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Background: Health literacy (HL) is defined as the ability to access, understand, evaluate, communicate, and use health information to make informed health decisions. Studies have reported a relationship between low HL and less health-related knowledge, poorer skills in taking medication, and treatment non-adherence. Despite this, measurement of HL (in particular to the abovementioned domains) is still in its infancy and the impact of HL on self-management (via a key informant lens) has yet to be studied. Objectives: The main aim in this thesis was to incorporate both sides of the HL equation (patients and key informants) into investigating the role of HL in chronic respiratory disease management. This led to two objectives: 1) To identify HL tools used in asthma and/or chronic obstructive pulmonary disease (COPD) management and examine their characteristics; and 2) To assess key informants’ perspectives re barriers to asthma/COPD self-management and the solutions to address such challenges. Methods: A systematic review was undertaken to review the literature on HL tools that assessed any of the five domains on asthma/COPD patients. Following this, a qualitative study was conducted with national and international key informants (e.g., health care professionals (HCPs), researchers, and policymakers) who were involved in the care of asthma/COPD patients to determine perceived patient barriers to competent self-management and the possible solutions to overcome these barriers. Results: The review identified 65 tools with a majority assessing ‘understanding’ and a minority on ‘communication’. Only two tools assessed all five domains and less than half had been validated. Thematic analysis of the 45 interviews resulted in seven barriers surrounding the themes of time, information overload, and jargon and six solutions focusing on tailored education, better communication, and building relationships. Conclusions: Self-management is a combined effort achieved only through the engagement of patients, HCPs, and the system. Both studies showed shortcomings in the ‘communication’ domain, possibly due to the complex phenomenon of communication requiring at least two individuals in the process. These findings suggest that HL researchers and health care programs should recommend new strategies for chronic respiratory disease management with a specific emphasis on the concept of ‘communication’.
RationaleHealth-related productivity loss and the impact of comorbidities on the economic burden of asthma are important, yet overlooked, components. I aimed at revising recent estimates of the costs of asthma worldwide. The empirical research involved evaluating the effect of comorbidities on productivity loss among adult asthma patients. Methods A literature review was conducted on studies regarding the costs of asthma (January 2008 to January 2015) and subsequently on the effects of comorbidities on productivity. In parallel data from a prospectively evaluated random sample of employed adults with asthma was used and the prevalence of comorbidities measured using a validated self-administered comorbidity questionnaire (SCQ), range 0 – 39, (the higher the score, the higher the level of comorbidity). Productivity loss, including absenteeism and presenteeism, were also measured using validated instruments in 2010 Canadian dollars ($). I used a two-part regression model to estimate the adjusted difference of productivity loss across levels of comorbidity, controlling for potential confounding variables.ResultsThe review demonstrated that asthma imposes a major economic burden, however there are large discrepancies in the reported estimates. There is also uncertainty about the indirect costs of asthma and the effects of comorbidities on these costs. A random sample of 284 adults with the mean age of 47.8 (SD 11.8) was included (68% women). The mean SCQ score was 2.47 (SD 2.97, range 0-15) and the average productivity loss was $317.5 per week (SD $858.8). Comorbidity was significantly associated with productivity loss. One-unit increase in the SCQ score was associated with a 14% (OR=1.14, 95% CI 1.02-1.28) increase in the odds of reporting productivity loss, and 9.0% (OR=1.09, 95% CI 1.01-1.18) increase in productivity loss among those who reported any loss of productivity. A person with a SCQ score of 15 had $1,685 per week more productivity loss than a patient with a SCQ of zero. ConclusionThis study demonstrates that comorbidities substantially decrease productivity in working asthma patients. Asthma management strategies must be cognizant of the role of comorbidities and should properly incorporate the effect of comorbidity and productivity loss in estimating the benefit of disease management strategies.