Netherlands Institute for Health Services Research, 3500 BN Utrecht, The Netherlands.
Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, 6200 MD Maastricht, The Netherlands.
Int J Environ Res Public Health. 2018 Aug 7;15(8):1676. doi: 10.3390/ijerph15081676.
Many health literacy interventions have a limited focus on functional/cognitive skills. In psychosocial models, the capacity to act however is seen as a major driver of behavioural change. This aspect is often lacking in health literacy concepts. In this study, we examine the impact of both aspects of health literacy (functional/cognitive and capacity to act) on specific healthcare outcomes (healthcare use, experiences with patient-centered care, shared-decision making, and self-management). In a sample of a national panel of people with a chronic disease (NPCD), questions about health literacy, patient activation, and outcomes were asked. The results indicated that 39.9% had limited HL levels and 36.9% had a low activation score. Combined, 22.7% of the sample scored low on both aspects, whereas 45.8% had adequate levels on both. Patients who score low on both use more healthcare and have less positive experiences with patient-centered care, shared decision making, and self-management. Patients who have adequate competency levels in both respects have the best outcomes. Both cognitive and non-cognitive aspects of health literacy are important, and they enhance each other. The capacity to act is especially important for the extent to which people feel able to self-manage.
许多健康素养干预措施的重点都局限在功能性/认知技能上。在心理社会模型中，行动能力被视为行为改变的主要驱动力。这一方面在健康素养概念中往往缺失。在这项研究中，我们考察了健康素养的两个方面（功能性/认知和行动能力）对特定医疗保健结果（医疗保健使用、以患者为中心的护理体验、共同决策制定和自我管理）的影响。在一个患有慢性病的全国患者小组（NPCD）的样本中，询问了有关健康素养、患者激活和结果的问题。结果表明，39.9%的人健康素养水平有限，36.9%的人患者激活得分较低。综合来看，样本中有 22.7%的人在这两个方面都得分较低，而 45.8%的人在这两个方面都有足够的水平。在这两个方面得分都较低的患者使用更多的医疗保健，并且对以患者为中心的护理、共同决策制定和自我管理的体验不太积极。在这两个方面都有足够能力水平的患者则拥有最佳的结果。健康素养的认知和非认知方面都很重要，而且它们相互增强。行动能力对于人们自我管理的能力有重要影响。
