Objectives
To describe and compare health literacy (HL) using contrasting instruments of Rapid Estimate of Adult Literacy in Medicine (REALM) and the Health Literacy Questionnaire (HLQ) in patients attending three Australian rheumatology clinics; and their associations with sociodemographic and clinical characteristics.
Methods
Cross-sectional study of rheumatology patients at Liverpool (Sydney) and Canberra public hospital clinics and a private Liverpool clinic using the REALM test and HLQ, sociodemographic and clinical questionnaires. One-way ANOVA and multivariate ordinal and binary logistic regressions were used to examine the association between HL and sociodemographic and clinical factors.
Results
278 participated (111 Liverpool public, 112 private, 55 Canberra public clinic). Compared with Canberra, Liverpool patients were older, non-native English speakers, less tertiary educated, and more likely to have comorbidities.
40% Liverpool public, 29% private and 13% Canberra patients had suboptimal REALM HL (p < 0.05). Lower REALM was associated with male gender, <10 years education, born outside Australia/New Zealand, and English as secondary language; but not associated with clinical characteristics. All 9 HLQ domain scores did not differ across sites despite inter-group comparisons as stratified by REALM bands. Completing ten years of schooling was associated with better scores in three HLQ scales: ‘Navigating the healthcare system’ (p = 0.009), ‘Ability to find information’ (p < 0.001), and ‘Reading and understanding information’ (p < 0.001).
Conclusion
Patient HL as measured by the REALM differed across sites, explained by differences in gender distribution, country of birth, English as primary language and years of education. HL as measured by the HLQ did not differ across sites and was more informative for understanding differing patient HL needs.