Health Literacy and Quality of Life after Acute Coronary Syndrome: The Mediating Role of Self-Care in Palestine

• Understanding the role of self-care behaviors is essential in mediating the relationship between health literacy and quality of life (QoL) in ACS patients. • The study found a strong correlation between health literacy, self-care practices, and QoL in ACS patients. • Critical and communicative health literacy was significant contributors to a better quality of life, when patients with ACS adapted healthy self-care behaviors. • These findings have implications for enhancing nursing education, healthcare practices, and policies regarding nurse practice. Understanding the role of self-care behaviors is essential in mediating the relationship between health literacy and quality of life (QoL) in ACS patients. The study found a strong correlation between health literacy, self-care practices, and QoL in ACS patients. Critical and communicative health literacy was significant contributors to a better quality of life, when patients with ACS adapted healthy self-care behaviors. These findings have implications for enhancing nursing education, healthcare practices, and policies regarding nurse practice. Acute coronary syndrome (ACS) significantly affects patients' quality of life (QoL). This study investigated the mediating role of self-care behaviors in the relationship between health literacy and QoL among Palestinian patients with ACS, a population with potentially unique challenges related to healthcare access and resources. A cross-sectional, multi-center study was conducted in 2021 among 320 patients with ACS receiving care in Palestinian healthcare settings. The participants completed validated instruments assessing health literacy (Health Literacy Questionnaire), self-care behaviors (Self-Care of Coronary Heart Disease Inventory V2.1), and QoL (WHOQOL-BREF). Multiple regression analyses were performed to explore the mediating role of self-care. The study revealed generally low health literacy levels, particularly in the basic/functional domain (mean=3.06, SD=0.56), and correspondingly low QoL (mean=57.3, SD=12.8). While basic/functional health literacy did not demonstrate a significant association with QoL mediated by self-care, a partial mediation effect was observed for communicative and critical health literacy. This suggests that higher levels of health literacy, when coupled with effective self-care behaviors, are crucial for improving QoL. This study highlights the importance of moving beyond basic health literacy to enhance communicative and critical health literacy skills in patients with ACS. Interventions designed to improve higher-order literacy skills, coupled with strategies to promote effective self-care, may be essential for optimizing QoL in this vulnerable population. These findings have significant implications for development of culturally appropriate interventions to support patients with ACS in resource-constrained settings. Further research is needed to explore the specific mechanisms through which communicative and critical health literacy influence self-care and QoL.