Health literacy and health-related outcomes in dialysed patients: cues to enhance health equity in patients with chronic health conditions

Chronic kidney disease (CKD) is one of the major public health problems worldwide and its prevalence is constantly rising. CKD is associated with increased morbidity and mortality. Patients in advanced stages of CKD, such as dialysed patients, are more likely to have a low health literacy, which makes them more vulnerable to adverse health outcomes. Health literacy is a multidimensional concept comprising individual skills in accessing, understanding, appraising, and applying health information. These skills are applied in complex health situations and in engaging with healthcare providers. In this thesis, we explored the association of multidimensional health literacy with diet and fluid intake non-adherence and health-related quality of life of dialysed patients. We found that patients with lower health literacy had a worse diet and fluid intake adherence than patients with high health literacy and that this association was modified by socio-economic status and mediated by depression and anxiety. Patients with lower health literacy had a worse mental and physical health-related quality of life than patients with high health literacy at baseline, but changes in health-related quality of life during two years of dialysis were not associated with health literacy. Our findings show that dialysed patients with low health literacy need special attention and tailored care to combat inequity based on low health literacy. Such tailored care requires changes in the healthcare system to make it more responsive to the needs and limitations related to health literacy, in order to deliver effective patient-centred care.