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Member Research & Reports

Member Research & Reports

Georgia State: Telecommunications Technology Could Aid Low Literacy Patients

Adults with low health literacy may benefit from technology-based interventions, such as automated calls reminding them to refill prescriptions, according to a recent study led by a researcher from the School of Public Health at Georgia State University.

The findings of the study, published in The Permanente Journal in an article titled “Difference in Effectiveness of Medication Adherence Intervention by Health Literacy Level,” indicate that patients with lower health literacy may benefit more from telephone-based interactive voice response technology than those with higher health literacy because they are more responsive to instructions delivered by speech than by text. The study’s lead author is Dr. Ashli Owen-Smith, an assistant professor of health management and policy at The School of Public Health.


[Photo: Dr. Ashli Owen-Smith]

The study surveyed and tracked 833 patients—148 of whom were considered to have low health literacy—from December 2011 to November 2012. Those deemed to have low health literacy reported frequently needing help reading instructions or other written materials from their doctors or pharmacies, according to the study. They also reported having low confidence in their ability to fill out medical forms.

All study participants were 40 or older, diagnosed with diabetes and/or cardiovascular disease, and taking medication to manage their cholesterol and/or blood pressure. They were randomly assigned to receive either usual care or one of two health information technology-based interventions. Participants in the first intervention group received automated phone calls when they were due or overdue for a refill of their medications. Those in the second intervention group also received automated phone calls using the interactive voice response technology as well as personalized reminder letters and live outreach calls if they were more than two months overdue in refilling their prescriptions.

Among the participants with lower health literacy, the interventions were associated with medication adherence that was higher (9 to 10.5 percent higher among patients taking statin drugs for cholesterol and 7.5 to 14.6 percent higher among patients taking drugs for blood pressure) than for those receiving the usual care. By contrast, medication adherence was lower among participants with high health literacy who were receiving the interventions.

Because the number of low health literacy patients in each of the three groups was small, the study’s results are not statistically significant, the researchers noted. However, the results “provide some preliminary support” for the notion that automated phone-based approaches could provide a less costly way to encourage patients to follow treatment instructions and may be particularly helpful for those with limited health literacy.

Its authors also included Dr. David H. Smith, Reesa Laws, Amy Waterbury and Dr. William Vollmer with Kaiser Permanente Center for Health Research; Dr. Cynthia S. Rand with the Johns Hopkins School of Medicine; Dr. Jeffrey O. Tom with the University of Hawaii John A Burns School of Medicine; and Dr. Andrew Williams with Maine Medical Center Research Institute.