Association between health literacy and mHealth use intention in heart failure patient-caregiver dyads: An actor-partner Interdependence mediation model (Preprint)

Abstract

Background: Chronic heart failure has become a serious threat to the health of the global population. Self-management is the key to treating chronic heart failure, and the emergence of mHealth has provided new ideas for self-management of chronic heart failure. Despite the many potential benefits of mHealth, public utilization of mHealth apps is low, and poor health literacy is a key barrier to mHealth use, although the mechanism of the influence is unclear.

Objective: To explore the dyadic associations between health literacy and mHealth usage intentions in dyads of patients with chronic heart failure and their caregivers, and the mediating role of mHealth perceived usefulness and perceived ease of use in these associations.

Methods: This study was a cross-sectional research design, with a sample of 312 dyads of chronic heart failure patients and their caregivers who had been hospitalized in the cardiology departments of two tertiary care hospitals in China from March to October 2023. A general information questionnaire, the Chinese version of the Heart Failure-Specific Health Literacy Scale, and the mHealth Intention to Use Scale were used to conduct the survey; the data were analyzed using the actor-partner interdependence mediation model.

Results: The results of the actor-partner interdependent mediation analysis of health literacy, perceived usefulness of mHealth, and mHealth use intention among patients with chronic heart failure and their caregivers showed that all of the model's actor effects were valid (β = 0.26-0.45, P < 0.001), the partner effects were partially valid (β = 0.08-0.20, P < 0.05), and the mediation effects were valid (β = 0.002-0.242, the 95% CI = 0.003-0.321, P < 0.05); actor-partner interdependent mediation analyses of health literacy, perceived ease of use of mHealth, and mHealth use intention among patients and caregivers with chronic heart failure showed that the model's actor effect partially held (β = 0.17-0.71, P < 0.01), and the partner effect partially held (β = 0.15, P < 0.01), the mediation effect partially held (β = 0.355-0.584, 95% CI = 0.234-0.764, P < 0.001).

Conclusion: Our study proposes that the health literacy of patients with chronic heart failure and their caregivers positively contributes to their own intention to use mHealth, suggesting that the use of mHealth by patients with chronic heart failure can be promoted by improving the health literacy of patients and caregivers as well. Our findings also suggest that the perceived usefulness of patients with chronic heart failure and caregivers affects patients' mHealth use intention, and therefore chronic heart failure patients and their caregivers should be involved throughout the mHealth development process to improve the usability of mHealth for both patients and caregivers. This study emphasizes the key role of chronic heart failure patients' perception that mHealth is easy to use in facilitating their use of mHealth. Therefore, it is recommended that the development of mHealth should focus on simplifying the operational procedures and providing relevant operational training according to the needs of the patients when necessary.