Educated patients follow directions better, study says

Well-being related to schooling among select HIV, diabetes sufferers

By Paul Recer

Associated Press

WASHINGTON -- Well-educated patients are better able to follow the complex medical treatments needed to treat some diseases than are patients with less schooling, according to a RAND study.

Researchers at RAND, a nonprofit research institution in Santa Monica, Calif., examined the health of patients with HIV or diabetes, each of which require carefully following directions and consistency in taking tests, keeping appointments and taking medicines.


Researchers then related the health of the patients to their level of education and found that schooling made a dramatic difference. Education was even more important for a patient's health than income, age, race or sex, the study found.

A federal expert said the study could lead to developing intensive new programs to help the less-educated follow complex treatments needed to combat some diseases.

"We found that the educated are much better able to adhere to the treatment regimen in the cases of HIV and diabetes," said Dana P. Goldman of RAND. He said that therapies for HIV and diabetes are "very, very complicated" and that people with advanced education have a proven experience in dealing with detailed and complex chores that have to be done consistently.

"Diabetes requires a person to monitor their blood sugar constantly and adjust their medication," Goldman said. "In HIV, patients have to take many different pills and coordinate them with other medications and their diet. The better educated are much better able to comply with this."

In analyzing a study of HIV patients and relating the findings to education levels, the researchers found that 68 percent of college graduates with HIV are receiving highly active antiretroviral therapy, or HAART, a complex pill-taking routine. Among high school dropouts with HIV, the study found only 54 percent were on HAART.

Among those taking HAART, there was 57 percent compliance among college graduates and only 37 percent compliance among high school dropouts.

The effect of education was directly reflected in the general health of the HIV patients. About 31 percent of the high school dropouts in the study said their health was fair or poor. Among college graduates, only 17.8 percent said their health was fair or poor.

When relating two diabetes studies, researchers found that only a third of the high school dropouts reported themselves to be in good or excellent health, while almost 75 percent of the college graduates were in good or excellent health.


Controlling diabetes requires frequent tests to determine the level of sugar in the blood. The study found that patients with a higher education checked their blood more often. The educated also got more exercise and were less likely to smoke cigarettes, the study found.

The researchers looked at the effect of an intensive diabetes treatment program where patients were seen often by doctors and received telephone reminders to test their blood and to take medication.

Goldman said this intensive care program improved the health of all the patients but had the most dramatic effect on those with less than a college degree.

"You find that intensive treatment was much more beneficial for those with little education," Goldman said. "Those with an education were already doing a pretty good job."

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