Factors associated with health literacy in multimorbid patients in primary care: a cross-sectional study in Switzerland

Alexandra A N'Goran; Jérôme Pasquier; Anouk Deruaz-Luyet; Bernard Burnand; Dagmar M Haller; Stefan Neuner-Jehle; Andreas Zeller; Sven Streit; Lilli Herzig; Patrick Bodenmann

doi:10.1136/bmjopen-2017-018281

Factors associated with health literacy in multimorbid patients in primary care: a cross-sectional study in Switzerland

BMJ Open. 2018 Feb 13;8(2):e018281. doi: 10.1136/bmjopen-2017-018281.

Authors

Affiliations

¹ Institute of Family Medicine, University of Lausanne, Lausanne, Switzerland.
² Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.
³ Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
⁴ Institute of Primary Care, University of Zurich, Zürich, Switzerland.
⁵ Centre for Primary Health Care, University of Basel, Basel, Switzerland.
⁶ Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
⁷ Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, Lausanne, Switzerland.

^# Contributed equally.

Abstract

Objective: To identify factors associated with health literacy in multimorbid patients.

Design: A nationwide cross-sectional study in Switzerland. Univariate and multivariate linear regressions were calculated to identify variables associated with health literacy. A multiple imputation approach was used to deal with missing values.

Participants: Multimorbid patients recruited in primary care settings (n=888), above 18 years old and suffering from at least 3 of 75 chronic conditions on a predefined list based on the International Classification of Primary Care 2.

Main measures: Health literacy was assessed using the European Health Literacy Survey project questionnaire (HLS-EU 6). This comprises six items scored from 1 to 4 (very difficult=1, fairly difficult=2, fairly easy=3, very easy=4), and the total health literacy score is computed as their mean. As we wished to understand the determinants associated with lower health literacy, the HLS-EU 6 score was the only dependent variable; all other covariates were considered independent.

Results: The mean health literacy score (SD) was 2.9 (0.5). Multivariate analyses found significant associations between low health literacy scores and treatment burden scores (β=-0.004, 95% CI -0.006 to 0.002); marital status, predominantly the divorced group (β=0.136, 95% CI 0.012 to 0.260); dimensions of the EuroQuol 5 Dimension 3 Level (EQ5D3L) quality of life assessment, that is, for moderate problems with mobility (β=-0.086, 95% CI -0.157 to 0.016); and with moderate problems (β=-0.129, 95% CI -0.198 to 0.060) and severe problems with anxiety/depression (β=-0.343, 95% CI -0.500 to 0.186).

Conclusions: Multimorbid patients with a high treatment burden, altered quality of life by problems with mobility, anxiety or depression, often also have low levels of health literacy. Primary care practitioners should therefore pay particular attention to these patients in their daily practice.

Keywords: general medicine (see internal medicine); primary care; public health.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Anxiety / epidemiology*
Chronic Disease / psychology
Cross-Sectional Studies
Depression / epidemiology*
Female
Health Literacy / statistics & numerical data*
Health Surveys
Humans
Linear Models
Male
Marital Status
Middle Aged
Mobility Limitation
Multimorbidity*
Multivariate Analysis
Primary Health Care
Quality of Life*
Switzerland / epidemiology