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HSS Journal ®
Published in: HSS Journal ® 1/2013

01-02-2013 | Original Article

The Relationship Among Health Literacy, Health Knowledge, and Adherence to Treatment in Patients with Rheumatoid Arthritis

Authors: Patricia Quinlan, DNSc, MPA, Kwanza O. Price, MPH, Steven K. Magid, MD, Stephen Lyman, PhD, Lisa A. Mandl, MD, MPH, Patricia W. Stone, PhD, MPH

Published in: HSS Journal ® | Issue 1/2013

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Abstract

Background

Patients with poor health literacy often lack the knowledge needed to manage their treatment.

Objective

The aim of this cross-sectional study is to determine whether health literacy is a predictor of health knowledge and/or adherence to medication treatment in patients with rheumatoid arthritis.

Method

The study was completed in an urban, outpatient rheumatology setting. Health literacy was measured using the Test of Functional Health Literacy in Adults. The Arthritis Knowledge Questionnaire was modified to measure medication specific health knowledge, and the Morisky Medication Adherence scale was used to measure adherence. Researchers used regression analyses to determine if health literacy was a predicator of knowledge and/or adherence.

Results

Participants (N = 125) had high mean health literacy scores. The average medication knowledge score was 0.73. Adherence to medication regimen was 0.84. Controlling for patient covariates, health literacy was positively associated with education, race, and age. In adjusted analyses, health literacy was a significant predictor of health knowledge but not adherence. Race, neighborhood income, and confidence with contacting provider about medications were predictors of adherence.

