Abstract
BACKGROUND: Health literacy (HL) is recognized as a key determinant in the management of chronic diseases, including heart failure (HF). Adequate HL facilitates understanding and application of health information, promoting effective self-care and improved clinical outcomes. In contrast, low HL is associated with poorer disease control, higher hospitalization rates, and increased mortality. Despite its importance, the relationship between HL and self-care in HF patients remains underexplored in specific sociodemographic and clinical contexts. OBJECTIVE: This study aimed to assess HL and self-care capacity in individuals with HF, identify associated sociodemographic and clinical variables, and explore the predictive value of HL on self-care behaviors. METHODS: A cross-sectional, observational study was conducted among 195 HF patients attending a referral center in Burgos, Spain. HL was assessed using the European health literacy survey questionnaire (HLS-EU-Q16), while self-care was evaluated using the European heart failure self-care behavior scale (EHFScBS). Data were collected via telephone interviews. Descriptive and inferential statistics were applied, including correlation and multiple linear regression analyzes. RESULTS: The mean age of participants was 69.26 (±9 years), with a predominance of males (83.1%). Most participants reported medium social class (87.7%) and basic education (64.6%). HL levels were significantly associated with educational attainment, social class, and gender; women and individuals with higher education levels demonstrated greater HL scores. Regression analysis revealed that HL negatively predicted self-care scores (p < 0.001), as higher EHFScB-9 scores indicate poorer self-care, and in our study higher HL was associated with lower EHFScB-9 scores (r = -0.320; β = -0.189), which is consistent with better self-care behaviors. Older age and lower educational attainment were linked to lower HL and poorer self-care. Notably, female sex and upper-middle social class were also significant predictors of self-care capacity. CONCLUSION: Health literacy is a significant predictor of self-care in HF patients, and its levels are influenced by key sociodemographic variables. These findings underscore the necessity of incorporating HL assessment into clinical practice and tailoring educational interventions to address disparities. Enhancing HL could promote more effective self-management and potentially reduce adverse outcomes in HF populations. Future research should focus on longitudinal analyzes and the development of targeted, equitable interventions based on HL profiles.