Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 154 No. 10 (2024)

Inadequate health literacy and higher healthcare utilisation among older adults in Switzerland: cross-sectional evidence from a population-based study

DOI
https://doi.org/10.57187/s.3515
Cite this as:
Swiss Med Wkly. 2024;154:3515
Published
24.10.2024

Summary

BACKGROUND AND AIM: Population ageing in Switzerland poses significant challenges, including for the healthcare system. Inadequate health literacy can hinder individuals’ ability to seek appropriate treatments and navigate the healthcare system efficiently. This study explores the associations between health literacy and the number of consultations with general practitioners and healthcare specialists in a population-based sample of adults aged 58+ in Switzerland.

METHODS: We used data from 1424 older adults who participated in Wave 8 (2020) of the Survey of Health, Ageing, and Retirement in Europe (SHARE). The analysis focuses on two outcomes: the reported number of consultations with (1) general practitioners or (2) healthcare specialists in the year prior to the interview. Health literacy, i.e. the ability to find, understand, assess and apply health information, is measured using the short version of the European Health Literacy Survey questionnaire (HLS-EU-Q16). The final health literacy score ranged from 0 to 16 and was categorised into three health literacy levels: inadequate (0–8), problematic (9–12) and sufficient (13–16). Bivariate analyses were conducted using Kruskal-Wallis tests. Partial associations were examined using multivariate generalised Poisson regression models controlling for key sociodemographic, regional and health-related variables.

RESULTS: Overall, 68.5% of the respondents were classified as having sufficient health literacy, while the health literacy level of 23.5% and 7.9% of respondents was classified as problematic or inadequate, respectively. The median number of general practitioner consultations and specialist visits was 2 and 1, respectively, both with an interquartile range of 1. Lower levels of health literacy were statistically significantly associated (p = 0.0011) with a higher number of general practitioner consultations in the year prior to the interview. By contrast, we did not find any significant association between health literacy and the number of specialist consultations.

CONCLUSION: This study finds that lower health literacy is associated with higher healthcare utilisation for older adults in Switzerland. The findings may suggest that general practitioners could have a significant role as advisors for individuals with low levels of health literacy, while a similar pattern is not observed for specialists. This discrepancy might be attributed, at least in part, to the role of general practitioners as intermediaries between patients and specialised care providers. Ensuring accessibility to general practitioners, particularly for individuals with low health literacy, could prove to be a beneficial strategy in addressing the healthcare requirements of this particularly vulnerable patient group. Additionally, improving health literacy in the population may provide further health benefits and lead to resource savings.

