Parental Health Literacy and Patient Clinical Outcomes in Juvenile Idiopathic Arthritis with a Health Equity Lens

Background/Objectives: Health literacy (HL) is the ability to obtain, understand, and use information to make health-related decisions. There is scarce information on the impact of HL on patients with rheumatologic conditions. We explored the relationship between parental HL and clinical outcomes of patients with juvenile idiopathic arthritis (JIA) in an ethnically diverse population at a large academic center. Methods: Parents of patients with JIA completed a demographic survey and the Newest Vital Sign (NVS) assessment to identify health literacy risk. Parental HL literacy was grouped by limited HL (score of 0-1) and possible limited HL plus adequate HL (score of 2-6). Clinical Juvenile Arthritis Disease Activity Score (c-JADAS) and Patient-Reported Outcomes Measurement Information System (PROMIS) were used to determine clinical outcomes. Clinical characteristics and outcomes were compared by HL score groups. Logistic regression analysis for active disease was performed using cJADAS. Results: Seventy-five parents participated, for which 15 (20%) scored limited HL. Primary language was English in 53 (71%) and Spanish in 22 (29%). The median cJADAS in polyarticular disease was significantly higher in the limited HL group (8 (3.0, 11.0) vs 2.2 (0.0, 7.0), p=0.017). For oligoarticular disease, PROMIS mobility scores were significantly lower in the limited HL group (35.3 (27.1, 45.4) vs 52.1 (52.1, 52.9), p=0.037). Limited HL had higher odds of active disease (OR=6.85, [CI 1.18-39.58], p=0.032). Conclusions: Limited parental HL was associated with significantly higher disease activity in polyarticular patients and with an overall higher odd of active disease.