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Wang J, Thombs BD, Schmid MR. The Swiss Health Literacy Survey: development and psychometric properties of a multidimensional instrument to assess competencies for health. Health Expect 2012; 17:396-417. [PMID: 22390287 DOI: 10.1111/j.1369-7625.2012.00766.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Growing recognition of the role of citizens and patients in health and health care has placed a spotlight on health literacy and patient education. OBJECTIVE To identify specific competencies for health in definitions of health literacy and patient-centred concepts and empirically test their dimensionality in the general population. METHODS A thorough review of the literature on health literacy, self-management, patient empowerment, patient education and shared decision making revealed considerable conceptual overlap as competencies for health and identified a corpus of 30 generic competencies for health. A questionnaire containing 127 items covering the 30 competencies was fielded as a telephone interview in German, French and Italian among 1255 respondents randomly selected from the resident population in Switzerland. FINDINGS Analyses with the software MPlus to model items with mixed response categories showed that the items do not load onto a single factor. Multifactorial models with good fit could be erected for each of five dimensions defined a priori and their corresponding competencies: information and knowledge (four competencies, 17 items), general cognitive skills (four competencies, 17 items), social roles (two competencies, seven items), medical management (four competencies, 27 items) and healthy lifestyle (two competencies, six items). Multiple indicators and multiple causes models identified problematic differential item functioning for only six items belonging to two competencies. CONCLUSIONS The psychometric analyses of this instrument support broader conceptualization of health literacy not as a single competence but rather as a package of competencies for health.
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Affiliation(s)
- Jen Wang
- Research Epidemiologist, Institute for Social and Preventive Medicine, University of Zurich, Zurich, SwitzerlandSenior Researcher, Institute for Social and Preventive Medicine, University of Zurich, Zurich, SwitzerlandAssistant Professor, Department of Psychiatry, McGill University, Montréal, QC, Canada
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Health literacy and asthma. J Allergy Clin Immunol 2012; 129:935-42. [PMID: 22326486 DOI: 10.1016/j.jaci.2012.01.040] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 01/05/2012] [Accepted: 01/12/2012] [Indexed: 11/20/2022]
Abstract
The report "Healthy people" from the US Department of Health and Human Services defines health literacy (HL) as follows: "The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions." The same report identifies asthma as a public health problem of high priority. Unfortunately, impaired HL is prevalent in our society, and patients with low HL and asthma face multiple challenges as they attempt to manage their disease. Indeed, the National Asthma Education and Prevention Program's current guidelines require patients to have considerable HL and self-management skills. Numerous studies have linked inadequate literacy with poor health outcomes. Unlike many sociodemographic variables, HL can potentially be addressed in the health care setting. The purpose of this review is to raise awareness of the problem, summarize the current evidence linking HL and asthma, and offer strategies to strengthen the communication between patients and health care providers to decrease asthma health disparities. In addition, we discuss potential future directions for research in this field.
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Carbone ET, Zoellner JM. Nutrition and Health Literacy: A Systematic Review to Inform Nutrition Research and Practice. J Acad Nutr Diet 2012; 112:254-65. [DOI: 10.1016/j.jada.2011.08.042] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 06/29/2011] [Indexed: 01/03/2023]
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Bhat AA, DeWalt DA, Zimmer CR, Fried BJ, Rangachari P, Seol YH, Callahan LF. Associations between low literacy and health status measures: cross-sectional analyses of two physical activity trials. JOURNAL OF HEALTH COMMUNICATION 2011; 17:230-245. [PMID: 22059652 DOI: 10.1080/10810730.2011.585688] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Arthritis researchers have thoroughly documented a powerful relationship between years of education and health outcomes, but they have not documented the role of literacy. The authors examined the associations between literacy and arthritis health status measures. Participants were recruited from southeastern urban and rural areas. Rapid Estimate of Adult Literacy in Medicine, which provides an estimate of reading level in less than 3 minutes, was administered to 447 participants at baseline in 2 community-based randomized controlled trials of lifestyle interventions designed for aging sedentary adults with arthritis. Those who read below ninth grade were considered to have low literacy. Among the 447 study participants, the median sample age was 69 years. A majority of the participants were women (86%), Caucasian (80%), overweight or obese (72%). Of all participants, 20% had low literacy. Significantly more African Americans (54%) than Caucasians (12%) had low literacy levels (p < .001). Individuals with low literacy did not have significantly worse disability or arthritis symptoms than individuals with adequate literacy (all ps > .05). Among our study participants, 1 in 5 had low literacy, but literacy was not associated with health status in this population.
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Affiliation(s)
- Anita A Bhat
- Medical College of Georgia, 1120 15th Street, EB 1011, Augusta, GA 30912, USA.
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Murray C, Johnson W, Wolf MS, Deary IJ. The association between cognitive ability across the lifespan and health literacy in old age: The Lothian Birth Cohort 1936. INTELLIGENCE 2011. [DOI: 10.1016/j.intell.2011.04.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Improved pregnancy outcome in refugees and migrants despite low literacy on the Thai-Burmese border: results of three cross-sectional surveys. BMC Pregnancy Childbirth 2011; 11:45. [PMID: 21679475 PMCID: PMC3142536 DOI: 10.1186/1471-2393-11-45] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2010] [Accepted: 06/17/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal and infant health has been associated with maternal education level, which is highly associated with literacy. We aimed at estimating literacy rates among reproductive age women attending antenatal clinics in camps for refugees and in migrant clinics in Tak province, north-western Thailand, to determine whether illiteracy had an impact on birth outcomes. METHODS Three reading assessments were conducted using an identical method each time, in 1995-97, 2003 and 2008. Midwives chose at random one of four pre-set sentences. Each woman was asked to read aloud and scoring was based on a "pass/fail" system. Pregnancy outcomes were compared with maternal literacy rate. RESULTS Overall, 47% (1149/2424) of women were able to read. A significant improvement was observed among migrant (34% in 2003 vs. 46% in 2008, p = 0.01), but not refugee (47% in 1995-97, 49% in 2003, and 51% in 2008) women. Literate women were significantly more likely to be of non-Karen ethnicity, primigravidae, non-smokers, to remain free from malaria during pregnancy and to deliver in a health clinic. Significant improvements in pregnancy outcome (reductions in premature births, low birth weight newborns and neonatal death) between 1995-97 and 2003 were unrelated to literacy. CONCLUSIONS Significant reductions in poor pregnancy outcome over time have not been driven by changes in literacy rates, which have remained low. Access to early diagnosis and treatment of malaria in this population, and delivery with skilled birth attendants, despite ongoing low literacy, appears to have played a significant role.
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King JP, Davis TC, Bailey SC, Jacobson KL, Hedlund LA, Di Francesco L, Parker RM, Wolf MS. Developing consumer-centered, nonprescription drug labeling a study in acetaminophen. Am J Prev Med 2011; 40:593-8. [PMID: 21565649 DOI: 10.1016/j.amepre.2011.02.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 02/11/2011] [Accepted: 02/14/2011] [Indexed: 02/05/2023]
Abstract
BACKGROUND In the U.S., acetaminophen overdose has surpassed viral hepatitis as the leading cause of acute liver failure, and misuse contributes to more than 30,000 hospitalizations annually. Half to two thirds of acetaminophen overdoses are unintentional, suggesting the root cause is likely poor understanding of medication labeling or failure to recognize the consequences of exceeding the recommended maximum daily dosage. PURPOSE Elicit subject feedback about active ingredient and dosing information on over-the-counter (OTC) acetaminophen and elicit feedback on proposed plain-language text and icons. METHODS Six focus groups, preceded by individual interviews, were conducted in April 2010 among 45 adults in two cities from two clinics and an adult basic education center. The individual interviews evaluated knowledge of OTC pain relievers, attention to product label information and literacy level while the group discussion elicited preference for label messages and icons. Analyses were conducted from April to June 2010. RESULTS Forty-four percent read at or below the 6th-grade level. Individual interviews revealed that <50% of participants routinely examine product label information. Only 31% know acetaminophen is in Tylenol®. The groups achieved consensus on a preferred icon for acetaminophen, desired explicit statement of potential liver damage in the warning against simultaneous use of acetaminophen products, and indicated preference for an icon and wording for maximum dose. CONCLUSIONS With the high prevalence of OTC use, a consumer-centered approach to developing icons and messages to promote awareness and safe use of acetaminophen could benefit consumers.
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Affiliation(s)
- Jennifer P King
- Health Literacy and Learning Program, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, Chicago, IL 60611, USA.
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Neafsey PJ, M’lan CE, Ge M, Walsh SJ, Lin CA, Anderson E. Reducing Adverse Self-Medication Behaviors in Older Adults with Hypertension: Results of an e-health Clinical Efficacy Trial. AGEING INTERNATIONAL 2011; 36:159-191. [PMID: 21654869 PMCID: PMC3092917 DOI: 10.1007/s12126-010-9085-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A randomized controlled efficacy trial targeting older adults with hypertension (age 60 and over) provided an e-health, tailored intervention with the "next generation" of the Personal Education Program (PEP-NG). Eleven primary care practices with advanced practice registered nurse (APRN) providers participated. Participants (N = 160) were randomly assigned by the PEP-NG (accessed via a wireless touchscreen tablet computer) to either control (entailing data collection and four routine APRN visits) or tailored intervention (involving PEP-NG intervention and four focused APRN visits) group. Compared to patients in the control group, patients receiving the PEP-NG e-health intervention achieved significant increases in both self-medication knowledge and self-efficacy measures, with large effect sizes. Among patients not at BP targets upon entry to the study, therapy intensification in controls (increased antihypertensive dose and/or an additional antihypertensive) was significant (p = .001) with an odds ratio of 21.27 in the control compared to the intervention group. Among patients not at BP targets on visit 1, there was a significant declining linear trend in proportion of the intervention group taking NSAIDs 21-31 days/month (p = 0.008). Satisfaction with the PEP-NG and the APRN provider relationship was high in both groups. These results suggest that the PEP-NG e-health intervention in primary care practices is effective in increasing knowledge and self-efficacy, as well as improving behavior regarding adverse self-medication practices among older adults with hypertension.
