Abstract
BackgroundLow health literacy is associated with low adherence to self-management in many chronic diseases. Additionally, health beliefs are thought to be determinants of self-management behaviors. In this study we sought to determine the association, if any, of health literacy and health beliefs among elderly individuals with COPD.MethodsWe enrolled a cohort of patients with COPD from two academic urban settings in New York, NY and Chicago, IL. Health literacy was measured using the Short Test of Functional Health Literacy in Adults. Using the framework of the Self-Regulation Model, illness and medication beliefs were measured with the Brief Illness Perception Questionnaire (B-IPQ) and Beliefs about Medications Questionnaire (BMQ). Unadjusted analyses, with corresponding Cohen’s d effect sizes, and multiple logistic regression were used to assess the relationships between HL and illness and medication beliefs.ResultsWe enrolled 235 participants, 29% of whom had low health literacy. Patients with low health literacy were more likely to belong to a racial minority group (p<0.001), not be married (p = 0.006), and to have lower income (p<0.001) or education (p<0.001). In unadjusted analyses, patients with low health literacy were less likely to believe they will always have COPD (p = 0.003, Cohen’s d = 0.42), and were more likely to be concerned about their illness ((p = 0.04, Cohen’s d = 0.17). In analyses adjusted for sociodemographic factors and other health beliefs, patients with low health literacy were less likely to believe that they will always have COPD (odds ratio [OR]: 0.78, 95% confidence interval [CI]: 0.65–0.94). In addition, the association of low health literacy with expressed concern about medications remained significant (OR: 1.20, 95% CI: 1.05–1.37) though the association of low health literacy with belief in the necessity of medications was no longer significant (OR: 0.92, 95% CI: 0.82–1.04).ConclusionsIn this cohort of urban individuals with COPD, low health literacy was prevalent, and associated with illness beliefs that predict decreased adherence. Our results suggest that targeted strategies to address low health literacy and related illness and medications beliefs might improve COPD medication adherence and other self-management behaviors.
Highlights
Chronic obstructive pulmonary disease (COPD) is a common medical condition associated with substantial morbidity, mortality, and high resource utilization[1,2,3]
Patients with low health literacy were more likely to belong to a racial minority group (p
Patients with low health literacy were less likely to believe they will always have COPD (p = 0.003, Cohen’s d = 0.42), and were more likely to be concerned about their illness ((p = 0.04, Cohen’s d = 0.17)
Summary
Chronic obstructive pulmonary disease (COPD) is a common medical condition associated with substantial morbidity, mortality, and high resource utilization[1,2,3]. Several studies have demonstrated that up to half of patients with COPD do not adhere to medication or perform other important self-management behaviors, such as effective inhaler use [5,6,7,8,9,10,11]. Low health literacy can negatively impact disease outcomes by compromising patient-provider communication about medications, limiting patients’ understanding of the treatment rationale, and interfering with the ability to acquire medications, among others. The pathways underlying the relationship between low health literacy and self-management behaviors have not been clearly established This gap in knowledge constitutes a barrier to designing interventions to address COPD self-management in low-literacy patients. In this study we sought to determine the association, if any, of health literacy and health beliefs among elderly individuals with COPD
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