Health literacy of home caregivers in a Brazilian capital

Cross-sectional study conducted with 90 caregivers of the Brazilian Home Care Program in a municipality in central Brazil. Data collection was performed at users’ homes using a sociodemographic questionnaire and the Brazilian version of the Health Literacy Questionnaire (HLQ-Br). Descriptive statistics were used for sociodemographic variables, the mean scores of the HLQ scales and non-parametric tests for measures of association of health literacy.

Results

Most respondents were women (90.0%), with a partner (58.9%), lived in the same location as the user (75.6%), had a personal income of up to one minimum wage (72.2%), did not have the habit of reading (57.8%), studied nine years or more (53.3%), were informal caregivers (91.1%) and had parents who did not study (42.2%). Health literacy limitations were identified in the scales “Actively managing my health” and “Navigating the healthcare system”. Health literacy conditions were negatively influenced by the infrequent reading habit; schooling of caregivers and their parents; the fact of being an informal caregiver; by the low income and less time as a caregiver. The strengths of caregivers were related to the access to those who understand and support the caregiver; understanding health information and knowing what to do, and understanding health professionals’ requests.

Conclusion

It is necessary to incorporate the principles of health literacy in the routine of caregivers, professionals and managers for better health outcomes and decisions in the home care context.

Health literacy; Caregivers; House calls

Scales and questions of the HLQ-Br	Mean (SD)
Part 1 (Scores 1-4)
1 - Feeling understood and supported by health providers	2.69(0.55)
Q22 - I can rely on at least one healthcare provider	2.81(0.58)
Q17 - I have the healthcare providers I need to help me work out what I need to do	2.53(0.66)
2 - Having sufficient information to manage my health	2.50(0.47)
Q01 - I feel I have good information about health	2.63(0.63)
Q10 - I have enough information to help me deal with my health problems	2.42(0.75)
3 - Actively managing my health	2.46(0.49)
Q18 - I set my own goals about health and fitness	2.76(0.66)
Q06 - I spend quite a lot of time actively managing my health	2.01(0.77)
4 - Social support for health	2.72(0.53)
Q03 - I can get access to several people who understand and support me	2.96(0.70)
Q15 - I have at least one person who can come to medical appointments with me	2.44(0.84)
5 - Appraisal of health information	2.72(0.49)
Q04 - I compare health information from different sources	2.77(0.70)
Q12 - I always compare health information from different sources and decide what is best for me	2.67(0.67)
Part 2 (Scores 1-5)
6 - Ability to actively engage with healthcare providers	3.50(0.80)
Q20 - Ask healthcare providers questions to get the health information you need	3.86(1.07)
Q02 - Make sure that healthcare providers understand your problems properly	3.22(1.22)
7 - Navigating the healthcare system	2.84(0.89)
Q11 - Decide which healthcare provider you need to see	3.31(1.35)
Q01 - Find the right health care	2.40(1.21)
8 - Ability to find good health information	3.14(0.88)
Q14 - Get health information in words you understand	3.28(1.29)
Q18 - Get health information by yourself	2.98(1.32)
9 - Understand health information well enough to know what to do	3.39(0.81)
Q21 - Understand what healthcare providers are asking you to do	3.88(1.17)
Q17 - Read and understand all the information on medication labels	2.92(1.33)

Variables (n)		Scale 1		Scale 2		Scale 5
Variables (n)		Mean (S.E.)	d¹	Mean (S.E.)	d¹	Mean (S.E.)	d¹
Type of caregiver	Formal (8)	3.00 (0.09)	-	2.69 (0.1)	-	3.13 (0.12)	-
	Informal (82)	2.66 (0.06)	0.62	2.48 (0.05)	0.44	2.68 (0.05)	0.93
p-value²		0.055		0.154		0.008
Reading habit	No (52)	2.59 (0.08)	-	2.42 (0.07)	-	2.61 (0.07)	-
	Yes (38)	2.83 (0.07)	0.45	2.61 (0.07)	0.41	2.87 (0.08)	0.56
p-value²		0.030		0.077		0.004
Caregiver’s schooling	≤ 9 years (42)	2.59 (0.09)	-	2.43 (0.07)	-	2.48 (0.07)	-
	> 9 years (48)	2.78 (0.08)	0.34	2.57 (0.07)	0.30	2.93 (0.06)	1.02
p-value²		0.051		0.247		<0.001
Personal income (MW)	≤ 1(65)	2.63 (0.07)	-	2.46 (0.05)	-	2.64 (0.06)	-
	> 1 (25)	2.83 (0.09)	0.36	2.62 (0.1)	0.35	2.94 (0.08)	0.63
p-value²		0.102		0.193		0.006
Family income (MW)	≤ 2 (47)	2.56 (0.08)	-	2.39 (0.06)	-	2.63 (0.07)	-
	> 2 (43)	2.83 (0.08)	0.51	2.62 (0.07)	0.50	2.82 (0.07)	0.39
p-value²		0.022		0.037		0.114
Parents’ schooling (year)	None (33)	2.67 (0.09)	-	2.47 (0.07)	-	2.58 (0.07)	-
	≤ 9 years (13)	2.46 (0.14)	0.39	2.37 (0.11)	0.25	2.43 (0.14)	0.33
	> 9 years (39)	2.78 (0.09)	0.20	2.58 (0.08)	0.22	2.95 (0.07)	0.85
p-value²		0.098		0.344		<0.001
Time as caregiver	< 6 months (18)	2.47 (0.14)	-	2.35 (0.1)	-	2.62 (0.12)	-
	6 months < 5 years (41)	2.84 (0.08)	0.70	2.62 (0.07)	0.60	2.86 (0.08)	0.48
	> 5 years (31)	2.62 (0.1)	0.26	2.44 (0.08)	0.21	2.59 (0.08)	0.06
p-value²		0.056		0.073		0.031
Type of school	Public (76)	2.65 (0.06)	-	2.52 (0.05)	-	2.73 (0.05)	-
	Private (5)	3.15 (0.13)	0.92	2.55 (0.17)	0.08	2.84 (0.23)	0.27
	Both (5)	3.05 (0.05)	0.74	2.75 (0.3)	0.51	3.2 (0.33)	1.09
	None (4)	2.31 (0.4)	0.61	1.88 (0.22)	1.46	1.8 (0.29)	2.23
p-value²		0.029		0.056		0.007

