Health Literacy and Cardiovascular Disease: Fundamental Relevance to Primary and Secondary Prevention: A Scientific Statement From the American Heart Association

Abstract

Health literacy is the degree to which individuals are able to access and process basic health information and services and thereby participate in health-related decisions. Limited health literacy is highly prevalent in the United States and is strongly associated with patient morbidity, mortality, healthcare use, and costs. The objectives of this American Heart Association scientific statement are (1) to summarize the relevance of health literacy to cardiovascular health; (2) to present the adverse associations of health literacy with cardiovascular risk factors, conditions, and treatments; (3) to suggest strategies that address barriers imposed by limited health literacy on the management and prevention of cardiovascular disease; (4) to demonstrate the contributions of health literacy to health disparities, given its association with social determinants of health; and (5) to propose future directions for how health literacy can be integrated into the American Heart Association's mandate to advance cardiovascular treatment and research, thereby improving patient care and public health. Inadequate health literacy is a barrier to the American Heart Association meeting its 2020 Impact Goals, and this statement articulates the rationale to anticipate and address the adverse cardiovascular effects associated with health literacy.

Keywords: AHA Scientific Statements; cardiovascular diseases; health disparities; health literacy; prevention and control.

Figure 1.

Health literacy nested within social determinants of health (education, race/ethnicity, income and wealth, community and environment, and English proficiency), which in turn are associated with a range of intermediate- and long-term healthcare outcomes.

Figure 2.. Health literacy presented as a life course trait.

Opportunities exist for the enfranchisement or impoverishment of health literacy beginning in infancy and spanning across the life course. Health literacy as encountered in adults reflects myriad familial, community and environmental, and educational influences. This statement emphasizes the overall goal as not correcting health literacy challenges in an individual but implementing approaches toward healthcare communication and delivery that are universally accessible.

Figure 3.. Multilevel domains of health literacy and challenges and solutions for achieving a health-literate organization.

Health literacy is operative in the healthcare organization, physician and provider, family and community, and individual patient. The organization has the chief responsibility and capacity for implementing strategies for effective healthcare delivery that address health literacy challenges.