This study, which appears in the July 24 issue of the Journal of the American Medical Association (JAMA), is the first to demonstrate that lower literacy is associated with worse health outcomes for patients with a chronic medical condition -- even after accounting for patients' educational attainment, age, race, insurance, and diabetes drug regimen.

"Having diabetes and difficulty reading creates a double bind. Diabetes patients rely on a number of tools to manage their disease and prevent serious health problems. For patients with low literacy, it's as though they have received the toolkit, but not the operating instructions," said Dean Schillinger, MD, UCSF assistant professor of medicine at San Francisco General Hospital Medical Center (SFGHMC) and lead author of the study. "Because our health system expects patients to be able to read at a very high level, we may be leaving a lot of patients in the dark."

The diabetes care regimen is one of the most challenging of any for chronic illness, he explained. Patients often must monitor their own blood sugar, manage multiple medications, visit many providers, maintain foot hygiene, adhere to diet and meal plans, and engage in exercise. Patients also have to be able to identify when they are having problems with these functions, problem-solve to prevent crises, and advocate for themselves in what is often an overwhelming health care system. For this reason, diabetes outcomes may be especially sensitive to problems in communication, empowerment, and self-management, Schillinger said.

"When a patient doesn't speak English, the communication problems are obvious. But even if a patient speaks the same language as the health care provider, literacy is often a hidden barrier. We're
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Contact: Maureen McInaney
mmcinaney@pubaff.ucsf.edu
415-476-2557
University of California - San Francisco
23-Jul-2002