Inadequate literacy is a barrier to asthma knowledge and self-care

Chest. 1998 Oct;114(4):1008-15. doi: 10.1378/chest.114.4.1008.


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 (< or =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.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Anti-Asthmatic Agents / therapeutic use
  • Asthma / drug therapy*
  • Asthma / psychology
  • Cross-Sectional Studies
  • Educational Status*
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Male
  • Middle Aged
  • Nebulizers and Vaporizers
  • Pilot Projects
  • Retrospective Studies
  • Self Care* / psychology
  • Self Care* / standards
  • Surveys and Questionnaires
  • Urban Population


  • Anti-Asthmatic Agents