Our study aimed to report on variables associated with communicative health literacy (COM-HL) in European adults. The HLS19 survey was conducted in 2019-2021 including nine countries which measured COM-HL by using a validated questionnaire (HLS19-COM-P-Q6 with a score ranging from 0 to 100). Linear regression models were used to study variables associated with COM-HL globally (multilevel model with random intercepts and slopes and at country level) and in each country. Additional models studied each of the HLS19-COM-P-Q6 items separately. The mean COM-HL score ranged between 62.5 and 76.6 across countries. Among the 18,137 pooled participants, COM-HL was positively associated with age, a higher self-perceived social status, previous training in healthcare, an increasing number of general practitioner visits; and negatively associated with female sex, reported financial difficulties, having a chronic condition and an increasing number of specialist visits. These effects were heterogeneous from one country to another, and from one item to another when analysing the different COM-HL items separately. However, there was a consistent statistically significant association between COM-HL (score and each item) and financial difficulties as well as self-perceived social status in all countries. Interventions to improve communication between patients and physicians should be a high priority to limit communication disparities.

APHM Public Health Department 13005 Marseille France

Communication Unit National Institute of Public Health Trubarjeva 2 1000 Ljubljana Slovenia

Competence Centre for Health Promotion and Health System Austrian National Public Health Institute 1010 Vienna Austria

Czech Health Literacy Institute Sokolská 490 31 120 00 Prague Czech Republic

Department of Cardiovascular Endocrine Metabolic Diseases and Aging Istituto Superiore Di Sanità 00162 Rome Italy

Department of Epidemiology and Public Health Sciensano Brussels Belgium

Department of Health and Nursing Sciences Faculty of Social and Health Sciences Inland Norway University of Applied Sciences P O Box 400 2418 Elverum Norway

Department of Public Health and Epidemiology Faculty of Medicine University of Debrecen 4028 Debrecen Hungary

INSERM IRD ISSPAM SESSTIM Cancer Biomedicine and Society Group Ligue 2019 Accredited Team Aix Marseille Univ 13009 Marseille France

Norwegian Centre for Science Education Faculty of Mathematics and Natural Sciences University of Oslo Blindern PO Box 1106 0317 Oslo Norway

Public Health and Epidemiology Department of Health Science and Technology Aalborg University 9220 Aalborg Denmark

School of Public Health Bielefeld University 33615 Bielefeld Germany

UMR1252 SESSTIM Institut Paoli Calmettes 232 Bd Ste Marguerite BP 156 13273 Marseille Cedex 9 France

Zobrazit více v PubMed

Sørensen, K. et al. Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health12, 80 (2012). PubMed PMC

Nutbeam, D. & Lloyd, J. E. Understanding and Responding to Health Literacy as a Social Determinant of Health. Annu. Rev. Public Health.42, 159–173 (2021). PubMed

Hickmann, E., Richter, P. & Schlieter, H. All together now – patient engagement, patient empowerment, and associated terms in personal healthcare. BMC Health Serv. Res.22, 1116 (2022). PubMed PMC

Nutbeam, D., McGill, B. & Premkumar, P. Improving health literacy in community populations: a review of progress. Health Promot. Int.33(5), 901–911 (2018). PubMed

Apfel, F. & Tsouros, A. D. Health literacy: the solid facts. Cph World Health Organ. 3‑26 (2013).

The HLS19 Consortium of the WHO Action Network M-POHL. International Report on the methodology, results and recommendations of the European Health Literacy Population Survey 2019–2021 (HLS19) of M-POHL. Austrian National Public Health Institute. HLS19 Consort WHO Action Netw M-POHL. 2021, 2019‑21 (2021).

Nowak, P. et al. Communicative Health Literacy with physicians in health care services. In The HLS19 Consortium of the WHO Action Network M-POHL, editor International Report on the Methodology, Results, and Recommendations of the European Health Literacy Population Survey 2019–2021 (HLS19) of M-POHL Austrian National Public Health Institute. 233–74 (2021).

van der Heide, I. et al. Health literacy in chronic disease management: a matter of interaction. J. Clin. Epidemiol.102, 134–138 (2018). PubMed

Paasche-Orlow, M. K. & Wolf, M. S. The causal pathways linking health literacy to health outcomes. Am. J. Health Behav.31(Suppl 1), S19-26 (2007). PubMed

CDC. Plain Language Materials & Resources. Centers for Disease Control and Prevention. [cité 30 août 2023]. Disponible sur: https://www.cdc.gov/healthliteracy/developmaterials/plainlanguage.html (2023).

