Abstract
BackgroundLow socioeconomic status (SES) is persistently associated with poor health and suboptimal use of healthcare services, and more unplanned healthcare use. Suboptimal use of emergency and acute healthcare services may increase health inequalities, due to late diagnosis or lack of continuity of care. Given that health literacy has been associated with healthcare utilisation and with education attainment, we sought to explore whether health literacy is related to the use of out-of-hours (OOH) Primary Care Services (PCSs). Additionally, we aimed to study whether and to what extent health literacy accounts for some of the association between education and OOH PSC use.MethodsA survey including measures of education attainment, health literacy (assessed by means of the Dutch version of the nine-dimension Health Literacy Questionnaire) and use of PCS was conducted among a sample of adults diagnosed with (any) somatic chronic condition in the Netherlands (response 76.3%, n = 1811). We conducted linear and logistic regression analyses to examine associations between education level and PCS use in the past year. We performed mediation analyses to assess whether the association between education and PCS use was (partly) explained by different aspects of health literacy. We adjusted the models for patient characteristics such as age and morbidity.ResultsHigher education attainment was associated with higher scores on the health literacy aspects Appraisal of health information, and Navigating the healthcare system. Additionally, appraisal and navigating the healthcare system partially accounted for educational differences in PCS use. Finally, higher appraisal of health information scores were associated with higher PCS utilisation.ConclusionSeveral aspects of health literacy were demonstrated to relate to PCS use, and partly accounted for educational differences herein. Accordingly, developing health literacy within individuals or communities may help to reduce inappropriate PCS use among people with low education.
Highlights
Low socioeconomic status (SES) is persistently associated with poor health and suboptimal use of healthcare services, and more unplanned healthcare use
Main findings The aim of the present study is to explore whether health literacy is related to the use of out-of-hours primary care services (PCSs) by people with chronic conditions
The present study supports that health literacy is a promising determinant of the use of out-of-hours primary care services (PCSs)
Summary
Low socioeconomic status (SES) is persistently associated with poor health and suboptimal use of healthcare services, and more unplanned healthcare use. Background characteristics of the respondents include age (continuous variable in main analyses, and in age groups for descriptive analysis: 15–39 years, 40–64 years, 65–74 years, and 75 and older), sex, household status (living with or without a partner), type and number of medically diagnosed chronic diseases (one, two, three or more), and illness duration in years (time since the first diagnosis of a chronic disease). We performed bivariate linear and logistic regression models to examine whether there was an association between the outcome variable having used a PCS in the past year and education level, and between the outcome and the nine distinct scales of health literacy. We used the KHB method to separately estimate the total effect of the independent variable education level on the outcome OOH primary care use. The total effect was divided in a direct effect of the independent variable socioeconomic status and indirect effect of the mediator health literacy (Fig. 1)
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