INADEQUATE LITERACY IS A BARRIER TO ASTHMA KNOWLEDGE AND SELF-CARE

Study objectives: To determine the relationship of literacy to asthma knowledge and ability to use a metered-dose inhaler (MDI) among patien ts with asthma. Design: Cross-sectional survey, Setting: Emergency dep artment and asthma clinic at an urban public hospital, Patients: Conve nience sample of 273 patients presenting to the emergency department f or an asthma exacerbation and 210 patients presenting to a specialized asthma clinic for routine care. Interventions: Measurement of literac y with the Rapid Estimate of Adult Literacy in Medicine, asthma knowle dge (20 question oral test), and demonstration of MDI technique (six-i tem assessment). Measurements and results: Only 27% of patients read a t the high-school level, although two thirds reported being high-schoo l graduates; 33% read at the seventh- to eighth-grade level, 27% at th e fourth- to sixth-grade level, and 13% at or below the third-grade le vel, Mean asthma knowledge scores (+/-SD) were directly related to rea ding levels: 15.1 +/- 2.5, 13.9 +/- 2.5, 13.4 +/- 2.8, 11.9 +/- 2.5, r espectively (p < 0.01), Patient reading level was the strongest predic tor of asthma knowledge score in multivariate analysis. Poor MDI techn ique (less than or equal to 3 correct steps) was found in 89% of patie nts reading at less than the third-grade level compared with 48% of pa tients reading at the high-school level. In multivariate regression an alyses, reading level was the strongest predictor of MDI technique. Co nclusions: Inadequate literacy was common and strongly correlated with poorer knowledge of asthma and improper MDI use.