title: A health care navigation tool assesses asthma self-management and health literacy.
abstract: Self-management of moderate-to-severe asthma depends on the patient's ability to (1) navigate (access health care to obtain diagnoses and treatment), (2) use inhaled corticosteroids (ICSs) properly, and (3) understand ICS function.
  
  
  
  We sought to test whether navigation skills (medication recall, knowledge of copay requirements, and ability to provide information needed for a medical visit about a persistent cough unresponsive to medication) are related to other self-management skills and health literacy.
  
  
  
  A 21-item Navigating Ability (NAV2) questionnaire was developed, validated, and then read to adults with moderate-to-severe asthma. ICS technique was evaluated by using scales derived from instructions in national guidelines; knowledge of ICS function was evaluated by using a validated 10-item questionnaire. Spearman correlation was computed between NAV2 score and these questionnaires and with numeracy (Asthma Numeracy Questionnaire) and print literacy (Short Test of Functional Health Literacy in Adults).
  
  
  
  Two hundred fifty adults participated: age, 51 ± 13 years; 72% female; 65% African American; 10% Latino; 50% with household income of less than $30,000/y; 47% with no more than a 12th-grade education; and 29% experienced hospitalizations for asthma in the prior year. A higher NAV2 score was associated with correct ICS technique (ρ = 0.24, P = .0002), knowledge of ICSs (ρ = 0.35, P < .001), better print literacy (ρ = 0.44, P < .001), and numeracy (ρ = 0.41, P < .001).
  
  
  
  Patients with poor navigational ability are likely to have poor inhaler technique and limited understanding of ICS function, as well as limited numeracy and print literacy. Clinicians should consider these elements of self-management for their effect on asthma care and as a marker of more general health literacy deficits.
authors.affiliation: Division of Pulmonary Allergy Critical Care Medicine, University of Pennsylvania, Philadelphia, Pa; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Luzmercy
authors.initials: L
authors.lastname: Perez
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Knashawn H
authors.initials: KH
authors.lastname: Morales
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Heather
authors.initials: H
authors.lastname: Klusaritz
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Han
authors.affiliation: Division of Pulmonary Allergy Critical Care Medicine, University of Pennsylvania, Philadelphia, Pa; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Jingru
authors.initials: J
authors.lastname: Huang
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Division of General Internal Medicine, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Marisa
authors.initials: M
authors.lastname: Rogers
authors.affiliation: Departments of Family Medicine & Psychiatry and Behavioral Sciences, University of Washington, Seattle, Wash.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Bennett
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Md.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Rand
authors.affiliation: Division of Pulmonary Allergy Critical Care Medicine, University of Pennsylvania, Philadelphia, Pa; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Grace
authors.initials: G
authors.lastname: Ndicu
authors.affiliation: Division of Pulmonary Allergy Critical Care Medicine, University of Pennsylvania, Philadelphia, Pa; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa. Electronic address: apter@mail.med.upenn.edu.
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Apter
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D001249:Asthma / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D057220:Health Literacy; D006297:Health Services Accessibility; D006801:Humans; D000067010:Literacy; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D062526:Patient Navigation; D012648:Self Care; D011795:Surveys and Questionnaires / Q000706:statistics & numerical data*; D014481:United States
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Adults; asthma; health disparities; health literacy; inhaled corticosteroids; minority groups; numeracy; print literacy; self-management