongqing, China. Data were collected via structured scales, including the Edinburgh Postpartum Depression Scale, the APGAR Family Care Index Scale, the Maternal Health Literacy Scale and the General Self-Efficacy Scale (GSES). Structural equation modeling(SEM) was used to test the hypothesized relationships among the variables.

RESULTS

In our survey, 31.90% participants had depression symptoms. Correlation analysis revealed that all the variables were significantly correlated with AD (p < 0.01). The model indicated that FF had the strongest correlation with AD (β = -0.276, p < 0.01), followed by MHL (β = -0.248, p < 0.01) and self-efficacy (SE) (β = -0.222, p < 0.01). SE fully mediated the relationship between FF and AD and mediated the relationship between MHL and AD. There was no evidence of a mediating effect of MHL on the relationship between FF and AD.

CONCLUSIONS

AD is correlated with MHL, SE and FF. MHL and FF can directly affect AD and mediate AD through SE. Future programs should consider MHL promotion, FF improvement and SE strengthening as breakthrough points when planning educational programs.

Influence of Health Literacy on Physical Activity and Sedentary Behaviors in Older Patients with Coronary Artery Disease

BACKGROUND

Coronary artery disease is a chronic condition that requires continuous adherence to healthy behaviors. Adhering to physical activity and reducing prolonged sedentary behavior are important for the physical health of older patients with coronary artery disease (CAD). Health literacy is increasingly recognized as a key factor in secondary prevention for these patients. However, evidence regarding the associations among health literacy, physical activity, and sedentary behaviors for secondary prevention in older patients with coronary artery disease remains limited.

OBJECTIVES

This study aimed to identify the prevalence of limited health literacy and the influence of health literacy on physical activity and sedentary behaviors in older patients with CAD.

METHODS

This study was a descriptive cross-sectional study conducted from May to December 2022 in South Korea. A total of 186 patients aged 65 and older diagnosed with coronary artery disease participated. Data on health literacy, physical activity, and sedentary behaviors were collected through self-reported questionnaires and electronic medical records.

RESULTS

The prevalence of limited health literacy in older patients was 66.7%. Hierarchical linear regression revealed that health literacy was a significant determinant of physical activity (β = -0.50, P < .001) and sedentary behaviors (β = 0.58, P < .001) after adjusting for confounding variables.

CONCLUSIONS

Our main findings showed that health literacy can facilitate improvements in physical activity and sedentary behaviors. Health literacy can facilitate health decisions for secondary prevention in older patients with CAD. Thus, healthcare professionals should assess patient health literacy and illness severity when designing secondary prevention programs.

Identifying Health Literacy Strengths and Needs Among Jordanian Acute Myocardial Infarction Patients

Acute myocardial infarction is a significant health issue, particularly in Jordan where ischemic heart disease is the leading cause of death. Effective management of acute myocardial infarction is essential to mitigate its consequences. Although health literacy is crucial for the successful management of acute myocardial infarction, research about the strengths and needs of health literacy among acute myocardial infarction patients is still limited. This study was conducted to identify the health literacy strengths and needs of Jordanian acute myocardial infarction patients using cluster analysis. A cross-sectional design was used to conduct this study in a sample of acute myocardial infarction patients in Jordan (N = 114). A demographics questionnaire and the Health Literacy Questionnaire were used to collect the data. Data analysis was performed using hierarchical cluster analysis using Ward's method. Seven distinct clusters of acute myocardial infarction patients were identified, each characterized by unique health literacy profiles and sociodemographic characteristics. Cluster 7 had the highest health literacy scores across all nine Health Literacy Questionnaire scales. Sociodemographic factors such as age, education level, and gender influenced health literacy levels, with female, younger, more educated patients exhibiting higher health literacy. Through identifying the specific strengths and needs, this research provides a foundation for developing targeted health literacy interventions for acute myocardial infarction patients. Improving health literacy among acute myocardial infarction patients can enhance their ability to manage their health and potentially reduce the complications associated with acute myocardial infarction.

