Health literacy and knowledge of chronic disease

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Abstract

We sought to examine the relationship between health literacy and knowledge of disease among patients with a chronic disease. A total of 653 new Medicare enrollees aged 65 years or older who had at least one chronic disease (115 asthma, 266 diabetes, 166 congestive heart failure, 214 hypertension), completed both the in-person and telephone survey. Health literacy measured by the short test of functional health literacy in adults (S-TOFHLA) and demographic information were collected during the in-person survey. Knowledge of disease was assessed by questions based on key elements in educational materials during a telephone survey. Overall, 24% of patients had inadequate and 12% had marginal health literacy skills. Respondents with inadequate health literacy knew significantly less about their disease than those with adequate literacy. Multivariate analysis indicated that health literacy was independently related to disease knowledge. There are many opportunities to improve patients’ knowledge of their chronic disease(s), and efforts need to consider their health literacy skills.

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.

References (38)

  • M.V. Williams et al.

    Inadequate functional health literacy among patients at two public hospitals

    JAMA

    (1995)
  • J.A. Gazmararian et al.

    Health literacy among Medicare enrollees in a managed care organization

    JAMA

    (1999)
  • B.D. Weiss et al.

    Health status of illiterate adults: relation between literacy and health status among persons with low literacy skills

    J. Am. Board Fam. Pract.

    (1992)
  • C. Hoffman et al.

    Persons with chronic conditions: their prevalence and costs

    JAMA

    (1996)
  • M.V. Williams et al.

    Relationship of functional health literacy to patients’ knowledge of their chronic disease

    Arch. Intern. Med.

    (1998)
  • D.W. Baker et al.

    Functional health literacy and the risk of hospital admission among Medicare managed care enrollees

    Am. J. Public Health

    (2002)
  • E.J. Mayeaux et al.

    Improving patient education for patients with low literacy skills

    Am. Fam. Physician

    (1996)
  • D.K. Ziegler et al.

    How much information about adverse effects of medication do patients want from physicians?

    Arch. Intern. Med.

    (2001)
  • L.J. Kozak et al.

    Trends in avoidable hospitalizations, 1980–1998

    Health Affairs

    (2001)
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    Formerly, the USQA Center for Health Care Research™.

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