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Affiliation(s)
- Patricia J. Neafsey
- School of Nursing Unit 2026, University of Connecticut, Storrs, CT 06269 USA
- Center for Health Intervention and Prevention (CHIP), University of Connecticut, Storrs, CT 06269 USA
| | - Cyr E. M’lan
- Department of Statistics, University of Connecticut, Storrs, CT 06269 USA
| | - Miaomiao Ge
- Department of Statistics, University of Connecticut, Storrs, CT 06269 USA
| | - Stephen J. Walsh
- Center for Nursing Scholarship, School of Nursing, University of Connecticut, Storrs, CT 06269 USA
| | - Carolyn A. Lin
- Center for Health Intervention and Prevention (CHIP), University of Connecticut, Storrs, CT 06269 USA
- Department of Communication Sciences, University of Connecticut, Storrs, CT 06269 USA
| | - Elizabeth Anderson
- School of Nursing Unit 2026, University of Connecticut, Storrs, CT 06269 USA
- Center for Health Intervention and Prevention (CHIP), University of Connecticut, Storrs, CT 06269 USA
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Critical health literacy: a review and critical analysis. Soc Sci Med 2011; 73:60-7. [PMID: 21640456 DOI: 10.1016/j.socscimed.2011.04.004] [Citation(s) in RCA: 229] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 01/04/2011] [Accepted: 04/12/2011] [Indexed: 11/20/2022]
Abstract
Though there has been a considerable expansion of interest in the health literacy concept worldwide, there has also been criticism that this concept has been poorly defined, that it stretches the idea of "literacy" to an indefensible extent and more specifically, that it adds little to the existing concerns and intervention approaches of the better established discipline of health promotion. This paper takes as a starting point the expanded model of health literacy advanced by Nutbeam (2000) and addresses these concerns by interrogating the concept of "critical health literacy" in order to draw conclusions about its utility for advancing the health of individuals and communities. The constituent domains of critical health literacy are identified; namely information appraisal, understanding the social determinants of health, and collective action, and as far as possible each are clearly delineated, with links to related concepts made explicit. The paper concludes that an appreciation of work undertaken in a range of different disciplines, such as media studies, medical sociology, and evidence-based medicine can enhance our understanding of the critical health literacy construct and help us understand its usefulness as a social asset which helps individuals towards a critical engagement with health information. There is some evidence that aspects of critical health literacy have indeed been found to be a resource for better health outcomes, but more research is needed in this area, both to develop quantitative and qualitative approaches to evaluating health literacy skills, and to offer convincing evidence that investment in programmes designed to enhance critical health literacy are worthwhile.
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Luk A, Aslani P. Tools used to evaluate written medicine and health information: document and user perspectives. HEALTH EDUCATION & BEHAVIOR 2011; 38:389-403. [PMID: 21490309 DOI: 10.1177/1090198110379576] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aims to identify and review tools used to evaluate consumer-oriented written medicine (WMI) and health (WHI) information from a document and user perspective. Articles that met the following inclusion criteria were reviewed: studies evaluating readability, presentation, suitability, quality of WMI/WHI. A total of 152 articles were identified, of which 64 satisfied the inclusion criteria. Fifty-nine original studies used evaluation tools and 5 reviewed a specific group of tools. Sixteen detailed the development or validation of an instrument. Fifteen studies evaluated WMI and 28 evaluated WHI. Twenty-three evaluation instruments were identified. Of the seven readability tests, SMOG was predominantly used (12 of 43 studies). Eight tools measured health literacy, with REALM being the most popular instrument (7 of 43). SAM was the most commonly used presentation tool (12 of 43 studies). Many tools are available to evaluate WMI and WHI. However, the majority are researcher focused. Most evaluate readability and presentation, revealing a gap in valid and reliable tools for assessing quality of information, and those that can be used by consumers.
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Affiliation(s)
- Alice Luk
- University of Sydney, New South Wales, Australia
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Brown SM, Culver JO, Osann KE, MacDonald DJ, Sand S, Thornton AA, Grant M, Bowen DJ, Metcalfe KA, Burke HB, Robson ME, Friedman S, Weitzel JN. Health literacy, numeracy, and interpretation of graphical breast cancer risk estimates. PATIENT EDUCATION AND COUNSELING 2011; 83:92-8. [PMID: 20554149 PMCID: PMC4041683 DOI: 10.1016/j.pec.2010.04.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 03/12/2010] [Accepted: 04/28/2010] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Health literacy and numeracy are necessary to understand health information and to make informed medical decisions. This study explored the relationships among health literacy, numeracy, and ability to accurately interpret graphical representations of breast cancer risk. METHODS Participants (N=120) were recruited from the Facing Our Risk of Cancer Empowered (FORCE) membership. Health literacy and numeracy were assessed. Participants interpreted graphs depicting breast cancer risk, made hypothetical treatment decisions, and rated preference of graphs. RESULTS Most participants were Caucasian (98%) and had completed at least one year of college (93%). Fifty-two percent had breast cancer, 86% had a family history of breast cancer, and 57% had a deleterious BRCA gene mutation. Mean health literacy score was 65/66; mean numeracy score was 4/6; and mean graphicacy score was 9/12. Education and numeracy were significantly associated with accurate graph interpretation (r=0.42, p<0.001 and r=0.65, p<0.001, respectively). However, after adjusting for numeracy in multivariate linear regression, education added little to the prediction of graphicacy (r(2)=0.41 versus 0.42, respectively). CONCLUSION In our highly health-literate population, numeracy was predictive of graphicacy. PRACTICE IMPLICATIONS Effective risk communication strategies should consider the impact of numeracy on graphicacy and patient understanding.
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Affiliation(s)
- Sandra M. Brown
- Saddleback Memorial Medical Center, USA
- University of California, Irvine, USA
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Screening for low literacy in a rheumatology setting: more than 10% of patients cannot read "cartilage," "diagnosis," "rheumatologist," or "symptom". J Clin Rheumatol 2011; 16:359-64. [PMID: 21085021 DOI: 10.1097/rhu.0b013e3181fe8ab1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objectives of the study were to analyze literacy in 194 consecutive patients at an academic rheumatology setting with the Rapid Estimate of Adult Literacy in Medicine (REALM) and an "Arthritis-Adapted" REALM (A-REALM), and to compare responses to one another and to demographic and clinical measures. METHODS The REALM and A-REALM are two 66-item word recognition tests. Both were administered to 194 consecutive patients in usual rheumatology care. Multidimensional Health Assessment Questionnaire (MDHAQ) scores for physical function, pain, fatigue, and global estimate, and laboratory assessments also were available. Descriptive statistics and analyses of agreement were computed. RESULTS REALM and A-REALM administration involved 2 to 3 minutes each. Scores below 61, indicating a reading level at eighth grade or less, were seen in 35 (18%) of 194 patients on the REALM and 46 patients (24%) on the A-REALM. No patient was classified as having severely low literacy at or below a third-grade level. However, words not read correctly by 10% or more of the patients on the REALM included diagnosis (14%), osteoporosis (17%), and inflammatory (10%), and on the A-REALM, rheumatologist (11%), cartilage (14%), and symptom (14%). REALM and A-REALM scores were correlated significantly (Pearson r = 0.94, P < 0.001). Almost all patients (33/35) with REALM scores of less than 61 also had A-REALM scores of less than 61, less formal education, and poorer clinical status on all measures, most not statistically significant. CONCLUSION Low literacy is an important underrecognized problem in medical care, which may be assessed easily in standard care using the REALM or A-REALM. Further attention to literacy-associated barriers may reduce socioeconomic disparities in health.
