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

Table 7 Adjusted odds ratios (OR) for direct, indirect and total effects for the association between education and out-of-hours primary care use, mediated through health literacy, using the KHB method with logistic regression^a

	Appraisal of health information (n = 1612)	Ability to actively engage with healthcare providers (n = 1603)	Navigating the healthcare system (n = 1612)	Ability to find good health information (n = 1603)	Understanding health information well enough to know what to do (n = 1609)
	OR (95% CI)^b	OR (95% CI)^b	OR (95% CI)^b	OR (95% CI)^b	OR (95% CI)^b
Total effect (education and HLQ)	0.82 (0.69; 0.98)*	0.82 (0.69; 0.97)*	0.80 (0.68; 0.95)*	0.82 (0.69; 0.97)*	0.81 (0.69; 0.96)*
Direct effect (education)	0.81 (0.68; 0.96)*	0.85 (0.71; 1.01)	0.83 (0.70; 0.98)*	0.85 (0.72; 1.01)	0.85 (0.71; 1.01)
Indirect effect (HLQ)	1.02 (1.00; 1.04)*	0.97 (0.94; 1.00)	0.97 (0.95; 1.00)*	0.96 (0.92; 0.99)*	0.96 (0.92; 1.00)
Confounding ratio (total effect/direct effect)	0.91	1.18	1.13	1.27	1.25
Confounding percentage (% of model affect attributable to mediator)	−9.79%	14.92%	11.83%	21.07%	19.91%
Pseudo R square ^c	0.02	0.02	0.02	0.02	0.02

^a All models are adjusted for age (continuous), sex (ref male), household status (ref living alone), number of chronic diseases (ref one chronic disease), and illness duration
^b P-value * < .05, ** < .01, *** < .001, significant results printed in bold
^c According to McFadden method [51]

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