Challenges in patient-physician communication: the results of an Angolan cross-sectional study on communicative health literacy and its determinants.

objectivesAssessing and understanding communicative health literacy (COM-HL) in healthcare settings is essential, as it constitutes a fundamental tool of public health and health promotion. Despite its importance, COM-HL remains an underinvestigated topic in Africa. Consequently, the development and validation of a Portuguese COM-HL scale could be regarded as a significant contribution to the assessment of the COM-HL in Portuguese-speaking African countries. Therefore, the aims of this study were to assess the psychometric properties of the Portuguese COM-HL instruments, to describe the COM-HL of Angolan adults and investigate its determinants.

designCross-sectional survey.

settingPurposively selected recruitment sites within the municipality/district in seven provinces of Angola across the North, South and East regions.

participants1839 Angolan adults from 3041 invited persons, predominantly females (53.6%). Quota sampling was used to ensure representation across key sociodemographic strata. Within each quota, recruitment sites, data collection time points and participants were randomly selected. The inclusion criteria were age 18 years or above, Angolan nationality, permanent residence in Angola, the ability to speak the language of the questionnaire and the absence of mental disabilities or any other incapacity to perform the interview. PRIMARY AND SECONDARY OUTCOME MEASURES: Measurement properties of the six-item and 11-item versions of the COM-HL instrument assessed through Cronbach's alpha and Spearman-Brown coefficient, construct validity of the questionnaire investigated by principal component analysis (PCA), the relationship between COM-HL and independent variables measured with linear regression analyses.

resultsThe Cronbach's alpha of the 11-item COM-HL scale was 0.92, and the Spearman-Brown correlation was 0.89. The items belonged to one factor, and 56.7% of the total variance was explained by this factor based on the PCA. The mean score was 52.4 (95% CI 51.42 to 53.45). For the six-item version, the Cronbach's alpha was 0.86, and the Spearman-Brown correlation was 0.83. The items belonged to one factor, and 58.1% of the total variance was explained by this factor based on the PCA. The mean score was 49.9 (95% CI 48.83 to 50.97). In both versions of the scale, getting enough time in the consultation with your doctor was rated as the most difficult task. The absence of financial deprivation (p<0.001), the location of residence within an urban area (p<0.001) and the possession of at least a fair health status (p<0.02) were identified as positive determinants of COM-HL.

conclusionsThe questionnaires can be characterised by good internal consistency and seem to be an appropriate tool to assess COM-HL in Portuguese-speaking countries. Angolan adults scored relatively low for COM-HL. People found it difficult to get enough time during consultations. Therefore, it is recommended to improve the communication skills of physicians and facilitate communication among healthcare users.