Research Article
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Influence of health literacy on primary healthcare utilization

Year 2025, Volume: 50 Issue: 3, 770 - 781, 30.09.2025
https://doi.org/10.17826/cumj.1677835

Abstract

Purpose: This study aims to evaluate the health literacy levels of individuals presenting to the emergency department with non-life-threatening and ambulatory care-appropriate conditions, and to investigate the relationship between health literacy defined as the ability to access, understand, and apply health information and primary care utilization.
Materials and Methods: A cross-sectional analytical study was conducted between May and October 2023 at the green triage section of İzmir Atatürk Training and Research Hospital emergency department. A total of 326 participants were included. Health literacy was assessed using validated Turkish versions of REALM and NVS instruments. Sociodemographic data and healthcare utilization habits were collected via face-to-face interviews.
Results: A total of 81.5% of particpants did not consult a family physician prior to their ED visit. According to REALM, 71.2% of participants had adequate health literacy, while this rate was 44.9% according to NVS. Chronic illness was reported by 43.7%, and 36.9% were on regular medication. Frequent family physician utilization was higher among women (57.8%), those with higher education (34.6% with university or higher), health insurance coverage (77.9%), chronic disease (43.7%), and regular medication use (36.9%). Health insurance increased the likelihood of family physician visits by 2.9 times, and regular medication use increased it by 3 times. Conclusion: Many emergency department visits could be managed at the primary care level. Enhancing health literacy particularly functional literacy, which involves individuals' ability to understand, interpret, and effectively apply health information in real-life situations and improving access to and the perception of family medicine services may help reduce potentially avoidable emergency department visits and contribute to more efficient health service delivery.

References

  • Boyacı İ, Ahmed R. Assessment of health system performance in Türkiye over 2000 2023: a descriptive international comparative analysis. Istanbul Ticaret Universitesi Dış Ticaret Dergisi. 2025;3:74 94.
  • Butun A. The role of family health centres in preventing paediatric emergency department usage of parents of children with non urgent conditions. BMC Prim Care. 2024;25:420.
  • Bas K. Family physician’s opinions and recommendations on the family medicine practices. Anatolian Journal opf Family Medicine. 2023;6:25 30.
  • Wang S, Cheng F, Xu J. The impact of family doctor contract services on the utilization of and satisfaction with primary health care among Chinese residents: a cross sectional study. J Family Med Prim Care. 2024;13:1887 93.
  • Akova S. Factors affecting health literacy and relationship between health literacy and child emergency utilization: relationship between health literacy and emergency service. Hamidiye Medical Journal. 2023;4:142 51.
  • Butun A, Kafdag EE, Gunduz H, Zincir V, Batibay M, Ciftci K et al. Emergency department overcrowding: causes and solutions. Emerg Crit Care Med. 2023;3:171 6.
  • Eidstø A, Ylä Mattila J, Tuominen J, Huhtala H, Palomäki A, Koivistoinen T et al. Emergency department crowding increases 10 day mortality for non critical patients: a retrospective observational study. Intern Emerg Med. 2024;19:175 81.
  • Jaramillo GD, Zuluaga NE, Avellaneda VAV et al. Implementation of an early attention strategy to reduce emergency room overcrowding in an academic institution in Colombia, a pilot study. Int J Emerg Med. 2024;17:152.
  • Pearce S, Marchand T, Shannon T et al. Emergency department crowding: an overview of reviews describing measures, causes and harms. Intern Emerg Med. 2023;18:1137 58.
  • McIntyre A, Janzen S, Shepherd L et al. An integrative review of adult patient reported reasons for non urgent use of the emergency department. BMC Nurs. 2023;22:85.
  • Ausserhofer D, Barbieri V, Lombardo S, Gärtner T, Eisendle K, Piccoliori G et al. Primary and emergency care use: the roles of health literacy, patient activation, and sleep quality in a latent profile analysis. Behav Sci (Basel). 2025;15:724.
  • Wang H, Sun H, Jin C, Wang M, Luo Y, Song W et al. Preference to family doctor contracted service of patients with chronic disease in urban China: a discrete choice experiment. Patient Prefer Adherence. 2022;16:2103 14.
  • Poleshuck E, Possemato K, Johnson EM, Cohen AJ, Fogarty CT, Funderburk JS. Leveraging integrated primary care to address patients’ and families’ unmet social needs: aligning practice with national academy of sciences, engineering and medicine recommendations. J Am Board Fam Med. 2022;35:185 9.
  • Alnasser S, Alharbi M, Alibrahim A, Ibrahim AA, Kentab O, Alassaf W et al. Analysis of emergency department use by non urgent patients and their visit characteristics at an academic center. Int J Gen Med. 2023;16:221 32.
  • Jansen T, Rademakers J, Waverijn G, Verheij R, Osborne R, Heijmans M. The role of health literacy in explaining the association between educational attainment and the use of out of hours primary care services in chronically ill people: a survey study. BMC Health Serv Res. 2018;18:394.
  • Rowland SA, Schumacher KL, Leinen DD, Phillips BG, Schulz PS, Yates BC. Couples’ experiences with healthy lifestyle behaviors after cardiac rehabilitation. J Cardiopulm Rehabil Prev. 2018;38:170 4.
  • Lyons KS, Han SH, Kim K, Miller LM. Dyadic appraisals of family decisions and health tasks in midlife older couples. Res Aging. 2025;47:151 62.
  • Green MA, McKee M, Hamilton OK, Shaw RJ, Macleod J, Boyd A et al. Associations between self reported healthcare disruption due to COVID 19 and avoidable hospital admission: evidence from seven linked longitudinal studies for England. BMJ. 2023;382:e075133.
  • Nummedal MA, King S, Uleberg O, Pedersen SA, Bjørnsen LP. Non emergency department interventions to reduce ED utilization: a scoping review. BMC Emerg Med. 2024;24:117.
  • Savira F, Frith M, Aditya CJ, Randall S, White N, Giddy A et al. Urgent care centres for reducing the demand on emergency departments: a scoping review of published quantitative and qualitative studies. Med J Aust. 2025;222:450 61.

