The impact of inadequate health literacy in a musculoskeletal pain population

Abstract

Musculoskeletal conditions are a major cause of ill-health and disability. Inadequate health literacy may partly explain why musculoskeletal self-management programmes are not effective for some patients. This study prospectively evaluates the impact of patients’ health literacy level on their musculoskeletal pain and physical function (PF) following usual primary care. 4720 primary care patients who had consulted for musculoskeletal pain were mailed a baseline questionnaire; responders were sent a 6-month follow-up. Outcome measures: PF and pain intensity at 6-months. Health literacy: Single-item Literacy Screener at baseline. Analysis was by linear regression. 1890 patients responded (40%). 17.3% (95%CI 15.6%-19.0%) of patients had inadequate health literacy. Inadequate health literacy was associated with older age (p<0.05), lower education, mental health and co-morbidities (all p<0.001), but not gender (p=0.642). At 6-month follow-up, patients with inadequate health literacy had lower PF (mean difference -12.2; -16.7,-7.6) and higher pain intensity (1.0; 0.6,1.4), adjusted for age, gender, education, mental health and co-morbidities, than patients with adequate health literacy. Differences in PF and particularly pain scores between patients with inadequate and adequate health literacy increase over 6 months. Future studies should develop interventions that better support musculoskeletal pain patients with inadequate health literacy to successfully manage their pain.