How Well Do Patients Understand Written Instructions?

Abstract

The aim of this study was to assess health literacy (word recognition and comprehension) in patients at a rural rheumatology practice and to compare this to health literacy levels in patients from an urban rheumatology practice.Inclusion criteria for this cross-sectional study were as follows: ≥18-year-old patients at a rural rheumatology practice (Mid-North Coast Arthritis Clinic, Coffs Harbour, Australia) and an urban Sydney rheumatology practice (Combined Rheumatology Practice, Kogarah, Australia). Exclusion criteria were as follows: ill-health precluding participation; poor vision/hearing, non-English primary language. Word recognition was assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM). Comprehension was assessed using the Test of Functional Health Literacy in Adults (TOFHLA). Practical comprehension and numeracy were assessed by asking patients to follow prescribing instructions for 5 common rheumatology medications.At the rural practice (Mid-North Coast Arthritis Clinic), 124/160 patients agreed to participate (F:M 83:41, mean age 60.3 ± 12.2) whereas the corresponding number at the urban practice (Combined Rheumatology Practice) was 99/119 (F:M 69:30, mean age 60.7 ± 17.5). Urban patients were more likely to be born overseas, speak another language at home, and be employed. There was no difference in REALM or TOFHLA scores between the 2 sites, and so data were pooled. REALM scores indicated 15% (33/223) of patients had a reading level ≤Grade 8 whereas 8% (18/223) had marginal or inadequate functional health literacy as assessed by the TOFHLA. Dosing instructions for ibuprofen and methotrexate were incorrectly understood by 32% (72/223) and 21% (46/223) of patients, respectively.Up to 15% of rural and urban patients had low health literacy and <1/3 of patients incorrectly followed dosing instructions for common rheumatology drugs.There was no significant difference in word recognition, functional health literacy, and numeracy between rural and urban rheumatology patients.

Official definitions for undesirable medical events

“…The medical literature is inconsistent concerning the observation that health literacy is better in urban populations [14, 15]. In the present analysis a better recognition of the correct definition was also not evident among participants from more populated areas; however, answer patterns differed between the federal states.…”

“…Although women have been seen to have better medical knowledge and higher health awareness than men [ 13 ], the ability of both men and women in our study to identify the correct wording for “complication” was almost identical. The medical literature is inconsistent concerning the observation that health literacy is better in urban populations [ 14 , 15 ]. In the present analysis a better recognition of the correct definition was also not evident among participants from more populated areas; however, answer patterns differed between the federal states.…”

‘Tired, afraid, breathless … .’ An international survey of the exercise experience for people living with pulmonary hypertension

“…Participants were likely to represent a highly engaged subset of the PH population. While the survey was offered in multiple formats (paper and electronic), the use of online survey advertising and dissemination may have favoured those with internet access, often a more literate population, 30 and those actively engaged with PH groups. Indeed, 67% of the present cohort reported an affiliation with at least one consumer support group, and levels of education in the present cohort appeared higher than the Australia population average.…”

Assessing the readability and patient comprehension of rheumatology medicine information sheets: a cross-sectional Health Literacy Study

“…In the UK, just under one in six adults has the literacy of an 11-year-old 26. A study of over 200 rural and urban Australian rheumatology patients found that 15% of patients had low health literacy and up to one-third of patients incorrectly followed dosing instructions for common rheumatology drugs 23. Ten per cent of patients with rheumatoid arthritis (RA) who attended an urban community-based Australian rheumatology practice had inadequate/marginal functional health literacy or a reading age at or below the US high school grade equivalent of seventh–eighth grade 27.…”