Anjali Singla, MD (AS), from the Montefiore Medical Center in Bronx, New York, discusses her abstract for the National Kidney Foundation’s 2016 Spring Clinical Meetings (SCM16), Associations of Poor Health Literacy and CKD Outcomes in the Bronx, with Dr. Kenar Jhaveri, AJKD Blog Editor.
AJKDblog: Why don’t you tell us a little about your research and abstract being presented at the NKF 2016 Spring Meetings?
AS: We conducted a single-center cross-sectional study investigating patients with chronic kidney disease (CKD) stages 3 and 4 to evaluate demographic, socioeconomic, and clinical factors associated with health literacy. We found that a remarkable 30% of our patient population had low health literacy. Furthermore, we discovered that low health literacy correlated with lower estimated glomerular filtration rate. We feel that recognizing the significant presence of low health literacy in our patients is very important to deliberately improve communication by clinicians and health systems to help them understand health information, follow medication regimens/instructions, and improve self-care. Low health literacy may be a major explanatory factor for the observed high non-adherence. Therefore, we should be addressing these issues in health literacy to improve the delivery of health care.
AJKDblog: What can be done to improve health literacy in the CKD population?
AS: We are not sure about the perfect intervention at this point and different methods speak to different people, but it seems a system change to prioritize health literacy would be the most effective approach. The goal would be to engage all patients (and perhaps their families as well) to understand their disease, factors that can affect progression, importance of medication adherence, and hope this improves renal and other health outcomes. Designing effective programs and creating brochures, posters, and handouts that abide by clear communication principles for patients to learn pertinent information is an ongoing goal for the nephrology community, though the significant impact on adherence and outcomes may not yet be fully appreciated.
Some examples include CKD education classes where patients can learn basics of kidney function and laboratory values, diet and lifestyle and their relationship to glucose, blood pressure, and renal outcomes. This can be done one-on-one with families/loved ones or in a group setting with others who share their diagnosis. During clinic visits, all caretakers including front desk, nursing, and clinicians should keep in mind that health literacy is a key component to providing healthcare. Simple methods of “teach-back” and repetition, as well as maintaining an environment of inquiry and engagement, may also be helpful to our patients.
AJKDblog: Where do you and your group go from here?
AS: We want to get the message out to clinicians and patients that health literacy is a real problem and addressing it could potentially impact patient experience, self-care, and clinical outcomes. The healthcare community should recognize that low health literacy is associated with poorer outcomes, and nephrologists should address this issue by targeting high-risk CKD patients and developing their interest in learning and maintaining disease-specific knowledge. We want to work on targeted interventions to increase patient understanding of disease management and subsequently encourage participation in better quality and quantity of self-care. These types of changes go along with a lot of the changes in health care in terms of patient-centered care. They also could potentially enhance patients’ experience with their nephrology team and with their disease, encourage participation and adherence, and hopefully improve renal and other health outcomes.
All Spring Clinical Meeting abstracts are available in the May issue of AJKD.