From Contact to Clarity: Patient engagement and health literacy in Belgian primary care

Background

Within the Patient-Reported Indicators Surveys (PaRIS), understanding how patients engage with care and use health information is increasingly important. In Belgian primary care, patient engagement, collaboration, and health literacy are key, but their intercorrelations across socio-demographic groups are unclear. This study used data from PaRIS to examine these associations and whether they differ by education level in patients aged ≥45. PREMs (patient-reported experience measures) and PROMs (patient-reported outcome measures) were included.

Methods

Using the 10-item Porter Novelli scale (PaRIS-PQ), factor analysis identified 3 dimensions: patient engagement (PNS1: 3,5,6,10), collaboration with healthcare professionals (PNS2: 1,4,8,9), and health literacy (PNS3: 2,7). Scores were calculated as item averages (1-5). Internal consistency was acceptable. A mixed-effects model was fitted on 4,421 respondents nested in 59 GP practices. Health literacy (PNS3) was the outcome; predictors were engagement and collaboration, adjusted for gender, age, number of chronic conditions, education, and income.

Results

Engagement (PNS1) was positively associated with health literacy (β = 0.285, p < 0.001). Collaboration (PNS2) showed a negative association (β=-0.243, p < 0.001). Correlations were small but significant (PNS1-PNS3: r = 0.119; PNS2-PNS3: r = −0.165; both p < 0.001). In an interaction model, the association between engagement and health literacy was not significant among respondents with low education (slope=0.084, p = 0.085), but remained positive in middle (0.344, p < 0.001) and high education groups (0.435, p < 0.001).

Conclusions

Greater engagement was associated with better health literacy, except among those with low education. Collaboration was associated with slightly lower health literacy, possibly reflecting compensatory help-seeking by people with lower literacy. These findings suggest that engagement alone may not be sufficient to reduce health literacy gaps.

Key messages

• Higher patient engagement is associated with better health literacy, but this relationship seems strongly influenced by level of education.

• Patients with lower health literacy may rely more on collaboration with healthcare professionals, underscoring the need for tailored support strategies in primary care settings.