An online survey to study the relationship between patients’ health literacy and coping style and their preferences for self-management-related information

Figures & data

Table 1 Descriptive statistics of survey completers who met study inclusion criteria (N=213)

Variable	Value
Section 1: sociodemographics, disease history, and information needs
Age, mean ± SD	55.9±14.0
Male sex	138 (64.8)
Educational level
Low (elementary and lower secondary education)	86 (40.4)
Intermediate (upper/postsecondary education)	87 (40.8)
High (tertiary education)	40 (18.8)
Marital status
Married or living together	162 (76.1)
Single	51 (23.9)
Work status
Paid or voluntary work	83 (39.0)
On sick leave (under the Dutch Sickness Benefits Act)	13 (6.1)
Retired or unemployed	117 (54.9)
Health perception
Very good	6 (2.8)
Good	67 (31.5)
Neither good nor poor	94 (44.1)
Poor	42 (19.7)
Very poor	4 (1.9)
Current or previous heart diseases and interventions (multiple response options)
Heart failure	76 (35.7)
Angina pectoris	90 (42.3)
Hypercholesterolemia and/or hypertension	178 (83.6)
Diabetes	54 (25.4)
Familial hypercholesterolemia	50 (23.5)
Cardiac arrhythmia	115 (54.0)
AMI	90 (42.3)
CABG	30 (14.1)
PCI	77 (36.2)
Pacemaker and/or ICD	15 (7.0)
CABG or AMI less than 1 year ago	22 (10.3)
PCI less than 1 year ago	20 (9.4)
Influence of heart disease on life, mean ± SD (range: 0–10)	6.1±2.7
Physical discomfort because of heart disease, mean ± SD (range: 0–10)	5.4±2.6
Availability of social support (N=212)
Never	2 (0.9)
Seldom	16 (7.5)
Sometimes	49 (23.1)
Often	50 (23.6)
Always	95 (44.8)
Availability of people who can give advice on a problem (N=212)
Never	10 (4.7)
Seldom	17 (8.0)
Sometimes	67 (31.6)
Often	56 (26.4)
Always	62 (29.2)
Categories with unanswered questions (N=208) (multiple response options)
The disease and its causes	41 (19.7)
The progress of the disease and the prognosis	50 (24.0)
Medication usage	79 (38.0)
Diet	30 (14.4)
Physical exercise	43 (20.7)
Smoking	18 (8.7)
Feelings and emotions	45 (21.6)
Alcohol consumption	10 (4.8)
Other or none	52 (25.0)
Section 2: health literacy and monitor–blunter coping style
Total health literacy score, mean ± SD (range: 0–4)	3.2±0.6
Need support with reading letters or leaflets, mean ± SD	3.3±1.0
Confidence filling in medical forms, mean ± SD	3.1±0.8
Understanding written information, mean ± SD	3.1±0.9
Monitor–blunter coping style score (range: −4 to +4), mean ± SD	−0.3±0.9
Blunter questions (range: 1–6), mean ± SD	3.1±0.8
Monitor questions (range: 1–6), mean ± SD	2.9±0.7
Section 3: respondents’ explicit information preferences
Explicit preferences with respect to information on disease and treatment (N=210)
I only want the information about my disease and treatment that I need to take care of myself properly	41 (19.5)
I want additional information about my disease and treatment, but only about the underlying mechanisms of the disease	21 (10.0)
I want as much information as possible about my disease and treatment, both about the underlying mechanisms of the disease as well as the risks and side effects	148 (70.5)
Preferred source of information (N=211)
Scientific research	56 (26.5)
Patient’s experience	33 (15.6)
Physician’s experience	122 (57.8)

Note: Unless stated otherwise, values represent number (percentage) of participants.

Abbreviations: N, number; SD, standard deviation; AMI, acute myocardial infarction; CABG, coronary artery bypass grafting; PCI, percutaneous coronary intervention; ICD, implantable cardioverter defibrillator.

