Sample Size

Main Findings

De Melo Ghisi, da Silva Chaves, Britto, & Oh (2017).

To explore the role of health literacy in the care of CAD patients.

systematic review

10 articles included

Showing the average prevalence of low HL was 30.5%. Low HL participants were more likely to be older, male, from a non-white ethnic group, have many CVD comorbidities, lower educational level, disadvantaged socioeconomic position, and less likely to be employed. Low HL was consistently associated with hospital readmissions, low HR QoL, higher anxiety and lower social support.

Martin, Schonlau, Haas, Derose, Rudd, Loucks, & Buka, (2011).

To evaluate the independent and interactive consequence of four literacy skills: reading, numeracy, language; oral speaking and aural listening on the calculated 10-year risk of CHD.

descriptive correlational

N = 409

When evaluated separately, reading, numeracy, and aural language skills were highly significant association with CHD risk between women, and no literacy skills were associated with CHD risk in men. When evaluated together, there was some evidence for an interaction between numeracy and aural language among women suggesting that higher skills in one area (e.g., aural language) may compensate for difficulties in another resulting in an equally low risk of CHD.

van Schaik, Jørstad, Twickler, Peters, Tijssen, Essink-Bot, & Fransen,


To explore the association between health literacy and the risk of cardiovascular disease (CVD).


N = 201

Inadequate health literacy is predominant in CAD patients in the Netherlands, and is associated with less favorable CVD risk profiles. Where many different forms of CVD prevention were unsuccessful, and nurse coordinated care appear to be influential among patients with inadequate health literacy.

McNaughton, & Kripalani, (2014).

To evaluate the association between low literacy and uncontrolled blood pressure (BP) and their associations with medication adherence.


N = 423

About 192 (45%) patients had low literacy and 227 (52.9%) had uncontrolled blood pressure. after adjusting for the following factors; age, gender, race, employment, education, mental status, and self-reported adherence, low literacy was associated with uncontrolled BP (OR 1.75, 95% CI 1.06 - 2.87). Lower self-reported adherence was associated with uncontrolled BP; the relationship between refill adherence and uncontrolled BP was not statistically significant.

Marzec, Carey, Lambert-Kerzner, Del Giacco, Melnyk, Bryson, & Ho, (2015).

To evaluate degrees of cognitive dysfunction and poor health literacy.

A randomized control trial

N = 249

Cognitive dysfunction and risk for poor health literacy are common in patients hospitalized with ACS. The study suggests an association between mild neurocognitive disorder and medication non-adherence in the usual care group but not in the intervention group.

Zhong, Zheng, Guo, & Luo, (2016).

To investigate medication literacy among discharged patients with the acute coronary syndrome.

Prospective Cohort study

N = 153

Showed that patients with Acute Coronary Syndrome who were investigated for medication literacy was insufficient; >20% did not have sufficient knowledge on the types of drugs and the frequency that they need to take the drugs, >30% did not know the name of and the dosage of the drugs they are taking, and >70% did not have adequate knowledge of the effects and side effects of the drugs they are taking.

Chen, Saczynski, Lapane, Kiefe,& Goldberg, (2015).

To assessed adherence to secondary prevention pharmacotherapy in adults after hospital discharge.

A systematic review

N = five electronic databases

Medication adherence rates at one-year in patients after hospital discharge for an ACS ranged about 54% and 86%, no consistent predictors of non-adherence through all cardiac medication categories, and the medication adherence to secondary prevention pharmacotherapy was less than the highest standard in patients after hospital discharge for an ACS.

Bailey, Fang, Annis, O’Conor, Paasche-Orlow, Wolf, (2015).

To assess the validity of a predictive model of health literacy, and to examine the relationship between derived health literacy estimates and 30-day hospital readmissions for acute myocardial infarction (AMI).

Retro-spective cohort study

N = 696

After adjusting for demographic and clinical characteristics, the risk of readmission was 12% lower and the incidence rate 16% lower for patients with above basic literacy, And was found to be a significant, independent predictor of readmissions. As a modifiable risk factor with evidence-based solutions, health literacy should be considered in readmission reduction efforts.