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Patient Educ Couns. 2009 Jun;75(3):334-9. doi: 10.1016/j.pec.2009.03.001. Epub 2009 Apr 3.

A randomized controlled trial of an intervention to reduce low literacy barriers in inflammatory arthritis management.

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Harvard School of Public Health, Department of Society, Human Development and Health, Boston, MA 02115, United States.



Test the efficacy of educational interventions to reduce literacy barriers and enhance health outcomes among patients with inflammatory arthritis.


The intervention consisted of plain language information materials and/or two individualized sessions with an arthritis educator. Randomization was stratified by education level. Principal outcomes included adherence to treatments, self-efficacy, satisfaction with care, and appointment keeping. Secondary outcomes included health status and mental health. Data were collected at baseline, six, and twelve months post.


Of the 127 patients, half had education beyond high school and three quarters had disease duration greater than five years. There were no differences in the primary outcome measures between the groups. In mixed models controlling for baseline score and demographic factors, the intervention group showed improvement in mental health score at six and twelve months (3.0 and 3.7 points, respectively), while the control group showed diminished scores (-4.5 and -2.6 points, respectively) (p=0.03 and 0.01).


While the intervention appears to have had no effect on primary outcomes, further studies with continued attention to literacy are warranted. Study site and disease duration must be considered as participants in this study had higher than average health literacy and had established diagnoses for years prior to this study.


The study offers insight into an application of many of the protocols currently recommended to ameliorate effects of limited literacy.

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