Thursday, December 16, 2010

Low Health Literacy Burdens Arthritis Patients

Language MattersHealth literacy has been defined as the capacity to obtain, process, and understand basic health information and services needed to make appropriate healthcare decisions. As recent research in patients with arthritis discovered, a great many them do not understand even basic terms relating to their care, which poses a challenge for healthcare providers.

A recently published study in JCR: Journal of Clinical Rheumatology found that many patients seen at a rheumatology clinic — including some with a long history of rheumatoid arthritis (RA) — do not recognize common and important terms related to their health and medical treatment. Researchers led by Christopher J. Swearingen, PhD, of the University of Arkansas for Medical Sciences, Little Rock, enrolled 194 patients seen at a university Rheumatology clinic. Each subject was tested using two word lists: one having terms relating to general health and medicine and the other including words specifically related to rheumatology and arthritis. Health literacy scores were compared with patients' health and other characteristics.

Many patients had low health literacy, with scores indicating an 8th-grade reading level or less. This included 18% of patients on the general health literacy test and nearly a quarter on the rheumatology-specific word list. Scores on the two word lists were closely related to each other, suggesting that general health literacy was a good indicator of rheumatology-specific health literacy. However, none of the patients had severely low literacy, defined as a 3rd-grade reading level or less.

More than 10% of patients did not recognize basic health terms like “diagnose” and “symptom.” And, even though most of them had been seeing a rheumatologist for some time, 11% of patients could not recognize the word “rheumatologist,” and 13% or more could not recognize common words related to arthritis, such as “cartilage,” “inflammatory,” or “osteoporosis.” As might be expected, higher percentages of patients did not recognize names of common arthritis drugs, such as “methotrexate” or “Naprosyn.”

Patients with lower health literacy scores also tended to have lower education and to be in worse health. The results are consistent with previous studies reporting that 14% of U.S. adults have “below basic literacy skills,” which is strongly related to low education and, in turn, is associated with increased rates of RA and other rheumatic diseases, the researchers note. However, they believe their study probably underestimates the true extent of the relationship between low literacy and poor health.

COMMENTARY: This was a small study in a specific academic clinical setting, so generalizability to overall medical practice and other settings must be cautiously considered. Still, this is a serious problem — according to the National Assessment of Adult Literacy, 9 out of 10 adults may lack the communication skills needed to effectively manage their health and prevent disease. And, as Swearingen and colleagues point out, low health literacy is an under-recognized problem and literacy-associated barriers may incur significant socioeconomic disparities throughout the healthcare system. The questions is: What can and should healthcare providers do to help address the problem of low health literacy among their patients?

Swearingen et al. recommend that following the U.S. Department of Health and Human Services' National Action Plan to Improve Health Literacy [resources available here] may help patients to develop self-management skills and enhance their ability to access and use health information. However, this could take time and resources unavailable to individual healthcare providers and even small clinical practices. At the least, practitioners should be aware of probable health literacy deficits in their patients and strive on a daily basis to improve the communication of health-related information. Never assume that patients truly understand what you are telling them.

REFERENCE: Swearingen CJ, McCollum L, Daltroy LH, et al. Screening for Low Literacy in a Rheumatology Setting: More Than 10% of Patients Cannot Read "Cartilage," "Diagnosis," "Rheumatologist," or "Symptom." JCR: Journal of Clinical Rheumatology. 2010(Dec);16(8):359-364 [abstract here].