Health Literacy among Swedish Patients in Opioid Substitution Treatment: A Mixed-Methods Study

Research output: Contribution to journalArticle


Background: Poor health and unmet healthcare needs is common among people with substance use disorder (SUD) including patients in opioid substitution treatment (OST). Low health literacy (HL) is associated with poverty, low education and physical limitations, but is unexplored in an OST context. Methods: Mixed-methods were used. Participants were consecutively recruited by clinic staff or researcher, from five OST clinics in Malmö, Sweden, during September – November 2019. HL level was measured through HLS-EU-Q16 (n?=?286). Self-reported socioeconomic correlates of HL were analyzed through logistic regression. Patients’ experiences of HL-related problems were assessed through six focus group interviews (n?=?23) moderated by an OST employee. Results: While 46% had sufficient HL (13–16 points of maximum 16), 32% did not receive a HL score due to too many missing answers. No correlates of sufficient HL level were found. Missing HL level was associated with low educational attainment (Ajusted odds ratio [AOR] 1.94; 95% Confidence interval [CI] 1.13–3.32) and negatively associated with employment (AOR 0.28; 95% CI 0.11–0.71). Qualitative data revealed a diversity in participants’ self-assessed capabilities, and problems associated with access, comprehension, trust and dependency on addiction-specific services. Conclusions: This study highlights that HL level is low, and identifies a number of concrete problems related to HL in the studied population. The results implicate a need for tailored interventions regarding health information among OST patients.


External organisations
  • Region Skåne
  • Lund University
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Substance Abuse
  • Public Health, Global Health, Social Medicine and Epidemiology


  • Health Equity, Health Literacy, HLS-EU-Q16, Mixed Methods, Opiate Substitution Treatment, Sweden
Original languageEnglish
Article number108186
JournalDrug and Alcohol Dependence
Publication statusPublished - 2020
Publication categoryResearch