Health literacy in patients participating in cardiac rehabilitation: A prospective cohort study with pre-post-test design

Background and aims

Adherence to recommendations regarding medical treatment and healthy behaviour serve as a significant challenge for patients experiencing a cardiac event. Optimizing the patients' health literacy (HL) may be crucial to meet this challenge and has gained increased focus the last decade. Despite cardiac rehabilitation (CR) being a central part of the treatment of patients experiencing a cardiac event, such programs have not been evaluated regarding HL. Therefore, the aim of this study was to describe and evaluate HL in patients participating in CR.

Methods

A prospective cohort study with pre-post-test design of patients participating in CR. Data were collected at program admission and completion (August 2017-June 2018). Patients from three different CR-programs were included. Descriptive and inferential statistics were applied to describe and evaluate HL and change in HL across categories of demographical variables and type of rehabilitation.

Results

In total, 113 patients attending CR were included. A statistically significant increase in HL was observed from pre-to post-CR (mean change: 2.24 ± 3.68 (p < 0.001)). Patients attending 12-weeks outpatients CR-program had statistically significant higher HL, both at pre- and post-CR, compared to those attending one-week residential CR.

Conclusions

Participation in CR statistically significantly improves HL. Overall, judging health information was found as the most difficult aspect of HL, both at pre- and post-CR. This should be emphasized in secondary prevention to overcome barriers related to adherence to medical treatment and healthy behaviour.

Health Literacy Among Patients With Acute Coronary Artery Diseases: Predictors, Consequences, and Enhancing Strategies: A Review of the Literature

The purpose of this study is to integrate evidence on predictors, consequences, in addition to the strategies for enhancing health literacy (HL) for patients with acute coronary artery diseases. An integrative review was conducted by searching four main electronic databases: the Web of Science, PubMed, ScienceDirect, and MEDLINE. Twenty-three studies met the inclusion criteria and were included in the final review process. The review identified the most common predictors, consequences, and relationship of HL with health outcomes in patients with acute coronary artery disease. In addition to the main strategies that enhance HL, patients with or at risk for acute coronary artery disease need a good level of HL to cope with the disease's consequences. It is recommended to include routine assessment and management of HL levels in acute coronary artery disease treatment protocols to improve clinical outcomes.

The association of electronic health literacy with behavioural and psychological coronary artery disease risk factors in patients after percutaneous coronary intervention: a 12-month follow-up study

Aims

Fundamental roadblocks, such as non-use and low electronic health (eHealth) literacy, prevent the implementation of eHealth resources. The aims were to study internet usage for health information and eHealth literacy in patients after percutaneous coronary intervention (PCI). Further, we aimed to evaluate temporal changes and determine whether the use of the internet to find health information and eHealth literacy were associated with coronary artery disease (CAD) risk factors at the index admission and 12-month follow-up of the same population.

Methods and results

This prospective longitudinal study recruited 2924 adult patients with internet access treated by PCI in two Nordic countries. Assessments were made at baseline and 12-month follow-up, including a de novo question Have you used the internet to find information about health?, the eHealth literacy scale, and assessment of clinical, behavioural, and psychological CAD risk factors. Regression analyses were used. Patients' use of the internet for health information and their eHealth literacy were moderate at baseline but significantly lower at 12-month follow-up. Non-users of the internet for health information were more often smokers and had a lower burden of anxiety symptoms. Lower eHealth literacy was associated with a higher burden of depression symptoms at baseline and lower physical activity and being a smoker at baseline and at 12-month follow-up.

Conclusion

Non-use of the internet and lower eHealth literacy need to be considered when implementing eHealth resources, as they are associated with behavioural and psychological CAD risk factors. eHealth should therefore be designed and implemented with high-risk CAD patients in mind.

Clinical trial registration

ClinicalTrials.gov NCT03810612 https://clinicaltrials.gov/ct2/show/NCT03810612.