Relationships among Health Literacy, Self-Care, and Hospital Readmission Status in African American Adults with Heart Failure

Abstract

Approximately six million adults are diagnosed with heart failure (HF) yearly in the U.S., with one million subsequent hospitalizations. Of these, 25%-30% are readmitted within 30 to 90 days of initial discharge. Little is known about relationships among health literacy (HL), self-care and 30-day hospital readmission status in adult African Americans (AAs) with HF. The primary purpose of this study was to explore relationships among HL, baseline self-care maintenance (BSCM), and 30-day hospital readmission status in adult AAs with HF. Two secondary purposes were to determine whether BSCM mediated the relationship between HL and readmission status and whether there was a moderating effect of age, gender, education, insurance status and perceived social support (PSS), on the relationships of HL with BSCM and readmission status. Using a one-month prospective cohort design, HL, BSCM, PSS, basic conditioning factors, and 30-day readmission status were measured in participants from two large hospitals in the Central Savannah River Area in Georgia. Statistical analyses included logistic regression, Pearson product-moment correlation, chi-square tests of independence, and mediation and moderation analyses. Eighty-nine participants were enrolled in this study. Most participants (71.9%) were male, and their mean age was 53.25 years (Standard Deviation, SD = 12.74; range 25-88 years). Of the 89 participants, 28.1% experienced at least one readmission within 30 days of discharge. The following findings have p values < .05. BSCM varied significantly with HL (X2 = 6.97 (degrees of freedom, df = 2, sample size (N) = 89)). Higher PSS was significantly associated with higher BSCM (r = .29). HL was significantly correlated with age (r = -.62). The influence of age on the relationship between HL and readmission status was significant (b = .005). Elderly patients (> 65 years) scoring high on HL had a higher probability of readmission, and younger patients (< 40 years) scoring low on HL had a higher probability of readmission. Post hoc analysis showed that lower ejection fraction predicted readmissions (odds ratio = 3.1, 95% confidence interval = 1.03 - 9.05) after controlling for the other predictors. The findings provide a basis for further research to better understand the impact of HL, self-care maintenance, and other patient characteristics on readmission of AAs with HF.