Abstract
Immigrants have unique healthcare challenges due to issues with language, access, and cultural differences. Health literacy, the ability to obtain, process, and understand basic health information to make health decisions and navigate complex health care systems, is associated with self-reported health and clinical outcomes. Self-care requires adequate literacy levels and support from others.
The purpose of this study was to evaluate the role of health literacy and acculturation on self-care maintenance and management of HF in Portuguese immigrants.
Demographics (age, gender, education, marital status, socioeconomic status (SES), comorbidity (CCI), self-care (SCHFI v6.2, maintenance 10-40, management 4-16), acculturation (ELAS, 5-25, higher more acculturation) and health literacy (S-TOFHLA, 0-16 inadequate, 17-22 marginal, 23-36 adequate) were collected in a convenience sample of 116 HF patients admitted to a community hospital. After controlling for age and educational level, hierarchical regression explored the influence of health literacy and acculturation on levels of self-care maintenance and management. Step one included demographic variables and social support; step two included ELAS and health literacy.
Subjects had a mean age of 75±13.9 years and education of 9.3±3.5 years, 50% female, 59% married, and 46% reported having enough to make ends meet. Patients had a mean EF of 42.1±14.7and CCI of 2.9±1.7. Sixty-two percent had inadequate/ marginal health literacy. Age (r = -.46, p <.001), education (r=.39, p<.001), acculturation (r = .23, p = .013) and social support (r= -.18, p <.05) were related to literacy. Acculturation (r = .21, p = .03) and literacy (r = -.15, p = .09) were related to self-care maintenance but not self-care management. Age and education explained 4.5% of variance in self-care maintenance and social support, ELAS and health literacy explained an additional 11% of variance in self-care maintenance. Age and education explained 13% of variance in self-care management and social support, ELAS and health literacy explained an additional 21% of variance in self-care management.
In this primarily elderly, sample of HF patients with low health literacy, social support and acculturation helped to explain the variance in self-care. Assessment of acculturation status and tailored culturally interventions may improve self-care.