Published Online: October 13, 2016
Self-management of moderate-to-severe asthma depends on patients’ ability to: (1) navigate (access healthcare to obtain diagnoses and treatment), (2) use inhaled corticosteroids (ICSs) properly, and (3) understand ICS function. Navigation, a concept first introduced in management of cancer, can include tasks such as successful medication recall, understanding copay and insurance requirements for medical visits, and knowing how to organize and respond to provider recommendations. Navigation and other self-management skills like proper use of ICSs and understanding their function depend upon health literacy. Patients who have limited literacy skills have greater difficulty accessing health care. Furthermore, low health literacy is associated with poor self-management of chronic diseases, including asthma. Identifying patients with low health literacy and developing effective interventions are needed. However, screening patients for low literacy as part of a medical appointment would be anxiety-provoking, embarrassing, and deter patient-provider communication. By correlating different self-management skills, such as knowledge of essential functions of ICSs or proper use of an ICS, and navigation, the assessment of one can inform the likelihood of difficulty with other skills.
In an article recently published in The Journal of Allergy & Clinical Immunology (JACI), Perez and colleagues reported the development and validation of a questionnaire called NAV2 which focuses on assessing asthma navigation skills. The authors hypothesized that higher score on NAV2, which includes asking patients to give the name and dose of their asthma medications and to describe a copay, would be associated with higher health literacy. Data were collected from 250 adults with moderate-to-severe asthma recruited from outpatient primary care and asthma specialty practices within the University of Pennsylvania Health System, a federally qualified health center, and a primary care practice serving mainly Spanish-speaking patients.
The authors found that patients with low NAV2 score are likely to have poor inhaler technique and limited understanding of inhaled steroid function, as well as limited health literacy. Additionally, they found that a single question from the NAV2 on medication recall, if answered incorrectly, is an indication of low health literacy. Thus routine questions in an asthma interview (medication recall, testing of inhaler technique) also assess the patient’s general health literacy skills without embarrassing the patient and allowing clinicians to adjust their recommendations. Attention to navigation may permit providers to tailor information and ultimately improve patient-provider communication.
The Journal of Allergy & Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.