Exploring the information and service needs of Chinese immigrants with heart disease: a health literacy perspective

Background Health literacy is essential for effective CHD secondary prevention, yet many immigrants face cultural, linguistic, and socioeconomic barriers that limit their ability to use health information and engage with standard patient education, contributing to poorer outcomes.Aim To understand the relationships between health literacy and health information, service-seeking, and self-care behaviours among Chinese immigrants living in Australia who were diagnosed with heart conditions.Methods Twenty Chinese immigrants with heart disease (13 female, 7 male; mean age 75.3 years; 19 self-reported poor English proficiency) were a nested subset recruited from a larger community survey study. Data were collected via semi-structured focus groups and individual interviews. Content analysis was guided by the Research Triangle Institute’s Health Literacy Skills Framework.Results Interviews revealed significant gaps between individuals’ health literacy skills and the health literacy demands of their healthcare environment. These gaps substantially impact participants’ approaches to accessing heart health information, comprehending and navigating healthcare services, and engaging in self-care behaviours. Factors mediating between the identified gaps and self-care behaviours included individuals’ motivation, relationship with healthcare providers, perceived disease severity and prognosis. Four interwoven core themes emerged: 1. A mismatch between health literacy skills and demands; 2. Individual strategies for bridging the gaps; 3. Partial information comprehension and suboptimal self-care behaviours; and 4. Internal and interpersonal mediators of self-care behaviours.Discussion The study highlights the unmet health information and service needs of Chinese immigrants with heart disease. Chinese immigrants face substantial English-language and health literacy challenges that limit their access to information, hinder the navigation of the healthcare system, and reduce engagement in self-care. Interventions should prioritise reducing language barriers and aligning health literacy demands with individuals’ capacities. Culturally and linguistically tailored strategies, calibrated to immigrants’ health literacy levels and that address motivation, provider relationships, and disease perceptions, are critical for improving self-care and health outcomes. Such approaches can enhance the availability and quality of heart health services while promoting more inclusive healthcare experiences.