Another BIG issue that we all tend to forget about that most certainly does affect the prevalance of eye disease in PWDs is health illiteracy.
Inadequate health literacy has been found to be independently associated with worse glycemic control and higher rates of retinopathy among primary care patients with type 2 diabetes, and it may contribute to the disproportionate burden of diabetes-related problems among disadvantaged populations (excerpt from the National Eye Health Education Program Five-Year Agenda).
The National Assessmemt of Adult Literacy (NAAL) measures the health literacy of adults living in the United States. Health literacy was reported using four performance levels: Below Basic, Basic, Intermediate, and Proficient. According to the NAAL, in 2003, approximately:
--36% of adults in the U.S. have limited health literacy
--22% have Basic
--14% have Below Basic health literacy.
--Additional 5% is not literate in English.
--Only 12% has a proficient health literacy level.
In recent years, the Institute of Medicine and the Agency for Healthcare Quality and Research published reports linking low health literacy with negative patient outcomes. The problem of low health literacy is also increasingly recognized as a problem that influences health care quality and costs.
Health literacy has an effect on a person’s ability to make sound health decisions about his or her health care, and it has a significant impact on the effectiveness of education efforts.
Patients with limited health literacy are more likely not to use preventive health services such as vaccinations and mammograms, and more likely to improperly read medication dosing instructions and referral paperwork.
In a series of focus groups and interviews with patients who have inadequate or marginal health literacy, the patients reported experiencing problems with:
--following medication instructions
--participating in provider-patient interactions
--reading appointment slips, and
--using coping strategies
A study among African American adults suggests that patients who have marginal or inadequate functional health literacy will have difficulty reading, understanding, and interpreting most written health texts and instructions. In Hispanic/Latino populations, these health literacy problems can be further complicated for those with limited English proficiency.
Studies attest that health literacy is also a marked problem among older adults. One study found that there was considerably higher prevalence of inadequate and marginal health literacy among people aged 85 and older.
A second study found this higher prevalence exists even in an affluent geriatric retirement community.
Failing eyesight, reduced memory, and hearing loss have been found to be variables that adversely affect reading ability and impact health outcomes.
These findings are particularly troubling given that eye disease and low vision noticeably increase with older age and that the average life span for Americans is increasing over time. The higher prevalence of poorer reading and comprehension with aging heightens the need to develop additional or different communications strategies that can address health literacy across diverse groups, but with particular attention to those over the age of 65.
This information is very disconcerting, especially in regard to helping our patients understand the connection between diabetes and eye disease (and how to decrease the risk) given the high rates in health illiteracy.
Mary Ann Hodorowicz