ArticlesLiteracy and Numeracy Skills and Anticoagulation Control
Section snippets
Methods
We performed a prospective cohort study among patients taking warfarin. We included patients over the age of 50 attending two outpatient anticoagulation management units who had been taking warfarin for at least 1 month. One unit was university-based (staffed by a registered nurse) and the other was based at a Veterans Affairs hospital (staffed by a Doctor of Pharmacy and a registered nurse). A convenience sample of patients were recruited during their regular visits over a 7-month period
Results
During the study period, 510 patients were enlisted at the anticoagulation management units. Of those, 184 patients who were eligible for the study were approached, 143 agreed to participate (77.7%), and 41 did not agree or were excluded from the study. Patients declined to participate due to lack of time (n = 24), lack of interest (n = 9), or other reasons (n = 9) (one patient had more than one reason). The other patients in the anticoagulation units were not approached because the recruiter was not
Discussion
Low literacy was prevalent among study patients on chronic warfarin therapy; more than half were unable to read health-related words written at levels beyond the eighth grade level. Not unexpectedly, the self-reported grade completed overestimated the patients’ ability to read. In our study, patients had difficulty computing basic mathematical concepts; about half of them were unable to answer more than three mathematical questions. Most importantly, we found that a patient’s inability to read
Acknowledgments
We thank Ms. Laurin Gibson and Mrs. Amy Jackson for technical assistance and Don Holbert, PhD, for statistical assistance. We also thank Drs. Elizabeth L. McNeill, Sangnya Patel, and Gregg Talente for reviewing prior versions of this manuscript.
References (27)
- et al.
Health literacy and health-related knowledge among persons living with HIV/AIDS
Am J Prev Med
(2000) - National Center for Education Statistics. 1992 National Adult Literacy Survey. Available at:...
- et al.
Health literacy among Medicare enrollees in a managed care organization
JAMA
(1999) Health literacy: report of the Council on Scientific Affairs. Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association
JAMA
(1999)- et al.
Inadequate functional health literacy among patients at two public hospitals
JAMA
(1995) - et al.
The role of numeracy in understanding the benefit of screening mammography
Ann Intern Med
(1997) - et al.
Acetaminophen and other risk factors for excessive warfarin anticoagulation
JAMA
(1998) - et al.
Rapid estimate of adult literacy in medicine: A shortened screening instrument
Fam Med
(1993) - et al.
The risk for and severity of bleeding complications in elderly patients treated with warfarin. The National Consortium of Anticoagulation Clinics
Ann Intern Med
(1996) - et al.
Risk factors for complications of chronic anticoagulation. A multicenter study. Warfarin Optimized Outpatient Follow-up Study Group
Ann Intern Med
(1993)
A method to determine the optimal intensity of oral anticoagulant therapy
Thromb Haemost
Relationship between test frequency and outcomes of anticoagulation: a literature review and commentary with implications for the design of randomized trials of patient self-management
J Thromb Thrombolysis
The role of compliance as a cause of instability in oral anticoagulant therapy
Br J Haematol
Cited by (171)
The predictive power of exponential numeracy
2022, Journal of Experimental Social PsychologyAbility-related political polarization in the COVID-19 pandemic
2021, IntelligenceCitation Excerpt :It is troublesome that education and attention to news did not predict attitudes and behaviors as much as ideology: People with more information and greater skill to use it should have greater understanding and make more normative choices, consistent with public health guidelines. In fact, for most non-COVID-19-related issues, greater intelligence and specific cognitive abilities (e.g., knowledge, numeracy, literacy) are associated with more accurate decisions (e.g., Bruine de Bruin, Parker, & Fischhoff, 2007; De keersmaecker & Roets, 2017; Klaczynski & Felmban, 2020; Murphy & Hall, 2011; Peters et al., 2006; Stanovich & West, 2008), taking more protective health behaviors (e.g., Dieckmann et al., 2015), and better health outcomes (e.g., Cavanaugh et al., 2008; Estrada, Martin-Hryniewicz, Peek, Collins, & Byrd, 2004; Gottfredson & Deary, 2004; Peters et al., 2017). Cognitive ability should help people evaluate evidence in more normative fashion and come to accurate conclusions about how to respond to COVID-19.
This work was supported by grant NR 04716 from the National Institute of Aging, National Institute of Nursing Research, and Office of Research on Minority Health from the Center on Minority Aging, University of North Carolina at Chapel Hill, and a Faculty Research Grant from the Brody School of Medicine at East Carolina University.