Abstract
ObjectivesTo estimate the prevalence of low health literacy, and evaluate the impact of low health literacy on outcomes in patients with chronic musculoskeletal conditions.Data SourcesWe searched Embase, Pubmed, PsycInfo, and CINAHL in January 2011 for relevant studies, restricted to English-language articles.Study Selection and Data ExtractionStudies were included if they measured health literacy and/or reported on the link between outcomes and health literacy levels in patients with osteoporosis, osteoarthritis, or rheumatoid arthritis. We assessed risk of bias from participant selection, methods of measuring health literacy and functional outcomes, missing data, and potential for confounding.Data SynthesisWe reviewed 1863 citations and judged 8 studies to be relevant. Most were cross-sectional in nature, and five were based in the United States. Diversity in measurements, participant characteristics, and settings meant that results had to be synthesized narratively. Prevalence of low health literacy varied from 7% to 42%. Of the five studies that reported on musculoskeletal outcomes, only one showed an association (unadjusted) between low health literacy and greater pain and limitations in physical functioning. However, other studies, including those with multivariate analyses, found no significant relationship between health literacy and measures of pain or disease specific questionnaires. One clinical trial found short-term improvements in the mental health of patients with musculoskeletal conditions after an intervention to improve health literacy.LimitationsMost of the studies were cross-sectional in nature, which precludes interpretation of a causal relationship. The sample sizes may not have been sufficiently large to enable detection of significant associations.ConclusionsThe current evidence does not show a consistent association between low health literacy and poorer functional outcomes in patients with chronic musculoskeletal conditions. In the absence of a definite link, efforts to develop interventions to improve health literacy would not necessarily improve health service or patient-related outcomes.
Highlights
The Institute of Medicine Committee for Health Literacy considers health literacy to be ‘‘the degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health’’. [1] Older patients with low health literacy and cancer show less knowledge of their condition and its management, and have more difficulty making informed choices. [2] Low levels of health literacy are linked with increased hospital admissions and mortality, [3] whilst higher health literacy has been shown to be associated with greater health knowledge and selfconfidence. [4].Health literacy is considered to encompass three different levels
The current evidence does not show a consistent association between low health literacy and poorer functional outcomes in patients with chronic musculoskeletal conditions
Three of the studies focused on rheumatoid arthritis, [13,14,15] one enrolled patients with a range of arthritic conditions, [19] while the other studies looked at patients attending Rheumatology/musculoskeletal clinics whose diagnoses were less clearly defined
Summary
[1] Older patients with low health literacy and cancer show less knowledge of their condition and its management, and have more difficulty making informed choices. Functional health literacy refers to the basic reading and writing skills to manage health information in common daily settings, whereas the interactive and critical levels involve more advanced cognitive skills (e.g. improved ability to appraise new information and act independently, perhaps to influence change at personal and community levels). [5] Validated tools such as the Rapid Estimate of Adult Literacy in Medicine (REALM) or the Test of Functional Health Literacy in Adults (TOFHLA) can be used to measure health literacy. Low levels of health literacy may potentially cause patients with chronic musculoskeletal conditions to face difficulties in use of health services, and to possibly experience poorer control of their illness. A study from a specialist rheumatology clinic in Glasgow, United Kingdom found that patients with low health literacy levels had significantly more clinic visits than those with higher health literacy. [8]
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