Using Single-Item Health Literacy Screening Questions to Identify Patients Who Read Written Nonsteroidal Anti-Inflammatory Medicine Information Provided at Pharmacies

Abstract

Our goal was to assess the relationships between single-item health literacy screening questions and reading prescription nonsteroidal anti-inflammatory drug (NSAID) written medicine information (WMI) provided at pharmacies. The health literacy of 382 patients from primary care physician practices in Alabama was estimated using validated health literacy screening questions related to understanding written medical information (SQ1); confidence in completing medical forms alone (SQ2); and need for assistance in reading hospital materials (SQ3). Reading WMI was measured by a “Yes” response to the question, “Often the drug store gives you written information such as pamphlets or handouts along with your prescription. Have you read about the risks of NSAIDs in this written material provided by the drug store?” Relationships were assessed using generalized linear latent and mixed models. Two-thirds (67.6%) of patients read WMI. Higher estimated health literacy was associated with increased odds of reading WMI. Adjusted odds ratios (95% CI) were 2.08 (1.08–4.03); 2.09 (1.12–3.91); and 1.98 (1.04–3.77) using SQ1–SQ3. Current WMI may be unable to meet the needs of those with inadequate health literacy. Health literacy screening questions can be used to triage patients at risk for not reading WMI so they can be assisted with supplemental educational strategies.

This project was supported in part by the Agency for Healthcare Research and Quality (AHRQ) Centers for Education and Research on Therapeutics cooperative agreement (U18-HS010389).

This research was presented, in part, at the Open Hearing of the FDA Risk Communication Advisory Committee on February 26–27, 2009, in Washington, DC.

This research was presented, in part, at the 2009 Annual Meeting and Exposition of the American Pharmacists Association in San Antonio, TX.

Notes

From (Chew et al., 2008; Chew, Bradley, & Boyko, 2004; Wallace et al., 2007; Wallace, Rogers, Roskos, Holiday, & Weiss, 2006).

^a For each variable, n may vary due to missing data.

^b Comorbidities included liver disease, kidney disease, high blood pressure, heart attack, stroke, heart failure, diabetes, ulcers or gastrointestinal bleeding, and arthritis.

^c Privately insured participants indicated private insurance with or without Medicare vs. having Medicaid, Medicare alone, or being uninsured.

^d Written medicine information.

^a Likelihood of reading written medical information assessed by a single question, “Often the drug store gives you written information such as pamphlets or handouts along with your prescription. Have you read about the risks of NSAIDS in this written material provided by the drug store?” Response: Yes vs. No.

^b Adequacy of income was assessed by a single question, “Currently, is your income enough to meet your basic needs for food, housing, clothing and medical care?” Response: Yes vs. No.

^c Privately insured participants indicated having private insurance with or without Medicare vs. having Medicaid, Medicare alone, or being uninsured.

^d Participants have multiple comorbidities greater than the median were considered to have high comorbidity.

^e Estimate of health literacy status based on response to question, “How often do you have problems learning about your medical condition because of difficulty understanding written information?” Dichotomized literacy levels: Adequate/Marginal Health Literacy [Occasionally; Never]; Inadequate Health Literacy [Always; Often; Sometimes] (reference).

^f Estimate of health literacy status based on response to question, “How confident are you in filling out medical forms by yourself?” Dichotomized literacy levels: Adequate/Marginal Health Literacy [Quite a bit; Extremely]; Inadequate Health Literacy [Not at all; A little bit; Somewhat] (reference).

^g Estimate of health literacy status based on response to question, “How often do you have someone (like a family member, friend, hospital/clinic worker, or caregiver) help you read hospital materials?” Dichotomized literacy levels: Adequate/Marginal Health Literacy [Occasionally; Never]; Inadequate Health Literacy [Always; Often; Sometimes] (reference).