MULTIDIMENSIONAL VIEW OF THE HEALTH LITERACY LEVEL OF ADULT PATIENTS IN PRIMARY HEALTHCAREABSTRACT
Objective: to identify the conditions of health literacy and their association with the sociodemographic and clinical profile of the population treated in primary healthcare.
Method: a cross-sectional study was conducted with 386 patients treated at a Basic Health Unit in the Federal District, Brazil. Individual interviews were conducted using a questionnaire to collect sociodemographic and health data from patients, in addition to the Brazilian version of the Health Literacy Questionnaire. Data collection took place between May and August 2022, and the data were analyzed using descriptive and inferential statistics.
Results: the majority of study participants were women (76.1%), aged 18 to 40 years (76.1%), with self-perceived health classified as good (38%). The average scores on the Health Literacy Questionnaire ranged from 2.36 to 3.73, indicating limitations in health literacy, especially on the scales of ‘Understanding and support from health professionals’ (2.36), ‘Sufficient information to take care of health’ (2.52), ‘Active care’ (2.67) and ‘Navigating the health system’ (2.98).
Conclusion: the data found indicate factors that can be worked on in the studied population to increase the level of health literacy, with the aim of increasing patient autonomy and their co-responsibility for continuous, effective and safe primary care.
DESCRIPTORS: Health literacy; Health instruments; Primary healthcare; Nursing; Health promotion
RESUMEN
Objetivo: identificar las condiciones de alfabetización en salud y su asociación con el perfil sociodemográfico y clínico de la población atendida en la atención primaria de salud.
Método: Estudio transversal realizado con 386 pacientes atendidos en una Unidad Básica de Salud del Distrito Federal, Brasil. Se realizó una entrevista individual, utilizando un cuestionario para recolectar datos sociodemográficos y de salud de los pacientes, además de la versión brasileña del Health Literacy Questionnaire. La recolección de datos se realizó entre mayo y agosto de 2022 y los datos se analizaron mediante estadística descriptiva e inferencial.
Resultados: la mayoría de los participantes del estudio fueron mujeres (76,1%), con edades entre 18 y 40 años (76,1%), con autopercepción de salud clasificada como buena (38%). Las puntuaciones medias del Cuestionario de Alfabetización en Salud oscilaron entre 2,36 y 3,73, lo que indica limitaciones en la alfabetización en salud, especialmente en las escalas de ‘Comprensión y apoyo de los profesionales de la salud’ (2,36), ‘Información suficiente para cuidar la salud’ (2,52), ‘Atención activa’ (2,67) y ‘Navegación por el sistema sanitario’ (2,98).
Conclusión: los datos encontrados indican factores que pueden ser trabajados en la población estudiada para incrementar el nivel de alfabetización en salud, con el objetivo de incrementar la autonomía y corresponsabilidad del paciente para una atención primaria continua, resolutiva y segura.
DESCRIPTORES: Alfabetización en salud; Instrumentos de salud; Atención Primaria de Salud; Promoción de la salud
RESUMO
Objetivo: identificar as condições de letramento em saúde e sua associação com o perfil sociodemográfico e clínico da população atendida na atenção primária à saúde.
Método: estudo transversal realizado com 386 pacientes atendidos em uma Unidade Básica de Saúde no Distrito Federal, Brasil. Foi realizada entrevista individual, utilizando questionário para coleta de dados sociodemográfico e de saúde dos pacientes, além da versão brasileira do Health Literacy Questionnaire. A coleta de dados ocorreu entre maio e agosto de 2022 e os dados foram analisados por meio de estatística descritiva e inferencial.
Resultados: a maioria dos participantes do estudo era composta por mulheres (76,1%), na faixa etária de 18 a 40 anos (76,1%), com autopercepção de saúde classificada como boa (38%). Os escores médios do Health Literacy Questionnaire variaram entre 2,36 e 3,73, indicando limitações no letramento em saúde, especialmente nas escalas de ‘Compreensão e apoio dos profissionais de saúde’ (2,36), ‘Informações suficientes para cuidar da saúde’ (2,52), ‘Cuidado ativo’ (2,67) e ‘Navegar no sistema de saúde’ (2,98).
Conclusão: os dados encontrados indicam fatores que podem ser trabalhados na população estudada para ampliar o nível de letramento em saúde, com o objetivo de aumentar a autonomia do paciente e sua corresponsabilização para um cuidado primário contínuo, resolutivo e seguro.
