What do COPD patients with low health literacy need to enhance their self-management? - Evidence from Swiss survey data

Background Health literacy (HL) is critical for enhancing self-management among patients with COPD. However, HL level among COPD patients remains low, limiting their ability to manage the disease effectively.Aims This study aims to (1) investigate how COPD patient characteristics differ across HL levels and (2) explore whether patients with varying HL levels report different challenges and support needs for better disease management.Methods Data was collected from 192 COPD patients through a web-based survey comprising 65 questions, including the European Health Literacy Survey Questionnaire (HLS-EU-Q16) to assess HL. We used chi-square test and analysis of variance (ANOVA) to compare patient demographics and disease-related characteristics across HL levels. We then employed Pearson’s chi-square test and Fisher’s test to compare challenges in disease management and desired support needs between patients with sufficient (high) and problematic or inadequate (low) HL levels.Results Among the participants, 44.8% had problematic or inadequate (low) HL. Significant differences across HL levels were observed in feeling secure in medication intake (p = 0.008), in dependency on assistance for managing the disease (p = 0.044), age (p < 0.001), and health-related quality of life (HRQoL): EQ-5D-5L (p < 0.001) and EQ-VAS (p = 0.020), and CAT score (p = 0.002). Moreover, COPD patients with inadequate or problematic HL subgroups reported significantly greater challenges (e.g., limited mobility, fears about the future, non-acceptance of their diagnosis). The subgroup analysis also showed that COPD patients with inadequate or problematic HL had a significantly greater support needs, e.g., for regular tips and information on dealing with COPD, regular exercises to alleviate symptoms, or smoking cessation support.Discussion Differences in patients’ characteristics, challenges and support needs across HL levels underscore the importance of HL in enabling personalized healthcare. Limited HL affects multiple interrelated domains of disease management, highlighting the need for personalized support. Given the mixed evidence on HL-tailored interventions, a combined approach - ensuring universally accessible health information while providing targeted support where needed - may be most effective. Self-management programs and digital health interventions may be key instruments for implementing these strategies and improving patient outcomes.