The impact of health literacy on health-related quality of life (HRQoL) and utility assessment among patients with rheumatic diseases.
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Objectives The objective of this study was to investigate the impact of health literacy (HL) on health-related quality of life (HRQoL) and utility assessment among patients with rheumatic diseases. Methods HL was measured by the rapid estimate of adult literacy in medicine (REALM) and was characterized as low or adequate. HRQoL and utility scores were assessed using the SF-36, SF-6D, and EQ-5D. Comparisons of sociodemographics and HRQoL in patients with low or adequate HL were made using t test, chi-square, or Mann-Whitney U tests. Spearman's correlation and partial correlations were used to study the relationship between HL, HRQoL, and utility scores, with significant correlations further explored using multiple linear regression models. Results Data were analyzed from 199 subjects. Patients with adequate HL had significantly higher education levels, better dwelling status, lower disease activity, and better physical functioning (PF). There was a significant although weak correlation between HL level and PF. After adjustment, HL level was shown to independently explain 3.7% of the variance in the PF score. Nevertheless, there was no impact of HL on utility assessment or other HRQoL domains. Conclusion HL did not impact HRQoL in general, but was found to have a weak impact on the PF of patients with rheumatic diseases.
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In Thailand, 48.7% of patients, caregivers, and general population had limited health literacy.
“Previous studies in Southeast Asia reported a high prevalence of limited health literacy in Malaysia (94.2% among caregivers in 2015 and 85.8% among type 2 DM patients in 2016), while in the neighbour countries such as Singapore (43.7%), Thailand (48.7%) and Myanmar (28.2%) a lower percentage could be found among patients, caregivers, and general population [21–25].”
From Digital health literacy, online information-seeking behaviour, and satisfaction of Covid-19 information among the university students of East and South-East Asia (2022) · cites this paper as [23]
The Subjects and Study Design section (pp. 106–109) places the study in Singapore, not Thailand. Subject Characteristics reports low health literacy in 87 of 199 patients (43.7%), not 48.7% among patients, caregivers, and the general population. (LLM, conf=0.88)
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Experimental — accuracy not yet measuredIn Singapore, 43.7% of patients, caregivers, and general population had limited health literacy.
“Previous studies in Southeast Asia reported a high prevalence of limited health literacy in Malaysia (94.2% among caregivers in 2015 and 85.8% among type 2 DM patients in 2016), while in the neighbour countries such as Singapore (43.7%), Thailand (48.7%) and Myanmar (28.2%) a lower percentage could be found among patients, caregivers, and general population [21–25].”
From Digital health literacy, online information-seeking behaviour, and satisfaction of Covid-19 information among the university students of East and South-East Asia (2022) · cites this paper as [23]
The Subject Characteristics section (pp. 106–109) reports that 87 of 199 Singapore patients with rheumatic diseases had low health literacy, which is 43.7%. The study did not sample caregivers or the general population, so it does not support applying that percentage to those groups. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn Myanmar, 28.2% of patients, caregivers, and general population had limited health literacy.
“Previous studies in Southeast Asia reported a high prevalence of limited health literacy in Malaysia (94.2% among caregivers in 2015 and 85.8% among type 2 DM patients in 2016), while in the neighbour countries such as Singapore (43.7%), Thailand (48.7%) and Myanmar (28.2%) a lower percentage could be found among patients, caregivers, and general population [21–25].”
From Digital health literacy, online information-seeking behaviour, and satisfaction of Covid-19 information among the university students of East and South-East Asia (2022) · cites this paper as [23]
The Subjects and Study Design section describes patients with rheumatic diseases recruited in Singapore, and the Discussion reports 44% with inadequate health literacy in that study. A search for Myanmar and 28.2% found no passage addressing the claimed Myanmar prevalence or its stated population. This source appears to support the Singapore figure in the longer citing sentence, not the extracted Myanmar claim. (LLM, conf=0.78)
Experimental — accuracy not yet measuredIn Malaysia, 85.8% of type 2 diabetes mellitus patients in 2016 had limited health literacy.
