The Impact of Inadequate Health Literacy in a Population with Musculoskeletal Pain

Abstract

Musculoskeletal conditions are a major cause of ill health and disability. Inadequate health literacy may partly explain why musculoskeletal self-management programs are not effective for some patients. This study prospectively evaluated the impact of patients' health literacy level on their musculoskeletal pain and physical function (PF) following usual primary care. Primary care patients ( N = 4,720) who had consulted for musculoskeletal pain were mailed a baseline questionnaire; responders were sent a 6-month follow-up questionnaire. The measure of health literacy used was the single-item Literary Screener at baseline, and the outcomes were PF and pain intensity at the 6-months follow-up. Analysis was conducted by linear regression. The number of patients who responded was 1,890 (40%); 17.3% (95% CI [15.6%–19%]) of them had inadequate health literacy. Inadequate health literacy was associated with older age ( p < .05), lower education, mental health, and comorbidities (all p < .001), but not by gender ( p = .642). At the 6-month follow-up stage, patients with inadequate health literacy had lower PF (mean difference −12.2; 95% CI [−16.7, −7.6]) and higher pain intensity (mean difference 1; 95% CI [0.6, 1.4]), which was adjusted for age, gender, education, mental health, and comorbidities. Differences in PF and particularly pain scores between patients with inadequate and adequate health literacy increased over 6 months. Future studies should develop interventions that better support patients who have musculoskeletal pain with inadequate health literacy to successfully manage their pain. [ HLRP: Health Literacy Research and Practice . 2018;2(4):e214–e220.]

Can patients with low health literacy be identified from routine primary care health records? A cross-sectional and prospective analysis

“…In this current cohort just over 16% of the population were defined as low HL using the categorisations “always, often, sometimes” from the SILS measure following previous methodology [13, 24]. This percentage of low HL is similar to Morris et al [13] (who used the S-TOFHLA and report 17%) within their primary care population who were participating in a diabetes RCT.…”

“…This dataset was chosen for this study because consultations for musculoskeletal pain conditions are common in primary care (up to 20% of the primary care population will consult about musculoskeletal conditions in a given year [20]), and most often require significant patient/healthcare engagement and self-management over time, therefore potentially placing HL as an important factor for this patient population [21–23]. Furthermore, a recent prospective study, using the KAPS dataset, showed those with low health literacy reported lower levels of physical function and higher levels of pain intensity at 6 months compared to those with adequate levels of health literacy, illustrating the relevance of HL status in this population [24].…”

“…The benchmark assessment of health literacy (HL) was measured at baseline in KAPS using the Single Item Literacy Screener (SILS): “How often do you need to have someone help you when you read instructions on pamphlets, or other written material from your doctor or pharmacy?” [13]. Response options were often, always, sometimes, rarely, never, and the identification of “low” HL was taken by combining groups who had responded “often”, “always” and “sometimes” to create two groups (low and adequate HL) following previous methodology [13, 24].…”

“…In order to improve this Cohort DAHL a number of additional measures within the KAPS dataset were examined as potentially associated with low HL. These measures were selected based on previous research demonstrating associations with HL [2, 24, 26, 27], and also the likelihood of these measures being available (i.e. either directly or via proxy) within primary care medical records (Table 1).…”

4P Model for Dynamic Prediction of Covid-19 with statistical and machine learning approach: Social Dynamics, Government Roles and Pathogen Behavior on Bangladesh Perspective

“…A detailed account of the history of epidemic and pandemic can be found in [1]. Throughout the history, it has been observed that inadequate knowledge about the disease, misinformation and misconception among populous, and improper handling of the situation caused more damage than it would have [2,3,4,5,6,7,8,9]. No wonder, in the case of Covid-19, we have acknowledged various confusing or sometimes conflicting information about the epidemic that affects the proper functioning of government.…”