Health & Digital Literacy and Complementary Medicine Attitudes in Rehabilitation Patients

Health Literacy in Relation to Attitudes Towards Traditional and Complementary Medicine Among Physical Therapy and Rehabilitation Patients.

This observational study aims to evaluate the relationship between health and digital health literacy and attitudes toward complementary and alternative medicine (CAM) in patients visiting a physical medicine and rehabilitation outpatient clinic. Low health literacy may lead patients to try potentially unsafe herbal products influenced by commercial or social media sources. This study highlights the importance of understanding patients' attitudes toward such methods and aims to contribute to the development of educational efforts to improve health literacy. Increasing patients' awareness can support better decision-making, enhance rehabilitation outcomes, and promote the use of evidence-based practices in physical medicine clinics..

Study Overview

• Status: Completed
• Conditions: Complementary and Alternative Therapies; Health Literacy Level; Digital Health Literacy

Detailed Description

This observational, cross-sectional clinical study will be conducted in the Physical Medicine and Rehabilitation outpatient clinic of Karabük Training and Research Hospital. The target population includes at least 200 volunteer patients aged between 18 and 65 years. The primary objective is to evaluate the level of general and digital health literacy and the attitudes toward complementary and alternative medicine (CAM), and to investigate the relationship between these variables.

Participants will be recruited consecutively from the outpatient clinic. Inclusion criteria consist of being aged 18-65, literate, and volunteering to participate. Individuals who are unwilling or unable to cooperate, or who have cognitive or psychiatric impairments that may hinder questionnaire completion, will be excluded from the study.

Data will be collected through self-administered or interviewer-assisted questionnaires. The tools to be used are:

A structured sociodemographic data form (age, gender, education level, marital status, etc.),

Health Literacy Index (25 items), assessing general health literacy,

Digital Health Literacy Instrument (DHLI) (18 items, 6 subscales), evaluating digital health-related skills,

Complementary and Alternative Medicine Attitude Scale (CAMAS) (27 items, 3 subscales), measuring participants' attitudes toward CAM.

Data will be analyzed using IBM SPSS software. Normality of data distribution will be assessed with the Kolmogorov-Smirnov test. Depending on data characteristics, appropriate statistical tests such as Pearson or Spearman correlation, independent sample t-tests, and ANOVA will be applied. The study will also compare health and digital health literacy levels and CAM attitudes across different sociodemographic and clinical variables.

Findings from this study are expected to highlight gaps in patient knowledge and perceptions regarding CAM and digital health, potentially informing future educational strategies and supporting evidence-based clinical decision-making in rehabilitation settings.

• Study Type: Observational
• Enrollment (Actual): 211

Contacts and Locations

Study Locations

• Turkey
  • Karabük, Turkey, 78050
    • Karabuk Education and Research Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

Adult patients aged 18 to 65 years who are literate and voluntarily applying to the Physical Medicine and Rehabilitation outpatient clinic of Karabük Training and Research Hospital. Participants must be able to provide informed consent and complete the required questionnaires.

Description

Inclusion Criteria:

• being aged 18-65
• being literate
• Volunteering to participate

Exclusion Criteria:

• Patients who are unwilling or unable to cooperate

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
Patients of a Physical Medicine and Rehabilitation Clinic

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Complementary, Alternative, Conventional Medicine Attitude Scale (CACMAS)	The CACMAS is a 27-item scale with three subscales: attitudes toward complementary, alternative, and conventional medicine.The scale uses a 7-point Likert-type rating system, with responses ranging from 1 (Strongly Disagree) to 7 (Strongly Agree). Total Score Range: 27 to 189 Interpretation: Higher scores indicate a more positive attitude toward the use of CAM and conventional medical practices.	Baseline
Digital Health Literacy Instrument	The scale consists of 18 items across 6 dimensions: Information Seeking, Evaluation of Reliability, Determining Interest Level, Content Addition, Navigation Skills, and Privacy Protection. Participants rated their experiences on a 4-point Likert scale (1 = Very difficult, 2 = Difficult, 3 = Easy, 4 = Very easy) for the subdimensions of Information Seeking, Evaluation of Reliability, Determining Interest Level, and Content Addition. For Navigation Skills and Privacy Protection, a reverse-coded 4-point Likert scale was used (1 = Never, 2 = Occasionally, 3 = Rarely, 4 = Frequently). The overall and subscale scores ranged from 1 to 4, with scores below 2 indicating low digital health literacy, scores between 2 and 3 indicating moderate digital health literacy, and scores above 3 indicating high digital health literacy.	Baseline
Health Literacy Scale	The HLS-25 is a 25-item instrument adapted into Turkish by Aras and Temel (2017) based on the simplified version of the Health Literacy Survey in Europe (HLS-EU). It consists of four subscales: accessing information (5 items, score range: 5-25), understanding information (7 items, range: 7-35), appraising information (8 items, range: 8-40), and applying information (5 items, range: 5-25). Total Score Range: 25 to 125 Interpretation: Higher scores indicate better health literacy. All items are scored on a 5-point Likert scale (1 = cannot do at all to 5 = no difficulty). There are no reverse-coded items. Lower scores reflect inadequate or problematic health literacy.	Baseline

Secondary Outcome Measures

Outcome Measure	Time Frame
Personal information form	Baseline

Collaborators and Investigators

• Sponsor: Karabuk University
• Investigators: Study Chair: Metehan Yana, Karabuk University

Publications and helpful links

General Publications

• Unal Toprak F, Coskun Palaz S, Caglar S. The impact of health literacy levels on women's fear of contracting Covid-19 and their attitudes toward holistic complementary and alternative medicine: Mediation analysis results. Health Care Women Int. 2023 Jul-Sep;44(7-8):869-884. doi: 10.1080/07399332.2022.2070623. Epub 2022 May 26.
• Okawa Y, Ideguchi N, Yamashita H. Relationship between health literacy and attitudes toward acupuncture: A web-based cross-sectional survey with a panel of Japanese residents. PLoS One. 2023 Oct 20;18(10):e0292729. doi: 10.1371/journal.pone.0292729. eCollection 2023.

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2025
• Primary Completion (Actual): July 10, 2025
• Study Completion (Actual): July 10, 2025

Study Registration Dates

• First Submitted: April 22, 2025
• First Submitted That Met QC Criteria: April 22, 2025
• First Posted (Actual): April 29, 2025

Study Record Updates

• Last Update Posted (Actual): July 22, 2025
• Last Update Submitted That Met QC Criteria: July 21, 2025
• Last Verified: April 1, 2025

More Information

Terms related to this study

• Other Study ID Numbers: health literacy and CAM

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No