Functional Health Literacy in Urban Glaucoma Patients

Abstract

Abstract: : Purpose: Health literacy is the ability to read, comprehend, and execute written medical instructions. Nearly half of all American adults have difficulty understanding and correctly executing health information. Lower health literacy is associated with chronic disease and worse health outcomes. This study seeks to assess the functional health literacy in urban glaucoma patients. Methods: Cross–sectional observational study of 91 English speaking patients treated for glaucoma for at least one year at the Kresge Eye Institute. Health literacy was assessed by the standardized Test of Functional Health Literacy in Adults (TOFHLA). A survey questionnaire assessing patients’ insight into their glaucoma care was performed. Additionally, demographic data was collected from the subject and a retrospective chart review was conducted. Results: Thirty–one participants (34%) had poor functional health literacy (<30 TOFHLA questions correct out of 50) as compared to those with adequate literacy (>30 correct out of 50). Sixty females and thirty–one males participated in the study. There is a significant difference in the participants’ level of education (p=0.0001), income (p=0.008), and type of insurance (p=0.04) between the two literacy groups. The physicians’ qualitative assessment of the participants’ reading level correlated with the measured literacy level (p=0.0001; r =0.85). Seventy–four participants were African–American and 17 were Caucasian. Sixty–four percent of African–Americans had poor health literacy compared with only 13% of Caucasians (p=0.03). The participants with poor health literacy had a higher number of missed appointments per annum (2 visits/yr; p=0.0001). Patients with adequate health literacy felt they had a good understanding of their overall glaucoma care (p<0.003), their glaucoma medications (p=0.0008), treatment of glaucoma (p=0.0004), prevention of its consequences (p=0.0006), and the benefits of lowering eye pressure (p=0.0002) compared to subjects with poor health literacy. Participants with poor health literacy also had worse visual field ( MD: –9.5 ± 10.8) on initial presentation compared with those in the adequate group (MD: –6.2 ± 5.8; p<0.01) . Conclusions: Poor health literacy in urban glaucoma patients correlates with socioeconomic factors, visit compliance, understanding of chronic disease, and worse visual field on presentation. This may have implications for developing educational programs targeting populations with poor functional health literacy.

Keywords: clinical (human) or epidemiologic studies: prevalence/incidence • clinical (human) or epidemiologic studies: health care delivery/economics/manpower