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Association of Limited Health Literacy With Clinical and Patient‐Reported Outcomes in Individuals With Systemic Lupus Erythematosus

dc.contributor.authorMithu Maheswaranathan
dc.contributor.authorAndrea D. Boan
dc.contributor.authorViswanathan Ramakrishnan
dc.contributor.authorHetlena Johnson
dc.contributor.authorJillian Rose
dc.contributor.authorClara L. Dismuke‐Greer
dc.contributor.authorJim C. Oates
dc.contributor.authorLeonard E. Egede
dc.contributor.authorEdith Williams
dc.contributor.otherDuke University Durham North Carolina
dc.contributor.otherMedical University of South Carolina Charleston
dc.contributor.otherMedical University of South Carolina Charleston
dc.contributor.otherLupus Columbia South Carolina Columbia South Carolina
dc.contributor.otherHospital for Special Surgery New York City New York
dc.contributor.otherHealth Economics Resource Center, Veterans Affairs Palo Alto Health System Menlo Park California
dc.contributor.otherMedical University of South Carolina Charleston
dc.contributor.otherMedical College of Wisconsin Milwaukee
dc.contributor.otherMedical University of South Carolina Charleston
dc.date.accessioned2025-10-09T04:53:43Z
dc.date.available2025-10-09T04:53:43Z
dc.date.issued01-11-2024
dc.identifier.urihttps://doi.org/10.1002/acr2.11719
dc.identifier.urihttp://digilib.fisipol.ugm.ac.id/repo/handle/15717717/40828
dc.description.abstractObjective 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. Methods 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. Results 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. Conclusion 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.
dc.language.isoEN
dc.publisherWiley
dc.subject.lccDiseases of the musculoskeletal system
dc.titleAssociation of Limited Health Literacy With Clinical and Patient‐Reported Outcomes in Individuals With Systemic Lupus Erythematosus
dc.typeArticle
dc.description.pages780-789
dc.description.doi10.1002/acr2.11719
dc.title.journalACR Open Rheumatology
dc.identifier.e-issn2578-5745
dc.identifier.oaioai:doaj.org/journal:8946c7c5aa664ded95a3b8709bfaed9b
dc.journal.infoVolume 6, Issue 11


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