Health Literacy And Medication Safety In Chinese American Patients

Purposes:Very little is known about health literacy in Chinese Americans and its effects on medication safety. The purposes of this study were to help clinicians and health care systems to gain more awareness about medication safety in Chinese American patients and to evaluate the effects of health literacy on their medication safety.Methods:The study has been approved by the Institutional Review Board at the University of California, San Diego (UCSD). It was conducted at the UCSD Internal Medicine Group-La Jolla Clinic. The study was a mixed-methods study including a quantitative component and a qualitative component. The quantitative component was to determine the statistical associations between health literacy and medication safety outcomes. The observational and cross-sectional study design was used. In-person structural interviews were conducted to collect demographics information and to access health literacy levels and medication safety outcomes. Short Test of Functional Health Literacy in Adults (S-TOFHLA) was used to measure functional health literacy. There were three groups of medication safety outcomes:medication understanding, medication name discrepancy and medication direction discrepancy. Statistical analysis was conducted by using Excel 2003 and Stata/SE version 10. Univariate analysis and multivariates Logistic regression were performed to test the statistical associations between predictive variables and outcome variables. The qualitative component was to further understand the medication use experiences and perceptions in Chinese American patients and the role of health literacy during these experiences. In-person semi-structural interviews were conducted to explore three key topics:1) the perceptions and experiences in obtaining, processing and understanding medication information; 2) the perceptions and experiences about making medication decision; and 3) the perceptions and experiences about seeking help on medication use. Interviews were audio-taped and transcribed verbatim into English. Interviews were continued until thematic saturation was achieved. Grounded theory and Constant Comparative Analysis methodology were used to guide the coding process and the themes generating process in qualitative data analysis. Qualitative analysis was conducted by using the software Atlas.ti 5.0.Results:A total of 158 Chinese American patients completed the quantitative component, including 86 patients with adequate health literacy and 72 patients with non-adequate health literacy. A total of 52 patients completed the qualitative component, including 29 patients with adequate health literacy and 23 patients with non-adequate health literacy. In the quantitative component, after adjusting the potential demographics covariates, health literacy showed statistically significant effects on five medication outcomes:1) patients with adequate health literacy had higher rates of reporting correct reasons for all their medications compared to those with non-adequate health literacy (87% vs 56%, OR=3.4,95%CI=1.2-9.7); 2) patients with adequate health literacy had higher rates of reporting correct reasons for all their prescription medications compared to those with non-adequate health literacy (94%vs 62%, OR=4.7,95%CI=1.2-19.3); 3) patients with adequate health literacy had lower rates of having medication direction discrepancy for all their medications compared to those with non-adequate health literacy (42%vs 62%, OR=0.18,95%CI=0.06-0.55); 4) patients with adequate health literacy had lower rates of having medication direction discrepancy for all their prescription medications compared to those with non-adequate health literacy (34%vs 68%, OR=0.25,95%CI=0.09-0.72); 5) patients with adequate health literacy had lower rates of having medication direction discrepancy for all their over-the-counter (OTC) medications compared to those with non-adequate health literacy (14%vs 18%, OR=0.21,95%CI=0.05-0.92). In the qualitative component, two conceptual frameworks were generated. One conceptual framework showed that health literacy could affect the sources to obtain, the extent and methods to process, and the levels to understand their medication information in Chinese American patients. The other conceptual framework showed that health literacy could affect the levels to understand doctors'suggestions on medication decisions, and the ability to make and conduct medication decisions in Chinese American patients.Conclusions:It was the first time that the mixed methods study design was used to systematically explore the associations between health literacy and medication safety in Chinese American patients. The study showed that potential risk factors existed in the medication safety in Chinese American patients and health literacy played a crucial role in their medication safety. The study provided important implications to clinical practice and research for Chinese American patients.