Health literacyFunctional, interactive and critical health literacy: Varying relationships with control over care and number of GP visits
Introduction
In chronic care, patients are expected to fulfil an active role in the care of their condition, for instance by fulfilling care tasks in their home environment. This active patient role is seen as important for obtaining or maintaining the best possible state of health [1], [2] and reducing the burden on healthcare [3], [4]. However, previous studies imply that not all adults with chronic conditions are able to fulfil this role [5], either because they are not interested and/or because they lack the knowledge or the skills [6]. Health literacy (i.e. the ability to access, understand, appraise and apply health-related information) is considered to be relevant for this [7], [8], [9]. Patients with higher health literacy are found to take a more active role with respect to their care [10], [11], [12], [13] and to make less use of healthcare services than those with lower health literacy [14].
To date, most studies on health literacy have focused on functional health literacy, which reflects basic skills in reading and writing [15]. However, increasing amounts of attention are being paid to interactive/communicative and critical health literacy [15], [16]. The terms ‘interactive’ and ‘communicative’ health literacy have both been used in literature to refer to the skills that can be used to participate actively in everyday situations, extract health information and derive meaning from different forms of health communication, and apply this to changing circumstances [15]. This includes for example searching for online health information. In the present paper, we will use the term ‘interactive health literacy’ to refer to these skills. Critical health literacy refers to the cognitive and social skills needed to critically assess the applicability of health information to personal situations or its reliability, such as information about the performance of healthcare providers [15]. Some consider critical health literacy to be especially relevant for individuals’ ability to exert control over situations [15], [16]. Few studies have actually addressed the relative importance of functional, interactive and critical health literacy in patients’ ability to fulfil an active role in their own care [17].
If theory-driven interventions to encourage active patient participation are to be developed, it is important to obtain insights into the relationships between different types of health literacy and patients’ abilities to fulfil an active role in the care for their condition. In that context, the present study will focus on health literacy in relation to patients’ perceived control over the care for their illness and the frequency of their visits to the general practitioner (GP). Being able to exert a certain degree of control is considered a precondition for active patient participation and is often discussed in relation to health literacy [15], [16], [18]. Patients’ perceived control over their care is indicated in the present study by their perceived ability to perform self-care activities in the home environment, to interact effectively with healthcare providers and to organize care at the right moment [2].
In the Netherlands, a referral from the GP is required for most specialists and for hospital treatment. GPs are generally the first point of contact in healthcare when people have problems with their health. The frequency of GP visits therefore gives a good indication of the support needs of adults with chronic conditions. The association between patients’ health literacy and the frequency of their GP visits will indicate whether patients with lower health literacy may need more support from their GP than patients with higher health literacy.
The literature suggests that older patients and patients who are less educated and/or less knowledgeable about their condition are more likely to have lower health literacy, visit their healthcare provider more frequently and perceive more difficulties in exerting control over their care than younger, more highly educated and more knowledgeable patients [19], [20], [21], [22], [23], [24]. The association between age and health literacy may in part be explained by age-related cognitive decline [25]. Furthermore, lower health literacy is associated with poorer health status and those who are in poorer health are more likely to visit their GP and to be less able to exert control over care than those who are in better health [14], [26]. These factors will therefore be taken into account in the present study.
The objective of the current study is to obtain insights into the extent to which functional, interactive and critical health literacy relate to patients’ perceived control over their care and to the frequency of their GP visits. We are specifically interested whether the three types of health literacy have differing associations with perceived control over care and frequency of GP visits. The following research questions have therefore been formulated:
- 1.
To what extent are functional, interactive and critical health literacy associated with patients’ perceived ability to perform self-care activities, interact with healthcare providers and organize care?
- 2.
To what extent are functional, interactive and critical health literacy associated with patients’ frequency of GP visits?
