Exploring the Role of Health Literacy in Cardiac Rehabilitation
: A Mixed Methods Approach

  • Catriona Walters

Student thesis: Doctoral ThesisDoctor of Philosophy (awarded by UHI)


Following a diagnosis of cardiovascular disease it is necessary for patients to self-manage their condition and they are commonly referred to cardiac rehabilitation to facilitate recovery. Despite being shown to have considerable physical and psychosocial health benefits, uptake, attendance, and adherence is low. Little is known about the role of health literacy in cardiac rehabilitation, yet it has been shown that health literacy is lower in patients with cardiovascular disease. This thesis explores the role of health literacy within cardiac rehabilitation with a view to potentially improving patient experience and increasing uptake and adherence to rehabilitation.
Following phase 1 of the OPtimising HEalth LIteracy Approach (OPHELIA) a sequential explanatory mixed method design was used. First, a systematic review showed that interventions to improve health literacy can be successful (15/22 studies) and lead to health behaviour change (7/8 studies). There was limited evidence specific to cardiac rehabilitation patients. Second, cluster analysis of a cross-sectional retrospective survey identified five broad profiles of health literacy from strong (cluster 1) to restricted (cluster 5). These profiles were associated with differences in health, health behaviours and psychological profiles. Third, using interview data, composite narrative analysis identified one composite staff experience and four composite patient experiences which included ‘proactive’, ‘reliant’, ‘independent’, and ‘struggling’ approaches. Finally, thematic analysis identified barriers and facilitators that occurred within five broad themes - social support, internal factors, engaging with healthcare providers, managing information, and taking action for health. Staff reported no health literacy specific training and limited knowledge of health literacy suggesting a lag between policy and practice.
Following the OPHELIA approach provided insight into both personal health literacy and organisational responsiveness. Social support - in particular peer support - was highly valued and offers the potential to tackle many of the challenges highlighted. There is a need for health literacy research to move beyond functional health literacy and focus on wider aspects such as critical and distributed health literacy. Work to strengthen the evidence base will help support implementation into evidence-based healthcare practice.
Date of Award14 Feb 2022
Original languageEnglish
Awarding Institution
  • University of the Highlands and Islands
SponsorsInterreg VA - Cross Border
SupervisorTrish Gorely (Supervisor)

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