Inadequate Literacy Is a Barrier to Asthma Knowledge and Self-Care

Williams, Mark; Baker, David W.; Honig, Eric; Lee, Theodore M.; Nowlan, Adam

doi:10.1378/chest.114.4.1008

Cited by 568 publications

(435 citation statements)

References 55 publications

Supporting

Mentioning

417

Contrasting

Unclassified

Order By: Relevance

“…Patient engagement is a broader concept that combines patient activation with interventions designed to increase activation and promote positive patient behavior, such as obtaining preventive care [9]. On the basis of available evidence in other settings of healthcare delivery [13,16,20,22,26,27,29,32,36,40,41], it is likely that patients with low health literacy presenting to a hand surgeon are at greater risk for poor treatment adherence, suboptimal outcomes, and misuse of resources; future studies should confirm these assumptions in this patient population. To the extent that asking more questions yields more information for patients, the observed difference in question-asking may reveal a source of health-literacy disparities in access to health information.…”

Section: Discussionmentioning

confidence: 99%

Patients With Limited Health Literacy Ask Fewer Questions During Office Visits With Hand Surgeons

Menendez

Hoorn

Mackert

et al. 2017

Clinical Orthopaedics &Amp; Related Research

107

View full text Add to dashboard Cite

Background In the midst of rapid expansion of medical knowledge and decision-support tools intended to benefit diverse patients, patients with limited health literacy (the ability to obtain, process, and understand information and services to make health decisions) will benefit from asking questions and engaging actively in their own care. But little is known regarding the relationship between health literacy and question-asking behavior during outpatient office visits. Questions/purposes (1) Do patients with lower levels of health literacy ask fewer questions in general, and as stratified by types of questions? (2) What other patient characteristics are associated with the number of questions asked? (3) How often do surgeons prompt patients to ask questions during an office visit? Methods We audio-recorded office visits of 84 patients visiting one of three orthopaedic hand surgeons for the first time. Patient questions were counted and coded using an adaptation of the Roter Interaction Analysis System in 11 categories: (1) therapeutic regimen; (2) medical condition; (3) lifestyle; (4) requests for services or medications; (5) psychosocial/feelings; (6) nonmedical/procedural; (7) asks for understanding; (8) asks for reassurance; (9) paraphrase/ checks for understanding; (10) bid for repetition; and (11) personal remarks/social conversation. Directly after the visit, patients completed the Newest Vital Sign (NVS) health literacy test, a sociodemographic survey (including age, sex, race, work status, marital status, insurance status), and three Patient-Reported Outcomes Measurement Information System-based questionnaires: Upper-Extremity Function, Pain Interference, and Depression. The NVS scores were divided into limited (0-3) and adequate (4-6) health literacy as done by the tool's creators. We also assessed whether the surgeons prompted patients to ask questions during the encounter. Results Patients with limited health literacy asked fewer questions than patients with adequate health literacy (5 ± 4 versus 9 ± 7; mean difference, À4; 95% CI, À7 to À1; p = 0.002). More specifically, patients with limited health literacy asked fewer questions regarding medical-care issues such as their therapeutic regimen (1 ± 2 versus 3 ± 4; Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at

show abstract

Section: Discussionmentioning

confidence: 99%

Patients With Limited Health Literacy Ask Fewer Questions During Office Visits With Hand Surgeons

Menendez

Hoorn

Mackert

et al. 2017

Clinical Orthopaedics &Amp; Related Research

107

View full text Add to dashboard Cite

show abstract

“…5,7,8 This relationship has led the World Health Organization and the Institute of Medicine to promote and exhort improving health literacy as a public health goal. 1 While a 'universal precautions' approach for using clear health communication practices has been recommended by the American Medical Association, 25 some studies have shown that simply using plain language and 'teach back' methods to confirm understanding may not be sufficient.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8][9] The magnitude of the effect of 'low health literacy' previously was equated to a diagnosis of cancer or chronic obstructive pulmonary disease (COPD), in terms of its impact on physical and mental health measures on the SF-36 assessment. 10 Part of any effective solution to this problem will then need to include a means to identify those at risk.…”

