INTERNATIONAL JOURNAL OF EVIDENCE-BASED MEDICINE
Original Article
Aug 04, 2026 6 4

Health Literacy and Self-Efficacy in Patients with Heart Failure: Insights from a Cross-Sectional Study

Zahra Azizi 1,
Akram Sadat Montazeri 2,
Leila Ranjbar 3,
Azam Zare 4 * ,
payman izadpanah 5
1 Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran2 Nursing Research Center, Midwifery, Golestan University of Medical Sciences, Gorgan, Iran3 School of Nursing, Fasa University of Medical Sciences, Fasa, Iran4 Department of Medical-Surgical Nursing, Nursing School, Fasa University of Medical Sciences, Fasa, Iran5 Department of Cardiology, School of Medicine, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran * Corresponding Author
International Journal of Evidence-Based Medicine, 1(3), 2026, jebm011, https://doi.org/10.63946/jebm/19057
Publication date: Aug 04, 2026
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ABSTRACT

Introduction: Heart failure is a chronic condition that can negatively affect patients’ self-efficacy and lead to disease-related complications. Limited health literacy may hinder patients’ ability to effectively manage their condition and maintain self-efficacy. This study aimed to investigate the association between health literacy and self-efficacy among patients with heart failure.
Methods: This cross-sectional study was conducted among 193 patients with heart failure who were referred to two hospitals in Fars Province, Iran, in 2023. Participants were selected using convenience sampling. Data were collected using the Cardiac Self-Efficacy Questionnaire developed by Sullivan et al. (1998) and a heart failure-specific health literacy scale. Descriptive statistics, Pearson’s correlation coefficient, and multiple linear regression analyses were performed using SPSS version 21.
Results: Overall, 63.7% of participants demonstrated high levels of self-efficacy. Among the dimensions of health literacy, functional health literacy had the highest mean score (8.33 ± 3.67), whereas critical health literacy had the lowest mean score (4.21 ± 3.91). Health literacy was positively associated with self-efficacy (r = 0.27, p < 0.001). Multiple linear regression analysis indicated that age was a significant negative predictor of self-efficacy (β = -0.134, p = 0.001).
Conclusions: Health literacy was significantly associated with self-efficacy among patients with heart failure. Interventions aimed at improving health literacy, particularly critical health literacy skills, may enhance patients’ self-efficacy and support better disease self-management.

KEYWORDS

Health Literacy Self-Efficacy Heart Failure

CITATION (Vancouver)

Azizi Z, Montazeri AS, Ranjbar L, Zare A, izadpanah P. Health Literacy and Self-Efficacy in Patients with Heart Failure: Insights from a Cross-Sectional Study. International Journal of Evidence-Based Medicine. 2026;1(3):jebm011. https://doi.org/10.63946/jebm/19057
APA
Azizi, Z., Montazeri, A. S., Ranjbar, L., Zare, A., & izadpanah, P. (2026). Health Literacy and Self-Efficacy in Patients with Heart Failure: Insights from a Cross-Sectional Study. International Journal of Evidence-Based Medicine, 1(3), jebm011. https://doi.org/10.63946/jebm/19057
Harvard
Azizi, Z., Montazeri, A. S., Ranjbar, L., Zare, A., and izadpanah, P. (2026). Health Literacy and Self-Efficacy in Patients with Heart Failure: Insights from a Cross-Sectional Study. International Journal of Evidence-Based Medicine, 1(3), jebm011. https://doi.org/10.63946/jebm/19057
AMA
Azizi Z, Montazeri AS, Ranjbar L, Zare A, izadpanah P. Health Literacy and Self-Efficacy in Patients with Heart Failure: Insights from a Cross-Sectional Study. International Journal of Evidence-Based Medicine. 2026;1(3), jebm011. https://doi.org/10.63946/jebm/19057
Chicago
Azizi, Zahra, Akram Sadat Montazeri, Leila Ranjbar, Azam Zare, and payman izadpanah. "Health Literacy and Self-Efficacy in Patients with Heart Failure: Insights from a Cross-Sectional Study". International Journal of Evidence-Based Medicine 2026 1 no. 3 (2026): jebm011. https://doi.org/10.63946/jebm/19057
MLA
Azizi, Zahra et al. "Health Literacy and Self-Efficacy in Patients with Heart Failure: Insights from a Cross-Sectional Study". International Journal of Evidence-Based Medicine, vol. 1, no. 3, 2026, jebm011. https://doi.org/10.63946/jebm/19057

