Development of a Low Literacy-Appropriate Telehealth Intervention to Improve Heart Failure Self Care Among Low Income Blacks

Monday, 30 July 2012: 11:15 AM

Cheryl R. Dennison, RN, ANP, PhD, FAAN
Tam H. Nguyen, RN, MSN/MPH
School of Nursing, Johns Hopkins University, Baltimore, MD


Heart Failure (HF) affects over 5.7 million Americans. Among Blacks, HF prevalence, mortality, clinical progression and hospitalization rates are c higher than Whites. Health literacy (HL) is an insidious barrier to HF self-care for many patients. Those with inadequate HL are at increased risk for poor self-care and negative health outcomes.  However, up to 50% of hospital readmissions for HF exacerbation are preventable. There is an urgent need to develop effective interventions that improve HF self-care and outcomes that are culturally-appropriate and suitable for low-literate populations. This paper describes the development and methodological considerations for a low literacy, culturally-appropriate telehealth-based behavioral intervention designed to improve HF self-care.


An innovative nurse (RN)-facilitated telehealth intervention was developed using patient-centered health informatics and behavior change principles to promote HF knowledge and self-care, problem-solving, and decision-making skills among low income Blacks with inadequate HL. The HF Self Care Navigator (HF SCAN) intervention was designed through a rigorous, iterative process involving content expert, patient, and clinician input.


Feasibility testing showed high levels of usability and acceptance. In-home pilot testing showed trends toward greater improvement in HF knowledge and HF self-care management from baseline to 90 days and lower rates of hospitalization at 30 and 90 days in the HF SCAN intervention versus usual care as well as high levels of participation and satisfaction with the HF SCAN intervention components among low-income Blacks. Key lessons from the intervention development and refinement phases will be presented.


Interventions designed for low-literate populations are highly received and show promise in improving HF knowledge and self-care management.