References

  1. Federal Office of Public Health FOPH. Assessing Equity. Available from https://www.bag.admin.ch/bag/en/home/strategie-und-politik/nationale-gesundheitsstrategien/gesundheitliche-chancengleichheit/chancengleichheit-in-der-gesundheitsversorgung/chancengerechtigkeit-messen.html
  2. Federal Office of Public Health FOPH. Health insurance. Available from https://www.bag.admin.ch/bag/en/home/versicherungen/krankenversicherung.html
  3. Federal Office of Public Health FOPH. Taking health to heart. Available from: https://www.bag.admin.ch/bag/en/home/das-bag/auftrag-ziele.html
  4. OECD. Health at a Glance 2021: OECD Indicators. Health at a Glance. OECD; 2021. 10.1787/ae3016b9-
  5. Federal Statistical Office. Ageing in Switzerland. Available from https://www.bfs.admin.ch/bfs/en/home/statistiken/querschnittsthemen/aelter-werden-schweiz.html
  6. Jaul E, Barron J. Age-Related Diseases and Clinical and Public Health Implications for the 85 Years Old and Over Population. Front Public Health. 2017 Dec;5:335. doi: https://doi.org/10.3389/fpubh.2017.00335 DOI: https://doi.org/10.3389/fpubh.2017.00335
  7. Djalali S, Meier T, Hasler S, Rosemann T, Tandjung R. Primary care in Switzerland gains strength. Fam Pract. 2015 Jun;32(3):348–53. doi: https://doi.org/10.1093/fampra/cmv005 DOI: https://doi.org/10.1093/fampra/cmv005
  8. Schnakenberg R, Goeldlin A, Boehm-Stiel C, Bleckwenn M, Weckbecker K, Radbruch L. Written survey on recently deceased patients in germany and switzerland: how do general practitioners see their role? BMC Health Serv Res. 2016 Jan;16(1):22. doi: https://doi.org/10.1186/s12913-016-1257-1 DOI: https://doi.org/10.1186/s12913-016-1257-1
  9. Cohidon C, Imhof F, Bovy L, Birrer P, Cornuz J, Senn N. Patients’ and General Practitioners’ Views About Preventive Care in Family Medicine in Switzerland: A Cross-sectional Study. J Prev Med Public Health. 2019 Sep;52(5):323–32. doi: https://doi.org/10.3961/jpmph.19.184 DOI: https://doi.org/10.3961/jpmph.19.184
  10. Santana S, Brach C, Harris L, Ochiai E, Blakey C, Bevington F, et al. Updating Health Literacy for Healthy People 2030: Defining Its Importance for a New Decade in Public Health. J Public Health Manag Pract. 2021 Nov-Dec;27(6 Suppl 6):S258–64. doi: https://doi.org/10.1097/PHH.0000000000001324 DOI: https://doi.org/10.1097/PHH.0000000000001324
  11. Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al.; (HLS-EU) Consortium Health Literacy Project European. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012 Jan;12(1):80. 10.1186/1471-2458-12-80 DOI: https://doi.org/10.1186/1471-2458-12-80
  12. Geboers B, de Winter AF, Luten KA, Jansen CJ, Reijneveld SA. The association of health literacy with physical activity and nutritional behavior in older adults, and its social cognitive mediators. J Health Commun. 2014;19(sup2 Suppl 2):61–76. doi: https://doi.org/10.1080/10810730.2014.934933 DOI: https://doi.org/10.1080/10810730.2014.934933
  13. Easton P, Entwistle VA, Williams B. Health in the ‘hidden population’ of people with low literacy. A systematic review of the literature. BMC Public Health. 2010 Aug;10(1):459. doi: https://doi.org/10.1186/1471-2458-10-459 DOI: https://doi.org/10.1186/1471-2458-10-459
  14. Chen JZ, Hsu HC, Tung HJ, Pan LY. Effects of health literacy to self-efficacy and preventive care utilization among older adults. Geriatr Gerontol Int. 2013 Jan;13(1):70–6. doi: https://doi.org/10.1111/j.1447-0594.2012.00862.x DOI: https://doi.org/10.1111/j.1447-0594.2012.00862.x
  15. Viktorsson L, Yngman-Uhlin P, Törnvall E, Falk M. Healthcare utilisation and health literacy among young adults seeking care in Sweden: findings from a cross-sectional and retrospective study with questionnaire and registry-based data. Prim Health Care Res Dev. 2019 Dec;20:e151. doi: https://doi.org/10.1017/S1463423619000859 DOI: https://doi.org/10.1017/S1463423619000859
