Adolescents with IBD making the transition to adult-oriented care may be less prepared in terms of health literacy than clinicians estimate, according to study results.
Researchers evaluated 74 pediatric patients with IBD aged 10 years or older treated at a tertiary care center in San Diego. Their functional literacy and interactive health literacy were determined, along with clinicians’ perceptions of the patients’ literacy and their preparedness for transition to adult care. Functional literacy was measured according to the Test of Functional Health Literacy in Adults (TOFHLA), and interactive literacy was measured using surveys on IBD knowledge, a self-efficacy scale indicating ability to self-manage the condition and the patients’ knowledge of their medical history.
Most participants (78%) had sufficient functional literacy (74%) and knowledge of their own medical histories to answer standard questionnaires administered at initial adult medical visits. Investigators found, however, that interactive literacy was less common (11% of participants), and that fewer patients were knowledgeable about IBD (16%) or self-management of illness (47%).
Eleven percent of participants were considered at literacy-related readiness for transition from adolescent to adult care, while clinicians indicated 47% of patients were ready for transition based on literacy standards. Investigators associated older age (P=.007), white race (18% white vs. 3% nonwhite, P=.03) and use of low-income insurance (25% low-income vs. 6% other health plans, P<.02) with readiness. Clinician determination for readiness was associated with gender (P=.10), socioeconomic status (P=.06) and duration of illness (P=.10), but these trends were not found statistically significant. Agreement between clinicians’ determinations and readiness as determined by the study was poor (P=.18).
“Clinicians are not able to adequately assess patient health literacy needs during the process of transition,” the researchers concluded. “Improved awareness of health literacy issues among adolescents with chronic disease is needed among health care providers and health care systems … Disease management interventions that target both functional and interactive health literacy might be helpful to the adolescent with IBD to ease the transition process from child-centered to adult-oriented health care.”