The association of health literacy with illness and medication beliefs among patients with chronic obstructive pulmonary disease
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BACKGROUND: Low health literacy is associated with low adherence to self-management in many chronic diseases. Additionally, health beliefs are thought to be determinants of self-management behaviors. In this study we sought to determine the association, if any, of health literacy and health beliefs among elderly individuals with COPD. METHODS: We enrolled a cohort of patients with COPD from two academic urban settings in New York, NY and Chicago, IL. Health literacy was measured using the Short Test of Functional Health Literacy in Adults. Using the framework of the Self-Regulation Model, illness and medication beliefs were measured with the Brief Illness Perception Questionnaire (B-IPQ) and Beliefs about Medications Questionnaire (BMQ). Unadjusted analyses, with corresponding Cohen's d effect sizes, and multiple logistic regression were used to assess the relationships between HL and illness and medication beliefs. RESULTS: We enrolled 235 participants, 29% of whom had low health literacy. Patients with low health literacy were more likely to belong to a racial minority group (p<0.001), not be married (p = 0.006), and to have lower income (p<0.001) or education (p<0.001). In unadjusted analyses, patients with low health literacy were less likely to believe they will always have COPD (p = 0.003, Cohen's d = 0.42), and were more likely to be concerned about their illness ((p = 0.04, Cohen's d = 0.17). In analyses adjusted for sociodemographic factors and other health beliefs, patients with low health literacy were less likely to believe that they will always have COPD (odds ratio [OR]: 0.78, 95% confidence interval [CI]: 0.65-0.94). In addition, the association of low health literacy with expressed concern about medications remained significant (OR: 1.20, 95% CI: 1.05-1.37) though the association of low health literacy with belief in the necessity of medications was no longer significant (OR: 0.92, 95% CI: 0.82-1.04). CONCLUSIONS: In this cohort of urban individuals with COPD, low health literacy was prevalent, and associated with illness beliefs that predict decreased adherence. Our results suggest that targeted strategies to address low health literacy and related illness and medications beliefs might improve COPD medication adherence and other self-management behaviors.
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Mixed-effects modeling accounted for missing data and loss of follow-up of at least 15% for 3 months.
“To assess the effects of the intervention immediately and over time, accounting for missing data and a loss of follow-up of at least 15% for 3 months, a 1:1 allocation ratio, primary outcome analysis implemented mixed-effects modeling, including mixed-model analysis of variance for linear data (63).”
From Promoting Acceptance and Adherence to Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. (2022) · cites this paper as [63]
The Methods (Statistical Analysis; page unavailable) describe chi-square or Fisher’s exact tests, Wilcoxon rank-sum tests, and logistic regression—not mixed-effects modeling. The Discussion (page unavailable) explicitly says the analyses were cross-sectional and that participant follow-up was not yet complete. The paper therefore does not describe a three-month intervention analysis accounting for follow-up loss. (LLM, conf=0.88)
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- Authors
- Kale, M. S., Federman, A. D., Krauskopf, K., Wolf, M., O’Conor, R., Martynenko, M., Leventhal, H., & Wisnivesky, J. P.
- Affiliations
- Icahn School of Medicine at Mount Sinai (US)
- Northwestern University (US)
- Rutgers, The State University of New Jersey (US)
- Corresponding author
- Kale, Minal S.
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2015-04-27
- Volume
- 10
- Issue
- 4
- Pages
- e0123937
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4411058
- OpenAlex
- W2048977676
- Cited by
- 117
- References
- 48
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 10 · 2023: 12 · 2022: 13 · 2021: 13 · 2020: 16 · 2019: 11 · 2018: 13 · 2017: 4 · 2016: 10 · 2015: 3
- FWCI
- 18.24
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Heart, Lung, and Blood Institute (R01HL105385)
- National Cancer Institute (K07CA187071)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Keywords
- health literacy, chronic obstructive pulmonary disease, illness beliefs, medication beliefs, medication adherence, self-management, self-regulation model, Brief Illness Perception Questionnaire, S-TOFHLA, elderly patients, sociodemographic factors, racial minorities, urban population, urban-rural differences, urban health disparities
- MeSH terms
- Aged, Chicago, Female, Humans, Health Knowledge, Attitudes, Practice, Male, Middle Aged, New York, Surveys and Questionnaires, Self Care, Socioeconomic Factors, Logistic Models, Drug Monitoring, Pulmonary Disease, Chronic Obstructive, Medication Adherence, Health Literacy
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