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Randomized Controlled Trial
. 2013 Aug;132(2):321-7.
doi: 10.1016/j.jaci.2013.02.014. Epub 2013 Apr 13.

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

Andrea J Apter  1 , Fei Wan, Susan Reisine, Bruce Bender, Cynthia Rand, Daniel K Bogen, Ian M Bennett, Tyra Bryant-Stephens, Jason Roy, Rodalyn Gonzalez, Chantel Priolo, Thomas Ten Have, Knashawn H Morales
Affiliations
Randomized Controlled Trial

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

Andrea J Apter et al. J Allergy Clin Immunol. 2013 Aug.

Abstract

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.

Keywords: AE; ANQ; AQOL; Asthma Numeracy Questionnaire; Asthma education; Asthma-related quality of life; ED; Emergency department; Health literacy; ICS; Inhaled corticosteroid; PS; Problem-solving; S-TOFHLA; Short Test of Functional Health Literacy in Adults; adherence; adults; asthma; asthma control; asthma-related quality of life; inhaled corticosteroids; inner-city asthma; numeracy; print literacy.

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Figures

Figure 1
Figure 1
Distribution of outcomes by high or low numeracy (Figure 1a) and print literacy (Figure 1b) over the observation period: (A) adherence, (B) asthma control, (C) FEV1, and (D) asthma-related quality of life. High numeracy is a score greater than 2. Randomization occurred at Visit 2. Adherence at any time point, e.g. Visit 2, represents mean adherence of data downloaded at that visit, so in the weeks preceding the visit.
Figure 1
Figure 1
Distribution of outcomes by high or low numeracy (Figure 1a) and print literacy (Figure 1b) over the observation period: (A) adherence, (B) asthma control, (C) FEV1, and (D) asthma-related quality of life. High numeracy is a score greater than 2. Randomization occurred at Visit 2. Adherence at any time point, e.g. Visit 2, represents mean adherence of data downloaded at that visit, so in the weeks preceding the visit.
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References

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