Background/Purpose: Disease diagnosis carries with it implications for self care and for healthful action. Public health campaigns, for example, are regularly launched to raise awareness of disease symptoms and new developments in medication and self management. In addition, self-report of musculoskeletal conditions is often used to provide population prevalence estimates and to determine disease burden and influence policy. However, self-report of certain conditions such as rheumatoid arthritis (RA) and osteoporosis are frequently inaccurate, suggesting that there is inadequate communication to the patient of their diagnosis. Such errors have consequences for treatment of those with musculoskeletal conditions, public health planning, and public policy.  

Purpose: To examine the association between functional health literacy (FHL) and three commonly self-reported musculoskeletal conditions in a South Australian representative population survey

Methods: A cross-sectional random population survey was conducted in 2008 of 2824 participants aged 15 years and over, using an interviewer-administered questionnaire. Functional health literacy was measured using the Newest Vital Sign (scored as inadequate FHL (score 0-1), at risk of inadequate FHL (2-3) and adequate FHL (4-6)). Participants were also asked about self-reported medically diagnosed arthritis (including subtype; rheumatoid arthritis, osteoarthritis, ‘other’, ‘don’t know’), gout, and osteoporosis. Multiple logistic regression was performed using adjustment for age and sex.

Results: Of the 2824 participants, the prevalence of self-reported medically-diagnosed arthritis, gout and osteoporosis were 25.2%, 4.9% and 5.6%, respectively.  The prevalence of those at-risk for inadequate FHL was 24.0% and of a high likelihood of inadequate FHL was 21.0%. However, over 50% of respondents with arthritis or gout had at risk or inadequate FHL, increasing to 70% of those self-reporting osteoporosis.  After adjustment for age and sex, respondents in the arthritis subgroup of ‘don’t know’, and self-reported osteoporosis were significantly more likely to have inadequate FHL than the general population (Table 1).

Conclusion: This cross sectional population survey indicates a substantial burden of low health literacy amongst people with musculoskeletal disease in the general population. Those participants who ‘don’t know’ the type of arthritis or who self-report osteoporosis are more likely to have poor FHL, suggesting that inadequate health literacy may influence communication and understanding of musculoskeletal diagnoses. This has implications for provider patient communication, individual health care, population estimates of musculoskeletal disease, and for the potential impact of public health messages.

Table 1. Associations of musculoskeletal conditions with limitations in functional health literacy.

	At risk or inadequate FHL		Inadequate FHL
	% (n)	Adjusted*	% (n)	Adjusted*
All arthritis
No	41.0%	1.00	18.1 %	1.00
Yes	56.9%	1.14 (0.93-1.38)	29.4 %	1.01 (0.81-1.27)
Arthritis type
No arthritis	41.0%	1.00	18.1%	1.00
OA	51.0%	0.77 (0.58-1.02)	26.9%	0.81 (0.59-1.13)
RA	58.2%	1.46 (1.01-2.14)	22.4%	0.82 (0.52-1.29)
‘don’t know” type	65.0%	1.58 (1.18-2.13)	37.5%	1.47 (1.08-2.00)
other	40.6%	0.71 (0.34-1.50)	18.2%	0.63 (0.24-1.65)
Gout
No	44.3%	1.00	20.3 %	1.00
Yes	59.1%	0.96 (0.66-1.41)	35.5%	1.09 (0.74-1.62)
Osteoporosis
No	43.5%	1.00	19.5%	1.00
Yes	70.3%	1.67 (1.15-2.44)	42.1%	1.62 (1.13-2.33)

*Adjusted for age and sex

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/role-of-health-literacy-in-population-estimates-of-musculoskeletal-disorders/