Impact of Health Literacy in Patients with Chronic Musculoskeletal Disease–Systematic Review

PLOS ONE, Dec 2019

Objectives To estimate the prevalence of low health literacy, and evaluate the impact of low health literacy on outcomes in patients with chronic musculoskeletal conditions. Data Sources We searched Embase, Pubmed, PsycInfo, and CINAHL in January 2011 for relevant studies, restricted to English-language articles. Study Selection and Data Extraction Studies were included if they measured health literacy and/or reported on the link between outcomes and health literacy levels in patients with osteoporosis, osteoarthritis, or rheumatoid arthritis. We assessed risk of bias from participant selection, methods of measuring health literacy and functional outcomes, missing data, and potential for confounding. Data Synthesis We reviewed 1863 citations and judged 8 studies to be relevant. Most were cross-sectional in nature, and five were based in the United States. Diversity in measurements, participant characteristics, and settings meant that results had to be synthesized narratively. Prevalence of low health literacy varied from 7% to 42%. Of the five studies that reported on musculoskeletal outcomes, only one showed an association (unadjusted) between low health literacy and greater pain and limitations in physical functioning. However, other studies, including those with multivariate analyses, found no significant relationship between health literacy and measures of pain or disease specific questionnaires. One clinical trial found short-term improvements in the mental health of patients with musculoskeletal conditions after an intervention to improve health literacy. Limitations Most of the studies were cross-sectional in nature, which precludes interpretation of a causal relationship. The sample sizes may not have been sufficiently large to enable detection of significant associations. Conclusions The current evidence does not show a consistent association between low health literacy and poorer functional outcomes in patients with chronic musculoskeletal conditions. In the absence of a definite link, efforts to develop interventions to improve health literacy would not necessarily improve health service or patient-related outcomes.

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Impact of Health Literacy in Patients with Chronic Musculoskeletal Disease–Systematic Review

et al. (2012) Impact of Health Literacy in Patients with Chronic Musculoskeletal Disease-Systematic Review. PLoS ONE 7(7): e40210. doi:10.1371/journal.pone.0040210 Impact of Health Literacy in Patients with Chronic Musculoskeletal Disease-Systematic Review Yoon K. Loke 0 Ina Hinz 0 Xia Wang 0 Gill Rowlands 0 David Scott 0 Charlotte Salter 0 Ulrich Thiem, Marienhospital Herne - University of Bochum, Germany 0 1 Norwich Medical School, University of East Anglia , Norwich, Norfolk , United Kingdom , 2 Institute of Primary Care and Public Health, London South Bank University , London , United Kingdom Objectives: To estimate the prevalence of low health literacy, and evaluate the impact of low health literacy on outcomes in patients with chronic musculoskeletal conditions. Study Selection and Data Extraction: Studies were included if they measured health literacy and/or reported on the link between outcomes and health literacy levels in patients with osteoporosis, osteoarthritis, or rheumatoid arthritis. We assessed risk of bias from participant selection, methods of measuring health literacy and functional outcomes, missing data, and potential for confounding. Data Synthesis: We reviewed 1863 citations and judged 8 studies to be relevant. Most were cross-sectional in nature, and five were based in the United States. Diversity in measurements, participant characteristics, and settings meant that results had to be synthesized narratively. Prevalence of low health literacy varied from 7% to 42%. Of the five studies that reported on musculoskeletal outcomes, only one showed an association (unadjusted) between low health literacy and greater pain and limitations in physical functioning. However, other studies, including those with multivariate analyses, found no significant relationship between health literacy and measures of pain or disease specific questionnaires. One clinical trial found short-term improvements in the mental health of patients with musculoskeletal conditions after an intervention to improve health literacy. Limitations: Most of the studies were cross-sectional in nature, which precludes interpretation of a causal relationship. The sample sizes may not have been sufficiently large to enable detection of significant associations. Conclusions: The current evidence does not show a consistent association between low health literacy and poorer functional outcomes in patients with chronic musculoskeletal conditions. In the absence of a definite link, efforts to develop interventions to improve health literacy would not necessarily improve health service or patient-related outcomes. - Funding: This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-1207-15244). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. The Institute of Medicine Committee for Health Literacy considers health literacy to be the degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health. [1] Older patients with low health literacy and cancer show less knowledge of their condition and its management, and have more difficulty making informed choices. [2] Low levels of health literacy are linked with increased hospital admissions and mortality, [3] whilst higher health literacy has been shown to be associated with greater health knowledge and selfconfidence. [4]. Health literacy is considered to encompass three different levels. Functional health literacy refers to the basic reading and writing skills to manage health information in common daily settings, whereas the interactive and critical levels involve more advanced cognitive skills (e.g. improved ability to appraise new information and act independently, perhaps to influence change at personal and community levels). [5] Validated tools such as the Rapid Estimate of Adult Literacy in Medicine (REALM) or the Test of Functional Health Literacy in Adults (TOFHLA) can be used to measure health literacy. Components of the REALM include word recognition and pronunciation, whereas the TOFHLA evaluates reading comprehension and numeracy. [6] Both these tools are primarily aimed at functional health literacy. [7]. The complexity and potential toxicity of treatments, effects on quality of life and activities of daily living mean that low health literacy may have an important impact on patients disease severity and adherence to treatment. Low levels of health literacy may potentially cause patients with chronic musculoskeletal conditions to face difficulties in use of he (...truncated)


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Yoon K. Loke, Ina Hinz, Xia Wang, Gill Rowlands, David Scott, Charlotte Salter. Impact of Health Literacy in Patients with Chronic Musculoskeletal Disease–Systematic Review, PLOS ONE, 2012, Volume 7, Issue 7, DOI: 10.1371/journal.pone.0040210