title: How well do patients understand written instructions?: health literacy assessment in rural and urban rheumatology outpatients.
abstract: The aim of this study was to assess health literacy (word recognition and comprehension) in patients at a rural rheumatology practice and to compare this to health literacy levels in patients from an urban rheumatology practice.Inclusion criteria for this cross-sectional study were as follows: ≥18-year-old patients at a rural rheumatology practice (Mid-North Coast Arthritis Clinic, Coffs Harbour, Australia) and an urban Sydney rheumatology practice (Combined Rheumatology Practice, Kogarah, Australia). Exclusion criteria were as follows: ill-health precluding participation; poor vision/hearing, non-English primary language. Word recognition was assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM). Comprehension was assessed using the Test of Functional Health Literacy in Adults (TOFHLA). Practical comprehension and numeracy were assessed by asking patients to follow prescribing instructions for 5 common rheumatology medications.At the rural practice (Mid-North Coast Arthritis Clinic), 124/160 patients agreed to participate (F:M 83:41, mean age 60.3 ± 12.2) whereas the corresponding number at the urban practice (Combined Rheumatology Practice) was 99/119 (F:M 69:30, mean age 60.7 ± 17.5). Urban patients were more likely to be born overseas, speak another language at home, and be employed. There was no difference in REALM or TOFHLA scores between the 2 sites, and so data were pooled. REALM scores indicated 15% (33/223) of patients had a reading level ≤Grade 8 whereas 8% (18/223) had marginal or inadequate functional health literacy as assessed by the TOFHLA. Dosing instructions for ibuprofen and methotrexate were incorrectly understood by 32% (72/223) and 21% (46/223) of patients, respectively.Up to 15% of rural and urban patients had low health literacy and <1/3 of patients incorrectly followed dosing instructions for common rheumatology drugs.There was no significant difference in word recognition, functional health literacy, and numeracy between rural and urban rheumatology patients.
authors.affiliation: From the Mid-North Coast Arthritis Clinic (PKKW, DF, HB); Rural Clinical School, University of New South Wales (PKKW, LC, KC); School of Education, Southern Cross University, Coffs Harbour (JJ); School of Health and Human Sciences, Southern Cross University, Coffs Harbour (AB); Combined Rheumatology Practice, Kogarah (FJ, PB); and Department of Rheumatology, Prince of Wales Hospital, Randwick (FJ), New South Wales, Australia.
authors.forename: Peter K K
authors.initials: PKK
authors.lastname: Wong
authors.forename: Laura
authors.initials: L
authors.lastname: Christie
authors.forename: Jenny
authors.initials: J
authors.lastname: Johnston
authors.forename: Alison
authors.initials: A
authors.lastname: Bowling
authors.forename: Diane
authors.initials: D
authors.lastname: Freeman
authors.forename: Fred
authors.initials: F
authors.lastname: Joshua
authors.forename: Paul
authors.initials: P
authors.lastname: Bird
authors.forename: Karen
authors.initials: K
authors.lastname: Chia
authors.forename: Hanish
authors.initials: H
authors.lastname: Bagga
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001315:Australia; D032882:Comprehension; D003430:Cross-Sectional Studies; D005260:Female; D057220:Health Literacy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D012219:Rheumatology; D012424:Rural Population; D012959:Socioeconomic Factors; D014505:Urban Population
chemical_list: D018501:Antirheumatic Agents