cause a longer hospital stay with increased costs and risks (CDC, 2010e). In a review of the costs of care for patients, Shannon and colleagues (2006) found that, “The costs of CLABSIs and the associated complications averaged 43 percent of the total cost of care” for patients with CLABSIs. Studies have shown that effective action can significantly reduce or eliminate CLABSI infections (Guerin et al., 2010; Pronovost et al., 2006; Royer et al., 2009).
Health literacy is defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (Ratzan and Parker, 2000). A systematic review of the evidence about the relationship of health literacy and health outcomes found poorer health outcomes and worse health care for adults with low health literacy but also that health literacy appropriate interventions can improve the outcome of knowledge for those with both higher and lower literacy levels (Berkman et al., 2004). Limited health literacy has been linked to less knowledge about managing chronic illness than those with higher health literacy, decreased ability to share in decision making about prostate cancer treatment, lower adherence to anticoagulation therapy, higher likelihood of poor glycemic control, higher rates of hospitalization, and lower self-reported health status (IOM, 2004).
According to the IOM (2004), “Nearly half of all American adults—90 million people—have difficulty understanding and acting upon health information.” The National Healthcare Disparities Report found that Hispanic adults were 4.5 times more likely to have below-basic health literacy than were white adults. African American, American Indian, and Alaskan Native adults were nearly three times more likely to have below-basic health literacy than were white adults (AHRQ, 2007).
Approximately 17.6 million people in the United States have coronary heart disease—about 9.2 million males and 8.4 million females (American Heart Association, 2010). Coronary heart disease (CHD) includes heart attack (myocardial infarction) and angina pectoris. In 2006, the latest date for which figures are available, about 8,500,000 people had a heart attack, and the American Heart Association (2010) estimates that an American suffers a heart attack about every 34 seconds. More than 10 million Americans (10,200,000) have angina pectoris or chest pain (American Heart Association, 2010). The prevalence rate for coronary heart disease among