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Assessing Health Literacy in Urban Patients With Implantable Cardioverter Defibrillators and Pacemakers

Hickey, Kathleen T. EdD, FNP-BC, ANP-BC, APGN, FAHA, FAAN; Sciacca, Robert R. EngScD; Gonzalez, Paul BS; Castillo, Carmen AAS; Frulla, Ashton BS

doi: 10.1097/JCN.0000000000000184
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Functional health literacy (FHL) has become an increasingly prevalent topic of discussion in patient health and well-being. Although FHL has been studied in a variety of populations, it has not been investigated in patients with pacemakers and implantable cardioverter defibrillators (ICDs).

The purpose of this study was to evaluate FHL in a primarily older, urban-dwelling ICD/pacemaker population. A secondary objective was to compare 2 commonly used instruments for assessing FHL.

A convenience sample of 116 patients was recruited from an urban ICD/pacemaker clinic. Participants were asked to complete the Short Test of Functional Health Literacy in Adults (STOFHLA) followed by the Test of Functional Health Literacy in Adults to assess reading comprehension and numeracy. Logistic regression was used to assess the association between FHL and patient descriptors.

The population was 68 ± 13 years of age, and 62.7% were men. The sample was ethnically diverse: 37.1% white, 39.7% Hispanic, and 22.4% African American; 77.4% of the population reported finishing high school. Of the 109 completing the Test of Functional Health Literacy in Adults, 60.6% had adequate FHL, 10.1% had marginal FHL, and 29.4% had inadequate FHL. The presence of coexisting chronic conditions such as diabetes mellitus, hyperlipidemia, and hypertension was associated with inadequate/marginal FHL (P = .007, P = .004, and P = .02, respectively). Of the 113 completing STOFHLA, 67.3% had adequate FHL, 7.1% had marginal FHL, and 25.7% had inadequate FHL. The presence of diabetes mellitus, hyperlipidemia, and hypertension was also associated with inadequate/marginal FHL as assessed by STOFHLA (P = .009, P = .02, and P = .004, respectively).

In this older, urban, ICD/pacemaker population, approximately 40% had inadequate/marginal FHL. These results warrant further investigation of FHL in other cardiovascular populations.

Kathleen T. Hickey, EdD, FNP-BC, ANP-BC, APGN, FAHA, FAAN Assistant Professor of Nursing, School of Nursing, Columbia University Medical Center, New York.

Robert R. Sciacca, EngScD Biostatistician, School of Nursing, Columbia University, New York.

Paul Gonzalez, BS Clinical Research Coordinator, Columbia University Medical Center, New York.

Carmen Castillo, AAS Clinical Research Coordinator, School of Nursing, Columbia University, New York.

Ashton Frulla, BS Clinical Research Coordinator, School of Nursing, Columbia University Medical Center, New York.

The authors have no conflicts of interest to disclose.

Correspondence Kathleen T. Hickey, EdD, FNP-BC, ANP-BC, APGN, FAHA, FAAN, School of Nursing, Columbia University Medical Center, Columbia University, Presbyterian Hospital Building, 10th Flr, Rm 203F, 630 West 168th St, New York, NY 10032 (kth6@columbia.edu).

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