Tailored Education May Reduce Health Literacy Disparities in Asthma Self-Management
Michael K. Paasche-Orlow,
Kristin A. Riekert,
Andrew Bilderback,
Arjun Chanmugam,
Peter Hill,
Cynthia S. Rand,
Fred L. Brancati and
Jerry A. Krishnan
Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; and Departments of Medicine, Emergency Medicine, and Epidemiology, Johns Hopkins University, Baltimore, Maryland
Correspondence and requests for reprints should be addressed to Michael Paasche-Orlow, M.D., M.P.H., Assistant Professor of Medicine, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 91 East Concord Street, Suite 200, Boston, MA 02118. E-mail: mpo{at}bu.edu
Rationale: Although inadequate health literacy has been associatedwith lower asthma medication knowledge and worse metered-doseinhaler (MDI) technique, the relationship between health literacyand the capacity to learn asthma self-management skills is unknown.
Objectives: In this prospective cohort study of adults hospitalizedfor severe asthma exacerbations at two inner-city hospitals,we examined the relationship between inadequate health literacyand difficulties learning and retaining instructions about dischargemedications and appropriate MDI technique.
Methods: At hospital discharge, participants received one-on-one,30-min, guideline-based, written and oral instruction abouttheir asthma discharge regimen as well as appropriate MDI technique.
Measurements and Main Results: Seventy-three patients were enrolled.Inadequate health literacy was identified in 16 (22%) participants.Before instruction, inadequate health literacy was associatedwith lower asthma medication knowledge (5.2/10 vs. 7.2/10, p< 0.001) and worse MDI technique (3.2/6 vs. 3.9/6, p = 0.03).However, inadequate health literacy was not associated withdifficulty learning (p = 0.33) or retaining (p = 0.35) instructionsabout the discharge regimen. Similarly, inadequate health literacywas not associated with difficulty learning (p = 0.26) or retaining(p = 0.97) appropriate MDI technique. Results were similar inmultivariable models adjusted for demographic characteristicsand asthma severity indicators.
Conclusions: These findings suggest that inadequate health literacyis a surmountable barrier to learning and remembering key asthmaself-management skills.
Key Words: asthma • education • functional health literacy
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