Functional, communicative and critical health literacy of chronic disease patients and their importance for self-management

Patient Educ Couns. 2015 Jan;98(1):41-8. doi: 10.1016/j.pec.2014.10.006. Epub 2014 Oct 16.


Objective: To provide insight into the level of health literacy among chronic disease patients in the Netherlands, to identify subgroups with low literacy and to examine the associations between health literacy and self-management.

Methods: Self-report questionnaires were sent to a nationwide sample of 1.341 chronic disease patients. The Dutch Functional Communicative and Critical Health Literacy scale (FCCHL), the Partners in Health scale (PIH) and Perceived Efficacy in Patient-Doctor Interactions (PEPPI-5) were used to assess health literacy and aspects of self-management.

Results: In general, health literacy skills were good. A higher age, lower education, lower income, multi-morbidity and/or functional limitations were associated with lower levels of health literacy. Communicative and critical health literacy were related to some aspects of self-management but not to all. Functional health literacy was less important.

Conclusion: Communicative and critical health literacy play a role in successful self-management of chronic disease but the impact differs by context. Health literacy levels vary according to socio-demographic and disease characteristics of patients.

Practice implications: Health care professionals should tailor their information and support to the health literacy skills and personal context of their patients.

Keywords: Chronic illness; Health literacy; Self-management; Self-management support.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Chronic Disease / therapy*
  • Communication*
  • Cross-Sectional Studies
  • Female
  • Health Behavior
  • Health Knowledge, Attitudes, Practice
  • Health Literacy*
  • Humans
  • Male
  • Middle Aged
  • Netherlands
  • Patient Education as Topic
  • Physician-Patient Relations*
  • Self Care*
  • Self Efficacy
  • Socioeconomic Factors
  • Surveys and Questionnaires*