Understanding Health Literacy Skills in Patients with Cardiovascular Disease and Diabetes

Health literacy is the ability to understand and act on health information and is linked to health outcomes. It is unclear how health literacy skills are developed in patients with complex conditions, such as cardiovascular disease and diabetes. The purpose of this grounded theory study was to gain perspectives of both patients and healthcare professionals on how health literacy skills were developed in patients with cardiovascular disease or diabetes. The research questions addressed how knowledge and skills were acquired, the role of digital tools, instructional strategies used by healthcare professionals, and how the instructional strategies of the healthcare professionals matched the learning preferences and needs of the patients. A social ecological framework was used, which underscored the importance of understanding health literacy from multiple sources. Semistructured interviews were conducted on 19 healthcare professionals and 16 patients. Emergent key themes included: (a) social support plays an important role as a learning opportunity; (b) many patients get their information from internet searches; (c) instructional strategies should be personalized, interactive, social, and relevant; and (d) patients are self-directed learners. Linking of these themes led to the development of the health literacy instructional model, which is a 3-step approach, including an emotional support, behavioral approach, and instructional strategy. Social support was the common element in all 3 phases and was perceived to be key to developing health literacy skills, resulting in the key implication for social change. Recommendations are to consider social support in the development of health literacy instructional strategies. Keywords: Health Literacy, Grounded Theory, Cardiovascular Disease, Diabetes Health literacy is the ability of a person to understand and act on instructions given by a healthcare professional on how to manage their health (Parker & Ratzan, 2012). More than assessing reading level, health literacy includes numeracy, navigating the healthcare system, communicating with healthcare team providers, and decision making (Nutbeam, 2008; Nielson-Bohlman, Panzer, & Kinzig, 2004). An estimated 90 million Americans have low health literacy skills, impacting their ability to manage their health (Kutner, Greenberg, Jin, & Paulsen, 2006). Low health literacy is linked to poor health outcomes (Paasche-Orlow & Wolf, 2007; Sheridan et al., 2011). Cardiovascular disease and diabetes are demanding conditions requiring knowledge, skill and involvement on the part of the patient (Smith et al., 2011). Terms like cholesterol, angina pectoris, carbohydrates, insulin resistance, and the names of medications are frequently used by healthcare providers, and are important in self-management of cardiovascular disease and diabetes (Smith et al., 2011). In the case of cardiovascular disease and diabetes, trade-offs must be made by healthcare professionals between readability, understanding, and an accurate description of the treatments, procedures, and tests that must be explained. Individuals who survived their first heart attack do not have a personal experience to rely on. Even if they are motivated and self-directed, they still need to know how and where to find the information, be able to validate it as credible information, and be able to apply the information to their specific circumstances (Smith et al., 2011). Since the publication of Health Literacy: A Prescription to End Confusion, health literacy is considered a population health priority in the United States and throughout the world (Nielson-Bohlman, Panzer, & Kinzig, 2004). The National Action Plan to Improve Health Literacy (U.S. Department of Health and Human Services, 2010) and the Health Literacy Toolkit (Dewalt et al., 2010) provide strategies designed to improve communication between patients and their health care providers. Since these strategies are designed to simplify the message, it is unclear how patients with a new diagnosis of cardiovascular disease and diabetes are able to acquire and build the knowledge and skills necessary to manage their condition. …