Health literacy and associated factors among patients with chronic diseases in Indonesia

Background Health literacy is key for guiding individuals toward healthy behaviors and preventing chronic disease. This requires people to be able to understand and apply health information to manage their health, including chronic illness. Aims To determine factors associated with health literacy among patients with chronic diseases and to explore the perceptions of nurses of health literacy. Methods A concurrent mixed methods with cross-sectional study was conducted across three public hospitals in Indonesia to measure patients' health literacy, and a qualitative approach was used to explore nurses' perception toward health literacy. To validate the results of the cross-sectional analysis, semi-structured interviews were conducted with nurses who are directly involved in health promotion and education. The sample was selected using a purposive sampling technique, and G*power analysis showed 958 respondents needed. Health literacy was assessed using the Indonesian Health Literacy Short-form Survey Questionnaire (HLS-EU-SQ10-IDN). Associated factors were examined using chi-square tests, and statistical analysis was conducted on the tabulated data with a significance level of p < 0.05. Result Variables correlated with health literacy were age, education, occupation, marital status, income, internet access, and social activities. For the health literacy level, 33% were on the problematic level and 16.2% inadequate. Findings were confirmed during interviews with the nurses. Nurses were aware that patients accessed social media and engaged in social activities. The nurses still lacked understanding about health literacy terminology. Conclusion The findings revealed that age, education, occupation, marital status, income, internet access, and social activities were associated with health literacy among patients with chronic diseases. A notable proportion of participants exhibited problematic or inadequate health literacy levels. Furthermore, interviews with nurses corroborated these findings and indicated their awareness of patients' engagement with social media and social activities. However, it was also evident that nurses still lacked a comprehensive understanding of health literacy terminology.