Section snippets
Study design and sample selection
Data from the ‘National Panel of People with Chronic Illness or Disability’ (NPCD) was used. This panel is a nationwide prospective panel in the Netherlands for studying the consequences of a chronic illness or a long term disability [27]. Panel members with a chronic illness were recruited from the patient files of general practices (national random samples of general practices, drawn from the Netherlands registration of General Practice). For these panel members, general practitioners
Sample characteristics
Table 1 presents the sample characteristics. The most typical respondent was female (58.4%), aged 45 to 64 (38.4%), attained an intermediate level of education (43.0%) and reported no problems with cognitive functioning (70.6%). The mean score on the perceived knowledge scale was 6.7 ± 1.1, indicating that patients felt they knew a lot about their care and medications. The mean scores for perceived general health status and functional health status scales were 47.3 ± 20.8 and 55.2 ± 30.2 respectively
Discussion
This study adds new insights to health literacy research by showing that the variance in chronic patients’ perceived control over care can be explained more by a contribution from interactive health literacy than from functional or critical health literacy. On the other hand, functional health literacy is the only type of health literacy that has a relationship with the yearly frequency of GP visits: chronic patients with lower health literacy visit their GPs more often than patients with
Acknowledgements
This study was based on data from the research programme for the ‘National Panel of people with Chronic Illness or Disability’, which is financed by the Netherlands Ministry of Public Health, Welfare and Sports and the Netherlands Ministry of Social Affairs and Employment. These ministries had no role in the design and execution of the study. The authors declare that they have no competing interests.
References (42)
- et al.
Hospital admissions, emergency department utilisation and patient activation for self-management among people with diabetes
Diabetes Res Clin Pract
(2011) - et al.
Self-management abilities, physical health and depressive symptoms among patients with cardiovascular diseases, chronic obstructive pulmonary disease, and diabetes
Patient Educ Couns
(2012) Predictors of self-management for chronic low back pain
Appl Nurs Res
(2014)- et al.
Diabetes self-management in patients with low health literacy: ordering findings from literature in a health literacy framework
Patient Educ Couns
(2012) Critical health literacy: a review and critical analysis
Soc Sci Med
(2011)The evolving concept of health literacy
Soc Sci Med
(2008)- et al.
Cognitive function is a risk for health literacy in older adults with diabetes
Diabetes Res Clin Pract
(2013) - et al.
Developments in patient activation of people with chronic illness and the impact of changes in self-reported health: results of a nationwide longitudinal study in The Netherlands
Patient Educ Couns
(2014) - et al.
Validation of the Dutch functional, communicative and critical health literacy scales
Patient Educ Couns
(2012) - et al.
Functional, communicative and critical health literacy of chronic disease patients and their importance for self-management
Patient Educ Couns
(2015)
Patient engagement—what works?
J Ambul Care Manage
Patient-centered communication: do patients really prefer it?
J Gen Intern Med
Participation of chronic patients in medical consultations: patients’ perceived efficacy, barriers and interest in support
Health Expect
Measuring patient activation in The Netherlands: translation and validation of the American short form Patient Activation Measure (PAM13)
BMC Public Health
(HLS-EU) Consortium Health Literacy Project European. Health literacy and public health: a systematic review and integration of definitions and models
BMC Public Health
Health literacy interventions and outcomes: an updated systematic review
Evid Rep Technol Assess (Full Rep)
Patient health literacy and patient–physician information exchange during a visit
Fam Pract
Patient activation and health literacy as predictors of health information use in a general sample of Dutch health care consumers
J Health Commun
Low health literacy and health outcomes: an updated systematic review
Ann Intern Med
Understanding critical health literacy: a concept analysis
BMC Public Health
Cited by (54)
Association of functional, interactive, and critical health literacy with good self-rated health among Taiwanese community-dwelling older adults
2022, Geriatric NursingCitation Excerpt :A better understanding of which subdomain of health literacy is most salient to good health can improve health promotion interventions. Based on the literature,16,25–28,33 we hypothesized that interactive and critical health literacy would be more closely associated with good self-rated health status than functional health literacy for community-dwelling older adults. This study was a secondary analysis using data from a cross-sectional survey.
Patient-reported outcome measures as determinants for the utilization of health care among outpatients with epilepsy: a prognostic cohort study
2023, Journal of Patient-Reported OutcomesRelationship between Health Literacy in Disease Prevention and Quality of Life of Older People in the Region Public Health of Thailand
2023, Journal of the Medical Association of Thailand