Health Literacy in Familial Hypercholesterolemia: A Cross-National Study
Background: High rates of inadequate health literacy (HL) are associated with maladaptive health outcomes in chronic disease including increased mortality and morbidity rates, poor treatment adherence, and poor health. Adequate HL may be an important factor in the effective treatment and management of Familial Hypercholesterolemia (FH), and may also be implicated in genetic screening for FH among index cases. The present study examined the prevalence and predictors of HL in FH patients attending clinics in seven countries. Design: Cross-sectional survey. Methods: Consecutive FH patients attending clinics in Australia, Brazil, China, Hong Kong, Malaysia, Taiwan, and the UK completed measures of demographic variables (age, gender, household income, and highest education level) and a brief three-item HL scale. Results: Rates of inadequate HL were lowest in the UK (7.0%), Australia (10.0%), Hong Kong (15.7%), and Taiwan (18.0%) samples, with higher rates in the Brazil (22.0%), Malaysia (25.0%), and China (37.0%) samples. Income was an independent predictor of HL levels, accounting for effects of age. HL was also independently related to China national group membership. Conclusions: Findings indicate non-trivial levels of inadequate HL in samples of FH patients. Consistent with previous research in chronic illness, inadequate HL is related to income as an index of health disparities. Chinese FH patients are more likely to have high rates of inadequate HL independent of income. Current findings highlight the imperative of education interventions targeting FH patients with inadequate HL.