Tailored education may reduce health literacy disparities in asthma self-management

Abstract

Rationale: Although inadequate health literacy has been associated with lower asthma medication knowledge and worse metered-dose inhaler (MDI) technique, the relationship between health literacy and the capacity to learn asthma self-management skills is unknown.

Objectives: In this prospective cohort study of adults hospitalized for severe asthma exacerbations at two inner-city hospitals, we examined the relationship between inadequate health literacy and difficulties learning and retaining instructions about discharge medications and appropriate MDI technique.

Methods: At hospital discharge, participants received one-on-one, 30-min, guideline-based, written and oral instruction about their asthma discharge regimen as well as appropriate MDI technique.

Measurements and main results: Seventy-three patients were enrolled. Inadequate health literacy was identified in 16 (22%) participants. Before instruction, inadequate health literacy was associated with lower asthma medication knowledge (5.2/10 vs. 7.2/10, p < 0.001) and worse MDI technique (3.2/6 vs. 3.9/6, p = 0.03). However, inadequate health literacy was not associated with difficulty learning (p = 0.33) or retaining (p = 0.35) instructions about the discharge regimen. Similarly, inadequate health literacy was not associated with difficulty learning (p = 0.26) or retaining (p = 0.97) appropriate MDI technique. Results were similar in multivariable models adjusted for demographic characteristics and asthma severity indicators.

Conclusions: These findings suggest that inadequate health literacy is a surmountable barrier to learning and remembering key asthma self-management skills.

Figures

Figure 1.

Proportion (%) of patients correctly performing each component of metered-dose inhaler (MDI) technique according to literacy level. Inadequate health literacy: white bars =yes; black bars =no. 1: shaking the inhaler (p =0.91); 2: exhaling before actuation (p =0.02); 3: closing lips around mouthpiece (p =0.97); 4: pressing down once (p =0.38); 5: taking a full/deep breath without triggering “whistle” (p =0.19); 6: holding breath > 5 s (p =0.18).

Figure 2.

Better MDI technique score (% with ⩾ 4/6 correctly done) and mastery of discharge medication regimen (% exhibiting 4/4 questions correctly answered for all three medications in the standardized regimen) by literacy category at discharge study visit and at 2 wk. Inadequate health literacy: white bars =yes; black bars =no.