Effects of health literacy and cognitive abilities on COPD self-management behaviors: A prospective cohort study

Rachel O'Conor*, Kimberly Muellers, Marina Arvanitis, Daniel P. Vicencio, Michael S. Wolf, Juan P. Wisnivesky, Alex D. Federman

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction: Low rates of adherence to self-management behaviors are common among patients with COPD. Health literacy and cognitive abilities may influence engagement in self-management behaviors. We sought to assess the association between health literacy and cognitive abilities with self-management behaviors in patients with COPD. Methods: We conducted an observational cohort study among American adults with COPD in New York, New York, and Chicago, Illinois. Outcomes included adherence to COPD medication, metered dose inhaler (MDI) and dry powder inhaler (DPI) technique, receipt of vaccination, and routine healthcare appointments. Health literacy was measured with the Short Test of Functional Health Literacy in Adults. Cognitive function was assessed in terms of global, fluid (working memory, processing speed, executive function) and crystallized (verbal) ability. Results: Adequate health literacy was associated with adequate adherence to COPD medications (OR 1.46; 95% CI, 1.02–2.08), correct MDI (OR 1.66; 95% CI, 1.13–2.44) and DPI (OR 2.17; 95% CI, 1.30–3.64) technique. Fluid abilities were also associated with medication behaviors and visiting a regular healthcare provider, while crystalized abilities were not. Global cognitive abilities were associated with correct inhaler technique. No other associations were found with non-medication self-management behaviors. Conclusions: COPD patients with limited health literacy and deficits in fluid cognitive abilities have lower rates of adherence and poorer inhaler technique than individuals with adequate health literacy and greater fluid cognitive abilities. These findings highlight the importance of considering the health literacy level and cognitive ability when caring for and educating patients with COPD.

Original languageEnglish (US)
Article number105630
JournalRespiratory Medicine
Volume160
DOIs
StatePublished - Nov 1 2019

Fingerprint

Health Literacy
Aptitude
Self Care
Chronic Obstructive Pulmonary Disease
Cohort Studies
Prospective Studies
Dry Powder Inhalers
Metered Dose Inhalers
Nebulizers and Vaporizers
Executive Function
Short-Term Memory
Health Personnel
Cognition
Observational Studies
Appointments and Schedules
Vaccination
Delivery of Health Care

Keywords

  • Chronic obstructive pulmonary disease
  • Cognition
  • Health literacy
  • Self care

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

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title = "Effects of health literacy and cognitive abilities on COPD self-management behaviors: A prospective cohort study",
abstract = "Introduction: Low rates of adherence to self-management behaviors are common among patients with COPD. Health literacy and cognitive abilities may influence engagement in self-management behaviors. We sought to assess the association between health literacy and cognitive abilities with self-management behaviors in patients with COPD. Methods: We conducted an observational cohort study among American adults with COPD in New York, New York, and Chicago, Illinois. Outcomes included adherence to COPD medication, metered dose inhaler (MDI) and dry powder inhaler (DPI) technique, receipt of vaccination, and routine healthcare appointments. Health literacy was measured with the Short Test of Functional Health Literacy in Adults. Cognitive function was assessed in terms of global, fluid (working memory, processing speed, executive function) and crystallized (verbal) ability. Results: Adequate health literacy was associated with adequate adherence to COPD medications (OR 1.46; 95{\%} CI, 1.02–2.08), correct MDI (OR 1.66; 95{\%} CI, 1.13–2.44) and DPI (OR 2.17; 95{\%} CI, 1.30–3.64) technique. Fluid abilities were also associated with medication behaviors and visiting a regular healthcare provider, while crystalized abilities were not. Global cognitive abilities were associated with correct inhaler technique. No other associations were found with non-medication self-management behaviors. Conclusions: COPD patients with limited health literacy and deficits in fluid cognitive abilities have lower rates of adherence and poorer inhaler technique than individuals with adequate health literacy and greater fluid cognitive abilities. These findings highlight the importance of considering the health literacy level and cognitive ability when caring for and educating patients with COPD.",
keywords = "Chronic obstructive pulmonary disease, Cognition, Health literacy, Self care",
author = "Rachel O'Conor and Kimberly Muellers and Marina Arvanitis and Vicencio, {Daniel P.} and Wolf, {Michael S.} and Wisnivesky, {Juan P.} and Federman, {Alex D.}",
year = "2019",
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Effects of health literacy and cognitive abilities on COPD self-management behaviors : A prospective cohort study. / O'Conor, Rachel; Muellers, Kimberly; Arvanitis, Marina; Vicencio, Daniel P.; Wolf, Michael S.; Wisnivesky, Juan P.; Federman, Alex D.

