AimThe aim of this study was to investigate health literacy in patients with chronic kidney disease in a multidimensional perspective.DesignA descriptive, cross‐sectional study.MethodsPatients with chronic kidney disease at stages 3–5 were included in the study between February–August 2017 (N = 187). Health literacy was measured by the Health Literacy Questionnaire (HLQ). Multiple linear regression analysis was performed to identify associations between health literacy and demographic and clinical variables. Hierarchical cluster analysis was performed to identify characteristics of groups with high and low health literacy.ResultsFinding and critical appraise health information were the most challenging dimensions of health literacy. Female gender, lower level of education, greater number of prescribed medications and depressive symptoms were associated with lower health literacy. The group identified with lowest health literacy was further characterized by living alone and presence of comorbidity.

SUMMARY Background Health literacy (HL) is a multidimensional concept with significance for self‐management and health outcomes in patients with chronic kidney disease (CKD); however, research with a multidimensional perspective on HL is scarce. Objectives This study aimed to explore the relationship between multidimensional HL, quality of life (QoL) and adherence to long‐term therapy in CKD patients. Design A descriptive single‐centre cross‐sectional study. Participants Patients with CKD in stages 3–5 were recruited from the nephrology unit in a Norwegian hospital. Measurements The Health Literacy Questionnaire (HLQ) was used to assess HL, QoL was measured by the Short Form‐12 (SF‐12) and a Visual Analogue Scale (VAS‐QoL). Adherence to long‐term therapy was measured by the Medical Adherence Rating Scale 5 (MARS‐5), participants' prescription withdrawals from pharmacies, and a VAS (VAS‐adherence). Hierarchical cluster analysis was performed to group patients with similar HLQ scores, and multiple linear regression analysis was performed to identify the HL dimensions that were associated with QoL and adherence to long‐term therapy. Results A total of 187 patients were included, 65% were male, and the mean (SD) age was 67 (13) years. The high‐level HL group (N = 52) had significantly better QoL than patients in the mid‐level (N = 106) and low‐level (N = 27) HL groups. The HL dimensions “actively managing health,” “actively engage with healthcare providers,” “ability to find good health information” and “ability to understand health information” were predictive of QoL and adherence to long‐term therapy. Conclusion HL seems to be important for both QoL and adherence to long‐term therapy.

Background: Patients with chronic kidney disease make day-today decisions about how to self-manage their disease. Chronic kidney disease (CKD) includes a risk for progression towards end-stage renal disease and the development of comorbidities, such as cardiovascular disease, which represents the leading cause of death among these patients. To reduce these risks, CKD patients are recommended to follow a healthy lifestyle with physical activity, food and fluid restrictions, and adherence to complex medication regimes throughout all phases of the disease. To manage the complexity of this health situation, health literacy (HL) is considered essential. The current prevailing understanding is that HL is a multidimensional concept and comprises a range of cognitive, affective, social, and personal skills that determine the motivation and ability to gain access to, understand, and use health information. Recently, we investigated multiple aspects of HL in CKD patients in a quantitative cross-sectional study utilizing the Health Literacy Questionnaire (HLQ) and observed that finding good health information and appraising health information were the most challenging aspects of HL. This study aimed to explore CKD patients' lived experiences of different dimensions of HL presented in the HLQ. Methods: This qualitative study utilized in-depth semistructured interviews. Twelve patients with different levels of HL were included. The interviews were analyzed using thematic analysis as described by Braun and Clarke. Results: We identified three main themes that were significant for CKD patients' HL: 1. Variation in people's attitudes and behavior as health information seekers, 2. The problem of fragmented healthcare in the context of multimorbidity makes the healthcare system challenging to navigate, and 3. The value of a good relationship with healthcare providers. Conclusion: CKD patients take different approaches to health information. Limiting or avoiding health information may be a strategy used by some individuals to cope with the disease and does not necessarily mean that health information is inaccessible or difficult to understand. Comorbidity and a fragmented healthcare system can make the healthcare system challenging to navigate. A good and trusting relationship with healthcare providers seems to promote several aspects of HL and should be promoted to optimize CKD patients' HL.