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Yaffe K, Weston A, Graff-Radford NR, Satterfield S, Simonsick EM, Younkin SG, Younkin LH, Kuller L, Ayonayon HN, Ding J, Harris TB. Association of plasma beta-amyloid level and cognitive reserve with subsequent cognitive decline. JAMA 2011; 305:261-6. [PMID: 21245181 PMCID: PMC3108075 DOI: 10.1001/jama.2010.1995] [Citation(s) in RCA: 161] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Lower plasma β-amyloid 42 and 42/40 levels have been associated with incident dementia, but results are conflicting and few have investigated cognitive decline among elders without dementia. OBJECTIVE To determine if plasma β-amyloid is associated with cognitive decline and if this association is modified by measures of cognitive reserve. DESIGN, SETTING, AND PARTICIPANTS We studied 997 black and white community-dwelling older adults from Memphis, Tennessee, and Pittsburgh, Pennsylvania, who were enrolled in the Health ABC Study, a prospective observational study begun in 1997-1998 with 10-year follow-up in 2006-2007. Participant mean age was 74.0 (SD, 3.0) years; 55.2% (n = 550) were female; and 54.0% (n = 538) were black. MAIN OUTCOME MEASURES Association of near-baseline plasma β-amyloid levels (42 and 42/40 measured in 2010) and repeatedly measured Modified Mini-Mental State Examination (3MS) results. RESULTS Low β-amyloid 42/40 level was associated with greater 9-year 3MS cognitive decline (lowest β-amyloid tertile: mean change in 3MS score, -6.59 [95% confidence interval [CI], -5.21 to -7.67] points; middle tertile: -6.16 [95% CI, -4.92 to -7.32] points; and highest tertile: -3.60 [95% CI, -2.27 to -4.73] points; P < .001). Results were similar after multivariate adjustment for age, race, education, diabetes, smoking, and apolipoprotein E [APOE ] e4 status and after excluding the 72 participants with incident dementia. Measures of cognitive reserve modified this association whereby among those with high reserve (at least a high school diploma, higher than sixth-grade literacy, or no APOE e4 allele), β-amyloid 42/40 was less associated with multivariate adjusted 9-year decline. For example, among participants with less than a high school diploma, the 3MS score decline was -8.94 (95% CI, -6.94 to -10.94) for the lowest tertile compared with -4.45 (95% CI, -2.31 to -6.59) for the highest tertile, but for those with at least a high school diploma, 3MS score decline was -4.60 (95% CI,-3.07 to -6.13) for the lowest tertile and -2.88 (95% CI,-1.41 to -4.35) for the highest tertile (P = .004 for interaction). Interactions were also observed for literacy (P = .005) and for APOE e4 allele (P = .02). CONCLUSION Lower plasma β-amyloid 42/40 is associated with greater cognitive decline among elderly persons without dementia over 9 years, and this association is stronger among those with low measures of cognitive reserve.
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Affiliation(s)
- Kristine Yaffe
- Department of Psychiatry, University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA.
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Tsai TI, Lee SYD, Tsai YW, Kuo KN. Methodology and validation of health literacy scale development in Taiwan. JOURNAL OF HEALTH COMMUNICATION 2011; 16:50-61. [PMID: 21058141 DOI: 10.1080/10810730.2010.529488] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This article reports a generic methodology for developing health literacy assessment tools, consisting of 5 steps: (a) semi-structured, in-depth interviews of health care consumers; (b) consultation with health care, education, and psychometrics experts; (c) generation of an item pool; (d) selection of items for inclusion in the Mandarin Health Literacy Scale; and (e) evaluation of readability. To illustrate, the authors applied the methodology in order to develop a health literacy scale for the Mandarin Chinese-speaking population. They field-tested the initial version of the scale with a random sample of 323 Taiwanese adults. In addition, the authors used item response theory and classical test theory to examine the psychometric properties of the scale. Results showed good validity and reliability.
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Affiliation(s)
- Tzu-I Tsai
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
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Emmerton LM, Mampallil L, Kairuz T, McKauge LM, Bush RA. Exploring health literacy competencies in community pharmacy. Health Expect 2010; 15:12-22. [PMID: 21122042 DOI: 10.1111/j.1369-7625.2010.00649.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Health literacy is the ability to obtain, interpret and use health information. Low rates of health literacy in Australia have been suggested, but no validated measure exists. OBJECTIVE To explore health literacy competencies in a sample of community pharmacy consumers. DESIGN Structured interviews were undertaken by a team of researchers during August, 2009. The instrument was derived from available literature, measuring aspects of functional, interactive and critical health literacy regarding use of medicines. SETTING AND PARTICIPANTS Twelve community pharmacies in the Brisbane region, Australia. RESULTS Six hundred and forty-seven consumers participated; 64% were women. A wide distribution of ages was evident. English was the first language of 89% of respondents. More than half of the sample (55%), predominantly aged 26-45 years, was tertiary educated. While 87% of respondents recognized a sample prescription, 20% could not readily match the prescription to a labelled medicine box. Eighty-two percentage of respondents interpreted 'three times a day' appropriately, but interpretation of a standard ancillary label was highly variable. Advanced age, less formal education, non-English-speaking background and male gender were independently related to lower performance in some variables. DISCUSSION This health literacy measure applied comprehension and numeracy skills required of adults receiving prescription medications. While the majority of consumers adequately performed these tasks, some behaviours and responses were of sufficient concern to propose additional verbal and written information interventions by pharmacy staff. CONCLUSIONS This research provides insight into issues that may affect consumers' appropriate use of medicines and self-efficacy. Initiatives to improve public health literacy are warranted.
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Affiliation(s)
- Lynne M Emmerton
- The University of Queensland, School of Pharmacy, PACE Precinct, Woolloongabba, Qld, Australia.
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Health literacy and emergency department outcomes: a systematic review. Ann Emerg Med 2010; 57:334-45. [PMID: 21035902 DOI: 10.1016/j.annemergmed.2010.08.035] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 08/19/2010] [Accepted: 08/25/2010] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE We assess emergency department (ED) patients' health literacy, the readability of ED patient materials, and the relationship between health literacy and ED outcomes through a systematic literature review. METHODS PubMed, PsychInfo, CINAHL, Web of Knowledge, and ERIC were searched for studies published January 1, 1980, to July 15, 2010, conducted in the United States, reporting original data, and measuring ED patients' health literacy, the readability of ED materials, or the association between health literacy and ED-related outcomes. Two reviewers evaluated each study and abstracted information from included studies into evidence tables. RESULTS We identified 413 articles, and 31 met inclusion criteria. Collectively, health literacy skills were assessed at or below the eighth-grade level for approximately 40% of ED patients. In contrast, ED patient materials were typically assessed at or above the ninth-grade level. Studies of adults aged 65 years and older found that those with lower health literacy were more likely to use the ED and incur higher ED costs. Studies of pediatric ED patients did not find direct effects of caregiver literacy on ED outcomes. CONCLUSION A substantial proportion of ED patients have limited health literacy, and ED materials are typically too complex for these patients. It is important for EDs to evaluate the accessibility and patient understanding of information presented. The evidence linking health literacy to ED outcomes is limited. Additional research is needed to better understand the relationship between health literacy and ED outcomes.
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Bhat AA, DeWalt DA, Zimmer CR, Fried BJ, Callahan LF. The role of helplessness, outcome expectation for exercise and literacy in predicting disability and symptoms in older adults with arthritis. PATIENT EDUCATION AND COUNSELING 2010; 81:73-78. [PMID: 20060257 DOI: 10.1016/j.pec.2009.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 12/02/2009] [Accepted: 12/05/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To examine the effect of outcome expectation for exercise (OEE), helplessness, and literacy on arthritis outcomes in 2 community-based lifestyle randomized controlled trials (RCTs) conducted in urban and rural communities with older adults with arthritis. METHODS Data from 391 participants in 2 RCTs were combined to examine associations of 2 psychosocial variables: helplessness and OEE, and literacy with arthritis outcomes. Arthritis outcomes namely, the Health Assessment Questionnaire-Disability Index (HAQ-DI) and arthritis symptoms pain, fatigue and stiffness Visual Analogue Scales (VAS), were measured at baseline and at the end of the interventions. Complete baseline and post-intervention data were analyzed using STATA version 9. RESULTS Disability after intervention was not predicted by helplessness, literacy, or OEE in the adjusted model. Arthritis symptoms after the intervention were all significantly predicted by helplessness at various magnitudes in adjusted models, but OEE and literacy were not significant predictors. CONCLUSION When literacy, helplessness, and OEE were examined as predictors of arthritis outcomes in intervention trials, they did not predict disability. However, helplessness predicted symptoms of pain, fatigue, and stiffness, but literacy did not predict symptoms. PRACTICE IMPLICATIONS Future sustainable interventions may include self-management components that address decreasing helplessness to improve arthritis outcomes.
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Affiliation(s)
- Anita A Bhat
- Department of Health Informatics, Medical College of Georgia, 1120 15th Street, Augusta, GA 30912, USA.
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Wilson EAH, Park DC, Curtis LM, Cameron KA, Clayman ML, Makoul G, Vom Eigen K, Wolf MS. Media and memory: the efficacy of video and print materials for promoting patient education about asthma. PATIENT EDUCATION AND COUNSELING 2010; 80:393-398. [PMID: 20688454 DOI: 10.1016/j.pec.2010.07.011] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 07/07/2010] [Accepted: 07/08/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE We examined the effects of presentation medium on immediate and delayed recall of information and assessed the effect of giving patients take-home materials after initial presentations. METHODS Primary-care patients received video-based, print-based or no asthma education about asthma symptoms and triggers and then answered knowledge-based questions. Print participants and half the video participants received take-home print materials. A week later, available participants completed the knowledge assessment again. RESULTS Participants receiving either intervention outperformed controls on immediate and delayed assessments (p<0.001). For symptom-related information, immediate performance did not significantly differ between print and video participants. A week later, receiving take-home print predicted better performance (p<0.05), as did self-reported review among recipients of take-home print (p<0.01). For content about inhaler usage, although video watchers outperformed print participants immediately after seeing the materials (p<0.001), a week later these two groups' performance did not significantly differ. Among participants given take-home materials, review predicted marginally better recall (p=0.06). CONCLUSION Video and print interventions can promote recall of health-related information. Additionally, reviewable materials, if they are utilized, may improve retention. PRACTICE IMPLICATIONS When creating educational tools, providers should consider how long information must be retained, its content, and the feasibility of providing tangible supporting materials.