“Previous studies in Southeast Asia reported a high prevalence of limited health literacy in Malaysia (94.2% among caregivers in 2015 and 85.8% among type 2 DM patients in 2016), while in the neighbour countries such as Singapore (43.7%), Thailand (48.7%) and Myanmar (28.2%) a lower percentage could be found among patients, caregivers, and general population [21–25].”
From Digital health literacy, online information-seeking behaviour, and satisfaction of Covid-19 information among the university students of East and South-East Asia (2022) · cites this paper as [23]
The Subjects and Study Design and Subject Characteristics sections (pp. 106–109) describe patients with rheumatic diseases in Singapore, not patients with type 2 diabetes in Malaysia. The paper supports the Singapore figure in the surrounding sentence (87 of 199 patients, or 43.7%), but a search for Malaysia, diabetes, and 85.8% found no passage addressing the attributed claim. (LLM, conf=0.77)
Experimental — accuracy not yet measuredIn Malaysia, 94.2% of caregivers in 2015 had limited health literacy.
“Previous studies in Southeast Asia reported a high prevalence of limited health literacy in Malaysia (94.2% among caregivers in 2015 and 85.8% among type 2 DM patients in 2016), while in the neighbour countries such as Singapore (43.7%), Thailand (48.7%) and Myanmar (28.2%) a lower percentage could be found among patients, caregivers, and general population [21–25].”
From Digital health literacy, online information-seeking behaviour, and satisfaction of Covid-19 information among the university students of East and South-East Asia (2022) · cites this paper as [23]
The Subjects and Study Design section describes patients with rheumatic diseases recruited in Singapore, not caregivers in Malaysia. Subject Characteristics reports 87 of 199 patients with low health literacy (43.7%). Our copy does not address the claimed 94.2% prevalence among Malaysian caregivers in 2015; searching for that figure and population found no matching passage. (LLM, conf=0.78)
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Research works printed but not linked: 1
- Health literacy: report of the Council of Scientific Affairs. Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association. JAMA 1999;281:552-7. For additional references 2-28, see The Impact of Health Literacy on Health-Related Quality of Life (HRQoL) and Utility Assessment among Patients with Rheumatic Diseases Value in Health Supporting Information, part III at: http://www.ispor.org/Publications/value/ ViHsupplementary/ViH12s3_Thumboo.asp.
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Rajah, R., Hassali, M. A. A., & Murugiah, M. K. (2019) · Public Health · doi:10.1016/j.puhe.2018.09.028 · Cited by 191 · see citing works
Neter, E., & Brainin, E. (2019) · European Psychologist · doi:10.1027/1016-9040/a000350 · Cited by 169 · see citing works
Htay, M. N. N., Parial, L. L., Tolabing, M. C., Dadaczynski, K., Okan, O., Leung, A. Y. M., & Su, T. T. (2022) · PLOS ONE · doi:10.1371/journal.pone.0266276 · Cited by 78 · see citing works
- Authors
- Zhang, X.-H., Li, S.-C., Fong, K.-Y., & Thumboo, J.
- Affiliations
- University of Newcastle Australia (AU)
- National University of Singapore (SG)
- Corresponding author
- Thumboo, Julian
- ORCID
- Thumboo, Julian
- Venue
- Value in Health
- Publisher
- Elsevier BV
- Published
- 2009-11
- Volume
- 12
- Pages
- S106-S109
- ISSN
- 1098-3015 (ISSN-L)
- OpenAlex
- W2102603883
- Cited by
- 44
- References
- 0
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2 · 2023: 2 · 2022: 3 · 2021: 2 · 2020: 3 · 2019: 2 · 2018: 5 · 2017: 3 · 2016: 3 · 2015: 2 · 2014: 6 · 2013: 2 · 2012: 3
- FWCI
- 2.88
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Value in Health (publishedVersion)
- PubMed (publishedVersion)
- National University of Singapore (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
- Keywords
- health literacy, health-related quality of life, utility analysis, rheumatic diseases, physical function, SF-36, SF-6D, EQ-5D, disease activity, sociodemographic factors
- MeSH terms
- Adult, Cross-Sectional Studies, Disability Evaluation, Female, Humans, Interviews as Topic, Male, Middle Aged, Quality of Life, Rheumatic Diseases, Singapore, Health Literacy
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