Research ArticleAccepted Articles

Impact of communicative and critical health literacy on trust in physicians among patients with systemic lupus erythematosus: the TRUMP2-SLE project

Nao Oguro, Nobuyuki Yajima, Yoshia Miyawaki, Ryusuke Yoshimi, Yasuhiro Shimojima, Ken-ei Sada, Keigo Hayashi, Kenta Shidahara, Natsuki Sakurai, Chiharu Hidekawa, Dai Kishida, Takanori Ichikawa, Yuichi Ishikawa and Noriaki Kurita
The Journal of Rheumatology November 2022, jrheum.220678; DOI: https://doi.org/10.3899/jrheum.220678

Abstract

Objective Patients who trust their physicians have been shown to demonstrate good medication adherence, self-management, and favorable disease outcomes. This study examines how trust in physicians is affected by functional health literacy (HL) and by broader concepts of HL, including communicative HL and critical HL among patients with systemic lupus erythematosus (SLE).

Methods This was a cross-sectional study using baseline data from the TRUMP2-SLE study, an ongoing multicenter cohort study conducted at five academic centers. The 14-item Functional Communicative Critical Health Literacy Scale assessed the three dimensions of HL (range: 1-4 points). Outcomes were trust in one's physician and physicians generally using the 5-item Wake Forest Physician Trust Scale (range: 0-100 points). General linear models were fit.

Results A total of 362 SLE patients were included. Trust in one's physician increased with higher functional and communicative HL (per 1-pt increase, 3.21 [95%CI 0.61, 5.81], 5.8 [95%CI 1.96, 9.63]). Trust in physicians in general increased with higher communicative HL and decreased with higher critical HL (per 1-pt increase, 7.01 [95%CI 2.27, 11.76], -6.83 [95%CI -11.67, -1.99]). Longer internet use was associated with both higher communicative and critical HL.

Conclusion The findings suggest that rheumatologists need to improve their communication to match each patient's health literacy, which may foster trust and lead to improved self-management and outcome in SLE. They also suggest that the formation of the rheumatologist-patient relationship may negate the effect of high critical HL in building trust.

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