The role of health literacy in explaining the association between educational attainment and the use of out-of-hours primary care services in chronically ill people: a survey study

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.

Health Literacy is Associated with Health Behaviors in Students from Vocational Education and Training Schools: A Danish Population-Based Survey

“…Exploring predictors and modifiers of youth health behavior is therefore a crucial step towards effective early prevention of poor health outcomes. Low socio-economic status (SES) has been identified as such a predictor [2,3], and one possible mediating factor is health literacy [4][5][6].…”

Health literacy and the health status of men with prostate cancer

“…To date, the HLQ has not been tested in a sample of men with prostate cancer. Given the HLQ's established psychometric properties and associations with health outcomes in various chronic disease cohorts and settings, we expect that it would demonstrate similar function in a prostate cancer population.…”

Comparing outpatient and inpatient utilization rate in physicians, informed healthcare service consumers, and non-physicians, uninformed healthcare service consumers

“…[40,41] Besides, university education is reported to positively correlate with health literacy. [42] Another possible reason contributing to more health service utilization in non-physicians might be their higher actual needs. This could be the result of better access to healthcare and bene cial health behaviors in physicians.…”