Background/Purpose: Low health literacy is common among US adults, including patients with SLE, and is associated with higher disease activity and worse patient-reported outcomes. The complex nature of managing lupus puts SLE patients with low health literacy at even greater risk of poor outcomes. Limited health literacy has also been associated with worse patient-provider communication in other chronic diseases, though this has not been evaluated in SLE. Our study aimed to explore the relationship between health literacy and patient-provider communication in patients with SLE.

Methods: Patients with SLE meeting ACR/SLICC criteria were recruited from a university lupus clinic. Patient-provider communication data, as measured by the Interpersonal Processes of Care (IPC-29) survey, with a 0-5 range, were collected 7/2018-1/2019. On the IPC-29 survey, we considered a difference of ≥ 0.5 points by median score as clinically significant for each individual question. Health literacy was assessed using the Newest Vital Sign (NVS), a validated 6-item measure of reading comprehension and numeracy; limited health literacy was defined as NVS < 4. The NVS was administered from 9/2020-2/2021 during routine clinic visits and over video call. We compared characteristics median IPC-29 scores between limited and adequate health literacy groups by descriptive statistics, and we stratified the IPC-29 domains by race.

Results: The study included 58 SLE patients (48% white, 48% Black, 5% Hispanic). Median age was 41 years; 97% were female, 59% had at least a college education, and 57% had Medicare or Medicaid, and 45% were on disability. 26% of our cohort was found to have limited health literacy.

Compared to adequate health literacy, those with limited health literacy were more likely to be Black, have Medicare/Medicaid, be on disability, have less than a college education, and have an annual income of ≤$50,000. Patients with limited health literacy were more likely to rate their providers as speaking too quickly, using difficult words, not finding out concerns, and not involving the patient in treatment decisions (Table 1).

Non-Black patients with limited health literacy reported lower provider eliciting of patient concerns, higher discrimination and worse physician compassion and respect compared to those with adequate health literacy. On the other hand, among Black patients, those with limited health literacy reported lower patient-centered decision making (Table 2).

Conclusion: Our results show that low health literacy is common, affecting 1 in 4 patients with SLE. While we did not find major differences in overall perceived communication based on level of health literacy, there were some notable differences in the eliciting concerns, patient-centered decision-making, and compassionate/respectful sub-domains by race. Our results suggest that avoiding fast speech and increasing patient involvement in decision making may be important in improving the patient-provider relationship, especially for those with low health literacy.

« Back to ACR Convergence 2021

ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-of-limited-health-literacy-with-patient-provider-communication-in-systemic-lupus-erythematosus/