Sağlık okuryazarlığının birinci basamak sağlık hizmeti kullanımı üzerindeki etkisi

Year 2025, Volume: 50 Issue: 3, 770 - 781, 30.09.2025
https://doi.org/10.17826/cumj.1677835

Abstract

Amaç: Bu çalışmanın amacı, acil servise hayati tehlike içermeyen ve ayaktan tedavi edilebilecek nedenlerle başvuran bireylerin sağlık okuryazarlığı düzeylerini sağlık bilgilerine ulaşma, anlama ve uygulama becerisi olarak tanımlanan sağlık okuryazarlığı değerlendirmek ve sağlık okuryazarlığı ile birinci basamak sağlık hizmeti kullanım sıklığı arasındaki ilişkiyi incelemektir.
Gereç ve Yöntem: Kesitsel analitik tasarıma sahip bu çalışma, Mayıs–Ekim 2023 tarihleri arasında İzmir Atatürk Eğitim ve Araştırma Hastanesi’nin acil servis yeşil alan bölümünde gerçekleştirilmiştir. Çalışmaya 326 katılımcı dahil edilmiştir. Sağlık okuryazarlığı, Türkçe geçerliliği yapılmış REALM ve NVS ölçekleriyle değerlendirilmiştir. Katılımcıların sosyodemografik özellikleri ve sağlık hizmeti kullanımları yüz yüze görüşmelerle toplanmıştır.
Bulgular: Katılımcıların %81,5’i acil servis başvurusu öncesinde aile hekimine başvurmamıştır. REALM’a göre katılımcıların %71,2’si yeterli sağlık okuryazarlığına sahipken, NVS’ye göre bu oran %44,9’dur. Katılımcıların %43,7’sinde kronik hastalık mevcut olup %36,9’u düzenli ilaç kullanmaktadır. Aile hekimine başvuru sıklığı, kadın cinsiyet (%57,8), yüksek eğitim düzeyi (%34,6 üniversite ve üzeri), sağlık güvencesi varlığı (%77,9), kronik hastalık (%43,7) ve düzenli ilaç kullanımı (%36,9) ile daha yüksek bulunmuştur. Sağlık güvencesine sahip olanların aile hekimine başvurma olasılığı 2,9 kat, düzenli ilaç kullananların ise 3 kat artmıştır.
Sonuç: Acil servise yapılan birçok başvuru birinci basamakta karşılanabilir durumdadır. Bireylerin sağlık bilgilerini gerçek yaşam durumlarında anlama, yorumlama ve etkili bir şekilde uygulama becerisini içeren işlevsel sağlık okuryazarlığının artırılması ve aile hekimliği hizmetlerinin erişilebilirliği ile algısının iyileştirilmesi, önlenebilir acil servis başvurularının azaltılmasına ve sağlık hizmet sunumunun etkinliğinin artırılmasına katkı sağlayabilir.

