Abstract
BackgroundLimited literacy is common among patients with chronic conditions and is associated with poor health outcomes. We sought to determine the association between literacy and blood pressure in primary care patients with hypertension and to determine if this relationship was consistent across distinct systems of healthcare delivery.MethodsWe conducted a cross-sectional study of 1224 patients with hypertension utilizing baseline data from two separate, but similar randomized controlled trials. Patients were enrolled from primary care clinics in the Veterans Affairs healthcare system (VAHS) and a university healthcare system (UHS) in Durham, North Carolina. We compared the association between literacy and the primary outcome systolic blood pressure (SBP) and secondary outcomes of diastolic blood pressure (DBP) and blood pressure (BP) control across the two different healthcare systems.ResultsPatients who read below a 9th grade level comprised 38.4% of patients in the VAHS and 27.5% of the patients in the UHS. There was a significant interaction between literacy and healthcare system for SBP. In adjusted analyses, SBP for patients with limited literacy was 1.2 mmHg lower than patients with adequate literacy in the VAHS (95% CI, -4.8 to 2.3), but 6.1 mmHg higher than patients with adequate literacy in the UHS (95% CI, 2.1 to 10.1); (p = 0.003 for test of interaction). This literacy by healthcare system interaction was not statistically significant for DBP or BP control.ConclusionThe relationship between patient literacy and systolic blood pressure varied significantly across different models of healthcare delivery. The attributes of the healthcare delivery system may influence the relationship between literacy and health outcomes.
Highlights
Limited literacy is common among patients with chronic conditions and is associated with poor health outcomes
We examined the relationship between literacy and blood pressure (BP) in primary care patients with hypertension
Limited literacy (REALM score indicating below 9th grade reading level) was present in 38.4% of the Veterans Affairs healthcare system (VAHS) sample (n = 226 patients) and 27.6% (n = 175 patients) of the university healthcare system (UHS) sample
Summary
Limited literacy is common among patients with chronic conditions and is associated with poor health outcomes. We sought to determine the association between literacy and blood pressure in primary care patients with hypertension and to determine if this relationship was consistent across distinct systems of healthcare delivery. Prior research has supported the association between literacy and disease knowledge, utilization of preventative services, hospitalization, overall health status, chronic disease control, and mortality in elderly adults [6,7,8]. Williams et al found that patients with hypertension and limited literacy at two public hospitals were significantly less knowledgeable about their hypertension care than patients with adequate literacy and had a 6 mmHg higher SBP; this blood pressure difference was not statistically significant [16]. Rothman et al reported that literacy was an important predictor of improved glycemic control for diabetic patients enrolled in a disease management trial; there were no significant differences between low and higher literacy patients in SBP either at baseline or at the conclusion of the trial. [17]
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