Effect of Communicative and Critical Health Literacy on Trust in Physicians Among Patients With Systemic Lupus Erythematosus (SLE): The TRUMP2-SLE Project

Nao Oguro; Nobuyuki Yajima; Yoshia Miyawaki; Ryusuke Yoshimi; Yasuhiro Shimojima; Ken-Ei Sada; Keigo Hayashi; Kenta Shidahara; Natsuki Sakurai; Chiharu Hidekawa; Dai Kishida; Takanori Ichikawa; Yuichi Ishikawa; Noriaki Kurita

doi:10.3899/jrheum.220678

Effect of Communicative and Critical Health Literacy on Trust in Physicians Among Patients With Systemic Lupus Erythematosus (SLE): The TRUMP2-SLE Project

J Rheumatol. 2023 May;50(5):649-655. doi: 10.3899/jrheum.220678. Epub 2022 Nov 15.

Authors

Affiliations

¹ N. Oguro, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, and Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima.
² N. Yajima, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine Kyoto University, Kyoto and Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima.
³ Y. Miyawaki, MD, PhD, K. Hayashi, MD, PhD, K. Shidahara, MD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama.
⁴ R. Yoshimi, MD, PhD, N. Sakurai, MD, Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama.
⁵ Y. Shimojima, MD, PhD, D. Kishida, MD, PhD, T. Ichikawa, MD, PhD, Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto.
⁶ K. Sada, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, and Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Nankoku.
⁷ C. Hidekawa, MD, Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama.
⁸ Y. Ishikawa, MD, The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu.
⁹ N. Kurita, MD, PhD, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, and Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukishima, Japan. kuritanoriaki@gmail.com.

PMID: 36379567
DOI: 10.3899/jrheum.220678

Abstract

Objective: Patients who trust their physicians have been shown to demonstrate good medication adherence, self-management, and favorable disease outcomes. This study examines how trust in physicians is affected by functional health literacy (HL) and by broader concepts of HL, including communicative HL and critical HL, among patients with systemic lupus erythematosus (SLE).

Methods: This was a cross-sectional study using baseline data from the Trust Measurement for Physicians and Patients with SLE (TRUMP2-SLE) study, an ongoing multicenter cohort study conducted at 5 academic centers. The 14-item Functional, Communicative, and Critical Health Literacy Scale assessed the 3 dimensions of HL; each item of the scale was scored on a 4-point Likert scale, ranging from 1 to 4. Outcomes were trust in one's physician and trust in physicians in general using the 5-item Wake Forest Physician Trust Scale, which ranged from 0 to 100 points. General linear models were fit.

Results: A total of 362 patients with SLE were included. Trust in one's physician increased with higher functional and communicative HL (per 1-point increase: mean difference 3.39, 95% CI 0.39-6.39, and mean difference 5.88, 95% CI 2.04-9.71, respectively). Trust in physicians in general increased with higher communicative HL and decreased with higher critical HL (per 1-point increase: mean difference 7.09, 95% CI 2.34-11.83, and mean difference -6.88, 95% CI -11.72 to -2.04, respectively). Longer internet use was associated with both higher communicative and critical HL.

Conclusion: The findings suggest that rheumatologists need to improve their communication to match each patient's HL, which may foster trust and lead to improved self-management and outcomes in SLE. They also suggest that the formation of the rheumatologist-patient relationship may negate the effect of high critical HL in building trust.

Keywords: communicative health literacy; critical health literacy; functional health literacy; physician trust; systemic lupus erythematosus.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Cohort Studies
Communication
Cross-Sectional Studies
Health Literacy*
Humans
Lupus Erythematosus, Systemic*
Physicians*
Trust