AHRQ-funded Health Literacy Tool Improves Care for COPD Patients in Spain

Grupo Saned, a health care and pharmaceutical marketing company in Barcelona, Spain, used an AHRQ-funded health literacy scale—Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA)—in a study aimed at improving care for patients with chronic obstructive pulmonary disease (COPD), a chronic condition with no cure where both bronchitis and emphysema are present.

The study was implemented on behalf of the Spanish Society of Pulmonology and Thoracic Surgery (Sociedad Española de Neumología y Cirugía Torácica or SEPAR), a nonprofit organization representing about 3,700 respiratory health and lung specialists in Spain.

The SAHLSA helped the group estimate COPD patients' capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. In addition to assessing health literacy, the study also examined COPD's correlation to socioeconomic variables, comorbidity, doctors' visits, and income.

Influenced by the study findings, SEPAR is developing strategies to improve health literacy, including more patient training and disseminating information to scientific societies. SEPAR plans to advocate for increasing the population's health knowledge by introducing basic health terms in upper elementary through high school.

Developed by AHRQ-funded researcher Shoou-Yih Daniel Lee, Ph.D., and colleagues, the SAHLSA is a validated health literacy assessment tool containing 50 items designed to determine a Spanish-speaking adult's ability to read and understand common medical terms. It is based on AHRQ's Rapid Estimates of Adult Literacy in Medicine (REALM) health literacy assessment, but takes into account that Spanish is a phonetic language.

The study was implemented during 2013 throughout Spain. "We conducted the study with the collaboration of 102 pulmonologists from public hospitals and private practice," said Luis Puente Maestu, M.D., scientific coordinator of the study and pulmonologist at the Gregorio Marañón General University Hospital in Madrid. "A total of 281 patients with COPD participated in the research."

Nearly nine percent of Spain's total adult population has COPD. According to Dr. Maestu, the research results were key to identifying the health literacy levels of these patients and for developing health literacy strategies to improve patients' understanding of health information and medical instructions.

"The study results revealed that only 43.4 percent of the patients demonstrated adequate health literacy. The average SAHLSA score for the participants was 35.3," Dr. Maestu noted. Adequate health literacy scores are 37 points or higher.

The study also collected demographic data about patients' conditions, comorbidities, and prior worsening of symptoms. Findings showed that patients with inadequate health literacy were older, averaging 67.3 years old, had a higher body mass index (27 or higher), higher comorbidity rates, and presented with more symptoms. Grupo Ferrer, an international pharmaceutical company, sponsored the study.