Health Literacy Rates in a Population of Patients with Rheumatoid Arthritis in Southwestern Ontario

Perceptions towards biologic and biosimilar therapy of patients with rheumatic and gastroenterological conditions

BACKGROUND

Biologic and targeted synthetic disease modifying agents (b/tsDMARDs) have broadened the treatment landscape for autoimmune diseases particularly in patients refractory to conventional DMARDs. More recently, the introduction of biosimilars has reduced the price of bDMARDs, potentially improving accessibility. Though efficacy and safety have been described, patient attitudes to b/tsDMARDs are not well-understood. We aim to investigate patients' beliefs about biologic and biosimilar therapy, and the factors influencing their perceptions.

METHODS

Patient consumer groups (Arthritis Australia, Crohn's and Colitis Australia) assisted in advertising an online questionnaire for people with a self-reported diagnosis of inflammatory arthritis (IA) or inflammatory bowel disease (IBD). The questionnaire incorporated the Belief about Medicines Questionnaire (BMQ) and the single-item literacy screener (SILS). Sources and favourability of biologic/biosimilar information were analysed, using the chi-square and a non-parametric trend test for unordered and ordered categorical variables respectively, comparing respondents with IA and IBD.

RESULTS

Eight hundred and thirty eight people (686-IA, 144-IBD, 8 both) responded. 658 (79%) used b/tsDMARDs. The BMQ demonstrated high necessity belief (median 4.2) with moderate concerns (median 2.8) about biologics. 95% of respondents obtained medication information from specialists though most used multiple sources (median 4). The most positive resources were specialists and specialist nurses. 73/141 (52%) respondents with IBD obtained information from specialist nurses compared with 202/685 (29%) with IA (p = 0.012). Respondents with limited reading ability on SILS were more likely to discuss information with a general practitioner or pharmacist. Younger respondents and those with higher BMQ concern scores more frequently consulted less reliable sources (e.g. social media). 502 respondents (60%) answered the biosimilar questions. Only 23 (4.6%) reported currently using a biosimilar and 336 (66.9%) were unsure if biosimilars were available in Australia. Specialist recommendation was the most frequent factor that would influence a patient to change from originator to biosimilar (352/495, 71.1%).

CONCLUSIONS

There is a high level of trust in specialists' recommendations about b/tsDMARDs, although most people also utilise additional information sources. Contextual factors influencing resource selection include age, reading ability and degree of concern about medicines. People with IA and IBD have similar attitudes though those with IBD more frequently access specialist nurse advice.

Self-Efficacy of Saudi Patients with Autoimmune Diseases in Managing Hydroxychloroquine-Induced Ocular Complications: A Cross-Sectional Survey

Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are common autoimmune diseases (AD) that affect joints and have multi-organ involvement that results in disability, morbidity, and increased mortality. Both conditions are known to cause a wide range of ocular manifestations. Antimalarial drugs, mainly hydroxychloroquine (HCQ), are among the treatment options for AD that is uniquely characterized by retinopathy as a main side effect. This study examines self-efficacy levels in autoimmune disease patients who were or are currently treated with HCQ and related factors such as patient education, communication with the physician, self-education, and ability to cope with the disease.

Evaluation of the health literacy level of female fibromyalgia patients and relationship between health literacy level and disease activity

Objectives

This study aims to evaluate the health literacy in women with fibromyalgia (FM) and relationship between health literacy and disease activity.

Patients and methods

This cross-sectional study included a total of 32 female patients (mean age: 46.2±8.8 years; range, 28 to 62 years) with FM according to the 2016 American College of Rheumatology classification criteria and 27 healthy female controls (mean age: 41.7±12.6 years; range, 24 to 65 years) between May 2020 and July 2020. Demographic and clinical characteristics were recorded. Health literacy levels of the participants were assessed with the Turkish version of European Health Literacy Scale (EHLS-TR), disease activity by Fibromyalgia Impact Questionnaire (FIQ), and pain level with the Numerical Rating Scale (NRS).

