The Effect of Health Literacy on Preventable Hospitalisation Rates Among Patients with Chronic Conditions in Lagos State: A Health System Perspective

Background: Preventable hospitalisation is a widely used indicator of primary care system performance and is theoretically linked to patient health literacy. The relationship between health literacy and preventable hospitalisation in the Nigerian health system context has not been examined using robust longitudinal methods. This study examines the effect of health literacy on preventable hospitalisation among patients with chronic conditions in Lagos State. Methodology: A prospective cohort of 450 patients with hypertension, diabetes, or asthma was recruited from family medicine clinics and followed for 18 months. Health literacy was assessed at baseline using the Newest Vital Sign. Hospitalisation events were captured through quarterly clinical record review and patient interview. Negative binomial regression modelled the count of preventable hospitalisations adjusting for disease severity, socioeconomic status, and healthcare access. Results: Low health literacy was independently associated with a significantly higher rate of preventable hospitalisation even after adjustment. Medication misunderstanding and failure to recognise exacerbation warning signs were the most common proximate causes of preventable admission among low-literacy patients. Conclusion: Health literacy is an independent systemic determinant of preventable hospitalisation in Lagos State, representing both an individual patient deficit and a health system failure. Family medicine departments must embed health literacy-responsive communication strategies and patient education in chronic disease management protocols. Keywords: health literacy, preventable hospitalisation, chronic disease, Lagos State, primary care