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BMC Primary Care
Published in: BMC Primary Care 1/2021

Open Access 01-12-2021 | Research

A cross-sectional analysis of health literacy: patient- versus family doctor-reported and associations with self-efficacy and chronic disease

Authors: Stephanie Stock, Sibel Altin, Farah Nawabi, Daniele Civello, Arim Shukri, Marcus Redaèlli, Adrienne Alayli

Published in: BMC Primary Care | Issue 1/2021

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Abstract

Background

Adequate health literacy (HL) levels contribute to good health outcomes and successful disease self-management in patients with chronic disease. Hence, it is essential that family doctors recognize patients with inadequate HL in need of additional support. This study had two aims: (1) to assess and compare patient self-reported versus family doctor-rated HL estimates, and (2) to explore associations between patient-reported HL, self-efficacy and chronic diseases.

Methods

Participants in this cross-sectional survey were recruited through general practices in North Rhine-Westphalia, Germany. Patient self-reported HL was measured using the European Health Literacy Survey-16. Family doctor-rated HL was measured with an adapted version of this instrument. Using crosstabulations patient-reported and family doctor-rated HL estimates were compared for 346 patient-family doctor pairs. Associations between HL, self-efficacy and chronic disease were investigated using regression analyses.

Results

Patient-reported and family doctor-rated HL estimates were concordant in 38% of all cases. On average family doctors rated their patients’ HL lower than patients rated their own HL. The lower average family doctor ratings were more pronounced when patients were older, male and had more than one chronic disease. Female family doctors rated HL of male patients lower than their male colleagues. Patient reported HL had a significant positive association with self-efficacy. Mediation analysis provided support that self-efficacy acts as mediator between HL and the number of chronic diseases.

