HEALTH LITERACY
IMPORTANCE IN COPD & ASTHMA
INTRODUCTION

Inhaled medication is the cornerstone of COPD and asthma treatment. However, patients often use their medication incorrectly. There are several explanations for this, such as complex medication schemes, difficulties in handling of the inhaler devices, inappropriate teaching, etc. Patient's health literacy is also a vital component.1

Health literacy is more than the ability to read medical information.2 It means the ability to understand the information in order to make sound health decisions. Particularly in chronic diseases
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Low literacy can go so far that patients have wrong health beliefs: they do not understand that they have a chronic disease that requires long-term treatment and they think the medication is harmful or they think that regular use may reduce its effects.6
, health literacy is a key requirement to achieve optimal self-administration and adherence to medication.

A set of skills is needed: reading, numeracy, communication, and nowadays also e-literacy.3 E-literacy additionally requires the ability to navigate the web and to distinguish between high- and low-quality information.4,5

DEFINITION OF HEALTH LITERACY
World Health Organization definition of health literacy: The cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and to use information in ways which promote and maintain good health.7
PREVALENCE & IMPLICATIONS OF LOW HEALTH LITERACY
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In the European health literacy survey of 8000 respondents from 8 countries,
47% showed limited (problematic to insufficient) health literacy.3
Excellent health literacy
Sufficient health literacy
Problematic health literacy
Inadequate health literacy
SOCIAL GRADIENT
Risk of poor health literacy is higher with:
  • Financial deprivation
  • Low social status
  • Low education
  • Old age
Figure adapted from Sorensen et al., 20159

The values may even underestimate the true severity of low literacy if selective response has occurred
(i.e. people with very low literacy and people ashamed about it are less likely to respond to the survey).

CONCLUSION

Strong evidence shows the association between health literacy and health outcomes, including mortality.13,14 The evidence in patients with respiratory diseases also shows more helplessness and worse quality of life in patients with low health literacy.15,16

In order to improve health results, physicians and other health care providers can help patients in redressing erroneous health beliefs and offer easy, multi-modal communication (verbal, print, digital). For instance, Beatty et al. showed that handouts specifically written for patients with low health literacy, significantly improved inhaler technique.17

These aids should be individualized. Keeping a record of patient preferences for verbal, printed and/or digital information is important.

Download the handover
HEALTH LITERACY PRECAUTIONS2,3
HEALTH LITERACY PRECAUTIONS2,3
Adapt personal information
in words
  • avoid medical jargon
  • breakdown instructions into small concrete steps
  • focus the visit on three key points
  • make numerical information more concrete
  • use written materials as support
in writing
  • use simple language
  • most important points come first
  • use active voice
  • include visual aids, graphs or pictures
electronic resources
  • consider that many patients look for information on the internet
  • benefit from repeated teaching opportunities (e.g. videos of inhaler technique)
  • guide patients to appropriate medical websites (e.g. patient organizations, hospital website, patient web portals)
Check patient preferences regarding the options mentioned above
Always assess for comprehension
  • encourage questions
  • use teach-back methods
Involve partners and relatives