Tailored education may reduce health literacy disparities in asthma self-management

Rationale: Although inadequate health literacy has been associated with lower asthmamedication knowledge andworsemetered-dose inhaler (MDI) technique, the relationship between health literacy and the capacity to learn asthma self-management skills is unknown. Objectives: In this prospective cohort study of adults hospitalized for severe asthma exacerbations at two inner-city hospitals, we examined the relationship between inadequate health literacy and difficulties learning and retaining instructions about dischargemed-ications and appropriate MDI technique. Methods: At hospital discharge, participants received one-on-one, 30-min, guideline-based, written and oral instruction about their asthma discharge regimen as well as appropriate MDI technique. Measurements and Main Results: Seventy-three patients were en-rolled. Inadequate health literacy was identified in 16 (22%) partici-pants. Before instruction, inadequate health literacy was associated with lower asthma medication knowledge (5.2/10 vs. 7.2/10, p 0.001) and worse MDI technique (3.2/6 vs. 3.9/6, p 0.03). How-ever, inadequate health literacy was not associated with difficulty learning (p 0.33) or retaining (p 0.35) instructions about the discharge regimen. Similarly, inadequate health literacy was not associated with difficulty learning (p 0.26) or retaining (p 0.97) appropriate MDI technique. Results were similar in multivariable models adjusted for demographic characteristics and asthma sever-ity indicators. Conclusions: These findings suggest that inadequate health literacy is a surmountable barrier to learning and remembering key asthma self-management skills