Association between health literacy and cardiac secondary prevention behaviours and health outcomes among culturally and linguistically diverse populations

Abstract Introduction Culturally and linguistically diverse (CALD) populations can encounter challenges in managing coronary artery disease due to lower health literacy, cultural differences, and language barriers. These factors may impact adherence to recommended cardiac secondary prevention (CSP) interventions, such as attendance at cardiac rehabilitation. Purpose To explore associations between health literacy and CSP behaviours and health outcomes within CALD groups. Methods Data from a multicentre, prospective observational study (ENHEARTEN) conducted across three metropolitan and one regional hospital in Victoria, Australia were collected for 440 adults (18 years) with their first myocardial infarction. The study explored associations between health literacy and CSP outcomes such as medication adherence, physical activity, cardiac rehabilitation, anxiety and depression. Data were collected via survey and medical records. Health literacy was measured using the 12-item European Health Literacy Survey (HLS-Q12) and four scales of the Health Literacy Questionnaire (HLQ): scale 3 (Actively managing my health), scale 4 (Social support for health), scale 6 (Engaging with healthcare providers) and scale 7 (Navigating the healthcare system). Descriptive statistics and univariate logistic regression were used to identify whether health literacy predicted CSP outcomes. Results CALD participants were more likely than non-CALD participants to have a higher level of education (10.4% vs. 5%; p0.001), less likely to be a current smoker (29.4% vs. 36.5%; p=0.02), and were more likely to have high cholesterol (44.1% vs. 27.3%; p0.01). Among CALD participants, higher scores on HLQ scales 6 and scale 7 were associated with improved medication adherence (OR=2.88, 95% CI:1.21, 6.90), (OR=2.16, 95% CI: 1.21, 3.86), respectively. Higher scores on HLQ scale 4 were associated with increased cardiac rehabilitation attendance in CALD participants (OR=2.69, 95% CI:1.21, 5.97). Higher scores on HLQ scales 4 were also associated with less likelihood of anxiety or depression (OR=0.21, 95% CI: 0.07, 0.61) (OR=0.29, 95% CI: 0.10, 0.86), respectively, as were higher scores on scale 6 (OR=0.37, 95% CI: 0.20, 0.72) (OR=0.43, 95% CI: 0.22, 0.84), and scale 7 (OR=0.46, 95% CI: 0.25, 0.84) (OR=0.40, 95% CI: 0.21, 0.77), respectively. No significant associations were found between health literacy and physical activity. And no significant associations were found between the HLS and CSP outcomes. Conclusion Higher health literacy in CALD participants was associated with improved CSP behaviours and health outcomes, including reduced depression and anxiety, greater medication adherence, and increased likelihood to attend cardiac rehabilitation. These findings highlight the importance of health literacy in managing cardiovascular health and suggest that targeted health literacy interventions may enhance secondary prevention and reduce health disparities in CALD populations.