Background
Methods
Sample
Measures
Use of out-of-hours primary care service
Education attainment
Health literacy
Scales | |
1. Feeling understood and supported by health care providers (1 = strongly disagree; 4 = strongly agree) 2. Having sufficient information to manage my health (1 = strongly disagree; 4 = strongly agree) 3. Actively managing my health (1 = strongly disagree; 4 = strongly agree) 4. Social support for health (1 = strongly disagree; 4 = strongly agree) 5. Appraisal of health information (1 = strongly disagree; 4 = strongly agree) 6. Ability to actively engage with health care providers (1 = cannot do; 5 = very easy) 7. Navigating the health care system (1 = cannot do; 5 = very easy) 8. Ability to find good health information (1 = cannot do; 5 = very easy) 9. Understand health information enough to know what to do (1 = cannot do; 5 = very easy) |
Background characteristics
Statistical analyses
Results
Characteristics of the sample
% or mean (SD) | ||
---|---|---|
(n = 1811) | ||
Age in years | 62.9 (14.0) | |
Sex | Male | 46.7 |
Female | 53.3 | |
Age group in years | 15–39 | 7.3 |
40–64 | 40.4 | |
65–74 | 32.8 | |
75 and older | 19.5 | |
Education | Low | 31.0 |
Intermediate | 42.2 | |
High | 24.4 | |
Unknown | 2.4 | |
Household status | Living alone | 27.1 |
Living together | 72.0 | |
Unknown | 0.9 | |
First diagnosed chronic condition | Cardiovascular disease | 15.6 |
Respiratory disease | 37.3 | |
Musculoskeletal disease | 10.4 | |
Cancer | 4.8 | |
Diabetes | 11.0 | |
Neurological disease | 5.0 | |
Digestive disease | 4.1 | |
Unspecified other disease | 11.9 | |
Number of chronic conditions | One | 46.8 |
Two | 30.7 | |
Three or more | 22.5 | |
Illness duration in years (n = 1783) | 12.8 (9.9) | |
used an out-of-hours primary care service in the past year | No | 75.8 |
Yes | 19.7 | |
Unknown | 4.5 |
Education and OOH primary care use
Used an out-of-hours primary care servicea (unadjusted) | Used an out-of-hours primary care servicea (adjusted)b | ||
---|---|---|---|
Mean scale score (SD) | OR (95 CI)c | OR (95 CI)c | |
Education | |||
Low (ref) | – | 1.00 | 1.00 |
Intermediate | – |
0.61 (0.46; 0.80)***
|
0.65 (0.49; 0.85)**
|
High | – |
0.63 (0.46; 0.86)**
|
0.70 (.50; 0.96)*
|
Number of chronic conditions | |||
One | – | 1.00 | – |
Two | – | 1.09 (0.83; 1.44) | – |
Three or more | – |
1.37 (1.02; 1.83)*
| – |
Illness duration in years | – |
1.01 (1.00; 1.02)*
| – |
HLQ scaled | |||
Feeling understood and supported by healthcare providers (range 1–4) (n = 1745) | 2.97 (.51) | 1.14 (0.90; 1.45) | 1.12 (0.88; 1.43) |
Having sufficient information to manage my health (range 1–4) (n = 1741) | 2.92 (.42) | 0.83 (0.63; 1.10) | 0.81 (0.61; 1.08) |
Actively managing my health (range 1–4) (n = 1723) | 2.85 (.43) | 1.29 (0.98; 1.70) | 1.31 (0.99; 1.74) |
Social support for health (range 1–4) (n = 1739) | 2.91 (.49) | 0.87 (0.68; 1.11) | 0.88 (0.69; 1.13) |
Appraisal of health information (range 1–4) (n = 1724) | 2.64 (.48) |
1.43 (1.11; 1.84)**
|
1.52 (1.18; 1.97)**
|
Ability to actively engage with healthcare providers (range 1–5) (n = 1709) | 3.97 (.62) |
0.76 (0.63; 0.92)**
|
0.79 (0.65; 0.96)*
|
Navigating the healthcare system (range 1–5) (n = 1720) | 3.87 (.62) |
0.75 (0.63; 0.91)**
|
0.79 (0.65; 0.95)*
|
Ability to find good health information (range 1–5) (n = 1709) | 3.90 (.62) |
0.71 (0.59; 0.85)***
|
0.76 (0.62; 0.92)**
|
Understanding health information well enough to know what to do (range 1–5) (n = 1711) | 4.03 (.57) |
0.73 (0.60; 0.89)**
|
0.76 (0.62; 0.94)*
|
Education and health literacy
Feeling understood and supported by healthcare providers (n = 1704) | Having sufficient information to manage my health (n = 1700) | Actively managing my health (n = 1682) | Social support for health (n = 1698) | Appraisal of health information (n = 1683) | Ability to actively engage with healthcare providers (n = 1669) | Navigating the healthcare system (n = 1680) | Ability to find good health information (n = 1669) | Understanding health information well enough to know what to do (n = 1671) | |
