Health literacy profile of a Musculoskeletal population


This paper reports on the findings of the first phase of a service improvement project that used the Ophelia approach developed by Deakin University, Australia to evaluate the health literacy (HL) needs of adults attending outpatients musculoskeletal (MSK) physiotherapy.

Little is known of the impact that the social determinates of health have on the health literacy needs of patients presenting with musculoskeletal pathologies so the relationship with demographic data, including the Welsh Index of Multiple Deprivation (WIMD) was explored.

The aim of the first phase was to profile adults' health literacy attending outpatient MSK physiotherapy. Objectives included:

  1. to evaluate adults across nine domains of health literacy
  2. to establish whether there is a relationship with measures of deprivation. The results of profiling will inform the development of specific health literacy interventions and resources for the local population in future phases.


This cross sectional survey used the health literacy questionnaire to describe the HL profile of participants attending physiotherapy outpatient departments with a musculoskeletal pathology. Participation was entirely voluntary, informed consent was gained prior to administrating the questionnaire and participants were free to withdraw at anytime. The differences within each domain between a number of demographic factors were investigated. These included gender, age, education etc. Additionally each participant was in one of three geographical areas, for which an overall WIMD quintile was found by adding the weighted (by size) WIMD scores of its constituent area. Several different types of deprivation were investigated along with the overall score. Results were analysed using SPSS version 22.

This service evaluation was approved by the Continuous Service Improvement Department in accordance with Health Board Policy.


A total of 323 questionnaires were collected from 5 different physiotherapy outpatient departments across the health board. The mean age of participants was 47. 59 and 59% were female.

Statistically significant differences (p< 0.05) were seen in mean differences of HL scales for gender, age, education, employment and duration of condition
Specific patterns of statistically significant (p< 0.05) lower HL scores were seen for patients with the co morbidities of arthritis, chronic pain and anxiety/depression.

Patients from known areas of deprivation show statistically significant (p< 0.05) lower mean scores for HL scales: Having sufficient information, social support and understanding health information.


This project revealed specific and unique health literacy differences across the nine domains of health literacy and provided insight into the impact of patients' socioeconomic background on health literacy.

Our findings provide some insight and guidance for healthcare services, policy makers and clinicians in considering the important role of health literacy in the development of interventions and service design.

Our findings highlight key areas where patients can be supported to access, understand and use health information, and are particularly relevant for physiotherapy services aiming to improve services for groups where demographic deprivation is known. The results of the evaluation highlight the need for services to have the capacity to respond with flexibility to meet local peoples unique needs.

Top three learning points

There is a need to further understand how service users appraise the quality of musculoskeletal health information.

Feeding back the results of this study to staff with population specific data helped facilitate conversations to specifically address needs of different populations and demographics.

The Health literacy questionnaire was an useful tool, and provided rich and comprehensive data which can be analysed as population groups or individually

Funding acknowledgements

Cardiff and Vale University Health Board, Physiotherapy department.

Additional notes

This work was presented at Physiotherapy UK 2017.

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