Health literacy level in a various nephrology population from Québec: predialysis clinic, in-centre hemodialysis and home dialysis; a transversal monocentric observational study

Abstract

Background Health literacy refers to the ability of individuals to gain access to, use, and understand health information and services in order to maintain a good health. It is especially important in nephrology due to the complexity of chronic kidney disease (CKD). The present study sought to define health literacy levels in patients followed in predialysis clinic, in-center dialysis (ICHD), peritoneal dialysis (PD) and home hemodialysis (HHD). Methods This transversal monocentric observational study analysed 363 patients between October 2016 and April 2017. The Brief Health Literacy Screen (BHLS) and the Health Literacy Questionnaire (HLQ) were used to measure health literacy. Multivariate linear regressions were used to compare the mean scores on the BHLS and HLQ, across the four groups. Results Patients on PD had a significantly higher BHLS’score than patients on ICHD (p = 0.04). HLQ’s scores differed across the groups: patients on HHD (p = 0.01) and PD (p = 0.002) were more likely to feel understood by their healthcare providers. Compared to ICHD, patients on HHD were more likely to have sufficient information to manage their health (p = 0.02), and patients in the predialysis clinic were more likely to report high abilities for health information appraisal (p < 0.001). Conclusion In a monocentric study, there is a significant proportion of CKD patients, especially in predialysis clinic and in-centre hemodialysis, with limited health literacy. Patients on home dialysis (HHD and PD) had a higher level of health literacy compared to the other groups.

The need for individualizing teaching and assurance of knowledge transmission to patients training for home dialysis

“…The World Health Organization defines health literacy as ‘the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health.’ 11 Health literacy is essential in the provision of dialysis given its complexity and level of engagement required for monitoring 11 . Health literacy is also important in developing good self‐care practices that include maintaining healthy dietary practices along with medication adherence 11 . It is estimated that 18%–28% of patients with chronic kidney disease have limited health literacy.…”

“…It is estimated that 18%–28% of patients with chronic kidney disease have limited health literacy. In the dialysis population, this is estimated to be 16%–32%; a brief health literacy screen scores highest for patients on HHD and lowest for those on in‐center haemodialysis (ICHD) 11 . Patients on HHD feel more supported and understood by their healthcare providers than those on ICHD 11 .…”

“…In the dialysis population, this is estimated to be 16%–32%; a brief health literacy screen scores highest for patients on HHD and lowest for those on in‐center haemodialysis (ICHD) 11 . Patients on HHD feel more supported and understood by their healthcare providers than those on ICHD 11 . Interestingly, although the global health literacy level of ICHD patients is lower, there are still patients with high health literacy on ICHD suggesting alternate factors are contributory to their decision not to perform HHD 11 …”

“…Patients on HHD feel more supported and understood by their healthcare providers than those on ICHD 11 . Interestingly, although the global health literacy level of ICHD patients is lower, there are still patients with high health literacy on ICHD suggesting alternate factors are contributory to their decision not to perform HHD 11 …”

“…Women were less likely to have home dialysis with increasing age, but interestingly were also more likely to have home dialysis if they received information from three or more different sources 12 . Studies have previously suggested that existing patient educational literature is inadequate for the needs of the patient with CKD 11 . As a consequence, low health literacy is associated with difficulties in navigating available information to make an informed health decision.…”