---|---|---|---|---|---|---|---|---|---|
B (95% CI)a | B (95% CI)a | B (95% CI)a | B (95% CI)a | B (95% CI)a | B (95% CI)a | B (95% CI)a | B (95% CI)a | B (95% CI)a | |
Education | |||||||||
intermediate | 0.03 (− 0.03; 0.09) |
0.06 (0.02; 0.11)**
| 0.02 (− 0.02; 0.07) | 0.00 (− 0.06; 0.05) | 0.05 (− 0.01; 0.10) |
0.17 (0.10; 0.24)***
|
0.20 (0.13; 0.27)***
|
0.26 (0.20; 0.33)***
|
0.25 (0.19; 0.31)***
|
High | 0.04 (−0.03; 0.10) |
0.09 (0.04; 0.14)**
| 0.01 (−0.04; 0.07) | 0.01 (−0.05; 0.07) |
0.11 (0.05; 0.17)***
|
0.32 (0.24; 0.40)***
|
0.29 (0.21; 0.37)***
|
0.40 (0.33; 0.48)***
|
0.44 (0.37; 0.51)***
|
Feeling understood and supported by healthcare providers (n = 1676) | Having sufficient information to manage my health (n = 1672) | Actively managing my health (n = 1682) | Social support for health (n = 1670) | Appraisal of health information (n = 1656) | Ability to actively engage with healthcare providers (n = 1642) | Navigating the healthcare system (n = 1651) | Ability to find good health information (n = 1642) | Understanding health information well enough to know what to do (n = 1642) | |
---|---|---|---|---|---|---|---|---|---|
B (95% CI)b | B (95% CI)b | B (95% CI)b | B (95% CI)b | B (95% CI)b | B (95% CI)b | B (95% CI)b | B (95% CI)b | B (95% CI)b | |
Educationc | |||||||||
intermediate | 0.04 (−0.02; 0.09) |
0.05 (0.01; 0.10)*
| 0.01 (−0.04; 0.06) | −0.01 (− 0.06; 0.05) | 0.02 (− 0.03; 0.08) |
0.14 (0.07; 0.21)***
|
0.16 (0.09; 0.23)***
|
0.20 (0.13; 0.27)***
|
0.20 (0.14; 0.26)***
|
High | 0.04 (−0.02; 0.11) |
0.09 (0.03; 0.14)**
| 0.00 (−0.06; 0.06) | 0.01 (−0.06; 0.05) |
0.09 (0.03; 0.15)**
|
0.29 (0.21; 0.37)***
|
0.25 (0.17; 0.33)***
|
0.34 (0.26; 0.42)***
|
0.39 (0.32; 0.46)***
|
Health literacy and OOH primary care use
Education and OOH primary care use mediated through health literacy
Appraisal of health information (n = 1638) | Ability to actively engage with healthcare providers (n = 1629) | Navigating the healthcare system (n = 1639) | Ability to find good health information (n = 1629) | Understanding health information well enough to know what to do (n = 1636) | |
---|---|---|---|---|---|
OR (95% CI)a | OR (95% CI)a | OR (95% CI)a | OR (95% CI)a | OR (95% CI)a | |
Total effect (education and HLQ) |
0.78 (0.66; 0.92)**
|
0.78 (0.66; 0.92)**
|
0.76 (0.65; 0.89)**
|
0.77 (0.66; 0.91)**
|
0.77 (0.65; 0.90)**
|
Direct effect (education) |
0.76 (0.65; 0.90)**
|
0.81 (0.68; 0.95)*
|
0.79 (0.67; 0.93)**
|
0.82 (0.69; 0.97)*
|
0.81 (0.68; 0.96)*
|
Indirect effect (HLQ) |
1.02 (1.00; 1.04)*
|
0.97 (0.94; 1.00)*
|
0.97 (0.94; 1.00)*
|
0.94 (0.90; 0.98)**
|
0.95 (0.90; 1.00)*
|
Confounding ratio (total effect/direct effect) | 0.92 | 1.16 | 1.14 | 1.30 | 1.24 |
Confounding percentage (% of model affect attributable to mediator) | −8.90% | 13.78% | 12.27% | 22.88% | 19.65% |
Pseudo R square b | 0.01 | 0.01 | 0.01 | 0.01 | 0.01 |
Appraisal of health information (n = 1612) | Ability to actively engage with healthcare providers (n = 1603) | Navigating the healthcare system (n = 1612) | Ability to find good health information (n = 1603) | Understanding health information well enough to know what to do (n = 1609) | |
---|---|---|---|---|---|
OR (95% CI)b | OR (95% CI)b | OR (95% CI)b | OR (95% CI)b | OR (95% CI)b | |
Total effect (education and HLQ) |
0.82 (0.69; 0.98)*
|
0.82 (0.69; 0.97)*
|
0.80 (0.68; 0.95)*
|
0.82 (0.69; 0.97)*
|
0.81 (0.69; 0.96)*
|
Direct effect (education) |
0.81 (0.68; 0.96)*
| 0.85 (0.71; 1.01) |
0.83 (0.70; 0.98)*
| 0.85 (0.72; 1.01) | 0.85 (0.71; 1.01) |
Indirect effect (HLQ) |
1.02 (1.00; 1.04)*
| 0.97 (0.94; 1.00) |
0.97 (0.95; 1.00)*
|
0.96 (0.92; 0.99)*
| 0.96 (0.92; 1.00) |
Confounding ratio (total effect/direct effect) | 0.91 | 1.18 | 1.13 | 1.27 | 1.25 |
Confounding percentage (% of model affect attributable to mediator) | −9.79% | 14.92% | 11.83% | 21.07% | 19.91% |
Pseudo R square c | 0.02 | 0.02 | 0.02 | 0.02 | 0.02 |