Unravelling complex relationships between health literacy and shared decision-making: a cross-sectional study in patients attending rheumatology rehabilitation

Objectives Consideration of health literacy (HL) in shared decision-making (SDM) is key to improving rehabilitation outcomes and addressing social health inequities. Therefore, the aim of this study was to investigate the relationship between HL skills and patient-perceived involvement in SDM within goal setting in rheumatology rehabilitation. Methods A multicentre online survey was sent to patients attending goal setting in rehabilitation. SDM was measured with the patient-reported questionnaire CollaboRATE (CollaboRATE is a brief patient‑reported measure of shared decision making; the top score reflects optimal SDM) and HL skills with the Health Literacy Questionnaire (HLQ, 9 scales). Associations between HLQ scores and CollaboRATE (suboptimal vs optimal [top score]) were investigated by polynomial logistic regression analyses adjusted for possible covariates. Results A total of 408/514 (79%) patients responded to the survey; 401 (78%) completed both questionnaires (mean age 58.5 years [SD: 12.4], disease duration 11.4 years [SD: 11.2], 85% women). A linear relationship between HLQ and CollaboRATE was demonstrated in 2/9 HLQ scales, while 5/9 HLQ scales showed a U/J-shaped pattern ( P < .039). Higher HLQ scores were associated with the greatest probability of reporting optimal SDM, followed by lower scores. In contrast, moderate scores were more frequently associated with suboptimal SDM. Two HLQ scales showed no association with SDM. More men than women reported suboptimal SDM (64% vs 48%, P = .02). Conclusions This study found a complex relationship between HL skills and patients' experience of involvement in SDM, and these findings highlight the need for tailored support from healthcare providers to facilitate meaningful SDM, particularly for those facing challenges related to HL including individuals with moderate HL skills.