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Affiliation(s)
- Elizabeth A H Wilson
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL 60611, USA.
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Garbers S, Schmitt K, Rappa AM, Chiasson MA. Functional health literacy in Spanish-speaking Latinas seeking breast cancer screening through the National Breast and Cervical Cancer Screening Program. Int J Womens Health 2010; 1:21-9. [PMID: 21072272 PMCID: PMC2971707 DOI: 10.2147/ijwh.s4957] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: This analysis examines the association between functional health literacy and follow-up after mammography among women receiving breast cancer screening at a National Breast and Cervical Cancer Early Detection Program site in New York City that provides universal bilingual case management. Methods: A total of 707 Latinas who spoke Spanish as their primary language completed a survey of health and demographic characteristics and the Test of Functional Health Literacy in Spanish (TOFHLA-S). Survey results were matched with clinical outcome data. Results: Among the survey participants, 98% were foreign-born and 99% had no health insurance. While the study found significant differences in access to health information and past screening behavior, women without adequate health literacy in Spanish were no less likely to receive clinical resolution of abnormal mammograms within 60 days (81.8% overall; n = 110) or to return for a repeat mammogram within 18 months (57.2% overall; n = 697). In fact, among those referred for a Pap test (n = 310), women without adequate health literacy were more likely to receive a Pap test within 60 days of their mammogram than those with adequate health literacy (82% compared to 71%, OR: 1.83, 95% CI: 1.04–3.22). Discussion: The lack of significantly lower follow-up outcomes among women with inadequate and marginal functional health literacy in this population of primary Spanish-speaking Latinas suggests that, once women have accessed screening services, programmatic approaches may exist to mitigate barriers to follow-up and to ensure optimal cancer screening outcomes for women of all literacy levels.
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Griffin JM, Partin MR, Noorbaloochi S, Grill JP, Saha S, Snyder A, Nugent S, Baines Simon A, Gralnek I, Provenzale D, van Ryn M. Variation in estimates of limited health literacy by assessment instruments and non-response bias. J Gen Intern Med 2010; 25:675-81. [PMID: 20224964 PMCID: PMC2881963 DOI: 10.1007/s11606-010-1304-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Revised: 02/01/2010] [Accepted: 02/08/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This paper compares estimates of poor health literacy using two widely used assessment tools and assesses the effect of non-response on these estimates. STUDY DESIGN AND SETTING A total of 4,868 veterans receiving care at four VA medical facilities between 2004 and 2005 were stratified by age and facility and randomly selected for recruitment. Interviewers collected demographic information and conducted assessments of health literacy (both REALM and S-TOFHLA) from 1,796 participants. Prevalence estimates for each assessment were computed. Non-respondents received a brief proxy questionnaire with demographic and self-report literacy questions to assess non-response bias. Available administrative data for non-participants were also used to assess non-response bias. RESULTS Among the 1,796 patients assessed using the S-TOFHLA, 8% had inadequate and 7% had marginal skills. For the REALM, 4% were categorized with 6th grade skills and 17% with 7-8th grade skills. Adjusting for non-response bias increased the S-TOFHLA prevalence estimates for inadequate and marginal skills to 9.3% and 11.8%, respectively, and the REALM estimates for < or = 6th and 7-8th grade skills to 5.4% and 33.8%, respectively. CONCLUSIONS Estimates of poor health literacy varied by the assessment used, especially after adjusting for non-response bias. Researchers and clinicians should consider the possible limitations of each assessment when considering the most suitable tool for their purposes.
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Affiliation(s)
- Joan M Griffin
- Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Minneapolis, MN 55417, USA.
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VanGeest JB, Welch VL, Weiner SJ. Patients' perceptions of screening for health literacy: reactions to the newest vital sign. JOURNAL OF HEALTH COMMUNICATION 2010; 15:402-412. [PMID: 20574878 DOI: 10.1080/10810731003753117] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Difficulties in caring for patients with limited health literacy have prompted interest in health literacy screening. Several prior studies, however, have suggested that health literacy testing can lead to feelings of shame and stigmatization. In this study, we examine patient reaction to the Newest Vital Sign (NVS), a screening instrument developed specifically for use in primary care. Data were collected in 2008 in the Morehouse School of Medicine, Department of Family Medicine Primary Care Clinics, where health literacy screening was implemented as part of routine intake procedures. Following the visit, patients completed a series of questions assessing their screening experiences. A total of 179 patients completed both the NVS and the reaction survey. Nearly all (> 99%) patients reported that the screening did not cause them to feel shameful. There were also no differences in the reported prevalence of shame (p <or= .33) by literacy level. Finally, when asked if they would recommend clinical screening, 97% of patients answered in the affirmative. These results suggest that screening for limited health literacy in primary care may not automatically elicit feelings of shame. Even patients with the lowest levels of literacy were both comfortable with and strongly supportive of clinical screening.
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Affiliation(s)
- Jonathan B VanGeest
- School of Community Health and Policy, Morgan State University, Baltimore, Maryland, USA
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Lee SYD, Stucky BD, Lee JY, Rozier RG, Bender DE. Short Assessment of Health Literacy-Spanish and English: a comparable test of health literacy for Spanish and English speakers. Health Serv Res 2010; 45:1105-20. [PMID: 20500222 DOI: 10.1111/j.1475-6773.2010.01119.x] [Citation(s) in RCA: 182] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE The intent of the study was to develop and validate a comparable health literacy test for Spanish-speaking and English-speaking populations. STUDY DESIGN The design of the instrument, named the Short Assessment of Health Literacy-Spanish and English (SAHL-S&E), combined a word recognition test, as appearing in the Rapid Estimate of Adult Literacy in Medicine (REALM), and a comprehension test using multiple-choice questions designed by an expert panel. We used the item response theory (IRT) in developing and validating the instrument. DATA COLLECTION Validation of SAHL-S&E involved testing and comparing the instrument with other health literacy instruments in a sample of 201 Spanish-speaking and 202 English-speaking subjects recruited from the Ambulatory Care Center at the University of North Carolina Healthcare System. PRINCIPAL FINDINGS Based on IRT analysis, 18 items were retained in the comparable test. The Spanish version of the test, SAHL-S, was highly correlated with other Spanish health literacy instruments, Short Assessment of Health Literacy for Spanish-Speaking Adults (r=0.88, p<.05) and the Spanish Test of Functional Health Literacy in Adults (TOFHLA) (r=0.62, p<.05). The English version, SAHL-E, had high correlations with REALM (r=0.94, p<.05) and the English TOFHLA (r=0.68, p<.05). Significant correlations were found between SAHL-S&E and years of schooling in both Spanish- and English-speaking samples (r=0.15 and 0.39, respectively). SAHL-S&E displayed satisfactory reliability of 0.80 and 0.89 in the Spanish- and English-speaking samples, respectively. IRT analysis indicated that the SAHL-S&E score was highly reliable for individuals with a low level of health literacy. CONCLUSIONS The new instrument, SAHL-S&E, has good reliability and validity. It is particularly useful for identifying individuals with low health literacy and could be used to screen for low health literacy among Spanish and English speakers.
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Affiliation(s)
- Shoou-Yih Daniel Lee
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, 1101 McGavran-Greenberg Hall, CB# 7411, Chapel Hill, NC 27599-7411, USA.
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Applicability of the REALM health literacy test to an English second-language South African population. ACTA ACUST UNITED AC 2010; 32:464-71. [PMID: 20490680 DOI: 10.1007/s11096-010-9392-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 04/19/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE AND SETTING To investigate health literacy in an English second language population using the REALM test, to evaluate its appropriateness and to compare health literacy between four different education categories. SETTING Primary healthcare clinics and participant homes in Grahamstown, South Africa. METHOD The REALM test, a US-developed test, was administered via an interpreter to 125 Xhosa-speaking, English second language participants from a range of educational backgrounds. Participants were asked to read all 66 words (three lists of 22 words each), and pronunciation was assessed. In a deviation from the standard method, an explanation for each word was requested to evaluate comprehension. Results were classified into four categories: adequately pronounced and comprehended; neither adequately pronounced nor comprehended; adequately pronounced but not comprehended; not adequately pronounced but comprehended. The first two categories were rated as "applicable". The percentage of "applicable" cases of the total of 8250 cases (125 participants; 66 words each) was calculated. The association between education and both pronunciation and comprehension was investigated using chi-square tests, with a significance level of P < 0.05. MAIN OUTCOME MEASURES Average grade-equivalent reading level; number of words adequately pronounced and comprehended; applicability of the REALM to individual words. RESULTS Average grade-equivalent reading level of the study population according to the REALM test was grade 7-8. An average of 46 of 66 words were adequately pronounced, whereas less than half this number (20) were adequately comprehended. Comprehension ability was 57% lower than the ability to adequately pronounce the words, a finding that highlights the inability of pronunciation data to predict comprehension of a health-related text. Examples of poor comprehension include antibiotics (16.0%), fatigue (6.4%), nausea (8.0%), anaemia (2.4%), osteoporosis (0.8%), hepatitis (0.8%), haemorrhoids (0%), impetigo (0%) and colitis (0%). Both pronunciation (P = 0.016) and comprehension (P = 0.001) were significantly influenced by education. Applicability of the REALM to individual words ranged from 20.8 to 96.0%, with an average of 59.1%. Given that the REALM was deemed inapplicable for an average of four out of every 10 words, it appears to be unsuitable for use in its current form for assessing health literacy of the study population.
