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

ABSTRACT Objectives Accessing the Internet has increased the gap in patient health literacy (HL), impacting patient-doctor trust. We examined how trust in physicians is affected by functional HL (the ability to read and write) and by broader concepts of HL, including communicative HL (the ability to extract information from communication to use) and critical HL (the ability to analyze and use information) among patients with systemic lupus erythematosus (SLE). Methods This cross-sectional study enrolled 362 SLE patients at five academic centers between June 2020 and August 2021. 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 adjusted for age, sex, education, income, disease activity, disease duration, depression, and time using the Internet. Results 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. Conclusions Our findings suggest that rheumatologists can help patients build trust by encouraging dialogue about their health issues with their doctors and family members, rather than trying to improve their ability to discern health information. Key messages What is already known on this topic Factors affecting trust in one’s physician among chronic diseases including SLE are economic status, misdiagnosis experience, and the duration of the physician-patient relationship. In the general population, higher trust in physicians generally was associated with functional HL as patients’ external factors. What this study adds This is the first study to reveal an association between trust in one’s own physician and HL among patients with SLE. In addition, we were able to expand the correlates of HL by measuring broader concepts of HL dimensions, such as communicative and critical HL. How this study may affect research, practice, or policy This study suggests the importance of rheumatologists’ encouragement of patients to communicate, share their concerns, and resolve their misunderstandings to develop a trusting relationship. This study recommends that communictive HL (ability to obtain useful health information) should be the focus and not critical HL (ability to discern health information).