REFERENCES

  1. Khezerloo Z, Aghakhani N, Cheraghi R, Alonejad V. Comparison of the effect of virtual and feedback-based self-care training on the self-care behaviors of heart failure patients referred to Seyyed Al-Shohada Urmia Medical Training Center in 2020-2021. Nurs Midwifery J. 2023;21(4):311–20. doi:10.61186/unmf.21.4.311
  2. Hosseini K, Mortazavi SH, Sadeghian S, Ayati A, Nalini M, Aminorroaya A, et al. Prevalence and trends of coronary artery disease risk factors and their effect on age of diagnosis in patients with established coronary artery disease: Tehran Heart Center (2005–2015). BMC Cardiovasc Disord. 2021;21(1):477. https://doi.org/10.1186/s12872-021-02293-y
  3. Kemp CD, Conte JV. The pathophysiology of heart failure. Cardiovasc Pathol. 2012;21(5):365–71. doi:10.1016/j.carpath.2011.11.007
  4. Dehghanzadeh S, Jafaraghaee F, Shishegaran M. Compliance and associated factors in patients with chronic heart failure. Iran J Nurs Res. 2015;9(4):36–46. doi:10.21859/ijnr-09045
  5. Shojafard J, Nadrian H, Baghiani Moghadam M, Mazlumi Mahmudabad S, Sanati H, Asgar Shahi M. Effects of an educational program on self-care behaviors and its perceived benefits and barriers in patients with Heart Failure in Tehran. Payavard Salamat. 2009;2(4):43–55.
  6. Javadzade SH, Sharifirad G, Radjati F, Mostafavi F, Reisi M, Hasanzade A. Relationship between health literacy, health status, and healthy behaviors among older adults in Isfahan, Iran. J Educ Health Promot. 2012;1(1):31. doi:10.4103/2277-9531.100160
  7. Aaby A, Friis K, Christensen B, Rowlands G, Maindal HT. Health literacy is associated with health behaviour and self-reported health: A large population-based study in individuals with cardiovascular disease. Eur J Prev Cardiol. 2017;24(17):1880–8. doi:10.1177/2047487317729538
  8. Kanejima Y, Shimogai T, Kitamura M, Ishihara K, Izawa KP. Impact of health literacy in patients with cardiovascular diseases: a systematic review and meta-analysis. Patient Educ Couns. 2022;105(7):1793–800. doi:10.1016/j.pec.2021.11.021
  9. Saatchi M, Panahi M, Mozafari AA, Sahebkar M, Azarpakan A, Baigi V, et al. Health literacy and its associated factors: a population-based study, Hormuz Island. 2017.
  10. Abdi M, Alaee N, Norouzadeh R. Investigating the association between health literacy and quality of life among patients with heart failure hospitalized in coronary care unit at selected hospitals in Tehran, Iran. Qom Univ Med Sci J. 2021;15(4):230–239. https://doi.org/10.32598/qums.15.4.230
  11. Hemmatipour A, Honarmandpour A, Asadi Chenareh S, Jahangirimehr A, Abdolahi Shahvali E, Mehri Z. The relationship of health literacy with general health in Iranian patients with heart disease using the structural equation modeling. J Prev Med. 2024;10(4):388–99. doi:10.52547/jpm.10.4.388
  12. Evangelista LS, Rasmusson KD, Laramee AS, Barr J, Ammon SE, Dunbar S, et al. Health literacy and the patient with heart failure—implications for patient care and research: a consensus statement of the Heart Failure Society of America. J Card Fail. 2010;16(1):9–16. doi:10.1016/j.cardfail.2009.08.002
