Health Literacy and Patient Empowerment: Separating Con-joined Twins in the Context of Chronic Low Back Pain

OBJECTIVES While health literacy has been widely considered key to patient empowerment, an alternative approach separates both concepts and distinguishes between different types of patients according to their levels of health literacy and empowerment. These types are deemed to vary in their health-related actions and outcomes. In this study, we examine the relationship between health literacy and patient empowerment and compare socio-demographic characteristics, health-related activities, and health outcomes in four types of patients suffering from chronic low back pain (cLBP). METHODS In a cross-sectional study, 273 cLBP patients from four Swiss cantons (Vaud, Geneva, Fribourg, Ticino) and Lombardy (Italy) were invited by their healthcare providers to complete a self-administered paper-and-pencil questionnaire which assessed patients' health literacy, empowerment, involvement in the medical encounter, medication non-adherence, and perceived pain and functionality as a measure of health outcomes. RESULTS Health literacy and patient empowerment were not significantly correlated with each other, r(271) = .09, p > .05, allowing to differentiate between four types of patients based on their levels of health literacy and patient empowerment. Subsequent chi-square tests and analyses of variances revealed significant differences among patients that could, however, only be attributed to health literacy, as in the case of age and educational attainment, or patient empowerment, as in the case of patients' involvement in the medical encounter. No significant differences were evident for gender, medication non-adherence, and health outcomes. CONCLUSION The study provides empirical evidence for the need to consider health literacy and patient empowerment as independent concepts in the context of cLBP but calls for further studies to be able to conclude on how the two concepts interact and determine health-related activities and outcomes.