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Research Project

Development and Testing of a Theory-driven Health Literacy-based Heart Failure Intervention (H2Lit)

Low health literacy (HL) negatively impacts the performance of heart failure (HF) self-care. Existing HF interventions aimed at people with low HL follow the core principle of HL universal precautions, which is to decrease the HL demand of all healthcare services (written and verbal) to minimize the risk of misunderstanding when it is unknown which patients may have low HL. While this is an important step in addressing health disparities due to low HL, it does not fully address the problem of low HL. The universal precautions approach overlooks the two-sided nature of HL by solely focusing on the health information provider. The proposed project will address this critical gap in HF self-care – HL research through the development and pilot testing of an innovative intervention designed to improve the individual’s HL while presenting essential HF self-care information following the HL universal precautions guidelines. In addition, improving HL can also increase self-efficacy, which facilitates the adoption of recommended HF self-care behaviors.

Principal Investigator
Cajita, Mia
Start Date
End Date
Funding Source
Internal Research Support Program


An estimated 39% of the 6 million adult Americans with heart failure (HF) have low health literacy. Health literacy (HLit)—or the ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions—has been shown to impact HF self-care. Existing HF self-care interventions aimed at people with low HLit only focus on decreasing the cognitive demand of the information provided to the participants. While making information more accessible is an important step in addressing health disparities due to low HLit, such an approach overlooks the other side of HLit—that is the actual skill of the individual. The proposed project will address this critical gap by including problem-solving exercises with automated feedback designed to improve the individual’s HLit while presenting HF self-care information in an easy-to-understand format. The long-term goal of the proposed project is to empower people with HF to effectively perform HF self-care. As a first step towards that goal, the proposed study has the following specific aims: (1) to develop the HLit-based HF self-care intervention (H2Lit) using an iterative user-centered approach, and (2) to test the usability of H2Lit.