Background. Inadequate health literacy may be a barrier to gaining knowledge about heart failure (HF) self-care expectations, strengthening self-efficacy for self-care behaviors, and adhering to self-care behaviors over time. Objective. To examine if health literacy is associated with HF knowledge, self-efficacy, and self-care adherence longitudinally. Methods. Prior to education, newly referred patients at three HF clinics ( , age: years) completed assessments of health literacy, HF knowledge, self-efficacy, and adherence to self-care at baseline, 2, and 4 months. Repeated measures analysis of variance with Bonferroni-adjusted alpha levels was used to test longitudinal outcomes. Results. Health literacy was associated with HF knowledge longitudinally ( ) but was not associated with self-efficacy self-care adherence. In posthoc analyses, participants with inadequate health literacy had less HF knowledge than participants with adequate ( ) but not marginal ( ) health literacy. Conclusions. Adequate health literacy was associated with greater HF knowledge but not self-efficacy or adherence to self-care expectations over time. If nurses understand patients’ health literacy level, they may educate patients using methods that promote understanding of concepts. Since interventions that promote self-efficacy and adherence to self-care were not associated with health literacy level, new approaches must be examined. 1. Introduction Heart failure is identified as a leading cause of hospitalizations [1], morbidity, mortality, and rising healthcare costs for nearly six million Americans [2, 3]. After a diagnosis of heart failure, patients must perform self-care behaviors to reduce negative clinical outcomes [4, 5]. Self-care is a decision-making process, where patients perform activities to prevent symptoms (maintenance) and respond to symptoms as they occur (management) [4]. Self-care maintenance activities for heart failure patients include exercising daily, eating a low sodium diet, monitoring fluid intake, and monitoring weight. Patients may respond to symptoms by engaging in the following self-care management activities: consulting their healthcare provider, reducing fluid and sodium intake, and increasing the dose of a diuretic. However, patients’ adherence to recommended self-care behaviors varies greatly and is generally poor [5–7]. Multiple factors may affect patients’ adherence to heart failure self-care including heart failure knowledge. Patients may not have received recommended heart failure education [8, 9] if the heart failure diagnosis was secondary
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