  16. MacLeod S, Musich S, Gulyas S, Cheng Y, Tkatch R, Cempellin D, et al. The impact of inadequate health literacy on patient satisfaction, healthcare utilization, and expenditures among older adults. Geriatr Nurs. 2017;38(4):334–41. doi: https://doi.org/10.1016/j.gerinurse.2016.12.003 DOI: https://doi.org/10.1016/j.gerinurse.2016.12.003
  17. Y. I. Cho, S.-Y. D. Lee, A. M. Arozullah, and K. S. Crittenden. Effects of health literacy on health status and health service utilization amongst the elderly. Soc. Sci. Med. 1982, vol. 66, no. 8, pp. 1809–1816, Apr. 2008. doi: https://doi.org/10.1016/j.socscimed.2008.01.003 DOI: https://doi.org/10.1016/j.socscimed.2008.01.003
  18. Hardie NA, Kyanko K, Busch S, Losasso AT, Levin RA. Health literacy and health care spending and utilization in a consumer-driven health plan. J Health Commun. 2011;16(sup3 Suppl 3):308–21. doi: https://doi.org/10.1080/10810730.2011.604703 DOI: https://doi.org/10.1080/10810730.2011.604703
  19. Rasu RS, Bawa WA, Suminski R, Snella K, Warady B. Health Literacy Impact on National Healthcare Utilization and Expenditure. Int J Health Policy Manag. 2015 Aug;4(11):747–55. doi: https://doi.org/10.15171/ijhpm.2015.151 DOI: https://doi.org/10.15171/ijhpm.2015.151
  20. Griffey RT, Kennedy SK, D’Agostino McGowan L, Goodman M, Kaphingst KA. Is low health literacy associated with increased emergency department utilization and recidivism? Acad Emerg Med. 2014 Oct;21(10):1109–15. doi: https://doi.org/10.1111/acem.12476 DOI: https://doi.org/10.1111/acem.12476
  21. Berens EM, Vogt D, Messer M, Hurrelmann K, Schaeffer D. Health literacy among different age groups in Germany: results of a cross-sectional survey. BMC Public Health. 2016 Nov;16(1):1151. doi: https://doi.org/10.1186/s12889-016-3810-6 DOI: https://doi.org/10.1186/s12889-016-3810-6
  22. Palumbo R, Annarumma C, Adinolfi P, Musella M, Piscopo G. The Italian Health Literacy Project: insights from the assessment of health literacy skills in Italy. Health Policy. 2016 Sep;120(9):1087–94. doi: https://doi.org/10.1016/j.healthpol.2016.08.007 DOI: https://doi.org/10.1016/j.healthpol.2016.08.007
  23. Mantwill S, Schulz PJ. Low health literacy and healthcare utilization among immigrants and non-immigrants in Switzerland. Patient Educ Couns. 2017 Nov;100(11):2020–7. doi: https://doi.org/10.1016/j.pec.2017.05.023 DOI: https://doi.org/10.1016/j.pec.2017.05.023
  24. N’Goran AA, Pasquier J, Deruaz-Luyet A, Burnand B, Haller DM, Neuner-Jehle S, et al. Factors associated with health literacy in multimorbid patients in primary care: a cross-sectional study in Switzerland. BMJ Open. 2018 Feb;8(2):e018281. doi: https://doi.org/10.1136/bmjopen-2017-018281 DOI: https://doi.org/10.1136/bmjopen-2017-018281
  25. Franzen J, Mantwill S, Rapold R, Schulz PJ. The relationship between functional health literacy and the use of the health system by diabetics in Switzerland. Eur J Public Health. 2014 Dec;24(6):997–1003. doi: https://doi.org/10.1093/eurpub/ckt202 DOI: https://doi.org/10.1093/eurpub/ckt202
  26. Wieczorek M, Meier C, Vilpert S, Reinecke R, Borrat-Besson C, Maurer J, et al. Association between multiple chronic conditions and insufficient health literacy: cross-sectional evidence from a population-based sample of older adults living in Switzerland. BMC Public Health. 2023 Feb;23(1):253. doi: https://doi.org/10.1186/s12889-023-15136-6 DOI: https://doi.org/10.1186/s12889-023-15136-6
  27. Meier C, Vilpert S, Borrat-Besson C, Jox RJ, Maurer J. Health literacy among older adults in Switzerland: cross-sectional evidence from a nationally representative population-based observational study. Swiss Med Wkly. 2022 Apr;152(1314):w30158. doi: https://doi.org/10.4414/SMW.2022.w30158 DOI: https://doi.org/10.4414/SMW.2022.w30158
