The association of health literacy with adherence and outcomes in moderate-severe asthma

• Published in: Journal of allergy and clinical immunology Vol. 132; no. 2; pp. 321 - 327
• Main Authors: Apter, Andrea J., MD, MSc, Wan, Fei, MS, Reisine, Susan, PhD, Bender, Bruce, PhD, Rand, Cynthia, PhD, Bogen, Daniel K., MD, PhD, Bennett, Ian M., MD, PhD, Bryant-Stephens, Tyra, MD, Roy, Jason, PhD, Gonzalez, Rodalyn, BA, Priolo, Chantel, BA, Have, Thomas Ten, PhD, MPH, Morales, Knashawn H., ScD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-08-2013; Elsevier; Elsevier Limited
• Subjects: adherence; Administration, Inhalation; Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - therapeutic use; Adult; adults; African Americans; Allergy and Immunology; asthma; Asthma - drug therapy; Asthma - ethnology; Asthma - prevention & control; asthma control; asthma-related quality of life; Biological and medical sciences; Cohort Studies; Computerized physician order entry; Educational attainment; Family income; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Health education; Health Literacy; Hispanic Americans; Hospitalization; Hospitals; Humans; inhaled corticosteroids; inner-city asthma; Male; Medical sciences; Medication Adherence - psychology; Middle Aged; numeracy; Patient satisfaction; Patients; print literacy; Prospective Studies; Quality of Life; Reading comprehension; Respiratory Function Tests; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Self Care; Studies; Surveys and Questionnaires; Health literacy; PS; AE; ANQ; adherence; adults; Inhaled corticosteroid; S-TOFHLA; asthma; asthma-related quality of life; asthma control; Asthma Numeracy Questionnaire; AQOL; Emergency department; inner-city asthma; Short Test of Functional Health Literacy in Adults; ICS; Asthma education; numeracy; Problem-solving; print literacy; inhaled corticosteroids; ED; Prognosis; Literacy; Association; Immunology; Adult; Evolution; Severe asthma; Human; Corticosteroid; Immunopathology; Urban environment; Health; Adhesion; Inhalation; Quality of life; Asthma-related quality of life
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2013.02.014

Background Low health literacy is associated with poor outcomes in asthma and other diseases, but the mechanisms governing this relationship are not well defined. Objective We sought to assess whether literacy is related to subsequent asthma self-management, measured as adherence to inhaled steroids, and asthma outcomes. Methods In a prospective longitudinal cohort study, numeric (Asthma Numeracy Questionnaire) and print literacy (Short Test of Functional Health Literacy in Adults) were assessed at baseline in adults with moderate or severe asthma for their impact on subsequent electronically monitored adherence and asthma outcomes (asthma control, asthma-related quality of life, and FEV1 ) over 26 weeks, using mixed-effects linear regression models. Results A total of 284 adults participated: age, 48 ± 14 years, 71% females, 70% African American, 6% Latino, mean FEV1 66% ± 19%, 86 (30%) with hospitalizations, and 148 (52%) with emergency department visits for asthma in the prior year. Mean Asthma Numeracy Questionnaire score was 2.3 ± 1.2 (range, 0-4); mean Short Test of Functional Health Literacy in Adults score was 31 ± 8 (range, 0-36). In unadjusted analyses, numeric and print literacy were associated with better adherence ( P  = .01 and P  = .08, respectively), asthma control ( P  = .005 and P  < .001, respectively), and quality of life ( P  < .001 and P  < .001, respectively). After controlling for age, sex, and race/ethnicity, the associations diminished and only quality of life (numeric P  = .03, print P  = .006) and asthma control (print P  = .005) remained significantly associated with literacy. Race/ethnicity, income, and educational attainment were correlated ( P  < .001). Conclusion While the relationship between literacy and health is complex, interventions that account for and address the literacy needs of patients may improve asthma outcomes.