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Can patients with low health literacy be identified from routine primary care health records? A cross-sectional and prospective analysis

Lookup NU author(s): Dr Philip Campbell, Professor Gill Rowlands



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


BackgroundPeople with low health literacy (HL) are at increased risk of poor health outcomes, and receive less benefit from healthcare services. However, healthcare practitioners can effectively adapt healthcare information if they are aware of their patients’ HL. Measurements are available to assess HL levels but may not be practical for use within primary care settings. New alternative methods based on demographic indicators have been successfully developed, and we aim to test if such methodology can be applied to routinely collected consultation records.MethodsSecondary analysis was carried out from a recently completed prospective cohort study thatinvestigated a primary care population who had consulted about a musculoskeletal pain problem. Participants completed questionnaires (assessing general health, HL, pain, and demographic information) at baseline and 6 months, with linked data from the participants’ consultation records. The Single-Item Literacy Screener was used as a benchmark for HL. We tested the performance of an existing demographic assessment of HL, whether this could be refined/improved further (using questionnaire data), and then test the application in primary care consultation data. Tests included accuracy, sensitivity, specificity, and area under the curve (AUC). Finally, the completed model was tested prospectively using logistic regression producing odds ratios (OR) in the prediction of poor health outcomes (physical health and pain intensity).ResultsIn total 1501 participants were included within the analysis and 16.1% were categorised as having low HL. Tests for the existing demographic assessment showed poor performance (AUC 0.52), refinement using additional components derived from the questionnaire improved the model (AUC 0.69), and the final model using data only from consultation data remained improved (AUC 0.64). Tests of this final consultation model in the prediction of outcomes showed those with low HL were 5 times more likely to report poor health (OR 5.1) and almost 4 times more likely to report higher pain intensity (OR 3.9). ConclusionsThis study has shown the feasibility of the assessment of HL using primary care consultation data, and that people indicated as having low HL have poorer health outcomes. Further refinement is now required to increase the accuracy of this method.

Publication metadata

Author(s): Campbell P, Lewis M, Chen Y, Lacey RJ, Rowlands G, Protheroe J

Publication type: Article

Publication status: Published

Journal: BMC Family Practice

Year: 2019

Volume: 20

Online publication date: 18/07/2019

Acceptance date: 11/07/2019

Date deposited: 12/07/2019

ISSN (electronic): 1471-2296

Publisher: BioMed Central Ltd.


DOI: 10.1186/s12875-019-0994-8


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