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Peer-reviewedCC BY 4.0Preventive Medicine Reports

Health literacy in primary care users from six Spanish autonomous communities: a multicenter study of territorial variation

  • David García-García1,2
  • Andrea González-Ayala3
  • Cristina María Lozano-Hernández4,5,6
  • Martín Rodríguez-Álvaro7,8
  • Pedro Ruymán Brito-Brito6,9,10
  • Macarena Chacón-Docampo11,12,13
  • María Gil-Marchena14
  • Francisco Javier Pérez-Rivas2,15,16
16 affiliations
  1. 1Medical Oncology Clinical Trials Unit, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
  2. 2UCM Research Group "Public Health – Lifestyles, Nursing Methodology and Care in the Community Setting", Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain
  3. 3Family and Community Care Specialist Nurse, Nursing Manager at José Luis Santamaría Health Centre, Burgos, Spain
  4. 4Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing, University of Castilla-La Mancha, Albacete, Spain
  5. 5Institute for Health Research of Castilla-La Mancha (IDISCAM), Albacete, Spain
  6. 6Research Network on Chronicity, Primary Care and Health Promotion -RICAPPS-(RICORS), ISCIII, Spain
  7. 7Primary Health Care, La Palma Health Services, The Canary Islands Health Service, 38713 Breña Alta, Spain
  8. 8Nursing Department, Healthcare Sciences School, University of La Laguna, 38200 Santa Cruz de Tenerife, Spain
  9. 9Primary Health Care, Tenerife Primary Health Care Services, The Canary Islands Health Service, 38005 Tenerife, Spain
  10. 10Nursing Department, Faculty of Nursing, University of La Laguna, 38200 Santa Cruz de Tenerife, Spain
  11. 11INVESTIC Translational Care Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Spain
  12. 12Meixoeiro University School of Nursing, UVIGO, 36214 Vigo, Galicia, Spain
  13. 13Care Research Unit, Vigo Health Area, Álvaro Cunqueiro Hospital, SERGAS, Spain
  14. 14Family and Community Care Specialist Nurse. Manager of San Roque Health Centre. Badajoz. Extremadura Health Service, Spain
  15. 15Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Spain
  16. 16Health Research Institute 12 de Octubre Hospital (Imas12), 28041 Madrid, Spain
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Abstract

Objective: Multicenter evidence comparing health literacy across Spanish autonomous communities in primary care remains scarce. We aimed to describe health literacy among adults attending scheduled nursing consultations and explore sociodemographic, clinical, and territorial differences.

Methods: Multicenter cross-sectional study in primary care health centers of six Spanish autonomous communities, conducted between June 2025 and January 2026. Adults aged 18–75 years (n = 980) completed the 16-item European Health Literacy Survey Questionnaire, Ponte a 100 lifestyle questionnaire, and 13-item Orientation to Life Questionnaire. Non-parametric tests and multiple linear regression were used.

Results: Among 920 participants with valid scores, 62.50% presented sufficient health literacy and 37.50% problematic or inadequate health literacy. Health literacy was largely homogeneous across sociodemographic groups. Older age was weakly associated with lower health literacy, whereas chronic disease and sense of coherence were associated with higher health literacy; lifestyle was not retained. Participants from Castilla-La Mancha and Castilla y León showed slightly lower adjusted health literacy scores. The model explained 9.50% of health literacy variability.

Conclusions: Sufficient health literacy predominated, but more than one third of participants had limited health literacy, and territorial differences were small. Contextual and healthcare-related factors may shape health literacy beyond individual characteristics.

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Cite

BibTeXRIS
BibTeX
@article{garciagarcia2026health,
  title = {{Health literacy in primary care users from six Spanish autonomous communities: a multicenter study of territorial variation}},
  author = {David García-García and Andrea González-Ayala and Cristina María Lozano-Hernández and Martín Rodríguez-Álvaro and Pedro Ruymán Brito-Brito and Macarena Chacón-Docampo and María Gil-Marchena and Francisco Javier Pérez-Rivas},
  journal = {Preventive Medicine Reports},
  year = {2026},
  month = oct,
  doi = {10.1016/j.pmedr.2026.103677},
  url = {https://doi.org/10.1016/j.pmedr.2026.103677},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Health literacy in primary care users from six Spanish autonomous communities: a multicenter study of territorial variation
AU  - David García-García
AU  - Andrea González-Ayala
AU  - Cristina María Lozano-Hernández
AU  - Martín Rodríguez-Álvaro
AU  - Pedro Ruymán Brito-Brito
AU  - Macarena Chacón-Docampo
AU  - María Gil-Marchena
AU  - Francisco Javier Pérez-Rivas
PY  - 2026
DA  - 2026/10/23
JO  - Preventive Medicine Reports
DO  - 10.1016/j.pmedr.2026.103677
UR  - https://doi.org/10.1016/j.pmedr.2026.103677
AB  - Objective: Multicenter evidence comparing health literacy across Spanish autonomous communities in primary care remains scarce. We aimed to describe health literacy among adults attending scheduled nursing consultations and explore sociodemographic, clinical, and territorial differences.  Methods: Multicenter cross-sectional study in primary care health centers of six Spanish autonomous communities, conducted between June 2025 and January 2026. Adults aged 18–75 years (n = 980) completed the 16-item European Health Literacy Survey Questionnaire, Ponte a 100 lifestyle questionnaire, and 13-item Orientation to Life Questionnaire. Non-parametric tests and multiple linear regression were used.  Results: Among 920 participants with valid scores, 62.50% presented sufficient health literacy and 37.50% problematic or inadequate health literacy. Health literacy was largely homogeneous across sociodemographic groups. Older age was weakly associated with lower health literacy, whereas chronic disease and sense of coherence were associated with higher health literacy; lifestyle was not retained. Participants from Castilla-La Mancha and Castilla y León showed slightly lower adjusted health literacy scores. The model explained 9.50% of health literacy variability.  Conclusions: Sufficient health literacy predominated, but more than one third of participants had limited health literacy, and territorial differences were small. Contextual and healthcare-related factors may shape health literacy beyond individual characteristics.
SN  - 2211-3355
ER  -