Health Literacy Status in Patients Undergoing Coronary Artery Bypass Graft Surgery

Abstract

Background: Health literacy (HL) plays a key role in understanding illness, adhering to treatment, and achieving optimal health outcomes, particularly in patients undergoing complex procedures such as coronary artery bypass graft (CABG) surgery. Objectives: This study aimed to investigate HL status among candidates for CABG at a university hospital. Methods: This cross-sectional study was conducted at Heshmat Hospital, an academic center in northern Iran, in 2024. Health literacy (HL) was assessed using the Iranian Health Literacy Instrument for Adults (HELIA) questionnaire, which consists of 33 items across five components: reading, access, comprehension, evaluation, and decision-making/behavior, which is treated as a single combined domain. Total HL was categorized as follows: 0 - 50, inadequate; 50.1 - 66, borderline; 66.1 - 84, adequate; and 84.1 - 100, excellent. Results: A total of 591 patients undergoing CABG were enrolled, with a mean age of 60.36 ± 9.53 years. The mean total HL score was 47.2 ± 13.58. Based on the cutoff points, 60.2% of patients had inadequate HL, 31% had borderline HL, 8.3% had adequate HL, and only 0.5% had excellent HL. HL was positively associated with years of education (r = 0.433, P < 0.001) and negatively associated with age (r = -0.181, P < 0.001). Among the five HL domains, the lowest mean scores were in reading (41.79 ± 28.2) and evaluation (45.26 ± 16.42). The most common sources of health information were doctors and healthcare staff (28.6%) and friends and acquaintances (24.7%). Conclusions: HL was inadequate or borderline in the vast majority of patients undergoing CABG at this center. Lower HL was associated with older age and lower educational attainment. Targeted educational programs, HL screening, and effective communication by healthcare teams are recommended.