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Sharif I, Blank AE. Relationship between child health literacy and body mass index in overweight children. PATIENT EDUCATION AND COUNSELING 2010; 79:43-48. [PMID: 19716255 PMCID: PMC2839034 DOI: 10.1016/j.pec.2009.07.035] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Revised: 07/21/2009] [Accepted: 07/22/2009] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To test the relationship between child health literacy and body mass index (BMI) Z-score in overweight children. METHODS Cross-sectional survey of overweight children and parents. Parent and child health literacy was measured by the Short Test of Functional Health Literacy (STOFHLA). Linear regression tested for predictors of childhood BMI Z-score, adjusting for confounders. RESULTS Of 171 total children, 107 (62%) participated, of whom 78 (73%) had complete data for analysis. Mean child BMI Z-score (SD) was 2.3 (0.40); median child age (interquartile range) was 11.5 (10-16); 53% were female; 80% were Medicaid recipients. Mean child STOFHLA was 22.9 (9.0); mean parental STOFHLA was 29.1 (8.6). Child STOFHLA correlated negatively with BMI Z-score (r=-0.37, p=0.0009) and positively with child eating self-efficacy (r=0.40, p<0.0001). After adjusting for confounders, child STOFHLA was independently associated with child BMI Z-score (standardized B=-0.43, p<0.0001). Overall adjusted r-squared for the regression model was 38%. Child STOFHLA contributed 13% to the overall model. CONCLUSIONS Child health literacy was negatively correlated with BMI Z-scores in overweight children, suggesting the need to consider health literacy in the intersection between self-efficacy and behavior change when planning interventions that aim to improve child BMI.
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Affiliation(s)
- Iman Sharif
- General Pediatrics, Thomas Jefferson University, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA.
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Thompson AE, Goldszmidt MA, Schwartz AJ, Bashook PG. A randomized trial of pictorial versus prose-based medication information pamphlets. PATIENT EDUCATION AND COUNSELING 2010; 78:389-393. [PMID: 20153597 DOI: 10.1016/j.pec.2010.01.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Revised: 01/17/2010] [Accepted: 01/18/2010] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The goal of this study was to compare prose and pictorial-based information pamphlets about the medication methotrexate in the domains of free recall, cued recall, comprehension and utility. METHODS A single blind, randomized trial of picture versus prose-based information pamphlets including 100 participants aged 18-65 years of age, who had not completed high school, could read English, and had no prior knowledge about methotrexate. Superiority of pamphlet type was assessed using immediate free recall, cued recall and comprehension. RESULTS There were no differences between picture and prose pamphlets in free recall, cued recall, and comprehension either immediately or after a 1-week interval. Immediate free recall of important information was 17-26%; free recall fell even lower to 7-16% after 1 week. The pictorial pamphlet was preferred over the prose-based pamphlet. CONCLUSION This study found no benefit in free recall, cued recall, or comprehension through the addition of pictograms to a simple prose-based medication pamphlet. PRACTICE IMPLICATIONS In order for them to be effective in clinical practice, even simple medication information pamphlets that have been assessed for patients' ability to comprehend them cannot be used as the sole means for conveying important medication-related information to patients.
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Affiliation(s)
- Andrew E Thompson
- Department of Medicine, University of Western Ontario, London, Canada.
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Osborn CY, Davis TC, Bailey SC, Wolf MS. Health literacy in the context of HIV treatment: introducing the Brief Estimate of Health Knowledge and Action (BEHKA)-HIV version. AIDS Behav 2010; 14:181-8. [PMID: 19023653 DOI: 10.1007/s10461-008-9484-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Accepted: 10/14/2008] [Indexed: 11/25/2022]
Abstract
A brief, 8-item assessment of HIV treatment knowledge and action was developed and evaluated. Patients with HIV were interviewed in 2001 at infectious disease clinics in Shreveport, LA and Chicago, IL. Analyses on demographics, self-reported medication adherence, and responses to the Rapid Estimate of Adult Literacy in Medicine (REALM) and new, Brief Estimate of Health Knowledge and Action-HIV version (BEHKA-HIV) were performed in 2007. The BEHKA-HIV demonstrated high internal consistency, and construct validity. Lower scores on the BEHKA-HIV were independently associated with poorer rates of HIV medication adherence, scores 4-5 out of 8, AOR 2.6 (95% CI 1.9-3.6), and scores 0-3, AOR 11.4 (95% CI 8.2-15.9), as were the lowest scores on the REALM, AOR 3.3 (95% CI 1.3-8.7). The BEHKA-HIV is a psychometrically sound tool for assessing health knowledge and action regarding HIV treatment, and predicting non-adherence to HIV medications.
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Affiliation(s)
- Chandra Y Osborn
- Division of General Internal Medicine and Public Health, Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, TN 37232-8300, USA.
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Shaw SJ, Huebner C, Armin J, Orzech K, Orzech K, Vivian J. The role of culture in health literacy and chronic disease screening and management. J Immigr Minor Health 2010; 11:460-7. [PMID: 18379877 DOI: 10.1007/s10903-008-9135-5] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Cultural and language differences and socioeconomic status interact with and contribute to low health literacy, defined as the inability to understand or act on medical/therapeutic instructions. Health literacy is increasingly recognized as an important factor in patient compliance, cancer screening utilization, and chronic disease outcomes. Commendable efforts have been initiated by the American Medical Association and other organizations to address low health literacy among patients. Less work has been done, however, to place health literacy in the broader context of socioeconomic and cultural differences among patients and providers that hinder communication and compliance. This review examines cultural influences on health literacy, cancer screening and chronic disease outcomes. We argue that cultural beliefs around health and illness contribute to an individual's ability to understand and act on a health care provider's instructions. This paper proposes key aspects of the intersection between health literacy and culturally varying beliefs about health which merit further exploration.
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Affiliation(s)
- Susan J Shaw
- Department of Anthropology, University of Arizona, Tucson, AZ 85721-0030, USA.
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Sabbahi DA, Lawrence HP, Limeback H, Rootman I. Development and evaluation of an oral health literacy instrument for adults. Community Dent Oral Epidemiol 2009; 37:451-62. [PMID: 19740249 DOI: 10.1111/j.1600-0528.2009.00490.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To develop and validate an instrument to measure the functional oral health literacy of adults. METHODS For the generation of items different dental patient educational materials and text types were selected that had reading levels similar to materials used for the Test of Functional Health Literacy in Adults (TOFHLA) which was the model for our Oral Health Literacy Instrument (OHLI). The OHLI contains reading comprehension and numeracy sections. The reading comprehension section is a 38-item test with words omitted from one passage on dental caries and another on periodontal disease. The numeracy section has 19 items to test comprehension of directions for taking common prescriptions associated with dental treatment, postextraction instructions and dental appointments. We also developed a 17-item oral health knowledge test. The OHLI, the TOFHLA, the oral health knowledge test and a brief questionnaire were administered to a convenience sample of 100 patients. Internal reliability of OHLI was assessed with Cronbach's alpha. Test-retest reliability was examined by intra-class correlation coefficient (ICC). Concurrent validity was tested by comparing OHLI scores across categories of education level and frequency of dental visits. Construct validity was assessed by correlating OHLI scores with TOFHLA scores and with the oral health knowledge scores using Spearman's rho (rho) and multiple linear regression. RESULTS Participants averaged 39 years (SD = 12.4); 73% were female; 64% had college/university education; 40% visited a dentist every 3-6 months. Total OHLI and TOFHLA weighted mean scores were 87.2 and 91.7, respectively (possible range 0-100). The Cronbach's alpha values were high (>0.7) for OHLI and its components. The ICC values indicated good agreement between the test and retest results for OHLI and the oral health knowledge test. Patients visiting a dentist every 3-6 months had significantly higher levels of oral health literacy than those visiting only when they felt pain. The association between OHLI and education level was not significant. OHLI scores were significantly correlated with the scores on the TOFHLA (rho = 0.613) and the test of oral health knowledge (rho = 0.573). These associations remained significant in multiple regression models. CONCLUSION Initial testing of OHLI suggested that it is a valid and reliable instrument to evaluate oral health literacy among adults, although additional work is needed to investigate the instrument's predictive validity and sensitivity to change using oral health outcomes with population groups known to be at high risk of low functional oral health literacy.
