How Do Health Literacy, Numeric Competencies and Patient Activation Impact Transition Readiness in Adolescents and Young Adults with Rheumatologic Diseases?

Samuel Lazaroff¹, Mary-Kate Tompkins², Alexa Meara³, Ellen Peters⁴ and Stacy P. Ardoin⁵, ¹College of Medicine, Ohio State University, Columbus, OH, ²The Ohio State University, Columbus, OH, ³Internal Medicine/Rheumatology, The Ohio State University, Columbus, OH, ⁴Ohio State University, Columbus, OH, ⁵Pediatric & Adult Rheumatology, Ohio State University, Columbus, OH

Meeting: 2017 Pediatric Rheumatology Symposium

Keywords: Adolescence, Transition and health literacy

Session Information

Date: Thursday, May 18, 2017

Title: Clinical and Therapeutic Poster Session

Session Type: Abstract Submissions

Session Time: 5:30PM-7:00PM

Background/Purpose: Transition from pediatric to adult health care is a vulnerable time during which gaps in care may negatively affect disease outcomes. Validated measures including the Transition Readiness Assessment Questionnaire (TRAQ) measure adolescent and young adults’ (AYA) readiness to transition to adult care. Although health literacy affects outcomes in many disease states, few published data address its impact on AYA’s transition readiness. Numeracy reflects individuals’ competency and comfort with numbers and is important in medical decision making. Little is known regarding parent/guardian (PG) literacy, numeracy and activation competencies influence AYA’s transition readiness.

Methods: AYA ages 16-25 years were recruited from outpatient pediatric rheumatology clinics at a single academic institution in this cross-sectional study. Subjects provided demographic information and completed TRAQ 5.0 , Short Form Test of Functional Health Literacy in Adults (STOFHLA), Patient Activation Measure (PAM), Subjective Numeracy Scale, Objective Numeracy Scale and Symbolic-Number Mapping. In addition, when possible, parents/guardians (PG) of AYA completed the same self-report measures excepting TRAQ. Descriptive statistics were performed. Using TRAQ score as dependent variable, multivariable linear regression models were developed using backwards, step-wise regression. P values < 0.05 were considered significant.

Results: Ninety-one AYA and 54 PG completed the study. Participants’ summary demographics and questionnaire scores are provided in Table 1. The majority of AYA (64/91; 70%) had juvenile idiopathic arthritis or rheumatoid arthritis; 4/91 (0.4%) had lupus or mixed connective tissue disease, 2/91 (0.2%) had JDM, and the remainder had other disorders. In a multivariable model, AYA female gender (p<0.01), age (p<0.01) and patient activation score (p<0.001) were independently associated with TRAQ score. The model R²=0.22, suggesting that the included variables accounted for 22% of variability in TRAQ score. In a multivariable model, none of the PG demographic variables or competencies were independently associated with AYA TRAQ scores.

Conclusion: The majority of AYA (98%) and PG (100%) had adequate health literacy, defined as STOFHLA score> 22. AYA with chronic rheumatologic conditions had mean TRAQ scores of 4.0, reflecting an “I am starting to do this” stage of change. AYA older age and female gender predicted higher transition readiness scores which is consistent with the published literature. AYA health literacy and numeracy competencies were not independently associated with transition readiness. Higher patient activation scores predicted higher transition readiness scores which is not surprising as the TRAQ and PAM instruments measure overlapping domains. PG demographics and health competencies were not associated with AYA transition readiness.

Table 1: Demographic Information and Survey Results for Transitioning Adolescents/Young Adults and Their Parents/Guardians
	Adolescent/Young Adult (n=91)	Parent/Guardian (n=54)
Age (years), mean (SD)	19 (1.3)	48 (7.9)
Gender, female n (%)	72 (80%)	45 (87%)
Race, n (%) White Black Other	70 (78.6) 11 (12.4) 8 (9.0)	46 (88.5) 3 (5.8) 3 (5.8)
Education, n (%) 10^th grade 11^th grade 12^th grade Some college/tech school Graduated college/tech school Graduate degree	1 (1.5) 4 (5.8) 18 (26.1) 46 (66.7) 0 0	0 0 9 (16.7) 12 (22.2) 20 (37.0) 13 (24.1)
Annual household Income, n (%) <$25,000 $25,000-49,999 $50,000-74,999 $75,000-99,000 $100,000-150,000 >$150,000	12 (18.5) 11 (16.9) 9 (13.6) 7 (10.8) 14 (21.5) 12 (18.5)	2 (4.0) 9 (18.0) 10 (20.0) 8 (16.0) 13 (26.0) 8 (16.0)
TRAQ score, mean (SD)	4.0 (0.67)	Not done
STOFHLA score, mean (SD)	34.1 (3.5)	37.4 (1.7)
Patient Activation score, mean (SD)	3.2 (0.5)	3.3 (0.4)
Subjective Numeracy Score, mean (SD)	3.8 (1.1)	4.0 (1.0)
Objective Numeracy Score, mean (SD)	3.7 (1.7)	3.8 (1.7)
Symbolic Number Mapping, mean (SD)	-0.87 (0.2)	-0.85 (0.2)
Abbreviations: STOFHLA = Short Form Test of Functional Health Literacy in Adults; TRAQ = Transition Readiness Assessment Questionnaire.

Disclosure: S. Lazaroff, None; M. K. Tompkins, None; A. Meara, None; E. Peters, None; S. P. Ardoin, None.

To cite this abstract in AMA style:

Lazaroff S, Tompkins MK, Meara A, Peters E, Ardoin SP. How Do Health Literacy, Numeric Competencies and Patient Activation Impact Transition Readiness in Adolescents and Young Adults with Rheumatologic Diseases? [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 4). https://acrabstracts.org/abstract/how-do-health-literacy-numeric-competencies-and-patient-activation-impact-transition-readiness-in-adolescents-and-young-adults-with-rheumatologic-diseases/. Accessed .

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