A randomized controlled trial of an intervention to reduce low literacy barriers in inflammatory arthritis management

Abstract

Objective Test the efficacy of educational interventions to reduce literacy barriers and enhance health outcomes among patients with inflammatory arthritis. Methods The intervention consisted of plain language information materials and/or two individualized sessions with an arthritis educator. Randomization was stratified by education level. Principal outcomes included adherence to treatments, self-efficacy, satisfaction with care, and appointment keeping. Secondary outcomes included health status and mental health. Data were collected at baseline, six, and twelve months post. Results Of the 127 patients, half had education beyond high school and three quarters had disease duration greater than five years. There were no differences in the primary outcome measures between the groups. In mixed models controlling for baseline score and demographic factors, the intervention group showed improvement in mental health score at six and twelve months (3.0 and 3.7 points, respectively), while the control group showed diminished scores (−4.5 and −2.6 points, respectively) (p=0.03 and 0.01). Conclusion While the intervention appears to have had no effect on primary outcomes, further studies with continued attention to literacy are warranted. Study site and disease duration must be considered as participants in this study had higher than average health literacy and had established diagnoses for years prior to this study. Practice Implications The study offers insight into an application of many of the protocols currently recommended to ameliorate effects of limited literacy.

EULAR recommendations for patient education for people with inflammatory arthritis

“…The SLR showed that PE is provided in various modes; individual face-to-face-meetings,19 20 23 26 30 37 42 67–73 groups,24 25 28 34–36 38–41 74–79 a combination of the two27 29 49 50 80 and online 81–83. Category I evidence was found for individual counselling.…”

“…Trained patients were involved in, or delivered two SMPs,75 82 two online programmes82 83 and one patient-led interactive workshop 89. The remaining interventions were provided by one HP 18–20 23 27 29 34 35 37 40 42 49 67–71 74 80 86 87 97. Which professionals should be involved, and how many, will depend on the aim, the topic and the context for the education.…”

Evaluation of Adherence to Drug Treatment in Patients with Rheumatoid Arthritis

“…This was in contrary to a recent study which tested the effect of a motivational interviewing programme on medication adherence in RA patients and did not demonstrate any significant change to patient beliefs about medications or in improving medication adherence and this may be due to focusing on patient-related factors only 32 . Other interventional studies failed to improve medication adherence were reported 33,34 . Most of this interventions were educational depends on enhancing patient knowledge and understanding of their disease but education alone is insufficient to increase medication adherence.…”

Mismatch Between Skills of Patients and Tools in Use: Might Literacy Affect Diagnoses and Research?

“…For example, researchers in rheumatology have been studying literacy level of patients 12 , examining the materials they develop and use 13 , studying the match between the reading level of materials and the skills of the intended audiences 14 , exploring the influence of literacy on recruitment processes 15 , and evaluating efforts to improve care through attention to literacy 16 .…”