Health literacy and education level correlates of participation and outcome in a remotely delivered epilepsy self-management program

• Published in: Epilepsy & behavior Vol. 107; p. 107026
• Main Authors: Sudhakar, Shwetha, Aebi, Michelle E., Burant, Christopher J., Wilson, Betsy, Wenk, Jocasta, Briggs, Farren B.S., Pyatka, Nataliya, Blixen, Carol, Sajatovic, Martha
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2020
• Subjects: Adult; Education; Educational Status; Epilepsy; Epilepsy - psychology; Epilepsy - therapy; Female; Health literacy; Health Literacy - methods; Humans; Income; Male; Middle Aged; Patient Participation - methods; Patient Participation - psychology; Prospective Studies; Seizures; Self-management; Self-Management - methods; Self-Management - psychology; Telemedicine - methods; Treatment Outcome; Waiting Lists; Self-management; Health literacy; Education; Epilepsy; Income; Seizures
• ISSN: 1525-5050; 1525-5069
• DOI: 10.1016/j.yebeh.2020.107026

Health literacy, the ability to understand necessary health information to make proper health decisions, has been linked to greater frequency of hospitalizations. However, there is limited literature on the associations between health literacy and outcomes in patients with epilepsy, and thus, this secondary analysis investigates the associations between health literacy and outcomes in patients with epilepsy enrolled in the self-management intervention “Self-management for people with epilepsy and a history of negative events” (SMART). We examined the associations between higher health literacy and higher education level and outcomes of the SMART trial. This is a secondary analysis of data from the SMART self-management intervention, where individuals were randomized to the SMART intervention or a 6-month waitlist (WL) control. Health literacy was assessed at baseline before randomization using the Rapid Estimate of Adult Literacy in Medicine (REALM-R). Education level was self-reported by participants at baseline. Pearson correlations between REALM-R scores and continuous demographic and clinical variables were conducted. Point-biserial Pearson correlations were computed for REALM-R and dichotomous variables. The effect of education on change in negative health events (NHEs) counts from baseline to six months was conducted using a linear regression. A logistic regression with health literacy and randomization arm as predictors and improvement in NHE (1 = improvement, 0 = no change or increased NHEs at 6 months) as the outcome was conducted. Lower education and lower income were significantly correlated with lower health literacy (p < 0.001 and p = 0.03). Higher education level was associated with a greater improvement in 6-month seizure counts (rs(105) = 0.29, p = 0.002), and a greater improvement in total 6-month NHEs (rs(95) = 0.20, p = 0.045). Health literacy was not associated with change in NHEs or with study retention. The SMART intervention appears effective for individuals regardless of health literacy competency. Nevertheless, individuals with higher levels of education have fewer epilepsy complications, and thus, those with limited education may still require additional support while participating in epilepsy self-management programs. •“Self-management for people with epilepsy and a history of negative health events” (SMART) is a novel, remotely delivered epilepsy self-management intervention.•This secondary analysis of the primary outcomes of a 6 month SMART randomized efficacy trial assessed correlations between health literacy and SMART study outcomes and education level and SMART outcomes.•Education level and income were significantly correlated with health literacy in our sample.•Higher education level was significantly correlated with a reduction in negative health events (NHEs).•There was no significant association between health literacy level and NHEs.•The health literacy and education levels were not associated with participation in SMART.•SMART is appropriate for epilepsy patients across a range of health literacy levels.