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health literacy, heart failure, latent class analysis (LCA), nursing, quality of life



  1. Jiang, SiXuan MD
  2. Zhang, Xiaonan PhD
  3. Li, Xuedong MD
  4. Li, Yanting MD
  5. Yang, Weiling MD
  6. Yao, Ying MD
  7. Fu, Li BD
  8. Zhao, Man BD
  9. Zang, Xiaoying PhD


Background: Although a growing number of studies have demonstrated that patients' health literacy is associated with health outcomes, the exact relationship between them is not clear.


Aims and objectives: The aim of this study was to explore latent classes of health literacy in patients with heart failure and analyze the differences among different groups.


Design and Methods: This is a cross-sectional survey. Patients diagnosed with heart failure were selected from 3 tertiary hospitals in Tianjin, China, from March 2019 to November 2019. We measured patients' health literacy using the Health Literacy Scale for Chronic Patients. Latent class analysis was carried out based on the patients' Health Literacy Scale for Chronic Patients scores. Multinomial logistic regression was used to identify the predictive indicators of the latent classes.


Results: The health literacy of patients with heart failure was divided into 3 different latent classes, named "high health literacy group," "low literacy high dependence group," and "moderate literacy high willingness group." There were statistically significant differences in gender, age, smoking history, marital status, education level, household income level, and quality of life among different health literacy classes. Low education level and household income level predicted poor health literacy.


Conclusion: There were 3 latent classes for the health literacy of patients with heart failure. Different health literacy classes exhibited their own distinctive characteristics. Patients in the "moderate literacy high willingness group" had the worst quality of life. Understanding the specific types of health literacy in patients with heart failure facilitates targeted nursing interventions to improve their quality of life.