September 2016
Volume 57, Issue 12
ARVO Annual Meeting Abstract  |   September 2016
Racial discrepancies in health literacy and adherence in glaucoma patients
Author Affiliations & Notes
  • Stella Y Chung
    Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Albert S Khouri
    Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Footnotes
    Commercial Relationships   Stella Chung, None; Albert Khouri, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 1557. doi:
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      Stella Y Chung, Albert S Khouri; Racial discrepancies in health literacy and adherence in glaucoma patients. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1557. doi:

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose :
Glaucoma is a chronic progressive disease that requires adherence with treatment to prevent progression. Patient and system level factors that hinder medication adherence include advanced age, low self-efficacy and lack of health literacy. We performed a prospective cross-sectional clinical study to determine the relationship between adherence and glaucoma knowledge in a diverse patient population with glaucoma.

Methods :
Patient knowledge of glaucoma, self-reported adherence rate, and health literacy were measured in 40 patients using the National Eye Health Education Program (NEHEP) quiz, Morisky Medication Adherence Scales (MMAS-4), and Short Assessment of Health Literacy (SAHL-E/S), respectively. NEHEP quiz covers eye pressure, diagnosis and screening, vision loss, clinical course, risk factors, and symptoms. Eligibility criteria included confirmed diagnosis of glaucoma in patients on treatment. Statistical analysis was performed using logistic regression and Kruskal-Wallis tests.

Results :
Forty patients consisted of 20 African-Americans (50%), 16 Hispanics (40%), and 4 others (10%). Poor adherence with treatment was reported in 21 out of 40 (52.5%) patients with no significant difference among racial groups (p>0.05). There was a significant difference in the percentage of correctly answered NEHEP quiz questions between African-American and Hispanic groups (57.0% vs. 44.4%, p<0.05). Factors significantly associated with poor adherence rate included incorrectly answering more than 30% of questions about glaucoma and its treatment in the African-American group (OR, 14.00; 95% CI, 1.252-156.617; p<0.05). No such correlation was observed in the Hispanic group (OR, 0.429; 95% CI, 0.031-5.985; p=0.529).

Conclusions :
Inadequate literacy may be a barrier in patient adherence to glaucoma treatment. Furthermore, our pilot study showed that there were racial disparities in glaucoma literacy. Adherence to treatment was positively correlated with glaucoma knowledge in black population. Further studies are needed to examine those racial discrepancies and methods to improve adherence rate adjusted to variables including race, health literacy, and comprehension of the disease.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.


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