Study: Patients With AD, Limited Health Literacy Face Impaired Quality of Life

A considerable number of patients with atopic dermatitis (AD) showed signs of limited health literacy (HL), which was associated with older age and an impaired health-related quality of life (HRQOL), according to a study published in the Journal of Allergy and Clinical Immunology Global.

The researchers explained that patients with limited HL, defined as the degree to which they can obtain, process, and understand basic health information and services, are less likely to manage chronic diseases appropriately. This is because they generally have less knowledge about their disease, show inadequate self-management, and have poor health outcomes. They noted that, ideally, patients with AD should have high HL, as adequate self-management of the disease can improve outcomes and HRQOL.

The cross-sectional questionnaire-based study to assess the prevalence of limited HL in patients with AD and its association with patient-reported outcome measures, namely disease control, disease severity, HRQoL, and treatment.

The researchers used the European Health Literacy Survey Questionnaire 16 (HLS-EU-Q16) to assess perception-based HL. The HLS-EU-Q16 consists of 16 questions, covering various aspects of health care, disease prevention, and health promotion; responses were categorized as very easy, fairly easy, fairly difficult, and very difficult, with a HL classification of inadequate, problematic, and adequate based on total scores (0-8, 9-12, and 13-16, respectively).

Also, to assess performance-based HL, the researchers used the Newest Vital Sign, a tool that assesses reading and numeral skills with 6 questions related to an ice cream nutrition label; HL was categorized as inadequate (0-3 correct answers) or adequate (4-6 correct answers). Lastly, they measured patient-perceived severity of AD using the Patient-Oriented Eczema Measure, HRQOL with the Dermatology Life Quality Index, and patient-perceived control of AD with the AD Control Tool.

Many patients with atopic dermatitis (AD) and limited health literacy (HL), especially older individuals, experience impaired health-related quality of life (HRQoL) | Image Credit: LIGHTFIELD STUDIOS - stock.adobe.com

The researchers created the study population by using electronic medical records to retrospectively identify patients 18 years or older both diagnosed with AD by a dermatologist and who visited the Department of Dermatology of the University Medical Center Groningen, a tertiary referral center for AD, between 2019 and 2021; eligible patients received a postal or digital survey.

Of those who received surveys, 48.3% (322 participants) responded. The mean (standard deviation [SD]) age of the included patients was 43.6 (16.2) years, and 53.1% of the participants were male. Additionally, according to the Patient-Oriented Eczema Measure, 61.6% of patients had moderate to severe AD, 62.5% used systemic therapy for their AD, 40.2% of the study population’s AD had a moderate to very large effect on their HRQoL, and 38.5% perceived their AD as out of control.

By using the HLS-EU-Q16, the researchers determined that 32.4% have limited HL (8.4% = inadequate; 24.0% = problematic). Also, a logistic regression analysis adjusted for age and sex showed a positive association between limited HL and the group whose AD largely impacted their HRQoL (OR, 2.75; 95% CI, 1.32-5.74).

Conversely, according to the NVS, 20.3% had inadequate HL. After adjusting for age and sex, the NVS showed a positive association between limited HL and older age, especially for those aged 50 years and older (OR, 6.63; 95% CI, 2.97-14.81).

Overall, based on these results, the proportion of patients with limited perception-based HL (32.4%) was higher compared with the proportion with limited performance-based HL (20.3%). Based on these findings, the researchers noted that there may be confusion as to the origin of patients' low HRQoL.

“In general, the symptoms of AD often have a negative impact on a patient’s HRQoL,” the authors wrote. "Furthermore, increased symptoms resulting from difficulties with self-management because of limited HL might indirectly lead to a decline in quality of life. Therefore, the patient’s symptoms could serve as a potential confounding factor, making it challenging to differentiate between the direct impact of limited HL and the influence of symptoms on the quality of life.”

The researchers acknowledged their study’s limitations, one being the self-administered questionnaire. They noted that it could have possibly caused selection bias and, as a result, an underestimation of the problem as patients with limited HL may have been less likely to respond. Despite its limitations, the researchers expressed their confidence in their study’s findings, using them to make suggestions for further research.

“Further research should evaluate the influence of inadequate HL on health outcomes and focus on strategies to improve organizational HL to eventually improve patient-centered care,” the authors concluded.

Reference

Leeman EJ, Loman L. Health literacy in adult patients with atopic dermatitis: A cross-sectional study. J Allergy Clin Immunol Glob. 2024;3(2):100218. doi:10.1016/j.jacig.2024.100218