References

  • Boyacı İ, Ahmed R. Assessment of health system performance in Türkiye over 2000 2023: a descriptive international comparative analysis. Istanbul Ticaret Universitesi Dış Ticaret Dergisi. 2025;3:74 94.
  • Butun A. The role of family health centres in preventing paediatric emergency department usage of parents of children with non urgent conditions. BMC Prim Care. 2024;25:420.
  • Bas K. Family physician’s opinions and recommendations on the family medicine practices. Anatolian Journal opf Family Medicine. 2023;6:25 30.
  • Wang S, Cheng F, Xu J. The impact of family doctor contract services on the utilization of and satisfaction with primary health care among Chinese residents: a cross sectional study. J Family Med Prim Care. 2024;13:1887 93.
  • Akova S. Factors affecting health literacy and relationship between health literacy and child emergency utilization: relationship between health literacy and emergency service. Hamidiye Medical Journal. 2023;4:142 51.
  • Butun A, Kafdag EE, Gunduz H, Zincir V, Batibay M, Ciftci K et al. Emergency department overcrowding: causes and solutions. Emerg Crit Care Med. 2023;3:171 6.
  • Eidstø A, Ylä Mattila J, Tuominen J, Huhtala H, Palomäki A, Koivistoinen T et al. Emergency department crowding increases 10 day mortality for non critical patients: a retrospective observational study. Intern Emerg Med. 2024;19:175 81.
  • Jaramillo GD, Zuluaga NE, Avellaneda VAV et al. Implementation of an early attention strategy to reduce emergency room overcrowding in an academic institution in Colombia, a pilot study. Int J Emerg Med. 2024;17:152.
  • Pearce S, Marchand T, Shannon T et al. Emergency department crowding: an overview of reviews describing measures, causes and harms. Intern Emerg Med. 2023;18:1137 58.
  • McIntyre A, Janzen S, Shepherd L et al. An integrative review of adult patient reported reasons for non urgent use of the emergency department. BMC Nurs. 2023;22:85.
  • Ausserhofer D, Barbieri V, Lombardo S, Gärtner T, Eisendle K, Piccoliori G et al. Primary and emergency care use: the roles of health literacy, patient activation, and sleep quality in a latent profile analysis. Behav Sci (Basel). 2025;15:724.
  • Wang H, Sun H, Jin C, Wang M, Luo Y, Song W et al. Preference to family doctor contracted service of patients with chronic disease in urban China: a discrete choice experiment. Patient Prefer Adherence. 2022;16:2103 14.
  • Poleshuck E, Possemato K, Johnson EM, Cohen AJ, Fogarty CT, Funderburk JS. Leveraging integrated primary care to address patients’ and families’ unmet social needs: aligning practice with national academy of sciences, engineering and medicine recommendations. J Am Board Fam Med. 2022;35:185 9.
  • Alnasser S, Alharbi M, Alibrahim A, Ibrahim AA, Kentab O, Alassaf W et al. Analysis of emergency department use by non urgent patients and their visit characteristics at an academic center. Int J Gen Med. 2023;16:221 32.
  • Jansen T, Rademakers J, Waverijn G, Verheij R, Osborne R, Heijmans M. The role of health literacy in explaining the association between educational attainment and the use of out of hours primary care services in chronically ill people: a survey study. BMC Health Serv Res. 2018;18:394.
  • Rowland SA, Schumacher KL, Leinen DD, Phillips BG, Schulz PS, Yates BC. Couples’ experiences with healthy lifestyle behaviors after cardiac rehabilitation. J Cardiopulm Rehabil Prev. 2018;38:170 4.
  • Lyons KS, Han SH, Kim K, Miller LM. Dyadic appraisals of family decisions and health tasks in midlife older couples. Res Aging. 2025;47:151 62.
  • Green MA, McKee M, Hamilton OK, Shaw RJ, Macleod J, Boyd A et al. Associations between self reported healthcare disruption due to COVID 19 and avoidable hospital admission: evidence from seven linked longitudinal studies for England. BMJ. 2023;382:e075133.
  • Nummedal MA, King S, Uleberg O, Pedersen SA, Bjørnsen LP. Non emergency department interventions to reduce ED utilization: a scoping review. BMC Emerg Med. 2024;24:117.
  • Savira F, Frith M, Aditya CJ, Randall S, White N, Giddy A et al. Urgent care centres for reducing the demand on emergency departments: a scoping review of published quantitative and qualitative studies. Med J Aust. 2025;222:450 61.
There are 20 citations in total.

Details

Primary Language English
Subjects Emergency Medicine, Clinical Sciences (Other)
Journal Section Research
Authors

Deniz Çınaroğlu 0009-0009-4349-9116

Meryem Çakır 0000-0003-1575-6946

Publication Date September 30, 2025
Submission Date April 17, 2025
Acceptance Date August 10, 2025
Published in Issue Year 2025 Volume: 50 Issue: 3

Cite

MLA Çınaroğlu, Deniz and Meryem Çakır. “Influence of Health Literacy on Primary Healthcare Utilization”. Cukurova Medical Journal, vol. 50, no. 3, 2025, pp. 770-81, doi:10.17826/cumj.1677835.