  13. Morrow D, Clark D, Tu W, Wu J, Weiner M, Steinley D, et al. Correlates of health literacy in patients with chronic heart failure. Gerontologist. 2006;46(5):669–76. doi:10.1093/geront/46.5.669
  14. Bozorgzad P, Salehi T, Hadadi P. The relationship between health literacy and illness belief in patients with heart failure. J Crit Care Nurs. 2021;14(3):40–50. doi:10.52547/jccnursing.14.3.40
  15. Dennison CR, McEntee ML, Samuel L, Johnson BJ, Rotman S, Kielty A, et al. Adequate health literacy is associated with higher heart failure knowledge and self-care confidence in hospitalized patients. J Cardiovasc Nurs. 2011;26(5):359–67. doi:10.1097/JCN.0b013e3181f16f88
  16. Heidari-Beni F, Ahmadi-Tameh Z, Tabatabaee A, Mohammadnejad E, Haji-Esmaeelpour A. The effect of peer education on self-efficacy in people with heart failure. Iran J Cardiovasc Nurs. 2017;6(1):40–7.
  17. Fathi A, Khayer M, Atigh M. Relationship between self-efficacy and quality of life with regards to resiliency as a mediator variable among cardiovascular patients. 2011.
  18. Chen AM, Yehle KS, Albert NM, Ferraro KF, Mason HL, Murawski MM, et al. Relationships between health literacy and heart failure knowledge, self-efficacy, and self-care adherence. Res Social Adm Pharm. 2014;10(2):378–86. doi:10.1016/j.sapharm.2013.06.001
  19. Farghadani Z, Taheri KZ, Amiri MA, Barati M. The relationship between health literacy and self-care behaviors among patients with heart failure. 2018.
  20. O'Neil A, Berk M, Davis J, Stafford L. Cardiac-self efficacy predicts adverse outcomes in coronary artery disease (CAD) patients. 2013. https://doi.org/10.4236/health.2013.57A3002
  21. Shamsizadeh M. Effects of peer education on anxiety and self-efficacy in patients for elective coronary artery bypass graft surgery: dissertation; 2012.
  22. Aghamohammadi T, Maddah SSB, Mohammadi SF, Dalvandi A, Khaleghipour M. The impact of self-management program on self-efficacy of elderly patients with heart failure. 2017.
  23. Cajita MI, Cajita TR, Han H-R. Health literacy and heart failure: a systematic review. J Cardiovasc Nurs. 2016;31(2):121–30. doi:10.1097/JCN.0000000000000229
  24. Aliakbari F, Tavassoli E, Alipour FM, Sedehi M. Promoting health literacy and perceived self-efficacy in people with chronic obstructive pulmonary disease. Iran J Nurs Midwifery Res. 2022;27(4):331–6. doi:10.4103/ijnmr.ijnmr_42_21
  25. Bandura A. Health promotion by social cognitive means. Health Educ Behav. 2004;31(2):143–64. doi:10.1177/1090198104263660
  26. Paasche-Orlow MK, Wolf MS. The causal pathways linking health literacy to health outcomes. Am J Health Behav. 2007;31(Suppl 1):S19–S26. https://doi.org/10.5993/AJHB.31.s1.4
  27. Mansoreyeh N, Poursharifi H, Taban Sadeghi M, Seirafi M. The predictive roles of self-efficacy, illness perception, and social support in self-care of patients with heart failure. Prev Care Nurs Midwifery J. 2017;7(3):39–46. doi:10.29252/pcnm.7.3.39
  28. van der Vaart R, Drossaert CH, Taal E, Drossaers-Bakker KW, Vonkeman HE, van de Laar MA. Impact of patient-accessible electronic medical records in rheumatology: use, satisfaction and effects on empowerment among patients. BMC Musculoskelet Disord. 2014;15(1):102. doi:10.1186/1471-2474-15-102

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