Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Ann M. Mayo, RN, DNSc, FAAN, Chairperson; Jane M. Georges, PhD, RN, Committee Member; Mary Jo Clark, PhD, RN, Committee Member


Cognitive impairment, health literacy, Heart Failure, medication adherence, nursing, veterans


Background: Heart failure (HF) affects 5.8 million people in the United States, costly in terms of patient mortality and morbidity as well as healthcare dollars. One important manifestation of poor HF outcomes is the excessive admission-readmission cycle. Non-adherence to medication is responsible for the majority of HF readmissions. Identification and intervention for key factors contributing to poor medication adherence is critical to improving outcomes. Two such factors prevalent in persons with HF are cognitive impairment (CI) and poor health literacy (HL). There is a paucity of tested interventions designed to improve medication adherence by addressing underlying CI or HL. A recent study tested a pictorial medication sheet to improve medication adherence in veterans with HF and CI, however no information on HL was collected. This new study examines what mediating effects HL may have played in the adherence scores of subjects in the completed study. Study Aims: Aim 1. Describe the level of HL in the study population. Aim 2. Determine the strength and direction of the relationships between reading HL and numeracy HL and selected clinical and demographic variables in the study population. Aim 3. Determine the direct and indirect effects that reading HL and numeracy HL and other key variables (including the intervention) have upon medication adherence in cognitively impaired veteran outpatients with HF based on prior data from an interventional study testing a pictorial medication sheet to improve medication adherence. Study Design A retrospective, correlational, cross-sectional design was employed to analyze HL scores from medical records with data from the completed study using conventional statistics and structural equation modeling. Results: 27 subjects with a mean age of 65.3 years (SD 8.2, range 45-80) had evaluable data. HL was less than adequate in 19% of the sample. HL scores were strongly correlated with cognition. HL did not significantly affect relationships between study covariates (cognition scores, depression, number of medications) and medication adherence. Conclusions and Significance: HL scores were associated with cognitive function scores. More research is needed to evaluate the prevalence and effect of poor HL in veterans with HF upon adherence.

Document Type

Dissertation: Open Access



Included in

Nursing Commons