Maheswaranathan Mithu, Boan Andrea D, Ramakrishnan Viswanathan, Johnson Hetlena, Rose Jillian, Dismuke-Greer Clara L, Oates Jim C, Egede Leonard E, Williams Edith
Duke University, Durham, North Carolina.
Medical University of South Carolina, Charleston.
ACR Open Rheumatol. 2024 Nov;6(11):780-789. doi: 10.1002/acr2.11719. Epub 2024 Aug 18.
Health literacy is an important social determinant of health, with limited health literacy associated with worse health outcomes. This study examined the associations between limited health literacy with patient-reported outcomes and disease activity/damage among 267 Black women with active systemic lupus erythematosus (SLE) enrolled in the Peer Approaches to Lupus Self-Management (PALS) program.
The three-item Chew Health Literacy Screening was used to dichotomize those reporting in the "limited" range on any item with outcomes compared via generalized linear models. Baseline surveys and assessments obtained at study entry as part of the PALS study were used. Primary outcomes included disease activity and lupus damage; other secondary outcomes included patient activation, self-efficacy, physician/patient communication, and quality of life.
The study included 267 Black women with SLE. In covariate-adjusted analyses, participants with limited health literacy (88 [33%]) were more likely to have lower patient activation (Patient Activation Measure P < 0.0001), lower self-efficacy (Lupus Self-Efficacy P < 0.0001), higher lupus damage (self-administered Brief Index of Lupus Damage P = .016), higher disease activity (Systemic Lupus Activity Questionnaire symptom severity P = 0.006), and worse physician/patient communication (patient-centered care P < 0.0001) compared to those with adequate health literacy. Those with limited health literacy also reported worse lupus quality of life (P = 0.0004) and greater levels of stress (Perceived Stress Scale-4 P < 0.0001) and were 2.4 times more likely to have probable major depression (Patient Health Questionnaire Depression Scale-8 of ≥10 P = 0.004) and probable anxiety disorder (General Anxiety Disorder-7 of ≥10 P = 0.007) compared to those with adequate health literacy.
Black women with SLE and limited health literacy have worse clinical outcomes and represent a particularly vulnerable population with significantly disparate health outcomes. These findings suggest health literacy and complexities of managing SLE may impair clinical care in multiple domains, ultimately contributing to higher disease activity and death/damage, and are important to address in clinical care and future interventions in patients with SLE.
健康素养是健康的重要社会决定因素，健康素养有限与较差的健康结果相关。本研究调查了267名参与狼疮自我管理同伴方法（PALS）项目的活动性系统性红斑狼疮（SLE）黑人女性中，健康素养有限与患者报告结局以及疾病活动/损伤之间的关联。
使用三项咀嚼健康素养筛查工具，将在任何一项上报告处于“有限”范围的人群进行二分法划分，并通过广义线性模型比较其结局。使用了作为PALS研究一部分在研究入组时获得的基线调查和评估。主要结局包括疾病活动和狼疮损伤；其他次要结局包括患者激活、自我效能感、医患沟通和生活质量。
该研究纳入了267名患有SLE的黑人女性。在协变量调整分析中，与健康素养充足的参与者相比，健康素养有限的参与者（88人[33%]）更有可能具有较低的患者激活水平（患者激活量表P<0.0001）、较低的自我效能感（狼疮自我效能量表P<(0.0001)）、较高的狼疮损伤（自我管理的狼疮损伤简要指数P=0.016）、较高的疾病活动度（系统性狼疮活动问卷症状严重程度P=0.006）以及较差的医患沟通（以患者为中心的护理P<0.0001）。健康素养有限的参与者还报告了更差的狼疮生活质量（P=0.0004）、更高水平的压力（感知压力量表-4 P<0.0001），并且与健康素养充足的参与者相比，患可能的重度抑郁症（患者健康问卷抑郁量表-8≥10分P=0.004）和可能的焦虑症（广泛性焦虑障碍-7≥10分P=0.007）的可能性高出2.4倍。
患有SLE且健康素养有限的黑人女性临床结局较差，是一个健康结局差异显著的特别脆弱的人群。这些发现表明，健康素养以及SLE管理的复杂性可能会在多个领域损害临床护理，最终导致更高的疾病活动度以及死亡/损伤，在SLE患者的临床护理和未来干预中解决这些问题非常重要。
