title: Limited health literacy in advanced kidney disease.
abstract: Limited health literacy may reduce the ability of patients with advanced kidney disease to understand their disease and treatment and take part in shared decision making. In dialysis and transplant patients, limited health literacy has been associated with low socioeconomic status, comorbidity, and mortality. Here, we investigated the prevalence and associations of limited health literacy using data from the United Kingdom-wide Access to Transplantation and Transplant Outcome Measures (ATTOM) program. Incident dialysis, incident transplant, and transplant wait-listed patients ages 18 to 75 were recruited from 2011 to 2013 and data were collected from patient questionnaires and case notes. A score >2 in the Single-Item Literacy Screener was used to define limited health literacy. Univariate and multivariate analyses were performed to identify patient factors associated with limited health literacy. We studied 6842 patients, 2621 were incident dialysis, 1959 were wait-listed, and 2262 were incident transplant. Limited health literacy prevalence was 20%, 15%, and 12% in each group, respectively. Limited health literacy was independently associated with low socioeconomic status, poor English fluency, and comorbidity. However, transplant wait-listing, preemptive transplantation, and live-donor transplantation were associated with increasing health literacy.
authors: Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK; Richard Bright Renal Service, North Bristol National Health Service Trust, Bristol, UK. Electronic address: dominic.taylor@nbt.nhs.uk.
authors: Dominic M
authors: DM
authors: Taylor
authors: Department of Surgery, University of Cambridge, and National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, UK.
authors: John A
authors: JA
authors: Bradley
authors: Health Psychology Research Unit, Royal Holloway, University of London, London, UK.
authors: Clare
authors: C
authors: Bradley
authors: Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
authors: Heather
authors: H
authors: Draper
authors: National Health Service Blood and Transplant, UK.
authors: Rachel
authors: R
authors: Johnson
authors: Scottish Renal Registry, UK.
authors: Wendy
authors: W
authors: Metcalfe
authors: Transplant Unit, Royal Infirmary of Edinburgh, UK.
authors: Gabriel
authors: G
authors: Oniscu
authors: National Health Service Blood and Transplant, UK.
authors: Matthew
authors: M
authors: Robb
authors: Department of Renal Medicine, Freeman Hospital, Newcastle-upon Tyne, UK.
authors: Charles
authors: C
authors: Tomson
authors: Department of Surgery, University of Cambridge, and National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, UK.
authors: Chris
authors: C
authors: Watson
authors: Richard Bright Renal Service, North Bristol National Health Service Trust, Bristol, UK.
authors: Rommel
authors: R
authors: Ravanan
authors: Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK.
authors: Paul
authors: P
authors: Roderick
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D057220:Health Literacy / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D006435:Renal Dialysis; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D006113:United Kingdom; D014850:Waiting Lists
keywords: dialysis; health care disparities; health literacy; kidney transplantation; social class