The association between health literacy and self-management abilities in adults aged 75 and older, and its moderators
Qual Life Res
DOI 10.1007/s11136-016-1298-2
The association between health literacy and self-management
abilities in adults aged 75 and older, and its moderators
Bas Geboers1 • Andrea F. de Winter1 • Sophie L. W. Spoorenberg1 •
Klaske Wynia1 • Sijmen A. Reijneveld1
Accepted: 12 April 2016
Ó The Author(s) 2016. This article is published with open access at Springerlink.com
Abstract
Purpose Low health literacy is an important predictor of
poor health outcomes and well-being among older adults.
A reason may be that low health literacy decreases older
adults’ self-management abilities. We therefore assessed
the association between health literacy and self-management abilities among adults aged 75 and older, and the
impact of demographic factors, socioeconomic factors, and
health status on this association.
Methods We used data of 1052 older adults, gathered for
a previously conducted randomized controlled trial on
Embrace, an integrated elderly care model. These data
pertained to health literacy, self-management abilities,
demographic background, socioeconomic situation, and
health status. Health literacy was measured by the validated three-item Brief Health Literacy Screening instrument. Self-management abilities were measured by the
validated Self-Management Ability Scale (SMAS-30).
Results After adjustment for confounders, self-management abilities were poorer in older adults with low health
literacy (b = .34, p \ .001). This was more pronounced in
medium- to high-educated older adults than in low-educated older adults. Sex, age, living situation, income,
presence of chronic illness, and mental health status did not
moderate the association between health literacy and selfmanagement abilities.
Conclusions Low health literacy is associated with poor
self-management abilities in a wide range of older adults.
& Bas Geboers
1
Department of Health Sciences, University Medical Center
Groningen, University of Groningen, FA10, P.O. Box 196,
9700 AD Groningen, The Netherlands
Early recognition of low health literacy among adults of
75 years and older and interventions to improve health
literacy might be very beneficial for older adults.
Keywords Health literacy Older adults Selfmanagement Well-being Educational level
Introduction
Health literacy is an increasingly important topic in public
health. A large-scale health literacy survey in eight European countries estimates that around 47 % of European
adults have low health literacy, i.e., that they have substantial problems with health-related tasks and situations
[1]. Older adults are an especially vulnerable group with
regard to health literacy [2–6]. Health literacy has been
defined as ‘the degree to which people are able to access,
understand, appraise, and communicate information to
engage with the demands of different health contexts in
order to promote and maintain good health across the lifecourse [7].’
Low health literacy has been shown to be an important
predictor of various negative health outcomes, such as
frequent hospitalization [8], higher mortality rates [9], and
lower well-being [10]. The association between health literacy and well-being could be because low health literacy
limits the self-management abilities of older adults. While
many health literacy studies among older adults have
focused on the association between health literacy and selfmanagement behaviors in the healthcare context [11–15],
the association between health literacy and self-management abilities (SMA) has largely been neglected. SMA
consist of a general repertoire of cognitive and behavioral
abilities for managing external resources in such a way that
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Qual Life Res
physical and social well-being is maintained or restored
when lost [16]. SMA have been shown to be associated
with major outcomes, such as well-being [17, 18] and
health status [19].
However, evidence as to the association between health
literacy and SMA is lacking, as is the case for its potential
moderators. These moderators may include demographic
factors like sex, age, and living situation. For example,
living alone could indicate a lower level of social support;
as a result, there could be too little social support to buffer
the negative consequences of low health literacy [20].
Moreover, socioeconomic status, e.g., educational level
and income, may also influence the association between
health literacy and SMA. It could, for example, be possible
for older adults with a higher educational level to have
good self-management abilities, even if they have low
health literacy.
This study therefore aims to (1) assess the association
between health literacy and SMA among adults aged 75
and older, and (2) assess the impact of potential moderators
(sex, age, living situation, educational level, income,
presence of chronic illness, and mental health status) on
this association.
Methods
Design and setting
This study consisted of secondary analyses of follow-up
data from the stratified randomized controlled trial of
Embrace, on adults aged 75 and older [21]. The study
started in 2011 and was conducted in the eastern part of the
province of Groningen, the Netherlands, which is one of
the most deprived rural areas of the country. Participants
were stratified into three risk profiles (i.e., robust, frail, and
complex care needs), based on their level of frailty and
their complexity of care needs. Next, balanced randomization was conducted per risk profile in order to achieve
equal distributions across treatment groups of characteristics that could affect intervention outcomes [22]. The balancing criteria were sex, age, complexity of care needs,
frailty, living situation, number of chronic conditions,
whether or not receiving homecare, and whether or not
receiving help with filling out the questionnaires. Embrace
is a novel population-based elderly care model which aims
to prolong the ability of older adults to age in place by
meeting their needs through supporting integrated care
[21]. The type and intensity of care and support that the
participants received was based on their risk profile. Participants in the robust profile received low intensity care
with a focus on self-management support and prevention;
participants in the frail profile received high intensity care
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with a focus on psychosocial aspects; and participants in
the profile with complex care needs received high intensity
care with a focus on health care. The participants in the
control group received care as usual, as provided by general practitioners and local health and community organizations. A more detailed description of the study design
can be found in the published study protocol [21].
Study population
Participants were recruited via their GPs and were eligible
for inclusion if they were aged 75 years or older. Exclusion criteria were long-term stay in a nursing home,
receiving an alternative type of integrated care, or participating in another research study. Of those eligible,
1456 old (...truncated)
