Inadequate Health Literacy Is Associated With Suboptimal Health Beliefs in Older Asthmatics

Objectives. To examine the relationship between suboptimal asthma beliefs and inadequate health literacy among older adults with asthma. Methods. The authors interviewed 100 English-and Spanish-speaking asthmatics (ages >= 50 years) in a New York City primary care clinic (response, 83%). Outcomes included the belief that one does not have asthma when symptoms are absent (no symptoms-no asthma), that asthma is temporary, is curable, and that medications work better if not used all the time. Health literacy was measured using the Short Test of Functional Health Literacy in Adults. Belief and health literacy associations were measured with multivariable logistic regression adjusting for age, sex, and race. Results. The mean age was 61 years; 35% had inadequate health literacy. Those with inadequate literacy were more likely than those with adequate or marginal literacy to have suboptimal beliefs: no symptoms-no asthma, 60% versus 34%, p = .01; temporary, 23% versus 9%, p = .07; curable, 54% versus 25%, p = .004; medication use, 44% versus 21%, p = .03. These relationships remained statistically significant in multivariable analyses that adjusted for age, sex, and race. Conclusions. Suboptimal asthma beliefs were more common among older asthmatics with inadequate health literacy. Interventions to improve asthma self-management in older adults should address both belief and health literacy barriers.