POS0299 SOCIOECONOMIC BACKGROUND IS ASSOCIATED WITH DISCORDANCE BETWEEN HEALTH LITERACY OF PEOPLE WITH RMDs AND ASSESSMENT OF HEALTH LITERACY BY THEIR TREATING HEALTH PROFESSIONAL
Authors: M. M. Bakker, C. Dikovec, P. Putrik, J. Rademakers, M. Van de Laar, H. Vonkeman, M. R. Kok, H. Voorneveld, S. Ramiro, M. De Wit, R. Buchbinder, R. Batterham, R. Osborne, A. Boonen
Journal: Annals of the Rheumatic Diseases (2021)

Background: Health literacy is increasingly recognised as a critical determinant of health. While care should be tailored to the health literacy needs of each patient [1], research in primary care shows that physicians often under- or overestimate their patients’ health literacy, with socioeconomic factors playing a role [2]. Evidence in a rheumatology setting is scarce. Objectives: -To investigate discordance between health literacy of patients with rheumatic and musculoskeletal diseases (RMDs) and assessment by their treating health professional, across the nine domains of the Health Literacy Questionnaire (HLQ). -To explore whether discordance is associated with the patient’s socioeconomic background. Methods: Patients with rheumatoid arthritis (RA), spondyloarthritis (SpA), or gout from three Dutch outpatient rheumatology clinics completed the HLQ [3]. The treating health professional (rheumatologist, physician assistant, nurse (practitioner) or resident) assessed their patient’s level for each HLQ domain, or answered “I don’t know”. Discordance per domain was calculated as the patient’s score subtracted from the professional’s score (both on a 0-10 scale). Discordance was defined as a ≥2-point difference in either direction. Adjusted multilevel multinomial regression models (ref. = no discordance) with patients clustered by health professionals were computed to test the role of socioeconomic factors (age, gender, education level, immigration background, living alone and employment status) in negative (i.e. professional scored lower) and positive (i.e. professional scored higher) discordance. Results: Of 778 patients included, 41% had RA, 34% had SpA, and 25% had gout. We observed considerable discordance across all HLQ domains (Table 1). Professionals answered “I don’t know” most often for “Having social support for health” (19.4%, domain 4). Most discordance occurred for “Critically appraising information” (42.1%, domain 5). For all HLQ domains except “Having social support for health” (domain 4), discordance was associated with socioeconomic factors. In patients with a non-Western immigration background, professionals were likely to assign lower scores than patients’ HLQ scores in six domains. Education level was an important driver of discordance in seven domains, with the direction of the association being domain-dependent. Other factors associated with discordance in multiple domains were type of rheumatic disease, comorbidities, mastery, how well the professional knew the patient, type of professional, and disease impact. Table 1. Discordance per HLQ domain (n=778) HLQ domain Professional scored lower No discordance Professional scored higher Professional did not know n (%) 1. Healthcare provider support 128 (16) 514 (66) 126 (16) 10 (1) 2. Having sufficient information 100 (13) 528 (68) 143 (18) 7 (1) 3. Actively managing health 95 (12) 461 (59) 208 (27) 14 (2) 4. Having social support for health 55 (7) 397 (51) 175 (22) 151 (19) 5. Critically appraising information 78 (10) 448 (58) 250 (32) 2 (0) 6. Actively engaging with providers 205 (26) 500 (64) 70 (9) 3 (0) 7. Navigating the health system 115 (15) 544 (70) 107 (14) 12 (2) 8. Finding health information 163 (21) 492 (63) 98 (13) 25 (3) 9. Understanding health information 145 (19) 511 (66) 110 (14) 12 (2) Conclusion: Considerable discordance between patients’ health literacy and their treating health professionals’ assessment exists across health literacy domains. In eight out of nine domains, discordance was associated with the patient’s socioeconomic background, particularly education and immigration background. Understanding and addressing the reasons for discordance between patient-reported and professional-perceived health literacy has potential to improve responsiveness to patients’ needs, promote better communication and ultimately improve care outcomes. References: [1]Bakker et al., Arthrit Care Res (2021) [2]Storms et al., BMJ Open (2019) [3]Osborne et al., BMC Public Health (2013) Disclosure of Interests: None declared