School of Medicine

Wayne State University School of Medicine

Lower health literacy worsens glaucoma, study finds

Mark Juzych, M.D.

Mark Juzych, M.D.

Glaucoma patients living in urban areas who have poor health literacy miss more appointments, don’t understand their condition thoroughly and exhibit greater disease progression than patients with adequate health literacy, according to a study conducted by a Wayne State University School of Medicine research team and reported in the May issue of Archives of Ophthalmology.

“Health literacy, as a discrete form of literacy, is increasingly important in health care,” states the article, “Functional Health Literacy in Patients With Glaucoma in Urban Settings.” Health literacy, as defined by the U.S. Department of Health and Human Services, is the ability of patients to obtain, process and understand basic health information and the services they require to make appropriate health decisions.

Mark S. Juzych, M.D., M.H.S.A., associate chair of the Department of Ophthalmology for the School of Medicine and the Kresge Eye Institute, and his colleagues used a standardized test to determine the health literacy of 204 English-speaking patients treated for glaucoma for at least one year. The team used an oral questionnaire to determine the patients’ demographic information and glaucoma understanding.

The team categorized half of the patients as having poor health literacy and the other half were categorized as having adequate health literacy.

“Being of white race, having an education of some college or more and having a household income of $20,000 or greater was associated with a lower likelihood of having poor health literacy,” the article states.

Members of the poor literacy group had less understanding of their glaucoma. They also missed more appointments per year and reported that they missed taking eye drops more frequently than those in the adequate literacy group, Dr. Juzych said. Sixty-five patients reported that they missed administering eye drops two or more times per month; only 34 patients in the adequate literacy group reported the same.

Patients with poor health literacy also showed greater visual field loss at the beginning of the study and significantly worse visual field parameters when comparing recent and initial visual fields, Dr. Juzych said.

“Closing the gap in health literacy is one essential component in reducing disparities in glaucoma care. Screening patients for poor literacy is a first step,” the authors concluded. “However, the real challenge is in shaping effective public health communication that is culturally and linguistically appropriate for patients and promotes compliance with medications and follow-up treatment with their physicians. … In addition, there is a need to improve physician communication, which should consider the needs and competencies of patients with poor health literacy.”

Dr. Juzych said it is incumbent upon physicians to ensure patients understand their condition and treatment regimen, and to ascertain their level of health literacy.

“It has to be something more than ‘here’s your prescription’ and out the door. We have to determine their literacy level and make sure they understand,” he said. “Some groups are doing it with pictures if there is a literacy or language barrier. Physicians need to be able to get a pretty good sense of the patient’s abilities.”

The results of the study, Dr. Juzych said, hold “important implications” for all levels of the health care delivery system, beginning with the patient and his or her physician.

Since symptoms appear only in advanced stages, people with glaucoma are often not aware they have the condition. In developed countries, only 50 percent of glaucoma cases have been identified.

“Because early detection of glaucoma is the key to preventing its progression, the need to enhance health literacy of glaucoma awareness, particularly among high-risk groups, is crucial,” the article states. “The patient who walks through the examination room door may have gained access to a medical facility, but access to effective health care will remain elusive if communication barriers have not been fully addressed.”

The study calls for further research to focus on effective health education techniques to combat chronic disease outcomes, as well as improving physician communication to consider the competency patients with poor health literacy.

Other members of the research team include Sandeep Randhawa, M.D.; Aman Shukairy, M.D.; Padmini Kaushal, M.D.; Anju Gupta, M.D.; and Nadia Shalautoa, Sc.D., M.S., of the Michigan Public Health Institute.

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