Conclusion

Study findings indicate that health literacy is independently associated with medication knowledge but not medication adherence in patients with rheumatoid arthritis. These results provide useful information for planning initiatives to support individuals with disease self-management.
Appendix
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Literature
1.
Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association. Health literacy report of the council of scientific affairs. 1999;281(6):552–557.
2.
Agency for Healthcare Research and Quality, Research Triangle Institute-University of North Carolina Evidence-based Practice Center. Literacy and health outcomes. Vol E007-2. Rockville, MD: The Agency; 2004:104.
3.
Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: An updated systematic review. Ann Intern Med. 2011;155(2):97–107.PubMed
4.
Brady TJ. Do common arthritis self-efficacy measures really measure self-efficacy? Arthritis Care and Research: The Official Journal of the Arthritis Health Professions Association. 1997; 10(1):1–8.
5.
Briggs SR, Cheek JM. The role of factor analysis in the development and evaluation of personality scales. J Personality Journal of Personality. 1986; 54(1):106–148.CrossRef
6.
Buchbinder R, Hall S, Youd JM. Functional health literacy of patients with rheumatoid arthritis attending a community-based rheumatology practice. J Rheumatol. 2006; 33(5):879–886.PubMed
7.
Burge S, White D, Bajorek E, et al. Correlates of medication knowledge and adherence: Findings from the residency research network of south texas. Fam Med. 2005; 37(10):712–718.PubMed
8.
9.
Davis TC, Wolf MS, Bass PF, 3rd, et al. Low literacy impairs comprehension of prescription drug warning labels. J Gen Intern Med. 2006; 21(8):847–851.PubMedCrossRef
10.
Dewalt DA, Berkman ND, Sheridan S, Lohr KN, Pignone MP. Literacy and health outcomes: A systematic review of the literature. J Gen Intern Med. 2004;19(12):1228–1239.PubMedCrossRef
11.
DiMatteo MR. Variations in patients' adherence to medical recommendations: A quantitative review of 50 years of research. Med Care. 2004; 42(3):200–209.PubMedCrossRef
12.
Edworthy SM, Devins GM, Watson MM. The arthritis knowledge questionnaire. A test for measuring patient knowledge of arthritis and its self-management. Arthritis Rheum. 1995; 38(5):590–600.PubMedCrossRef
13.
Elliot RA. Poor adherence to medication in adults with rheumatoid arthritis. Disease Management Health Outcomes. 2008; 16(1):13–29.CrossRef
14.
Federman AD, Wisnivesky JP, Wolf MS, Leventhal H, Halm EA. Inadequate health literacy is associated with suboptimal health beliefs in older asthmatics. J Asthma. 2010; 47(6):620–626.PubMedCrossRef
15.
Feinberg J. The effect of patient-practitioner interaction on compliance: A review of the literature and application in rheumatoid arthritis. Patient Educ Couns. 1988; 11(3):171–187.PubMedCrossRef
16.
17.
Gazmararian J, Jacobson KL, Pan Y, Schmotzer B, Kripalani S. Effect of a pharmacy-based health literacy intervention and patient characteristics on medication refill adherence in an urban health system. Ann Pharmacother. 2010; 44(1):80–87.PubMedCrossRef
18.
Gazmararian JA, Kripalani S, Miller MJ, Echt KV, Ren J, Rask K. Factors associated with medication refill adherence in cardiovascular-related diseases: A focus on health literacy. J Gen Intern Med. 2006; 21(12):1215–1221.PubMedCrossRef
19.
Gellad WF, Grenard JL, Marcum ZA. A systematic review of barriers to medication adherence in the elderly: Looking beyond cost and regimen complexity. Am J Geriatr Pharmacother. 2011; 9(1):11–23.PubMedCrossRef
20.
Gerber BS, Cho YI, Arozullah AM, Lee SY. Racial differences in medication adherence: A cross-sectional study of medicare enrollees. Am J Geriatr Pharmacother. 2010; 8(2):136–145.PubMedCrossRef
21.
Gordon MM, Hampson R, Capell HA, Madhok R. Illiteracy in rheumatoid arthritis patients as determined by the rapid estimate of adult literacy in medicine (REALM) score. Rheumatology (Oxford). 2002; 41(7):750–754.CrossRef
22.
Harrold LR, Andrade SE. Medication adherence of patients with selected rheumatic conditions: A systematic review of the literature. Semin Arthritis Rheum. 2009; 38(5):396–402.PubMedCrossRef
23.
Helmick CG, Felson DT, Lawrence RC, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. part I. Arthritis Rheum. 2008; 58(1):15–25.PubMedCrossRef
24.
Hirsh JM, Boyle DJ, Collier DH, et al. Limited health literacy is a common finding in a public health hospital's rheumatology clinic and is predictive of disease severity. J Clin Rheumatol. 2011; 17(5):236–241.PubMedCrossRef
25.
Howard DH, Sentell T, Gazmararian JA. Impact of health literacy on socioeconomic and racial differences in health in an elderly population. J Gen Intern Med. 2006; 21(8):857–861.PubMedCrossRef
26.
Hu A, Chow CM, Dao D, Errett L, Keith M. Factors influencing patient knowledge of warfarin therapy after mechanical heart valve replacement. J Cardiovasc Nurs. 2006; 21(3):169–75; quiz 176-7.PubMed
27.
28.
Iren UT, Walker MS, Hochman E, Brasington R. A pilot study to determine whether disability and disease activity are different in african-american and caucasian patients with rheumatoid arthritis in st. louis, missouri, USA. J Rheumatol. 2005; 32(4):602–608.PubMed
29.
Kalichman SC, Rompa D. Functional health literacy is associated with health status and health-related knowledge in people living with HIV-AIDS. J Acquir Immune Defic Syndr. 2000; 25(4):337–344.PubMedCrossRef
30.
Kjeken I, Dagfinrud H, Mowinckel P, Uhlig T, Kvien TK, Finset A. Rheumatology care: Involvement in medical decisions, received information, satisfaction with care, and unmet health care needs in patients with rheumatoid arthritis and ankylosing spondylitis. Arthritis Rheum. 2006; 55(3):394–401.PubMedCrossRef
31.
