An exploration of the relationship between health literacy and engagement with cardiac rehabilitation programmes

Abstract

Coronary artery disease is one of leading causes of mortality. Cardiac rehabilitation programmes provide educational support and are found to be beneficial when patients participate therein, yet the attendance rate is low worldwide. Health literacy is a complex skill which hugely affects a person’s health behaviour. This study aimed to explore the relationship between health literacy and completion of cardiac rehabilitation programmes by patients who had an initial diagnosis of coronary artery disease. The study was conducted in a large hospital in an urban area of New Zealand over a four months period on patients who had undergone coronary artery bypass and graft surgery after an initial diagnosis of coronary artery disease. The study conducted a survey using the Health Literacy Questionnaire (HLQ) to create health literacy profiles of participants while they were inpatients. Demographic data such as age, gender and education level were also collected. Then data collection from the participants’ patient records followed after their discharge to ascertain the participants’ cardiac rehabilitation completion status and uptake of prescribed medications on discharge and three months after discharge. Of the 113 eligible patients, 61 participated. The majority were Pakeha and other European males with a mean age of 65 years. Completion data was only available on 53 of the original 61 participants due to eight either still participating in, or awaiting to commence the cardiac rehabilitation programmes. In overall, the mean scores on the nine domains of the HLQ were similar to those from other previous studies using the HLQ. The only significant difference between the groups was that those who had completed cardiac rehabilitation scored more in domain 9 ‘Understanding health information well enough to know what to do’ than those who had not. Demographic data showed that those in the completion group were significantly more likely to have completed tertiary education and to be employed. Analysis of item responses showed a wide response variance within domains which was somewhat greater in the non-completion group. However, significant differences were found on only four items with the completion group scoring higher on health literacy items regarding ‘having healthcare provider to discuss health problems with’, ‘can rely on at least one healthcare provider’, ‘accurately follow instructions’ and ‘understand what healthcare providers are asking me to do’. There were no significant findings regarding uptake of prescribed medications. This study has revealed that a large percentage of participants, regardless of the cardiac rehabilitation completion, have a certain level of difficulty with health literacy tasks. This highlights the need for health literacy support for patients and provides guidance for future interventions and research.