title: Inadequate literacy is a barrier to asthma knowledge and self-care.
abstract: OBJECTIVE
  To determine the relationship of literacy to asthma knowledge and ability to use a metered-dose inhaler (MDI) among patients with asthma.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Emergency department and asthma clinic at an urban public hospital.
  
  
  METHODS
  Convenience sample of 273 patients presenting to the emergency department for an asthma exacerbation and 210 patients presenting to a specialized asthma clinic for routine care.
  
  
  METHODS
  Measurement of literacy with the Rapid Estimate of Adult Literacy in Medicine, asthma knowledge (20 question oral test), and demonstration of MDI technique (six-item assessment).
  
  
  RESULTS
  Only 27% of patients read at the high-school level, although two thirds reported being high-school graduates; 33% read at the seventh- to eighth-grade level, 27% at the fourth- to sixth-grade level, and 13% at or below the third-grade level. Mean asthma knowledge scores (+/-SD) were directly related to reading levels: 15.1+/-2.5, 13.9+/-2.5, 13.4+/-2.8, 11.9+/-2.5, respectively (p < 0.01). Patient reading level was the strongest predictor of asthma knowledge score in multivariate analysis. Poor MDI technique (< or =3 correct steps) was found in 89% of patients reading at less than the third-grade level compared with 48% of patients reading at the high-school level. In multivariate regression analyses, reading level was the strongest predictor of MDI technique.
  
  
  CONCLUSIONS
  Inadequate literacy was common and strongly correlated with poorer knowledge of asthma and improper MDI use.
authors.affiliation: Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA.
authors.forename: M V
authors.initials: MV
authors.lastname: Williams
authors.forename: D W
authors.initials: DW
authors.lastname: Baker
authors.forename: E G
authors.initials: EG
authors.lastname: Honig
authors.forename: T M
authors.initials: TM
authors.lastname: Lee
authors.forename: A
authors.initials: A
authors.lastname: Nowlan
mesh_terms: D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy* / Q000523:psychology; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D010865:Pilot Projects; D012189:Retrospective Studies; D012648:Self Care / Q000523:psychology / Q000592:standards; D011795:Surveys and Questionnaires; D014505:Urban Population
chemical_list: D018927:Anti-Asthmatic Agents