Effects of Health literacy on Health Service Utilization. Findings from Germany

Background Health literacy (HL) is defined as the ability to process health related information and reflects the fit between personal competences and situational demands. A growing number of HL research demonstrates for low HL negative effects on medication adherence and health status and also effects on over-utilization of health services. However, most of the existing HL studies have been conducted outside Europe. This study also investigated how HL is related to the use of different types of health services in Germany. Methods A representative 2,000-person sample (older than 15) was interviewed face-to-face (CAPI) for the HLS-GER study in 2014 in German. The survey included amongst other indicators: a comprehensive HL measure (HLS-EU-Q47), which has been developed for the European Health Literacy Study, socio-economic indicators and indicators for health service use (doctor visits, use of hospital services, other health professionals and emergency services). For hypothesis testing (effects of comprehensive HL on health service use) correlation analysis and regression analysis were performed. Results Respondents with lower HL scores used health services more often (p < 0.001). In a multiple regression model the direct effect of comprehensive HL on doctor visits (beta =-.066) and use of other health professionals (beta =-.103) HL remained an important predictor, also when adjusting for gender, age, financial deprivation, education, migration, self-perceived health and chronic illness. But the direct effect of HL on use of hospital services and emergency services vanished in this multi-variate model. Conclusions As persons with low health literacy have more contacts to doctors and other health professionals regardless of their health and socio-demographic status, they need special attention in measures to navigate the health care system and (self-)manage their health. In addition, the health professionals need to adapt to users with low health literacy. Key messages: The role of health literacy differs considerably by type of health service use. For extent of contacts to doctors and other health professionals, health literacy is an important predictor.