title: The association of health literacy with adherence and outcomes in moderate-severe asthma.
abstract: BACKGROUND
  Low health literacy is associated with poor outcomes in asthma and other diseases, but the mechanisms governing this relationship are not well defined.
  
  
  OBJECTIVE
  We sought to assess whether literacy is related to subsequent asthma self-management, measured as adherence to inhaled steroids, and asthma outcomes.
  
  
  METHODS
  In a prospective longitudinal cohort study, numeric (Asthma Numeracy Questionnaire) and print literacy (Short Test of Functional Health Literacy in Adults) were assessed at baseline in adults with moderate or severe asthma for their impact on subsequent electronically monitored adherence and asthma outcomes (asthma control, asthma-related quality of life, and FEV1) over 26 weeks, using mixed-effects linear regression models.
  
  
  RESULTS
  A total of 284 adults participated: age, 48 ± 14 years, 71% females, 70% African American, 6% Latino, mean FEV1 66% ± 19%, 86 (30%) with hospitalizations, and 148 (52%) with emergency department visits for asthma in the prior year. Mean Asthma Numeracy Questionnaire score was 2.3 ± 1.2 (range, 0-4); mean Short Test of Functional Health Literacy in Adults score was 31 ± 8 (range, 0-36). In unadjusted analyses, numeric and print literacy were associated with better adherence (P = .01 and P = .08, respectively), asthma control (P = .005 and P < .001, respectively), and quality of life (P < .001 and P < .001, respectively). After controlling for age, sex, and race/ethnicity, the associations diminished and only quality of life (numeric P = .03, print P = .006) and asthma control (print P = .005) remained significantly associated with literacy. Race/ethnicity, income, and educational attainment were correlated (P < .001).
  
  
  CONCLUSIONS
  While the relationship between literacy and health is complex, interventions that account for and address the literacy needs of patients may improve asthma outcomes.
authors.affiliation: Section of Allergy and Immunology, Division of Pulmonary, Allergy, and Critical Care 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: Fei
authors.initials: F
authors.lastname: Wan
authors.forename: Susan
authors.initials: S
authors.lastname: Reisine
authors.forename: Bruce
authors.initials: B
authors.lastname: Bender
authors.forename: Cynthia
authors.initials: C
authors.lastname: Rand
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Bogen
authors.forename: Ian M
authors.initials: IM
authors.lastname: Bennett
authors.forename: Tyra
authors.initials: T
authors.lastname: Bryant-Stephens
authors.forename: Jason
authors.initials: J
authors.lastname: Roy
authors.forename: Rodalyn
authors.initials: R
authors.lastname: Gonzalez
authors.forename: Chantel
authors.initials: C
authors.lastname: Priolo
authors.forename: Thomas Ten
authors.initials: TT
authors.lastname: Have
authors.forename: Knashawn H
authors.initials: KH
authors.lastname: Morales
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000627:therapeutic use; D000328:Adult; D001741:Black or African American; D001249:Asthma / Q000188:drug therapy* / Q000208:ethnology / Q000517:prevention & control*; D015331:Cohort Studies; D005260:Female; D057220:Health Literacy; D006630:Hispanic or Latino; D006760:Hospitalization; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012129:Respiratory Function Tests; D012648:Self Care; D011795:Surveys and Questionnaires
chemical_list: D000305:Adrenal Cortex Hormones
keywords: AE; ANQ; AQOL; Asthma Numeracy Questionnaire; Asthma education; Asthma-related quality of life; ED; Emergency department; Health literacy; ICS; Inhaled corticosteroid; PS; Problem-solving; S-TOFHLA; Short Test of Functional Health Literacy in Adults; adherence; adults; asthma; asthma control; asthma-related quality of life; inhaled corticosteroids; inner-city asthma; numeracy; print literacy