Abstract / Summary
Background: We examined whether health literacy and chronic-disease self-efficacy were independently associated with healthcare use among older adults with multimorbidity.
Methods: This secondary cross-sectional analysis included 464 community-dwelling adults aged ≥65 years with ≥2 chronic conditions receiving primary care in Vlora Municipality, Albania. Six-month general practitioner (GP), emergency department (ED), admission, and hospital-night counts were analysed using negative-binomial, logistic, and zero-truncated count models. Models adjusted for age, gender, education, BMI, self-rated health, chronic-disease count, health centre, and residence.
Results: Health literacy was not associated with GP-visit frequency (IRR 1.002, 95% CI 0.982–1.023; p=0.820), whereas higher self-efficacy was associated with fewer GP visits (IRR 0.909, 95% CI 0.857–0.964; p=0.002). Higher health literacy was associated with greater odds of ED use (OR 1.112, 95% CI 1.055–1.172), admission (OR 1.097, 95% CI 1.034–1.164), and hospital use (OR 1.092, 95% CI 1.031–1.157), while self-efficacy was associated with lower odds (ORs 0.731, 0.636, and 0.647; all p<0.001). Among users, health literacy predicted more admissions (IRR 1.085, 95% CI 1.014–1.160; p=0.018), but neither exposure predicted ED frequency or hospital-night duration.
Conclusions: Self-efficacy and health literacy were associated mainly with entry into acute and hospital care, rather than subsequent intensity. Prospective, record-linked studies are needed to clarify these relationships.