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Health literacy: varying relations with control over care and number of GP visits.

Heide, I. van der, Heijmans, M., Schuit, A.J., Uiters, E., Rademakers, J. Health literacy: varying relations with control over care and number of GP visits. European Journal of Public Health: 2015, 25(spl. 3) 321. Abstract: 8th European Public Health Conference: "Health in Europe - from global to local policies, methods and practices". 14-17 oktober 2015 in Milan.
Introduction
In chronic care, patients are expected to exert a certain degree of control over the care for their condition, for instance by fulfilling care tasks in their home environment. Health literacy is considered relevant in this regard, especially critical health literacy. The aim of this study was to examine to what extent functional, interactive and critical health literacy are associated with patients’ perceived control over care and with the frequency of GP visits.

Methods
Data from the Dutch ‘National Panel of people with Chronic illness or Disability’ were used (N = 2508). Functional, interactive and critical health literacy was assessed by the Functional, Communicative and Critical Health Literacy measure (FCCHL). Perceived control over care was indicated by perceived ability to: organize care, interact with providers and perform self-care. By stepwise linear regression analyses, associations between health literacy and ability to organize care, interact with providers and perform self-care were studied. By stepwise logistic regression analysis, associations between health literacy and frequency of GP visits was studied. Analyses were adjusted for sex, disease knowledge, cognitive functioning, age, level of education, and health status.

Results
Lower functional and interactive health literacy were significantly associated with a lower perceived ability to organize care and to perform self-care. Only lower interactive health literacy was significantly associated with a lower perceived ability to interact with healthcare providers. Only lower functional health literacy was significantly associated with a higher frequency of GP visits.

Conclusions
The results imply that functional, interactive and critical health literacy vary in their relevance for patients’ ability to exert control over care. Initiatives to strengthen patients’ role in healthcare may be improved by attention for patients’ health literacy, especially functional and interactive.

Key messages
Attention for functional and interactive health literacy skills may help chronically ill people to exert control over their care. Chronically ill people with lower functional health literacy seem to need more support from general practitioners than those with higher functional health literacy. (aut. ref.)