Effect of a mHealth intervention on health literacy in patients completing cardiac rehabilitation: A randomized controlled trial with one- and five-year follow-up

Abstract

Background and aims

Adherence to treatment is a significant challenge for patients with cardiac disease. Optimizing health literacy (HL) is essential in this context. Mobile health (mHealth) interventions have been suggested to improve both treatment adherence and HL. This study aimed to examine the effect of a one-year mHealth intervention on HL and to compare HL changes between the intervention- and the control group.

Methods

This randomized controlled trial included patients completing cardiac rehabilitation, who were randomly allocated to either an intervention group receiving individualized follow-up via an app for one year or a control group receiving usual care. From one-year follow-up to the five-year follow-up, both groups received usual care. HL was measured using the HLS-Q12. Mixed model for repeated measurements and Wilcoxon signed rank test were used to analyse differences between groups, while paired sample t-test and Kendall's Tau b correlation analysed within-group changes.

Results

A total of 113 patients were included in the study. No statistically significant differences between the groups were found in total HLS-Q12 score or at item level at any follow-up. However, a statistically significant within-group improvement was observed in the intervention group for the total score (mean change of 2.5 ± 4.6, p < 0.01) and several HLS-Q12 items from baseline to one-year follow-up.

Conclusions

The one-year mHealth intervention did not show an effect on HL levels at one- or five-year follow-ups. However, significant within-group HL improvement from baseline to one-year follow-up suggests that mHealth interventions may have the potential to enhance HL.