Objectives Low health literacy (HL) is associated with worse clinical outcomes. ?In systemic lupus erythematosus (SLE) this has not been extensively studied, particularly in the United Kingdom. We sought to evaluate the health literacy in patients with lupus nephritis (LN) in a deprived area of East London.

Methods Health literacy in patients with biopsy proven LN was assessed. Patients were contacted via phone and with verbal consent completed two assessments of health literacy. The Brief Health Literacy Screening Tool (BRIEF), a validated assessment of health literacy, and the Lupus Knowledge Assessment Test (LKAT) developed within Duke University Hospital to assess SLE specific knowledge. Highest educational attainment and first language was recorded. Univariate analyses (Fisher’s exact and Kruskal Wallis rank-sum test) were applied to the results.

Results 161 eligible patients were identified,?99 were successfully surveyed, 13 refused, 2 were unable to take part and 47 were unsuccessfully contacted on two separate occasions. 53/99 patients (53.54%) spoke English as a first language and 73 patients (73.73%) belonged to a minority ethnic group, the majority being Asian ethnicity (38/99) followed by White (27/99) and Black (17/99). 85/99 patients were female (85.86%). 46/99 patients (46.46%) attended higher education (classified as college or university), 29 patients (29.29%) achieved A-level equivalent and 16 patients (16.16%) GCSE.

Average LKAT score was 2.43 (maximum score 4) and 62 patients (62.63%) achieved ‘adequate HL’ according to BRIEF. Educational attainment and first language were not statistically linked (P < 0.102). Performance on the BRIEF and LKAT were strongly correlated (P < 0.00013). LKAT was significantly linked with first language (P < 0.042) but not educational attainment (P < 0.056). BRIEF was significantly related to educational attainment (P < 0.0017) but not first language (P < 0.229), with attending higher education being the most significant factor for good health literacy.

Conclusion This study has identified that language and educational attainment are important correlates of health literacy in patients with LN. For the LN specific assessment language more than educational attainment was a key discriminator. Using this information, targeted intervention to improve HL in LN, with a focus on language will help to improve HL in LN.