Variables (n)		Scale 6		Scale 7		Scale 8		Scale 9
Variables (n)		Mean (S.E.)	d¹	Mean (S.E.)	d¹	Mean (S.E.)	d¹	Mean (S.E.)	d¹
Type of caregiver	Formal (8)	3.58 (0.23)	-	2.81 (0.29)	-	3.75 (0.26)	-	3.38 (0.17)	-
	Informal (82)	3.5 (0.09)	0.10	2.84 (0.10)	0.03	3.08 (0.10)	0.78	3.39 (0.09)	0.02
p-value²		0.870		0.809		0.035		0.966
Reading habit	No (52)	3.35 (0.12)	-	2.65 (0.12)	-	2.86 (0.11)	-	3.14 (0.11)	-
	Yes (38)	3.72 (0.11)	0.48	3.1 (0.14)	0.53	3.52 (0.14)	0.80	3.72 (0.12)	0.76
p-value²		0.056		0.014		0.001		<0.001
Lives with patients and family income> one wage	No (23)	3.31 (0.14)	-	2.49 (0.13)	-	3.03 (0.17)	-	3.16 (0.15)	-
	Yes (67)	3.57 (0.1)	0.32	2.96 (0.11)	0.54	3.17 (0.11)	0.15	3.47 (0.1)	0.38
p-value²		0.135		0.023		0.597		0.147
Caregiver’s schooling	≤ 9 years (42)	3.45 (0.14)	-	2.57 (0.13)	-	2.73 (0.12)	-	2.93 (0.11)	-
	> 9 years (48)	3.55 (0.1)	0.12	3.07 (0.13)	0.59	3.49 (0.12)	0.96	3.78 (0.1)	1.23
p-value²		0.877		0.004		<0.001		<0.001
Family income (MW)	≤ 2 (47)	3.46 (0.12)	-	2.69 (0.11)	-	2.94 (0.13)	-	3.25 (0.12)	-
	> 2 (43)	3.56 (0.12)	0.13	3 (0.15)	0.35	3.35 (0.12)	0.47	3.53 (0.12)	0.35
p-value²		0.509		0.081		0.020		0.135
Parents’ schooling (year)	No education (38)	3.52 (0.15)	-	2.75 (0.15)	-	2.82 (0.14)	-	3.11 (0.13)	-
	≤ 9 years (13)	3.08 (0.17)	0.53	2.27 (0.12)	0.59	2.72 (0.09)	0.13	3 (0.14)	0.14
	> 9 years (39)	3.63 (0.11)	0.14	3.12 (0.14)	0.42	3.58 (0.13)	0.89	3.79 (0.12)	0.89
p-value²		0.064		0.003		<0.001		<0.001
Type of school	Public (76)	3.47 (0.09)	-	2.77 (0.10)	-	3.12 (0.09)	-	3.37 (0.09)	-
	Private (5)	3.72 (0.4)	0.31	3.47 (0.47)	0.81	3.56 (0.43)	0.53	4.04 (0.39)	0.85
	Both (5)	3.84 (0.38)	0.46	3.67 (0.37)	1.06	4.04 (0.23)	1.14	3.8 (0.34)	0.55
	Did not attend (4)	3.4 (0.42)	0.09	2.34 (0.43)	0.51	1.75 (0.36)	1.68	2.3 (0.10)	1.41
p-value²		0.610		0.077		0.003		0.010

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author Thales Antônio Martins Soares E-mail: enf.thalesams@gmail.com