Abstract
BackgroundPeople with limited health literacy are more likely to be socioeconomically disadvantaged and have risk factors for preventable chronic diseases. General practice is the ideal setting to address these inequalities however these patients engage less in preventive activities and experience difficulties navigating health services.This study aimed to compare primary care patients with and without sufficient health literacy in terms of their lifestyle risk factors, and explore factors associated with receiving advice and referral for these risk factors from their GPs.MethodsA mailed survey of 739 patients from 30 general practices across four Australian states was conducted in 2012. Health literacy was measured using the Health Literacy Management Scale. Patients with a mean score of <4 within any domain were defined as having insufficient health literacy. Multilevel logistic regression was used to adjust for clustering of patients within practices.ResultsPatients with insufficient health literacy (n = 351; 48%) were more likely to report being overweight or obese, and less likely to exercise adequately. Having insufficient health literacy increased a patient’s chance of receiving advice on diet, physical activity or weight management, and referral to and attendance at lifestyle modification programs. Not speaking English at home; being overweight or obese; and attending a small sized practice also increased patients’ chances of receiving advice on these lifestyle risks. Few (5%, n = 37) of all patients reported being referred to lifestyle modification program and of those around three-quarters had insufficient health literacy. Overweight or obese patients were more likely to be referred to lifestyle modification programs and patients not in paid employment were more likely to be referred to and attend lifestyle programs.ConclusionPatients with insufficient health literacy were more likely to report receiving advice and being referred by GPs to attend lifestyle modification. Although the number of patients referred from this sample was very low, these findings are positive in that they indicate that GPs are identifying patients with low health literacy and appropriately referring them for assistance with lifestyle modification. Future research should measure the effectiveness of these lifestyle programs for patients with low health literacy.
Highlights
People with limited health literacy are more likely to be socioeconomically disadvantaged and have risk factors for preventable chronic diseases
We found that those with insufficient health literacy were more likely to report being overweight or obese and have inadequate levels of physical activity, which is consistent with current evidence and supports our study hypothesis
We found that patient-reported General Practitioner (GP) behavioural risk factor advice and referral was generally sub-optimal
Summary
People with limited health literacy are more likely to be socioeconomically disadvantaged and have risk factors for preventable chronic diseases. They tend to limit their conversational engagement with health care providers to cover up their low literacy [9] Even when they do seek preventive care, these patients often do not receive or are not referred to interventions of sufficient intensity and duration to achieve physiological changes, and fail to maintain changes due to lack of follow up and support [10]. This may be partly due to provider factors, because providers communicate less well with people with low health literacy, do not fully explain conditions or processes related to care and incorrectly assume these patients are either not interested, or desire a less active role in their health care [11,12]
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