  28. Sykes S, Wills J, Rowlands G, Popple K. Understanding critical health literacy: a concept analysis. BMC Public Health. 2013 Feb;13(1):150. doi: https://doi.org/10.1186/1471-2458-13-150 DOI: https://doi.org/10.1186/1471-2458-13-150
  29. Börsch-Supan A. (2022). Survey of Health, Ageing and Retirement in Europe (SHARE) Wave 8. Release version: 8.0.0. SHARE-ERIC. Data set. DOI: 10.6103/SHARE.w8.800”
  30. Okan O, Bauer U, Levin‐Zamir D, Pinheiro P, Sørensen K. International Handbook of Health Literacy: Research, practice and policy across the lifespan. Policy Press; 2019. https://library.oapen.org/handle/20.500. 12657/24879. DOI: https://doi.org/10.56687/9781447344520
  31. Pelikan J, Ganahl K, Van den Broucke S, Sorensen K. Measuring health literacy in Europe: Introducing the European Health Literacy Survey Questionnaire (HLS-EU-Q). 2019. https://www.degruyter.com/document/doi/10.56687/9781447344520-011/html DOI: https://doi.org/10.56687/9781447344520-011
  32. Ryser VA, Meier C, Vilpert S, Maurer J. Health literacy across personality traits among older adults: cross-sectional evidence from Switzerland. Eur J Ageing. 2023 Jun;20(1):28. doi: https://doi.org/10.1007/s10433-023-00774-x DOI: https://doi.org/10.1007/s10433-023-00774-x
  33. Hoffmeyer-Zlotnik JH, Wolf C, editors. Advances in Cross-National Comparison: A European Working Book for Demographic and Socio-Economic Variables. Boston (MA): Springer US; 2003. pp. 195–220. doi: https://doi.org/10.1007/978-1-4419-9186-7 DOI: https://doi.org/10.1007/978-1-4419-9186-7
  34. Katz S. Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc. 1983 Dec;31(12):721–7. doi: https://doi.org/10.1111/j.1532-5415.1983.tb03391.x DOI: https://doi.org/10.1111/j.1532-5415.1983.tb03391.x
  35. Edemekong PF, Bomgaars DL, Sukumaran S, et al. Activities of Daily Living. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 Jan., Available from https://www.ncbi.nlm.nih.gov/books/NBK470404/
  36. Cameron AC, Trivedi PK. Regression Analysis of Count Data, 2nd ed. in Econometric Society Monographs. Cambridge: Cambridge University Press, 2013. ISBN 9781139013567. doi: https://doi.org/10.1017/CBO9781139013567 DOI: https://doi.org/10.1017/CBO9781139013567
  37. Giezendanner S, Bretschneider W, Fischer R, Diaz Hernandez L, Zeller A. The ecology of medical care in Switzerland: prevalence of illness in the community and healthcare utilisation in Switzerland. Swiss Med Wkly. 2020 May;150(1920):w20221. doi: https://doi.org/10.4414/smw.2020.20221 DOI: https://doi.org/10.4414/smw.2020.20221
  38. Böhlert I, Adam I, Robra BP. [The Swiss gatekeeper system—a model for improving capacity development and economic effectiveness]. Gesundheitswesen. 1997;59(8-9):488–94.
  39. De Pietro C, Camenzind P, Sturny I, Crivelli L, Edwards-Garavoglia S, Spranger A, et al. Switzerland: health system review. Health Syst Transit. 2015;17(4):1–288.
  40. Schoen C, Osborn R, Squires D, Doty MM, Pierson R, Applebaum S. How health insurance design affects access to care and costs, by income, in eleven countries. Health Aff (Millwood). 2010 Dec;29(12):2323–34. doi: https://doi.org/10.1377/hlthaff.2010.0862 DOI: https://doi.org/10.1377/hlthaff.2010.0862
  41. Fabbri E, Zoli M, Gonzalez-Freire M, Salive ME, Studenski SA, Ferrucci L. Aging and Multimorbidity: New Tasks, Priorities, and Frontiers for Integrated Gerontological and Clinical Research. J Am Med Dir Assoc. 2015 Aug;16(8):640–7. doi: https://doi.org/10.1016/j.jamda.2015.03.013 DOI: https://doi.org/10.1016/j.jamda.2015.03.013
  42. Bähler C, Huber CA, Brüngger B, Reich O. Multimorbidity, health care utilization and costs in an elderly community-dwelling population: a claims data based observational study. BMC Health Serv Res. 2015 Jan;15(1):23. doi: https://doi.org/10.1186/s12913-015-0698-2 DOI: https://doi.org/10.1186/s12913-015-0698-2
