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Characteristics of people with low health literacy on coronary heart disease GP registers in South London: a cross-sectional study

Rowlands, G. P., Mehay, A. ORCID: 0000-0001-7329-9056, Hampshire, S. , Phillips, R., Williams, P., Mann, A., Steptoe, A., Walters, P. & Tylee, A. T. (2013). Characteristics of people with low health literacy on coronary heart disease GP registers in South London: a cross-sectional study. BMJ Open, 3(1), article number e001503. doi: 10.1136/bmjopen-2012-001503


Objective To explore characteristics associated with, and prevalence of, low health literacy in patients recruited to investigate the role of depression in patients on General Practice (GP) Coronary Heart Disease (CHD) registers (the Up-Beat UK study).

Design Cross-sectional cohort. The health literacy measure was the Rapid Estimate of Health Literacy in Medicine (REALM). Univariable analyses identified characteristics associated with low health literacy and compared health service use between health literacy statuses. Those variables where there was a statistically significant/borderline significant difference between health literacy statuses were entered into a multivariable model.

Setting 16 General Practices in South London, UK.

Participants Inclusion: patients >18 years, registered with a GP and on a GP CHD register. Exclusion: patients temporarily registered.

Primary outcome measure REALM.

Results Of the 803 Up-Beat cohort participants, 687 (85.55%) completed the REALM of whom 106 (15.43%) had low health literacy. Twenty-eight participants could not be included in the multivariable analysis due to missing predictor variable data, leaving a sample of 659. The variables remaining in the final model were age, gender, ethnicity, Indices of Multiple Deprivation score, years of education, employment; body mass index and alcohol intake, and anxiety scores (Hospital Anxiety and Depression Scale). Univariable analysis also showed that people with low health literacy may have more, and longer, practice nurse consultations than people with adequate health literacy.

Conclusions There is a disadvantaged group of people on GP CHD registers with low health literacy. The multivariable model showed that patients with low health literacy have significantly higher anxiety levels than people with adequate health literacy. In addition, the univariable analyses show that such patients have more, and longer, consultations with practice nurses. We will collect 4-year longitudinal cohort data to explore the impact of health literacy in people on GP CHD registers and the impact of health literacy on health service use.

Publication Type: Article
Additional Information: This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and
Subjects: L Education > L Education (General)
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Departments: School of Health & Psychological Sciences > Healthcare Services Research & Management
SWORD Depositor:
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