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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (3): 560-565. doi: 10.19723/j.issn.1671-167X.2021.03.020

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Impact of health literacy on patient experience of outpatients in China and its mechanism

WANG Xiao-qi1,CHEN Mei-jun1,YUN Qing-ping1,SUN Si-wei1,2,WANG Xi-kai3,SHI Yu-hui1,JI Ying1,GUAN Zhong-jun3,CHANG Chun1,Δ()   

  1. 1. Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China
    2. Peking University Sixth Hospital, Beijing 100191, China
    3. School of Health Management and Education, Capital Medical University, Beijing 100069, China
  • Received:2021-03-02 Online:2021-06-18 Published:2021-06-16
  • Contact: Chun CHANG E-mail:changchun@bjmu.edu.cn

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Abstract:

Objective: To understand the relationship between health literacy and patient experience of outpatients in China, and to explore its mechanism. Methods: The conceptual framework was developed based on Andersen’s behavioral model of health services use and health literacy skills framework. An online cross-sectional survey was conducted with snowball sampling method, while the health literacy was measured by self-designed patient health literacy scale, and the patient experience was measured by the Chinese patient experience questionnaire for ambulatory care developed by Peking Union Medical College. And a structural equation model was built to explore the relationship between them and test the mechanism of health literacy influencing patient experience. Results: A total of 2 773 subjects were investigated. The average score of health literacy was (90.72±12.90) points, accounting for 78.89% of the full score, and the dimension of seeking social support had the lowest score. The average score of overall rating of patient experience was (3.71±0.74) points, and the scores of each dimension of patient experience were between 3.56 and 3.80. The model fit indices of structural equation model for overall rating of patient experience among the outpatients were χ2/df=9.29 (χ2=4 107.27, df=442), root mean square error of approximation (RMSEA)=0.055 (<0.06), comparative fit index (CFI)=0.926 (>0.90), Tucker-Lewis index (TLI)=0.918 (>0.90), standardized root mean square residual (SRMR)=0.061 (<0.08), the model was acceptable. The variance in patient experience explained by the model was 0.108. The structural equation model analysis results showed that the overall rating of outpatient experience was directly affected by health literacy (β=0.263, P<0.001), also indirectly affected by health literacy (β=0.012, P<0.001). In other words, the overall rating increased by 0.275 units for each standard deviation increase of health literacy. Self-evaluated health status mediated the relationship between health literacy and the overall rating of outpatient experience. In terms of diffe-rent dimensions of patient experience, the standardized path coefficient of the total effect of health literacy on patient experience was as follows: Information guidance 0.337, humanistic care 0.319, communication with doctors 0.294, service efficiency 0.240, and hospital environment 0.173. Conclusion: The patients with higher level of health literacy were more likely to have a better outpatient experience in China, and the information guidance experience and humanistic care experience were most affected by health literacy. And the communication and information utilization ability had the greatest influence on patient experience.

Key words: Health literacy, Patient experience, Outpatients, Structural equation model

CLC Number: 

  • R193

Table 1

Socio-demographic characteristics of study participants (n=2 773)"

Variables Outpatients, n (%)
Gender
Male 1 010 (36.42)
Female 1 763 (63.58)
Age
18 years- 903 (32.56)
30 years- 587 (21.17)
40 years- 477 (17.20)
50 years- 366 (13.20)
60-80 years 440 (15.87)
Nationality
Han ethnic 2 601 (93.80)
Others 172 (6.20)
Education
Junior high school and below 279 (10.06)
High or technical school 333 (12.01)
University or college 1 609 (58.02)
Graduate or higher 552 (19.91)
Account
Urban 1 996 (71.98)
Rural 777 (28.02)
Marital status
Married 1 818 (65.56)
Single/Widow/Divorced/Separated 955 (34.44)
Annual per capital income
≤5 000 Yuan 148 (5.73)
5 001-10 000 Yuan 228 (8.83)
10 001-20 000 Yuan 419 (16.23)
20 001-30 000 Yuan 281 (10.88)
30 001-50 000 Yuan 601 (23.28)
50 001-100 000 Yuan 611 (23.66)
>100 000 Yuan 294 (11.39)
Health insurance
Self-pay 164 (5.93)
Urban employee basic medical insurance 1 345 (48.62)
Urban resident basic medical insurance 422 (15.26)
Rural cooperative medical insurance 405 (14.64)
Commercial health insurance 47 (1.70)
State medicine 383 (13.85)
Chronic disease
Suffering 1 003 (36.17)
No 1 770 (63.83)

Table 2

Health literacy and patient experience scores of outpatients (n=2 773)"

Variables Dimensions Number of items Total score $\bar{x} \pm s$ Percentagea
Health literacy Medical treatment skills 9 45 38.29±6.79 85.09%
Health improvement willingness 4 20 16.59±2.80 82.95%
Seeking social support 5 25 16.19±3.73 64.76%
Communication and information utilization skills 5 25 19.64±3.49 78.56%
Total 23 115 90.72±12.90 78.89%
Patient experience Service efficiency 6 5 3.62±0.75 72.40%
Information guidance 4 5 3.77±0.69 75.40%
Communication with doctors 3 5 3.71±0.80 74.20%
Humanistic care 4 5 3.80±0.72 76.00%
Hospital environment 4 5 3.56±0.75 71.20%
Overall rating 2 5 3.71±0.74 74.20%

Figure 1

Structural equation model of influencing factors for overall rating of outpatients’ experience *P<0.05, #P<0.01, ΔP<0.001."

Table 3

The relationship between different dimensions of patient experience and health literacy in outpatients"

Total effect Estimator Product of coefficients Forest plot of estimator Bias-corrected
bootstrap
(5 000 times),
95%CI
SE Z P
Health literacy → Overall rating 0.275 0.030 9.308 <0.001 0.216-0.332
Health literacy → Service efficiency 0.240 0.025 9.475 <0.001 0.191-0.291
Health literacy → Information guidance 0.337 0.028 11.899 <0.001 0.280-0.392
Health literacy → Communication with doctors 0.294 0.026 11.206 <0.001 0.244-0.346
Health literacy → Humanistic care 0.319 0.027 11.623 <0.001 0.266-0.372
Health literacy → Hospital environment 0.173 0.029 5.991 <0.001 0.115-0.230
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