Table 2 Preference for message features and univariate analysis of the association between monitor–blunter coping style/health literacy and preference for message features

Text set	Respondents’ preference for the message feature	Participants	Monitor–blunter coping style	Health literacy	P-value
		N (%)	Mean ± SD	Mean ± SD
`1.	Language style (N=208)
	Layperson’s language	60 (28.8)		3.08±0.676
	Medical language	117 (56.3)		3.22±0.554	0.138
	Preference for this message feature			3.17±0.600
	No preference for this message feature	31 (14.9)		3.09±0.672	0.474
2.	Level of abstractness (N=213)
	Concrete recommendations	128 (60.1)		3.17±0.634
	Abstract recommendations	53 (24.9)		3.09±0.579	0.459
	Preference for this message feature			3.15±0.618
	No preference for this message feature	32 (15.0)		3.21±0.579	0.604
3.	Actionability (N=210)
	Non-actionable recommendations	43 (20.5)		3.02±0.709
	Actionable recommendations	143 (68.1)		3.18±0.552	0.103
	Preference for this message feature			3.15±0.594
	No preference for this message feature	24 (11.4)		3.22±0.727	0.561
4.	Source of information (N=209)
	Physician’s experience	63 (29.7)		3.19±0.652
	Patient’s experience	34 (16.0)		2.83±0.653
	Scientific research	71 (33.5)		3.27±0.559	0.003*
	Preference for this message feature			3.15±0.633
	No preference for this message feature	44 (20.8)		3.16±0.521	0.936
5.	Temporal perspective (N=212)
	Current	86 (40.6)	−0.06±1.024
	Future	87 (41.0)	−0.37±0.824		0.029*
	Preference for this message feature		−0.22±0.939
	No preference for this message feature	39 (18.4)	−0.43±0.902		0.208
6.	Level of disease-specific information provided (N=210)
	Concise information	35 (16.7)	−0.35±1.077
	Detailed information	146 (69.5)	−0.21±0.920		0.444
	Preference for this message feature		−0.24±0.951
	No preference for this message feature	29 (13.8)	−0.41±0.755		0.340
7.	Level of treatment-specific information provided (N=211)
	Concise information	30 (14.2)	−0.35±1.076
	Detailed information	151 (71.6)	−0.20±0.935		0.441
	Preference for this message feature		−0.23±0.959
	No preference for this message feature	30 (14.2)	−0.43±0.756		0.259
8.	Explicitly threatening content (N=213)
	Information that includes explicit risks and side effects	118 (55.4)	−0.11±0.949
	Information that excludes explicit risks and side effects	73 (34.3)	−0.51±0.922		0.005*
	Preference for this message feature		−0.27±0.956
	No preference for this message feature	22 (10.3)	−0.24±0.734		0.914
9.	Cues (positive or negative) (N=212)
	Risks reduced by physical exercise	58 (27.4)	−0.24±0.910
	Benefits of physical exercise	119 (56.1)	−0.22±0.969		0.903
	Preference for this message feature		−0.23±0.947
	No preference for this message feature	35 (16.5)	−0.46±0.865		0.183

Notes: Preference for text sets 1–4 were hypothesized to be related to health literacy, and text sets 5–9 were hypothesized to be related to monitor–blunter coping style. Higher monitor–blunter coping style scores mean a greater tendency toward a monitoring coping style (range −4 to +4). Higher health literacy scores mean higher health literacy (range 1–5).

* P<0.05.

Abbreviations: N, number; SD, standard deviation.

