The impact of health literacy and life style risk factors on health-related quality of life of Australian patients

Abstract

BackgroundLimited evidence exists regarding the relationship between health literacy and health-related quality of life (HRQoL) in Australian patients from primary care. The objective of this study was to investigate the impact of health literacy on HRQoL in a large sample of patients without known vascular disease or diabetes and to examine whether the difference in HRQoL between low and high health literacy groups was clinically significant.MethodsThis was a cross-sectional study of baseline data from a cluster randomised trial. The study included 739 patients from 30 general practices across four Australian states conducted in 2012 and 2013 using the standard Short Form Health Survey (SF-12) version 2. SF-12 physical component score (PCS-12) and mental component score (MCS-12) are derived using the standard US algorithm. Health literacy was measured using the Health Literacy Management Scale (HeLMS). Multilevel regression analysis (patients at level 1 and general practices at level 2) was applied to relate PCS-12 and MCS-12 to patient reported life style risk behaviours including health literacy and demographic factors.ResultsLow health literacy patients were more likely to be smokers (12 % vs 6 %, P = 0.005), do insufficient physical activity (63 % vs 47 %, P < 0.001), be overweight (68 % vs 52 %, P < 0.001), and have lower physical health and lower mental health with large clinically significant effect sizes of 0.56 (B (regression coefficient) = −5.4, P < 0.001) and 0.78(B = -6.4, P < 0.001) respectively after adjustment for confounding factors. Patients with insufficient physical activity were likely to have a lower physical health score (effect size = 0.42, B = −3.1, P < 0.001) and lower mental health (effect size = 0.37, B = −2.6, P < 0.001). Being overweight tended to be related to a lower PCS-12 (effect size = 0.41, B = −1.8, P < 0.05). Less well-educated, unemployed and smoking patients with low health literacy reported worse physical health. Health literacy accounted for 45 and 70 % of the total between patient variance explained in PCS-12 and MCS-12 respectively.ConclusionsAddressing health literacy related barriers to preventive care may help reduce some of the disparities in HRQoL. Recognising and tailoring health related communication to those with low health literacy may improve health outcomes including HRQoL in general practice.

Health literacy of the baby boomer generation and the implications for nursing

“…Two studies were descriptive, using a single instrument, the Health Literacy Questionnaire (Beauchamp et al., ; Bo, Friis, Osborne, & Maindal, ). Two studies used comparative analyses, using two instruments in each study (Jayasinghe et al., ; Tennant et al., ). In terms of sampling, two studies used randomised samples from specific settings, health and community care organisations (Beauchamp et al., ) and general practices (Jayasinghe et al., ), and two were population based samples.…”

“…Two studies used comparative analyses, using two instruments in each study (Jayasinghe et al., ; Tennant et al., ). In terms of sampling, two studies used randomised samples from specific settings, health and community care organisations (Beauchamp et al., ) and general practices (Jayasinghe et al., ), and two were population based samples. Sample size ranged from 283 participants in individual studies, to 29,473 participants in population surveys.…”

“…Although language is not reported, Jayasinghe et al. () found that the number of people born outside Australia was balanced between low and high health literacy. Language was not reported as a variable in the fourth study (Jayasinghe et al., ).…”

“…Jayasinghe et al. () found that people with low health literacy and lower education experienced worse physical health. Finally, Tennant et al.…”

“…Although older people reported accessing information on the internet (Tennant et al., ), access does not guarantee understanding, as noted by the research team (Tennant et al., ). In two studies, low health literacy was associated with lack of engagement with health professionals (Beauchamp et al., ; Jayasinghe et al., ). This is supported by the finding in a third study, that people with low health literacy report difficulty in discussing problems with their health care practitioners, leaving them feeling misunderstood (Bo et al., ).…”