(PS1-80) Better Health Literacy Is Associated with Greater Symptom Management Self-efficacy and Reduced Pain Intensity in Patients with Headache

Background:  Improving health literacy in patients with headaches may reduce morbidity and increase the quality of life by enhancing awareness and utilization of effective migraine treatments and behavior change, facilitating communication between patients and providers, and debunking misinformation. Improving health literacy may also be an important target to reduce health disparities.

Method: The current study involved a secondary analysis of a longitudinal study of patients with headaches (N = 66) who were asked to monitor their headache symptoms, nutrition, headache management, and lifestyle behaviors over six months. The study tested the hypothesis that better performance on "Newest Vital Sign" (NVS), a test of health literacy, is associated with more favorable headache outcomes. Chi-square tests ascertained associations between health literacy and socioeconomic status.

Results: The sample was recruited from the Montefiore Headache Center in the Bronx. They were predominantly female (83.9%), with an average age of 38 years. They identified as White (71%), Asian (6.5%), Black (14.5%), Biracial (8.1%), and Hispanic (16.1%).  Spearman’s rho correlations indicated that patients higher in health literacy reported significantly lower pain intensity ratings of their headaches on the Migraine Disability Assessment (MIDAS), r (61) = -.33, p = .01, lower impact of their headaches on their role functioning-prevention on the Migraine-Specific Quality of Life Scale (MSQ), r (61) = -.29, p = .02, and greater headache management self-efficacy on the Headache Management Self-Efficacy Scale (HMSE), r (61) = .27, p =.03 compared to patients lower in health literacy. Chi-square tests of independence indicated that patients who make $49,999 a year or less were significantly less likely to attain adequate health literacy scores (63.6%) compared to patients with incomes of $50,000 a year or more (89.6%), 𝜒² (1) = 4.66, p = .03. Patients whose education exceeded a high school diploma/GED were significantly more likely to attain adequate health literacy scores (89.9%) compared to patients with a high school diploma or less (50%), 𝜒² (1) = 6.41, p = .01.

Discussion: The results suggest that improving health literacy in patients with headaches may improve outcomes like pain intensity, possibly through a beneficial effect on headache management self-efficacy and quality of life. Patients who have greater knowledge about their health condition may have greater confidence in their ability to manage it and therefore less pain. For example, patients with better health literacy may be more likely to take rescue medications at the first sign of an attack. Patients with lower health literacy may hold incorrect beliefs about their pain or symptoms that reduce their quality of life, like incorrectly assuming they must avoid valued activities. Last, our results suggest a disparity in health literacy by SES. Further research should investigate the relationship between health literacy, headache management self-efficacy, and outcomes like pain, as well as explore health literacy as a target of intervention to reduce disparities in lower SES patients.