Let's talk numbers: A qualitative study of community-dwelling US adults to understand the role of numeracy in the management of heart failure

Abstract

Objective To examine the perspectives of adults with heart failure (HF) about numerical concepts integral to HF self-care. Setting This qualitative study took place at an urban academic primary care practice. Participants Thirty men and women aged 47-89 years with a history of HF were recruited to participate. Eligibility criteria included: A history of HF (≥1 year), seen at the clinic within the last year, and a HF hospitalisation within the last 6 months. Non-English speakers and those with severe cognitive impairment were excluded. Methods In-depth semistructured interviews were conducted. Participants were interviewed about numeracy across three domains of HF self-care: (1) monitoring weight,(2) maintaining a diet low in salt and (3) monitoring blood pressure. Interviews were audio-taped, transcribed verbatim and analysed using grounded theory and word cloud techniques. Results Five key themes reflecting participants' attitudes towards numerical concepts pertaining to weight, diet and blood pressure were identified: (1) Communication between healthcare providers and patients is a complex, multistage process; (2) Patients possess a wide range of knowledge and understanding; (3) Social and caregiver support is critical for the application of numerical concepts; (4) Prior health experiences shape outlook towards numerical concepts and instructions and (5) Fear serves as a barrier and a facilitator to carrying out HF selfcare tasks that involve numbers. The findings informed a theoretical framework of health numeracy in HF. Conclusion Effective communication of numerical concepts which pertain to HF self-care is highly variable. Many patients with HF lack basic understanding and numeracy skills required for adequate self-care. As such, patients rely on caregivers who may lack HF training. HF-specific training of caregivers and research that seeks to elucidate the intricacies of the patient-caregiver relationship in the context of health numeracy and HF selfcare are warranted.