Impact of health literacy on longitudinal asthma outcomes

Abstract

BACKGROUND: The impact of health literacy on longitudinal asthma outcomes is not known. OBJECTIVES: To measure the association between health literacy and asthma outcomes and to assess how health literacy affects outcomes through covariates. DESIGN: Longitudinal cohort. PATIENTS: One hundred and seventy‐five adult asthma patients. MEASUREMENTS: Independent variables measured at enrollment included demographic and asthma characteristics, depressive symptoms, self‐efficacy, and asthma knowledge. Health literacy was measured with the Test of Functional Health Literacy in Adults. Outcomes were Asthma Quality of Life Questionnaire and SF‐36 scores and emergency department utilization for asthma measured every 3 to 6 months for 2 years. The effects of health literacy on outcomes and interactions between health literacy and covariates were measured with multivariable models. RESULTS: The mean age of study participants was 42 years, and 83% were women. Less health literacy was associated with worse quality of life, worse physical function, and more emergency department utilization for asthma over 2 years (P≤.05 for all comparisons). In multivariable analysis, health literacy did not remain statistically significant with any of the outcomes. Although the magnitude of its effect on emergency department utilization remained relatively intact, its effects on quality of life and functional status became attenuated with the sequential addition of covariates, particularly asthma knowledge. CONCLUSIONS: Less health literacy was associated with poor longitudinal asthma outcomes. This relationship was both direct and indirect through effects on other independent variables, particularly patients' knowledge of asthma and self‐management. Efforts to improve asthma outcomes should focus on improving literacy skills that are required to learn, understand, and implement effective self‐management.

Teaching the Use of Respiratory Inhalers to Hospitalized Patients with Asthma or COPD: a Randomized Trial

“…Unfortunately, only half the participants had sufficient vision to complete it, leading to small numbers of patients in either group (TTG, BI) with health literacy data. Given the known effect of health literacy on self-management skills and clinical outcomes, [33][34][35][36] our study informs the planning of future studies. For instance, it may be necessary to either use a measure not dependent on vision (e.g., interviewbased assessment), or to stratify based on level of health literacy.…”

Lower Health Literacy is Associated with Poorer Health Status and Outcomes in Chronic Obstructive Pulmonary Disease

“…Learned helplessness is closely related to the construct of self-efficacy, 27,28 and it is interesting that Mancuso and colleagues did not find a relationship in asthma patients between limited health literacy and poor self-efficacy. 49 It is possible that these contrasting findings are due to differences in the constructs assessed or potentially due to differences between asthma and COPD; relative to asthma, COPD is a more progressive and chronically deteriorating disease. 28,50 Health literacy was not statistically associated with the likelihood of experiencing a ≥1 week worsening of respiratory symptoms but was associated with the likelihood of seeking advice or treatment for such worsening symptoms.…”

The Impact of Parent's Health Literacy on Pediatric Asthma Outcomes

“…Paradoxically, an appropriate asthma action plan relies upon the parent providing accurate information to the healthcare provider. Low literacy adults with asthma often lack these skills; [14][15][16] low literacy parents likely lack them as well. While health literacy may be difficult to change, how and what skills parents are taught has the potential to improve children's asthma outcomes.…”

“…13 One possible source of these asthma disparities is the parents' understanding and use of health information, that is, the parents' health literacy. Studies among adults with asthma indicate that lower health literacy predicts worse asthma outcomes, 14 medical decision making, knowledge, and selfmanagement skills, such as correctly using a meter-dose inhaler and communicating with their healthcare provider. 15,16 Parents need these same skills, as well as reading and numeracy skills, to manage their children's asthma successfully in order to achieve better asthma health outcomes.…”