Published ahead of print on August 4, 2005, doi:10.1164/rccm.200409-1291OC
American Journal of Respiratory and Critical Care Medicine Vol 172. pp. 980-986, (2005)
© 2005 American Thoracic Society
doi: 10.1164/rccm.200409-1291OC
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 associated with lower asthma medication knowledge and worse metered-dose inhaler (MDI) technique, the relationship between health literacy and the capacity to learn asthma self-management skills is unknown.
Objectives: In this prospective cohort study of adults hospitalized for severe asthma exacerbations at two inner-city hospitals, we examined the relationship between inadequate health literacy and difficulties learning and retaining instructions about discharge medications and appropriate MDI technique.
Methods: At hospital discharge, participants received one-on-one, 30-min, guideline-based, written and oral instruction about their 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 associated with 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 with difficulty learning (p = 0.33) or retaining (p = 0.35) instructions about the discharge regimen. Similarly, inadequate health literacy was not associated with difficulty learning (p = 0.26) or retaining (p = 0.97) appropriate MDI technique. Results were similar in multivariable models adjusted for demographic characteristics and asthma severity indicators.
Conclusions: These findings suggest that inadequate health literacy is a surmountable barrier to learning and remembering key asthma self-management skills.
Key Words: asthma • education • functional health literacy
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|
|
|
|
|
|
|
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|
|
|
|
|
|
|
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[Full Text]
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|
|
|
|
|
|
|
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[Full Text]
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|
|
|
|
|
|
|
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[PDF]
|
|
|
|
|
|
|
K. Fiscella and R. M. Epstein
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168(17):
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|
|
|
|
|
|
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Arch. Dis. Child.,
May 1, 2008;
93(5):
428 - 432.
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|
|
|
|
|
|
|
G. B. Diette and C. Rand
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November 1, 2007;
132(5_suppl):
802S - 809S.
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|
|
|
|
|
|
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Ann Intern Med,
December 19, 2006;
145(12):
926 - 928.
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|
|
|
|
|
|
|
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Am. J. Respir. Crit. Care Med.,
April 1, 2006;
173(7):
698 - 706.
[Full Text]
[PDF]
|
|
|
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