Assessing Health Literacy and Communication Skills in Medical Referrals: A Survey Study

Document Type : Original Article


1 Media studies, Azad university, central branch, Tehran

2 Institute of Communication and Health, Università della Svizzera italiana, Lugano, Switzerland

3 School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran

4 Communications and Media studies, Azad central branch university, Tehran


Background and Objectives n: The aim of this study is to draw a comprehensive picture of patients’ functional and critical health literacy and its association with socio-demographic variables and self-efficacy. We investigated the referrals to Isfahan health centers, in particular the dimensions of reading ability, numeracy and eHealth literacy using two different measures, NVS for the functional and the eHEALS for critical aspects. 

Materials and Methods: The surveys were administered to a random sample (N = 384), which resembled Iran Isfahan residents in terms, educational attainment and self-efficacy but not age and gender. For testing individuals with low health literacy, the NVS is a reliable and quick screening tool. eHEALS helps to measure patients’ capabilities in Internet searches. Both of tools are validated in Persian. Pearson’s correlation coefficient, χ2-test, independent t-test and regression were also used to assess the association between health literacy measures, self-efficacy and predictor variables. (p <0.05)

Results: More than 60% of our respondents had an inadequate or marginal level of health literacy with NVS, and with eHEALS, more than 50% were classified accordingly. NVS and eHEALS scores showed an association with higher education one of the predictors of health literacy. Higher eHEALS scores were associated with higher self-efficacy. eHEALS provides a valid self-reported assessment of patients’ eHealth literacy, and NVS provides a useful appraisal of patients’ functional health literacy. 

Conclusions: In our sample, more than 50% of patients had a low level of literacy. eHEALS provides a valid self-reported assessment of patients’ eHealth literacy, and NVS provides a useful appraisal of patients’ functional health literacy. Determining health literacy in patients leads to a better understanding of their perception, application and decision-making in health problems.


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