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Health literacy, cognitive ability may affect COPD self-management behaviors

Limited health literacy and fluid cognitive ability deficits are associated with lower adherence to self-management behaviors in patients with COPD, an observational cohort study suggests.

“Patients may initially comprehend new information while within a health care encounter, but they may have difficulty later recalling this information when they return home and must execute these behaviors,” the researchers wrote. “Additionally, patients may experience difficulty processing medical information presented to them in a rapid verbal interaction, which is commonplace during health care encounters.”

Researchers examined 482 adults with COPD from November 2011 to January 2015 via in-person interviews, with follow-up visits occurring at 6, 12, 18 and 24 months. Community-dwelling patients aged 55 years or older who spoke English and Spanish were included in the analysis. Patients who had asthma or a chronic respiratory illness, any neurological or psychological conditions that greatly affect cognition, a chart documented dementia diagnosis or more than two errors on a six-item dementia screening tool were excluded.

Ability to administer dry powder and metered-dose inhalers was assessed using prevalidated, standardized checklists, and adherence to COPD medication was measured via self-reporting to the Medication Adherence Reporting Scale. The reading comprehension portion of the Short Test of Functional Health Literacy in Adults was used to gauge health literacy, and a patient’s fluid cognitive ability was assessed using the Size Judgement Span task for working memory, the Pattern Comparison test for processing speed, the New York University Paragraph Recall test for long-term memory and the Trail Marking Test for executive function. To measure crystallized and global cognitive abilities, the animal naming task and Mini-Mental State Examination were used, respectively.

Chi-square statistics and t tests were utilized to compare differences in self-management by global cognitive and health literacy levels. Adequate health literacy was tied to adequate adherence to medication (OR = 1.46; 95% CI, 1.02-2.08), as well as correct dry powder (OR = 2.17; 95% CI, 1.3-3.64) and metered-dose (OR = 1.66; 95% CI, 1.13-2.44) inhaler technique. Additionally, fluid cognitive abilities were associated with visiting a COPD health care provider in the past 12 months (OR = 1.42; 95% CI, 1.01-1.99) as well as medication adherence (OR = 1.74; 95% CI, 1.37-2.21) and proper inhaler technique. However, crystalized cognitive abilities were not associated with medication behaviors or regular visits to health care providers, and global cognitive abilities were associated only with correct metered-dose and dry powder inhaler technique.

“Our findings support the need to incorporate health literacy and cognitive science best practices in managing patients with COPD,” the researchers wrote. “Self-management education materials for this population should be designed with features that support understanding of printed materials.” – by Eamon Dreisbach

Disclosures: O’Conor reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.