M. 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;
M. 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.
J Rheumatol. 2022 Jun;49(6):585-591. doi: 10.3899/jrheum.210708. Epub 2022 Mar 1.
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.
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.
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.
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.
健康素养和计算能力有限与系统性红斑狼疮（SLE）患者报告结局较差和疾病活动度较高相关，但尚不清楚哪些因素可能介导这种关联。我们旨在确定健康素养和计算能力与 SLE 知识之间的关联。
从学术中心诊所招募 SLE 患者。参与者完成了健康素养的验证评估（最新生命体征[ NVS ]；n=96）和计算能力（医学理解计算能力工具，简短版[ S-NUMI ]；n=85）。他们还完成了狼疮知识评估测试（ LKAT ），该测试由 4 个问题组成，评估 SLE 知识，这些问题是通过共识专家意见确定的，因为它们具有广泛的适用性，并且与疾病的自我管理有关。使用描述性统计和多变量逻辑回归模型分析结果。
在我们的 SLE 队列（n=125）中，33%（32/96）的患者健康素养有限，76%（65/85）的患者计算能力有限。大多数患者正确识别出羟氯喹可预防 SLE 发作（91%）；然而，只有 23%的参与者正确回答了一个评估尿蛋白与肌酐（UPC）比值>1000mg/g 的计算能力问题。平均 LKAT 得分为 4.0 分中的 2.7 分。即使在校正了教育程度后，健康素养有限，而不是计算能力有限，与 SLE 知识较低相关，这是通过 LKAT 测量的。
健康素养有限的 SLE 患者对 SLE 的知识较少。LKAT 可以进一步细化和/或用作识别知识差距患者的筛选工具。需要进一步的工作来提高患者对蛋白尿的理解，并调查是否可以通过敏感阅读的教育来改善护理。
