fessionals to even recognise limited health
literacy in the clinical setting.”
The researchers evaluated 895 patients
with rheumatoid arthritis, spondyloarthri-
tis, or gout at three outpatient clinics in
the Netherlands. The patients completed
the Health Literacy Questionnaire (HLQ),
which, according to Mr. Bakker, was spe-
cifically designed to evaluate the multidi-
mensional nature of health literacy.
The researchers identified 10 distinct
health-literacy profiles, each depending
on average scores across nine different
health-literacy domains ranging from pro-
vider support to the patient’s ability to un-
derstand health information. The highest
health-literacy scores across all domains
comprised profile 1, and the lowest scores
represented profile 10. However, rather
than categorising patients as “high” and
“low,” Mr. Bakker noted that the approach
allows for diverse patterns in scores
across domains. These diverse patterns
should be of note, he said.
The goal is to enhance the capacity ofhealth systems and professionals to respondto the health-literacy needs of patients withRMDs, he said. This can be of benefit toall patients in the clinic and specifically forpatients with a particular profile. The approach his team has taken to identify toolsthat could address local health literacy needsis known as the Ophelia approach, whichstands for OPtimising HEalth LIteracy andAccess (BMC Public Health. 2014;14:694. doi:10.1186/1471-2458-14-694).
“The key lesson is to raise awareness ofhealth literacy, and recognise the need foraction,” Mr. Bakker said.
“Our patients have different health-literacy profiles, and our work can inspirethe healthcare system to think aboutthese different health-literacy profilesthat you see in your own clinical context,”he said.
The idea, Mr. Bakker explained, is forrheumatologists to consider health-literacychallenges in the context of their own setting, and to collaborate with local experts,including both professionals and patients,to develop methods for addressing thosehealth-literacy shortcomings.
“It’s not meant that individual health
professionals should do this or individual
patients should do that,” he said. “It’s
more of a systemic approach that needs to
be taken to tailor care.”
Mr. Bakker and colleagues have no rele-
vant conflicts to disclose.
Continued from page 9
Atotal of 30%-80% of patients who have rheumatic and musculoskel- etal diseases (RMDs) are thought o not take their medications according to their physicians’instructions. New researchoffers more comprehensiveinsights into addressingadherence issues with non-pharmacologic interventions– an area not comprehensively addressed by EULARuntil now.
“The problem of poor
adherence is addressed in
some EULAR recommenda-
tions/points to consider on
the management of specific
health conditions or on the
role of professionals,” first author Valentin
Ritschl of the Medical University of Vienna
said in an interview. “However, all these
recommendations focus on limited aspects
of nonadherence and do not cover the mul-
Mr. Ritschl and colleagues conducted an
extensive systematic literature review, the
results of which they presented to a task
force consisting of a panel of international
experts hailing from 12 different countries.
The task force included rheumatologistsand other health professionals in rheumatology, as well as patient representatives.
The collaboration resulted in investiga-
tors crafting a definition of
adherence in addition to
drafting four overarching
principles and nine points to
consider, which Mr. Ritschl
will present 6 June in a
EULAR Health Professionals
in Rheumatology session,
as well as on a poster,
They defined adherence
as “... the extent to which
a person’s behaviour cor-
responds with the agreed
The four overarching principles empha-
sise the following concepts:
• That adherence affects outcomes in
people who have RMDs.
• The importance of shared decision-mak-
ing, with the understanding that the
adherence describes the patient’s
behaviour “... following an agreed pre-
• That numerous factors can affect adher-
• The notion of adherence being a dynamic process that, consequently, requirescontinuous evaluation.
Among the nine points to consider,Mr. Ritschl and coauthors encourage allhealthcare providers involved in caring forRMD patients to assume responsibility forpromoting adherence. Practitioners shouldalso strive to create an ongoing, opendialogue to discuss adherence, especiallyin cases in which the patient’s RMD isnot well controlled. The patient-centredrecommendations include taking into account the patient’s goals and preferencesbecause these greatly contribute to thepatient’s ability to adhere to any medication regimen. Another arm of that exploration also requires the medical professionalto evaluate any circumstances that couldbear a negative effect on the patient’sadherence – whether it be medication access issues related to cost or availability,or functional challenges such as memory,motivation, or complexity of the medication regimen.
Mr. Ritschl believes his team’s study willadd value and help improve overall outcomes in RMD population management.
“Until today, there are no recommenda
EULAR recommendations define strategies
to improve adherence in RMDs
Continued on page 11