DESCRITORES: Letramento em saúde; Instrumentos em saúde; Atenção Primária em Saúde; Enfermagem; Promoção da saúde
INTRODUCTION
Health literacy refers to the knowledge and personal skills acquired through daily activities, social interactions and intergenerational transmission. This knowledge and personal skills are mediated by organizational structures and the availability of resources, which enable people to access, understand, evaluate and use information and services in ways that promote and maintain health and well-being for both themselves and those around them1. By facilitating access to understandable and reliable health information, as well as the ability to use it effectively, health literacy becomes essential to empower individuals to make informed decisions about their personal health and to promote their engagement in collective health promotion actions considering health determinants1.
Within the development plan for preventing and controlling chronic non-communicable diseases (NCDs), the World Health Organization (WHO) mentions the importance of building community health literacy based on knowledge, resources and skills, which are considered health literacy assets. In this context, it is essential to assess whether the knowledge circulating within the community is reliable, in addition to monitoring health promotion customs incorporated into beliefs, cultural norms and traditional or emerging practices of daily life. It is also essential to understand the community’s relationship with external information sources2.
Health literacy should be a central approach in primary healthcare (PHC), which encompasses “individual, family and collective health actions involving promotion, prevention, protection, diagnosis, treatment, rehabilitation, harm reduction, palliative care and health surveillance, developed through integrated care practices and qualified management”3:1. In the context of healthcare, PHC is the gateway and communication center of the Healthcare Network, exercising the function of coordinating care and organizing the network’s actions and services based on health determinants and conditions3.
PHC is structured through the Family Health Strategy (Estratégia de Saúde da Família - EFS), and when well executed offers several benefits to the population served, such as reducing child and adult morbidity and mortality, expanding access to treatment for infectious diseases, reducing inequalities and increasing efficiency in the Unified Health System (Sistema Único de Saúde - SUS). These factors result in a reduction in hospitalizations and the need for rehabilitation due to non-communicable diseases (NCDs)4.
In view of this, investigating the health literacy of the population served in the context of primary care enables optimizing its contribution to mediating the causes and effects of social determinants. Furthermore, existing interventions demonstrate the feasibility of improving health education among high-risk populations5.
Assessing health literacy allows researchers, health professionals and policy makers to assess the current ability of community members to understand available information about their health needs and use it to make informed decisions which positively influence outcomes. Health literacy has been found to be the factor that most impacts health, surpassing other social determinants such as education, employment, socioeconomic status and lifestyle-related factors. It mediates the relationship between demographic, economic and social factors, influencing general health status, health-related quality of life, health habits and the use of preventive services6.
In this context, identifying the population profile in relation to their level of health literacy generates scientific evidence and enables developing strategies for community involvement in their health-disease process, positively impacting health improvement and promotion. Considering that health literacy encompasses multiple dimensions, the use of a validated and multidimensional instrument broadens understanding of possible problems, helps create tools to support both patients and professionals in self-management of health, and reinforces aspects related to health promotion and its determinants.
In view of the above, with the aim of deepening and building evidence on the relationship between health literacy and PHC care, the present study aimed to identify the conditions of health literacy and its association with the sociodemographic and clinical profile of the population served by PHC.
METHOD
This is a cross-sectional study conducted with 386 patients treated at the Basic Health Unit (Unidade Básica de Saúde - UBS) of the Federal District, Brazil. The UBS setting is composed of 11 family health teams, each consisting of the minimum team, which includes a doctor, a nurse, two nursing technicians and a community health agent.
The study included adult patients, aged between 18 and 60 years, of both sexes, who were registered on the UBS health map. The exclusion criterion was considered those patients who did not use the basic health unit services in question even though they were registered.
The total number of users eligible to participate in the study was calculated based on the number of people served by each team, according to the National Primary Care Policy (Política Nacional de Atenção Básica - PNAB), the number of teams in the study setting (11) and the proportion of adult users in the Santa Maria region (80%). The study sample was calculated on the OpenEpi platform considering 30,000 users, a 95% confidence interval, a prevalence of the phenomenon found in the international literature of 47%, a precision of 5.0 and a design effect of 1.0, totaling 378 users. The final study sample was 386 users, selected by convenience (not randomly).
