Glaucoma patients with poor health literacy may have greater disease progression

Glaucoma patients in urban areas who have poor health literacy appear to miss more appointments and to have worse disease understanding and greater disease progression than patients with adequate health literacy, according to a report in the May issue of Archives of Ophthalmology, one of the JAMA/Archives journals.

"Health literacy, as a discrete form of literacy, is increasingly important in health care," according to background information in the article. "The U.S. Department of Health and Human Services defines health literacy as 'the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions'."

Mark S. Juzych, M.D., M.H.S.A., of the Kresge Eye Institute, Wayne State University, Detroit, and colleagues used a standardized test to determine the health literacy of 204 English-speaking patients treated for glaucoma for at least one year. Patients' demographic information and glaucoma understanding were assessed through an oral questionnaire.

Of the 204 glaucoma patients, half were categorized 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 authors write.

On average, the poor literacy group had lower glaucoma understanding, missed more appointments per year and reported having missed taking eye drops more frequently than those in the adequate literacy group, with 65 patients having missed taking eye drops two or more times per month compared with only 34 patients in the adequate literacy group. 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.

"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 conclude. "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."