Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Section of Gastroenterology, Department of Medicine, Boston Medical Center, Boston, Massachusetts.
Inflamm Bowel Dis. 2019 Jan 1;25(1):204-212. doi: 10.1093/ibd/izy237.
Patients with inflammatory bowel disease (IBD) face complex health tasks and decisions. Limited health literacy is a risk factor for poor health outcomes, but this has not been examined in IBD. This study aims to assess the role of health literacy for patients with IBD.
We prospectively enrolled adults with IBD receiving care from the Section of Gastroenterology at the Boston Medical Center. In-person, standardized questionnaires were administered to measure health literacy with the Newest Vital Sign, self-efficacy with the Medication Use and Self-Efficacy Scale, quality of life with the 10-question Short Inflammatory Bowel Disease Questionnaire, depression with the Patient-Reported Outcomes Measurement System Short Form, and clinical disease activity for patients with Crohn's disease with the Harvey-Bradshaw Index and for patients with ulcerative colitis with the Simple Clinical Colitis Activity Index (SCCAI). The relationships between health literacy and these variables were subsequently examined.
Of 112 patients invited to participate, 99 enrolled and completed the interview. Limited health literacy was identified in 40% (n = 40) of patients. Patients with limited health literacy reported significantly worse overall health (P = 0.03) and more depressive symptoms (P = 0.01). Of the 56 patients with Crohn's disease, those with adequate health literacy were more likely to be in clinical remission (mean Harvey-Bradshaw Index score < 5), compared with those with limited health literacy (odds ratio, 4.15; 95% confidence interval, 1.37 to 13.45; P = 0.01). There was no significant association between health literacy and clinical disease activity (SCCAI) in patients with ulcerative colitis.
Limited health literacy is associated with lower ratings of subjective health and depression in IBD and more symptoms of active disease in patients with Crohn's disease.
炎症性肠病（IBD）患者面临着复杂的健康任务和决策。健康素养有限是健康结局不佳的一个风险因素，但这在 IBD 中尚未得到检验。本研究旨在评估健康素养在 IBD 患者中的作用。
我们前瞻性招募了在波士顿医疗中心胃肠病科接受治疗的成年 IBD 患者。通过面对面的方式，使用最新生命体征（Newest Vital Sign）来测量健康素养，使用用药使用和自我效能量表（Medication Use and Self-Efficacy Scale）来测量自我效能，使用 10 项简短炎症性肠病问卷（10-question Short Inflammatory Bowel Disease Questionnaire）来测量生活质量，使用患者报告结局测量系统简明表格（Patient-Reported Outcomes Measurement System Short Form）来测量抑郁，对于克罗恩病患者，使用 Harvey-Bradshaw 指数（Harvey-Bradshaw Index）来测量临床疾病活动，对于溃疡性结肠炎患者，使用简单临床结肠炎活动指数（Simple Clinical Colitis Activity Index，SCCAI）来测量临床疾病活动。随后，检查了健康素养与这些变量之间的关系。
在邀请参加的 112 名患者中，有 99 名患者参加并完成了访谈。40%（n=40）的患者存在有限的健康素养。与健康素养较高的患者相比，健康素养有限的患者报告的总体健康状况明显更差（P=0.03），抑郁症状也更严重（P=0.01）。在 56 名克罗恩病患者中，健康素养足够的患者更有可能处于临床缓解状态（平均 Harvey-Bradshaw 指数评分<5），而健康素养有限的患者则不然（比值比，4.15；95%置信区间，1.37 至 13.45；P=0.01）。在溃疡性结肠炎患者中，健康素养与临床疾病活动（SCCAI）之间没有显著关联。
在 IBD 患者中，健康素养有限与主观健康和抑郁评分较低以及克罗恩病患者更多的疾病活动症状有关。
