Limited health literacy associated with worse health outcomes in IBD
WASHINGTON — The prevalence of limited health literacy among patients with inflammatory bowel disease was found to be high and associated with worse health outcomes, according to research presented at DDW 2015.
The concept of health literacy can be defined as “the extent to which individuals have the capacity to obtain, understand and process basic health information that is needed to make appropriate health decisions,” Lauren K. Tormey, MD, from Boston Medical Center, told Healio Gastroenterology. “In the field of health literacy, there has been a great deal of research looking at the … relationships between health literacy and health outcomes. Limited health literacy is significantly associated with worse health outcomes in several different contexts, [including] increased use of emergency care services, increased risk of hospitalization, increased risk of readmission and even mortality in elderly adults. But this has never really been studied in patients with IBD, who have to make a lot of complex, difficult decisions throughout the course of their chronic illness.”
Lauren K. Tormey
Tormey and colleagues presented ad interim results from their ongoing prospective cohort study, which had thus far enrolled 82 adult patients (63% Crohn’s disease; 37% ulcerative or indeterminate colitis; mean age, 47.5 years). They administered a validated health literacy assessment tool as patients presented at their academic, inner city safety-net hospital, then assessed patient-reported health outcomes, including health-related quality of life, depression and subjective health status.
“We found a high prevalence of limited health literacy in this population; out of 82 participating subjects a total of 31 patients had limited health literacy (38%),” Tormey said. “If you look nationally at larger studies that have assessed the prevalence of limited health literacy in the U.S. population, that’s right about on par with where we stand; so about a third of the U.S. population has limited health literacy.”
Their findings also showed patients with limited health literacy had significantly worse reported health-related quality of life (P = .04), more depressive symptoms (P = .02) and worse overall subjective health status (P = .001) compared to patients with adequate health literacy.
“Limited health literacy is a significant problem in our patients, and why this is so important is because we have moved so far from paternalistic medicine to an approach that is all about shared decision making,” Tormey said, which increases the health literacy burden on the patient. “Most patients want to be involved…they want to be engaged, but [patients with limited health literacy] have more barriers to doing so, and they interpret communication differently than patients with adequate health literacy. So we really need to be able to develop tools that can engage these patients and make them feel supported as they embark on these kind of decisions.”
Furthermore, there is a need to better understand the relationships between limited health literacy and health outcomes, Tormey said. “This is a preliminary analysis, and as we continue to enroll patients, our goal is to further incorporate socioeconomic status, educational level, race and ethnicity and other factors into the model. … Health literacy is a potentially modifiable factor, unlike race or socioeconomic status or education, so I think it is an area where we can actually improve health outcomes, and I think that’s the value of pursuing research in this field.”
This study is currently ongoing, Tormey said, and their goal is to enroll several hundred patients to do a more in-depth analysis. - by Adam Leitenberger
Tormey LK, et al. Abstract Sa1205. Presented at: Digestive Disease Week; May 16-19, 2015; Washington, D.C.
Disclosure: Tormey reports no relevant financial disclosures. Please see the DDW faculty index for all other authors’ relevant financial disclosures.
Editor’s Note: This article was updated on July 27 to reflect additional information.