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Affiliation(s)
- Dania A Sabbahi
- Community Dentistry Discipline, Department of Biological and Diagnostic Sciences, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
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Neafsey PJ, Anderson E, Coleman C, Lin CA, M’lan CE, Walsh S. Reducing adverse self-medication behaviors in older adults with the Next Generation Personal Education Program (PEP-NG): Design and methodology. Patient Prefer Adherence 2009; 3:323-34. [PMID: 20016796 PMCID: PMC2792870 DOI: 10.2147/ppa.s7906] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A randomized controlled efficacy trial targeting older adults with hypertension is providing a tailored education intervention with a Next Generation Personal Education Program (PEP-NG) in primary care practices in New England. Ten participating advanced practice registered nurses (APRNs) completed online knowledge and self-efficacy measures pre-onsite training and twice more after completing a continuing education program. Patient participants self-refer in response to study recruitment brochures and posters. Twenty-four participants from each APRN practice (total N = 240) are randomly assigned by the PEP-NG software to either control (data collection and four routine APRN visits) or tailored intervention (PEP-NG interface and four focused APRN visits) conditions. Patients access the PEP-NG interface via wireless tablet and use a stylus to answer demographic, knowledge, and self-efficacy questions as well as prescription and over-the-counter self-medication practice questions. The PEP-NG analyzes patient-reported information and delivers tailored educational content. Patients' outcome measures are self-reported antihypertensive medication adherence, blood pressure, knowledge and self-efficacy concerning potential adverse self-medication practices, adverse self-medication behavior "risk" score and satisfaction with the PEP-NG and APRN provider relationship. APRN outcome measures are knowledge and self-efficacy concerning adverse self-medication practices, self-efficacy for communicating with older adults and satisfaction with the PEP-NG. Time-motion and cost-benefit analyses will be conducted.
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Affiliation(s)
| | | | | | - Carolyn A Lin
- Center for Health Intervention and Prevention (CHIP)
- Department of Communication Sciences
| | | | - Stephen Walsh
- Center for Nursing Research, School of Nursing, University of Connecticut, Storrs, CT, USA
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Donelle L, Hoffman-Goetz L, Gatobu S, Arocha JF. Comprehension of Internet-based numeric cancer information by older adults. Inform Health Soc Care 2009; 34:209-24. [DOI: 10.3109/17538150903358552] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mayhorn CB, Goldsworthy RC. New and improved: The role of text augmentation and the application of response interpretation standards (coding schemes) in a final iteration of birth defects warnings development. ACTA ACUST UNITED AC 2009; 85:864-71. [DOI: 10.1002/bdra.20601] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ngoh LN. Health literacy: A barrier to pharmacist–patient communication and medication adherence. J Am Pharm Assoc (2003) 2009; 49:e132-46; quiz e147-9. [PMID: 19748861 DOI: 10.1331/japha.2009.07075] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Lucy Nkukuma Ngoh
- College of Pharmacy, Ferris State University, Big Rapids, MI 49307, USA.
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Mancuso JM. Assessment and measurement of health literacy: an integrative review of the literature. Nurs Health Sci 2009; 11:77-89. [PMID: 19298313 DOI: 10.1111/j.1442-2018.2008.00408.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Research linking health literacy to health knowledge, health behaviors, health outcomes, health disparity, health status, and increasing health-care costs is prevalent around the globe. Given the importance of health literacy, it is prudent to examine the tools available to assure that patients are health-literate. This article provides an integrative review in order to investigate what has been developed to evaluate health literacy in the health-care setting. The research questions considered include: (i) Which instruments or screening tools are available to assess or measure health literacy in the clinical setting?; and (ii) What are the psychometric properties, advantages, and limitations of the identified tools? A number of databases are utilized to locate research specific to this topic. The research is analyzed, the findings are summarized, and the limitations are mentioned. The implications, recommendations, and the need for future research are discussed.
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Affiliation(s)
- Josephine M Mancuso
- College of Nursing, Marquette University, Milwaukee, Wisconsin 53201-1881, USA.
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Abstract
CONTEXT Although low health literacy can affect patients' treatment decision making, comprehension of health information, and medication adherence, little is known about health literacy skills of kidney transplant recipients. OBJECTIVE To examine the relationship among kidney transplant recipients' health literacy levels, transplant knowledge, and graft function. DESIGN Cross-sectional study of 124 adult kidney transplant recipients. MAIN OUTCOME MEASURES Health literacy was assessed via the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the Rapid Estimate of Adult Literacy in Medicine-Transplantation (REALM-T). Data on recipients' transplant numeracy, knowledge needs, and demographics were collected via semistructured interviews. Multivariable linear regressions were used to assess the relationship between health literacy and graft function. RESULTS Most kidney recipients (91%) had adequate health literacy (S-TOFHLA); however, 81% were unfamiliar with at least 1 kidney transplant-related term (REALM-T). The 5 least familiar terms were sensitization (50%), urethra (45%), trough level (41%), blood urea nitrogen (32%), and toxicity (31%). Numeracy levels varied: 21% knew the likelihood of 1-year graft survival; 29% knew that half of kidney recipients have problems with the transplant in the first 6 months; 68% were aware of the risk of death within the first year after transplantation; and 86% knew the normal range for creatinine in kidney recipients. Patients with lower health literacy (REALM-T) had higher creatinine levels. CONCLUSIONS Transplant providers should intervene with better patient education materials to improve patients' health literacy, which may improve patients' medication adherence or transplant outcomes.
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Affiliation(s)
- Elisa J Gordon
- Institute for HealthCare Studies, Department of Surgery, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL 60611, USA.
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86
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Rudd RE, Blanch DC, Gall V, Chibnik LB, Wright EA, Reichmann W, Liang MH, Katz JN. A randomized controlled trial of an intervention to reduce low literacy barriers in inflammatory arthritis management. PATIENT EDUCATION AND COUNSELING 2009; 75:334-9. [PMID: 19345053 PMCID: PMC2748845 DOI: 10.1016/j.pec.2009.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Revised: 02/21/2009] [Accepted: 03/03/2009] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Test the efficacy of educational interventions to reduce literacy barriers and enhance health outcomes among patients with inflammatory arthritis. METHODS The intervention consisted of plain language information materials and/or two individualized sessions with an arthritis educator. Randomization was stratified by education level. Principal outcomes included adherence to treatments, self-efficacy, satisfaction with care, and appointment keeping. Secondary outcomes included health status and mental health. Data were collected at baseline, six, and twelve months post. RESULTS Of the 127 patients, half had education beyond high school and three quarters had disease duration greater than five years. There were no differences in the primary outcome measures between the groups. In mixed models controlling for baseline score and demographic factors, the intervention group showed improvement in mental health score at six and twelve months (3.0 and 3.7 points, respectively), while the control group showed diminished scores (-4.5 and -2.6 points, respectively) (p=0.03 and 0.01). CONCLUSION While the intervention appears to have had no effect on primary outcomes, further studies with continued attention to literacy are warranted. Study site and disease duration must be considered as participants in this study had higher than average health literacy and had established diagnoses for years prior to this study. PRACTICE IMPLICATIONS The study offers insight into an application of many of the protocols currently recommended to ameliorate effects of limited literacy.
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Affiliation(s)
- Rima E Rudd
- Harvard School of Public Health, Department of Society, Human Development and Health, Boston, MA 02115, United States.
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87
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Abstract
Context Although low health literacy can affect patients' treatment decision making, comprehension of health information, and medication adherence, little is known about health literacy skills of kidney transplant recipients. Objective To examine the relationship among kidney transplant recipients' health literacy levels, transplant knowledge, and graft function. Design Cross-sectional study of 124 adult kidney transplant recipients. Main Outcome Measures Health literacy was assessed via the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the Rapid Estimate of Adult Literacy in Medicine-Transplantation (REALM-T). Data on recipients' transplant numeracy, knowledge needs, and demographics were collected via semistructured interviews. Multivariable linear regressions were used to assess the relationship between health literacy and graft function. Results Most kidney recipients (91%) had adequate health literacy (S-TOFHLA); however, 81% were unfamiliar with at least 1 kidney transplant–related term (REALM-T). The 5 least familiar terms were sensitization (50%), urethra (45%), trough level (41%), blood urea nitrogen (32%), and toxicity (31%). Numeracy levels varied: 21% knew the likelihood of 1-year graft survival; 29% knew that half of kidney recipients have problems with the transplant in the first 6 months; 68% were aware of the risk of death within the first year after transplantation; and 86% knew the normal range for creatinine in kidney recipients. Patients with lower health literacy (REALM-T) had higher creatinine levels. Conclusions Transplant providers should intervene with better patient education materials to improve patients' health literacy, which may improve patients' medication adherence or transplant outcomes.
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88
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Pickard AS, Lin HW, Knight SJ, Knight SL, Sharifi R, Wu Z, Hung SY, Witt WP, Chang CH, Bennett CL. Proxy assessment of health-related quality of life in african american and white respondents with prostate cancer: perspective matters. Med Care 2009; 47:176-83. [PMID: 19169118 PMCID: PMC3215256 DOI: 10.1097/mlr.0b013e31818475f4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES An emerging issue in the proxy literature is whether specifying different proxy viewpoints contributes to different health-related quality of life (HRQL) assessments, and if so, how might each perspective be informative in medical decision making. The aims of this study were to determine if informal caregiver assessments of patients with prostate cancer differed when prompted from both the patient perspective (proxy-patient) and their own viewpoint (proxy-proxy), and to identify factors associated with differences in proxy perspectives (ie, the intraproxy gap). RESEARCH DESIGN AND METHODS Using a cross-sectional design, prostate cancer patients and their informal caregivers were recruited from urology clinics in the Jesse Brown Veterans Affairs Healthcare System in Chicago. Dyads assessed HRQL using the EQ-5D visual analog scale (VAS) and EORTC QLQ-C30. RESULTS Of 87 dyads, most caregivers were female (83%) and were spouses/partners (58%). Mean difference scores between proxy-patient and proxy-proxy perspectives were statistically significant for QLQ-C30 physical and emotional functioning, and VAS (all P < 0.05), with the proxy-patient perspective closer to patient self-report. Emotional functioning had the largest difference, mean 6.0 (SD 12.8), an effect size = 0.47. Factors weakly correlated with the intraproxy gap included relationship (spouse) and proxy gender for role functioning, and health literacy (limited/functional) for physical functioning (all P < 0.05, 0.20 < r < 0.35). CONCLUSIONS Meaningful differences between proxy-patient and proxy-proxy perspectives on mental health were consistent with a conceptual framework for understanding proxy perspectives. Prompting different proxy viewpoints on patient health could help clinicians identify patients who may benefit from clinical intervention.
