The National Adult Literacy Survey of 1992 found that 90 to 94 million U.S. adults (47% to 51%) have low functional literacy skills, at levels that impair full participation in society. Patients with low literacy report worse health, and know less about their disease and management. The overall goals of our study are (1) to develop new knowledge of the impact of low literacy on health, its causal pathways, and how patients with low literacy learn best; and (2) to test a patient educational intervention designed to minimize literacy requirements. Two-hundred twenty-five (225) patients with systemic inflammatory rheumatic conditions will be randomly assigned to three experimental groups. Assignment will be stratified and balanced within reading low (low literacy subjects 8th grade or lower, 9th-11th grade readers, and 12th grade+ readers). The three groups are: Control. Regimen- and disease-specific materials from the Arthritis Foundation (about 11th grade reading level), plus a mediation calender, which the patient can fill in; Plain English Materials. Regimen and disease-specific materials written in Plain English (5th to 8th grade reading level), and a medication calendar and glossary of arthritis terms; Individual Education. Plain English materials, plus arthritis glossary, a medication schedule, and a one-hour, in-person session with a Study Educator using interactive, text-free methods. Topics and skills will include setting up and following a regimen using the calendar., , communicating with caregivers, and navigating the health care system. The Study Educator will help with reading-related problems at future visits and over the telephone for the next six months. The goal is to build patient capacity for independence in self-management. Subjects will be followed for one year post-intervention for changes in health status, disease activity, communications with the physician, self- efficacy for arthritis management, understanding of and adherence to prescribed treatments, satisfaction, and health care utilization.
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