title: Gaps in understanding health and engagement with healthcare providers across common long-term conditions: a population survey of health literacy in 29,473 Danish citizens.
abstract: OBJECTIVE
  To (1) quantify levels of subjective health literacy in people with long-term health conditions (diabetes, cardiovascular disease, chronic obstructive pulmonary disease, musculoskeletal disorders, cancer and mental disorders) and compare these to levels in the general population and (2) examine the association between health literacy, socioeconomic characteristics and comorbidity in each long-term condition group.
  
  
  METHODS
  Population-based survey in the Central Denmark Region (n=29,473).
  
  
  METHODS
  Health literacy was measured using two scales from the Health Literacy Questionnaire (HLQ): (1) Ability to understand health information and (2) Ability to actively engage with healthcare providers.
  
  
  RESULTS
  People with long-term conditions reported more difficulties than the general population in understanding health information and actively engaging with healthcare providers. Wide variation was found between disease groups, with people with cancer having fewer difficulties and people with mental health disorders having more difficulties in actively engaging with healthcare providers than other long-term condition groups. Having more than one long-term condition was associated with more difficulty in engaging with healthcare providers and understanding health information. People with low levels of education had lower health literacy than people with high levels of education.
  
  
  CONCLUSIONS
  Compared with the general population, people with long-term conditions report more difficulties in understanding health information and engaging with healthcare providers. These two dimensions are critical to the provision of patient-centred healthcare and for optimising health outcomes. More effort should be made to respond to the health literacy needs among individuals with long-term conditions, multiple comorbidities and low education levels, to improve health outcomes and to reduce social inequality in health.
authors.affiliation: Public Health and Quality Improvement, Central Denmark Region, Aarhus, Denmark.
authors.forename: Karina
authors.initials: K
authors.lastname: Friis
authors.affiliation: Public Health and Quality Improvement, Central Denmark Region, Aarhus, Denmark Department of Psychology, University of Southern Denmark, Odense, Denmark.
authors.forename: Mathias
authors.initials: M
authors.lastname: Lasgaard
authors.affiliation: Public Health Innovation, Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Osborne
authors.affiliation: Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, Aarhus, Denmark.
authors.forename: Helle T
authors.initials: HT
authors.lastname: Maindal
mesh_terms: D000368:Aged; D002908:Chronic Disease; D015897:Comorbidity; D032882:Comprehension; D003718:Denmark; D005260:Female; D057220:Health Literacy; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires
keywords: CARDIOLOGY; MENTAL HEALTH