Assessing health literacy in adults with multiple chronic diseases

Dr Thi Thuy Ha Dinh1,2, Prof  Ann  Bonner2,3

1School of Nursing, University of Tasmania, Newnham, Australia, 2School of Nursing and Midwifery, Griffith University, Nathan, Australia, 3Kidney Health Service, Metro North Hospital and Health Service, Herston, Australia



Health literacy (HL) capabilities are crucial for people with multiple chronic diseases to understand information, to make good health decisions, and to adhere to treatment. These capabilities comprise functional literacy skills, communication with healthcare professionals, critical appraisal, and problem-solving skills. Understanding strengths and weaknesses of health literacy perceived by these people will inform clinicians to develop supporting strategies.


To determine HL abilities and demographic predictors in adults with multiple chronic diseases.


Using a cross-sectional design, 600 adults with ≥ 2 chronic diseases were conveniently recruited. Participants completed the Health Literacy Questionnaire which assesses 9 domains of HL. Clinical data was extracted from hospital records. Charlson Comorbidity Index (CCI) was used to assess comorbidity status. Parametric tests (t-test, ANOVA) were used to distinguish HL between various demographic characteristics.


Participants’ mean age was 61 years, half were male (54%), and 71.3% has severe CCI scores. The most common chronic diseases were hypertension (89%), diabetes (62%), chronic kidney disease (61%), and heart failure (28%). The proportions of low HL were highest in domains 1, 5, 8 related to healthcare providers’ support, appraisal of health information and finding information (52%, 40%, 38%, respectively). Increased comorbidity severity was significantly associated with greater difficulties in domains Finding good health information (p = 0.02) and Appraisal of health information (p = 0.01).


Clinicians ought to use universal principles and consider that all patients with comorbidities will have low HL and are likely to struggle with finding, understanding and appraising health information.


Dr Ha Dinh (PhD, RN) is a research staff at School of Nursing, University of Tasmania, Australia. She is interested in research topics of chronic disease management, health literacy, learning and teaching in nursing education. Ha Dinh is a growing nurse researcher and has received two prestigious research fellowships (Endeavour Research Fellowship, APEC Women in Research Fellowship) to pursue her research interest.