title: Functional, communicative and critical health literacy of chronic disease patients and their importance for self-management.
abstract: OBJECTIVE
  To provide insight into the level of health literacy among chronic disease patients in the Netherlands, to identify subgroups with low literacy and to examine the associations between health literacy and self-management.
  
  
  METHODS
  Self-report questionnaires were sent to a nationwide sample of 1.341 chronic disease patients. The Dutch Functional Communicative and Critical Health Literacy scale (FCCHL), the Partners in Health scale (PIH) and Perceived Efficacy in Patient-Doctor Interactions (PEPPI-5) were used to assess health literacy and aspects of self-management.
  
  
  RESULTS
  In general, health literacy skills were good. A higher age, lower education, lower income, multi-morbidity and/or functional limitations were associated with lower levels of health literacy. Communicative and critical health literacy were related to some aspects of self-management but not to all. Functional health literacy was less important.
  
  
  CONCLUSIONS
  Communicative and critical health literacy play a role in successful self-management of chronic disease but the impact differs by context. Health literacy levels vary according to socio-demographic and disease characteristics of patients.
  
  
  CONCLUSIONS
  Health care professionals should tailor their information and support to the health literacy skills and personal context of their patients.
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands. Electronic address: m.heijmans@nivel.nl.
authors.forename: Monique
authors.initials: M
authors.lastname: Heijmans
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors.forename: Geeke
authors.initials: G
authors.lastname: Waverijn
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors.forename: Jany
authors.initials: J
authors.lastname: Rademakers
authors.affiliation: Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands.
authors.forename: Rosalie
authors.initials: R
authors.lastname: van der Vaart
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors.forename: Mieke
authors.initials: M
authors.lastname: Rijken
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000628:therapy*; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D012648:Self Care; D020377:Self Efficacy; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: Chronic illness; Health literacy; Self-management; Self-management support