***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Although health literacy and quality of life are important concepts in health care , the link between them is unclear , especially for a population of frequent users of health care services with chronic diseases . Low health literacy is a common problem that has been linked to several negative health outcomes . Quality of life is an important health outcome in patient-centered care . Frequent users of health care services are a vulnerable population that deserves attention due to high costs and negative outcomes such as lower quality of life and higher mortality . The objective of this study was to examine the relationship between health literacy and the physical and mental components of quality of life among frequent users of health care services with chronic diseases . Methods This study presents the cross-sectional analysis of data collected through the V1SAGES project , a r and omized controlled trial on the effectiveness of a case management intervention in primary care in Quebec , Canada . Participants ( n = 247 ) were frequent users of health care services presenting at least one chronic condition .  Health literacy was measured by the Newest Vital Sign ( NVS ) , and the physical and mental components of quality of life were evaluated by the Short Form Health Survey Version 2 ( SF-12v2 ) . The association between health literacy ( independent variable ) and the physical and mental components of quality of life was examined using biserial correlation . Results No association was found between health literacy and quality of life ( physical component : r = 0.108 , ρ = 0.11 ; mental component : r = 0.147 , ρ = 0.15 ) . Conclusion This study suggests that there is no relationship between health literacy and the physical and mental components of quality of life among frequent users of health care services . Trial registration NCT01719991 . Registered October 25 , 2012 Purpose The levels of health literacy in patients with long-term conditions ( LTCs ) are critical for better disease management and quality of life ( QoL ) . However , the impact of health literacy on QoL in older adults with LTCs is unclear . This study examined the association between health literacy and domains of QoL in older people with LTCs , investigating key socio-demographic and clinical variables , as confounders . Methods A prospect i ve cohort study was conducted on older adults ( n = 4278 ; aged 65 years and over ) with at least one LTC , registered in general practice s in Salford , UK . Participants completed measures of health literacy , QoL , multi-morbidity , depression , social support , and socio-demographic characteristics . Multivariate linear regressions were performed to examine the effects of health literacy on four QoL domains at baseline , and then changes in QoL over 12 months . Results At baseline , poor health literacy was associated with lower scores in all four QoL domains ( physical , psychological , social relationships and environment ) , after adjusting for the effects of multi-morbidity , depression , social support and socio-demographic factors . At 12-month follow-up , low health literacy significantly predicted declines in the physical , psychological and environment domains of QoL , but not in social relationships QoL. Conclusions This is the largest , most complete assessment of the effects of health literacy on QoL in older adults with LTCs . Low health literacy is an independent indicator of poor QoL older patients with LTCs . Interventions to improve health literacy in older people with LTCs are encouraged by these findings Background Limited evidence exists regarding the relationship between health literacy and health-related quality of life ( HRQoL ) in Australian patients from primary care . The objective of this study was to investigate the impact of health literacy on HRQoL in a large sample of patients without known vascular disease or diabetes and to examine whether the difference in HRQoL between low and high health literacy groups was clinical ly significant . Methods This was a cross-sectional study of baseline data from a cluster r and omised trial . The study included 739 patients from 30 general practice s across four Australian states conducted in 2012 and 2013 using the st and ard Short Form Health Survey ( SF-12 ) version 2 .  SF-12 physical component score ( PCS-12 ) and mental component score ( MCS-12 ) are derived using the st and ard US algorithm . Health literacy was measured using the Health Literacy Management Scale ( HeLMS ) . Multilevel regression analysis ( patients at level 1 and general practice s at level 2 ) was applied to relate PCS-12 and MCS-12 to patient reported life style risk behaviours including health literacy and demographic factors . Results Low health literacy patients were more likely to be smokers ( 12 % vs 6 % , P = 0.005 ) , do insufficient physical activity ( 63 % vs 47 % , P < 0.001 ) , be overweight ( 68 % vs 52 % , P < 0.001 ) , and have lower physical health and lower mental health with large clinical ly significant effect sizes of 0.56 ( B ( regression coefficient ) = −5.4 , P < 0.001 ) and 0.78(B = -6.4 , P < 0.001 ) respectively after adjustment for confounding factors . Patients with insufficient physical activity were likely to have a lower physical health score ( effect size = 0.42 , B = −3.1 , P < 0.001 ) and lower mental health ( effect size = 0.37 , B = −2.6 , P < 0.001 ) . Being overweight tended to be related to a lower PCS-12 ( effect size = 0.41 , B = −1.8 , P < 0.05 ) . Less well-educated , unemployed and smoking patients with low health literacy reported worse physical health . Health literacy accounted for 45 and 70 % of the total between patient variance explained in PCS-12 and MCS-12 respectively . Conclusions Addressing health literacy related barriers to preventive care may help reduce some of