Individuals with low health literacy (HL) are known to have poorer health outcomes and to have higher mortality rates compared to individuals with higher HL; hence, the improvement of HL is a key outcome in modern healthcare systems. Healthcare providers are therefore asked to support patients in becoming more and more engaged in their healthcare, thus augmenting their literacy skills. Our main hypothesis is that the well-known relationship between patients' perceived autonomy supportive healthcare climate and HL skills is mediated by the Patient Health Engagement Model (PHE-model) which describes the patients' progressive maturation of a psychological readiness to become active players in their healthcare. The purpose of this study was to formulate a hypothetical structural equation model (SEM) linking an autonomy-supportive healthcare climate to PHE-model and HL. A cross-sectional survey design was employed involving 1007 Italian chronic patients. The hypothetical model was tested using SEM to verify the hypothesized mediation of the PHE-model between autonomy-supportive healthcare climate and HL. Results show that the theoretical model has a good fit indexes and that PHE-model fully mediates the relationship between autonomy-supportive healthcare climate and HL. This finding suggests healthcare systems to implement a new paradigm where patients are supported to play an autonomous role in their own healthcare.
Keywords: Health Care Climate Questionnaire; PHE-S; Patient Health Engagement Scale; health communication; health literacy; patient autonomy; patient engagement; patient health engagement model; patient-centered communication.