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Cited by 11Health Literacy and Information AccessibilityMusculoskeletal pain and rehabilitationPatient-Provider Communication in Healthcare

Health literacy in individuals with knee pain—a mixed methods study

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Sylwander, Charlotte, Wahl, Astrid Klopstad, Andersson, Maria L.E, Haglund, Emma, Larsson, Ingrid·2023·BMC Public Health
DOI 10.1186/s12889-023-16585-9PMC PMC10463821
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Abstract

Background: Low health literacy is associated with worse pain and poorer self-management. This study (1) examined the level of health literacy and associations with lifestyle habits, health status, chronic pain, and radiographic knee osteoarthritis; and (2) explored experiences illuminating health literacy among individuals with knee pain. Methods: A convergent parallel mixed-methods design was used, including 221 individuals. Health literacy was assessed by HLS-EU-Q16 and eHEALS. The questionnaire included questions on lifestyle habits, health status, and pain distribution. Radiographic knee osteoarthritis was assessed with x-rays. Associations were analysed using logistic regression analyses. Individual semi-structured interviews were conducted (n = 19) and analysed with qualitative content analysis. Results: The result showed that 71% reported sufficient health literacy. Higher education, healthy lifestyle habits, better general health, and absence of widespread pain were associated with sufficient health literacy. Experiences regarding health literacy influencing the decision-making process toward a decision on action comprised: (1) searching for information actively or passively; (2) processing of the information included being informed, critical, and interpretive; and (3) taking a stand on the information based on trustfulness and motivation. Conclusion: Seven out of 10 reported sufficient health literacy. Despite this, unhealthy lifestyles were common, suggesting that having sufficient HL is not enough for a behavioural change and the decision-making process, including different phases such as searching, processing, and taking a stand on health information is important to consider. More research on health literacy is needed to gain knowledge of how best to develop health promotion in individuals with knee pain.

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  • Patients with low health literacy usually face obstacles in engaging with the healthcare system, including difficulties completing questionnaires, understanding clinicians' professional terms and language, and knowing when to return for follow-up care.

    “Patients with low health literacy usually face obstacles in engaging with the healthcare system, including difficulties completing questionnaires [55], understanding clinicians’ professional terms and language [56,57], and knowing when to return for follow-up care [58,59].”

    From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [59]

    The Results section (‘Processing of information influences the decision-making process’; page unavailable) reports that participants with limited health literacy had difficulty understanding health information and, in some circumstances, information from healthcare personnel. It does not specifically identify clinicians’ professional terminology as the difficulty. The passages found also do not link low health literacy to difficulty completing questionnaires or knowing when to return for follow-up care. (LLM, conf=0.82)

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Cited by

Sorted by citations

Authors
Sylwander, C., Wahl, A. K., Andersson, M. L. E., Haglund, E., & Larsson, I.
Affiliations
  • Halmstad University (SE)
  • University of Oslo (NO)
  • Lund University (SE)
Corresponding author
Sylwander, Charlotte
ORCID
Venue
BMC Public Health
Publisher
Springer Science and Business Media LLC
Published
2023-08-29
Volume
23
Issue
1
Pages
1656-1656
ISSN
1471-2458 (ISSN-L)
DOI
10.1186/s12889-023-16585-9
PMC
PMC10463821
OpenAlex
W4386251436
Cited by
11
References
4
Citations by year
2026: 5 · 2025: 5 · 2024: 1
FWCI
3.90
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Lund University Publications (Lund University) (submittedVersion)
  • Duo Research Archive (University of Oslo) (submittedVersion, cc-by)
Funders
  • The Swedish Rheumatism Association (R-967899)
  • Anna and Edwin Berger Foundation (F-22-0006)
  • Halmstad University
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
Keywords
health literacy, knee pain, knee osteoarthritis, lifestyle habits, chronic pain, health information seeking, medical data processing, health decision-making, HLS-EU-Q16, eHealth Literacy Scale, health promotion
MeSH terms
Habits, Health Promotion, Humans, Osteoarthritis, Knee, Health Literacy, Chronic Pain

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