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The Relationship Among Health Literacy, Health Knowledge, and Adherence to Treatment in Patients with Rheumatoid Arthritis

  • Original Article
  • Published:
HSS Journal ®

Abstract

Background

Patients with poor health literacy often lack the knowledge needed to manage their treatment.

Objective

The aim of this cross-sectional study is to determine whether health literacy is a predictor of health knowledge and/or adherence to medication treatment in patients with rheumatoid arthritis.

Method

The study was completed in an urban, outpatient rheumatology setting. Health literacy was measured using the Test of Functional Health Literacy in Adults. The Arthritis Knowledge Questionnaire was modified to measure medication specific health knowledge, and the Morisky Medication Adherence scale was used to measure adherence. Researchers used regression analyses to determine if health literacy was a predicator of knowledge and/or adherence.

Results

Participants (N = 125) had high mean health literacy scores. The average medication knowledge score was 0.73. Adherence to medication regimen was 0.84. Controlling for patient covariates, health literacy was positively associated with education, race, and age. In adjusted analyses, health literacy was a significant predictor of health knowledge but not adherence. Race, neighborhood income, and confidence with contacting provider about medications were predictors of adherence.

Conclusion

Study findings indicate that health literacy is independently associated with medication knowledge but not medication adherence in patients with rheumatoid arthritis. These results provide useful information for planning initiatives to support individuals with disease self-management.

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Acknowledgments

Dr. Quinlan’s effort was supported by the REDcap Database of the Cornell Clinical and Translational Science Center—Grant UL11RR024996.

Disclosures

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participating in the study was obtained

Author information

Authors and Affiliations

  1. Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Patricia Quinlan DNSc, MPA, Kwanza O. Price MPH, Steven K. Magid MD, Stephen Lyman PhD & Lisa A. Mandl MD, MPH

  2. Weill Cornell University Medical College, New York, NY, USA

    Steven K. Magid MD & Lisa A. Mandl MD, MPH

  3. Center for Health Policy, Columbia University School of Nursing, New York, NY, USA

    Patricia W. Stone PhD, MPH

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  1. Patricia Quinlan DNSc, MPA
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Correspondence to Patricia Quinlan DNSc, MPA.

Additional information

Level of Evidence: Level II prognostic study. See levels of evidence for a complete description.

Appendix

Appendix

Selection 2: Medication Knowledge Questionnaire

The following are questions about rheumatoid arthritis and medications you may be familiar with. Read the questions carefully and circle the letter next to what you think is the best answer:

  1. 1.

    Rheumatoid arthritis is the result of:

    1. a.

      Wear and tear on the body

    2. b.

      The aging process

    3. c.

      Too much or too little of some kinds of foods

    4. d.

      A disorder of the body’s immune system

    5. e.

      Don’t know

  2. 2.

    Pain is one of the biggest problems in arthritis. This can:

    1. a.

      Never completely be controlled

    2. b.

      Only can be controlled with some medication

    3. c.

      Can be controlled by very few people using a combination of medication and other methods

    4. d.

      Can be controlled by most people using a combination of medications and other methods

    5. e.

      Don’t know

  3. 3.

    Steroids such as Prednisone or Medrol are used in arthritis to:

    1. a.

      Help reduce the symptoms of arthritis

    2. b.

      Increase the progress of arthritis

    3. c.

      Cure arthritis

    4. d.

      Make arthritis worse

    5. e.

      Don’t know

  4. 4.

    Side effects of Prednisone:

    1. a.

      Can include cataracts, brittle bones, muscle wasting and increased blood sugar

    2. b.

      Can be reduced by keeping the dose low

    3. c.

      Are most common with long-term use (more than a month)

    4. d.

      All of the above

    5. e.

      Don’t know

  5. 5.

    Disease modifying drugs often called DMARDs:

    1. a.

      Modify the disease process

    2. b.

      Work to prevent bone and joint deformities

    3. c.

      Are not available without prescription

    4. d.

      All of the above

    5. e.

      Don’t know

  6. 6.

    Methotrexate is a/an:

    1. a.

      Medication to treat blood sugar

    2. b.

      Medication to decrease blood pressure

    3. c.

      Multivitamin

    4. d.

      Medication to reduce inflammation

    5. e.

      Don’t know

  7. 7.

    Plaquenil usually begins to act:

    1. a.

      Right away

    2. b.

      Within the second or third dose

    3. c.

      After about 6 weeks

    4. d.

      In about 3–6 months

    5. e.

      Don’t know

  8. 8.

    Allergies to medications:

    1. a.

      Are very common

    2. b.

      Will happen to anyone who takes too much of a medication

    3. c.

      Are the same things as side effects

    4. d.

      Are rare reactions that mean you should not use that drug again

    5. e.

      Don’t know.

  9. 9.

    Non-steroidal anti-inflammatory drugs such as Advil or Motrin:

    1. a.

      Reduce pain and swelling

    2. b.

      Should not be relied on as the only treatment for rheumatoid arthritis

    3. c.

      Can sometime cause stomach problems

    4. d.

      All of the above

    5. e.

      Don’t know

  10. 10.

    Two to four tablets of aspirin or non steroidal anti-inflammatory drugs:

    1. a.

      Only reduce mild pain

    2. b.

      Reduce inflammation

    3. c.

      Fight infection

    4. d.

      Help both pain and inflammation

    5. e.

      Don’t know

  11. 11.

    Acetaminophen (Tylenol):

    1. a.

      Helps reduce inflammation in arthritis

    2. b.

      Only provides temporary relief of mild pain

    3. c.

      Cannot be taken along with your other arthritis medication

    4. d.

      Helps stop joint damage

    5. e.

      Don’t know

  12. 12.

    Medications that you buy without a prescription:

    1. a.

      Can sometimes interact with other medicines you may be taking

    2. b.

      Should be mentioned to your doctor

    3. c.

      Can sometimes be taken with prescribed medications

    4. d.

      All of the above

    5. e.

      Don’t know

  13. 13.

    If you are often tired because of your arthritis, you should:

    1. a.

      Force yourself to carry on in spite of it

    2. b.

      Recognize your limitations and talk about your problem with others

    3. c.

      Alter your medications because they can be the cause of tiredness

    4. d.

      Stay in bed until you feel better

    5. e.

      Don’t know

  14. 14.

    If an arthritis medication does not work within a few days, you should:

    1. a.

      Keep taking the prescription as it says and call your doctor

    2. b.

      Probably be taking more of it

    3. c.

      Probably be taking something else with it

    4. d.

      Consider exercising to speed up your system

    5. e.

      Don’t know

  15. 15.

    There are new drugs called ‘biologics’ available to treat rheumatoid arthritis. These drugs:

    1. a.

      Can be administered early in the disease

    2. b.

      Are usually given by injection

    3. c.

      Are expensive

    4. d.

      All of the above

    5. e.

      Don’t know

  16. 16.

    The newer drugs have side effects that:

    1. a.

      Do not affect men

    2. b.

      Destroy tooth enamel

    3. c.

      Can result in getting an infection

    4. d.

      Are not important

    5. e.

      Don’t know

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Quinlan, P., Price, K.O., Magid, S.K. et al. The Relationship Among Health Literacy, Health Knowledge, and Adherence to Treatment in Patients with Rheumatoid Arthritis. HSS Jrnl 9, 42–49 (2013). https://doi.org/10.1007/s11420-012-9308-6

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