Abstract
ObjectiveTo explore health literacy (HL) profiles within a cohort of people with psoriasis. A cluster approach identifies groups of individuals that have similar HL profiles. The method unmasks sub‐groups with particular HL strengths, or subgroups with limitations, which require tailored healthcare services to improve.MethodsA cross‐sectional sample of 792 patients from the Norwegian Climate Helio Therapy Programme in Gran Canaria participated. The HL questionnaire assessed nine HL dimensions. Using Ward's Hierarchical Clustering Method (Stata version 16), we looked for subgroups of patients across the dimensions. We also explored whether these clusters had specific demographic features and associations to outcomes such as psoriasis knowledge, quality of life and self‐management capacity.ResultThe analysis revealed four unique clusters identifying clinically meaningful subgroups. Two groups stood out as especially interesting. One cluster representing 26.6% of the sample presented severe HL limitations associated with lower psoriasis knowledge, quality of life, self‐management and self‐efficacy. HL domains connected to cooperation with healthcare professionals showed deficient scores. The other cluster included a smaller percentage (7.7%) with high HL compared to the total sample. This cluster was associated with higher self‐management, quality of life and better self‐efficacy.ConclusionThe cluster analysis revealed substantial differences in HL profiles within the sample. These results support the importance of a holistic understanding of the HL needs and the vulnerabilities within a psoriasis cohort. Implementing one size fits all approaches, may not be sufficient in psoriasis context to target HL.
Highlights
Psoriasis is a chronic inflammatory skin disease, and in later years, knowledge about pathogenesis and effective pharmacological treatment options has advanced significantly
Our findings suggest that knowing health literacy (HL) profiles can guide the development of tailored HL interventions, securing high utility and uptake in the psoriasis context
The main finding was that 26.6% of the psoriasis population belonged to the cluster with the lowest Health Literacy Questionnaire (HLQ) scores. This is in contrast to other HLQ studies within other chronic conditions, where the clusters with the lowest score are much smaller in percentage.[28,29]
Summary
Psoriasis is a chronic inflammatory skin disease, and in later years, knowledge about pathogenesis and effective pharmacological treatment options has advanced significantly. In the HL field, most of the research has been focusing on reading comprehension and numeracy skills, better known as ‘functional’ HL.[5] measuring only functional HL overlooks the complexity of cultural and personal values, the importance of context, and the social resources and individual motivation that influence peoples’ ability to understand and act upon information associated with their health.[6] Previous findings from this sample[7] showed that the participants with psoriasis generally scored low on most of the HL domains, compared to people with other chronic conditions.[8,9,10] these results provided only information of the whole sample, and the linear regression models gave no indications to whether there were significant HL differences within the psoriasis cohort. The following research question is asked: What types of HL profiles can be identified by investigating HLQ clusters and their characteristics in a sample of patients with psoriasis?
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