Published ahead of print on August 4, 2005, doi:10.1164/rccm.200409-1291OC Am. J. Respir. Crit. Care Med., Volume 172, Number 8, October 2005, 980-986 A more recent version of this article appeared on October 15, 2005
Submitted on September 28, 2004 Tailored Education May Reduce Health Literacy Disparities in Asthma Self-ManagementMichael K Paasche-Orlow1*,1 Department of Medicine, Boston University School of Medicine, Boston, MA, USA, 2 Department of Medicine, Johns Hopkins University, Baltimore, MD, USA, 3 Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA, 4 Department of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA * To whom correspondence should be addressed. E-mail: mpo{at}bu.edu.
Rationale: Although inadequate health literacy has been associated with lower asthma medication knowledge and worse 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 2 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 minute, 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. Prior to instruction, inadequate health literacy was associated with lower asthma medication knowledge (5.2 versus 7.2, p<0.001) and worse MDI technique (p=3.2 versus 3.9, 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 utilization. Conclusions: These findings suggest that inadequate health literacy is a surmountable barrier to learning and remembering key asthma self-management skills. Key words: Asthma, Health Literacy, Education
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