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Editors Selection IGR 16-4

Health and Quality of Life: Health literacy

Comment by Henry Jampel on:

21322 Functional health literacy in patients with glaucoma in urban settings, Juzych MS; Randhawa S; Shukairy A et al., Archives of Ophthalmology, 2008; 126: 718-724

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Juzych et al. (903) report on the func-tional health literacy of a group of 204 patients diagnosed with glaucoma and followed at the Kresge Eye Institute in downtown Detroit. The patient population was predominantly poor (55% with an annual household income of less than US$ 20,000) and African-American (81%). Functional health literacy was defined as 'adequate' if the subject's score was 30 or more on a scale of 0-50, and poor if the score was less than 30 on the reading comprehension section of the Test of Functional Health Literacy in Adults. Half of the subjects had poor functional health literacy by this dichotomous criterion.

There is an association between poor functional health literacy and worse glaucoma outcomes

The investigators found that poor functional health literacy was associated with African-American race, lower levels of education (high school graduate or less) and a household income of less than $20,000 annually. Furthermore, the poor health literacy group was more likely to report more missed appointments and more missed eye drops than the adequate health literacy group. They also had worse visual filed loss on presentation and more visual field deterioration during follow-up. The authors conclude that there is an association between low income and less education and poor functional health literacy, and an association between poor functional health literacy and worse clinical outcomes. Although association is not causality, readers may infer that the identification of those likely to have poor health literacy, and then intervening to improve their understanding of their disease, may lead to better adherence and better outcomes.

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