Background/Purpose:

Vulnerable populations with rheumatoid arthritis (RA) experience poorer health outcomes despite access to current therapies. These disparities may result from limited health literacy, cultural barriers, or mood disorders leading to negative beliefs and concerns about medications, which are in turn associated with poor medication adherence. RA patients with limited health literacy also report suboptimal patient-provider communication and shared decision making, suggesting missed opportunities to address negative beliefs about medications. Prior research has demonstrated these pathways to disparities in other conditions such as HIV but has not been studied in RA. Our objective was to examine associations between health literacy, ethnicity, communication with physicians, and mood, with beliefs about medicine in a diverse population with RA.

Methods:

Data were derived from RA patients enrolled in a longitudinal observational cohort (Rheumatoid Arthritis Outcomes Study or RA OS). Subjects completed a telephone interview in either English or Spanish that included measures of patient-provider communication, health literacy, depressive symptoms (PHQ), demographics and the Beliefs about Medicine Questionnaire (BMQ). Linear regression was performed to identify correlates of the two subscales of the BMQ – necessity of taking RA medications and concerns about medication use and long-term effects.

Results:

Of 438 patients, 88% were female, 29% were Latino, 32% had high school education or less and 30% had limited health literacy. Mean age was 61 (SD 13) years and mean disease duration was 23 (SD 12) years. Subjects with limited health literacy were more likely than those with adequate literacy to be female, of Latino ethnicity, have high school or less education, and have depressed mood. More than half of subjects with adequate health literacy reported their doctor “always” spent enough time with them (63%) compared to only 48% of those with limited health literacy (p=0.006). Subjects with limited health literacy had more concerns about medicines compared to those with adequate literacy (p<0.001) as did those who did not report that their doctor always spend enough time with them (p<0.001). In multivariate linear regression, limited health literacy, depression, Latino ethnicity, female gender, younger age and reports that the doctor did not “always” spend enough time were associated with stronger concerns about medicines. None of these factors was associated with perceived necessity of medicines.

Conclusion:

Among a diverse cohort of adults with RA, limited health literacy, Latino ethnicity, depressed mood and lower perceived quality of communication with the doctor were independently associated with stronger concerns about medicines. This may in turn be associated with poorer adherence and poorer outcomes in these vulnerable populations who also have significant barriers to communication. Future research should focus on knowledge transfer, including evidence based risk and benefit information, and promotion of patient engagement in shared decision making to reduce disparities.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/associations-between-health-literacy-ethnicity-communication-quality-and-beliefs-about-medicines-in-rheumatoid-arthritis/