Health literacy and uptake of anti-fracture medications in a population-based sample of Australian women

https://doi.org/10.1016/j.sapharm.2018.05.002Get rights and content

Abstract

This study investigated associations between health literacy and use of anti-fracture medications in women with osteoporosis.

Data were collected for women participating in the population-based Geelong Osteoporosis Study in Australia. Health literacy was ascertained using the Health Literacy Questionnaire (HLQ) and bone mineral density by dual x-ray absorptiometry. Self-reported current medications were classified using MIMS codes, with the category ‘Agent affecting calcium and bone metabolism’ indicating osteoporosis treatment. Analysis of Variance (p-value <0.1 indicating a trend) and Cohen's d effect sizes (ES [95%CI]) (categorised; Small >0.2-<0.5, Moderate >0.5–0.8, Large >0.8) were calculated for differences in HLQ scale scores between participants who did vs. did not self-report medication use.

Among 620 women, 134 (21.6%) had osteoporosis, 14 (10.5%) of whom self-reported current anti-fracture medication use. Small/moderate ES indicated women taking medication had lower HLQ scores in scales ‘Navigating the healthcare system’, ‘Ability to find health information’ and ‘Understand health information’ (ES 0.36 [0.25–0.79], 0.41 [0.29–0.87] and 0.64 [0.54–1.03], respectively). A trend was observed (p = 0.09) for ‘Understand health information’ scale scores and utilisation of medication. These data suggest women with less confidence in their ability to find and understand health information may follow healthcare provider recommendations and utilise anti-fracture medications more readily.

Section snippets

Background

Osteoporosis is characterised by loss of bone mineral density (BMD) and micro-architectural deterioration of bone tissue increasing the risk of fragility fracture.1 Globally, the number of people at risk of fragility fracture is estimated to double, rising from 157 million to 319 million by 2040.2 Fragility fractures are common and costly in terms of both healthcare costs associated with treating fracture3 as well as personal costs resulting from a fragility fracture such as loss of income,

Participants

Data were collected for women participating in the Geelong Osteoporosis Study (GOS), a randomly selected population-based cohort in south-eastern Australia. The GOS protocol has previously been published.20 Data regarding current medication use and BMD were obtained as part of a 15-year follow-up of GOS female participants, conducted between 2011 and 2014. Subsequently, all women enrolled in the GOS as of December 2014 were sent the Health Literacy Questionnaire (HLQ) to complete, with data

Results

Of the 849 women participating in the GOS 15-year follow-up, 620 had provided information regarding medication use and health literacy and had undergone a DXA scan. Of these 620 women, 134 (21.6%) were considered to have osteoporosis as defined by study criteria and were included in analyses.

Characteristics of participants with osteoporosis are presented in Table 2. Overall, 14 women with osteoporosis (10.5%), self-reported currently using an anti-fracture medication. Women who self-reported

Discussion

The results of this study found that women with osteoporosis who reported currently using anti-fracture medication had lower mean scores for three health literacy scales related to navigating the healthcare system and finding and understanding health information. These associations were attenuated by age adjustment.

Our findings differ from previous research regarding health literacy and self-management of other chronic conditions where higher health literacy was associated with better

Conclusion

The results of this study suggest that older women who demonstrated lower health literacy scores in scales relating to ability to find and understand health information are more likely to report using anti-fracture medications. It may be that these women are more likely to follow recommendations from their healthcare provider due to a lower confidence in their own ability. However, it could also indicate a prescription bias among GPs with GPs inclined to prescribe anti-fracture medications to

Conflicts of interest

None.

Funding

The Geelong Osteoporosis Study is funded by the National Health and Medical Research Council (NHMRC) of Australia (Project number 628582). SLB-O and LJW are supported by NHMRC Career Development Fellowships (1107510, and 1064272, respectively). RB is supported by an NHMRC Senior Principal Research Fellowship (1082138).

Acknowledgments

The authors wish to acknowledge the contributions of the research staff and participants of the Geelong Osteoporosis Study.

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