Top Things to Know: Health Literacy and Cardiovascular Disease: Fundamental Relevance to Primary and Secondary Prevention
Published: June 04, 2018
- Health literacy is the degree to which individuals can access and process basic health information and services and thereby participate in health-related decisions. Limited health literacy is highly prevalent in the United States and strongly associated with increased patient morbidity, mortality, health care utilization, and costs.
- Awareness of health literacy, its implications, and relevance towards individual and public health are fundamental towards achieving the American Heart Association 2020 Impact Goals to improve cardiovascular health by 20% while reducing deaths from cardiovascular diseases and stroke by 20% for all Americans.
- The goal of this AHA Scientific Statement is to clarify the central relevance of health literacy to cardiovascular health. Inadequate health literacy is a barrier to the AHA meeting its 2020 Impact Goals, and this Statement articulates the rationale to anticipate and address the adverse cardiovascular effects associated with health literacy.
- Limited health literacy is more prevalent among racial and ethnic minorities, older adults, and individuals with less education. Likewise, health literacy is strongly related to socioeconomic position and English language proficiency and development of general literacy.
- Language and cultural barriers may interfere with health care delivery. There is extensive literature on health literacy challenges faced by refugees and immigrants, in addition to individuals with limited English proficiency. Such populations are vulnerable to poor communication around health-related services.
- Multifaceted interventions that incorporate patients, providers and health systems are essential to address health literacy barriers and promote patient empowerment and success with long-term hypertension management. Community-based interventions can leverage resources like neighborhood pharmacies to promote blood pressure screening, monitoring and adherence.
- Health literacy informs health-related knowledge and self-efficacy that is essential for promotion of healthy behaviors, such as physical activity, and general health maintenance. Literature consistently demonstrates the association between health literacy and obesity, dietary choices, and exercise.
- Health literacy related to stroke signs and symptoms remain poor, with low recognition of cardinal stroke symptoms and awareness of acute treatments. Interventions developed for individuals with limited health literacy have consistently shown improvement in knowledge and recognition of stroke signs and symptoms.
- Adequate health literacy is associated with a higher level of understanding about medications and life-style modifications in populations with diabetes and congestive heart failure. This effect may be mediated by self-efficacy, which allows patients to take “ownership” of their treatment when they understand the rationale for each strategy. Adequate health literacy also allows patients to avoid medication errors and manage polypharmacy; understand which symptoms may be due to cardiovascular disease and initiate timely responses as instructed; and report side effects which could impact outcomes.
- Inadequate health literacy is a barrier that will need to be overcome to fulfill the mission of cardiovascular health across the spectrum of prevention, screening, and treatment. The public health effectiveness of cardiovascular treatments that have demonstrated efficacy in clinical trials cannot be realized without managing the issue of health literacy. Further work on health literacy in patients with or at risk for CVD should focus on effectively addressing the adverse health impact of limited health literacy.
Citation
Magnani JW, Mujahid MS, Aronow HD, Cené CW, Dickson VV, Havranek E, et al; on behalf of the American Heart Association Council on Epidemiology and Prevention; Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Peripheral Vascular Disease; Council on Quality of Care and Outcomes Research; and Stroke Council. Health literacy and cardiovascular disease: fundamental relevance to primary and secondary prevention: a scientific statement from the American Heart Association [published online ahead of print June 4, 2018]. Circulation. DOI: 10.1161/CIR.0000000000000579.