Next, two instruments were used to collect data: the first, entitled “Survey of Sociodemographic and Health Data of Patients”, was specifically created for this study and consisted of questions that investigated age, sex, education level (elementary, secondary and higher), health insurance contracting, health condition, self-assessment of health status, and the presence of chronic diseases, totaling 8 questions. The second instrument is designed to identify the specific potentialities and limitations in health literacy of individuals and communities, called the Health Literacy Questionnaire (HLQ-Br). This instrument was translated and validated for use in Brazil in 2018, presenting good psychometric properties, with Cronbach’s Alpha of 0.76 in eight of the nine scales7.
The HLQ-Br is a multidimensional instrument that assesses nine areas of health literacy, distributed in 44 items, as shown in Figure 1. The instrument is divided into two parts. The first part includes five Likert-type scales, with scores from 1 to 4 (strongly disagree = 1, disagree = 2, agree = 3, strongly agree = 4). Of these, scales 1 and 2 guide decisions about needs and outcomes at the organizational level, while scales 3, 4, and 5 focus on the individual level. The second part contains four scales, with scores from 1 to 5 (can’t do or always difficult = 1, usually difficult = 2, sometimes difficult = 3, usually easy = 4, always easy = 5), which guide decisions at the individual and organizational levels7.
The HLQ-Br is a multidimensional instrument that does not provide an overall score for the questionnaire; the scores are assessed separately for each of the nine scales. There is no possibility of obtaining stratifications for health literacy conditions. Thus, an analysis of the score enables identifying the strengths and limitations of each person in relation to their health literacy, depending on whether the values are higher or lower, respectively7. The scores were calculated by adding the values of each item on the scales and then dividing this total by the number of items on the scale, presenting the result as the average score.
Data were collected between May and August 2022 using the individual interview technique, conducted by a research team composed of seven undergraduate nursing students affiliated with a higher education institution recognized by the Ministry of Education. After training on data collection techniques, the undergraduate students were trained on the research topic. Patients were contacted in the UBS hallways while waiting for care and invited to participate in the study. At that time, the study objective, participation forms and benefits were explained, in addition to being offered the opportunity to read and clarify the Informed Consent Form. The estimated time to complete the HLQ and apply the sociodemographic questionnaire was approximately 20 minutes.
The data were analyzed using the R version 4.3 program. Quantitative data were subjected to descriptive statistics, presenting mean and standard deviation for continuous variables, as well as absolute and relative frequency for categorical variables. The factors associated with literacy level were calculated using the Mann-Whitney test and the Kruskal-Wallis test as association measures, with a 95% confidence interval. Associations with p < 0.05 were considered significant. The justification for using these tests is due to the absence of a priori distribution of the data analyzed, in addition to the need to compare a numerical variable between independent groups.
The study was approved by the Human Research Ethics Committee. The use of the HLQ-Br occurred after authorization from Swinburne University of Technology through contact by email.
RESULTS
The sociodemographic profile of the 386 patients who composed the sample is detailed in Table 1.
Distribution of sociodemographic characteristics of users treated in primary healthcare according to sex, stable companion, education level and health insurance. Brasília, DF, Brazil, 2022 (n= 386).
Of the 387 patients, 147 (38%) described their health as good, 128 (33%) as fair, 46 (12%) as very good, 34 (9%) as excellent and 31 (8%) as poor. A total of 286 (74%) stated that they had no chronic diseases. Among the 100 (26%) patients who reported some disease, the most common were arterial hypertension (45 patients, 39%), diabetes mellitus (17 patients, 16%), respiratory conditions (15 patients, 13%) and neuromuscular and osteoarticular conditions (15 patients, 13%). Other diseases reported included depression and anxiety (5 patients, 4.3%), gastrointestinal diseases (5 patients, 4.3%), cardiovascular diseases (4 patients, 3.5%), metabolic diseases (4 patients, 3.5%) and others (4 patients, 3.5%). The mean health literacy scores for each of the HLQ-Br scales ranged from 2.36 to 3.73, as detailed in Table 2.
The lowest scores were identified in the HLQ-Br scales, part 1: “Understanding and Support from Health Professionals”, “Sufficient Information for Healthcare” and “Active Healthcare”, as well as in part 2: “Navigating the Health System”. On the other hand, the highest score was observed in the scale “Understanding Health Information and Knowing What to Do”.
