A health care navigation tool assesses asthma self-management and health literacy

Abstract

BACKGROUND Self-management of moderate/severe asthma depends upon patients’ ability to: 1) navigate (access health care to obtain diagnoses and treatment), 2) use inhaled corticosteroids (ICS) properly, and 3) understand ICS function. OBJECTIVE To test whether navigation skills (medication recall, knowledge of copay requirements ability to provide information needed for a medical visit about a persistent cough unresponsive to medication), are related to other self-management skills and to health literacy. METHODS A 21-item Navigating Ability (NAV2) questionnaire was developed, validated, then read to adults with moderate/severe asthma. ICS technique was evaluated by scales derived from instructions in national guidelines; knowledge of ICS function by a validated 10-item questionnaire. Spearman correlation was computed between NAV2 score and these questionnaires and with numeracy (Asthma Numeracy Questionnaire) and print literacy (Short Test of Functional Health Literacy in Adults). RESULTS 250 adults participated: age 51±13 years, 72% female, 65% African-American, 10% Latino, 50% with less than $30,000 household income per year, 47% with no more than a 12th grade education, 29% experienced hospitalizations for asthma in the prior year. Higher NAV2 score was associated with correct ICS technique (ρ=0.24, p=0.0002), knowledge of ICS (ρ =0.35, p<0.001), better print literacy (ρ=0.44, p<0.001) and numeracy (ρ=0.41, p<0.001). CONCLUSIONS Patients with poor navigating ability are likely to have poor inhaler technique and limited understanding of ICS function, as well as limited numeracy and print literacy. Clinicians should consider these elements of self-management for their impact on asthma care and as a marker of more general health literacy deficits.

Loneliness and Facebook use: the role of social comparison and rumination

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A patient advocate to facilitate access and improve communication, care, and outcomes in adults with moderate or severe asthma: Rationale, design, and methods of a randomized controlled trial

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