Approximately six million adults are diagnosed with heart failure (HF) yearly in the U.S., with one million subsequent hospitalizations. Of these, 25%--30% are readmitted within 30 to 90 days of initial discharge. Little is known about relationships among health literacy (HL), self-care and 30-day hospital readmission status in adult African Americans (AAs) with HF. The primary purpose of this study was to explore relationships among HL, baseline self-care maintenance (BSCM), and 30-day hospital readmission status in adult AAs with HF. Two secondary purposes were to determine whether BSCM mediated the relationship between HL and readmission status and whether there was a moderating effect of age, gender, education, insurance status and perceived social support (PSS), on the relationships of HL with BSCM and readmission status.

Using a one-month prospective cohort design, HL, BSCM, PSS, basic conditioning factors, and 30-day readmission status were measured in participants from two large hospitals in the Central Savannah River Area in Georgia. Statistical analyses included logistic regression, Pearson product-moment correlation, chi-square tests of independence, and mediation and moderation analyses. Eighty-nine participants were enrolled in this study. Most participants (71.9%) were male, and their mean age was 53.25 years (Standard Deviation, SD = 12.74; range 25--88 years). Of the 89 participants, 28.1% experienced at least one readmission within 30 days of discharge.

The following findings have p values < .05. BSCM varied significantly with HL (X2 = 6.97 (degrees of freedom, df = 2, sample size (N) = 89)). Higher PSS was significantly associated with higher BSCM (r = .29). HL was significantly correlated with age (r = --.62). The influence of age on the relationship between HL and readmission status was significant ( b = .005). Elderly patients (> 65 years) scoring high on HL had a higher probability of readmission, and younger patients (< 40 years) scoring low on HL had a higher probability of readmission. Post hoc analysis showed that lower ejection fraction predicted readmissions (odds ratio = 3.1, 95% confidence interval = 1.03--9.05) after controlling for the other predictors. The findings provide a basis for further research to better understand the impact of HL, self-care maintenance, and other patient characteristics on readmission of AAs with HF.