Does health literacy affect patients' receipt of preventative primary care? A multilevel analysis.
BACKGROUND
People with limited health literacy are more likely to be socioeconomically disadvantaged and have risk factors for preventable chronic diseases. General practice is the ideal setting to address these inequalities however these patients engage less in preventive activities and experience difficulties navigating health services. This study aimed to compare primary care patients with and without sufficient health literacy in terms of their lifestyle risk factors, and explore factors associated with receiving advice and referral for these risk factors from their GPs.


METHODS
A mailed survey of 739 patients from 30 general practices across four Australian states was conducted in 2012. Health literacy was measured using the Health Literacy Management Scale. Patients with a mean score of <4 within any domain were defined as having insufficient health literacy. Multilevel logistic regression was used to adjust for clustering of patients within practices.


RESULTS
Patients with insufficient health literacy (n = 351; 48%) were more likely to report being overweight or obese, and less likely to exercise adequately. Having insufficient health literacy increased a patient's chance of receiving advice on diet, physical activity or weight management, and referral to and attendance at lifestyle modification programs. Not speaking English at home; being overweight or obese; and attending a small sized practice also increased patients' chances of receiving advice on these lifestyle risks. Few (5%, n = 37) of all patients reported being referred to lifestyle modification program and of those around three-quarters had insufficient health literacy. Overweight or obese patients were more likely to be referred to lifestyle modification programs and patients not in paid employment were more likely to be referred to and attend lifestyle programs.


CONCLUSIONS
Patients with insufficient health literacy were more likely to report receiving advice and being referred by GPs to attend lifestyle modification. Although the number of patients referred from this sample was very low, these findings are positive in that they indicate that GPs are identifying patients with low health literacy and appropriately referring them for assistance with lifestyle modification. Future research should measure the effectiveness of these lifestyle programs for patients with low health literacy.
Centre for Primary Health Care and Equity, University of New South Wales, Sydney, 2052, Australia. c.joshi@unsw.edu.au.
Chandni
C
Joshi
Centre for Primary Health Care and Equity, University of New South Wales, Sydney, 2052, Australia. upali.jay@unsw.edu.au.
Upali W
UW
Jayasinghe
Centre for Primary Health Care and Equity, University of New South Wales, Sydney, 2052, Australia. sharon.parker@unsw.edu.au.
Sharon
S
Parker
Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, 4229, Australia. cdelmar@bond.edu.au.
Chris
C
Del Mar
Southern Academic Primary Care Research Unit, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia. grant.russell@monash.edu.
Grant
G
Russell
Centre for Primary Health Care and Equity, University of New South Wales, Sydney, 2052, Australia. j.lloyd@unsw.edu.au.
Jane
J
Lloyd
Department of General Practice, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia. danielle.mazza@monash.edu.
Danielle
D
Mazza
Faculty of Health, University of Technology, Sydney, Australia. Elizabeth.Denney-Wilson@uts.edu.au.
Elizabeth
E
Denney-Wilson
Discipline of General Practice, School of Medicine, The University of Queensland, Brisbane, Australia. m.vandriel@uq.edu.au.
Mieke
M
van Driel
School of Public Health and Community Medicine, University of New South Wales, Sydney, 2052, Australia. r.taylor@unsw.edu.au.
Richard
R
Taylor
Centre for Primary Health Care and Equity, University of New South Wales, Sydney, 2052, Australia. m.f.harris@unsw.edu.au.
Mark F
MF
Harris
D000328:Adult; D000368:Aged; D001315:Australia; D003376:Counseling / Q000706:statistics & numerical data*; D015444:Exercise; D005260:Female; D057220:Health Literacy / Q000706:statistics & numerical data*; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis; D009765:Obesity / Q000628:therapy*; D050177:Overweight / Q000628:therapy; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011322:Primary Prevention / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D040242:Risk Reduction Behavior; D061217:Weight Reduction Programs / Q000706:statistics & numerical data