Associations between health literacy, socio-demographics and health behaviours in adults with myocardial infarction: a cross-sectional analysis of the ENHEARTEN Study

Background Health literacy – the ability to find, understand, and use health information – is a determinant of health. Low health literacy can negatively impact health outcomes and contribute to health inequalities. Approximately one-third of patients with cardiovascular disease (CVD) have low health literacy, which may affect their ability to actively engage in healthy behaviours required for effective CVD secondary prevention. Purpose To explore factors associated with health literacy in adults with myocardial infarction (MI). Methods The ENhancing HEAlth literacy in secondary pRevenTion of cardiac evENts (ENHEARTEN) study is a prospective observational study exploring the relationship between health literacy and health outcomes over 24-months. Adults with their first MI were recruited across three metropolitan and one regional hospital in Australia. Health literacy was assessed using the 12-item European Health Literacy Survey (HLS-Q12). Baseline data was analysed including medical history, sociodemographic variables, health system competence, personal health behaviours, and health-related outcomes (using validated tools). Multivariate quantile regression was used to determine associations between health literacy and study variables. Results A total of 440 patients were recruited. The mean age of the cohort was 59.5 years (range: 27-91), 78.2% were male, 39.1% were born outside Australia and 37.1% resided in a regional or rural area. The median HLS-Q12 score was 35 (range: 12-48). Health literacy tasks more frequently reported as difficult were: being able to judge if the information on health risks provided by the media is reliable, ability to compare the advantages or disadvantages of different treatment options, and being able to find information on how to manage mental health problems (Figure 1). Patients aged >60 years had lower health literacy compared to younger participants (β = -2.00, 95% CI: -3.44 to -0.56). Participants who had completed secondary education had higher health literacy (β = 2.0, 95% CI: 0.60 to 3.40), as did those in the highest income group (β = 2.00, 95% CI: 0.12 to 3.88). Positive significant associations were observed between health literacy and levels of health system competence, social support, cardiac self-efficacy and health related quality of life (p<0.05). Conclusion This study demonstrates the relationship between health literacy and several socioeconomic and behavioural factors in cardiac disease for the first time. Addressing health literacy may play a role in supporting patient engagement with the health system and enhancing self-management after MI. Our findings highlight the importance of early intervention to support post-MI patients to find reliable sources of information given they may have limited appraisal skills.Category responses for the HLS-Q12