Perez Luzmercy, Morales Knashawn H, Klusaritz Heather, Han Xiaoyan, Huang Jingru, Rogers Marisa, Bennett Ian M, Rand Cynthia S, Ndicu Grace, Apter Andrea J
Division of Pulmonary Allergy Critical Care Medicine, University of Pennsylvania, Philadelphia, Pa; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pa.
J Allergy Clin Immunol. 2016 Dec;138(6):1593-1599.e3. doi: 10.1016/j.jaci.2016.08.043. Epub 2016 Oct 13.
Self-management of moderate-to-severe asthma depends on the patient's ability to (1) navigate (access health care to obtain diagnoses and treatment), (2) use inhaled corticosteroids (ICSs) properly, and (3) understand ICS function.
We sought to test whether navigation skills (medication recall, knowledge of copay requirements, and ability to provide information needed for a medical visit about a persistent cough unresponsive to medication) are related to other self-management skills and health literacy.
A 21-item Navigating Ability (NAV2) questionnaire was developed, validated, and then read to adults with moderate-to-severe asthma. ICS technique was evaluated by using scales derived from instructions in national guidelines; knowledge of ICS function was evaluated by using a validated 10-item questionnaire. Spearman correlation was computed between NAV2 score and these questionnaires and with numeracy (Asthma Numeracy Questionnaire) and print literacy (Short Test of Functional Health Literacy in Adults).
Two hundred fifty adults participated: age, 51 ± 13 years; 72% female; 65% African American; 10% Latino; 50% with household income of less than $30,000/y; 47% with no more than a 12th-grade education; and 29% experienced hospitalizations for asthma in the prior year. A higher NAV2 score was associated with correct ICS technique (ρ = 0.24, P = .0002), knowledge of ICSs (ρ = 0.35, P < .001), better print literacy (ρ = 0.44, P < .001), and numeracy (ρ = 0.41, P < .001).
Patients with poor navigational ability are likely to have poor inhaler technique and limited understanding of ICS function, as well as limited numeracy and print literacy. Clinicians should consider these elements of self-management for their effect on asthma care and as a marker of more general health literacy deficits.
中重度哮喘的自我管理取决于患者的以下能力：（1）应对（获得医疗保健以进行诊断和治疗），（2）正确使用吸入性糖皮质激素（ICS），以及（3）了解ICS的作用。
我们试图测试应对技能（药物记忆、对自付费用要求的了解以及就持续咳嗽且药物治疗无效的情况提供就诊所需信息的能力）是否与其他自我管理技能和健康素养相关。
编制了一份包含21个条目的应对能力（NAV2）问卷，进行验证后向患有中重度哮喘的成年人宣读。通过使用从国家指南中的说明得出的量表评估ICS技术；通过使用一份经验证的包含10个条目的问卷评估对ICS作用的了解。计算NAV2得分与这些问卷之间以及与算术能力（哮喘算术问卷）和印刷品读写能力（成人功能性健康素养简短测试）之间的Spearman相关性。
250名成年人参与研究：年龄51±13岁；72%为女性；65%为非裔美国人；10%为拉丁裔；50%家庭年收入低于30,000美元；47%接受的教育不超过12年级；29%在前一年因哮喘住院。较高的NAV2得分与正确的ICS技术（ρ = 0.24，P = 0.0002）、对ICS的了解（ρ = 0.35，P < 0.001）、更好的印刷品读写能力（ρ = 0.44，P < 0.001）和算术能力（ρ = 0.41，P < 0.001）相关。
应对能力差的患者可能吸入器技术不佳，对ICS作用的理解有限，算术能力和印刷品读写能力也有限。临床医生应考虑这些自我管理要素对哮喘护理的影响以及作为更普遍的健康素养缺陷的一个标志。
