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Health literacy in hemodialysis patients

Green J, Mor MK, Shields A, Porter P, Palevsky P, Fine MJ, Arnold RM, Weisbord SD. Health literacy in hemodialysis patients. Poster session presented at: American Society of Nephrology Renal Week Annual Meeting; 2009 Oct 30; San Diego, CA.


INTRODUCTION: Past research suggests that approximately one third of dialysis patients have inadequate health literacy; however, these estimates are from small studies. We sought to characterize the prevalence and demographic associations of health literacy in a larger cohort of patients receiving maintenance hemodialysis. METHODS: As part of a prospective clinical trial of symptom management strategies in patients receiving chronic hemodialysis at eight dialysis units, we assessed health literacy using the Rapid Estimate of Adult Literacy in Medicine (REALM), a widely used and validated 66-item word-recognition tool. REALM scores range from 0 to 66. Inadequate health literacy is defined as a score < 60, which correlates with less than 9th grade reading level. RESULTS: Of 240 clinical trial participants, 213 completed the REALM. The mean age was 62 yrs, 56% were male, 54% were white, and 100% reported English to be their primary language. Overall, 35 patients (15%) demonstrated inadequate health literacy. Of these, 66% reported a high school equivalent or higher level of education. African-Americans were significantly more likely to demonstrate inadequate health literacy than whites (24.7% vs. 10.4%, p = 0.01). There was no difference in the mean age of patients with adequate health literacy and those with inadequate health literacy (62 v. 63 years, p = 0.8) There was a trend toward lower health literacy among patients with lower annual incomes (p = 0.09). CONCLUSIONS: Although we found lower rates of inadequate health literacy than reported in past studies, this problem is common among hemodialysis patients, even among high school graduates. Future studies should assess the clinical implications of inadequate health literacy in the ESRD population.

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