Section: Introductionmentioning

confidence: 99%

The Mini Mental Status Exam as a Surrogate Measure of Health Literacy

Dahlke¹,

Curtis

Federman

et al. 2013

J GEN INTERN MED

View full text Add to dashboard Cite

BACKGROUND: Studies have documented strong associations between cognitive function, health literacy skills, and health outcomes, such that outcome performance may be partially explained by cognitive ability. Common cognitive assessments such as the Mini Mental Status Exam (MMSE) therefore may be measuring the same latent construct as existing health literacy tools. OBJECTIVES: We evaluated the potential of the MMSE as a surrogate measure of health literacy by comparing its convergent and predictive validity to the three most commonly used health literacy assessments and education. SUBJECTS: 827 older adults recruited from an academic general internal medicine ambulatory care clinic or one of five federally qualified health centers in Chicago, IL. Non-English speakers and those with severe cognitive impairment were excluded. MEASURES: Pearson correlations were completed to test the convergent validity of the MMSE with assessments of health literacy and education. Receiver Operating Characteristic (ROC) curves and the d statistic were calculated to determine the optimal cut point on the MMSE for classifying participants with limited health literacy. Multivariate logistic regression models were completed to measure the predictive validity of the new MMSE cut point. KEY RESULTS: The MMSE was found to have moderate to high convergent validity with the existing health literacy measures. The ROC and d statistic analyses suggested an optimal cut point of ≤ 27 on the MMSE. The new threshold score was found to predict health outcomes at least as well as, or better than, existing health literacy measures or education alone. CONCLUSIONS: The MMSE has considerable face validity as a health literacy measure that could be easily administered in the healthcare setting. Further research should aim to validate this cut point and examine the constructs being measured by the MMSE and other literacy assessments.

show abstract

“…15 Misuse was defined as <75% of steps correct for each device (<9/12 steps for MDI; <8/10 steps for Diskus®). 15 Because inadequate health literacy is associated with poor inhaler technique, 24,25 participants' health literacy was measured using the Short Test of Functional Health Literacy in Adults (STOFHLA), 26,27 a 36-item written comprehension test (scores: range 0-36); less-than-adequate: <23/36; adequate: ≥23/36. 26 Participants with screened visual acuity better than 20/50 in ≥1 eye were eligible to complete the STOFHLA.…”

Section: Study Proceduresmentioning

confidence: 99%

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

et al. 2012

View full text Add to dashboard Cite

BACKGROUND:Hospitalized patients frequently misuse their respiratory inhalers, yet it is unclear what the most effective hospital-based educational intervention is for this population. OBJECTIVE: To compare two strategies for teaching inhaler use to hospitalized patients with asthma or chronic obstructive pulmonary disease (COPD). DESIGN: A Phase-II randomized controlled clinical trial enrolled hospitalized adults with physician diagnosed asthma or COPD. PARTICIPANTS: Hospitalized adults (age 18 years or older) with asthma or COPD. INTERVENTIONS: Participants were randomized to brief intervention [BI]: single-set of verbal and written step-by-step instructions, or, teach-to-goal [TTG]: BI plus repeated demonstrations of inhaler use and participant comprehension assessments (teach-back). MAIN MEASURES: The primary outcome was metereddose inhaler (MDI) misuse post-intervention (<75% steps correct). Secondary outcomes included Diskus® misuse, self-reported inhaler technique confidence and prevalence of 30-day health-related events. KEY RESULTS: Of 80 eligible participants, fifty (63%) were enrolled (BI n=26, TTG n=24). While the majority of participants reported being confident with their inhaler technique (MDI 70%, Diskus® 94%), most misused their inhalers pre-intervention (MDI 62%, Diskus® 78%). Post-intervention MDI misuse was significantly lower after TTG vs. BI (12.5 vs. 46%, p= 0.01). The results for Diskus® were similar and approached significance (25 vs. 80%, p=0.05). Participants with 30-day acute health-related events were less common in the group receiving TTG vs. BI (1 vs. 8, p=0.02).CONCLUSIONS: TTG appears to be more effective compared with BI. Patients over-estimate their inhaler technique, emphasizing the need for hospital-based interventions to correct inhaler misuse. Although TTG was associated with fewer post-hospitalization healthrelated events, larger, multi-centered studies are needed to evaluate the durability and clinical outcomes associated with this hospital-based education.

show abstract

Inadequate Literacy Is a Barrier to Asthma Knowledge and Self-Care

Cited by 568 publications

References 55 publications

Patients With Limited Health Literacy Ask Fewer Questions During Office Visits With Hand Surgeons

Patients With Limited Health Literacy Ask Fewer Questions During Office Visits With Hand Surgeons

The Mini Mental Status Exam as a Surrogate Measure of Health Literacy

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

Contact Info

Product

Resources

About