In a new research published Journal BMJ Open, researchers have reported that multimorbid patients with a high treatment burden, altered quality of life by problems with mobility, anxiety or depression, often also have low levels of health literacy. Primary care practitioners should, therefore, pay particular attention to these patients in their daily practice.

A nationwide cross-sectional study in Switzerland. Univariate and multivariate linear regressions were calculated to identify variables associated with health literacy. A multiple imputation approaches was used to deal with missing values. Multimorbid patients recruited in primary care settings (n=888), above 18 years old and suffering from at least 3 of 75 chronic conditions on a predefined list based on the International Classification of Primary Care 2.

Health literacy was assessed using the European Health Literacy Survey project questionnaire (HLS-EU 6). This comprises six items scored from 1 to 4 (very difficult=1, fairly difficult=2, fairly easy=3, very easy=4), and the total health literacy score is computed as their mean. As we wished to understand the determinants associated with lower health literacy, the HLS-EU 6 score was the only dependent variable; all other covariates were considered independent.

The mean health literacy score (SD) was 2.9 (0.5). Multivariate analyses found significant associations between low health literacy scores and treatment burden scores; marital status, predominantly the divorced group; dimensions of the EuroQuol 5 Dimension 3 Level (EQ5D3L) quality of life assessment, that is, for moderate problems with mobility; and with moderate problems and severe problems with anxiety/depression.

The present study highlights factors associated with HL (health literacy) in multimorbid patients in primary care: a high treatment burden, altered quality of life by problems with anxiety or depression and poor mobility were associated with a low level of HL. This could guide GPs in their daily practice and help them to better identify patients at risk of having low HL. Even though with the current state of knowledge, researchers cannot demonstrate causal relationships between multimorbidity and the treatment burden, GPs should carefully weigh up how best to transmit clinical information to patients whom they believe to be at risk of low HL.