Health literacy and adherence to glaucoma therapy

PURPOSE: To describe the health literacy of subjects with open angle glaucoma and to investigate the hypothesis that low health literacy is associated with poor glaucoma medication adherence. DESIGN: Cross-sectional patient survey and concomitant chart review. METHODS: One hundred and ninety-seven subjects with open angle glaucoma participated in a survey which included basic demographic information such as age, gender, ethnicity, and level of education completed, and a test of heath literacy, the Rapid Assessment of Adult Literacy in Medicine. Information was collected regarding visual field tests and prescribed medication. The subjects' pharmacies were contacted to ascertain the number of refills requested over the previous six months. RESULTS: Although 146 subjects (74%) reported completing high school, only 94 subjects (48.0%) read at or above a ninth grade level; 23 (11.7%) read at a level of third grade or below. The mean number of refills requested by a subject in the preceding six months was not predicted by race (P =.27) gender (P =.31), age (P =.92), mean deviation of the visual field (P =.36), or level of education (P =.58). There was a positive relationship between health literacy and the number of refills obtained (P =.003). CONCLUSIONS: Many patients with open angle glau-coma may have poor health literacy. The subjects in our study with low literacy were less adherent with their glaucoma medications than those with a higher level of literacy. Interventions specifically targeting patients with low literacy may improve medication adherence.