Table 3 Multivariate analysis of all patient characteristics per text set that were associated (P<0.1) with preferences for that text set in the univariate analysis

Text pair or trio	Variable	OR (95% CI)
Medical language (N=177)
	Female sex	1.24 (0.61–2.53)
	Higher age (per 10 years)	1.17 (0.92–1.49)
	High educational level	Reference category
	Low educational level	0.30 (0.09–0.99)*
	Intermediate educational level	0.29 (0.09–0.94)*
	Having a pacemaker and/or ICD	0.38 (0.11–1.31)
	Having someone who can give support	2.10 (1.02–4.31)*
High level of abstractness (N=179)
	Female sex	1.08 (0.53–2.20)
	Higher age (per 10 years)	1.41 (1.07–1.84)*
	Explicit preference for little information about disease and treatment	1.99 (0.97–4.08)
Highly actionable message (N=184)
	Female sex	1.38 (0.63–3.05)
	Lower age (per 10 years)	1.01 (0.78–1.30)
	Having had an AMI	1.98 (0.84–4.67)
	Having had a PCI	1.45 (0.59–3.53)
	Explicit preference for detailed information about disease and treatment	3.21 (1.53–6.71)*
Source of information – patient’s experience versus physician’s experience or scientific research (N=164)
	Higher age (per 10 years)	1.10 (0.80–1.51)
	Female sex	1.91 (0.72–5.12)
	Information source: scientific research	Reference category
	Information source: physician’s experience	0.49 (0.16–1.48)
	Information source: patient’s experience	1.42 (0.42–4.80)
	Lower health literacy (range: 0–4)	3.00 (1.45–6.21)*
	Higher number of categories with unanswered questions	1.56 (1.15–2.12)*
	Having diabetes	0.35 (0.09–1.42)
	Having cardiac arrhythmia	0.39 (0.14–0.96)*
	Explicit preference for little information about disease and treatment	1.70 (0.64–4.51)
Source of information – scientific research versus patient’s or physician’s experience (N=168)
	Lower age (per 10 years)	1.10 (0.87–1.40)
	Male sex	1.48 (0.72–3.04)
	Being single	2.19 (1.00–4.76)*
	High health literacy (range: 0–4)	1.89 (1.07–3.35)
	Having heart failure	1.98 (1.01–3.88)
	No AMI or CABG less than 1 year ago, or no AMI or CABG at all	2.10 (0.67–6.58)
Future temporal perspective (N=172)
	Female sex	1.01 (0.50–2.03)
	Higher age (per 10 years)	1.02 (0.81–1.30)
	A more blunting coping style (range: −4 to +4)	1.42 (0.99–2.05)
	Being single	3.01 (1.30–6.99)*
	Having diabetes	0.52 (0.25–1.09)
	Having someone who can give advice	2.15 (1.08–4.26)*
High level of disease-specific information provided (N=178)
	Female sex	1.11 (0.47–2.63)
	Higher age (per 10 years)	1.07 (0.80–1.43)
	Married or living together	2.22 (0.93–5.32)
	Having diabetes	2.70 (0.84–8.62)
	Explicit preference for detailed information about disease and treatment	2.89 (1.30–6.41)*
High level of treatment-specific information provided (N=179)
	Female sex	1.94 (0.79–4.72)
	Lower age (per 10 years)	1.62 (1.11–2.35)*
	Having had a PCI more than 1 year ago or not having had a PCI	3.77 (1.13–12.52)*
	Explicit preference for detailed information about disease and treatment	3.03 (1.29–7.14)*
Nonthreatening information (N=188)
	Female sex	1.20 (0.60–2.38)
	Higher age (per 10 years)	1.51 (1.16–1.97)*
	A more blunting coping style (range: −4 to +4)	1.35 (0.92–1.98)
	Lower health literacy (range: 0–4)	1.95 (1.11–3.44)*
	Explicit preference for little information about disease and treatment	2.65 (1.28–5.48)*
Positive cues (N=177)
	Female sex	1.53 (0.74–3.19)
	Lower age (per 10 years)	1.26 (0.98–1.63)
	Higher health literacy (range: 0–4)	1.41 (0.79–2.50)
	Medical history of cardiac arrhythmia	0.51 (0.26–1.02)
	Poor health perception	Reference category
	Good health perception	2.22 (0.87–5.70)
	Intermediate health perception	0.86 (0.38–1.97)

Note:

* P<0.05.

Abbreviations: N, number; OR, odds ratio; CI, confidence interval; ICD, implantable cardioverter defibrillator; AMI, acute myocardial infarction; PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting.