Person:

Rudd, Rima

Objectives

To examine the relationship between literacy and asthma management with a focus on the oral exchange.

Methods

Study participants, all of whom reported asthma, were drawn from the New England Family Study (NEFS), an examination of links between education and health. NEFS data included reading, oral (speaking), and aural (listening) literacy measures. An additional survey was conducted with this group of study participants related to asthma issues, particularly asthma management. Data analysis focused on bivariate and multivariable logistic regression.

Results

In bivariate logistic regression models exploring aural literacy, there was a statistically significant association between those participants with lower aural literacy skills and less successful asthma management (OR:4.37, 95%CI:1.11, 17.32). In multivariable logistic regression analyses, controlling for gender, income, and race in separate models (one-at-a-time), there remained a statistically significant association between those participants with lower aural literacy skills and less successful asthma management.

Conclusion

Lower aural literacy skills seem to complicate asthma management capabilities.

Practice Implications

Greater attention to the oral exchange, in particular the listening skills highlighted by aural literacy, as well as other related literacy skills may help us develop strategies for clear communication related to asthma management.

Attention to the effect of a patient's literacy skills on health care interactions is relatively new. So too are studies of either structural or personal factors that inhibit or support a patient's ability to navigate health services and systems and to advocate for their own needs within a service delivery system. Contributions of the structural environment, of interpersonal dynamics, and of a variety of psychological and sociological factors in the relationship between patients and providers have long been under study. Less frequently examined is the advocacy role expected of patients. However, the complex nature of health care in the U.S. increasingly requires a proactive stance.

This study examined whether four literacy skills (reading, numeracy, speaking, and listening) were associated with patient self-advocacy, a component of health literacy itself, when faced with a hypothetical barrier to scheduling a medical appointment. While all literacy skills were significantly associated with advocacy when examined in isolation, greater speaking and listening skills remained significantly associated with better patient advocacy when all four skills were examined simultaneously. These findings suggest that speaking and listening skills and support for such skills may be important factors to consider when developing patient activation and advocacy skills.

Background

Research has demonstrated associations between smoking and reading skills, but other literacy skills such as speaking, listening and numeracy are less studied despite our dependence on the use of numbers and the oral exchange to deliver information on the risks of smoking.

Methods

We used multivariable logistic regression to examine the effects of reading, numeracy, speaking and listening skills on 1) becoming a regular smoker and 2) smoking cessation. Further, multivariable linear regression was used to examine the relation between literacy skills and amount smoked among current smokers. Models controlled for education, gender, age, race/ethnicity, income, and, when relevant, age they became a regular smoker.

Results

For each grade equivalent increase in reading skills, the odds of quitting smoking increased by about 8% (OR=1.08, 95%CI: 1.01–1.15). For every point increase in numeracy skills, the odds of quitting increased by about 24% (OR=1.24, 95%CI: 1.06 – 1.46). No literacy skills were associated with becoming a regular smoker or current amount smoked.

Conclusion

The ability to locate, understand and use information related to the risks of smoking may impact one’s decision to quit. Messaging should be designed with the goal of being easily understood by all individuals regardless of literacy level.

OBJECTIVE

Education is inversely associated with coronary heart disease (CHD) risk, however the mechanisms are poorly understood. The study objectives were to evaluate the extent to which rarely measured factors (literacy, time preference, sense of control) and more commonly measured factors (income, depressive symptomatology, body mass index) in the education-CHD literature explain the associations between education and CHD risk.

METHOD

The study sample included 346 participants, aged 38–47 years (59.5% women), of the New England Family Study birth cohort. Ten-year CHD risk was calculated using the validated Framingham risk algorithm that utilizes diabetes, smoking, blood pressure, total cholesterol, HDL cholesterol, age and gender. Multivariable regression and mediation analyses were performed.

RESULTS

Regression analyses adjusting for age, race/ethnicity and childhood confounders (e.g. parental socioeconomic status, intelligence) demonstrated that relative to those with ≥college education, men and women with <high school had 73.7% (95% confidence interval (CI): 29.5, 133.0) and 48.2% (95% CI: 17.5, 86.8) higher 10-year CHD risk, respectively. Mediation analyses demonstrated significant indirect effects for reading comprehension in women (7.2%; 95% CI: 0.7, 19.4) and men (7.2%; 95% CI: 0.8, 19.1), and depressive symptoms (11.8%; 95% CI: 2.5, 26.6) and perceived constraint (6.7%, 95% CI: 0.7, 19.1) in women.

CONCLUSIONS

Evidence suggested that reading comprehension in women and men, and depressive symptoms and perceived constraint in women, may mediate some of the association between education and CHD risk. If these mediated effects are interpreted causally, interventions targeting reading, depressive symptoms, and perceived constraint could reduce educational inequalities in CHD.