title: Health literacy and anticoagulation-related outcomes among patients taking warfarin.
abstract: BACKGROUND
  Little is known about whether health literacy affects anticoagulation-related outcomes.
  
  
  OBJECTIVE
  To assess how health literacy is associated with warfarin knowledge, adherence, and warfarin control (measured by the international normalized ratio [INR]).
  
  
  METHODS
  Survey.
  
  
  METHODS
  Patients taking warfarin through an anticoagulation clinic.
  
  
  METHODS
  Health literacy was measured using the short-form Test of Functional Health Literacy in Adults (s-TOFHLA), dichotomized as "limited" (score 0 to 22) and "adequate" (score 23 to 36). We asked patients to answer questions relating to their warfarin therapy and used multivariable logistic regression to assess whether health literacy was associated with incorrect answers. We also assessed whether health literacy was associated with nonadherence to warfarin as well as time in therapeutic INR range.
  
  
  RESULTS
  Bilingual research assistants administered the survey and s-TOFHLA to 179 anticoagulated English- or Spanish-speaking patients. Limited health literacy was associated with incorrect answers to questions on warfarin's mechanism (adjusted odds ratio [OR] 4.8 [1.3 to 17.6]), side-effects (OR 6.4 [2.3 to 18.0]), medication interactions (OR 2.5 [1.1 to 5.5]), and frequency of monitoring (OR 2.7 [1.1 to 6.7]), after adjusting for age, sex, race/ethnicity, education, cognitive impairment, and years on warfarin. However, limited health literacy was not significantly associated with missing warfarin doses in 3 months (OR 0.9 [0.4 to 2.0]) nor with the proportion of person-time in therapeutic INR range (OR 1.0 [0.7 to 1.4]).
  
  
  CONCLUSIONS
  Limited health literacy is associated with deficits in warfarin-related knowledge but not with self-reported adherence to warfarin or INR control. Efforts should concentrate on investigating alternative means of educating patients on the management and potential risks of anticoagulation.
authors.affiliation: Division of General Internal Medicine, University of California at San Francisco, San Francisco, CA, USA. mfang@medicine.ucsf.edu
authors.forename: Margaret C
authors.initials: MC
authors.lastname: Fang
authors.forename: Edward L
authors.initials: EL
authors.lastname: Machtinger
authors.forename: Frances
authors.initials: F
authors.lastname: Wang
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin