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General practice / Family practice
Research
Factors associated with health literacy in multimorbid patients in primary care: a cross-sectional study in Switzerland
  1. Alexandra A N’Goran1,
  2. Jérôme Pasquier2,
  3. Anouk Deruaz-Luyet1,
  4. Bernard Burnand2,
  5. Dagmar M Haller3,
  6. Stefan Neuner-Jehle4,
  7. Andreas Zeller5,
  8. Sven Streit6,
  9. Lilli Herzig1,
  10. Patrick Bodenmann7
  1. 1 Institute of Family Medicine, University of Lausanne, Lausanne, Switzerland
  2. 2 Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
  3. 3 Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
  4. 4 Institute of Primary Care, University of Zurich, Zürich, Switzerland
  5. 5 Centre for Primary Health Care, University of Basel, Basel, Switzerland
  6. 6 Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
  7. 7 Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, Lausanne, Switzerland
  1. Correspondence to Dr Lilli Herzig; lilli.herzig{at}hin.ch

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.

  • general medicine (see internal medicine)
  • primary care
  • public health

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-018281

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    Footnotes

    • LH and PB contributed equally.

    • Contributors AAN, AD-L, BB, DMH, AZ, LH and PB developed the protocol for the MMFM study. LH, AZ and DMH ensured the recruitment of participating GPs. AAN was primarily responsible for planning the analysis and drafting the manuscript. JP was responsible for the analyses. PB, JP, and LH helped to improve the manuscript during this process. BB, AD, DMH, SS, SNJ, AZ, PB and LH made contributions to the interpretation of the findings and the content of the final manuscript. All authors read and approved the final manuscript.

    • Funding This work was supported by Swiss University Conference project P10, which granted funding to reinforce teaching and research in Primary Care in Switzerland. Within the framework of this financial support, Switzerland’s five university institutes of family medicine (in Basel, Bern, Geneva, Lausanne and Zurich) collaborate as the Swiss Academy of Family Medicine (SAFMED).

    • Disclaimer The funding source had no role in study design, data collection, analysis or interpretation, nor in the preparation of the manuscript and the decision to submit the paper for publication.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval The study protocol (Protocol No 314/15) was approved by the Human Research Ethics Committee of the Canton Vaud, Switzerland.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data are available at family medicine institute of Lausanne.