ArticleBMC health services research2018
The role of health literacy in explaining the association between educational attainment and the use of out-of-hours primary care services in chronically ill people: a survey study.
Article in BMC health services research, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 161 papers, 6 of them syntheses that pooled it.
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Who cites it
161 citing papers in PubMed, 6 syntheses or guidelines pooled it, 275 citations in OpenAlex.
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- Sociodemographic and Socioeconomic Determinants for the Usage of Digital Patient Portals in Hospitals: Systematic Review and Meta-Analysis on the Digital Divide.Journal of medical Internet research · 2025Pooled it
- Adherence to antihypertensives in the United States: A comparative meta-analysis of 23 million patients.Journal of clinical hypertension (Greenwich, Conn.) · 2024Pooled it
- Frequency and associated factors for swallowing impairment in community-dwelling older persons: a systematic review and meta-analysis.Aging clinical and experimental research · 2022Pooled it
- Inequalities in Older age and Primary Health Care Utilization in Low- and Middle-Income Countries: A Systematic Review.International journal of health services : planning, administration, evaluation · 2022Pooled it
- Diabetes distress among immigrants of south Asian descent living in New York City: baseline results from the DREAM randomized control trial.BMC public health · 2025Trial
- The influence of decisional conflict on treatment decision in pelvic organ prolapse-data from the SHADE-POP trial.Archives of gynecology and obstetrics · 2024Trial
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- Effects by educational attainment of a mammography screening patient decision aid for women aged 75 years and older.Cancer · 2021Trial
- Use and usability of the dr. Bart app and its relation with health care utilisation and clinical outcomes in people with knee and/or hip osteoarthritis.BMC health services research · 2021Trial
- Treatment trajectories among patients with musculoskeletal disorders in Norway - a register-based cohort study over 2 years.Scandinavian journal of primary health care · 2026Article
- Impact of maternal health on neonatal and long-term kidney outcomes.Pediatric nephrology (Berlin, Germany) · 2026Review
- Telehealth Use and Satisfaction in Primary and Mental Health Care Across 9 High-Income Countries.Mayo Clinic proceedings. Digital health · 2026Article
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- Autistic traits and mental health support service use among parents of young children with autism.Research in neurodiversity · 2026Article
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- Beyond the Lines: Exploration of Health Literacy Among Inmates in a European Prison in Africa.Journal of racial and ethnic health disparities · 2026Article
- Hospital contacts before childhood cancer and the risk of early mortality: a Danish and Swedish population-based cohort study.British journal of cancer · 2026Article
- Health literacy of the Deaf community: a scoping review.Journal of deaf studies and deaf education · 2026Article
101 more citing papers are in PubMed but not listed here.
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Authors and funding
6 authors at 3 institutions in 4 countries.
Funding
Abstract
backgroundLow socioeconomic status (SES) is persistently associated with poor health and suboptimal use of healthcare services, and more unplanned healthcare use. Suboptimal use of emergency and acute healthcare services may increase health inequalities, due to late diagnosis or lack of continuity of care. Given that health literacy has been associated with healthcare utilisation and with education attainment, we sought to explore whether health literacy is related to the use of out-of-hours (OOH) Primary Care Services (PCSs). Additionally, we aimed to study whether and to what extent health literacy accounts for some of the association between education and OOH PSC use.
methodsA survey including measures of education attainment, health literacy (assessed by means of the Dutch version of the nine-dimension Health Literacy Questionnaire) and use of PCS was conducted among a sample of adults diagnosed with (any) somatic chronic condition in the Netherlands (response 76.3%, n = 1811). We conducted linear and logistic regression analyses to examine associations between education level and PCS use in the past year. We performed mediation analyses to assess whether the association between education and PCS use was (partly) explained by different aspects of health literacy. We adjusted the models for patient characteristics such as age and morbidity.
resultsHigher education attainment was associated with higher scores on the health literacy aspects Appraisal of health information, and Navigating the healthcare system. Additionally, appraisal and navigating the healthcare system partially accounted for educational differences in PCS use. Finally, higher appraisal of health information scores were associated with higher PCS utilisation.
conclusionSeveral aspects of health literacy were demonstrated to relate to PCS use, and partly accounted for educational differences herein. Accordingly, developing health literacy within individuals or communities may help to reduce inappropriate PCS use among people with low education.
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