Conclusions

Our study findings indicate a significant discrepancy between patients’ self-reported HL and externally rated HL by family doctors. A more systematic utilization of HL screeners might help reduce this discrepancy. At the same time, consideration should be given to enhancing communication training for family doctors and addressing critical HL skills in patient education.
Literature
1.
Sorensen K, Van den Broucke S, Fullam J, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012;12(1):80.PubMedPubMedCentralCrossRef
2.
Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97–107.CrossRef
3.
Dewalt DA, Berkman ND, Sheridan S, Lohr KN, Pignone MP. Literacy and health outcomes: a systematic review of the literature. J Gen Intern Med. 2004;19(12):1228–39.PubMedPubMedCentralCrossRef
4.
Heijmans M, Waverijn G, Rademakers J, van der Vaart R, Rijken M. Functional, communicative and critical health literacy of chronic disease patients and their importance for self-management. Patient Educ Couns. 2015;98(1):41–8.PubMedCrossRef
5.
Rachmawati U, Sahar J, Wati DNK. The association of diabetes literacy with self-management among older people with type 2 diabetes mellitus: a cross-sectional study. BMC Nurs. 2019;18(Suppl 1):34.PubMedPubMedCentralCrossRef
6.
van der Heide I, Wang J, Droomers M, Spreeuwenberg P, Rademakers J, Uiters E. The relationship between health, education, and health literacy: results from the Dutch Adult Literacy and Life Skills Survey. J Health Commun. 2013;18(Suppl 1):172–84.PubMedPubMedCentralCrossRef
7.
Bennett IM, Chen J, Soroui JS, White S. The contribution of health literacy to disparities in self-rated health status and preventive health behaviors in older adults. Ann Fam Med. 2009;7(3):204–11.PubMedPubMedCentralCrossRef
8.
Kim S, Love F, Quistberg DA, Shea JA. Association of health literacy with self-management behavior in patients with diabetes. Diabetes Care. 2004;27(12):2980–2.PubMedCrossRef
9.
10.
Seligman HK, Wang FF, Palacios JL, et al. Physician notification of their diabetes patients’ limited health literacy: A randomized, controlled trial. J Gen Intern Med. 2005;20(11):1077.
11.
Bass PF, Wilson JF, Griffith CH, Barnett DR. Residents’ ability to identify patients with poor literacy skills. Acad Med. 2002;77(10):1039–41.
12.
Kelly PA, Haidet P. Physician overestimation of patient literacy: a potential source of health care disparities. Patient Educ Couns. 2007;66(1):119–22.PubMedCrossRef
13.
Storms H, Aertgeerts B, Vandenabeele F, Claes N. General practitioners' predictions of their own patients' health literacy: a cross-sectional study in Belgium. BMJ Open. 2019;9(9): e029357.
14.
van der Heide I, Uiters E, Rademakers J, Struijs JN, Schuit AJ, Baan CA. Associations among health literacy, diabetes knowledge, and self-management behavior in adults with diabetes: results of a dutch cross-sectional study. J Health Commun. 2014;19(Suppl 2):115–31.PubMedCrossRef
15.
16.
17.
18.
19.
20.
21.
22.
The HLS-EU Consortium 2012. Measurement of health literacy in Europe: HLS-EU-Q47; HLS-EU-Q16; and HLS-EU-Q86.
23.
24.
Maddux JE. Measurement of General Self-Efficacy. In: Zeigler-Hill V, Shackelford TK. Encyclopedia of Personality and Individual Differences. Springer; 2017.
25.
Beierlein C, Kemper CJ, Kovaleva A, Rammstedt B. Short Scale for Measuring General Self-efficacy Beliefs (ASKU). Mda. 2013;7(2):251–278252.
26.
Hayes AF, Matthes J. Computational procedures for probing interactions in OLS and logistic regression: SPSS and SAS implementations. Behav Res Methods. 2009;41(3):924–36.PubMedCrossRef
27.
Preacher KJ, Hayes AF. SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behav Res Methods Instrum Comput. 2004;36(4):717–31.PubMedCrossRef
28.
Fiedler K, Schott M, Meiser T. What mediation analysis can (not) do. J Exp Soc Psychol. 2011;47(6):1231–6.CrossRef
29.
Hayes AF. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. New York, NY: Guilford Publications; 2013.
30.
Hayes AF. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. 2nd ed. New York, NY: Guilford Publications; 2018.
31.
Hayes AF, Rockwood NJ. Regression-based statistical mediation and moderation analysis in clinical research: Observations, recommendations, and implementation. Behav Res Ther. 2017;98:39–57.PubMedCrossRef
32.
Frazier PA, Tix AP, Barron KE. Testing moderator and mediator effects in counseling psychology research. J Couns Psychol. 2004;51(1):115.CrossRef
33.
Jordan S, Hoebel J. Health literacy of adults in Germany: Findings from the German Health Update (GEDA) study. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2015;58(9):942–50.PubMedCrossRef