In: Respiratory Medicine, Vol. 160, 105630, 01.11.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Effects of health literacy and cognitive abilities on COPD self-management behaviors

T2 - A prospective cohort study

AU - O'Conor, Rachel

AU - Muellers, Kimberly

AU - Arvanitis, Marina

AU - Vicencio, Daniel P.

AU - Wolf, Michael S.

AU - Wisnivesky, Juan P.

AU - Federman, Alex D.

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Introduction: Low rates of adherence to self-management behaviors are common among patients with COPD. Health literacy and cognitive abilities may influence engagement in self-management behaviors. We sought to assess the association between health literacy and cognitive abilities with self-management behaviors in patients with COPD. Methods: We conducted an observational cohort study among American adults with COPD in New York, New York, and Chicago, Illinois. Outcomes included adherence to COPD medication, metered dose inhaler (MDI) and dry powder inhaler (DPI) technique, receipt of vaccination, and routine healthcare appointments. Health literacy was measured with the Short Test of Functional Health Literacy in Adults. Cognitive function was assessed in terms of global, fluid (working memory, processing speed, executive function) and crystallized (verbal) ability. Results: Adequate health literacy was associated with adequate adherence to COPD medications (OR 1.46; 95% CI, 1.02–2.08), correct MDI (OR 1.66; 95% CI, 1.13–2.44) and DPI (OR 2.17; 95% CI, 1.30–3.64) technique. Fluid abilities were also associated with medication behaviors and visiting a regular healthcare provider, while crystalized abilities were not. Global cognitive abilities were associated with correct inhaler technique. No other associations were found with non-medication self-management behaviors. Conclusions: COPD patients with limited health literacy and deficits in fluid cognitive abilities have lower rates of adherence and poorer inhaler technique than individuals with adequate health literacy and greater fluid cognitive abilities. These findings highlight the importance of considering the health literacy level and cognitive ability when caring for and educating patients with COPD.

AB - Introduction: Low rates of adherence to self-management behaviors are common among patients with COPD. Health literacy and cognitive abilities may influence engagement in self-management behaviors. We sought to assess the association between health literacy and cognitive abilities with self-management behaviors in patients with COPD. Methods: We conducted an observational cohort study among American adults with COPD in New York, New York, and Chicago, Illinois. Outcomes included adherence to COPD medication, metered dose inhaler (MDI) and dry powder inhaler (DPI) technique, receipt of vaccination, and routine healthcare appointments. Health literacy was measured with the Short Test of Functional Health Literacy in Adults. Cognitive function was assessed in terms of global, fluid (working memory, processing speed, executive function) and crystallized (verbal) ability. Results: Adequate health literacy was associated with adequate adherence to COPD medications (OR 1.46; 95% CI, 1.02–2.08), correct MDI (OR 1.66; 95% CI, 1.13–2.44) and DPI (OR 2.17; 95% CI, 1.30–3.64) technique. Fluid abilities were also associated with medication behaviors and visiting a regular healthcare provider, while crystalized abilities were not. Global cognitive abilities were associated with correct inhaler technique. No other associations were found with non-medication self-management behaviors. Conclusions: COPD patients with limited health literacy and deficits in fluid cognitive abilities have lower rates of adherence and poorer inhaler technique than individuals with adequate health literacy and greater fluid cognitive abilities. These findings highlight the importance of considering the health literacy level and cognitive ability when caring for and educating patients with COPD.

KW - Chronic obstructive pulmonary disease

KW - Cognition

KW - Health literacy

KW - Self care

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