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A Randomized Controlled Trial of a Literacy-Sensitive Self-Management Intervention for Chronic Obstructive Pulmonary Disease Patients

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Abstract

Background

Low literacy skills are common and associated with a variety of poor health outcomes. This may be particularly important in patients with chronic illnesses such as chronic obstructive pulmonary disease (COPD) that require appropriate inhaler technique to maintain quality of life and avoid exacerbations.

Objective

To explore the impact of a literacy-sensitive self-management intervention on inhaler technique scores in COPD patients and to determine if effects differ by literacy.

Design

Randomized controlled trial.

Participants

Ninety-nine patients with COPD.

Intervention

Patients were randomly assigned to a one-on-one self-management educational intervention or usual care. The intervention focused on inhaler technique, smoking cessation, and using a COPD action plan.

Main Measures

At baseline, an inhaler technique assessment, literacy assessment, health-related quality of life questionnaires, and pulmonary function tests were completed. Inhaler technique was re-evaluated after two to eight weeks.

Key Results

Mean age 63, 65% female, 69% Caucasian, moderate COPD severity on average, 36% with low literacy, moderately impaired health-related quality of life, and similar baseline metered dose inhaler technique scores. Patients in the intervention group had greater mean improvement from baseline in metered dose inhaler technique score compared to those in the usual care group (difference in mean change 2.1, 95% CI 1.1, 3.0). The patients in the intervention group also had greater mean improvements in metered dose inhaler technique score than those in the usual care group whether they had low health literacy (difference in mean change 2.8, 95% CI 0.6, 4.9) or higher health literacy (1.8, 95% CI 0.7, 2.9).

Conclusions

A literacy-sensitive self-management intervention can lead to improvements in inhaler technique, with benefits for patients with both low and higher health literacy.

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Acknowledgements

Prior poster presentation at the 2007 American Society of Health-System Pharmacists Midyear Meeting in Las Vegas and prior oral presentation at the 2009 Society of General Internal Medicine Annual Meeting in Miami, FL (title: Randomized Controlled Trial of a Self-management Intervention in COPD Patients with Low Health Literacy).

Conflict of Interest

None disclosed.

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Katie Kiser PharmD, BCPS.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Online Appendix 1

Living With COPD Handout (PDF 2.20 MB)

Online Appendix 2

Percentage of Subjects Achieving each Inhaler Technique Score at baseline and follow-up for the Intervention and Usual Care groups (DOC 87.5 KB)

Online Appendix 3

Percentage of Subjects with Incorrect Inhaler Technique for each Item at baseline and follow-up for the Intervention and Usual Care groups (DOC 89.5 KB)

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Kiser, K., Jonas, D., Warner, Z. et al. A Randomized Controlled Trial of a Literacy-Sensitive Self-Management Intervention for Chronic Obstructive Pulmonary Disease Patients. J GEN INTERN MED 27, 190–195 (2012). https://doi.org/10.1007/s11606-011-1867-6

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  • DOI: https://doi.org/10.1007/s11606-011-1867-6

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