Table 3 details the inferential statistics, evidencing a significant difference between the means of the education groups, associated with the scales “Social Support for Health”, “Evaluation of Health Information”, “Ability to Find Good Health Information” and “Understanding Health Information and Knowing What to Do”. Furthermore, in Table 4 it can be seen that having a health plan demonstrated a statistical difference, being associated with the “Understanding and Support from Health Professionals”, “Sufficient Information to Take Care of Health”, “Social Support for Health” and “Navigating the Health System” scales.
Table 5 presents the statistical distribution of the association between the “Sufficient Information to Take Care of Health”, “Social Support for Health”, “Evaluation of Health Information”, “Navigating the Health System” and “Understanding Health Information and Knowing What to Do” scales in relation to the self-perception of health variable. A significant difference was found between the means of the groups.
DISCUSSION
Studies which used the same HLQ-Br instrument were compared in order to discuss the data obtained on health literacy through its application, aiming to promote a reflective and effective discussion on the data from this study.
The present study presents a multidimensional result which goes beyond the analysis of functional health literacy (basic reading and numeracy skills), interactive health literacy (cognitive skills to perform daily activities, with social and communicative relationships) and critical health literacy (advanced skills to analyze information and use it in health control)9.
In this context, a study conducted in Spain with a sample of 166 patients showed higher scores for all HLQ scales, which differs from the results of the present study. It was observed that patients who rated their health status as good or very good obtained higher scores in all scales compared to those who considered themselves to be in fair, poor or very poor health - except for scales 1, “Feeling Understood and Supported by Health Professionals”, and 2, “Having Sufficient Information to Manage My Health”10.
A study in Australia with 410 participants treated in PHC obtained lower scores on health literacy scales, referring to the ability to actively manage one’s own health, evaluate health information, have social support for health, have sufficient information to manage health and feel understood and supported by health professionals11, corroborating the data obtained in the present study.
It is noteworthy that the highest scores on scale 1, “Feeling Understood and Supported by Health Professionals”, and on scale 4, “Social Support for Health”, reflect dependence on external factors and direct access to health professionals. High scores can therefore be attributed to the available public health system, and possibly to the patients’ social networks. The score obtained for the remaining scales depends more on the knowledge, skills and abilities of each individual10.
A study conducted in Vietnam with 367 patients with chronic kidney disease found that more than half of the participants reported not feeling understood and supported by their health professionals (scale 1, mean 2.95), not being able to find good health information (scale 8, mean 3.31) and not being able to understand health information (scale 9, mean 3.33). In this context, having sufficient health literacy indicates that a person is able to find, evaluate and understand health information, using it to respond to signs and symptoms, adhere to treatment, take proactive steps to self-manage and make decisions about their health12.
In this same direction, there is a need to improve health literacy among vulnerable target groups and to understand local issues. Feedback sessions with health services and local government organizations can be useful to identify the types of people who should be targeted for any interventions, as well as areas which already have high levels of health literacy13.
The first step to obtain information and improve health literacy is to assess a patient’s health literacy skills. This requires the use of appropriate tools, such as the HLQ, which performs a multidimensional analysis of health literacy. In addition, health organizations should provide education on what health literacy is to professionals, so that the principles of health literacy can be applied in clinical practice12.
A significant difference was observed in the present study between education level (elementary school), associated with scales 4 (Social Support for Health), 5 (Evaluation of Health Information), 8 (Ability to Find Good Health Information) and 9 (Understanding Health Information and Knowing What to Do). A study conducted with 3,118 patients in Australia indicated that socioeconomic factors, such as low education and low income, are associated with lower health literacy levels14. Thus, with the rapid advancement of health technology and the excess of information related to the topic, many individuals have difficulty identifying which information is relevant to their own condition. Therefore, it is up to health professionals and institutions to actively act in providing, understanding, using and mediating quality information and resources, always focusing on the needs of patients15.
Another important aspect is the observation of higher levels on scale 7, “Navigating the Health System” (3.7 and 3.8), in international studies11-12,16-17 in the context of primary and hospital care when compared to the levels of the Brazilian population7,18. A study involving 351 adults seen in two primary healthcare clinics in Australia describes this area (navigating the health system) as challenging, despite finding an average of 3.84, a significantly higher number when compared to the average of this study (2.98)16.