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Affiliation(s)
- A Simon Pickard
- Department of Pharmacy Practice and Pharmacy Administration, Center for Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, Chicago, USA.
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89
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Weiss KB, Shannon JJ, Sadowski LS, Sharp LK, Curtis L, Lyttle CS, Kumar R, Shalowitz MU, Weiselberg L, Catrambone CD, Evans A, Kee R, Miller J, Kimmel L, Grammer LC. The burden of asthma in the Chicago community fifteen years after the availability of national asthma guidelines: the design and initial results from the CHIRAH study. Contemp Clin Trials 2009; 30:246-55. [PMID: 19470314 DOI: 10.1016/j.cct.2009.01.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 12/23/2008] [Accepted: 01/07/2009] [Indexed: 01/30/2023]
Affiliation(s)
- Kevin B Weiss
- Institute for Healthcare Studies, Northwestern University, Chicago, IL 60611, USA.
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90
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Improving patient understanding of prescription drug label instructions. J Gen Intern Med 2009; 24:57-62. [PMID: 18979142 PMCID: PMC2607498 DOI: 10.1007/s11606-008-0833-4] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 08/08/2008] [Accepted: 10/01/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patient misunderstanding of instructions on prescription drug labels is common and a likely cause of medication error and less effective treatment. OBJECTIVE To test whether the use of more explicit language to describe dose and frequency of use for prescribed drugs could improve comprehension, especially among patients with limited literacy. DESIGN Cross-sectional study using in-person, structured interviews. PATIENTS Three hundred and fifty-nine adults waiting for an appointment in two hospital-based primary care clinics and one federally qualified health center in Shreveport, Louisiana; Chicago, Illinois; and New York, New York, respectively. MEASUREMENT Correct understanding of each of ten label instructions as determined by a blinded panel review of patients' verbatim responses. RESULTS Patient understanding of prescription label instructions ranged from 53% for the least understood to 89% for the most commonly understood label. Patients were significantly more likely to understand instructions with explicit times periods (i.e., morning) or precise times of day compared to instructions stating times per day (i.e., twice) or hourly intervals (89%, 77%, 61%, and 53%, respectively, p < 0.001). In multivariate analyses, dosage instructions with specific times or time periods were significantly more likely to be understood compared to instructions stating times per day (time periods--adjusted relative risk ratio (ARR) 0.42, 95% Confidence Interval (CI) 0.34-0.52; specific times--ARR 0.60, 95% CI 0.49-0.74). Low and marginal literacy remained statistically significant independent predictors of misinterpreting instructions (low--ARR 2.70, 95% CI 1.81-4.03; marginal--ARR 1.66, 95% CI 1.18-2.32). CONCLUSIONS Use of precise wording on prescription drug label instructions can improve patient comprehension. However, patients with limited literacy were more likely to misinterpret instructions despite use of more explicit language.
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91
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Neafsey PJ, Anderson E, Peabody S, Lin CA, Strickler Z, Vaughn K. Beta testing of a network-based health literacy program tailored for older adults with hypertension. Comput Inform Nurs 2008; 26:311-9. [PMID: 19047879 PMCID: PMC3655693 DOI: 10.1097/01.ncn.0000336466.17811.e7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A touch screen-enabled "Personal Education Program" was modified to the "next generation" to capture self-medication behaviors of older adults with hypertension and assess related knowledge and self-efficacy. The program analyzes patient-entered information and delivers interactive educational content tailored to the reported behaviors. Summaries of self-reported symptoms, medication use (including frequency/time), drug interactions, and corrective strategies with an illustration of the drug interaction are printed to inform the provider before the primary care visit and for the patient to take home for self-study. After formative research during development and formal diagnostic and verification usability studies with advanced practice nurses and older adults, a beta test was conducted with older adults with hypertension over a 3-month period. Findings from the beta test suggest that older adult user satisfaction was high. Blood pressure declined over the four visits for 82% of the participants. The next generation of the Personal Education Program had a large effect size in increasing knowledge and self-efficacy for avoiding adverse self-medication behaviors. Behavior risk score did not change significantly but was significantly correlated with systolic blood pressure on the fourth visit. The positive results found in this small sample suggest that the next generation of the Personal Education Program could play a central role in facilitating patient-provider communication and medication adherence.
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Affiliation(s)
- Patricia J Neafsey
- School of Nursing, University of Connecticut, Storrs, Connecticut 06269, USA.
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92
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Shedlosky-Shoemaker R, Sturm AC, Saleem M, Kelly KM. Tools for assessing readability and quality of health-related Web sites. J Genet Couns 2008; 18:49-59. [PMID: 18937063 DOI: 10.1007/s10897-008-9181-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Accepted: 07/11/2008] [Indexed: 11/28/2022]
Abstract
With the Internet becoming a growing source of information on genetics, genetic counselors and other health-care providers may be called upon to guide their patients to appropriate material, which is written at a suitable reading level for the individual and contains quality information. Given that many health-related Web sites are written at a high school or higher reading level, without direction from a genetic counselor or health-care provider, many Internet users may currently be turning to health-related Web sites that they do not understand. Additionally, Internet users may not know how to evaluate the quality of information they find, which could lead to them access inaccurate or irrelevant information. To aid in the process of finding and designing Web sites that are appropriate for patients, the current article provides guidelines for assessing readability and quality of health-related content. Additionally, a demonstration of an assessment is provided. Finally, limitations of these assessments are discussed.
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93
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Abstract
Traditional delivery of primary care takes place in a face-to-face transaction between provider and patient. In telemedicine, however, the transaction is 'filtered' by the distance and technology. The potential problem of filtered communication in a telemedicine encounter was examined from a human factors perspective. Patients with and without experience of telemedicine, and providers who had experience of telemedicine, were asked about patient-provider relationships in interviews and focus groups. Seven themes emerged: initial impressions, style of questions, field of view, physical interaction, social talk, control of encounter and ancillary services. This suggests that communication can be improved and better patient-provider relationships can be developed in a primary care telemedicine encounter if attention is paid to four areas of the interaction: verbal, non-verbal, relational and actions/transactional. The human factors dimension of telemedicine is an important element in delivery of health care at a distance - and is one of few factors over which the provider has direct control.
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Affiliation(s)
- Robert J Bulik
- AT&T Center for Telehealth Research and Policy, University of Texas Medical Branch, Galveston, TX 77555-0406, USA.
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94
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Brewer NT, Edwards AS, O'Neill SC, Tzeng JP, Carey LA, Rimer BK. When genomic and standard test results diverge: implications for breast cancer patients' preference for chemotherapy. Breast Cancer Res Treat 2008; 117:25-9. [PMID: 18785002 DOI: 10.1007/s10549-008-0175-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Accepted: 08/25/2008] [Indexed: 11/26/2022]
Abstract
PURPOSE We examined how women incorporate potentially differing genomic and standard assessments of breast cancer recurrence risk into chemotherapy decisions. METHODS 165 women previously treated for early-stage breast cancer indicated their interest in chemotherapy regimens to prevent recurrence of breast cancer in response to six hypothetical vignettes that presented breast cancer recurrence risk estimates from standard criteria and a genomic test, some of which were discordant. RESULTS Standard and genomic test results each elicited greater interest in chemotherapy when they indicated high rather than low risk for recurrence (89% vs. 26%, and 87% vs. 22%, respectively, Ps < 0.001). Genomic test results had a larger impact on chemotherapy preferences than standard measures to predict recurrence. CONCLUSIONS Some women may be reluctant to forgo chemotherapy when genomic tests indicate low recurrence risk but standard criteria suggest high risk. Additional research including replication of the findings of this small, vignette-based study is needed.
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Affiliation(s)
- Noel T Brewer
- Department of Health Behavior and Health Education, University of North Carolina, Chapel Hill, 27516, USA.
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Waite KR, Paasche-Orlow M, Rintamaki LS, Davis TC, Wolf MS. Literacy, social stigma, and HIV medication adherence. J Gen Intern Med 2008; 23:1367-72. [PMID: 18563494 PMCID: PMC2518013 DOI: 10.1007/s11606-008-0662-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Revised: 03/27/2008] [Accepted: 04/28/2008] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prior studies have linked limited literacy to poorer HIV medication adherence, although the precise causal pathways of this relationship have only been initially investigated. OBJECTIVE To examine whether social stigma is a possible mediator to the relationship between literacy and self-reported HIV medication adherence. DESIGN Structured patient interviews with a literacy assessment, supplemented by medical chart review, were conducted among patients receiving care at infectious disease clinics in Shreveport, Louisiana and Chicago, Illinois. Literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), while stigma was measured using items taken from the Patient Medication Adherence Questionnaire (PMAQ). PARTICIPANTS Two hundred and four consecutive patients participated. RESULTS Approximately one-third of the patients (30.4%) were less than 100% adherent to their regimen, and 31.4% had marginal (7th-8th grade) or low (< or = 6th grade) literacy. In multivariate analyses, patients with low literacy were 3.3 times more likely to be non-adherent to antiretroviral regimens (95% CI 1.3-8.7; p < 0.001). Perceived social stigma was found to mediate the relationship between literacy and medication adherence (AOR 3.1, 95% CI 1.3-7.7). CONCLUSIONS While low literacy was a significant risk factor for improper adherence to HIV medication regimens in our study, perceived social stigma mediated this relationship. Low literacy HIV intervention strategies may also need to incorporate more comprehensive psychosocial approaches to overcome stigma barriers.