  43. Aubert CE, Fankhauser N, Marques-Vidal P, Stirnemann J, Aujesky D, Limacher A, et al. Multimorbidity and healthcare resource utilization in Switzerland: a multicentre cohort study. BMC Health Serv Res. 2019 Oct;19(1):708. doi: https://doi.org/10.1186/s12913-019-4575-2 DOI: https://doi.org/10.1186/s12913-019-4575-2
  44. Aaby A, Friis K, Christensen B, Rowlands G, Maindal HT. Health literacy is associated with health behaviour and self-reported health: A large population-based study in individuals with cardiovascular disease. Eur J Prev Cardiol. 2017 Nov;24(17):1880–8. doi: https://doi.org/10.1177/2047487317729538 DOI: https://doi.org/10.1177/2047487317729538
  45. Mackey LM, Doody C, Werner EL, Fullen B. Self-Management Skills in Chronic Disease Management: What Role Does Health Literacy Have? Med Decis Making. 2016 Aug;36(6):741–59. doi: https://doi.org/10.1177/0272989X16638330 DOI: https://doi.org/10.1177/0272989X16638330
  46. Ezzati M, Hoorn SV, Rodgers A, Lopez AD, Mathers CD, Murray CJ; Comparative Risk Assessment Collaborating Group. Estimates of global and regional potential health gains from reducing multiple major risk factors. Lancet. 2003 Jul;362(9380):271–80. doi: https://doi.org/10.1016/S0140-6736(03)13968-2 DOI: https://doi.org/10.1016/S0140-6736(03)13968-2
  47. Eichler K, Wieser S, Brügger U. The costs of limited health literacy: a systematic review. Int J Public Health. 2009;54(5):313–24. doi: https://doi.org/10.1007/s00038-009-0058-2 DOI: https://doi.org/10.1007/s00038-009-0058-2
  48. Visscher BB, Steunenberg B, Heijmans M, Hofstede JM, Devillé W, van der Heide I, et al. Evidence on the effectiveness of health literacy interventions in the EU: a systematic review. BMC Public Health. 2018 Dec;18(1):1414. doi: https://doi.org/10.1186/s12889-018-6331-7 DOI: https://doi.org/10.1186/s12889-018-6331-7
  49. Osborne RH, Elmer S, Hawkins M, Cheng CC, Batterham RW, Dias S, et al. Health literacy development is central to the prevention and control of non-communicable diseases. BMJ Glob Health. 2022 Dec;7(12):e010362. doi: https://doi.org/10.1136/bmjgh-2022-010362 DOI: https://doi.org/10.1136/bmjgh-2022-010362
  50. Samerski S. Health literacy as a social practice: social and empirical dimensions of knowledge on health and healthcare. Soc Sci Med. 2019 Apr;226:1–8. doi: https://doi.org/10.1016/j.socscimed.2019.02.024 DOI: https://doi.org/10.1016/j.socscimed.2019.02.024
  51. De Gani SM, Jaks R, Bieri U, Kocher JP. Health Literacy Survey Schweiz 2019-2021. Schlussbericht im Auftrag des Bundesamtes für Gesundheit BAG. Zürich, Careum Stiftung. 2021. Available from: https://www.bag.admin.ch/bag/en/home/strate-gie-und-politik/nationale-gesundheitspolitik/gesundheitskompetenz.html
  52. Liu Z, Shan J, Delaloye M, Piguet JG, Glassey Balet N. The Role of Public Trust and Media in Managing the Dissemination of COVID-19-Related News in Switzerland. J Med. 2020 Dec;1(1):1. doi: https://doi.org/10.3390/journalmedia1010010 DOI: https://doi.org/10.3390/journalmedia1010010
  53. van der Heide I, Poureslami I, Mitic W, Shum J, Rootman I, FitzGerald JM. Health literacy in chronic disease management: a matter of interaction. J Clin Epidemiol. 2018 Oct;102:134–8. doi: https://doi.org/10.1016/j.jclinepi.2018.05.010 DOI: https://doi.org/10.1016/j.jclinepi.2018.05.010
  54. Mata ÁN, de Azevedo KP, Braga LP, de Medeiros GC, de Oliveira Segundo VH, Bezerra IN, et al. Training in communication skills for self-efficacy of health professionals: a systematic review. Hum Resour Health. 2021 Mar;19(1):30. doi: https://doi.org/10.1186/s12960-021-00574-3 DOI: https://doi.org/10.1186/s12960-021-00574-3