Abstract 12093: Randomized Trial of Intensive Telephone Education and Counseling to Overcome Disparities in Knowledge, Self-Care Behaviors and Symptom Severity for Patients with Heart Failure and Low Health Literacy
Objective: Patients with low health literacy (HL) have worse knowledge, self-care behaviors, and health outcomes than those with adequate HL. We developed an intervention based on educational principles and learning mastery theory (“teach to goal”; TTG) to try to mitigate these disparities and conducted a randomized trial to see if TTG was more successful than a brief educational intervention (BEI) for improving knowledge, self-care behaviors, and heart failure (HF) symptoms for patients with low and adequate HL.
Methods: We recruited patients with NYHA class II-IV HF from 4 centers. Participants received the BEI session and were then randomized to no further intervention or TTG. TTG immediately taught how to adjust diuretic dose to maintain target weight and reinforced learning goals and behaviors with 5–8 telephone counseling sessions over one month. Blinded interviewers assessed knowledge, self-efficacy, behaviors, and the HF Symptom Scale (HFSS; range 0–100; higher scores denote fewer symptoms). HL was measured by the short Test of Functional Health Literacy in Adults; inadequate and marginal literacy were grouped as“low” HL.
Results: Of 605 participants, 526 (86.9%) completed the one month interview. Mean age was 61 yrs; 48% were female, 38% African-American, and 16% Latino; 37% had low HL; 69% had ejection fraction < 0.45; and 31% were NYHA class III or IV. At baseline, those with low health HL had worse knowledge and self-care behaviors. At one month, general HF knowledge, knowledge about high salt foods, and self-care behaviors improved significantly more in the TTG group vs. the BEI group (p < 0.005 for all); the absolute benefits of the TTG intervention vs. the BEI were similar for those with low and adequate HL. The HFSS improved from 58.5 to 64.6 for the TTG group but did not change for the BEI group (64.7 to 63.9; p < 0.001); there were similar differences in the improvement in HF symptoms between the TTG and BEI group for those with low and adequate HL.
Conclusions: The TTG strategy of multiple, progressive, reinforcing telephone education and counseling sessions was able to overcome learning barriers caused by low HL and improve knowledge, health behaviors, and HF symptoms for all patients. But, TTG did not narrow the disparities by HL that existed at baseline.
- © 2010 by American Heart Association, Inc.