Health literacy and knowledge of chronic disease
Introduction
The prevalence and effects of health literacy—the ability to read and comprehend prescription bottles, appointment slips, and the other essential health-related materials required to successfully function as a patient—have received increasing attention over the past 5 years [1]. Studies in both indigent [2] and Medicare [3] populations indicate that health literacy is lower among older individuals. One study measuring patients’ functional health literacy at a public hospital found that 81% of English-speaking patients 60 years or older had inadequate health literacy [2]. Another study of low-income, community-dwelling adults, aged 60–94 years, found mean reading skills at a fifth grade level, and 25% reported difficulty understanding written information from clinicians [4]. Our previous study in a Medicare managed care population found that over 30% of enrollees do not have adequate health literacy skills [3].
In addition to being most susceptible to inadequate health literacy, Medicare patients (age 65 and older) bear the greatest burden of chronic disease in the United States [5]. Studies in an indigent population indicate that patients with low health literacy skills and chronic diseases such as diabetes, asthma, or hypertension have less knowledge of their disease and its treatment, as well as fewer correct self-management skills than literate patients [6], [7]. For example, low-literate patients with asthma were less able to correctly use their metered-dose inhaler than literate patients. Even among patients who had participated in standardized educational programs for diabetes or asthma, those with lower literacy had worse knowledge and self-management skills. This may explain why patients with inadequate functional health literacy are more likely to be hospitalized than those with adequate health literacy, even after adjusting for differences in demographics and health status [8]. Since these studies were conducted at a public hospital serving almost exclusively an indigent population, further research is needed to understand whether the relation between literacy and knowledge of chronic disease is generalizable to other populations, especially the elderly.
During the past 20 years, dramatic advances in the treatment of chronic diseases have improved outcomes, but at the cost of increasingly complex medication, diet, and exercise regimens. Patients, especially women with less education, want to know information about the medications they must take [9]. Even when information is provided, however, patients commonly complain that physicians do not provide understandable explanations [10]. With increasing rates of avoidable hospitalizations among elderly patients [11], health care providers need to be aware of patients’ knowledge deficits to develop effective education strategies. We undertook this study to explore the relationship between health literacy and knowledge of chronic disease among Medicare managed care patients with asthma, diabetes, congestive heart failure, and/or hypertension.
Section snippets
Methods
The study design for this project was approved by the Institutional Review Boards at MetroHealth Medical Center, USQA Center for Health Care Research™, and Emory University. This analysis is a part of a larger study that examined the prevalence of low health literacy among community-dwelling Medicare enrollees in a national managed care organization [3]. Briefly, we selected four of the eight locations where the managed care organization had a large population of Medicare managed care enrollees
Results
Most participants (83.5%) completing the telephone survey had only one of the chronic conditions of interest, while 16.5% had two conditions (Table 1). The mean age of respondents was 72.5 years, and the majority were female (62%), white (78%), or had at least 12 years of education (65%). Overall, 24% of patients (n=157) had inadequate health literacy and another 12% (n=77) had marginal health literacy skills.
The mean number of years of having each condition (duration) varied for each disease:
Conclusions
This study is the first to our knowledge to examine the relationship between health literacy and patients’ knowledge of chronic diseases in a non-indigent population. Similar to studies in indigent populations [6], [7], our study in a Medicare managed care population found a relationship between health literacy and knowledge of chronic disease. Health literacy level proved to be an independent predictor of patients’ knowledge of their chronic illness even after controlling for age, disease
Acknowledgements
This work was partially supported by a grant from The Robert Wood Johnson Foundation. The study was performed and supported by the Prudential Center for Health Care Research, which became the USQA Center for Health Care Research™, now the Emory Center on Health Outcomes and Quality.
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Formerly, the USQA Center for Health Care Research™.