The challenge of navigating the healthcare system arises when patients are forced to identify an appropriate entry point, navigate a multitude of organizations, maneuver through the system, and find the right place to solve their problems. In addition, it is essential that patients are able to interact and communicate effectively so that their questions and problems are adequately addressed, allowing for informed decision-making about healthcare. However, not all patients and users are able to meet these navigation criteria, which results in disorientation, fruitless and stressful searches for healthcare services, uncertainty, and interruptions in healthcare19.
Thus, the HL-NAV (Health Literacy Navigation) instrument was developed to address the barriers imposed on patients in navigating the healthcare system, such as fragmentation, complexity, and lack of transparency. This instrument helps measure and formulate strategies to reduce the difficulties faced by patients when navigating this system19.
In this context, a study conducted with medical students revealed an interesting fact about navigation in the health system: participants obtained scores below the general average of the Australian population on scale 7 (navigation in the health system). This gap may indicate that a substantial proportion of future health professionals begin their careers with deficiencies in their understanding of how the health system works, which may make it difficult for them to assist patients who use these services20. A study conducted in Brazil with 309 patients with breast and prostate cancer revealed that the average on scale 7 (navigation in the health system) was 2.82. The barriers identified on this scale influence the clinical evolution of the disease, resulting in delays in treatment and generating irreparable consequences for patients21.
It is important to highlight that the present study also showed a low literacy level on scale 3, “Active health care”, with an average of 2.67. These results reflect what was observed in a study conducted in Lithuania which involved 399 patients treated in primary healthcare. In this study, most patients had health literacy that was considered problematic or inadequate in the areas of healthcare, disease prevention, and health promotion. Furthermore, patients with higher health literacy levels reported better health behaviors22.
Reduced active care can influence inefficient self-care decisions, increasing the risk of developing diseases that generate serious complications and increasing morbidity and mortality. In turn, a systematic review with meta-analysis revealed that lower health literacy scores are associated with a higher risk of mortality. This association may have been underestimated due to the restricted measurement of resources and characteristics that determine an individual’s health literacy23.
A prospective cohort study conducted with 150 patients admitted to the emergency department in two hospitals in Canada revealed that those with inadequate health literacy scores are more likely to return to the emergency department within 90 days after hospital discharge. This relationship highlights the importance of expanding health literacy in primary care. By strengthening health literacy, it is possible to not only improve patients’ ability to manage their conditions, but also to reduce the frequency of emergency room visits, promoting a more effective approach to health focused on promotion and prevention22,24.
In this sense, the WHO1 reinforces health literacy as an effective tool for health promotion and prevention, emphasizing community strengthening and educational approaches to increase health literacy. Given that low levels of health literacy constitute one of the most significant problems for both health policy formulation and the promotion of healthy behaviors, efforts to acquire these skills are recommended, in conjunction with initiatives that promote public health. This should be achieved by utilizing the capacities of cultural and educational entities, as well as organizations under the supervision of the Ministry of Health.
A meta-analysis of randomized clinical trials revealed that inadequate health literacy is associated with adverse outcomes in specific health conditions, highlighting the need for comprehensive understanding of how current health literacy interventions impact health-related outcomes among patients with chronic conditions. Universal health literacy precautions define some steps for the creation, implementation and improvement of health literacy in organizations. In the context of primary healthcare, the focus is on five relevant areas: 1. Practice change; 2. Spoken communication; 3. Written communication; 4. Self-management and empowerment; 5. Support systems26.
Creating a health literacy improvement plan in PHC begins with identifying areas that need improvement, such as oral and written communication, as well as self-management support. After this analysis, a detailed action plan is developed. Clear communication with patients is essential to ensure that they understand and implement the health information they receive. This can be assessed by methods such as “teach-back”26.
Furthermore, it is essential to provide adequate follow-up and create a welcoming and accessible environment, minimizing barriers to care. Attention to the social, cultural and linguistic needs of patients, as well as ensuring that everyone can navigate the health system efficiently, are key elements to promote health equity, improve health outcomes and increase patient satisfaction26.
Limitations of the study include response bias from users, since data collection took place within the primary healthcare unit. This situation may have generated the need to provide more positive responses for fear of being harmed during the care they were waiting for. This process has been discussed previously, and it was emphasized that the responses would not be taken to professionals at that time and that the participants would not be identified in order to minimize this bias.
In the local context, the results of the study provide managers and care teams with a comprehensive view of the needs and adaptations necessary for involving patients in health promotion and prevention strategies. More broadly, this study has contributed to identifying gaps in the health system and may generate strategies that reflect the needs of the community and individuals.
