The impact of health literacy on health outcomes in individuals with chronic pain: a cross-sectional study

Abstract

Objective: To establish if health literacy (HL) is linked to poorer outcomes and behaviours in patients with chronic pain.

Design: A prospective cross-sectional observational study.

Setting: Multidisciplinary out-patient pain clinics in three university teaching hospitals.

Patients: New patients (n=131) referred to the pain clinic with a history of chronic pain (>12 weeks).

Methods: A questionnaire was distributed to chronic pain patients attending their first appointment. Those eligible for inclusion were newly referred patients who had pain lasting longer than three months. The questionnaire comprised the following sections: demographics, chronic pain status and disease-related knowledge, quality of life (SF-36), beliefs (Beliefs About Pain Control Questionnaire), and a validated HL tool (Newest Vital Sign).

Results: Of the 131 participants recruited, 54% had inadequate HL. The group was subsequently stratified according to HL level. In bivariate analysis, inadequate HL was associated with older age (p<0.001), being unemployed or retired (p=0.005), less education (p<0.001), lower income, increased comorbidities (p=0.038), being less likely to utilise allied health services (p=0.001), poorer disease-related knowledge (p=0.002), and poorer beliefs about pain (p<0.05). In multivariate analysis, disease-related knowledge (OR 2.5, 95%CI 1.0 to 6.3, p=0.05) and beliefs about pain (B=-2.3, S.E=0.9, p=0.01) remained independently associated with HL.

Conclusion: Inadequate HL is prevalent in chronic pain patients, and may impact on the development of certain characteristics necessary for effective self-management.

Keywords: Beliefs; Chronic pain; Health literacy; Self-management.