34.
Sorensen K, Pelikan JM, Rothlin F, et al. Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU). Eur J Public Health. 2015;25(6):1053–8.PubMedPubMedCentralCrossRef
35.
Davis SN, Wischhusen JW, Sutton SK, et al. Demographic and psychosocial factors associated with limited health literacy in a community-based sample of older Black Americans. Patient Educ Couns. 2020;103(2):385–91.PubMedCrossRef
36.
37.
38.
Dickens C, Lambert BL, Cromwell T, Piano MR. Nurse overestimation of patients’ health literacy. J Health Commun. 2013;18(Suppl 1):62–9.
39.
Gazmararian JA, Baker DW, Williams MV, et al. Health literacy among Medicare enrollees in a managed care organization. JAMA. 1999;281(6):545–51.PubMedCrossRef
40.
Kobayashi LC, Wardle J, Wolf MS, von Wagner C. Aging and Functional Health Literacy: A Systematic Review and Meta-Analysis. J Gerontol B Psychol Sci Soc Sci. 2016;71(3):445–57.PubMedCrossRef
41.
42.
Bidmon S, Terlutter R. Gender Differences in Searching for Health Information on the Internet and the Virtual Patient-Physician Relationship in Germany: Exploratory Results on How Men and Women Differ and Why. J Med Internet Res; 2015; 17(6): e156. https://​doi.​org/​10.​2196/​jmir.​4127.
43.
44.
Aldin A, Chakraverty D, Baumeiste A, Monsef I, Noyes J. Gender differences in health literacy of migrants: a synthesis of qualitative evidence. Cochrane Database of Systematic Reviews 2019, Issue 4. Art. No.: CD013302. https://​doi.​org/​10.​1002/​14651858.​CD013302. Accessed 11 June 2021.
45.
46.
47.
48.
Mounce LTA, Campbell JL, Henley WE, Arreal MCT, Porter I, Valderas JM. Prediciting idident multiborbidity. Ann Fam Med. 2018;1(4):322–9.CrossRef
49.
Aaby A, Beuchamp A, O’Hara J, Maindal HT. Large diversity in Danish health literacy profiles: perspectives for care of long-term illness and multimorbidity. The European Journal of Public Health. 2019;30(1):75–80.
50.
Masoompour M, Tirgari B, Ghazafnfari Z. The relationship between health literacy, self-efficacy, and self-care behaviors in diabeteic patients. Evid Based Care. 2017;7(3):17–25.
51.
Dennison CR, McEntee ML, Samuel L, et al. Adequate health literacy is associated with higher heart failure knowledge and self-care confidence in hospitalized patients. J Cardiovasc Nurs. 2011;26(5):359–67.PubMedPubMedCentralCrossRef
52.
Osborn CY, Cavanaugh K, Wallston KA, Rothman RL. Self-efficacy links health literacy and numeracy to glycemic control. J Health Commun. 2010;15(Suppl 2):146–58.PubMedPubMedCentralCrossRef
53.
Xu XY, Leung AYM, Chau PH. Health Literacy, Self-Efficacy, and Associated Factors Among Patients with Diabetes. Health Lit Res Pract. 2018;2(2):e67–77.PubMedPubMedCentral
54.
Safeer RS, Keenan J. Health literacy: the gap between physicians and patients. Am Fam Physician. 2005;72(3):463–8.PubMed
55.
Dinh H, Thuy T, Bonner A, Clark R, Ramsbotham J, Hines S. The effectiveness of the teach-back method on adherence and self-management in health education for people with chronic disease: a systematic review, JBI Database of Systematic Reviews and Implementation Reports 2016; 14 (1): 210–247. https://​doi.​org/​10.​11124/​jbisrir-2016-2296.
56.
Saunders C, Palesy D, Lewis J. Systematic review and conceptual framework for health literacy training in health professions education. Health Prof Educ. 2019;5(1):13–29.CrossRef
57.
Kaper MS, Winter AF, Bevilacqua R, et al. Positive Outcomes of a Comprehensive Health Literacy Communication Training for Health Professionals in Three European Countries: A Multi-centre Pre-post Intervention Study. Int J Environ Res Public Health. 2019;16(20):3923.PubMedCentralCrossRef
58.
Chew LD, Bradley KA, Boyko EJ. Brief questions to identify patients with inadequate health literacy. Fam Med. 2004;36(8):588–94.PubMed
59.
Campbell P, Lewis M, Chen Y, Lacey RJ, et al. Can patients with low health literacy be identified from routine primary care health records? A cross-sectional and prospective analysis. BMC Fam Pract. 2019;20:101.PubMedPubMedCentralCrossRef
60.
Metadata
Title
A cross-sectional analysis of health literacy: patient- versus family doctor-reported and associations with self-efficacy and chronic disease
Authors
Stephanie Stock
Sibel Altin
Farah Nawabi
Daniele Civello
Arim Shukri
Marcus Redaèlli
Adrienne Alayli
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2021
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-021-01527-4

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