Proper disease management for people with chronic airway conditions can be the difference between staying symptom-free and needing an emergency visit to the hospital. Research led by Vancouver Coastal Health Research Institute researcher Dr. Iraj Poureslami underscores the crucial role of health literacy in supporting patient adherence to prescription medications and treatment regimen suggested by respiratory doctors.  

“Self-management practices mean that a person should be able to manage their condition from home,” explains Poureslami. “As such, care providers need to ensure that each patient has a level of understanding, trust in health care recommendations and the necessary skills to properly take their medication and follow instructions to control their chronic condition.”

A relatively new area of research, health literacy can be defined as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.”

Despite the importance of health literacy in disease management, over 60 per cent of Canadian adults aged 19 and older – and 88 per cent of seniors – are impacted by low levels of health literacy that can affect their ability to make informed health decisions, according to the Public Health Agency of Canada. 

“Health literacy is essential to effective chronic airways disease management and desirable outcomes.”

For his study, published in the journal Respiratory Care, Poureslami and the Canadian Airways Health Literacy Study Group, led by late Dr. J. Mark FitzGerald, developed a performance-based, disease-specific Vancouver Airways Health Literacy Tool (VAHLT) with input from patients and health care professionals. VAHLT is specifically designed to evaluate the level of health literacy skills among people with chronic airway conditions that involve airway and breathing restriction, such as that found in asthma, emphysema, bronchitis and chronic obstructive pulmonary disease (COPD).

Three hundred and eighty patients with chronic airway conditions from six specialty care clinics in British Columbia and Ontario were given the VAHLT health literacy evaluation measurement tool in the form of a scenario-based questionnaire. Participants’ health literacy scores were compared against the severity of their chronic airway condition, medication adherence, disease control and quality of life. 

 The research team found no significant correlation between VAHLT scores and disease severity or quality of life. However, age and level of education were highly correlated with health literacy skills. The latter finding “emphasizes the importance of addressing these factors and their impact on self-management practices in health literacy interventions among patients with chronic airways disease,” the study team reports.

Clear health care messaging is needed to support better health outcomes 

Low health literacy is often associated with decreased health outcomes, including a greater likelihood of being readmitted to an emergency department, as well as medication non-adherence and poorer self-care.

Health literacy can not only improve health outcomes, it can also promote equal access to appropriate care, according to the World Health Organization. Additionally, it can eventually reduce disparities and inequalities in obtaining needed care. This includes bridging barriers that may impede access to quality health care among marginalised and equity-deserving groups, such as the elderly, low-income individuals and people with mobility and language needs. 

B.C.’s aging and increasingly multicultural social landscape requires swift action by provincial health authorities to support optimal levels of health information comprehension, states Poureslami. This can mean respecting patients’ cultural beliefs and practices related to health and disease, as well as translating health information into different languages, providing educational videos on self-care management and spending more time explaining treatment recommendations to patients during office visits. 

Involving family members in discussions about treatment plans is another approach that can help break down barriers and ensure that patients have understood treatment recommendations, such as how many doses of an inhaler to take each day and when to increase the doses. 

 “Proper communication between care providers and patients is an essential stepping stone to improve patient adherence to prescribed medications and treatment regimens,” states Poureslami. “A suggested approach to foster open and interactive patient-provider communication is to complement plain language resources with a ‘teach-back’ approach that involves asking a patient to repeat aloud what was understood about the treatment recommendations to ensure that the patient understood the information correctly. This also stimulates dialogue and question-asking.” 

“One of the key questions that a care provider can ask their patient is: ‘Can you please repeat that back to me? I want to make sure that you understand the treatment plan’,” states Poureslami. 

In the long run, those extra minutes during the office visit can add up to better patient health outcomes, quality of life and reduced emergency visits or hospital admissions, Poureslami says.