Educational Tools for Improving Health Literacy Among Patients With Rheumatoid Arthritis

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Self-administration of an educational video and booklet was associated with improved health literacy and decreased decisional conflict among patients with RA.

Self-administration of an educational video and booklet was associated with improved health literacy and decreased decisional conflict among patients with rheumatoid arthritis (RA), according to findings reported in Arthritis Care & Research

This randomized controlled trial enrolled patients with RA from 5 outpatient clinics in Houston, Texas. Eligible patients were ≥18 years of age and had been diagnosed with RA by a rheumatologist. Patients with disease duration >10 years were excluded. Participants were randomized in a 1:1 ratio to the following study conditions: an educational video and booklet; or a booklet only. The video tool comprised 24 brief episodes, each addressing a different aspect of RA. The booklet was a consumer guide to RA developed by the Agency for Healthcare Research and Quality. Participants completed a health literacy questionnaire at baseline and follow-up. Disease literacy was scored on a scale of 0 to 100, with higher scores suggesting greater self-perceived knowledge. The primary outcome was knowledge score at the 3- and 6-month follow-up visits. Logistic regression analyses were used to identify predictors of improved health literacy.  

In total, 111 patients were randomized to the video with booklet and 110 were randomized to the booklet only. Mean patient age was 50.8 years, and 85% were women. Mean disease duration was 4.8 years, and 24% had limited health literacy levels at baseline. Mean knowledge scores increased immediately after viewing educational materials in both the booklet and video arm (5.5 to 7.6; P <.0001) and in the booklet only arm (5.5 to 7.2; P <.0001). Knowledge scores also increased between baseline and follow-up, though improvements were not significantly different between groups at (P =.73 at 3 months; P =.74 at 6 months). Decisional conflict scores also decreased immediately after reviewing materials, though results were not significantly different between groups. Patients reported high satisfaction with their educational materials, though the video group outperformed the booklet group. Specifically, a greater proportion of patients in the video group rated the presentation as “excellent” for providing information about the following items: impact of RA (56% vs 37%), medication options (62% vs 43%), evidence about medications (49% vs 32%), benefits of medications (54% vs 37%), and self-care options (48% vs 26%) (P <.05). Predictors of improved health literacy at 6 months included lower literacy at baseline, lower educational level, and shorter disease duration.

Limitations are that the study did not include patients with longstanding disease, the attrition rate at 3 and 6 months was high which may have increased the probability of a type II error, and the lack of blinding may have affected the results.

These data support the efficacy of self-implemented educational materials in improving patients’ knowledge of RA. “Our findings support the implementation of self-administered educational materials in clinical settings as they can result in sustained improvements in disease knowledge and decisional conflict,” concluded the investigators.


Lopez‐Olivo MA, Lin H, Rizvi T, et al. Randomized controlled trial of patient education tools for patients with rheumatoid arthritis [published online June 25, 2020]. Arthritis Care Res. doi: 10.1002/acr.24362