Characteristics and influencing factors of health literacy in elderly patients with knee osteoarthritis: a latent profile analysis

For millions of older adults, the knees are the silent engine of daily life, bearing the weight of walking, standing, and rising from a chair. When this joint wears down into a condition known as knee osteoarthritis, it brings chronic pain and stiffness that can slowly erode a person's independence. Managing this long-term condition requires more than just medicine; it demands that patients understand their disease, know how to care for themselves, and make informed choices about their health. This ability to find, understand, and use health information is called health literacy. It acts as a bridge between a doctor's advice and a patient's daily actions. Without it, even the best treatment plans can fail because the person living with the pain does not know how to navigate the complex world of self-care.

Researchers have long known that not all patients handle this information in the same way. Some seem to grasp health concepts quickly, while others struggle to keep up, but the reasons for these differences have often been treated as a simple list of separate factors like age or income. A new study from Honghui Hospital in Xi'an, China, sought to look deeper. Instead of just counting how many people had high or low scores, the team asked whether patients naturally fell into distinct groups based on how they combined different skills, such as finding information, talking to doctors, and feeling confident in their ability to manage their own care. By studying 318 elderly patients with knee osteoarthritis, the researchers discovered that these individuals do not exist on a single smooth scale, but rather cluster into two very different profiles.

The study began by gathering detailed information from patients who visited the hospital's orthopedic outpatient department. The team used a set of standard questions to measure four key areas: how well a person could find health information, how easily they could communicate with others about their health, their willingness to improve their condition, and their readiness to pay for care. They also asked about the patients' family support, their confidence in handling difficult tasks, and their personal history with chronic diseases. Using a statistical method that looks for hidden patterns in the data, the researchers sorted the patients into groups that shared similar patterns of answers.

The analysis revealed two clear groups. The first, and much larger group, consisted of 248 patients, or 78 percent of the total. These individuals scored high across all four areas of health literacy. They were confident in finding information, comfortable talking to medical staff, and eager to take action to improve their health. The researchers called this the "high acquired health literacy" group. The second group was smaller, comprising 70 patients, or 22 percent. These individuals scored significantly lower, particularly in their ability to find and understand health information. This group was labeled the "low acquired health literacy" group. The finding that the population splits into these two distinct categories suggests that health literacy is not just a matter of having a little more or a little less knowledge, but rather that patients fall into different modes of engaging with their health.

The researchers then investigated what pushed a patient into one group or the other. They found that money played a significant role. Patients with higher per capita household income were more likely to belong to the high literacy group. This makes sense, as having more resources often means having better access to the internet, health portals, and medical professionals who can provide clear information. Conversely, patients with lower incomes were more likely to be in the low literacy group, facing barriers that made it harder to gather the knowledge they needed.

Family history and other health conditions also shaped these groups in surprising ways. Patients who had family members with arthritis were more likely to fall into the low literacy group. The researchers suggest that while having a family history might seem like it would make someone more aware, it can sometimes lead to avoidance. If the threat of the disease feels too overwhelming, or if the patient is busy caring for a sick relative, they may withdraw from learning about their own condition. In contrast, patients who already lived with other chronic diseases were more likely to be in the high literacy group. These individuals had likely spent years navigating the medical system, building up a reservoir of experience and confidence in managing their health that transferred to their knee care.

Perhaps the most encouraging factors were the psychological ones. Patients who felt they had strong support from their families and who believed in their own ability to handle challenges were far more likely to be in the high literacy group. When a person feels supported by loved ones and confident in their own skills, they are more willing to seek out information and take action. The study showed that these internal feelings of confidence and external support were just as important as education or income in determining how well a patient understood their health.

The implications of these findings are clear for the doctors and nurses who treat these patients. A one-size-fits-all approach to health education will not work because the patients are not all the same. The 22 percent of patients in the low literacy group need different help than the majority who are already managing well. Medical staff should focus extra attention on those with lower incomes, those with a family history of arthritis, and those who lack family support. For these individuals, simply handing out a pamphlet is not enough. They need help finding free and easy-to-understand resources, reassurance to overcome their fears, and encouragement to build their confidence. By recognizing that these patients fall into two distinct groups, healthcare providers can tailor their support to meet the specific needs of each, helping the most vulnerable patients gain the skills they need to live better with their condition.