title: Limited health literacy is a common finding in a public health hospital's rheumatology clinic and is predictive of disease severity.
abstract: BACKGROUND
  Health literacy (HL) is associated with outcomes in many conditions, but little is known about its impact on arthritic diseases.
  
  
  OBJECTIVE
  We sought to determine whether HL is related to disease activity and severity in patients with rheumatoid arthritis (RA).
  
  
  METHODS
  English-speaking adult RA patients were recruited for this cross-sectional study. Background information was ascertained by medical record review; Disease Activity Score 28 (DAS-28) scores were determined by providers; subjects completed the Multidimensional Health Assessment Questionnaire (MDHAQ), demographic questionnaires, and validated HL instruments, including the Short Test of Functional Health Literacy in Adults, Rapid Estimate of Adult Literacy in Medicine, and the single-item literacy screener. We used linear regression to assess whether HL was associated with MDHAQ and DAS-28 scores.
  
  
  RESULTS
  One hundred ten subjects participated in the study. Limited HL was a common finding, especially among ethnic minorities. The single-item literacy screener results were predictive of lower MDHAQ scores by univariate regression analysis. Similar trends were observed for the Short Test of Functional Health Literacy in Adults and Rapid Estimate of Adult Literacy in Medicine. The relationship between the single-item literacy screener and MDHAQ remained statistically significant in multivariate analysis that controlled for the impact of demographic features and RA disease characteristics. Health literacy scores were not associated with DAS-28 scores.
  
  
  CONCLUSIONS
  Health literacy was independently associated with functional impairment in English-speaking RA patients at an urban safety-net clinic. This new finding suggests that RA functional status might be improved by strategies that target limited HL's causal pathways.
authors.affiliation: Division of Rheumatology, Department of Medicine, Denver Health Medical Center, Denver, CO 80204, USA. joel.hirshMD@dhha.org
authors.forename: Joel M
authors.initials: JM
authors.lastname: Hirsh
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Boyle
authors.forename: David H
authors.initials: DH
authors.lastname: Collier
authors.forename: Abbey J
authors.initials: AJ
authors.lastname: Oxenfeld
authors.forename: Alyssa
authors.initials: A
authors.lastname: Nash
authors.forename: Itziar
authors.initials: I
authors.lastname: Quinzanos
authors.forename: Liron
authors.initials: L
authors.lastname: Caplan
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000208:ethnology / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D012044:Regression Analysis; D012648:Self Care; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires