The relationship between health literacy and self-care in persons with chronic diseases: a multicenter cross-sectional study

Background To examine the relationship between health literacy and self-care (maintenance, monitoring, and management) in people with chronic diseases. Methods A multicenter cross-sectional study was conducted in six hospitals (one academic, four teaching, and one general) in the Netherlands among 536 adults (≥ 18 years) with at least one chronic disease between October 2022 and June 2024. Participants completed sociodemographic data, the European Health Literacy Survey Questionnaire (HLS-EU-Q16), the Self-Care of Chronic Illness Inventory (SC-CII v4c), and the Self-Care Self-Efficacy Scale. Associations between health literacy (adequate vs. inadequate) and self-care (maintenance, monitoring and management) were tested with multivariable linear regression adjusted for age, gender, number of chronic conditions, educational level, living situation, and self-efficacy. Results Of 536 adults (mean age 67 ± 14 years, 54% men), 46% had inadequate health literacy. Mean self-care scores were 70.4 ± 14.7 (maintenance), 69.9 ± 22.3 (monitoring), and 70.9 ± 19.7 (management) on a 0-100 scale. In multivariable models, adequate health literacy is associated with better self-care maintenance (β = 5.6, 95% CI 3.1–8.1), self-care monitoring (β = 8.7, 95% CI 5.0-1.5), and self-care management (β = 5.5, 95% CI 2.1–8.9) when adjusting for all controlled variables. However, this association become non-significant after adding self-efficacy, which explained most of the residual variance. Conclusions Adequate health literacy is associated with higher self-care scores among adults with chronic diseases. However, such association was diminished when self-efficacy is accounted for, indicating that self-efficacy mediates the relationship between health literacy and self-care. Clinical trial number: Not applicable