Tailored education may reduce health literacy disparities in asthma self-management

Am J Respir Crit Care Med. 2005 Oct 15;172(8):980-6. doi: 10.1164/rccm.200409-1291OC. Epub 2005 Aug 4.


Rationale: Although inadequate health literacy has been associated with lower asthma medication knowledge and worse metered-dose inhaler (MDI) technique, the relationship between health literacy and the capacity to learn asthma self-management skills is unknown.

Objectives: In this prospective cohort study of adults hospitalized for severe asthma exacerbations at two inner-city hospitals, we examined the relationship between inadequate health literacy and difficulties learning and retaining instructions about discharge medications and appropriate MDI technique.

Methods: At hospital discharge, participants received one-on-one, 30-min, guideline-based, written and oral instruction about their asthma discharge regimen as well as appropriate MDI technique.

Measurements and main results: Seventy-three patients were enrolled. Inadequate health literacy was identified in 16 (22%) participants. Before instruction, inadequate health literacy was associated with lower asthma medication knowledge (5.2/10 vs. 7.2/10, p < 0.001) and worse MDI technique (3.2/6 vs. 3.9/6, p = 0.03). However, inadequate health literacy was not associated with difficulty learning (p = 0.33) or retaining (p = 0.35) instructions about the discharge regimen. Similarly, inadequate health literacy was not associated with difficulty learning (p = 0.26) or retaining (p = 0.97) appropriate MDI technique. Results were similar in multivariable models adjusted for demographic characteristics and asthma severity indicators.

Conclusions: These findings suggest that inadequate health literacy is a surmountable barrier to learning and remembering key asthma self-management skills.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Academic Medical Centers
  • Asthma / prevention & control*
  • Asthma / psychology
  • Baltimore
  • Black or African American / education
  • Educational Measurement
  • Educational Status*
  • Female
  • Health Status
  • Humans
  • Inpatients / education*
  • Inpatients / psychology
  • Logistic Models
  • Male
  • Needs Assessment
  • Patient Care Planning / organization & administration*
  • Patient Compliance / psychology
  • Patient Compliance / statistics & numerical data
  • Patient Discharge
  • Patient Education as Topic / organization & administration*
  • Practice Guidelines as Topic
  • Prospective Studies
  • Self Care* / psychology
  • Self Care* / standards
  • Socioeconomic Factors
  • Surveys and Questionnaires
  • White People / education