Results

Age, education, marital status, and residential area were similar between the groups. There was a significant difference in the job and income level between the groups (p=0.004 and p<0.001, respectively). The EHLS-TR scores were significantly lower, in FM group compared to the control group (p=0.006, p<0.001, and p<0.001, respectively). There was a negative correlation between the EHLS-TR scores and age in the FM group (r=-0.499, p<0.001). A positive significant correlation was found between education status, income level, and EHLS-TR scores in the FM group (r=0.416, p<0.05 and r=0.316, p<0.05, respectively).

Conclusion

Our study results suggest that healthy literacy level is lower in patients with FM compared to healthy controls. In addition, healthy literacy is associated with age, education status, and income level in this patient population.

Association between Health Literacy, Patient Activation, and Functional Capacity in Individuals with Rheumatoid Arthritis

Objectives:

To describe health literacy, patient activation, and functional capacity in individuals with rheumatoid arthritis and to evaluate the associations of health literacy and activation level with functional capacity.

Methods:

A cross-sectional study involving patients with rheumatoid arthritis was carried out at the rheumatology service of a teaching hospital. Health literacy was assessed by applying the short version of the Test of Functional Health Literacy in Adults. Patient Activation was measured by using the summarized version of the Patient Activation Measure. The Health Assessment Questionnaire was applied to evaluate functional capacity. Sociodemographic and clinical variables were also collected to carried out univariate and multivariate analyses by using logistic regression.

Results:

The sample was composed of 179 patients, of whom 90.5% (n = 162) were women. The participants’ average age was 58.3 ± 11.4 years. The prevalence of patients with inadequate or marginal health literacy was high (67%). In contrast, 74% of the patients showed high activation levels. The average score on the Health Assessment Questionnaire was 1.08 ± 0.7. Adequate health literacy was negatively associated with higher Health Assessment Questionnaire scores (OR = 0.42; 95% CI 0.20 – 0.86; p = 0.018), and high activation levels were negatively associated with moderate to severe functional limitation (level 3/moderate activation level – OR = 0.24; 95% CI 0.10 – 0.56; p = 0.001; level 4/high activation level – OR = 0.22; 95% CI 0.08 – 0.50; p = 0.000).

Conclusion:

Health professionals must be aware of health literacy and activation levels of patients with rheumatoid arthritis, given that interventions to improve them represent an opportunity to increase functional capacity.

La version franco-canadienne de l'outil « OA Go Away » : Au revoir Arthrose | Comité d'experts pour la rédaction de la première version expérimentale de l'outil « OA Go Away » | Comité d'experts pour l'évaluation de la deuxième version expérimentale de l'outil « OA Go Away »

Purpose: the purpose of the article is to produce a French-Canadian translation of the "OA Go Away" tool and to assess the validity of its contents as well as its test-retest reliability. "OA Go Away" is a customized tool that measures the various symptoms, their impact, and the physical activities of people with osteoarthritis of the hip or knee to improve self-care and help them be physically active. Method: Vallerand's cross-cultural validation methodology was used. First, professional translators and rehabilitation professionals produced a parallel reverse translation of the "OA Go Away" tool. Then, a committee of experts examined the translated versions and created a first experimental draft of the "Au revoir arthrose" tool. This draft was assessed and modified by a second committee of experts. Three users with osteoarthritis of the knee then assessed this version. Finally, a linguist examined the draft and an expert produced a final reverse translation of that version. The main co-researchers proposed final modifications of that version. Results: Twenty-one users indicated that the wording of the final "Au revoir arthrose" version was clear. The test-retest reliability was acceptable for the main elements of the "Au revoir arthrose" journal. Conclusions: The process's five rigorous steps enabled the creation of a valid French-Canadian version of the "Au revoir arthrose" tool. On average, the French-Canadian version of the "Au revoir arthrose" tool has moderate test-retest reliability for all of its elements. This tool can prove to be relevant for people suffering from osteoarthritis of the hip or knee, motivating them to be physically active, and for the health professionals who care for them.