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Affiliation(s)
- Katherine R. Waite
- Health Literacy and Learning Program, Institute for Healthcare Studies, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Michael Paasche-Orlow
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA USA
| | - Lance S. Rintamaki
- Department of Communication, State University of New York, Buffalo, NY USA
- Department of Health Behavior, State University of New York, Buffalo, NY USA
| | - Terry C. Davis
- Louisiana State University Health Sciences Center, Shreveport, LA USA
| | - Michael S. Wolf
- Health Literacy and Learning Program, Institute for Healthcare Studies, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
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96
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Johnson TV, Abbasi A, Ehrlich SS, Kleris RS, Schoenberg ED, Owen-Smith A, Goodman M, Master VA. Patient Misunderstanding of the Individual Questions of the American Urological Association Symptom Score. J Urol 2008; 179:2291-4; discussion 2294-5. [DOI: 10.1016/j.juro.2008.01.140] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Indexed: 11/29/2022]
Affiliation(s)
- Timothy V. Johnson
- Department of Urology, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ammara Abbasi
- Department of Urology, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Samantha S. Ehrlich
- Department of Urology, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Renee S. Kleris
- Department of Urology, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Evan D. Schoenberg
- Department of Urology, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ashli Owen-Smith
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Viraj A. Master
- Department of Urology, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia
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97
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Validation of screening questions for limited health literacy in a large VA outpatient population. J Gen Intern Med 2008; 23:561-6. [PMID: 18335281 PMCID: PMC2324160 DOI: 10.1007/s11606-008-0520-5] [Citation(s) in RCA: 1009] [Impact Index Per Article: 63.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2007] [Revised: 12/11/2007] [Accepted: 01/14/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Previous studies have shown that a single question may identify individuals with inadequate health literacy. We evaluated and compared the performance of 3 health literacy screening questions for detecting patients with inadequate or marginal health literacy in a large VA population. METHODS We conducted in-person interviews among a random sample of patients from 4 VA medical centers that included 3 health literacy screening questions and 2 validated health literacy measures. Patients were classified as having inadequate, marginal, or adequate health literacy based on the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the Rapid Estimate of Adult Literacy in Medicine (REALM). We evaluated the ability of each of 3 questions to detect: 1) inadequate and the combination of "inadequate or marginal" health literacy based on the S-TOFHLA and 2) inadequate and the combination of "inadequate or marginal" health literacy based on the REALM. MEASUREMENTS AND MAIN RESULTS Of 4,384 patients, 1,796 (41%) completed interviews. The prevalences of inadequate health literacy were 6.8% and 4.2%, based on the S-TOHFLA and REALM, respectively. Comparable prevalences for marginal health literacy were 7.4% and 17%, respectively. For detecting inadequate health literacy, "How confident are you filling out medical forms by yourself?" had the largest area under the Receiver Operating Characteristic Curve (AUROC) of 0.74 (95% CI: 0.69-0.79) and 0.84 (95% CI: 0.79-0.89) based on the S-TOFHLA and REALM, respectively. AUROCs were lower for detecting "inadequate or marginal" health literacy than for detecting inadequate health literacy for each of the 3 questions. CONCLUSION A single question may be useful for detecting patients with inadequate health literacy in a VA population.
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98
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Goldsworthy RC, Schwartz NC, Mayhorn CB. Beyond abuse and exposure: framing the impact of prescription-medication sharing. Am J Public Health 2008; 98:1115-21. [PMID: 18445792 DOI: 10.2105/ajph.2007.123257] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to document the frequency, circumstances, and consequences of prescription medication-sharing behaviors and to use a medication-sharing impact framework to organize the resulting data regarding medication-loaning and -borrowing practices. METHODS One-on-one interviews were conducted in 2006, and participants indicated (1) prescription medicine taken in the past year, (2) whether they had previously loaned or borrowed prescription medicine, (3) scenarios in which they would consider loaning or borrowing prescription medicine, and (4) the types of prescription medicines they had loaned or borrowed. RESULTS Of the 700 participants, 22.9% reported having loaned their medications to someone else and 26.9% reported having borrowed someone else's prescription. An even greater proportion of participants reported situations in which medication sharing was acceptable to them. CONCLUSIONS Sharing prescription medication places individuals at risk for diverse consequences, and further research regarding medication loaning and borrowing behaviors and their associated consequences is merited.
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Affiliation(s)
- Richard C Goldsworthy
- Research & Development, Academic Edge Inc, 108 E 14th St, Bloomington, IN 47408, USA.
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99
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Lau DT, Briesacher B, Mercaldo ND, Halpern L, Osterberg EC, Jarzebowski M, McKoy JM, Mazor K. Older patients' perceptions of medication importance and worth: an exploratory pilot study. Drugs Aging 2008; 25:1061-75. [PMID: 19021304 PMCID: PMC2747735 DOI: 10.2165/0002512-200825120-00007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cost-related medication non-adherence may be influenced by patients' perceived importance of their medications. OBJECTIVES This exploratory pilot study addresses three related but distinct questions: Do patients perceive different levels of importance among their medications? What factors influence perceptions of medication importance? Is perceived importance associated with perceived worth of medications, and does expense impact on that association? METHODS Study participants included individuals aged >or=60 years who were taking three or more prescription drugs. Semi-structured, in-person interviews were conducted to measure how patients rated their medications in terms of importance, expense and worth. Factors that influenced medication importance were identified using qualitative analysis. Ordinal logistic regression analyses were employed to examine the association between perceived importance and perceived worth of medications, and the impact of expense on that association. RESULTS For 143 prescription drugs reported by 20 participants, the weighted mean rating of medication importance was 8.2 (SD 1.04) on a scale from 0 (not important at all) to 10 (most important). Patients considered 38% of these medications to be expensive. The weighted mean rating of worth was 8.4 (SD 1.46) on a scale from 0 (not worth it at all) to 10 (most worth). Three major factors influenced medication importance: drug-related (characteristics, indications, effects and alternatives); patient-related (knowledge, attitudes and health); and external (the media, healthcare and family caregivers, and peers). Regression analyses showed an association between perceived importance and perceived worth for inexpensive medications (odds ratio [OR] 2.23; p = 0.002) and an even greater association between perceived importance and perceived worth for expensive medications (OR 4.29; p < 0.001). DISCUSSION This study provides preliminary evidence that elderly patients perceive different levels of importance for their medications based on factors beyond clinical efficacy. Their perception of importance influences how they perceive their medications' worth, especially for medications of high costs. Understanding how patients perceive medication importance may help in the development of interventions to reduce cost-related non-adherence.
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Affiliation(s)
- Denys T. Lau
- Buehler Center on Aging, Health & Society, Northwestern University, Feinberg School of Medicine. Address: 750 North Lake Shore Drive, Suite 601, Chicago, IL 60611. (W) 312-503-1231. (F) 312-503-5868.
| | - Becky Briesacher
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, MA.
| | | | - Leslie Halpern
- Buehler Center on Aging, Health & Society, Northwestern University, Feinberg School of Medicine, Chicago, IL.
| | | | - Mary Jarzebowski
- Medical Sciences Division, University of Oxford, Oxford, England.
| | - June M. McKoy
- Division of Geriatric Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL.
| | - Kathleen Mazor
- Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA.
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100
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Wolf MS, Williams MV, Parker RM, Parikh NS, Nowlan AW, Baker DW. Patients' shame and attitudes toward discussing the results of literacy screening. JOURNAL OF HEALTH COMMUNICATION 2007; 12:721-732. [PMID: 18030638 DOI: 10.1080/10810730701672173] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We investigated patients' willingness to have their reading ability documented in their medical records and the degree of shame and embarrassment associated with such disclosure. Structured interviews were conducted among a consecutive sample of 283 primary care patients at an urban public hospital. Patients' literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM). Self-report of degree of shame and embarrassment related to literacy skills was measured using an orally administered questionnaire. Fifty-one percent of patients had low literacy skills (< or =sixth grade) and 27.9% were assessed as having marginal literacy (seventh-eighth grade). Half (47.6%) of patients reading at or below the third-grade level admitted feeling ashamed or embarrassed about their difficulties reading, compared with 19.2% of those reading at the fourth-sixth-grade level and 6.5% of those reading at the seventh-eighth-grade level (p < 0.001). More than 90% of patients with low or marginal literacy reported it would be helpful for the doctor or nurse to know they did not understand some medical words. Patients with limited literacy were more likely to report feelings of shame as a result of disclosure (p < 0.05). Health care providers must recognize the potential shame patients might experience as a result of literacy screening.
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Affiliation(s)
- Michael S Wolf
- Health Literacy and Learning Program, Division of General Internal Medicine, Northwestern University, Chicago, Illinois, USA.
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