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

Stephanie Stock; Sibel Altin; Farah Nawabi; Daniele Civello; Arim Shukri; Marcus Redaèlli; Adrienne Alayli

doi:10.1186/s12875-021-01527-4

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

BMC Fam Pract. 2021 Sep 15;22(1):187. doi: 10.1186/s12875-021-01527-4.

Authors

Stephanie Stock¹, Sibel Altin², Farah Nawabi¹, Daniele Civello¹, Arim Shukri¹, Marcus Redaèlli¹, Adrienne Alayli³

Affiliations

¹ Institute for Health Economics and Clinical Epidemiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Gleueler Str. 176-178, 50924, Cologne, Germany.
² AOK Rheinland/Hamburg, Hamburg, Germany.
³ Institute for Health Economics and Clinical Epidemiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Gleueler Str. 176-178, 50924, Cologne, Germany. adrienne.alayli@uk-koeln.de.

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.

Keywords: Chronic disease; General practice; Health literacy; Multimorbidity; Self-efficacy; Sex/gender.

Publication types

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

MeSH terms

Chronic Disease
Cross-Sectional Studies
Female
Health Literacy*
Humans
Male
Self Efficacy
Surveys and Questionnaires