New research reports more than 10% of RA patients lack health literacy

Many patients seen at a rheumatology clinic—including some with a long history of rheumatoid arthritis (RA)—don't recognize important terms related to their health and medical treatment, reports a study in the December issue of JCR: Journal of Clinical Rheumatology. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, and pharmacy.

"More than 10 percent of patients who had been living with RA for an average of 11 years could not read the words osteoporosis, inflammatory, rheumatologist, cartilage, and symptom correctly," according to the new research, led by Christopher J. Swearingen, Ph.D., of University of Arkansas for Medical Sciences, Little Rock. The results add to recent evidence identifying low health literacy as a common problem that may contribute to poor health outcomes.

Low Health Literacy Is Frequent, Linked to Worse Outcomes
The study included 194 patients seen at a university Rheumatology clinic. Health literacy was assessed using two word lists: one listing terms related to general health and medicine and the other including words specifically related to rheumatology and arthritis. Health literacy scores were compared with the patients' health and other characteristics.

Many patients had low health literacy, with scores indicating an eighth-grade reading level or less. This included 18 percent of patients on the general health literacy test and 24 percent on the rheumatology-specific word list. None of the patients had severely low literacy, defined as a third-grade reading level or less.

More than ten percent of patients didn't recognize common health terms like diagnose and symptom. Even though most of the patients had been seeing a rheumatologist for some time, 13 percent did not recognize common words related to rheumatology and arthritis, such as cartilage and anti-inflammatory.

Eleven percent of patients didn't recognize the word rheumatologist. Even higher percentages didn't recognize the names of common arthritis drugs, such as methotrexate or Naprosyn.

Patients with lower health literacy scores tended to have lower education and to be in worse health. Scores on the two word lists were closely related to each other, suggesting that general health literacy was a good indicator of rheumatology-specific health literacy.

The results are consistent with previous studies reporting that 14 percent of U.S. adults have "below basic literacy skills." Low literacy is strongly related to low education—which in turn is associated with increased rates of RA and other rheumatic diseases.

"Low literacy may be a mutable risk factor for poor health and outcomes in rheumatic and other chronic diseases," the researchers write. They think it's likely their study underestimates the true extent of the relationship between low literacy and poor health.

What can doctors' offices do to help address the problem of low health literacy? Following the U.S. Department of Health and Human Services' National Action Plan to Improve Health Literacy may help patients to develop self-management skills and enhance their ability to access and use health information, Dr. Swearingen and co-authors believe. They conclude, "Reduction of literacy-related barriers may help to narrow widening disparities in health according to socioeconomic status."