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Inadequate Literacy Is a Barrier to Asthma Knowledge and Self-Care

  • Mark V. Williams
    Correspondence
    Correspondence to: Mark V. Williams, MD, Department of Medicine, Emory University School of Medicine, 69 Butler Str, SE, Atlanta, GA 30303
    Affiliations
    Department of Medicine, Divisions of General Medicine (Dr. Williams and Mr. Nowlan), Pulmonary Medicine (Dr. Honig), and Allergy and Immunology (Dr. Lee), Emory University School of Medicine, Atlanta, GA, and the Department of Medicine, MetroHealth Medical Center, Department of Epidemiology and Biostatistics (Dr. Baker), Case Western Reserve University, Cleveland, OH
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  • David W. Baker
    Affiliations
    Department of Medicine, Divisions of General Medicine (Dr. Williams and Mr. Nowlan), Pulmonary Medicine (Dr. Honig), and Allergy and Immunology (Dr. Lee), Emory University School of Medicine, Atlanta, GA, and the Department of Medicine, MetroHealth Medical Center, Department of Epidemiology and Biostatistics (Dr. Baker), Case Western Reserve University, Cleveland, OH
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  • Eric G. Honig
    Affiliations
    Department of Medicine, Divisions of General Medicine (Dr. Williams and Mr. Nowlan), Pulmonary Medicine (Dr. Honig), and Allergy and Immunology (Dr. Lee), Emory University School of Medicine, Atlanta, GA, and the Department of Medicine, MetroHealth Medical Center, Department of Epidemiology and Biostatistics (Dr. Baker), Case Western Reserve University, Cleveland, OH
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  • Theodore M. Lee
    Affiliations
    Department of Medicine, Divisions of General Medicine (Dr. Williams and Mr. Nowlan), Pulmonary Medicine (Dr. Honig), and Allergy and Immunology (Dr. Lee), Emory University School of Medicine, Atlanta, GA, and the Department of Medicine, MetroHealth Medical Center, Department of Epidemiology and Biostatistics (Dr. Baker), Case Western Reserve University, Cleveland, OH
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  • Adam Nowlan
    Affiliations
    Department of Medicine, Divisions of General Medicine (Dr. Williams and Mr. Nowlan), Pulmonary Medicine (Dr. Honig), and Allergy and Immunology (Dr. Lee), Emory University School of Medicine, Atlanta, GA, and the Department of Medicine, MetroHealth Medical Center, Department of Epidemiology and Biostatistics (Dr. Baker), Case Western Reserve University, Cleveland, OH
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      Study objectives

      To determine the relationship of literacy to asthma knowledge and ability to use a metered-dose inhaler (MDI) among patients with asthma.

      Design

      Cross-sectional survey.

      Setting

      Emergency department and asthma clinic at an urban public hospital.

      Patients

      Convenience sample of 273 patients presenting to the emergency department for an asthma exacerbation and 210 patients presenting to a specialized asthma clinic for routine care.

      Interventions

      Measurement of literacy with the Rapid Estimate of Adult Literacy in Medicine, asthma knowledge (20 question oral test), and demonstration of MDI technique (six-item assessment).

      Measurements and results

      Only 27% of patients read at the high-school level, although two thirds reported being high-school graduates; 33% read at the seventh- to eighth-grade level, 27% at the fourth- to sixth-grade level, and 13% at or below the third-grade level. Mean asthma knowledge scores (±SD) were directly related to reading levels: 15.1 ± 2.5, 13.9 ± 2.5, 13.4 ± 2.8, 11.9 ± 2.5, respectively (p < 0.01). Patient reading level was the strongest predictor of asthma knowledge score in multivariate analysis. Poor MDI technique (≤3 correct steps) was found in 89% of patients reading at less than the third-grade level compared with 48% of patients reading at the high-school level. In multivariate regression analyses, reading level was the strongest predictor of MDI technique.

      Conclusions

      Inadequate literacy was common and strongly correlated with poorer knowledge of asthma and improper MDI use.
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