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  • Title: Examining the causal model linking health literacy to health outcomes of asthma patients.
    Author: Wang KY, Chu NF, Lin SH, Chiang IC, Perng WC, Lai HR.
    Journal: J Clin Nurs; 2014 Jul; 23(13-14):2031-42. PubMed ID: 24329740.
    Abstract:
    AIMS AND OBJECTIVES: To explore health literacy status in asthma patients and to examine the causal model linking health literacy to health outcome-related factors via mediator and moderator variables. BACKGROUND: Understanding how low health literacy may influence health outcomes is important. DESIGN: This is a cross-sectional survey study. METHODS: A total of 326 asthma patients aged 20 years and older (average: 51 ± 18·3 years) were recruited by purposive sampling from pulmonary medicine outpatient departments at three medical centres and a regional teaching hospital in northern Taiwan. Data were collected via structured questionnaires, including measures of socio-demographic and disease characteristics; medical decision-making; asthma knowledge, attitudes and self-efficacy; healthcare experience and health outcome-related factors (metered-dose inhaler/dry-powder inhaler usage proficiency, medical use, self-management behaviour). Three hundred patients who met the inclusion criteria and completed the questionnaire survey were analysed. RESULTS: Overall, 217 subjects (72·3%) had adequate functional health literacy, 42 (14%) had inadequate functional health literacy, and 41 (13·7%) had marginal functional health literacy. Subjects' average asthma knowledge, attitudes and self-efficacy scores were 7·23 ± 2·69, 51·46 ± 6·18 and 58·31 ± 8·10, respectively. Health literacy correlated positively with asthma knowledge (r = 0·605), attitudes (r = 0·192) and medical decision-making (r = 0·413). CONCLUSIONS: Health literacy is positively associated with proficiency in metered-dose inhaler usage, asthma knowledge, attitudes and medical decision-making, but is not significantly associated with medical care use and self-management behaviour. Health literacy had an indirect effect on self-management behaviour through the mediation effect of asthma attitudes. No moderator was found for the effect of health literacy on health outcome-related factors. RELEVANCE TO CLINICAL PRACTICE: Results of this study may help to develop adequate intervention strategies to improve the health outcomes of asthma patients.
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