title: Linking numeracy and asthma-related quality of life.
abstract: OBJECTIVE
  To examine the correlation of numerical skills used in patients' self-management of asthma with asthma-related quality of life (AQOL).
  
  
  METHODS
  Adults with moderate-severe asthma completed the Asthma Numeracy Questionnaire (ANQ), assessments of reading comprehension and self-efficacy, and the mini-Asthma Quality of Life Questionnaire (miniAQLQ). The numeracy-AQOL relationship was evaluated in the context of potential confounders (demographic variables) and mediators (e.g. income and self-efficacy), using tests of correlation then multivariable models to assess for confounders and mediators.
  
  
  RESULTS
  80 adults with moderate or severe asthma were evaluated. Mean ANQ score was 2.3+/-1.2 (range 0-4). ANQ was correlated with miniAQLQ (rho=0.24, p=0.03). This association was sustained (rho=0.27, p=0.02) when controlling for potential confounders significantly associated with AQOL (age, Latino ethnicity). The ANQ-miniAQLQ association was mediated by household income; the correlation was reduced by 81% when adjusting for income (rho=0.05, p=0.65). In contrast, self-efficacy less strongly mediated this association; the correlation was reduced by 26% when controlled for self-efficacy (rho=0.20, p=0.08).
  
  
  CONCLUSIONS
  Numerical skills needed for asthma self-management influence AQOL primarily through their impact on income and, to a lesser extent, on self-efficacy.
  
  
  CONCLUSIONS
  Adults with asthma will benefit from self-management instructions employing the simplest mathematical constructs whose understanding is confirmed by clinicians.
authors.affiliation: Division of Pulmonary, Allergy, Critical Care Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA. apter@mail.med.upenn.edu
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Apter
authors.forename: Xingmei
authors.initials: X
authors.lastname: Wang
authors.forename: Daniel
authors.initials: D
authors.lastname: Bogen
authors.forename: Ian M
authors.initials: IM
authors.lastname: Bennett
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Jennings
authors.forename: Laura
authors.initials: L
authors.lastname: Garcia
authors.forename: Tamie
authors.initials: T
authors.lastname: Sharpe
authors.forename: Carmen
authors.initials: C
authors.lastname: Frazier
authors.forename: Thomas
authors.initials: T
authors.lastname: Ten Have
mesh_terms: D001249:Asthma; D004522:Educational Status; D005260:Female; D005541:Forced Expiratory Volume; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008433:Mathematics; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D011788:Quality of Life; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D014797:Vital Capacity