Health literacy is a term that practi- tioners increasingly use but rarely define. For patients with rheumat- ic and musculoskeletal disease(RMDs), health literacy – or, actually, alack of health literacy – can manifest indifferent ways, and addressing these defi-ciencies is not a one-size-fits-all approach.
At this year’s congress, Mark Bakker, adoctoral student at Maastricht (Netherlands) University, explained how identifying different profiles of health literacy mayhelp to break through those health-literacybarriers.
“Health literacy is so much more than just
being able to read and write,” Mr. Bakker
said. “It’s so much more than just health be-
haviour. It’s often misunderstood.”
Mr. Bakker and his research team took a
multidimensional approach to health litera-
cy. “It involves personal competencies,” he
said. “It also involves situational resources
in which people might need to find, ap-
praise, and understand information, but
also to access services in health, to make
Health literacy also involves interactive
skills, a capacity to critically appraise care,
and having a social support structure, he
said. Different estimations of limited health
literacy in the Netherlands point towards a
prevalence of about 30%, which, he said, is
a lot higher than many might realise.
Patients with low health literacy may use
disproportionate amounts of health resourc-
es, Mr. Bakker noted. These patients may
display poor decision-making about their
own health, lack medication adherence, and
use emergency services and specialised
care more frequently
while using pre-
less. “There is an
increasing amount of
health literacy to a
number of worsening
outcomes,” he said.
patients have difficulty asking the right
questions. “They may not even know
where to begin,” Mr. Bakker said.
Healthcare professionals may feel like
they don’t have enough time to probe these
issues deeper with patients. “They might not
have the tools to provide patients with the
right information in the right way,” he said.
“And it might be very hard for professionals
to even recognise limited health literacy in
Mr. Bakker and his colleagues evaluated
895 patients with rheumatoid arthritis,
spondyloarthritis, or gout at three outpatient
clinics in the Netherlands. The patients
completed the Health Literacy Questionnaire
(HLQ), which, according to Mr. Bakker, was
specifically designed to evaluate the multidi-
mensional nature of health literacy.
The researchers identified 10 distinct
health-literacy profiles, each depending
on average scores across nine different
health-literacy domains ranging from provider
support to the patient’s ability to understand
health information. The highest health-
literacy scores across all domains comprised
profile 1, and the lowest scores represented
profile 10. However, rather than categorising
patients in “high” and “low,” Mr. Bakker
noted that the approach allows for diverse
patterns in scores across domains. These
diverse patterns should be of note, he said.
The goal is to enhance the capacity of
health systems and professionals to respond
to the health-literacy needs of patients with
RMDs, he said. This can be of benefit to all
patients in the clinic and specifically for pa-
tients with a particular profile. The approach
his team has taken to identify tools that
could address local health-literacy needs
is known as the Ophelia approach, which
stands for OPtimising HEalth LIteracy and
Access (BMC Public Health. 2014;14:694. doi:
“Our patients have different health-lit-
eracy profiles, and our work can inspire
the healthcare system to think about these
different health-literacy profiles that you
see in your own clinical context,” he said.
The idea, Mr. Bakker explained, is for
rheumatologists to consider health-literacy
challenges in the context of their own set-
ting, and to collaborate with local experts,
including both professionals and patients,
to develop methods for addressing those
health-literacy shortcomings systemically.
Mr. Bakker and colleagues have no rele-
vant conflicts to disclose.
Efforts towards identifying health-literacy
profiles fill an important need in rheumatology
comes, including activities of dailyliving ( 2. 9; 95% CI, 0. 2-5. 6), pain( 3. 5; 95% CI, 0. 9-6.0), and symptoms ( 2. 6; 95% CI, 0. 4-4. 9) amongparticipants in the dr. Bart groupversus usual care. Nonsignificantdifferences between the groupswere observed for health-relatedquality of life, self-managementbehavior, illness perceptions, andphysical activity.
“Use of the dr. Bart app results
in small but positive effects on
symptoms, pain, and activities of
daily living,” he said.
Overall, the findings suggestthat the self-management app maypositively impact the health ofindividuals with knee/hip OA, theresearchers explained.
“[No] future studies are plannedyet, but we are [currently] performing an economic evaluation of thedr. Bart app,” Mr. Pelle noted.
No funding sources were reported. The authors reported having noconflicts of interest.
Theoretical framework of the dr. Bart app, Pelle T et al.BMC Musculoskelet Disord. 2019;20:398. doi: 10.1186/s12891-019-2768-9
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