Factors associated with health literacy in multimorbid patients in primary care: a cross-sectional study in Switzerland.

TitreFactors associated with health literacy in multimorbid patients in primary care: a cross-sectional study in Switzerland.
Publication TypeJournal Article
Year of Publication2018
AuthorsN'Goran, AA, Pasquier, J, Deruaz-Luyet, A, Burnand, B, Haller, DM, Neuner-Jehle, S, Zeller, A, Streit, S, Herzig, L, Bodenmann, P
JournalBMJ Open
Date Published02/2018
Mots-clésGeneral Medicine (see Internal Medicine), Primary Care, Public Health

OBJECTIVE: To identify factors associated with health literacy in multimorbid patients.

DESIGN: A nationwide cross-sectional study in Switzerland. Univariate and multivariate linear regressions were calculated to identify variables associated with health literacy. A multiple imputation approach was used to deal with missing values.

PARTICIPANTS: Multimorbid patients recruited in primary care settings (n=888), above 18 years old and suffering from at least 3 of 75 chronic conditions on a predefined list based on the International Classification of Primary Care 2.

MAIN MEASURES: Health literacy was assessed using the European Health Literacy Survey project questionnaire (HLS-EU 6). This comprises six items scored from 1 to 4 (very difficult=1, fairly difficult=2, fairly easy=3, very easy=4), and the total health literacy score is computed as their mean. As we wished to understand the determinants associated with lower health literacy, the HLS-EU 6 score was the only dependent variable; all other covariates were considered independent.

RESULTS: The mean health literacy score (SD) was 2.9 (0.5). Multivariate analyses found significant associations between low health literacy scores and treatment burden scores (β=-0.004, 95% CI -0.006 to 0.002); marital status, predominantly the divorced group (β=0.136, 95% CI 0.012 to 0.260); dimensions of the EuroQuol 5 Dimension 3 Level (EQ5D3L) quality of life assessment, that is, for moderate problems with mobility (β=-0.086, 95% CI -0.157 to 0.016); and with moderate problems (β=-0.129, 95% CI -0.198 to 0.060) and severe problems with anxiety/depression (β=-0.343, 95% CI -0.500 to 0.186).

CONCLUSIONS: Multimorbid patients with a high treatment burden, altered quality of life by problems with mobility, anxiety or depression, often also have low levels of health literacy. Primary care practitioners should therefore pay particular attention to these patients in their daily practice.


Publication types: Journal Article ; Research Support, Non-U.S. Gov't

Alternate URL


Alternate JournalBMJ Open
Citation Key / SERVAL ID8622
Peer reviewRefereed
PubMed ID29440210


IUMSP | www.iumsp.ch
Institut universitaire de médecine sociale et préventive
Route de la Corniche 10, 1010 Lausanne - Switzerland
+41 21 314 72 72 | dess.info@unisante.ch

Go to top