ABSTRACT
BACKGROUND: Health Literacy (HL) is the knowledge and competence to access, understand, appraise, and apply health information for health judgment. We analyze for the first time HL level of Catalonia's population. Our objective was to assess HL of population in our area and to identify social determinants of HL in order to improve the strategies of the Healthcare Plan, aimed at establishing a person-centered system and reducing social inequalities in health. METHODS: This was a cross-sectional study based on the Health Survey for Catalonia (ESCA, Enquesta de Salut de Catalunya), which included the 16 items of the European Health Literacy Survey Questionnaire (HLS-EU-Q16). The statements in the questionnaire cover three different health literacy domains: Health Care, Disease Prevention, and Health Promotion. HL was categorized in three levels: Sufficient, Problematic and Inadequate. Chi-square tests were performed to compare the percentages of subjects with adequate or inadequate HL across sociodemographic and health-related variables. Variables showing significant differences were included in a stepwise logistic regression to predict inadequate HL level. RESULTS: The questionnaire was administered to 2433 subjects aged between 15 and 98 years old (mean of 45.9 years, SD 18.0). Overall, 2059 subjects (84.6%) showed sufficient HL, 250 (10.3%) inadequate HL, and 124 (5.1%) problematic HL, with no significant differences between men and women (p = 0.070). A logistic regression analysis showed that low health literacy is associated with a lower level of education (OR 2.08, CI 95% 1.32-3.28, p = 0.002), low socioeconomic status (OR 2.11, CI 95% 1.42-3.15, p < 0.001) and a physical limitation to perform everyday activities (OR 2.50, CI 95% 1.34-4.66, p = 0.004). We also found a more modest association with low physical activity, having a self-perceived chronic disorder and performing preventive activities. CONCLUSIONS: Catalonia has a high percentage of subjects with sufficient HL. Education level, socioeconomic status and physical limitations were the factors with the strongest contribution to inadequate or problematic health literacy. Although these results are likely to be country-specific, the factors identified will allow policymakers of areas with similar socioeconomic profiles to identify groups with high risk of problematic or inadequate HL, which is essential for a successful patient-centered model of care.
Subject(s)
Health Literacy/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Health Surveys , Humans , Male , Middle Aged , Socioeconomic Factors , Spain , Young AdultABSTRACT
Se presenta el trabajo que está realizando el Servei Català de la Salut entorno las enfermedades raras (ER) desde el año 2009. En este sentido, la Comisión Asesora de ER de Cataluña promovió la definición de un modelo de atención a las ER, que aprobó el año 2010. Desde entonces, se está trabajando en distintas líneas de actuación para poder implantar el modelo. Se repasan los aspectos clave en la trayectoria histórica de los centros sanitarios en relación a las enfermedades raras y se describen los objetivos y los principios generales en los que se basa la atención a las ER en Catalunya: niveles asistenciales, trabajo en red para una atención integral, equipo multidisciplinario y participación de los recursos del ámbito educativo, social y laboral. Destaca la concentración de la atención especializada en las Unidades Clínicas Expertas que inician el proceso de reconocimento por parte del CatSalut. Así mismo, se identifica la figura del gestor de casos como el interlocutor interno en el ámbito especializado y otro en el ámbito comunitario. También destaca la importancia de garantizar el proceso de transición de los pacientes pe-diátricos a los servicios asistenciales adultos. Se comenta el proceso de elaboración del Mapa de Unidades Clínicas Expertas y del Registro de ER y de la Información que se presenta en el Canal Salud. Se aplican estos conceptos a la red asistencial de Catalunya para la Enfermedad de Huntington y el grupo de enfermedades con demencia de inicio precoz
Herein, it is presented the work the Catalan Health Service has done in the field of Rare Diseases (RD) since 2009. In this sense, it was the Committee of Advisors of RD in Catalonia who promoted the definition of a Care Model of RD, which was finally approved in 2010. Since then, much work has been done in distinct lines in order to implement this Model. From that time, the main aspects in the historical trajectory of the health centres, according to the RD Care Model, are revised, and a description of the objectives and general principles, in which the holistic RD Care Model is based, is made: care levels, networking for a comprehensive care, multidisciplinary team and involvement of the educational, social and employment resources. It stands out the concentration of the specialised care in the Expert Care Units, which are submitted to an acknowledgement process realised by the Catalan Health Service. Likewise, the role of case managers is identified as the internal speaker between the specialised and the community levels. It is also emphasised the importance of warranting the transition process of the paediatric patients to the adult healthcare services. In addition, a Map of the Expert Care Units and a RD Registry are developed, as it is the information presented in the "Canal Salut" (the Catalan Health Services Webpage). All this concepts are employed in the Catalan Healthcare Network for the Huntingtons disease and the group of diseases with early onset dementia