the disparities in HRQoL. Recognising and tailoring health related communication to those with low health literacy may improve health outcomes including HRQoL in general practice OBJECTIVE To measure the level of  functional health literacy ( FHL ) in an Australian population , and to explore the level of risk associated with level of FHL . DESIGN , SETTING AND PARTICIPANTS Cross-sectional , r and om population survey administered to 2824 South Australians aged > or=15 years , September-October 2008 . MAIN OUTCOME MEASURES Newest Vital Sign as a measure of FHL , self-reported general health status , and use of health services . RESULTS 24 % of respondents were at risk of limited FHL , and 21 % had a high likelihood of inadequate FHL ; this increased with age ( > or=65 years , 50 % v 25 - 44 years , 11 % ) . In multiple logistic regression models , a high likelihood of inadequate FHL was significantly more common among those with lower education ( left school < or=15 years of age , odds ratio [ OR ] , 8.1 ; 95 % CI , 4.8 - 13.6 ) ; with lower annual income ( < $ 20 000 , OR , 4.1 ; 95 % CI , 2.3 - 7.4 ) ; who were born in countries other than Australia , New Zeal and , the United Kingdom and Irel and ; and with poorer health status ( OR , 1.6 ; 95 % CI , 1.2 - 2.2 ) . Inadequate FHL was significantly less common among females ( OR , 0.6 ; 95 % CI , 0.5 - 0.8 ) . People with inadequate or at-risk FHL were significantly more likely to report having diabetes , cardiac disease or stroke , and significantly less likely to have recently attended a doctor . Respondents aged > or=65 years with inadequate FHL were more likely to have been admitted to hospital ( OR , 2.2 ; 95 % CI , 1.1 - 4.5 ) . CONCLUSION Many Australians are likely to have limited health literacy , and this is a risk to effective health care delivery and health improvement across the community Background Hypertension is a common and frequently occurring chronic disease of the cardiovascular system . Besides the pathological factors , the occurrence and exacerbation of hypertension are also associated with many factors of lifestyle and behaviors . Thus hypertensive patients ’ Health-related quality of life ( HRQL ) is not only influenced by the disease itself but also by many subjective factors such as health literacy and self-management efficacy , especially in the deeper part of southwestern China and thus is less developed compared to the other places . The purpose of this study was to examine the association between the HRQL  of hypertensive patients and health literacy and self-management efficacy as well as how they affect the HRQL , so as to provide a theoretical reference for improving the HRQL of patients with hypertension in less developed areas . Methods This was a cross-sectional study of baseline data from a clustered r and omized controlled trial . The study design had passed a cross-national peer review and accepted grants by the China Medical Board . It was also registered in the Chinese Clinical Trial Registry (ChiCTR-OOR-14005563).A st and ardized question naire adapted from a previous vali date d WHO question naire was used for the survey which included detailed questions about patient ’s socio-demographic characteristics and self-reported information .  Patients ’ HRQL was measured by the M and arin version of the 36-item Short Form . We used the vali date d M and arin version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale to assess patients ’ self-management efficacy . The vali date d three-item Brief Health Literacy Screening ( BHLS ) was used to measure the patients ’ health literacy . A structural equation model was constructed , and p ≤ 0.05 was taken as significant . Results Demographic characteristics , health literacy and self-management efficacy have all significant effects on HRQL . Age , education level , self-management efficacy and health literacy were significantly related to the HRQL . The constructed model had a good fit for the data according to the model fit indices . Based on the model , health literacy ( r = 0.604 , p = 0.029 ) and Self-management efficacy ( r = 0.714 , p = 0.018 ) have a significant impact on HRQL . Demographic characteristics were inversely related to HRQL ( r = −0.419 , p = 0.007 ) , but have a significant impact on health literacy ( r = 0.675 , p = 0.029 ) and self-management efficacy ( r = 0.379 , p = 0.029 ) . At the same time , self-management efficacy was positively correlated to health literacy ( r = 0.413 , p < 0.01 ) . Conclusions Age , education level , self-management efficacy and health literacy were all related to the HRQL of patient with hypertension , which means that patients who are more elderly and have lower education level , low self-management efficacy and poor health literacy get worse HRQL . This may imply the necessary to introduce routine assessment of health literacy and self-management efficacy into assessment procedures for hypertensive patients ’ health management . Such assessment can help professionals to identify the population at greatest risk for poor health outcomes and low well-being in the future . In clinical practice , effective interventions such as direct guidance and education to raise the self-management efficacy and enhance health literacy might improve the HRQL of patients with hypertension . Trial registration Retrospectively registered Chinese Clinical Trial Registry (ChiCTR-OOR-14005563).Name of registry : Effects of the integrated delivery system and payment system of community-based intervention on rural patients of chronic diseases in Qianjiang District , China Date of registration : Retrospectively registered 23 November 2014 . Date of enrolment of the first participant to the trial : 5 July 
    Output:
    
Meta-regression showed that cohort study design , studies conducted in China , and publication before 2012 may be important influencing factors .