Shared-decision-making, trust in the healthcare system and health literacy are associated with self-reported pain levels a population-based cross-sectional study in individuals living with a chronic health condition in Wales

Background Pain is an invisible condition which has significant morbidity, mortality and healthcare system burden, and is a leading cause of disability worldwide. Pain is associated with negative health, health-system and social-economic consequences. Wales has a high prevalence of chronic pain and long waiting lists for chronic pain treatments. With the recommendation by NICE for person-centred care and the Welsh Government’s A Healthier Wales and Value-Based Healthcare agendas, this study aims to assess the association between self-reported pain levels and (i) experience of shared-decision-making, (ii) perception of the healthcare system, and (iii) health literacy in adults aged 46 years old and over within Wales. Methods The nationally representative Population Health Survey collected patient-reported outcomes, experiences and basic demographics between July-October 2023 across Wales. The survey was deployed to adults aged 46 years old and over, online, using paper and via telephone. An adjusted linear regression, controlling for individuals and situational characteristics, was used to assess the association between self-reported pain levels in the last 7-days and (i) experience of shared-decision-making, (ii) level of trust in the healthcare system, and (iii) health literacy. Results A lack of shared-decision-making, lower health literacy level and lower trust in the healthcare system were all associated with an increase in self-reported pain levels. Being female, having two or more chronic health conditions, being unable to work due to sickness or ill-health, a lower education level, not drinking alcohol, lower exercise levels and poorer mental health were all individual factors associated with an increase in self-reported pain. Living in an area with a lower deprivation level was the only situational factor associated with an increase in self-reported pain.