Association of Health Literacy and Numeracy With Lupus Knowledge and the Creation of the Lupus Knowledge Assessment Test

Mithu Maheswaranathan*, Amanda M. Eudy, Ann Cameron Barr, Catherine Howe, Jayanth Doss, Rebecca E. Sadun, Lisa G. Criscione-Schreiber, Kai Sun, Eliana M. Perrin, Stacy C. Bailey, Susan N. Hastings, Megan E.B. Clowse, Jennifer L. Rogers

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Objective. Limited health literacy and numeracy are associated with worse patient-reported outcomes and higher disease activity in systemic lupus erythematosus (SLE), but which factors may mediate this association is unknown. We sought to determine the association of health literacy and numeracy with SLE knowledge. Methods. Patients with SLE were recruited from an academic center clinic. Participants completed validated assessments of health literacy (Newest Vital Sign [NVS]; n = 96) and numeracy (Numeracy Understanding in Medicine Instrument, Short Version [S-NUMI]; n = 85). They also completed the Lupus Knowledge Assessment Test (LKAT), which consists of 4 questions assessing SLE knowledge that were determined through consensus expert opinion for their wide applicability and importance related to self-management of the disease. Descriptive statistics and multivariable logistic regression modeling were used to analyze the results. Results. In our SLE cohort (n = 125), 33% (32/96) had limited health literacy and 76% (65/85) had limited numeracy. The majority correctly identified that hydroxychloroquine prevented SLE flares (91%); however, only 23% of participants correctly answered a numeracy question assessing which urine protein to creatinine (UPC) ratio was > 1000 mg/g. The mean LKAT score was 2.7 out of 4.0. Limited health literacy, but not numeracy, was associated with lower knowledge about SLE as measured by the LKAT, even after adjusting for education. Conclusion. Patients with SLE with limited health literacy had lower knowledge about SLE. The LKAT could be further refined and/or used as a screening tool to identify patients with knowledge gaps. Further work is needed to improve patients' understanding of proteinuria and investigate whether literacy-sensitive education can improve care.

Original languageEnglish (US)
Article number210708
Pages (from-to)585-591
Number of pages7
JournalJournal of Rheumatology
Volume49
Issue number6
DOIs
StatePublished - Jun 1 2022

Funding

AME is supported by the National Institutions of Health National Center for Advancing Translational Sciences (NIH NCATS Award Number 1KL2TR002554). 1M. Maheswaranathan, MD, Fellow, A.M. Eudy, PhD, Assistant Professor, J. Doss, MD, Assistant Professor, L.G. Criscione-Schreiber, MD, MEd, Professor, K. Sun, MD, Assistant Professor, M.E.B. Clowse, MD, MPH, Associate Professor, J.L. Rogers, MD, Assistant Professor, Division of Rheumatology & Immunology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; 2A.C. Barr, MD, Resident, C. Howe, MD, Resident, Department of Medicine, Duke University Hospital, Durham, North Carolina; 3R.E. Sadun, MD, PhD, Assistant Professor, Division of Rheumatology, Departments of Medicine and Pediatrics, Duke University School of Medicine, Durham, North Carolina; 4E.M. Perrin, MD, MPH, Professor, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina; 5S.C. Bailey, PhD, MPH, Associate Professor of Medicine, Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, Illinois; 6S.N. Hastings, MD, Departments of Medicine & Population Health Sciences and Center for the Study of Aging, Duke University, and Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA. SCB reports grants from the NIH, Merck, Pfizer, Gordon and Betty Moore Foundation, Retirement Research Foundation for Aging, Lundbeck, and Eli Lilly through her institution; and personal fees from Sanofi, Pfizer, University of Westminster, Lundbeck, and Luto outside the submitted work. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. M. Maheswaranathan, Duke University Medical Center, DUMC 2918, Durham, NC 27710, USA. Email: [email protected]. Accepted for publication February 16, 2022.

Keywords

  • health literacy
  • health numeracy
  • lupus knowledge
  • patient education
  • systemic lupus erythematosus

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology

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