Low Health Literacy Linked to Social Media Reliance and Emergency Visits

Patients with limited health literacy prioritize emergency care over outpatient clinics when faced with long wait times or online advice.

For Doctors in a Hurry

Clinicians frequently question whether low health literacy contributes to the inappropriate use of emergency department services.
The researchers conducted a prospective cross-sectional study of 466 adults presenting to an Istanbul emergency department.
Only 13.9% of participants achieved an excellent health literacy score on the standardized 50-point assessment scale.
The study concludes that lower health literacy correlates with reliance on social media for medical information.
Physicians should prioritize digital health literacy initiatives to help patients navigate outpatient systems and reduce emergency visits.

Emergency department crowding remains a persistent challenge for global health systems, often exacerbated by patients seeking care for non-urgent conditions that could be managed in primary care settings. While systemic factors like provider shortages contribute to these disparities, the role of patient-level variables remains a subject of intense clinical investigation [1]. Previous systematic reviews have indicated that approximately one in three parents in emergency settings possesses low health literacy (a patient's ability to find, understand, and use information to inform health-related decisions), which may correlate with increased service utilization [2]. Furthermore, the rise of digital health information has introduced new complexities, as patients increasingly turn to unverified sources that may bypass traditional clinical pathways [3]. Identifying the specific risk factors that lead vulnerable populations to utilize emergency services for routine concerns is critical for developing effective risk-stratification instruments [4]. A new study now offers fresh insights into how health literacy levels and social media consumption patterns influence the decision to seek emergency care.

Study Design and Patient Demographics

The researchers conducted a prospective cross-sectional study (an observational study design that analyzes data from a population at a specific point in time) at a university hospital emergency department in Istanbul. The study duration spanned from December 2021 to January 2023, capturing over a year of patient interactions to assess the relationship between health literacy and service utilization. To focus on the drivers of potentially avoidable emergency visits, the investigators recruited 466 participants who were adults over 18 years of age. These individuals were specifically selected from the green or yellow triage areas, which represent patients presenting with non-urgent or moderately urgent conditions, respectively. This selection criteria allowed the authors to examine the health literacy of patients whose medical needs might have been appropriately addressed in an outpatient or primary care setting, where resource intensity is lower and continuity of care is higher.

Quantifying Health Literacy and Clinical Correlations

The researchers quantified patient proficiency using the Turkish Health Literacy Scale-32 (THLS-32), a validated instrument that measures the ability to access, understand, appraise, and apply health information on a scale from 0 to 50. Within this cohort, the mean THLS-32 score was 30.35±10.11, indicating a moderate but suboptimal level of literacy across the group. A granular analysis of the scoring tiers revealed a significant deficit in high-level proficiency, as only 13.9% of participants (scoring between 42 and 50 points) were classified as having 'excellent' health literacy. This finding suggests that the vast majority of patients presenting to the emergency department, even for non-urgent issues, may lack the advanced skills necessary to navigate complex medical decisions or interpret nuanced health guidance independently. For the practicing physician, this underscores the necessity of using clear, jargon-free communication even with patients who appear highly functional.

Clinicians often assume that higher educational attainment or maturity correlates with better health navigation skills, but the data from this study challenge those assumptions. The researchers found no statistically significant association between health literacy levels and age, gender, or educational level. This is particularly relevant for practitioners, as it indicates that even university-educated patients, who comprised the majority of this study's sample, may struggle with health literacy. The lack of demographic predictors suggests that health literacy is a distinct clinical variable that cannot be inferred from a patient's socioeconomic or educational background, necessitating a standardized approach to patient education regardless of their perceived status. While low health literacy was linked to specific drivers for seeking emergency care, such as long outpatient wait times or social media influence, it did not serve as a predictor for the total volume of visits. The analysis showed no statistically significant association between health literacy and frequent emergency department attendance. This suggests that while literacy levels influence the decision-making process for a specific episode of care, the phenomenon of high-utilizers may be driven by other complex factors, such as chronic disease burden or systemic barriers to primary care, rather than literacy alone.

The volume of emergency department visits in Turkey continues to increase, a trend that places significant strain on acute care resources and necessitates a deeper understanding of patient decision-making. The study confirmed that low health literacy is associated with inappropriate use of emergency departments, particularly for non-urgent conditions that could be managed in other settings. A critical factor in this utilization pattern is the source of medical information; the data showed that participants who reported relying on social media for health news had lower THLS-32 scores. This indicates that lower health literacy is associated with greater reliance on unverified information in social media for health news, which may lead patients to misjudge the severity of their symptoms or the necessity of emergency intervention. For the clinician, this highlights the importance of asking patients where they obtain their health information, as those relying on social platforms may require more intensive counseling to correct misinformation.

Systemic barriers also interact with patient proficiency to drive emergency department traffic. The researchers found that participants who visited the emergency department due to 'long waits for a hospital outpatient clinic' had lower THLS-32 scores, suggesting that lower health literacy is associated with emergency department attendance due to long outpatient waits. For the practicing physician, this suggests that patients with limited health literacy may view the emergency department as a primary entry point to the healthcare system when faced with administrative delays, rather than a resource reserved for acute crises. These findings highlight the need for targeted health literacy and digital health literacy initiatives (programs designed to improve a patient's ability to find and evaluate health information from electronic sources) to reduce avoidable emergency department visits and strengthen healthcare navigation skills. By improving a patient's ability to evaluate online information and navigate outpatient scheduling, health systems may be able to redirect non-urgent cases to more appropriate levels of care.

Study Info

From health literacy to emergency room: understanding the factors behind adult emergency visits

Hatice Dilek Doğan, Seda Tuğba Baykara Mat

Journal Emergency Medicine Journal

Published April 15, 2026