title: Tailored education may reduce health literacy disparities in asthma self-management.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA. mpo@bu.edu
authors.forename: Michael K
authors.initials: MK
authors.lastname: Paasche-Orlow
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Riekert
authors.forename: Andrew
authors.initials: A
authors.lastname: Bilderback
authors.forename: Arjun
authors.initials: A
authors.lastname: Chanmugam
authors.forename: Peter
authors.initials: P
authors.lastname: Hill
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Rand
authors.forename: Fred L
authors.initials: FL
authors.lastname: Brancati
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Krishnan
mesh_terms: D000046:Academic Medical Centers; D001741:Black or African American / Q000193:education; D001249:Asthma / Q000517:prevention & control* / Q000523:psychology; D015142:Baltimore; D004521:Educational Measurement; D004522:Educational Status; D005260:Female; D006304:Health Status; D006801:Humans; D007297:Inpatients / Q000193:education* / Q000523:psychology; D016015:Logistic Models; D008297:Male; D020380:Needs Assessment; D010347:Patient Care Planning / Q000458:organization & administration*; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data; D010351:Patient Discharge; D010353:Patient Education as Topic / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012648:Self Care / Q000523:psychology / Q000592:standards; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D044465:White People / Q000193:education