Abstract
Objectives: To describe health literacy, patient activation, and functional capacity in individuals with rheumatoid arthritis and to evaluate the associations of health literacy and activation level with functional capacity. Methods: A cross-sectional study involving patients with rheumatoid arthritis was carried out at the rheumatology service of a teaching hospital. Health literacy was assessed by applying the short version of the Test of Functional Health Literacy in Adults. Patient Activation was measured by using the summarized version of the Patient Activation Measure. The Health Assessment Questionnaire was applied to evaluate functional capacity. Sociodemographic and clinical variables were also collected to carried out univariate and multivariate analyses by using logistic regression. Results: The sample was composed of 179 patients, of whom 90.5% (n = 162) were women. The participants’ average age was 58.3 ± 11.4 years. The prevalence of patients with inadequate or marginal health literacy was high (67%). In contrast, 74% of the patients showed high activation levels. The average score on the Health Assessment Questionnaire was 1.08 ± 0.7. Adequate health literacy was negatively associated with higher Health Assessment Questionnaire scores (OR = 0.42; 95% CI 0.20 – 0.86; p = 0.018), and high activation levels were negatively associated with moderate to severe functional limitation (level 3/moderate activation level – OR = 0.24; 95% CI 0.10 – 0.56; p = 0.001; level 4/high activation level – OR = 0.22; 95% CI 0.08 – 0.50; p = 0.000). Conclusion: Health professionals must be aware of health literacy and activation levels of patients with rheumatoid arthritis, given that interventions to improve them represent an opportunity to increase functional capacity.
Highlights
Rheumatoid Arthritis (RA) is a chronic, inflammatory, and autoimmune disease that affects mainly joints [1]
Health professionals must be aware of health literacy and activation levels of patients with rheumatoid arthritis, given that interventions to improve them represent an opportunity to increase functional capacity
The present study directly addresses two of these factors: health literacy and active participation in care for patients with RA
Summary
Rheumatoid Arthritis (RA) is a chronic, inflammatory, and autoimmune disease that affects mainly joints [1]. Shared decision-making has been seen as an essential component in the treat-to-target strategy [3, 7], an approach based on strict monitoring of the disease’s activity and the promotion of changes in treatment if therapeutic goals are not reached by the established time [3, 5, 8]. This strategy has contributed to more patients with RA reaching and maintaining remission over the years [9]. Many factors can influence shared decision-making, such as communication and the therapeutic relationship established between patients and health professionals, lack of knowledge and training about shared decision-making, the nature of decisions, disease type, patients’ health literacy levels, and patients’ motivation to have control over their health [10 - 13]. Health literacy and patient activation are closely related concepts that can be improved by the healthcare team and have been shown to influence shared decision-making and, functional capacity [11, 16 - 18]
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