Summary

The findings highlight the importance of tailored communication strategies and support to enhance patient engagement and self-management for patients with limited health literacy.

Abstract

In Europe almost 1 in 2 (47%) people has limited (insufficient or problematic) health literacy. However, the distribution of levels differed substantially across countries (29-62%). In the Netherlands, approximately one in four adults possesses limited health literacy, affecting their ability to obtain, comprehend, and apply health information. Patient with rotator cuff pathology encounter difficulties in locating, comprehending, and utilizing healthcare information greatly impacting their outcomes and recovery after treatment. The prevalence and impact on the health of patients with limited health literacy and with rotator cuff pathologies is still unknown. . Therefore, this study aims to answer the following questions: (1) What is the prevalence of limited health literacy among patients with rotator cuff pathologies? (2) What challenges do these patients face in finding, understanding, and applying healthcare information?

Methods

To determine the prevalence of limited health literacy, the Single-Item Literacy Screener (SILS) was used. SILS scores categorized patients into 'limited' or 'sufficient' health literacy based on their responses and educational background. To get insight in the challenges patients face during their treatment for rotator cuff disorders semi-structured interviews were conducted, guided by the Health Literacy Questionnaire (HLQ). Data was collected through audio recordings and field notes, then transcribed and analysed using ATLAS.ti.

Results

From 145 screened patients, 22 were identified as having limited health literacy (15.2%). In total 8 out of 22 patients with limited health literacy participated in the semi-structured interviews. Patients reported challenges related to finding information and assessing if the information is reliable. Almost all patients reported difficulties with digital skills. Patients expressed a preference for verbal explanations from healthcare providers, supplemented by written information. The written information should be comprehensible regarding shoulder anatomy and pathology presented in clear and understandable language. Most patients ask help from an informal caregiver to manage their health (e.g. making appointments or fill in a questionnaire). Some patients feel insufficiently involved in treatment decisions and perceive that only one treatment option exists. Most patients describe the preference to discuss all treatment options with their healthcare provider using a decision aid to clarify choices.

Conclusion

The findings underscore the importance of recognizing that limited health literacy is relatively common. Preferably, screening for limited literacy should be conducted beforehand to better identify and address the needs of these patients. During the initial consultation, healthcare providers should assess the patient's specific information needs to personalize the materials provided (e.g. images or videos). The findings highlight the importance of tailored communication strategies and support to enhance patient engagement and self-management for patients with limited health literacy. For patients with limited digital skills, preferences for receiving information digitally or in print should be addressed, with a focus on verbal and written communication if needed.