Kripalani S, Gatti ME, Jacobson TA. Association of age, health literacy, and medication management strategies with cardiovascular medication adherence. Patient Educ Couns. 2010; 81(2):177–181.PubMedCrossRef
32.
Larson I, Schumacher HR. Comparison of literacy level of patients in a VA arthritis center with the reading level required by educational materials. Arthritis Care Res. 1992; 5(1):13–16.PubMedCrossRef
33.
Lorig K, Fries JF. The arthritis helpbook: A tested self-management program for coping with your arthritis. Reading, Mass.: Addison-Wesley; 1990.
34.
Lorig K, Fries JF. The arthritis helpbook : A tested self-management program for coping with arthritis and fibromyalgia. Cambridge, Mass.; London: Da Capo Lifelong; Perseus Running, distributor]; 2006.
35.
Lorig K, Ritter, P. & Plant K. A disease specific self-help program compared with a generalized chronic disease self-help program for arthritis patients. Arthritis Care and Research: The Official Journal of the Arthritis Health Professions Association. 2005; 53(16):950–957.
36.
Lorish CD, Richards B, Brown S. Missed medication doses in rheumatic arthritis patients: Intentional and unintentional reasons. Arthritis Care Res. 1989;2(1):3–9.PubMedCrossRef
37.
Louis-Simonet M, Kossovsky MP, Sarasin FP, et al. Effects of a structured patient-centered discharge interview on patients' knowledge about their medications. Am J Med. 2004; 117(8):563–568.PubMedCrossRef
38.
Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986; 24(1):67–74.PubMedCrossRef
39.
Murphy DA, Lam P, Naar-King S, et al. Health literacy and antiretroviral adherence among HIV-infected adolescents. Patient Educ Couns. 2010; 79(1):25–29.PubMedCrossRef
40.
Nielsen-Bohlman L, Panzer AM, Kindig DA, Institute of Medicine (U.S.). Committee on Health Literacy. Health literacy: A prescription to end confusion. Washington, D.C.: National Academies Press; 2004.
41.
Nunally JC, ed. Psychometric theory. McGraw Hill;1994.
42.
Nurss JR, Parker RM, Baker DW. TOFHLA: Test of functional health literacy. Snow Camp, North Carolina: Peppercorn Books and Press; 1995.
43.
Osborn CY, Cavanaugh K, Wallston KA, et al. Health literacy explains racial disparities in diabetes medication adherence. J Health Commun. 2011; 16 Suppl 3:268–278.PubMedCrossRef
44.
Paasche-Orlow MK, Cheng DM, Palepu A, Meli S, Faber V, Samet JH. Health literacy, antiretroviral adherence, and HIV-RNA suppression: A longitudinal perspective. J Gen Intern Med. 2006; 21(8):835–840.PubMedCrossRef
45.
Paasche-Orlow MK, Parker RM, Gazmararian JA, Nielsen-Bohlman LT, Rudd RR. The prevalence of limited health literacy. J Gen Intern Med. 2005;20(2):175–184.PubMedCrossRef
46.
Paasche-Orlow MK, Riekert KA, Bilderback A, et al. Tailored education may reduce health literacy disparities in asthma self-management. Am J Respir Crit Care Med. 2005; 172(8):980–986.PubMedCrossRef
47.
Piette JD, Heisler M, Horne R, Caleb Alexander G. A conceptually based approach to understanding chronically ill patients' responses to medication cost pressures. Soc Sci Med. 2006; 62(4):846–857.PubMedCrossRef
48.
Pincus T, Sokka T, Swearingen T, Daltroy, L. and Davis, T. Analysis of a rapid estimate of adult literacy in medicine (REALM) and education level in rheumatoid arthritis. Arthritis and Rheumatism. 2000 (S109).
49.
Rindfleisch JA, Muller D. Diagnosis and management of rheumatoid arthritis. Am Fam Physician. 2005; 72(6):1037–1047.PubMed
50.
Ryan R, Santesso N, Lowe D, Kaufman, C. & Grimshaw, J. Consumer-oriented interventions for evidence-based prescribing and medicine use: An overview of systematic reviews. The Cochrane Collaboration. 2011(11):1–66.
51.
Salt E, Frazier SK. Adherence to disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: A narrative review of the literature. Orthop Nurs. 2010; 29(4):260–275.PubMedCrossRef
52.
Schillinger D, Grumbach K, Piette J, et al. Association of health literacy with diabetes outcomes. JAMA. 2002; 288(4):475–482.PubMedCrossRef
53.
Swearingen CJ, McCollum L, Daltroy LH, Pincus T, Dewalt DA, Davis TC. Screening for low literacy in a rheumatology setting: More than 10% of patients cannot read "cartilage," "diagnosis," "rheumatologist," or "symptom". J Clin Rheumatol. 2010; 16(8):359–364.PubMed
54.
Treharne, GJ, Lyons, AC, Kitas, GD. Medication adherence in rheumatoid arthritis effects of psychosocial factors. Psychology, Health and Medicine. 2004; 9(3):337–39.CrossRef
55.
Viller F, Guillemin F, Briancon S, Moum T, Suurmeijer T, van den Heuvel W. Compliance to drug treatment of patients with rheumatoid arthritis: A 3 year longitudinal study. J Rheumatol. 1999; 26(10):2114–2122.PubMed
56.
Walker, D., Adebajo, A., Heslop, P., Hill, J., Firth, J., Bishop, P. et al. Patient education in rheumatoid arthritis: The effectiveness of the ARC booklet and the mind map. Rheumatology (Oxford). 2007; 46(10):1593–1596.CrossRef
57.
Williams MV, Baker DW, Honig EG, Lee TM, Nowlan A. Inadequate literacy is a barrier to asthma knowledge and self-care. Chest. 1998; 114(4):1008–1015.PubMedCrossRef
58.
Williams MV, Baker DW, Parker RM, Nurss JR. Relationship of functional health literacy to patients' knowledge of their chronic disease. A study of patients with hypertension and diabetes. Arch Intern Med. 1998; 158 (2):166–172.PubMedCrossRef
Metadata
Title
The Relationship Among Health Literacy, Health Knowledge, and Adherence to Treatment in Patients with Rheumatoid Arthritis
Authors
Patricia Quinlan, DNSc, MPA
Kwanza O. Price, MPH
Steven K. Magid, MD
Stephen Lyman, PhD
Lisa A. Mandl, MD, MPH
Patricia W. Stone, PhD, MPH
Publication date
01-02-2013
Publisher
Springer-Verlag
Published in
HSS Journal ® / Issue 1/2013
Print ISSN: 1556-3316
Electronic ISSN: 1556-3324
DOI
https://doi.org/10.1007/s11420-012-9308-6

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