The impact of traditional literacy and education on health literacy in adolescents with asthma

Abstract

Introduction: People with low health literacy have poorer self-management of chronic diseases like asthma. Studies of parent health literacy and education level on the management of children’s chronic illnesses reveal inconclusive results. We hypothesized a correlation between parent and adolescent health literacy in teens with asthma. Methods: Sociodemographic data were obtained; health literacy was assessed on adolescents and parents with three instruments: Rapid Estimate of Adolescent/Adult Literacy in Medicine (REALM), Single Item Literacy Screener (SILS) and Newest Vital Sign (NVS). Agreement between scores was examined by calculating weighted kappa statistics and performing Bowkers test of symmetry. Results: In all, 243 adolescents and 203 parents completed health literacy assessments yielding 198 paired observations. 9th–12th graders, 60.6% female, 72.7% African-American (AA), mean age: 15.3 years (±0.9). Parent education ranged from < high school (19.1%) to college graduate (24.0%). Agreement between adolescent and parent scores was poor: REALM (κ_w = 0.26), SILS (κ_w = 0.12), and NVS (κ_w = 0.29) and disagreement did not significantly differ by race. Positive correlations of moderate strength (overall and between racial groups) were found between reading scores and both REALM and NVS scores, and between REALM and NVS scores. Due to the inverse relationship of SILS scores with health literacy level, SILS scores (overall and between racial groups) were weakly and negatively correlated with reading scores, REALM and NVS. Conclusion: Correlation between education level and traditional literacy suggests that these are contributing factors to the health literacy of adolescents with asthma. Correlation between adolescent and caregiver health literacy was not supported.

Keywords:

• Adolescents
• African-American
• asthma
• caregivers
• health literacy
• rural

Acknowledgements

The authors wish to thank the school systems and study participants. Also, the authors express appreciation to the research team who assisted substantially with implementation and building professional relationships with the adolescents and their caregivers, which facilitated adherence to the study protocol, robust data collection and subject retention. The team included Maudesta Caleb, MEd; Sheree Cartee, BS; Kelora Cofer, MPH; Matthew Humphries, MS, CCRP; Zubin Mehta, MD; Ashley Stevenson, MS and Joseph Tingen, MD.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Additional information

Funding

Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number R01HL092412. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The study is registered with Clinical-Trials.gov with number NCT01170676.