The overall objective of this study is to investigate the association between health literacy, health beliefs, and self-care behaviors among older adults with asthma. Greater engagement of older adults in self-management of their chronic diseases can improve health outcomes in this vulnerable population. Evidence suggests that health literacy is an important mediator of disease self-management. This observation is especially important for the elderly who experience disproportionately higher rates of inadequate health literacy and cognitive impairment. Unfortunately, most interventions aimed at promoting better disease self-management among low-literacy adults achieve only modest gains. The failure of these interventions, and other observations, show that the pathways linking health literacy to self-management remain poorly defined. Disease-specific health beliefs and medication beliefs may lie along this pathway. We have found a strong association between asthma-specific medication and health beliefs among adults with asthma, and our preliminary data suggest that older adults with low health literacy are more likely to have asthma beliefs that predict poor self- management behaviors. These findings indicate that health and medication beliefs may mediate health literacy's impact on self-management. This proposal brings together investigators with combined expertise in health literacy, disease specific health beliefs, and asthma in aging adults, to expand understanding of the pathways through which health literacy affects health behaviors and ultimately, health outcomes in older asthmatics. We propose to address three aims: (1) to determine the association of health literacy with asthma self-management behaviors among older asthmatics;(2) to determine the association of health literacy with asthma-specific disease and medication beliefs among older asthmatics;(3) to determine the causal pathways linking health literacy and asthma- specific health beliefs with self-management behaviors, using structural equation modeling. We will conduct a longitudinal study of 500 English and Spanish-speaking adults, ages 60 years and older with persistent asthma, recruited from the socioeconomically and racially diverse inner-city primary care practices of Mount Sinai Hospital in New York City, NY and the Northwestern Memorial Hospital in Chicago, IL. Interviews will occur at baseline, 3 and 12 months. This study will expand understanding of the mechanisms through which health literacy influences chronic disease self-management in older adults and concurrently identify specific, modifiable beliefs that mitigate the effects of low-health literacy on asthma-self management in older asthmatics, creating an opportunity to improve asthma outcomes in a highly vulnerable population. Study findings will inform refinement of a low-literacy asthma intervention developed by the Northwestern Team. We plan to continue this Mount Sinai-Northwestern collaboration with a follow-up R01 application to test the modified approach in a multi-site trial.

Public Health Relevance

The objective of this study is to understand how health literacy and beliefs about chronic disease interact to affect older adults'ability to self-manage their chronic illness. The study will be conducted in New York City and Chicago, IL, and will involve interviews of 500 patients, 60 years or older with chronic asthma. The study findings will expand our understanding of health literacy and provide new insights into best methods for educating older asthmatics about managing their disease.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Special Emphasis Panel (ZRG1-RPHB-B (50))
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Freemer, Michelle M,
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Icahn School of Medicine at Mount Sinai
Internal Medicine/Medicine
Schools of Medicine
New York
United States
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Brooks, Taylor L; Leventhal, Howard; Wolf, Michael S et al. (2014) Strategies used by older adults with asthma for adherence to inhaled corticosteroids. J Gen Intern Med 29:1506-12
Federman, Alex D; Wolf, Michael S; Sofianou, Anastasia et al. (2014) Self-management behaviors in older adults with asthma: associations with health literacy. J Am Geriatr Soc 62:872-9
Federman, Alex D; Wolf, Michael S; Sofianou, Anastasia et al. (2014) Asthma outcomes are poor among older adults with low health literacy. J Asthma 51:162-7
Sofianou, Anastasia; Martynenko, Melissa; Wolf, Michael S et al. (2013) Asthma beliefs are associated with medication adherence in older asthmatics. J Gen Intern Med 28:67-73
Krauskopf, Katherine A; Sofianou, Anastasia; Goel, Mita S et al. (2013) Depressive symptoms, low adherence, and poor asthma outcomes in the elderly. J Asthma 50:260-6
Federman, Alex D; Wolf, Michael; Sofianou, Anastasia et al. (2013) The association of health literacy with illness and medication beliefs among older adults with asthma. Patient Educ Couns 92:273-8