It is recommended that multidimensional instruments be disseminated and applied to identify and parameterize the care provided by PHC. As a multidimensional instrument, the HLQ is a useful tool which can be directly applied to the target population and health professionals. Changes in the work process based on the analysis of health literacy can favor developing strategies that help to consolidate an efficient and effective health service.
CONCLUSION
Knowledge of the sociodemographic profile of the population served is essential for developing care strategies, especially for understanding and expanding the community’s health literacy. This study provides valuable insights into the health literacy of the population served and highlights critical areas for intervention. Identifying the scales with the lowest scores reveals where health services need to focus efforts to improve care quality and increase patients’ ability to navigate the health system and understand health-related information.
The association between education and health literacy indicates that people with lower educational levels may need additional support to access and interpret health information effectively. The lack of health insurance is associated with greater challenges on the comprehension and support scales, which suggests the need to improve public health services. In addition, having coverage/access to health services positively impacts patients’ experience regarding their health literacy.
Patients’ self-perception of their health is crucial for planning interventions that increase their autonomy and co-responsibility in care. These strategies are essential to improve health literacy and the care quality, in turn contributing to a more informed population capable of managing their own health.
REFERENCES
-
1. World Health Organization - WHO. Health Promotion Glossary of Terms 2021 [Internet]. 2021 [cited 08 Oct 2024]. Available from: https://www.who.int/publications/i/item/9789240038349
» https://www.who.int/publications/i/item/9789240038349 -
2. World Health Organization - WHO. Health literacy development for the prevention and control of noncommunicable diseases [Internet]. 2022 [cited 13 Apr 2023]. Available from: https://www.who.int/publications/i/item/9789240055391
» https://www.who.int/publications/i/item/9789240055391 -
3. Brasil. Ministério da Saúde. Portaria n° 2.436, de 21 de setembro de 2017. Aprova a Política Nacional de Atenção Básica (PNAB), estabelecendo a revisão de diretrizes para a organização da Atenção Básica, no âmbito do Sistema Único de Saúde (SUS) [Internet]. 2017 [cited 08 Oct 2024]. Available from: https://bvsms.saude.gov.br/bvs/saudelegis/gm/2017/prt2436_22_09_2017.html
» https://bvsms.saude.gov.br/bvs/saudelegis/gm/2017/prt2436_22_09_2017.html -
4. Macinko J, Mendonça CS. Estratégia Saúde da Família, um forte modelo de Atenção Primária à Saúde que traz resultados. Saúde em Debate [Internet]. 2018 [cited 2023 Apr 15];42(Spec 1):18-37. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-11042018000500018&lng=pt&tlng=pt
» http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-11042018000500018&lng=pt&tlng=pt -
5. Nutbeam D, Lloyd JE. Understanding and Responding to Health Literacy as a Social Determinant of Health. Annu Rev Public Health [Internet]. 2021 [cited 2023 Apr 15];42:159-73. Available from: https://doi.org/10.1146/annurev-publhealth-090419-102529
» https://doi.org/10.1146/annurev-publhealth-090419-102529 -
6. Tannous WK, Ahmed MU, John JR, Reece G, Ahlenstiel G. Estimating the Economic Burden of Low Health Literacy in the Blacktown Community in Sydney, Australia: A Population-Based Study. Int J Environ Res Public Health [Internet]. 2021 Feb 26;18(5):2303. [cited 08 Oct 2024]. Available from: https://doi.org/10.3390/ijerph18052303
» https://doi.org/10.3390/ijerph18052303 -
