Initial evaluation of functional, communicative and critical health literacy in chronic disease patients in Serbia

Abstract

Introduction: Most studies on health literacy among chronic disease patients in Serbia focused on functional health literacy. Several studies among diabetes patients conducted in Japan and the Netherlands found that functional health literacy is less important than communicative and critical health literacy for diabetes self-management (1-3). In the context of medication self-management of chronic illness a Nutbeam model (1) of three different types of health literacy (functional, communicative and critical health literacy) could be of more value to explore barriers in self-management for chronic patients, including the ability to extract, compare, communicate and critically analyze medications information (pharmacotherapy literacy). Objective: To provide insight into the level of health literacy among chronic disease patients in Serbia, to identify subgroups with low literacy and to examine the associations between health literacy and socio-demographic characteristics of patients. Material and methods: A cross-sectional study was conducted on a suitable sample consisting of chronic patients applying for the first time in Serbia, the specific assessment instrument: Functional Communicative and Critical Health Literacy scale (FCCHL) (1). The FCCHL-Serbian consists of 14 statements with 4 points Likert scales (1–4) with functional (5 items), communicative (5 items) and critical health literacy (4 items). Mean scale scores were obtained for total health literacy and all three subscales, resulting in a score ranging from low health literacy (0 to 2) to high health literacy (2.1 to 4). Statistical analysis of the collected data included methods of descriptive statistics and inferential statistics. Results: The majority of participants were women (69%), married (75%), employed (75%) and with 8 to 16 years of education (74%). A large number of participants were non-smokers (66%). Every second patient rated its health as good (48%), while every fifth patient rated its health as excellent (19%). Overall, health literacy skills were good. Total health literacy score was 2.57 ± 0.39, which is considered high level of health literacy. The results indicate that the best rated was communication health literacy (2.96), followed by functional health literacy (2.28) by comparing mean values. Patients experienced items reflecting critical health literacy as most difficult ones (1.96 ± 0.62). There were no significant differences in scores of all three health literacy types between subgroups of patients differing in age, gender and education levels (p ≥ 0.05). In general, lower levels of total and functional health literacy were found at patients with higher age, lower education and male gender. Conclusion: Total, functional and communicative health literacy levels were high among chronic disease patients but they had difficulty considering the applicability, validity and reliability in analyzing and reflecting on information or advice received. We found that health literacy levels did not vary according to certain socio-demographic characteristics of patients. Further research with this instrument is needed in the future to understand the impact on critical health literacy to pharmacotherapy literacy and medication adherence especially with chronic disease patients.