A systematic review of 25 studies found that self-management interventions for heart failure patients with limited health literacy primarily focus on lifestyle and clinical management.
Systematic Review
What are the characteristics and components of self-management interventions in patients with chronic heart failure and limited health literacy?
Self-management interventions for heart failure patients with limited health literacy primarily focus on lifestyle and clinical management using health literacy-friendly approaches, but often lack focus on psychosocial domains.
Abstract Background Health literacy (HL) ̶ the ability to access, understand, appraise, and apply health information ̶ is an important determinant of outcomes in patients with heart failure. Limited HL is highly prevalent in this population and is associated with higher hospitalization, emergency-department use, and mortality. Although self-management interventions show potential for improving outcomes in patients with heart failure and limited HL, it remains unclear which components are most appropriate and effectively address their specific needs. Purpose To systematically describe the intervention components and characteristics regarding self-management in patients with heart failure and limited HL, using the COMPAR-EU taxonomy. Methods This systematic review followed PRISMA-guidelines. Databases were searched from 2001 to November 2021 (updated in 2026). RCTs and quasi-experimental studies evaluating self-management interventions in patients with heart failure and reported HL in baseline characteristics were included. Titles and abstracts were independently screened using EndNote X9 and Rayyan.AI. Intervention characteristics were extracted using COMPAR-EU taxonomy, including target population, intervention characteristics, expected self-management behaviors, and self-management related outcomes. Study quality was assessed using RoB 2 and ROBINS-I. Results We included 25 studies (14 RCTs, 4 pretest-posttest design, and 7 secondary analyses and outcomes of 3 RCTs included in this study). Target population: most studies focused solely on patients, some also included informal caregivers. Inclusion criteria commonly required participants to meet thresholds e.g., the ability to speak English or Spanish, or adequate cognitive function. Intervention characteristics: despite variability in the design and implementation of patient-support interventions, several common patterns emerged across support techniques, delivery methods, provider roles and settings. Self-management behaviors focused on lifestyle changes, clinical self-care, emotional coping, social functioning, and collaboration with health care providers. Most interventions emphasized lifestyle and clinical management, fewer addressed psychological or social domains. Self-management outcomes included empowerment, behavioral change, clinical status, quality of life, perceptions of care, and healthcare utilization. Collectively, these outcomes reflect a multidimensional approach in supporting patients with heart failure in their self-management. Conclusion(s) Self-management interventions for patients with heart failure and limited HL are characterized by considerable variability but also by recurring patterns, with a primary focus on lifestyle and clinical management and less attention paid to psychosocial domains. HL-friendly approaches, such as plain-language education materials, teach-back communication, symptom monitoring with visual cues and family involvement were used.
Driel et al. (Wed,) conducted a systematic review in chronic heart failure and limited health literacy. Self-management interventions was evaluated on intervention components and characteristics regarding self-management. A systematic review of 25 studies found that self-management interventions for heart failure patients with limited health literacy primarily focus on lifestyle and clinical management.