7. Moraes KL, Brasil VV, Mialhe FL, Sampaio HAC, Sousa ALL, Canhestro MR, et al. Validação do Health Literacy Questionnaire (HLQ) para o português brasileiro. Acta Paulista de Enfermagem [Internet]. 2021 [cited 2022 Sep 17];34:eAPE02171. Available from: https://acta-ape.org/article/validacao-do-health-literacy-questionnaire-hlq-para-o-portugues-brasileiro/
» https://acta-ape.org/article/validacao-do-health-literacy-questionnaire-hlq-para-o-portugues-brasileiro/ -
8. Hawkins M, Gill SD, Batterham R, Elsworth GR, Osborne RH. The Health Literacy Questionnaire (HLQ) at the patient-clinician interface: A qualitative study of what patients and clinicians mean by their HLQ scores. BMC Health Serv Res [Internet]. 2017 [cited 08 Oct 2024];17(1):309. Available from: https://doi.org/10.1186/s12913-017-2254-8
» https://doi.org/10.1186/s12913-017-2254-8 -
9. Nutbeam D. Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int [Internet]. 2000 [cited 08 Oct 2024];15(3):259-67. Available from: https://doi.org/10.1093/heapro/15.3.259
» https://doi.org/10.1093/heapro/15.3.259 -
10. García-García D, Pérez-Rivas FJ. Health Literacy and Its Sociodemographic Predictors: A Cross-Sectional Study of a Population in Madrid (Spain). Int J Environ Res Public Health [Internet]. 2022 [cited 08 Oct 2024];19(18):11363. Available from: https://doi.org/10.3390/ijerph191811363
» https://doi.org/10.3390/ijerph191811363 -
11. Millar L, Bhoyroo R, Molina YP, Watts J, Geagea A, Murphy J, et al. Intersection between health, health literacy and local government: A mixed methods approach to identifying ways to better connect people to place-based primary health care in Western Australia. BMC Health Serv Res [Internet]. 2023 [cited 08 Oct 2024];23(1):63. Available from: https://doi.org/10.1186/s12913-022-08872-9
» https://doi.org/10.1186/s12913-022-08872-9 -
12. Dinh HTT, Nguyen NT, Bonner A. Healthcare systems and professionals are key to improving health literacy in chronic kidney disease. J Ren Care [Internet]. 2022 [cited 08 Oct 2024];48(1):4-13. Available from: https://doi.org/10.1111/jorc.12503
» https://doi.org/10.1111/jorc.12503 -
13. Millar L, Bhoyroo R, Molina YP, Watts J, Geagea A, Murphy J, et al. Intersection between health, health literacy and local government: A mixed methods approach to identifying ways to better connect people to place-based primary health care in Western Australia. BMC Health Serv Res [Internet]. 2023 [cited 08 Oct 2024];23(1):63. Available from: https://doi.org/10.1186/s12913-022-08872-9
» https://doi.org/10.1186/s12913-022-08872-9 -
14. Bourne A, Peerbux S, Jessup R, Staples M, Beauchamp A, Buchbinder R. Health literacy profile of recently hospitalised patients in the private hospital setting: A cross-sectional survey using the Health Literacy Questionnaire (HLQ). BMC Health Serv Res [Internet]. 2018 [cited 08 Oct 2024];18(1):877. Available from: https://doi.org/10.1186/s12913-018-3667-1
» https://doi.org/10.1186/s12913-018-3667-1 -
15. Seo YH, Osborne RH, Kwak Y, Ahn JW. Validity testing of the Korean version of the Health Literacy Questionnaire (HLQ) and its application in people with chronic diseases. Acta Paul Enferm [Internet]. 2024 [cited 2024 Sep 9];34:eAPE02171. Available from: https://doi.org/10.1371/journal.pone.0308086
» https://doi.org/10.1371/journal.pone.0308086 -
16. Beasant B, Sanigorski A, Brayshaw N, Vaughan V, Lotfaliany M, McCoombe S, et al. A cross-sectional health literacy profile of Australian regional adults using the Health Literacy Questionnaire©. Aust NZ J Public Health [Internet]. 2023 [cited 08 Oct 2024];47(1):100009. Available from: https://doi.org/10.1016/j.anzjph.2022.100009
» https://doi.org/10.1016/j.anzjph.2022.100009 -
17. Alqarni AS, Pasay-an E, Saguban R, Cabansag D, Gonzales F, Alkubati S, et al. Relationship between the Health Literacy and self-medication behavior of primary health care clientele in the hail region, Saudi Arabia: Implications for Public Health. Eur J Investig Health Psychol Educ [Internet]. 2023 [cited 08 Oct 2024];13(6):1043-57. Available from: https://doi.org/10.3390/ejihpe13060072
» https://doi.org/10.3390/ejihpe13060072 -
