Journal of General Internal Medicine

, Volume 27, Issue 2, pp 190–195

A Randomized Controlled Trial of a Literacy-Sensitive Self-Management Intervention for Chronic Obstructive Pulmonary Disease Patients

  • Katie Kiser
  • Daniel Jonas
  • Zachary Warner
  • Kelli Scanlon
  • Betsy Bryant Shilliday
  • Darren A. DeWalt
Original Research

DOI: 10.1007/s11606-011-1867-6

Cite this article as:
Kiser, K., Jonas, D., Warner, Z. et al. J GEN INTERN MED (2012) 27: 190. doi:10.1007/s11606-011-1867-6



Low literacy skills are common and associated with a variety of poor health outcomes. This may be particularly important in patients with chronic illnesses such as chronic obstructive pulmonary disease (COPD) that require appropriate inhaler technique to maintain quality of life and avoid exacerbations.


To explore the impact of a literacy-sensitive self-management intervention on inhaler technique scores in COPD patients and to determine if effects differ by literacy.


Randomized controlled trial.


Ninety-nine patients with COPD.


Patients were randomly assigned to a one-on-one self-management educational intervention or usual care. The intervention focused on inhaler technique, smoking cessation, and using a COPD action plan.

Main Measures

At baseline, an inhaler technique assessment, literacy assessment, health-related quality of life questionnaires, and pulmonary function tests were completed. Inhaler technique was re-evaluated after two to eight weeks.

Key Results

Mean age 63, 65% female, 69% Caucasian, moderate COPD severity on average, 36% with low literacy, moderately impaired health-related quality of life, and similar baseline metered dose inhaler technique scores. Patients in the intervention group had greater mean improvement from baseline in metered dose inhaler technique score compared to those in the usual care group (difference in mean change 2.1, 95% CI 1.1, 3.0). The patients in the intervention group also had greater mean improvements in metered dose inhaler technique score than those in the usual care group whether they had low health literacy (difference in mean change 2.8, 95% CI 0.6, 4.9) or higher health literacy (1.8, 95% CI 0.7, 2.9).


A literacy-sensitive self-management intervention can lead to improvements in inhaler technique, with benefits for patients with both low and higher health literacy.


COPD inhaler technique health literacy self-management randomized controlled trial 

Supplementary material

11606_2011_1867_MOESM1_ESM.pdf (2.2 mb)
Online Appendix 1Living With COPD Handout (PDF 2.20 MB)
11606_2011_1867_MOESM2_ESM.doc (88 kb)
Online Appendix 2Percentage of Subjects Achieving each Inhaler Technique Score at baseline and follow-up for the Intervention and Usual Care groups (DOC 87.5 KB)
11606_2011_1867_MOESM3_ESM.doc (90 kb)
Online Appendix 3Percentage of Subjects with Incorrect Inhaler Technique for each Item at baseline and follow-up for the Intervention and Usual Care groups (DOC 89.5 KB)

Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Katie Kiser
    • 1
    • 3
  • Daniel Jonas
    • 2
  • Zachary Warner
    • 2
  • Kelli Scanlon
    • 2
  • Betsy Bryant Shilliday
    • 2
  • Darren A. DeWalt
    • 2
  1. 1.School of PharmacyUniversity of MarylandBaltimoreUSA
  2. 2.Department of MedicineUniversity of North Carolina Chapel HillChapel HillUSA
  3. 3.University of Maryland School of PharmacyBaltimoreUSA

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