Health literacy in men and women with cardiovascular diseases and its association with the use of health care services - Results from the population-based GEDA2014/2015-EHIS survey in Germany

Abstract

BackgroundHealth literacy (HL), defined as the ability to access, understand, appraise and apply health information, offers a promising approach to reduce the development of cardiovascular diseases (CVD) and to improve the management of CVD in populations.DesignWe used data from nationwide cross-sectional German Health Update (GEDA2014/2015-EHIS) survey. 13,577 adults ≥ 40 years completed a comprehensive standardized paper or online questionnaire including the short form of the European Health Literacy Survey Questionnaire (HLS-EU-Q16).MethodsWe compared participants with and without CVD with regard to their HL. We also analyzed the association between HL level and health care outcomes among individuals with CVD, i.e. frequency of general practitioner or specialist consultations, hospitalization and treatment delay.ResultsThe percentage of “problematic” or “inadequate” HL, defined as “not sufficient” HL, was significantly higher in individuals with CVD compared to without CVD (men 41.8% vs. 33.6%, women 46.7% vs. 33.4%). Having CVD was independently associated with “not sufficient” HL after adjusting for age, education, income, health consciousness and social support (adjusted OR: men 1.36, women 1.64). Among participants with CVD, individuals with “inadequate” HL were more likely to have more than 6 general practitioner consultations (49.3% vs. 28.7%), hospitalization (46.6% vs. 36.0%) in the last 12 months and to experience delay in getting health care because of long waiting lists for an appointment (30.7% vs. 18.5%) compared to participants with “sufficient” HL.Conclusion“Problematic” or “inadequate” HL is independently associated with CVD and health care use. This is a challenge and an opportunity for both CVD prevention and treatment.

What is the Prevalence of Low Health Literacy in European Union Member States? A Systematic Review and Meta-analysis

“…Conversely, only four studies were conducted in the East 10 , 86 , 87 , and two studies referred to refugees from non-EU countries 29 , 88 . A consistent heterogeneity was observed among the tools used to assess HL: the most frequently used tools were the Newest Vital Sign, applied in 21 studies 42 , 43 , 45 , 47 , 52 , 55 – 58 , 63 , 67 , 73 , 77 , 79 , 82 , 84 , followed by the European Health Literacy Survey Questionnaire with 16 items ( n = 15) 26 , 27 , 33 , 34 , 38 , 50 , 60 , 71 , 75 , 78 , 83 , 86 and the Rapid Estimate of Adult Literacy in Medicine ( n = 12) 30 , 31 , 40 – 42 , 47 – 49 , 73 , 76 . The European Health Literacy Survey Questionnaire with 47 items 38 , 43 , 55 , 62 , 63 , 78 , 84 , 87 and its longer version with 86 items 10 , 58 were used eleven and nine times each, respectively, followed by the Single Item Literacy Screener ( n = 8) 44 , 61 , 65 , 66 , 69 , 82 and the Medical Term Recognition Test ( n = 7) 56 , 64 , ...…”

“…The other tools were used in a limited number of studies, from one to three each (Table 1 ). Most studies investigated HL using self-reported comprehension items 26 , 27 , 30 , 33 , 34 , 36 , 38 , 44 , 48 – 50 , 54 , 55 , 58 , 60 , 61 , 67 , 68 , 70 – 72 , 74 – 76 , 78 , 81 , 83 , 85 , 86 ( n = 38); 29 studies used reading or numeracy comprehension items 35 , 37 , 39 – 43 , 45 – 47 , 51 , 52 , 55 – 58 , 63 , 67 , 73 , 77 , 79 , 80 , 82 , 84 ; 23 studies used word recognition items 28 – 32 , 58 , 59 , 62 , 65 , 66 , 79 , 82 ; and nine studies used a mixed method 10 , 58 . Sixty-six studies quantified low HL in the general population 10 , 26 , 29 , 31 – 34 , 36 , 39 , 40…”

“…Sixty-six studies quantified low HL in the general population 10 , 26 , 29 , 31 – 34 , 36 , 39 , 40 , 43 – 45 , 47 , 48 , 50 – 65 , 70 , 71 , 73 , 75 , 76 , 78 , 80 , 83 , 84 . Patients with chronic diseases were investigated in 25 studies 28 , 35 , 37 , 38 , 41 , 42 , 46 , 49 , 66 , 68 , 69 , 71 , 74 , 77 , 79 , 82 , 85 , whereas a smaller number of studies ( n = 6) looked at oncology patients 47 , 61 , 75 , 80 . Only two studies 29 , 88 investigated low HL in refugees.…”

Gesundheitskompetenz von Menschen mit chronischer Erkrankung in Deutschland

“…Lediglich zu einzelnen Erkrankungen wie bspw. zur Gesundheitskompetenz bei Herz-Kreislauf-und Krebserkrankungen existieren hier erste explorative Studien [11][12][13]. International, v. a. in den USA, besteht eine langjährige Forschungstradition zur Gesundheitskompetenz von MmcE [14].…”

“…Die Zahl dieser Studien ist in Deutschland jedoch noch gering. Auch Auswertungen für einzelne Bevölkerungsgruppen liegen nur vereinzelt vor [11,20]. Wichtig ist bei chronischer Krankheit zudem, die Dauer und die Anzahl der Krankheiten zu berücksichtigen.…”