18. Soares TAM, Brasil VV, Moraes KL, Santos LTZ, Vila VSC, Júnior LHB. Health literacy of home caregivers in a Brazilian capital. Acta Paul Enferm [Internet]. 2021 [cited 08 Oct 2024];34. Available from: https://acta-ape.org/article/letramento-em-saude-de-cuidadores-domiciliares-de-uma-capital-brasileira/
» https://acta-ape.org/article/letramento-em-saude-de-cuidadores-domiciliares-de-uma-capital-brasileira/ -
19. Griese L, Berens EM, Nowak P, Pelikan JM, Schaeffer D. Challenges in navigating the health care system: Development of an instrument measuring navigation health literacy. Int J Environ Res Public Health [Internet]. 2020 [cited 08 Oct 2024];17(16):1-17. Available from: https://doi.org/10.3390/ijerph17166481
» https://doi.org/10.3390/ijerph17166481 -
20. Lane M, Dixon R, Donald KJ, Ware RS. Health literacy profiles of medical students in an Australian Doctor of Medicine programme: A cross-sectional study using the Health Literacy Questionnaire. Health Promot J Austr [Internet]. 2023 [cited 08 Oct 2024];35(3):617-27. Available from: https://doi.org/10.1002/hpja.790
» https://doi.org/10.1002/hpja.790 -
21. Henriques E, Sampaio HAC, Galiza DD, Brasil VV. Letramento em saúde para navegar pelo sistema de saúde: percepções de pacientes oncológicos. In: Anais do 8º Congresso Brasileiro de Ciências da Saúde [Internet]. 2019 [cited 08 Oct 2024]. Available from: https://proceedings.science/8o-cbcshs/trabalhos/letramento-em-saude-para-navegar-pelo-sistema-de-saude-percepcoes-de-pacientes-o?lang=pt-br
» https://proceedings.science/8o-cbcshs/trabalhos/letramento-em-saude-para-navegar-pelo-sistema-de-saude-percepcoes-de-pacientes-o?lang=pt-br -
22. Šulinskaitė K, Zagurskienė D, Blaževičienė A. Patients’ health literacy and health behaviour assessment in primary health care: Evidence from a cross-sectional survey. BMC Prim Care [Internet]. 2022 [cited 08 Oct 2024];23(1):223. Available from: https://doi.org/10.1186/s12875-022-01809-5
» https://doi.org/10.1186/s12875-022-01809-5 -
23. Fan Z, Yang Y, Zhang F. Association between health literacy and mortality: A systematic review and meta-analysis. Arch Public Health [Internet]. 2021 [cited 08 Oct 2024];79(1):119. Available from: https://doi.org/10.1186/s13690-021-00648-7
» https://doi.org/10.1186/s13690-021-00648-7 -
24. Shahid R, Shoker M, Chu LM, Frehlick R, Ward H, Pahwa P. Impact of low health literacy on patients’ health outcomes: A multicenter cohort study. BMC Health Serv Res [Internet]. 2022 [cited 08 Oct 2024];22(1):1148. Available from: https://doi.org/10.1186/s12913-022-08527-9
» https://doi.org/10.1186/s12913-022-08527-9 -
25. Shao Y, Hu H, Liang Y, Hong Y, Yu Y, Liu C, et al. Health literacy interventions among patients with chronic diseases: a meta-analysis of randomized controlled trials. Patient Educ Couns [Internet]. 2023 [cited 08 Oct 2024];114:107829. Available from: https://www.sciencedirect.com/science/article/pii/S0738399123002094
» https://www.sciencedirect.com/science/article/pii/S0738399123002094 -
26. Agency for Healthcare Research and Quality (AHRQ). AHRQ Health Literacy Universal Precautions Toolkit [Internet]. 3rd ed. 2024. [cited 08 Oct 2024]. Available from: https://www.ahrq.gov/health-literacy/improve/precautions/toolkit.html
» https://www.ahrq.gov/health-literacy/improve/precautions/toolkit.html
NOTES
-
ORIGIN OF THE ARTICLE
Article extracted from the thesis “Construção e validação de material educativo para promoção do letramento em saúde de usuários da atenção primária”, which will be presented to the Postgraduate Program in Nursing Universidade de Brasília, in 2025.
-
APPROVAL OF ETHICS COMMITTEE IN RESEARCH
Approved by the Ethics Committee in Research of the Faculty of Health Sciences Universidade de Brasília, opinion no. 5,214,953, Certificate of Presentation for Ethical Assessment 54245221.0.0000.0030.
-
TRANSLATED BY
Christopher J. Quinn
Edited by
Publication Dates
-
Publication in this collection
20 Dec 2024 -
Date of issue
2024
History
-
Received
03 Apr 2024 -
Accepted
02 Oct 2024