Hironaka, L. K. & Paasche-Orlow, M. K. The implications of health literacy on patient-provider communication. Arch. Dis. Child.93(5), 428–432 (2008). PubMed

Bostock, S. & Steptoe, A. Association between low functional health literacy and mortality in older adults: longitudinal cohort study. BMJ.344, e1602 (2012). PubMed PMC

Turkoglu, A. R. et al. Evaluation of the relationship between compliance with the follow-up and treatment protocol and health literacy in bladder tumor patients. Aging Male Off. J. Int. Soc. Study Aging Male.22(4), 266–271 (2019). PubMed

Marciano, L., Camerini, A. L. & Schulz, P. J. The role of health literacy in diabetes knowledge, self-care, and glycemic control: a meta-analysis. J. Gen. Intern. Med.34(6), 1007–1017 (2019). PubMed PMC

Xu, X. Y., Leung, A. Y. M. & Chau, P. H. Health literacy, self-efficacy, and associated factors among patients with diabetes. Health Lit. Res. Pract.2(2), e67-77 (2018). PubMed PMC

Finbråten, H. S. et al. The HLS19-COM-P, a new instrument for measuring communicative health literacy in interaction with physicians: development and validation in nine European countries. Int. J. Environ. Res. Public Health.19(18), 11592 (2022). PubMed PMC

The HLS19 Consortium of the WHO Action Network M-POHL. Factsheet_p HLS19-COM-P.pdf. Disponible sur: https://m-pohl.net/sites/m-pohl.net/files/inline-files/Factsheet_p%20HLS19-COM-P.pdf (2021).

Lorkowski, J. & Jugowicz, A. Shortage of physicians: a critical review. Adv. Exp. Med. Biol.1324, 57–62 (2021). PubMed

Coulter, A. Do patients want a choice and does it work?. BMJ.341, c4989 (2010). PubMed

Sørensen, K. et al. Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU). Eur. J. Public Health.25(6), 1053–1058 (2015). PubMed PMC

Van Hoa, H., Giang, H. T., Vu, P. T., Van Tuyen, D. & Khue, P. M. Factors associated with health literacy among the elderly people in Vietnam. BioMed Res. Int.2020, 3490635 (2020). PubMed PMC

Kobayashi, L. C., Wardle, J., Wolf, M. S. & von Wagner, C. aging and functional health literacy: a systematic review and meta-analysis. J. Gerontol. B Psychol. Sci. Soc. Sci.71(3), 445-457. (2016). PubMed PMC

Australia’s health 2018, Health literacy [Internet]. Australian Institute of Health and Welfare. [cité 5 janv 2024]. Disponible sur: https://www.aihw.gov.au/reports/australias-health/australias-health-2018/contents/indicators-of-australias-health/health-literacy (2018).

Mirczak, A. Functional, communicative and critical health literacy among older Polish citizens. Med. Pr.73(3), 191–199 (2022). PubMed

Tabenkin, H., Goodwin, M. A., Zyzanski, S. J., Stange, K. C. & Medalie, J. H. Gender differences in time spent during direct observation of doctor-patient encounters. J. Womens Health.13(3), 341–349 (2004). PubMed

Bertakis, K. D. The influence of gender on the doctor-patient interaction. Patient Educ. Couns.76(3), 356–360 (2009). PubMed

Rogers, H. L., Dumenci, L., Epstein, R. M. & Siminoff, L. A. Impact of patient gender and race and physician communication on colorectal cancer diagnostic visits in primary care. J. Womens Health.28(5), 612–620 (2019). PubMed PMC

Heijmans, M., Waverijn, G., Rademakers, J., van der Vaart, R. & Rijken, M. Functional, communicative and critical health literacy of chronic disease patients and their importance for self-management. Patient Educ. Couns.98(1), 41–48 (2015). PubMed

Bhusal, S. et al. Health literacy and associated factors among undergraduates: A university-based cross-sectional study in Nepal. PLoS Glob. Public Health.1(11), e0000016 (2021). PubMed PMC

Khori, V. et al. Relationship between consultation length and rational prescribing of drugs in Gorgan City, Islamic Republic of Iran. East Mediterr. Health J. Rev. Sante Mediterr. Orient Al-Majallah Al-Sihhiyah Li-Sharq Al-Mutawassit.18(5), 480–486 (2012). PubMed

Lurquin, B., Kellou, N., Colin, C. & Letrilliart, L. Comparison of rural and urban French GPs’ activity: a cross-sectional study. Rural Remote Health.21(3), 5865 (2021). PubMed

Mor-Anavy, S., Lev-Ari, S. & Levin-Zamir, D. Health literacy, primary care health care providers, and communication. HLRP Health Lit. Res. Pract.5(3), e194–200. PubMed PMC

Wieczorek, M. et al. Association between multiple chronic conditions and insufficient health literacy: cross-sectional evidence from a population-based sample of older adults living in Switzerland. BMC Public Health.23(1), 253 (2023). PubMed PMC

van den Brink-Muinen, A. et al. Doctor–patient communication in different European health care systems: Relevance and performance from the patients’ perspective. Patient Educ. Couns.39(1), 115–127 (2000). PubMed

Gani, S. D. et al. Professional health literacy - first results of a pilot study in Austria, Germany, and Switzerland. Popul. Med.5(Supplement). http://www.populationmedicine.eu/Professional-health-literacy-first-results-of-a-pilot-study-in-Austria-Germany-and,164043,0,2.html (2023).