Health literacy and success with glaucoma drop administration.

Abstract

PURPOSE\nTo assess the relationship between health literacy and successful glaucoma drop administration.\n\n\nDESIGN\nThis sub-study of a single-site interventional randomized controlled trial.\n\n\nSUBJECTS\nParticipants included veterans receiving care at the Durham VA Eye Clinic. Patients were eligible if they had a diagnosis of open angle glaucoma and were recruited if they endorsed poor drop adherence.\n\n\nMETHODS\nParticipants underwent a health literacy evaluation using the Rapid Estimate of Adult Literacy in Medicine (REALM) as well as a qualitative assessment of their eye drop administration technique using 3 different criteria: (1) the drop was instilled in the eye (2) only one drop was dispensed, and (3) the bottle was not potentially contaminated. A multivariable logistic regression model was used to assess the association of REALM score and successful drop administration, adjusting for age, disease severity, and VA Care Assessment Needs (CAN) score.\n\n\nMAIN OUTCOME MEASURES\nThe main outcome measure of this sub-study was successful drop administration RESULTS: Of the 179 participants with REALM scores and observed drop administration, 78% read at a high school level (HSL) or above and 22% read below HSL. Of the 179 participants, 87% (n=156) successfully instilled the drop into the eye (criterion 1). A greater proportion of participants who read at HSL or above successfully instilled the drop in the eye, compared to those reading below HSL (90.6% vs 75.0%, p = 0.02). Rates of success with criterion 1 were similar across different levels of visual field severity. CAN scores were not statistically significantly between those who did and did not have successful overall drop technique.\n\n\nCONCLUSIONS\nPoor health literacy may be associated with decreased successful drop instillation in the eye in glaucoma patients. Screening for and considering health literacy in developing interventions to improve glaucoma self-management, may improve treatment adherence in a vulnerable population.