title: Health literacy and beliefs among a community cohort with and without chronic low back pain.
abstract: Health literacy, the ability to seek, understand and utilise health information, is important for good health. Suboptimal health literacy has been associated with poorer health outcomes in many chronic conditions although this has not been studied in chronic low back pain (CLBP). We examined the health literacy of individuals with CLBP using a mixed methods approach. One-hundred and seventeen adults, comprising 61 with no history of CLBP and 56 with CLBP (28 with low and high disability, respectively, as determined by a median split in Oswestry scores) participated. Data regarding severity of pain, LBP-related disability, fear avoidance, beliefs about LBP and pain catastrophizing were collected using questionnaires. Health literacy was measured using the Short-form Test of Functional Health Literacy in Adults (S-TOFHLA). A sub-sample of 36 participants with CLBP also participated in in-depth interviews to qualitatively explore their beliefs about LBP and experiences in seeking, understanding and using information related to LBP. LBP-related beliefs and behaviours, rather than pain intensity and health literacy skills, were found to be important correlates of disability related to LBP. Individuals with CLBP-high disability had poorer back pain beliefs and increased fear avoidance behaviours relating to physical activity. Health literacy (S-TOFHLA) was not related to LBP beliefs and attitudes. Qualitatively, individuals with CLBP-high disability adopted a more passive coping style and had a pathoanatomic view of their disorder compared to individuals with CLBP-low disability. While all participants with CLBP had adequate health literacy scores (S-TOFHLA), qualitative data highlighted difficulties in seeking, understanding and utilising LBP information.
authors.affiliation: School of Physiotherapy and Curtin Health Innovation Research Institute, Curtin University of Technology, Australia University of Melbourne Department of Medicine, Royal Melbourne Hospital, Australia Monash Department of Clinical Epidemiology at Cabrini Hospital, School of Public Health and Preventive Medicine, Monash University, Australia School of Exercise, Biomedical, and Health Sciences, Edith Cowan University, Australia Deakin Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, Australia.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Briggs
authors.forename: Joanne E
authors.initials: JE
authors.lastname: Jordan
authors.forename: Rachelle
authors.initials: R
authors.lastname: Buchbinder
authors.forename: Angus F
authors.initials: AF
authors.lastname: Burnett
authors.forename: Peter B
authors.initials: PB
authors.lastname: O'Sullivan
authors.forename: Jason Y Y
authors.initials: JYY
authors.lastname: Chua
authors.forename: Richard H
authors.initials: RH
authors.lastname: Osborne
authors.forename: Leon M
authors.initials: LM
authors.lastname: Straker
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D002908:Chronic Disease / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D017116:Low Back Pain / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires