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Abrams EM, Singer AG, Greenhawt M, Stukus D, Shaker M. Ten tips for improving your clinical practice during the COVID-19 pandemic. Curr Opin Pediatr 2021; 33:260-267. [PMID: 33587368 PMCID: PMC8048379 DOI: 10.1097/mop.0000000000000998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW This review provides ten tips for improving clinical practice during COVID-19 as pandemic fatigue begins to complicate personal and professional lives of clinicians. RECENT FINDINGS COVID-19 has created unique and unexpected challenges to healthcare delivery, but has also provided opportunities for re-evaluation of practice patterns to optimize high-value practices. With ongoing uncertainty, key factors to appreciate for patient and population health include the continued touchstones of empathy and compassion, the use of effective risk communication with shared clinical decision-making when appropriate, attention to resource stewardship and vulnerable populations, importance of health literacy and need for critical assessment of media and medical literature to mitigate misinformation, and the hidden costs of the pandemic on children. Although there has been some international concern for allergic reactions to the recently approved Pfizer-BioNTech COVID-19 vaccine, neither the United States Pfizer-BioNTech or Moderna COVID-19 vaccine emergency use authorizations exclude patients without a specific allergy to a vaccine component from receiving vaccination. SUMMARY Practical adjustments to practice during COVID-19 are feasible and acceptable. Experience during COVID-19 reinforces the critical need for human connection while providing care and service in every encounter.
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Affiliation(s)
- Elissa M Abrams
- University of Manitoba, Department of Pediatrics, Section of Allergy and Clinical Immunology
| | - Alexander G Singer
- University of Manitoba, Department of Family Medicine, Winnipeg, Manitoba, Canada
| | - Matthew Greenhawt
- Children's Hospital of Colorado, University of Colorado School of Medicine, Department of Pediatrics, Section of Allergy and Immunology, Aurora, Colorado
| | - David Stukus
- Division of Allergy and Immunology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Marcus Shaker
- Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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Bhatt N, Boggio L, Simpson ML. Using an educational intervention to assess and improve disease-specific knowledge and health literacy and numeracy in adolescents and young adults with haemophilia A and B. Haemophilia 2021; 27:229-236. [PMID: 33590938 DOI: 10.1111/hae.14228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 11/08/2020] [Accepted: 11/24/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Health literacy (HL) and health numeracy (HN) are underestimated barriers to treatment adherence in patients with haemophilia. AIM To test the ability of an educational intervention to improve knowledge, HL, HN, adherence and joint health in adolescent and young adult (AYA) males with haemophilia. METHODS We performed a longitudinal pilot study of 41 participants aged 12-21 years with haemophilia A or B during two clinic visits 6-12 months apart. The first visit included a comprehensive pre-intervention assessment: demographics, knowledge survey, Montreal Cognitive Assessment testing, 5-question tool to assess baseline HN, assessment of HL with the Rapid Estimate of Adolescent Literacy in Medicine tool, history of adherence and Haemophilia Joint Health Score (HJHS). An educational intervention using a visual aid explained basic pharmacokinetic (PK) concepts and personal teaching regarding haemophilia treatment regimens was used during this visit. The second visit included a post-intervention assessment: a reassessment of knowledge, HL, HN, HJHS, adherence to prescribed therapy and number of joint bleeds since the pre-intervention visit. RESULTS Forty-one males with haemophilia A or B were enrolled in the study. Of these, 33 completed the post-intervention assessment. Knowledge (p = .002) and HN (p = .05) were significantly improved post-intervention, although the HL, number of joint bleeds, adherence to prescribed therapy and HJHS were not. CONCLUSIONS Participants with low HL and/or HN may benefit from alternate methods of education such as audiovisual material. Education using audiovisual materials improved knowledge and HN in this study; however, this did not affect adherence to prescribed therapy.
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Affiliation(s)
- Nidhi Bhatt
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA.,Rush Hemophilia and Thrombophilia Center, Rush University Medical Center, Chicago, IL, USA.,Department of Hematology-Oncology, University of Illinois at Chicago Hospital, Chicago, IL, USA
| | - Lisa Boggio
- Rush Hemophilia and Thrombophilia Center, Rush University Medical Center, Chicago, IL, USA
| | - Mindy L Simpson
- Rush Hemophilia and Thrombophilia Center, Rush University Medical Center, Chicago, IL, USA
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Philips K, Zhou R, Lee DS, Marrese C, Nazif J, Browne C, Sinnett M, Tuckman S, Modi A, Rinke ML. Implementation of a Standardized Approach to Improve the Pediatric Discharge Medication Process. Pediatrics 2021; 147:peds.2019-2711. [PMID: 33408070 PMCID: PMC7849199 DOI: 10.1542/peds.2019-2711] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The pediatric inpatient discharge medication process is complicated, and caregivers have difficulty managing instructions. Authors of few studies evaluate systematic processes for ensuring quality in these care transitions. We aimed to improve caregiver medication management and understanding of discharge medications by standardizing the discharge medication process. METHODS An interprofessional team at an urban, tertiary care children's hospital trialed interventions to improve caregiver medication management and understanding. These included mnemonics to aid in complete medication counseling, electronic medical record enhancements to standardize medication documentation and simplify dose rounding, and housestaff education. The primary outcome measure was the proportion of discharge medication-related failures in each 4-week period. Failure was defined as an incorrect response on ≥1 survey questions. Statistical process control was used to analyze improvement over time. Process measures related to medication documentation and dose rounding were compared by using the χ2 test and process control. RESULTS Special cause variation occurred in the mean discharge medication-related failure rate, which decreased from 70.1% to 36.1% and was sustained. There were significantly more complete after-visit summaries (21.0% vs 85.1%; P < .001) and more patients with simplified dosing (75.2% vs 95.6%; P < .001) in the intervention period. Special cause variation also occurred for these measures. CONCLUSIONS A systematic approach to standardizing the discharge medication process led to improved caregiver medication management and understanding after pediatric inpatient discharge. These changes could be adapted by other hospitals to enhance the quality of this care transition.
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Affiliation(s)
- Kaitlyn Philips
- Children's Hospital at Montefiore, Bronx, New York; .,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Roy Zhou
- NewYork-Presbyterian Queens Hospital, Flushing, New York
| | - Diana S. Lee
- Mount Sinai Kravis Children’s Hospital, New York, New York; and
| | - Christine Marrese
- Baystate Children’s Hospital, Baystate Medical Center, Springfield, Massachusetts
| | - Joanne Nazif
- Children’s Hospital at Montefiore, Bronx, New York;,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | | | - Mark Sinnett
- Children’s Hospital at Montefiore, Bronx, New York
| | | | - Anjali Modi
- Children’s Hospital at Montefiore, Bronx, New York
| | - Michael L. Rinke
- Children’s Hospital at Montefiore, Bronx, New York;,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
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Ulrich L, Welty M, Henderson A, Allen E. Quality improvement approach to increasing respiratory therapist driven teach back style asthma education. J Asthma 2021; 59:823-828. [PMID: 33385211 DOI: 10.1080/02770903.2020.1870131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Asthma is a common chronic medical condition that can require treatment with multiple inhaled medications. Our quality improvement group established a standard asthma teaching protocol with respiratory therapists utilizing the teach back method. We aimed to increase the percentage of pulmonary asthma clinic visits receiving this education from a baseline of 42.7% in 2016 to 80% by December 2019. METHODS Multiple interventions were put in place and data was collected monthly from the electronic medical record system. Data was recorded in statistical process control charts using a p chart. Nelson's established rules for determining special versus common cause variation were used. RESULTS Over the three-year project the percentage of asthma clinic visits receiving the standardized respiratory therapist driven teach back asthma education increased to 82.3%. CONCLUSION Utilizing a standardized approach, it's possible to deliver standardized asthma education in a busy pulmonary clinic.
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Affiliation(s)
- Lisa Ulrich
- Pediatric Pulmonology, Nationwide Children's Hospital Columbus, Columbus, OH, USA.,The Ohio State University Columbus, Columbus, OH, USA
| | - Michael Welty
- Quality Improvement Services, Nationwide Children's Hospital Columbus, Columbus, OH, USA
| | - Amy Henderson
- Pediatric Pulmonology, Nationwide Children's Hospital Columbus, Columbus, OH, USA
| | - Elizabeth Allen
- Pediatric Pulmonology, Nationwide Children's Hospital Columbus, Columbus, OH, USA.,The Ohio State University Columbus, Columbus, OH, USA
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Development of a Health Literacy Program for Parents of Children with Cancer: A Mixed-Methods Study Protocol. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2021. [DOI: 10.5812/ijcm.108332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objectives: Parents’ health literacy plays an important role in the proper management of symptoms and providing appropriate care for their children living with cancer. However, studies conducted on health literacy in Iranian culture is very limited. Therefore, this study will identify the health literacy needs of parents of children with cancer and will design a program for promoting their health literacy. Methods: This exploratory mixed-methods study, using qualitative-quantitative methods including 4 consecutive phases. In the first phase, the literature review will be carried out to conceptualize and determine the domains of health literacy. In the second phase, a qualitative study will be conducted to identify and determine the needs and strategies for promoting the health literacy of parents using deep semi-structured interviews. Participants will be selected by purposive and snowball sampling methods and data will be analyzed using the directed content analysis method. In the third phase, participants’ needs will be prioritized using a panel of experts and the initial draft of the program will be designed. In the fourth phase, the modified Delphi method will be used to prioritize program strategies and select the final program. Discussion: Developing a program using a qualitative method and literature review can provide some evidence for promoting health literacy in parents of children living with cancer. Moreover, it is expected that this program promotes knowledge and empowerment of health team members, especially nurses to provide family-centered care for children with cancer. This, in turn, will increase the quality of provided treatment and care and will decrease the costs.
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Hardy RY, Liu GC, Kelleher K. Contribution of Social Determinant of Health Factors to Rural-Urban Preventive Care Differences Among Medicaid Enrollees. Acad Pediatr 2021; 21:93-100. [PMID: 32891801 DOI: 10.1016/j.acap.2020.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/14/2020] [Accepted: 08/30/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE 1) Assess whether rural-urban disparities are present in pediatric preventive health care utilization; and 2) use regression decomposition to measure the contribution of social determinants of health (SDH) to those disparities. METHODS With an Ohio Medicaid population served by a pediatric Accountable Care Organization, Partners For Kids, between 2017 and 2019, we used regression decomposition (a nonlinear multivariate regression decomposition model) to analyze the contribution of patient, provider, and SDH factors to the rural-urban well-child visit gap among children in Ohio. RESULTS Among the 453,519 eligible Medicaid enrollees, 61.2% of urban children received a well-child visit. Well-child visit receipt among children from large rural cities/towns and small/isolated towns was 58.2% and 55.5%, respectively. Comparing large rural towns to urban centers, 55.8% of the 3.0 percentage-point difference was explained by patient, provider, and community-level SDH factors. In comparing small/isolated town to urban centers, 89.8% of the 5.7 percentage-point difference was explained by these characteristics. Of provider characteristics, pediatrician providers were associated with increased well visit receipt. Of the SDH factors, unemployment and education contributed the most to the explained difference in large rural towns while unemployment, education, and food deserts contributed significantly to the small/isolated town difference. CONCLUSIONS The receipt of pediatric preventive care is slightly lower in rural communities. While modest, the largest part of the rural-urban preventive care gap can be explained by differences in provider type, poverty, unemployment, and education levels. More could be done to improve pediatric preventive care in all communities.
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Affiliation(s)
- Rose Y Hardy
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Center for Innovation in Pediatric Practice (RY Hardy and K Kelleher), Columbus, Ohio.
| | - Gilbert C Liu
- Partners For Kids, Nationwide Children's Hospital (GC Liu), Columbus, Ohio
| | - Kelly Kelleher
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Center for Innovation in Pediatric Practice (RY Hardy and K Kelleher), Columbus, Ohio; Department of Pediatrics, Nationwide Children's Hospital (K Kelleher), Columbus, Ohio
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Jenssen BP, Kelly MK, Faerber J, Hannan C, Asch DA, Shults J, Schnoll RA, Fiks AG. Pediatrician Delivered Smoking Cessation Messages for Parents: A Latent Class Approach to Behavioral Phenotyping. Acad Pediatr 2021; 21:129-138. [PMID: 32730914 PMCID: PMC7785572 DOI: 10.1016/j.acap.2020.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/08/2020] [Accepted: 07/22/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Message framing can be leveraged to motivate adult smokers to quit, but its value for parents in pediatric settings is unknown. Understanding parents' preferences for smoking cessation messages may help clinicians tailor interventions to increase quitting. METHODS We conducted a discrete choice experiment in which parent smokers of pediatric patients rated the relative importance of 26 messages designed to increase smoking cessation treatment. Messages varied on who the message featured (child, parent, and family), whether the message was gain- or loss-framed (emphasizing benefits of engaging or costs of failing to engage in treatment), and the specific outcome included (eg, general health, cancer, respiratory illnesses, and financial impact). Participants included 180 parent smokers at 4 pediatric primary care sites. We used latent class analysis of message ratings to identify groups of parents with similar preferences. Multinomial logistic regression described child and parent characteristics associated with group membership. RESULTS We identified 3 groups of parents with similar preferences for messages: Group 1 prioritized the impact of smoking on the child (n = 92, 51%), Group 2 favored gain-framed messages (n = 63, 35%), and Group 3 preferred messages emphasizing the financial impact of smoking (n = 25, 14%). Parents in Group 2 were more likely to have limited health literacy and have a child over age 6 and with asthma, compared to Group 1. CONCLUSIONS We identified 3 groups of parent smokers with different message preferences. This work may inform testing of tailored smoking cessation messages to different parent groups, a form of behavioral phenotyping supporting motivational precision medicine.
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Affiliation(s)
- Brian P Jenssen
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania (BP Jenssen, J Faerber, and AG Fiks), Philadelphia, Pa; PolicyLab and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia (BP Jenssen, MK Kelly, C Hannan, and AG Fiks), Philadelphia, Pa.
| | - Mary Kate Kelly
- PolicyLab and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia (BP Jenssen, MK Kelly, C Hannan, and AG Fiks), Philadelphia, Pa
| | - Jennifer Faerber
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania (BP Jenssen, J Faerber, and AG Fiks), Philadelphia, Pa
| | - Chloe Hannan
- PolicyLab and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia (BP Jenssen, MK Kelly, C Hannan, and AG Fiks), Philadelphia, Pa
| | - David A Asch
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania (DA Asch), Philadelphia, Pa
| | - Justine Shults
- Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania (J Shults), Philadelphia, Pa
| | - Robert A Schnoll
- Department of Psychiatry and Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania (RA Schnoll), Philadelphia, Pa
| | - Alexander G Fiks
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania (BP Jenssen, J Faerber, and AG Fiks), Philadelphia, Pa; PolicyLab and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia (BP Jenssen, MK Kelly, C Hannan, and AG Fiks), Philadelphia, Pa
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Webb J. Social aspects of chronic transfusions: addressing social determinants of health, health literacy, and quality of life. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2020; 2020:175-183. [PMID: 33275666 PMCID: PMC7727521 DOI: 10.1182/hematology.2020000104] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Chronic monthly transfusions are a lifesaving preventative therapy for many patients with sickle cell disease; however, the burden of this therapy for patients and families is high. In the United States, there is overlap in the population affected by sickle cell disease and those with the greatest burden of social needs. Hematology providers caring for patients with SCD have an opportunity to screen for and mitigate social determinants of health, especially in those receiving chronic transfusion therapy given the frequent interactions with the healthcare system and increased demand on already potentially limited resources. Given the complexity of the treatment and medication regimens, providers caring for patients receiving chronic transfusions should implement universal strategies to minimize the impact of low health literacy, as this therapy imposes a significant demand on the health literacy skills of a family. Despite the social and literacy burden of this intervention, it is reassuring that quality of life is preserved as patients with SCD on chronic transfusion therapy often report higher health related quality of life than their peers receiving other disease modifying therapies.
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Okolie F, South-Paul JE, Watchko JF. Combating the Hidden Health Disparity of Kernicterus in Black Infants: A Review. JAMA Pediatr 2020; 174:1199-1205. [PMID: 32628268 DOI: 10.1001/jamapediatrics.2020.1767] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Kernicterus is a devastating, permanently disabling neurologic condition resulting from bilirubin neurotoxicity. Black neonates account for more than 25% of kernicterus cases in the US, despite making up only approximately 14% of all births. This is a largely overlooked health disparity. OBSERVATIONS The black kernicterus health disparity exists despite a lower overall incidence of clinically significant hyperbilirubinemia among black neonates, a paradox recently explained by a previously unrecognized risk for hazardous hyperbilirubinemia. Aligned with national and global health initiatives to reduce or eliminate health disparities, this review highlights the multiple biologic and nonbiologic factors contributing to kernicterus risk in black infants and approaches to reduce this health disparity. This includes both parent-level and clinician-level kernicterus prevention strategies, with an emphasis on improving parental health literacy on neonatal jaundice and acute bilirubin encephalopathy and clinician awareness of the key factors that contribute to hazardous hyperbilirubinemia risk in this vulnerable group. Parent-level prevention strategies include efforts to improve their health literacy on neonatal jaundice and acute bilirubin encephalopathy and empower care seeking for jaundice. Clinician-level prevention strategies include efforts to eliminate community and institutional barriers that impede access to care, heighten clinician awareness of the factors that contribute to kernicterus risk in this vulnerable patient group, and strengthen newborn hyperbilirubinemia management and bilirubin surveillance. CONCLUSIONS AND RELEVANCE There are multiple opportunities for intervention to reduce black kernicterus risk. Although kernicterus is a rare disorder, the incidence among black infants is not a trivial matter nor are efforts to prevent kernicterus. While the multiple interacting biologic and nonbiologic contributors to increased kernicterus risk among black infants pose a considerable challenge to clinicians, there are opportunities for intervention to reduce this risk and health disparity. Continued study is imperative to understand the current scope of kernicterus and its occurrence in black neonates.
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Affiliation(s)
- Francesca Okolie
- Division of Neonatology, Department of Pediatrics, Columbia University, New York, New York
| | - Jeannette E South-Paul
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jon F Watchko
- Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Leung JY, Ni Riordain R, Porter S. Readability and quality of online information regarding dental treatment for patients with ischaemic heart disease. Br Dent J 2020; 228:609-614. [PMID: 32332963 DOI: 10.1038/s41415-020-1331-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Healthcare information is increasingly being sought on the Internet. Ischaemic heart disease (IHD) poses a significant health burden. Concern often arises for patients with IHD when undergoing dental treatment, leading to online searching for relevant healthcare information.Objective To evaluate the readability and quality of webpages regarding IHD and dental treatment.Materials and methods Three searches were performed on the Google search engine. The first hundred results of each search were collated and exclusion criteria applied. The remaining 66 webpages were categorised. Readability was assessed using the FRES and SMOG readability tools. Quality was assessed using the PEMAT questionnaire, the JAMA benchmarks and the Health On the Net (HON) seal.Results Most examined webpages were commercial. Readability of 90.1% of webpages was deemed fairly to very difficult. Understandability and actionability scores were generally below the comprehension level of the general population. Less than 50% of websites achieved the authorship, attribution and disclosure JAMA benchmarks. Only 12.1% of websites displayed the HON seal.Conclusions Online health information related to IHD and dental treatment is generally too difficult for the average individual to read, understand, or act upon, and may be of questionable quality. Given the low health literacy rates among the general population, future revisions of educational materials by non-commercial sources regarding IHD and dental treatment are warranted, in order to ensure online health information is understandable and of genuine benefit to patients and/or their carers.
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Affiliation(s)
- Jee-Yun Leung
- MSc in Special Care Dentistry, UCL Eastman Dental Institute, UK
| | - Richeal Ni Riordain
- Honorary Associate Professor of Oral Medicine, UCL Eastman Dental Institute, UK
| | - Stephen Porter
- Institute Director and Professor of Oral Medicine, UCL Eastman Dental Institute, UK.
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Parekh N, Khalife G, Hellmers N, D'Eramo Melkus G. The Healthy Eating and Living Against Noncommunicable Diseases Study: An Innovative Family-Based Intervention. DIABETES EDUCATOR 2020; 46:569-579. [PMID: 33124519 DOI: 10.1177/0145721720965491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Inadequate nutrition literacy within families is a barrier for healthy dietary choices and influences chronic disease risk. This pilot study examined the feasibility of providing an in-person nutrition intervention for families at high risk of developing prediabetes or type 2 diabetes and cardiovascular risk-factors. METHODS Eligible families had at least one member with a non-communicable disease (NCD) or metabolic risk factor, fluency in English, willingness to attend all three educational sessions and complete questionnaires as a family unit. Sessions included didactic and experiential activities on food label reading, portion sizing, physical activity and modifiable lifestyle factors to reduce NCD risk. Demographics and fruit and vegetable screeners were collected from all participants at baseline and after completion of sessions. Families participated in focus groups to evaluate the program. RESULTS Twelve families (n=35;17 adults;18 children) were recruited from New York City. Participants self-identified as Asian, Hispanic or Black. Adults had a mean age of 40y, BMI of 32.29kg/m2, household income of $35,000-$49,000y, and 13 of 17 adult participants had college degrees. Children ranged from 1-17y. Based on focus group feedback, three sessions were acceptable, families reported enjoying interactive activities and group learning and requested child-friendly activities. They reported improved knowledge of food labels, strategies for grocery shopping, portion-sizing, and increased awareness of the links between diet quality and NCDs. CONCLUSIONS AND IMPLICATIONS The study met recruitment goals within 4 months. The educational intervention was acceptable and may be scaled-up for future studies on NCD prevention, particularly prediabetes and type 2 diabetes.
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Affiliation(s)
- Niyati Parekh
- From NYU School of Global Public Health, New York University, New York, New York
| | - Gabrielle Khalife
- From NYU School of Global Public Health, New York University, New York, New York
| | - Natalie Hellmers
- NYU Rory Meyers College of Nursing, New York University, New York, New York
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Factors Associated With Childhood Vaccination Adherence in Kindergartens of the Houston Independent School District. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 26:131-138. [PMID: 31990882 DOI: 10.1097/phh.0000000000001093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Adequate childhood vaccination rates are crucial for successful control of infectious diseases. Nevertheless, exemption requests, lack of health care access and information and other barriers can reduce vaccination adherence rates, and increase the risk of epidemics. This study aimed to identify factors associated with kindergarten vaccination adherence in the Houston Independent School District (HISD). DESIGN AND SETTING This study was a retrospective observational data analysis. The study used data from 155 elementary schools of the HISD. The data sets included were (1) Elementary School Profile Reports (2015-2016) and (2) Annual Report of Immunization Status (2016-2017). Logistic regression was used to examine the association between vaccination adherence in schools and the school's student demographic and economic profile, student behavior indicators, teacher profile, and school rank. MAIN OUTCOME MEASURE A binary variable measuring adequate vaccination adherence rates in schools is the main outcome variable. RESULTS Lower vaccination adherence among the kindergarten students was associated with higher enrollment, a higher percentage of African American students and students with English as second language, and a lower percentage of gifted/talented students in the schools. CONCLUSIONS The school characteristics that were found to be significantly associated with kindergarten student vaccination adherence in this study are the ones that have historically been associated with socioeconomic determinants of health and socioeconomic privilege. Hence, the findings of this study suggest the need for development of policies and interventions that can help overcome the barriers associated with low socioeconomic status, language, and marginalization in order to improve vaccination rates in school districts. These include culturally appropriate polices and health promotion, patient navigation, and educational interventions that can overcome the challenges faced by socially and economically vulnerable minorities and immigrant communities in order to improve vaccination rates.
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Abstract
Republished with written permission granted from the American Optometric Association, October 2, 2020.
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Messito MJ, Mendelsohn AL, Katzow MW, Scott MA, Vandyousefi S, Gross RS. Prenatal and Pediatric Primary Care-Based Child Obesity Prevention Program: A Randomized Trial. Pediatrics 2020; 146:e20200709. [PMID: 32883807 PMCID: PMC7546096 DOI: 10.1542/peds.2020-0709] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To determine impact of a primary care-based child obesity prevention intervention beginning during pregnancy on early childhood weight outcomes in low-income Hispanic families. METHODS A randomized controlled trial comparing mother-infant pairs receiving either standard care or the Starting Early Program providing prenatal and postpartum nutrition counseling and nutrition parenting support groups targeting key obesity-related feeding practices in low-income groups. Primary outcomes were reduction in weight-for-age z-scores (WFAzs) from clinical anthropometric measures, obesity prevalence (weight for age ≥95th percentile), and excess weight gain (WFAz trajectory) from birth to age 3 years. Secondary outcomes included dose effects. RESULTS Pregnant women (n = 566) were enrolled in the third trimester; 533 randomized to intervention (n = 266) or control (n = 267). Also, 358 children had their weight measured at age 2 years; 285 children had weight measured at age 3 years. Intervention infants had lower mean WFAz at 18 months (0.49 vs 0.73, P = .04) and 2 years (0.56 vs 0.81, P = .03) but not at 3 years (0.63 vs 0.59, P = .76). No group differences in obesity prevalence were found. When generalized estimating equations were used, significant average treatment effects were detected between 10-26 months (B = -0.19, P = .047), although not through age 3 years. In within group dose analyses at 3 years, obesity rates (26.4%, 22.5%, 8.0%, P = .02) decreased as attendance increased with low, medium, and high attendance. CONCLUSIONS Mean WFAz and growth trajectories were lower for the intervention group through age 2 years, but there were no group differences at age 3. Further study is needed to enhance sustainability of effects beyond age 2.
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Affiliation(s)
| | - Alan L Mendelsohn
- Developmental and Behavioral Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine and
| | - Michelle W Katzow
- Division of General Pediatrics, Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Marc A Scott
- Department of Applied Statistics, Social Science, and Humanities, Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York; and
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Abstract
BACKGROUND CHD is the most common birth defect type, with one-fourth of patients requiring intervention in the first year of life. Caregiver understanding of CHD may vary. Health literacy may be one factor contributing to this variability. METHODS The study occurred at a large, free-standing children's hospital. Recruitment occurred at a free-of-charge CHD camp and during outpatient cardiology follow-up visits. The study team revised the CHD Guided Questions Tool from an eighth- to a sixth-grade reading level. Caregivers of children with CHD completed the "Newest Vital Sign" health literacy screen and demographic surveys. Health literacy was categorised as "high" (Newest Vital Sign score 4-6) or "low" (score 0-3). Caregivers were randomised to read either the original or revised Guided Questions Tool and completed a validated survey measuring understandability and actionability of the Guided Questions Tool. Understandability and actionability data analysis used two-sample t-testing, and within demographic group differences in these parameters were assessed via one-way analysis of variance. RESULTS Eighty-two caregivers participated who were largely well educated with a high income. The majority (79.3%) of participants scored "high" for health literacy. No differences in understanding (p = 0.43) or actionability (p = 0.11) of the original and revised Guided Questions Tool were noted. There were no socio-economic-based differences in understandability or actionability (p > 0.05). There was a trend towards improved understanding of the revised tool (p = 0.06). CONCLUSIONS This study demonstrated that readability of the Guided Questions Tool could be improved. Future work is needed to expand the study population and further understand health literacy's impact on the CHD community.
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Abrams EM. The Impact of Caregiver Health Literacy on Pediatric Asthma: An Integrative Review. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2020; 33:110-116. [DOI: 10.1089/ped.2020.1192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Elissa M. Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba Winnipeg, Canada
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67
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Lindly O, Crossman M, Eaves M, Philpotts L, Kuhlthau K. Health Literacy and Health Outcomes Among Children With Developmental Disabilities: A Systematic Review. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2020; 125:389-407. [PMID: 32936893 DOI: 10.1352/1944-7558-125.5.389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 12/07/2019] [Indexed: 06/11/2023]
Abstract
Developmental disabilities (DDs) are prevalent and associated with health disparities among children. Family health literacy of parents and/or children is one modifiable factor associated with child health; however, little is known about family health literacy for children with DDs. This systematic review was conducted to determine evidence on associations of health literacy with health outcomes among children with DDs. Medline, CINAHL, Embase, ERIC, PsycInfo, and Web of Science were searched through August 2018. Of 2,768 unique records, 53 full text articles were reviewed and four articles were included. Associations of family health literacy with health outcomes among children with DDs were mixed. Future research should include more diverse samples, greater breadth in health outcomes assessed, and increased methodological rigor.
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Affiliation(s)
| | | | | | | | - Karen Kuhlthau
- Karen Kuhlthau, Massachusetts General Hospital & Harvard Medical School
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68
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Brega AG, Jiang L, Johnson RL, Wilson AR, Schmiege SJ, Albino J. Health Literacy and Parental Oral Health Knowledge, Beliefs, Behavior, and Status Among Parents of American Indian Newborns. J Racial Ethn Health Disparities 2020; 7:598-608. [PMID: 32385848 PMCID: PMC8053009 DOI: 10.1007/s40615-019-00688-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/16/2019] [Accepted: 12/19/2019] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To examine the relationship between health literacy (HL) and parental oral health knowledge, beliefs, behavior, and self-reported oral health status (OHS) among parents of American Indian (AI) children. METHODS This analysis used baseline data from a randomized controlled trial that tested an oral health intervention with parents of AI newborns. Participants were recruited in parent-child dyads (N = 579). Parents completed items assessing sociodemographic characteristics, HL, and parental oral health knowledge, beliefs, behavior, and self-reported OHS. We examined the correlation of HL with each oral health construct, controlling for parent age and income. RESULTS On average, parents felt quite confident in their HL skills, performed well on questions assessing parental oral health knowledge, and endorsed beliefs likely to encourage positive parental oral health behaviors (e.g., confidence that one can successfully engage in such behaviors). Parents with more limited HL had significantly less knowledge, perceived cavities to be less severe, perceived more barriers and fewer benefits to recommended oral health behaviors, were less confident they could engage in these behaviors, and were more likely to believe their children's oral health was under the control of the dentist or a matter of chance (P values < 0.001). Limited HL was not associated with behavior (P > 0.05) but was linked to worse self-reported OHS (P = 0.040). CONCLUSIONS HL was associated with parental oral health knowledge, beliefs, and self-reported OHS. Oral health education interventions targeting AI families should facilitate development of knowledge and positive oral health beliefs among parents with more limited HL skills.
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Affiliation(s)
- Angela G Brega
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13055 East 17th Avenue, Aurora, CO, 80045, USA.
| | - Luohua Jiang
- Department of Epidemiology, School of Medicine, University of California Irvine, 205B Irvine Hall, Irvine, CA, 92697, USA
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 East 17th Place, Aurora, CO, 80045, USA
| | - Anne R Wilson
- Department of Pediatric Dentistry, School of Dental Medicine, University of Colorado Anschutz Medical Campus, 13123 East 16th Avenue, Aurora, CO, 80045, USA
| | - Sarah J Schmiege
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 East 17th Place, Aurora, CO, 80045, USA
| | - Judith Albino
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13055 East 17th Avenue, Aurora, CO, 80045, USA
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69
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de Buhr E, Tannen A. Parental health literacy and health knowledge, behaviours and outcomes in children: a cross-sectional survey. BMC Public Health 2020; 20:1096. [PMID: 32660459 PMCID: PMC7359277 DOI: 10.1186/s12889-020-08881-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/10/2020] [Indexed: 11/16/2022] Open
Abstract
Background Health literacy (HL) is closely associated with leading health indicators such as engaging in healthy behaviours and experiencing a healthy social environment. Parents represent a critical subgroup among the adult population since they are not only responsible for their own health but also for the health of their children. Previous research suggests that parents with low HL are less likely to meet the preventive and health care needs of their children but there are gaps in the available information and there is not any data available yet for the German context. Methods In preparation of an implementation study, a cross-sectional survey was conducted in 28 elementary and secondary schools in Germany. The parent questionnaire was completed by 4217 parents and included the short form of the European Health Literacy Survey Questionnaire (HLS-EU-Q16). The child questionnaire examined children’s health knowledge, behaviours and outcomes. For children between 6 and 10 years, a parent reported on behalf of their children (N = 1518). Students 11 years and older completed a self-administered questionnaire (N = 2776). Bivariate and multivariate analyses were carried out. Spearman’s Rho correlations assess the relationships between household characteristics, parental HL and the health behaviour and outcomes in children. Results Among the participating parents, 45.8% showed problematic or inadequate HL. The major determinants of high parental HL were high socio-economic status (SES) (r = .088***, 95% CI [.052, .124]), living in West Germany (r = .064***, 95% CI [.032, .096]) and older parental age (r = .057**, 95% CI [.024, .090]). In the multivariate model, only SES remained significant. High parental HL was associated with positive health behaviours in children including healthier nutrition, regular tooth brushing and more physical activity. The relationships between parental HL and smoking, alcohol, sexual activity among children and children’s weight were not significant. Conclusions The results confirm a relationship between low parental HL, SES and some child health behaviours likely to negatively impact their health and wellbeing including less healthy nutrition and less exercise. Strengthening the health knowledge and competencies of parents may contribute to improved child outcomes particularly in the areas of nutrition, exercise and dental health.
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Affiliation(s)
- Elke de Buhr
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and Nursing Science, Augustenburger Platz 1, D-13353, Berlin, Germany. .,Tulane University, School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA, 70112, USA.
| | - Antje Tannen
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and Nursing Science, Augustenburger Platz 1, D-13353, Berlin, Germany
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Jenssen BP, Kelly MK, Faerber J, Hannan C, Asch DA, Shults J, Schnoll RA, Fiks AG. Parent Preferences for Pediatric Clinician Messaging to Promote Smoking Cessation Treatment. Pediatrics 2020; 146:peds.2019-3901. [PMID: 32571991 PMCID: PMC7329258 DOI: 10.1542/peds.2019-3901] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Insights from behavioral economics suggests that the effectiveness of health messages depends on how a message is framed. Parent preferences for smoking cessation messaging has not been studied in pediatrics, warranting further exploration to maximize benefit. We sought to assess parents' perceptions regarding the relative importance of distinct message framings to promote their smoking cessation. METHODS We conducted a cross-sectional discrete choice experiment in which parent smokers rated the relative importance of 26 messages designed to encourage them to begin cessation treatment. Messages varied on who was featured (child, parent, or family), whether the message was gain or loss framed, and what outcome was included (general health, cancer, respiratory illnesses, child becoming a smoker, or financial impact). The participants were 180 parent smokers attending primary care visits with their children at 4 diverse pediatric sites. The main outcome was the importance of smoking cessation messages based on who was featured, gain or loss framing, and the outcome emphasized. RESULTS Parent smokers highly prioritized cessation messages emphasizing the impact of quitting smoking on their child versus parent or family. Messages focusing on respiratory illness, cancer, or general health outcomes consistently ranked highest, whereas messages focused on the financial benefits of quitting ranked lowest. Gain versus loss framing did not meaningfully influence rankings. CONCLUSIONS Parent smokers identified smoking cessation messages that emphasized the impact on their child, with outcomes focused on respiratory health, cancer, or general health, as most important. The clinical impact of these messages should be tested in future research.
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Affiliation(s)
- Brian P. Jenssen
- Departments of Pediatrics,,PolicyLab and the Center for Pediatric Clinical
Effectiveness, Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania
| | - Mary Kate Kelly
- PolicyLab and the Center for Pediatric Clinical
Effectiveness, Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania
| | | | - Chloe Hannan
- PolicyLab and the Center for Pediatric Clinical
Effectiveness, Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania
| | | | | | - Robert A. Schnoll
- Psychiatry, Perelman School of Medicine, University
of Pennsylvania, Philadelphia, Pennsylvania,Abramson Cancer Center, Penn Medicine, Philadelphia,
Pennsylvania
| | - Alexander G. Fiks
- Departments of Pediatrics,,PolicyLab and the Center for Pediatric Clinical
Effectiveness, Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania
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Gupta A, Wood M, Kumar S, Misra S, Turner T. No Faculty Required: Use of a Health Literacy Low Inference Self-Assessment Measure to Promote Behavior Change. Acad Pediatr 2020; 20:712-720. [PMID: 32087380 DOI: 10.1016/j.acap.2020.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 02/07/2020] [Accepted: 02/16/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine if use of a health literacy low-inference, self-assessment measure (LISAM), promoted behavior change as measured by increased use of health literacy communication skills (HLCS). METHODS The LISAM is a tool used by educators to self-assess their performances after giving a lecture. The tool is low inference because it self-assesses behaviors that are specific, with little room for subjectivity. Forty-four third-year medical students self-assessed HLCS using a LISAM modified to include health literacy communication skills (LISAM-HLCS). Self-assessment followed participation in an audio recorded, standardized patient encounter and again after listening to the recording. Students also created 3 written goals for improvement. This session was repeated 1 week later. RESULTS At Session 2, 71.4% of students met at least 2 of their 3 self-created objectives. The 3 most commonly created objectives were using teach-back, asking more open ended questions, and obtaining patient input into the management plan. Use of the LISAM increased HLCS use at Session 2 versus Session 1 as assessed by both students and study investigators (P < .05). CONCLUSIONS Without faculty present, students met and adjusted objectives, catalyzing changes in HLCS. The LISAM-HLCS has the potential to empower students to improve communication skills and to reduce dependence on faculty observations.
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Affiliation(s)
- Aditi Gupta
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital (A Gupta, M Wood, S Kumar, S Misra, and T Turner), Houston, Tex.
| | - Margaret Wood
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital (A Gupta, M Wood, S Kumar, S Misra, and T Turner), Houston, Tex
| | - Shelley Kumar
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital (A Gupta, M Wood, S Kumar, S Misra, and T Turner), Houston, Tex; Center for Research, Innovation and Scholarship in Medical Education, Texas Children's Hospital (S Kumar and T Turner), Houston, Tex
| | - Sanghamitra Misra
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital (A Gupta, M Wood, S Kumar, S Misra, and T Turner), Houston, Tex
| | - Teri Turner
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital (A Gupta, M Wood, S Kumar, S Misra, and T Turner), Houston, Tex; Center for Research, Innovation and Scholarship in Medical Education, Texas Children's Hospital (S Kumar and T Turner), Houston, Tex
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O'Donnell HC, Suresh S. Electronic Documentation in Pediatrics: The Rationale and Functionality Requirements. Pediatrics 2020; 146:0. [PMID: 32601127 DOI: 10.1542/peds.2020-1684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Clinical documentation has dramatically changed since the implementation and use of electronic health records and electronic provider documentation. The purpose of this report is to review these changes and promote the development of standards and best practices for electronic documentation for pediatric patients. In this report, we evaluate the unique aspects of clinical documentation for pediatric care, including specialized information needs and stakeholders specific to the care of children. Additionally, we explore new models of documentation, such as shared documentation, in which patients may be both authors and consumers, and among care teams while still maintaining the ability to clearly define care and services provided to patients in a given day or encounter. Finally, we describe alternative documentation techniques and newer technologies that could improve provider efficiency and the reuse of clinical data.
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Affiliation(s)
- Heather C O'Donnell
- Department of Pediatrics, Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, New York.,Pediatric Physicians' Organization at Children's Hospital, Boston Children's Hospital, Brookline, Massachusetts; and
| | - Srinivasan Suresh
- Divisions of Health Informatics and Emergency Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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Valderrama A, Courcy I, Weis-Heitner L, Forgeot d’Arc B. Les enjeux de littératie dans la communication aux parents du diagnostic de trouble du spectre de l’autisme chez l’enfant. SANTE MENTALE AU QUEBEC 2020. [DOI: 10.7202/1070244ar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Informer les parents dont l’enfant vient de recevoir un diagnostic de trouble du spectre de l’autisme (TSA) est un enjeu majeur. Il est nécessaire de mieux comprendre comment les parents interprètent et s’approprient cette information dans leur vie quotidienne afin de mieux répondre à leurs besoins.
Objectif Mettre en évidence les besoins d’information, le processus de recherche d’information à partir de cadre conceptuel de la littératie en santé (accès, compréhension, interprétation et utilisation) ainsi que les obstacles et les éléments facilitateurs rencontrés.
Méthode Une recherche qualitative auprès de groupes de discussion a été menée avec des parents d’enfants ayant reçu un diagnostic de TSA dans les deux dernières années. Deux des trois groupes étaient formés de parents présentant des facteurs de risque associés à un faible niveau de littératie : monoparentalité, faible scolarité, sans-emploi, immigration récente.
Résultats Un manque généralisé d’information sur l’autisme et des préoccupations quant à la qualité de l’information trouvée sur Internet sont constatés. Tous les parents ont exprimé leur difficulté à comprendre l’information présentée. Le nombre d’obstacles rencontrés par ces derniers dans la recherche d’information s’est révélé être amplifié par des besoins importants de soutien social.
Conclusion Ces résultats soulèvent la nécessité de mieux répondre aux besoins d’information des parents en adaptant les outils proposés en termes d’accès et de compréhension pour la prise de décisions. En plus du soutien informationnel, il demeure crucial d’offrir différentes formes de soutien social, et ce, tout particulièrement aux parents en situation de vulnérabilité. Des propositions pour améliorer la communication sur l’autisme autour du diagnostic sont proposées.
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Affiliation(s)
- Alena Valderrama
- M.D., M. Sc, FRCPC, CHU Sainte-Justine ; Département de médecine sociale et préventive, École de santé publique de l’Université de Montréal, Centre de recherche du CHU Sainte-Justine
| | - Isabelle Courcy
- Ph. D., Département de sociologie, Université du Québec à Montréal ; Centre de recherche et de partage des savoirs InterActions, CIUSSS Nord-de-l’Île-de-Montréal
| | - Lindsay Weis-Heitner
- Dt. P., M. Sc, Département de médecine sociale et préventive, École de santé publique de l’Université de Montréal
| | - Baudouin Forgeot d’Arc
- M.D., Ph. D., Département de psychiatre, CHU Sainte-Justine ; Département de psychiatrie, CIUSSS nord-de-l’île-de-Montréal ; Département de psychiatrie & addictologie, Université de Montréal ; Centre de recherche du CHU Sainte-Justine
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74
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Jimenez N, Fuentes M, Frias-Garcia M, Crawley D, Moore M, Rivara F. Transitions to Outpatient Care After Traumatic Brain Injury for Hispanic Children. Hosp Pediatr 2020; 10:509-515. [PMID: 32393515 PMCID: PMC7250677 DOI: 10.1542/hpeds.2019-0304] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND AND OBJECTIVES Rehabilitation after a child's traumatic brain injury (TBI) occurs in hospital, community, and school settings, requiring coordination of care and advocacy by parents. Our objective was to explore Hispanic parents' experiences during child's transitions of care after TBI. METHODS We conducted this qualitative study using semistructured interviews. We used a convenient sample of Hispanic parents of children hospitalized for a TBI in a single level I trauma center. Thematic content analysis using iterative deductive coding and triangulation with clinical data was conducted to identify barriers and facilitators for transitions of care. RESULTS Fifteen mothers, mostly from rural areas and with limited English proficiency, participated in the study. Obtaining outpatient rehabilitation was difficult. Barriers included lack of therapists and clinical providers close to home, worsened by insufficient transportation and other support resources; poor understanding of child's illness and treatments; and suboptimal communication with clinicians and school administrators. Facilitators included interpreter use, availability of Spanish written information, and receipt of inpatient rehabilitation. Parents of patients discharged to inpatient rehabilitation reported that observing therapies, receiving school discharge plans by hospital-teachers, and coordination of care were facilitators to access outpatient treatments and to support school return. Parents of children discharged from the hospital from acute care reported need of legal services to obtain school services. CONCLUSIONS Hispanic parents, especially those with limited English proficiency, can face significant challenges accessing TBI outpatient rehabilitation and school resources for their children. Although barriers are multifactorial, efforts to improve communication, parent's TBI education, and care coordination during transitions of care may facilitate a child's reintegration to the community and school.
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Affiliation(s)
- Nathalia Jimenez
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; and
| | - Molly Fuentes
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; and
| | - Mariana Frias-Garcia
- Department of Family Medicine, West Virginia University, Bridgeport, West Virginia; and
| | | | - Megan Moore
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; and
| | - Frederick Rivara
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; and
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Rau NM, Hasan K, Ahamed SI, Asan O, Flynn KE, Basir MA. Designing a tablet-based prematurity education app for parents hospitalized for preterm birth. Int J Med Inform 2020; 141:104200. [PMID: 32563027 DOI: 10.1016/j.ijmedinf.2020.104200] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 04/10/2020] [Accepted: 05/24/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND As technology has advanced over the last decade, handheld Mobile Health (mHealth) applications have increased in popularity. Pregnancy is one area of mHealth that has rapidly expanded, however very few pregnancy apps are developed in collaboration with health professionals. This creates an environment where the pregnancy information women are accessing may be inaccurate or even dangerous. Additionally, there are relatively few medical apps devoted to prematurity or targeted to women at risk for premature birth. To address the gap in premature birth education, we assembled a multidisciplinary team, including health care professionals, and developed the Preemie Prep for Parents (P3) app. METHODS Our team previously conducted 5 focus group meetings to assess the information needs of our target audience. Based on this information we developed a low fidelity P3 prototype. Our software development team transferred the low fidelity prototype into a high fidelity prototype which was hosted on Test Flight (a beta testing platform). We performed heuristic evaluation as well as user testing to improve the P3 app. RESULTS User testing of the high fidelity P3 prototype was performed with 13 diverse participants. 6 participants were parents of currently admitted Neonatal Intensive Care Unit (NICU) babies and 7 participants were women who had been or were currently pregnant. The native language of participants included English, Spanish, and Hmong and their educational level varied between completing high school and graduate degree. Participants provided feedback on the content of the P3 app, as well as its organization and aesthetics. The feedback led to 83 iterations of the P3 app prior to its deployment. Overall, participants noted that the information was "informative" and "reliable". They also noted that the P3 app provided control over the information they could view and when they viewed it, stating "I could see info on my time". Overall, participants felt that the P3 app was a valuable tool for mothers in preterm labor and it would help them ask questions. CONCLUSIONS Development of a mHealth app provides unique challenges regarding content, reliability of information, organization, and aesthetics. Creation of the P3 app to address the educational needs of women at risk for premature birth required assembling a multidisciplinary team, which included target users, and implementing an iterative design process. The efficacy of this app in improving user knowledge and decreasing anxiety is currently being tested in a randomized controlled trial.
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Affiliation(s)
- Nicole M Rau
- Medical College of Wisconsin, Department of Pediatrics, 999 N 92ndSt, Suite C410, PO Box 1997, Wauwatosa, WI, 53226, United States
| | - Kamrul Hasan
- Marquette University, Department of Computer Science, Katharine R. Cudahy Hall, Room 201 1313 W. Wisconsin Avenue, Milwaukee, WI, 53233, United States
| | - Sheikh Iqbal Ahamed
- Marquette University, Department of Computer Science, Katharine R. Cudahy Hall, Room 201 1313 W. Wisconsin Avenue, Milwaukee, WI, 53233, United States
| | - Onur Asan
- Medical College of Wisconsin, Department of Medicine, 9200 W. Wisconsin Ave, Suite C5500, Milwaukee, WI, 53226, United States
| | - Kathryn E Flynn
- Medical College of Wisconsin, Department of Medicine, 9200 W. Wisconsin Ave, Suite C5500, Milwaukee, WI, 53226, United States
| | - Mir A Basir
- Medical College of Wisconsin, Department of Pediatrics, 999 N 92ndSt, Suite C410, PO Box 1997, Wauwatosa, WI, 53226, United States.
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Pade KH, Thompson LR, Ravandi B, Chang TP, Barry F, Halterman JS, Szilagyi PG, Okelo SO. Parental perception of a picture-based chronic asthma care management tool in an urban pediatric emergency department. J Asthma 2020; 58:1013-1023. [PMID: 32249659 DOI: 10.1080/02770903.2020.1753210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND National asthma guidelines recommend use of an asthma action plan (AAP) as part of chronic asthma care. Unfortunately, AAPs have not been tailored for use in acute care settings, where many patients at risk for poor chronic asthma care are seen, including those who are non-English-speaking or have low literacy levels. We previously developed a picture-based medication plan (PBMP), a unique type of AAP for use in an ambulatory setting and designed to increase patient use and understanding. However, little is known about how parents seeking emergency department (ED) asthma care would perceive the PBMP. OBJECTIVE To assess parental attitudes toward an asthma PBMP in the largest pediatric ED in Los Angeles County. METHODS We surveyed a consecutive sample of English- or Spanish-speaking parents of children 2-17 years seeking ED asthma care. Parents used a 5-point Likert scale for various statements regarding their perceptions of the PBMP. Responses were analyzed by sociodemographics, asthma control, and health literacy using Chi-squared and t-tests. RESULTS 90 parents provided feedback on the PBMP. The majority of parents endorsed the PBMP. Endorsement was 20%-30% higher among Spanish-speaking parents and those who did not complete high-school compared to English-speaking parents and parents with a high school education or higher (p < 0.05 for both comparisons). CONCLUSION Spanish-speaking parents and parents with less than a high-school education overwhelmingly endorsed the PBMP. It may be useful to consider incorporating the PBMP as part of patient-centered chronic asthma care strategies for populations seen in ED settings.
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Affiliation(s)
- K H Pade
- UCSD School of Medicine, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - L R Thompson
- Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - B Ravandi
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - T P Chang
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - F Barry
- Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - J S Halterman
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY, USA
| | - P G Szilagyi
- Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - S O Okelo
- Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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Using the Health Literacy Questionnaire (HLQ) with Providers in the Early Intervention Setting: A Qualitative Validity Testing Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072603. [PMID: 32290295 PMCID: PMC7178191 DOI: 10.3390/ijerph17072603] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/25/2020] [Accepted: 04/07/2020] [Indexed: 12/17/2022]
Abstract
More than one in four parents in the United States of America (USA) have low health literacy, which is associated with reduced health equity and negatively impacts child health outcomes. Early intervention (EI) programs are optimally placed to build the health literacy capacity of caregivers, which could improve health equity. The health literacy of interdisciplinary EI providers has not previously been measured. This study used the Health Literacy Questionnaire (HLQ) with EI providers (n = 10) to investigate evidence based on response (cognitive) processes. Narratives from cognitive interviews gave reasons for HLQ score choices, and concordance and discordance between HLQ item intent descriptions and narrative data were assessed using thematic analysis. Results found scales with highest concordance for Scales 3, 6, and 9 (each 96%, n = 24). Concordance was lowest on Scale 5 (88%, n = 22), although still strong with only 12% discordance. Three themes reflecting discordance were identified: (1) Differences between Australian and USA culture/health systems; (2) Healthcare provider perspective; and (3) Participants with no health problems to manage. Results show strong concordance between EI providers’ narrative responses and item intents. Study results contribute validity evidence for the use of HLQ data to inform interventions that build health literacy capacity of EI providers to then empower and build the health literacy of EI parents.
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Kampouroglou G, Velonaki VS, Pavlopoulou I, Drakou E, Kosmopoulos M, Kouvas N, Tsagkaris S, Fildissis G, Nikas K, Tsoumakas K. Parental anxiety in pediatric surgery consultations: the role of health literacy and need for information. J Pediatr Surg 2020; 55:590-596. [PMID: 31431293 DOI: 10.1016/j.jpedsurg.2019.07.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 06/15/2019] [Accepted: 07/18/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Although important, parental anxiety, health literacy and need-for-information in pediatric surgery outpatient clinics have not been extensively studied. Lower educational attainments, minorities and lower socioeconomic status have been associated with limited health literacy. Parental anxiety has been related to health literacy, sex, education and information needs. The aim of this study is to investigate health literacy and need-for-information and their association to parental anxiety in consultations of pediatric surgery. MATERIALS & METHODS We conducted an observational, cross-sectional study in the outpatient pediatric surgery clinic from December 2016 to October 2017. Health literacy, anxiety and need-for-information of parents/guardians of children waiting for pediatric surgical consultation were evaluated. Multivariate regression analysis was used to examine the impact of health literacy and need-for-information on parental/guardian anxiety considering sociodemographic and clinical characteristics of the participants. RESULTS Almost half (46.1%) of the 664 parents/guardians recruited had limited or problematic health literacy and 79.8% of the sample was classified as being anxious. Parental/guardian anxiety was associated at the multiple regression analysis with parental health literacy level (β = -0.282, p < 0.001), need-for-information preoperatively (β = 0.907, p < 0.001), educational level (β = -0.716, p = 0.001), sex (β = 1.563, p < 0.001), and severity of the condition of the child (β = 0.379, p < 0.001). CONCLUSION Parents/guardians experience high levels of anxiety, which is associated to health literacy and need-for-information. These factors should be considered in pediatric surgical consultations, aiming to reduce parental anxiety. TYPE OF STUDY Retrospective Study. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
| | - Venetia-Sofia Velonaki
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Ioanna Pavlopoulou
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Eleni Drakou
- Medical School of Athens, National and Kapodistrian University of Athens, Greece
| | - Marinos Kosmopoulos
- Medical School of Athens, National and Kapodistrian University of Athens, Greece
| | - Nikos Kouvas
- Medical School of Athens, National and Kapodistrian University of Athens, Greece
| | - Stavros Tsagkaris
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Georgios Fildissis
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Konstantinos Nikas
- Department of Pediatric Surgery, Agia Sophia Children's Hospital, Athens, Greece
| | - Konstantinos Tsoumakas
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Greece
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Arvanitis M, Davis MM, Wolf MS. Topical Review: Proposing a Developmentally Informed Research Agenda for the Study of Health Literacy in Children. J Pediatr Psychol 2020; 45:266-270. [PMID: 31693133 DOI: 10.1093/jpepsy/jsz086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 11/13/2022] Open
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Lightfoot MA, Cheng JW, Hu X, Tschokert M, McCracken C, Kirsch AJ, Smith EA, Cerwinka WH, Arlen AM, Chamberlin DA, Garcia-Roig ML. Assessment of health literacy in adolescents with spina bifida and their caregivers: a multi-institutional study. J Pediatr Urol 2020; 16:167.e1-167.e6. [PMID: 32037145 DOI: 10.1016/j.jpurol.2019.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION and Objective: Health literacy is defined as the ability to obtain, integrate, and appraise health-related knowledge. It is known to correlate with disparities in clinical outcomes in adults with chronic disease. Patients with spina bifida represent a potentially vulnerable cohort as they often have multiple comorbidities. The authors aimed to characterize health literacy in adolescent patients with spina bifida and their caregivers. STUDY DESIGN The Newest Vital Sign (NVS), a validated assessment of health literacy and numeracy, was administered to patients (aged ≥10 years) and caregivers in outpatient pediatric urology and multidisciplinary spina bifida clinics. Subjects not fluent in English or Spanish and those with cognitive delay were excluded. Survey responses and demographic information were analyzed and compared between the spina bifida and control groups. RESULTS Three hundred eleven caregivers (caregivers for patients with spina bifida: 185, caregivers for the controls: 126) and 84 adolescents (those with spina bifida: 46, controls: 38) completed the NVS. Although there was no difference in health literacy between caregivers (p = 0.98), adolescents with spina bifida demonstrated lower NVS scores (spina bifida 1 [0-3] vs. control 2 [2-4]; p = 0.02) (Figure). Health literacy of patients with spina bifida and controls increased with age (p = 0.002). Adjusting for age and gender, the odds of having limited literacy were 5.5 times higher in patients with spina bifida than in the controls (p = 0.004). Inadequate caregiver health literacy was associated with a lower education level (p < 0.001). DISCUSSION Spina bifida is among the most complex birth defects compatible with life and affects a multitude of systems. Although it is well established that limited health literacy in adults with chronic disease is associated with adverse outcomes, there are considerably fewer data in the pediatric population. The authors found that caregivers of patients with spina bifida exhibited health literacy and numeracy comparable with parents in the control group, despite lower education levels. In contrast, adolescents with spina bifida demonstrated poorer health literacy than the controls. Multidisciplinary care is necessary, given the medical complexity of spina bifida; therefore, impaired understanding of adults' own needs may pose a barrier to successful transition to their care and subsequent outcomes. CONCLUSIONS The majority of surveyed caregivers for patients with spina bifida exhibited adequate health literacy, especially those with some college education; however inadequate health literacy was more likely among adolescents with spina bifida when compared with the controls. Screening for health literacy may be useful to assess readiness for transition to more independent self-care among patients with spina bifida.
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Affiliation(s)
| | - Julie W Cheng
- Loma Linda University Health, Department of Urology, Loma Linda, CA, USA
| | - Xiaowen Hu
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Merete Tschokert
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Courtney McCracken
- Emory University Department of Pediatrics Biostatistics Core, Atlanta, GA, USA
| | - Andrew J Kirsch
- Children's Healthcare of Atlanta and Emory University, Atlanta, GA, USA
| | - Edwin A Smith
- Children's Healthcare of Atlanta and Emory University, Atlanta, GA, USA
| | | | | | - David A Chamberlin
- Loma Linda University Health, Department of Urology, Loma Linda, CA, USA
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Salgado TM, Liu J, Reed HL, Quinn CS, Syverson JG, Le-Rademacher J, Lopez CL, Beutler AS, Loprinzi CL, Vangipuram K, Smith EML, Henry NL, Farris KB, Hertz DL. Patient factors associated with discrepancies between patient-reported and clinician-documented peripheral neuropathy in women with breast cancer receiving paclitaxel: A pilot study. Breast 2020; 51:21-28. [PMID: 32193049 PMCID: PMC7198332 DOI: 10.1016/j.breast.2020.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/27/2020] [Accepted: 02/28/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose Discrepancies between clinicians’ assessment of chemotherapy-induced peripheral neuropathy (CIPN) and patient-reported outcomes (PRO) have been described, though the underlying reasons are unknown. Our objective was to identify potential patient-specific factors associated with under-describing of CIPN to clinicians in women with non-metastatic breast cancer treated with paclitaxel. Methods Patients enrolled in an observational study (n = 60) completed weekly CIPN PRO using the EORTC CIPN20. Clinician-documented CIPN using the NCI CTCAE were abstracted from the electronic medical record and paired with CIPN20 data at weeks 7 and 10. Patients were classified as under-describers if their CIPN20 was above the 80th percentile of the CIPN20 distribution for that CTCAE grade from an independent clinical trial (N08CA). Demographics, Assessment of Survivor Concerns (ASC), Trust in Oncologist Scale (TiOS), and health literacy assessment were collected post-treatment via survey. Repeated measures cumulative logistic regression models were used to identify factors associated with under-describing CIPN. Results Forty-two women completed the survey (response rate 70%). Three and 9 patients were categorized as under-describers at weeks 7 and 10, respectively. Women who were not working (OR = 9.00, 95%CI 1.06–76.15), had lower income (OR = 7.04, 95%CI 1.5–32.99), and displayed higher trust in their oncologist’s competence (OR = 1.29, 95%CI 1.03–1.62 for a 0.1-unit increase in score) were more likely to under-describe CIPN symptoms. Conclusions This preliminary study identified non-working status, low income and trust in oncologist’s competence as potential factors influencing under-description of CIPN to the clinical team. Further work is needed to clarify these relationships and test additional factors. This pilot study examined factors associated with under-describing of neuropathy. Patient-reported and clinician-documented neuropathy severity were compared. Non-working status and low income were associated with neuropathy under-describing. Trust in oncologist’s competence was associated with neuropathy under-describing. Recording patient-clinician interactions would confirm under-describing behavior.
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Affiliation(s)
- Teresa M Salgado
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, 410 N. 12th Street PO Box 98053, 23298, Richmond, VA, USA.
| | - Jin Liu
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University, 830 East Main Street, 7th Floor, 23298, Richmond, VA, USA
| | - Holly L Reed
- Department of Pharmaceutical and Nutrition Care, Nebraska Medicine, 981090 Nebraska Medical Center, 68198-1090, Omaha, NE, USA
| | - Caroline S Quinn
- Department of Pharmacy, University of Wisconsin Health, 600 Highland Avenue, 53792, Madison, WI, USA
| | | | - Jennifer Le-Rademacher
- Alliance Statistics and Data Center, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA; Mayo Clinic Cancer Center, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA
| | - Camden L Lopez
- Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA
| | - Andreas S Beutler
- Mayo Clinic Cancer Center, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA; Department of Oncology, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA
| | - Charles L Loprinzi
- Mayo Clinic Cancer Center, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA; Department of Oncology, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA
| | - Kiran Vangipuram
- Takeda Pharmaceuticals Inc., 40 Landsdowne St, 02139, Cambridge, MA, USA
| | - Ellen M Lavoie Smith
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 426 N Ingalls St, 48104, Ann Arbor, MI, USA
| | - N Lynn Henry
- Rogel Cancer Center, University of Michigan, 1500 E Medical Center Dr, 48109, Ann Arbor, MI, USA
| | - Karen B Farris
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, 428 Church St, 48109, Ann Arbor, MI, USA
| | - Daniel L Hertz
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, 428 Church St, 48109, Ann Arbor, MI, USA
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James TG, Sullivan MK, Dumeny L, Lindsey K, Cheong J, Nicolette G. Health insurance literacy and health service utilization among college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2020; 68:200-206. [PMID: 30526397 DOI: 10.1080/07448481.2018.1538151] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/01/2018] [Accepted: 10/14/2018] [Indexed: 06/09/2023]
Abstract
Objective: Health literacy and health insurance literacy affect healthcare utilization. The purpose of this study was to determine the relation between health insurance knowledge, self-efficacy, and student healthcare utilization in the past year. Participants: A random sample of 1,450 respondents, over the age of 18, attending a public university in the southeastern United States completed a survey in March 2017. Methods: A model was constructed to test the effect of health insurance self-efficacy on the relation between knowledge and healthcare utilization in the past year. Results: Health insurance knowledge (M = 5.8, range 0-10) and self-efficacy (M = 2.48, range 1-4) were low. Self-efficacy was a significant moderator when explaining healthcare utilization in the past year. Conclusions: College students have low knowledge and self-efficacy regarding health insurance. These findings can be used for developing policies and self-efficacy-based health education programs that may increase student healthcare utilization.
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Affiliation(s)
- Tyler G James
- Department of Health Education and Behavior, University of Florida, Gainesville, Florida, USA
| | - Meagan K Sullivan
- Department of Social and Behavioral Sciences, University of Florida, Gainesville, Florida, USA
| | - Leanne Dumeny
- Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, Florida, USA
| | - Katherine Lindsey
- Student Health Care Center, University of Florida, Gainesville, Florida, USA
| | - JeeWon Cheong
- Department of Health Education and Behavior, University of Florida, Gainesville, Florida, USA
| | - Guy Nicolette
- Student Health Care Center, University of Florida, Gainesville, Florida, USA
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA
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83
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Wang TC, Chang FC, Lee CH, Chi HY, Huang LJ, Tseng CC. Adolescents’ misperceptions and low literacy associated with the inappropriate use of over-the-counter cold medicines. JOURNAL OF SUBSTANCE USE 2020. [DOI: 10.1080/14659891.2019.1664661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Tzu-Chueh Wang
- Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Fong-Ching Chang
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei Taiwan
| | - Chun-Hsien Lee
- Division of Pharmacy, Tri-Service General Hospital, Taipei Taiwan
| | - Hsueh-Yun Chi
- Department of Health Developing and Marketing, Kainan University, Taoyuan, Taiwan
| | - Li-Jung Huang
- Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chie-Chien Tseng
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei Taiwan
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Meyers N, Glick AF, Mendelsohn AL, Parker RM, Sanders LM, Wolf MS, Bailey S, Dreyer BP, Velazquez JJ, Yin HS. Parents' Use of Technologies for Health Management: A Health Literacy Perspective. Acad Pediatr 2020; 20:23-30. [PMID: 30862511 PMCID: PMC6733672 DOI: 10.1016/j.acap.2019.01.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Parent use of technology to manage child health issues has the potential to improve access and health outcomes. Few studies have examined how parent health literacy affects usage of Internet and cell phone technologies for health management. METHODS Cross-sectional analysis of data collected as part of a randomized controlled experiment in 3 urban pediatric clinics. English- and Spanish-speaking parents (n = 858) of children ≤8 years answered questions regarding use of and preferences related to Internet and cell phone technologies. Parent health literacy was measured using the Newest Vital Sign. RESULTS The majority of parents were high Internet (70.2%) and cell phone (85.1%) users (multiple times a day). A total of 75.1% had limited health literacy (32.1% low, 43.0% marginal). Parents with higher health literacy levels had greater Internet and cell phone use (adequate vs low: adjusted odds ratio [AOR], 1.7 [confidence interval, 1.2-2.5]) and were more likely to use them for health management (AOR, 1.5 [confidence interval, 1.2-1.8]); those with higher health literacy levels were more likely to use the Internet for provider communication (adequate vs marginal vs low: 25.0% vs 18.0% vs 12.0%, P = .001) and health-related cell phone apps (40.6% vs 29.7% vs 16.4%, P < .001). Overall preference for using technology for provider communication was high (∼70%) and did not differ by health literacy, although Internet and cell phone apps were preferred by higher literacy parents; no differences were seen for texting. CONCLUSIONS Health literacy-associated disparities in parent use of Internet and cell phone technologies exist, but parents' desire for use of these technologies for provider communication was overall high and did not differ by health literacy.
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Affiliation(s)
- Nicole Meyers
- Pediatrics, NYU School of Medicine - Bellevue Hospital, New York, NY
| | | | - Alan L. Mendelsohn
- Pediatrics, NYU School of Medicine - Bellevue Hospital, New York, NY,Population Health, NYU School of Medicine, New York, NY
| | - Ruth M. Parker
- Medicine, Emory University School of Medicine, Atlanta, GA
| | - Lee M. Sanders
- Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Michael S. Wolf
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Stacy Bailey
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Benard P. Dreyer
- Pediatrics, NYU School of Medicine - Bellevue Hospital, New York, NY
| | | | - H. Shonna Yin
- Pediatrics, NYU School of Medicine - Bellevue Hospital, New York, NY,Population Health, NYU School of Medicine, New York, NY
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Brandstetter S, Atzendorf J, Seelbach-Göbel B, Melter M, Kabesch M, Apfelbacher C. Sociodemographic factors associated with health literacy in a large sample of mothers of newborn children: cross-sectional findings from the KUNO-Kids birth cohort study. Eur J Pediatr 2020; 179:165-169. [PMID: 31659468 DOI: 10.1007/s00431-019-03483-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/22/2019] [Accepted: 09/23/2019] [Indexed: 11/28/2022]
Abstract
Health literacy is an important public health goal and of particular relevance when people are starting a family. Health literacy is thought to be crucial for the management of the manifold demands relating to child health which are imposed on parents. The aim of this study was to investigate health literacy in a large sample of mothers of newborn children in Germany. Sociodemographic factors and health literacy (as assessed by the HLS-EU health care scale) were analyzed using data from 2403 mothers of newborns who take part in an ongoing birth cohort study (KUNO-Kids health study). Almost 40% of mothers had a limited health literacy level. Being primiparous was significantly associated with lower health literacy, while having a high level of education compared with a medium level of education was significantly associated with higher health literacy.Conclusion: The finding of a substantial amount of mothers experiencing problems in dealing with and navigating through the healthcare system is important for the design of pediatric health services.What is Known:• New parents are confronted with many recommendations about child health.• Health literacy of parents is considered crucial for child health outcomes.What is New:• Many mothers of newborns have a limited health literacy level.• First-time mothers and mothers with lower education are particularly at risk for low health literacy.
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Affiliation(s)
- Susanne Brandstetter
- University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Klinik St. Hedwig, Steinmetzstr., 1-3, 93049, Regensburg, Germany.
| | - Josefine Atzendorf
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany
| | - Birgit Seelbach-Göbel
- Clinic of Gynecology and Obstetrics St. Hedwig, University of Regensburg, Klinik St. Hedwig, Steinmetzstr., 1-3, 93049, Regensburg, Germany
| | - Michael Melter
- University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Klinik St. Hedwig, Steinmetzstr., 1-3, 93049, Regensburg, Germany
| | - Michael Kabesch
- University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Klinik St. Hedwig, Steinmetzstr., 1-3, 93049, Regensburg, Germany
| | - Christian Apfelbacher
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany.,Institute of Social Medicine and Health Economics, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
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Philips K, Zhou R, Lee DS, Marrese C, Nazif J, Browne C, Sinnett M, Tuckman S, Griffith K, Kiely V, Lutz M, Modi A, Rinke ML. Caregiver Medication Management and Understanding After Pediatric Hospital Discharge. Hosp Pediatr 2019; 9:844-850. [PMID: 31582401 PMCID: PMC6818354 DOI: 10.1542/hpeds.2019-0036] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Caregivers frequently make mistakes when following instructions on discharge medications, and these instructions often contain discrepancies. Minimal literature reflects inpatient discharges. Our objective was to describe failures in caregiver management and understanding of inpatient discharge medications and to test the association of documentation discrepancies and sociodemographic factors with medication-related failures after an inpatient hospitalization. METHODS This study took place in an urban tertiary care children's hospital that serves a low-income, minority population. English-speaking caregivers of children discharged on an oral prescription medication were surveyed about discharge medication knowledge 48 to 96 hours after discharge. The primary outcome was the proportion of caregivers who failed questions on a 10-item questionnaire (analyzed as individual question responses and as a composite outcome of any discharge medication-related failure). Bivariate tests were used to compare documentation errors, complex dosing, and sociodemographic factors to having any discharge medication-related failure. RESULTS Of 157 caregivers surveyed, 70% had a discharge medication-related failure, most commonly because of lack of knowledge about side effects (52%), wrong duration (17%), and wrong start time (16%). Additionally, 80% of discharge instructions provided to caregivers lacked integral medication information, such as duration or when the next dose after discharge was due. Twenty five percent of prescriptions contained numerically complex doses. In bivariate testing, only race and/or ethnicity was significantly associated with having any failure (P = .03). CONCLUSIONS The majority of caregivers had a medication-related failure after discharge, and most discharge instructions lacked key medication information. Future work to optimize the discharge process to support caregiver management and understanding of medications is needed.
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Affiliation(s)
- Kaitlyn Philips
- Children's Hospital at Montefiore, Bronx, New York;
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York; and
| | - Roy Zhou
- Children's Hospital at Montefiore, Bronx, New York
| | - Diana S Lee
- Children's Hospital at Montefiore, Bronx, New York
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York; and
| | | | - Joanne Nazif
- Children's Hospital at Montefiore, Bronx, New York
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York; and
| | | | - Mark Sinnett
- Children's Hospital at Montefiore, Bronx, New York
| | | | | | | | - Marcia Lutz
- Children's Hospital at Montefiore, Bronx, New York
| | - Anjali Modi
- Children's Hospital at Montefiore, Bronx, New York
| | - Michael L Rinke
- Children's Hospital at Montefiore, Bronx, New York
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York; and
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Glick AF, Farkas JS, Mendelsohn AL, Fierman AH, Tomopoulos S, Rosenberg RE, Dreyer BP, Melgar J, Varriano J, Yin HS. Discharge Instruction Comprehension and Adherence Errors: Interrelationship Between Plan Complexity and Parent Health Literacy. J Pediatr 2019; 214:193-200.e3. [PMID: 31253406 PMCID: PMC10866623 DOI: 10.1016/j.jpeds.2019.04.052] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/12/2019] [Accepted: 04/25/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To examine associations between parent health literacy, discharge plan complexity, and parent comprehension of and adherence to inpatient discharge instructions. STUDY DESIGN This was a prospective cohort study of English/Spanish-speaking parents (n = 165) of children ≤12 years discharged on ≥1 daily medication from an urban, public hospital. Outcome variables were parent comprehension (survey) of and adherence (survey, in-person dosing assessment, chart review) to discharge instructions. Predictor variables included low parent health literacy (Newest Vital Sign score 0-3) and plan complexity. Generalized estimating equations were used to account for the assessment of multiple types of comprehension and adherence errors for each subject, adjusting for ethnicity, language, child age, length of stay, and chronic disease status. Similar analyses were performed to assess for mediation and moderation. RESULTS Error rates were highest for comprehension of medication side effects (50%), adherence to medication dose (34%), and return precaution (78%) instructions. Comprehension errors were associated with adherence errors (aOR, 8.7; 95% CI, 5.9-12.9). Discharge plan complexity was associated with comprehension (aOR, 7.0; 95% CI, 5.4-9.1) and adherence (aOR, 5.5; 95% CI, 4.0-7.6) errors. Low health literacy was indirectly associated with adherence errors through comprehension errors. The association between plan complexity and comprehension errors was greater in parents with low (aOR, 8.3; 95% CI, 6.2-11.2) compared with adequate (aOR, 3.8; 95% CI, 2.2-6.5) health literacy (interaction term P = .004). CONCLUSIONS Parent health literacy and discharge plan complexity play key roles in comprehension and adherence errors. Future work will focus on the development of health literacy-informed interventions to promote discharge plan comprehension.
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Affiliation(s)
- Alexander F Glick
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY.
| | - Jonathan S Farkas
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY
| | - Alan L Mendelsohn
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY
| | - Arthur H Fierman
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY
| | - Suzy Tomopoulos
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY
| | - Rebecca E Rosenberg
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY
| | - Benard P Dreyer
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY
| | - Jennifer Melgar
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY
| | - John Varriano
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY
| | - H Shonna Yin
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY
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88
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Aaronson NL, Cox CT, Boss EF. Parental health literacy in pediatric otolaryngology: A pilot study. Int J Pediatr Otorhinolaryngol 2019; 125:87-91. [PMID: 31271973 DOI: 10.1016/j.ijporl.2019.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 06/25/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Pediatric otolaryngology bears the highest frequency of elective surgical cases in children, but little is known regarding the health literacy of these children's parents. In a questionnaire-based pilot study, we assessed parental health literacy in our pediatric otolaryngology clinic and evaluated its relation to personal demographics. We also evaluated postoperative and diagnosis-based leaflets for readability using validated measures. METHODS Parents completed the Short Assessment of Health Literacy-English (SAHL-E) and were defined as low (0-14) or high (>14) literacy based on mean scores. RESULTS Fifty parents participated (mean SAHL-E score, 17.6), and all scored >14, indicating proficient health literacy. No differences existed in mean or median scores based on demographics. Continued education after high school was associated with higher scores (P = 0.003) and was the only significant variable in multivariable linear regression. All leaflets were at or below the recommended reading level for public health information. CONCLUSIONS Parents generally had high health literacy.
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Affiliation(s)
- Nicole Leigh Aaronson
- Nemours/Alfred I. duPont Hospital for Children, Department of Surgery, Section of Otolaryngology, Wilmington, DE, USA; Thomas Jefferson University School of Medicine, Departments of Otolaryngology and Pediatrics, Philadelphia, PA, USA.
| | - Courtney T Cox
- Nemours/Alfred I. duPont Hospital for Children, Department of Surgery, Section of Otolaryngology, Wilmington, DE, USA.
| | - Emily F Boss
- Johns Hopkins University Departments of Otolaryngology and Health Policy & Management, Baltimore, MD, USA.
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89
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Leslie C, Smith D, Nicholas P. Health Literacy Understanding of Early Intervention Providers: A Scoping Review. J Nurse Pract 2019. [DOI: 10.1016/j.nurpra.2019.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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90
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Lee JY, Murry N, Ko J, Kim MT. Exploring the Relationship between Maternal Health Literacy, Parenting Self-Efficacy, and Early Parenting Practices among Low-Income Mothers with Infants. J Health Care Poor Underserved 2019; 29:1455-1471. [PMID: 30449757 DOI: 10.1353/hpu.2018.0106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To explore the association of maternal health literacy (MHL), parenting self-efficacy and early parenting practices among low-income mothers with infants. DESIGN A cross-sectional, descriptive correlational design. PARTICIPANTS Low-income mothers (N=186) with infants. METHODS Face-to-face interviews were conducted using English and Spanish versions of questionnaires by trained bilingual research assistants. The Newest Vital Sign (NVS) screening tool was used to measure MHL. RESULTS Nearly three-quarters (72%) of mothers were rated as having low MHL. In the bivariate analysis, MHL was positively correlated with education, household income, language, social support, parenting self-efficacy, and early parenting practices, but negatively correlated with number of children. The study findings demonstrate that parenting self-efficacy had a mediating effect on MHL and early parenting practices among mothers with infants. CONCLUSION Results suggest that future research is needed to advance MHL in low-income mothers and to inform potential HL interventions for this target population.
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91
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Pharmacotherapy Literacy of Parents in the Rural and Urban Areas of Serbia—Are There Any Differences? Medicina (B Aires) 2019; 55:medicina55090590. [PMID: 31540338 PMCID: PMC6781223 DOI: 10.3390/medicina55090590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/09/2019] [Accepted: 09/09/2019] [Indexed: 11/16/2022] Open
Abstract
Background and objectives: Pharmacotherapy literacy (PHTL) is an individual’s capacity to obtain, evaluate, calculate, and comprehend basic information about pharmacotherapy and pharmacy-related services necessary to make appropriate medication-related decisions, regardless of the mode of content delivery (e.g., written, oral, visual images and symbols). It is already proven that low PHTL of parents can cause serious problems in the treatment of a pediatric population. We aimed to identify the differences in parental PHTL levels, socio-demographic and health-related characteristics (chronic disease of a child, breastfeeding of a child, annual visits to a pediatrician, parental-self-estimation of health status) between rural and urban areas and to investigate the influence of living in rural areas on a low PHTL level. Materials and methods: Our study was cross-sectional with a validated 14-item instrument (“Parental pharmacotherapy literacy questionnaire—Serbian”), which assessed overall PHTL and its three domains of knowledge, understanding and numerical skills necessary for the safe use of medicines. We analyzed 250 parents of pre-school children (1–7 years old) in rural areas and 182 parents from urban areas in Serbia. Results: Every tenth parent from rural and every fourth parent from urban areas had the highest PHTL level or more than 85% correct answers. However, 51% and 28% of parents in rural and urban areas, respectively, had a low PHTL level (less than 65% correct answers), [Х2(1, n = 432) = 33.2; p < 0.001]. Parents from different areas statistically differed in age, education level, employment, breastfeeding and annual visits to pediatrician rate. Those from rural areas had almost twice the probability of low PHTL levels (ORa = 2.033; p = 0.003) than their urban counterparts, independently of other examined parental characteristics. Conclusions: Parents from rural areas have more difficulties to obtain, evaluate, calculate and comprehend basic information related to pharmacotherapy than parents from urban areas.
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92
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Gutierrez KM, Cohn LD. Medication Competence, Numeracy, and Health Literacy. Health Lit Res Pract 2019; 3:e181-e186. [PMID: 31428735 PMCID: PMC6690220 DOI: 10.3928/24748307-20190625-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 11/30/2018] [Indexed: 11/20/2022] Open
Abstract
Two studies investigated the association between medication literacy and numeracy. Study 1 revealed an association between both variables in a sample of adults. Study 2 replicated the finding in a sample of parents of young children, even after controlling for level of parental health literacy. Both studies employed the Medication Literacy in Spanish and English (MedLitRxSE) assessment tool. Objective and subjective numeracy scores were significantly correlated with MedLitRxSE scores in both studies, suggesting that interventions for reducing medication errors might benefit by simplifying the numerical information presented in medication instructions. [HLRP: Health Literacy Research and Practice. 2019;3(3):e181–e186.]
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Affiliation(s)
| | - Lawrence D. Cohn
- Address correspondence to Lawrence D. Cohn, PhD, University of Texas at El Paso, Psychology Building, Room 118, 500 W. University, El Paso, TX 79902;
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93
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Belice PJ, Mosnaim G, Galant S, Kim Y, Shin HW, Pires-Barracosa N, Hall JP, Malik R, Becker E. The impact of caregiver health literacy on healthcare outcomes for low income minority children with asthma. J Asthma 2019; 57:1316-1322. [PMID: 31340703 DOI: 10.1080/02770903.2019.1648507] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: The aim of this exploratory study was to assess the impact of caregiver health literacy (HL) on health care outcomes for their child with asthma.Methods: Caregiver dyads across two different healthcare delivery systems completed a battery of validated asthma outcome instruments, including the Newest Vital Sign™ as a measure of HL for the caregivers of children ages 7-18 y. Utilization history was obtained through the electronic medical record. Descriptive analysis with bivariate associations was conducted.Results: There was no direct relationship between HL and asthma outcomes in the 34 Hispanic and African American caregiver-child dyads. However, caregiver health literacy was significantly related to language (p = 0.02). African American English-speaking caregivers, seen in an urban emergency department, demonstrated adequate health literacy. Hispanic Spanish-speaking caregivers, seeking care in a mobile asthma van, showed limited health literacy. There was no significant association between caregivers' HL and routine asthma care visits when language and child age were controlled.Conclusions: Assessing patient factors can identify persons at risk who need additional support to negotiate the healthcare system when providing care for a child with asthma.
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Affiliation(s)
- Paula Jo Belice
- College of Health Sciences, Rush University, Chicago, IL, USA
| | - Giselle Mosnaim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| | - Stanley Galant
- Allergy/Immunology, Children's Hospital of Orange County, Orange, CA, USA
| | - Yoonsang Kim
- Health Research and Policy, NORC, Chicago, IL, USA
| | - Hye-Won Shin
- Department of Pediatrics, University of California Irvine, Irvine, CA, USA
| | | | - Julianne P Hall
- Internal Medicine-Neurology Preliminary, Rush University Medical Center, Chicago, IL, USA
| | - Rabia Malik
- Primary Care, AMITA Health Adventist Medical Center La Grange, La Grange, TX, USA
| | - Ellen Becker
- Cardiopulmonary Sciences, Rush University, Chicago, IL, USA
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94
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Abstract
Health literacy plays a role in the events leading up to children's hospitalizations, during hospital admission, and after discharge. Hospitals and providers should use a universal precautions approach and routinely incorporate health-literacy-informed strategies in communicating with all patients and families to ensure that they can understand health information, follow medical instructions, participate actively in their own/their child's care, and successfully navigate the health care system. Interventions that incorporate health-literacy-informed strategies and that target patients/families and health care systems should be implemented to improve patient outcomes and patient-centered and family-centered care.
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95
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Jordan DM, Bush JS, Ownby DR, Waller JL, Tingen MS. The impact of traditional literacy and education on health literacy in adolescents with asthma. J Asthma 2019; 56:882-890. [PMID: 29984589 PMCID: PMC6443504 DOI: 10.1080/02770903.2018.1494191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 06/23/2018] [Accepted: 06/24/2018] [Indexed: 10/28/2022]
Abstract
Introduction: People with low health literacy have poorer self-management of chronic diseases like asthma. Studies of parent health literacy and education level on the management of children's chronic illnesses reveal inconclusive results. We hypothesized a correlation between parent and adolescent health literacy in teens with asthma. Methods: Sociodemographic data were obtained; health literacy was assessed on adolescents and parents with three instruments: Rapid Estimate of Adolescent/Adult Literacy in Medicine (REALM), Single Item Literacy Screener (SILS) and Newest Vital Sign (NVS). Agreement between scores was examined by calculating weighted kappa statistics and performing Bowkers test of symmetry. Results: In all, 243 adolescents and 203 parents completed health literacy assessments yielding 198 paired observations. 9th-12th graders, 60.6% female, 72.7% African-American (AA), mean age: 15.3 years (±0.9). Parent education ranged from < high school (19.1%) to college graduate (24.0%). Agreement between adolescent and parent scores was poor: REALM (κw = 0.26), SILS (κw = 0.12), and NVS (κw = 0.29) and disagreement did not significantly differ by race. Positive correlations of moderate strength (overall and between racial groups) were found between reading scores and both REALM and NVS scores, and between REALM and NVS scores. Due to the inverse relationship of SILS scores with health literacy level, SILS scores (overall and between racial groups) were weakly and negatively correlated with reading scores, REALM and NVS. Conclusion: Correlation between education level and traditional literacy suggests that these are contributing factors to the health literacy of adolescents with asthma. Correlation between adolescent and caregiver health literacy was not supported.
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Affiliation(s)
- Desha M. Jordan
- Division of Allergy-Immunology & Rheumatology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Jeana S. Bush
- Division of Allergy-Immunology & Rheumatology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Dennis R. Ownby
- Division of Allergy-Immunology & Rheumatology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Jennifer L. Waller
- Department of Biostatistics & Epidemiology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Martha S. Tingen
- Division of Allergy-Immunology & Rheumatology, Medical College of Georgia, Augusta University, Augusta, Georgia
- Georgia Prevention Institute, Department of Pediatrics; Medical College of Georgia, Augusta University, Augusta, Georgia
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96
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Statile AM, White CM, Sucharew HJ, Moore M, Tubbs-Cooley HL, Simmons JM, Shah SS, Auger KA. Comparison of Parent Report with Administrative Data to Identify Pediatric Reutilization Following Hospital Discharge. J Hosp Med 2019; 14:411-414. [PMID: 31112494 PMCID: PMC6613522 DOI: 10.12788/jhm.3200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Healthcare providers rely on historical data reported by parents to make medical decisions. The Hospital to Home Outcomes (H2O) trial assessed the effects of a onetime home nurse visit following pediatric hospitalization for common conditions. The H2O primary outcome, reutilization (hospital readmission, emergency department visit, or urgent care visit), relied on administrative data to identify reutilization events after discharge. We sought to compare parent recall of reutilization events two weeks after discharge with administrative records. Agreement was relatively high for any reutilization (kappa 0.74); however, this high agreement was driven by agreement between sources when no reutilization occurred (sources agreed 98%-99%). Agreement between sources was lower when reutilization occurred (48%-76%). Some discrepancies were related to parents misclassifying the site of care. The possibility of inaccurate parent report of reutilization has clinical implications that may be mitigated by confirmation of parent-reported data through verification with additional sources, such as electronic health record review.
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Affiliation(s)
- Angela M Statile
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Corresponding Author: Angela M Statile, MD, MEd; E-mail: ; Telephone: 513-803-3237
| | - Christine M White
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Heidi J Sucharew
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Margo Moore
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Heather L Tubbs-Cooley
- The Ohio State University College of Nursing Center for Women, Children, and Youth, Columbus, Ohio
| | - Jeffrey M Simmons
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Samir S Shah
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Katherine A Auger
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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97
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Nga VT, Dung VNT, Chu DT, Tien NLB, Van Thanh V, Ngoc VTN, Hoan LN, Phuong NT, Pham VH, Tao Y, Linh NP, Show PL, Do DL. School education and childhood obesity: A systemic review. Diabetes Metab Syndr 2019; 13:2495-2501. [PMID: 31405667 DOI: 10.1016/j.dsx.2019.07.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/08/2019] [Indexed: 01/24/2023]
Abstract
Childhood obesity prevalence is shooting up at a phenomenal rate worldwide, leading to long-term devastating consequences. A great number of studies have investigated factors contributing to the increase in BMI of children and adolescents. School-based, home-based and clinic-based solutions have been suggested as possible viable strategies, among which school-based interventions is believed to produce a noticeable effect on a massive scale. However, the question of whether school interventions, especially school education exert significant impact on childhood obesity or not, is left with mixing results. This article aims to holistically review the relationship between school education and childhood obesity. Various factors are covered, including health education, nutrition education, school nutrition, physical education, teachers' awareness, teaching practice and school stress, In all, school education is not the answer to childhood obesity but just part of it. More attempts from other stakeholders (parents, community, policy makers, researchers, etc.) should be made in order to solve this complicated puzzle.
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Affiliation(s)
- Vu Thi Nga
- Institute for Research and Development, Duy Tan University, 03 QuangTrung, Danang, Viet Nam
| | | | - Dinh-Toi Chu
- Faculty of Biology, Hanoi National University of Education, Hanoi, Viet Nam; School of Odonto Stomatology, Hanoi Medical University, Hanoi, Viet Nam.
| | - Nguyen Le Bao Tien
- Institute of Orthopaedics and Trauma Surgery, Viet Duc Hospital, Hanoi, Viet Nam
| | - Vo Van Thanh
- Institute of Orthopaedics and Trauma Surgery, Viet Duc Hospital, Hanoi, Viet Nam; Department of Surgery, Hanoi Medical University, Hanoi, Viet Nam
| | | | - Le Ngoc Hoan
- Faculty of Biology, Hanoi National University of Education, Hanoi, Viet Nam
| | - Nguyen Thi Phuong
- NTT Hi-tech Institute, Nguyen Tat Thanh University, 300A Nguyen Tat Thanh St, Ward 13, District 4, Ho Chi Minh City, Viet Nam
| | - Van-Huy Pham
- AI Lab, Faculty of Information Technology, Ton Duc Thang University, Ho Chi Minh City, Viet Nam.
| | - Yang Tao
- College of Food Science and Technology, Nanjing Agricultural University, Nanjing 8, 210095, China
| | | | - Pau Loke Show
- Department of Chemical and Environmental Engineering, Faculty of Engineering, University of Nottingham Malaysia Campus, JalanBroga, 43500, Semenyih, Selangor Darul Ehsan, Malaysia
| | - Duc-Lan Do
- National Centre for Sustainable Development of General Education Quality, Vietnam National Institute of Educational Sciences, Hanoi, Viet Nam
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98
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Yee MEM, Meyer EK, Fasano RM, Lane PA, Josephson CD, Brega AG. Health literacy and knowledge of chronic transfusion therapy in adolescents with sickle cell disease and caregivers. Pediatr Blood Cancer 2019; 66:e27733. [PMID: 30941859 DOI: 10.1002/pbc.27733] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/05/2019] [Accepted: 03/07/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Patients with sickle cell disease (SCD) may require chronic transfusion therapy (CTT) for prevention of stroke or other complications. Limited health literacy (HL) is common and is associated with poor health-related knowledge and outcomes in chronic disease. We sought to assess HL and transfusion knowledge in patients with SCD on CTT and their caregivers. METHODS A cross-sectional study of patients was conducted in outpatient hematology clinics. Forty-five pairs of adolescent patients and caregivers and 20 caregivers of pre-adolescent patients completed the Newest Vital Sign HL assessment and answered questions assessing SCD and transfusion knowledge. Community-level median income and unemployment rates were estimated from Census data. We computed the correlation of HL with knowledge and compared each to Census variables, payor status, educational attainment, and stroke. RESULTS HL was inadequate in 22 (34%) caregivers and 31 (69%) adolescents. Adequate caregiver HL was associated with higher educational attainment but not community-level socioeconomics or payor status. Mean knowledge score was lower in adolescents than in caregivers and correlated with age in adolescents (r = 0.42, P = .004). HL correlated with knowledge (r = 0.46, P < .0001). There were no significant correlations of HL or knowledge between adolescents and their caregivers. Neither HL nor knowledge was associated with prior stroke. The greatest knowledge was demonstrated for iron overload and SCD genotype, whereas knowledge gaps existed in alloimmunization, indication for CTT, and SCD curative therapy. CONCLUSIONS Enhanced educational resources in transfusion therapy, alloimmunization, and curative therapy are needed for patients with SCD and caregivers of all HL levels.
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Affiliation(s)
- Marianne E McPherson Yee
- Department of Pediatrics, Division of Hematology/Oncology, Emory University, Atlanta, Georgia.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Erin K Meyer
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Ross M Fasano
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia
| | - Peter A Lane
- Department of Pediatrics, Division of Hematology/Oncology, Emory University, Atlanta, Georgia.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Cassandra D Josephson
- Department of Pediatrics, Division of Hematology/Oncology, Emory University, Atlanta, Georgia.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia
| | - Angela G Brega
- Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
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99
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Jones NL, Burger J, Hall A, Reeves KA. The Intersection of Urban and Global Health. Pediatr Clin North Am 2019; 66:561-573. [PMID: 31036235 DOI: 10.1016/j.pcl.2019.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Providers from high-income countries are often drawn to practicing medicine in settings identified as having greater need, whether that be in a low- or middle-income country or within an underserved area within their own high-income country. Despite sharing the goal of fostering health equity, global health and urban health are often considered in dichotomous ways. This article points a lens at the intersection of these 2 fields, highlighting what they can learn from each other.
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Affiliation(s)
- Nora L Jones
- Center for Bioethics, Urban Health, and Policy, Lewis Katz School of Medicine at Temple University, 3500 North Broad Street, Suite 324, Philadelphia, PA 19140, USA.
| | - Julia Burger
- Department of Pediatrics, Lewis Katz School of Medicine at Temple University, 3223 North Broad Street, 1st Floor, Old Dental School, Philadelphia, PA 19140, USA
| | - Ashleigh Hall
- Department of Pediatrics, Lewis Katz School of Medicine at Temple University, 3223 North Broad Street, 1st Floor, Old Dental School, Philadelphia, PA 19140, USA
| | - Kathleen A Reeves
- Center for Bioethics, Urban Health, and Policy, Lewis Katz School of Medicine at Temple University, 3500 North Broad Street, Suite 324, Philadelphia, PA 19140, USA
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100
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Health literacy of parents of very preterm infants at NICU admission and discharge: a prospective cohort study. J Perinatol 2019; 39:866-875. [PMID: 30770882 DOI: 10.1038/s41372-019-0340-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/23/2019] [Accepted: 01/30/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the prevalence of limited health literacy in parents of infants born ≤32 and 0/7 weeks and if health literacy changes during hospitalization. STUDY DESIGN Multi-site, prospective cohort study measuring health literacy using the Parent Health Literacy Activities Test, which estimates caregivers' ability to complete tasks such as reading prescription labels and preparing bottles. Data were analyzed using parametric and nonparametric comparison tests and multivariable regression to control for confounders. RESULT Of the 137 participants, 31% missed ≥3 questions of 8. Scores were not associated with admission characteristics or NICU complications. Lower scores were associated with lower nurses' (rho 0.20, p = 0.04) but not parents' (rho -0.12, p = 0.22) ratings of discharge readiness. Scores improved slightly from admission to discharge (p = 0.049). CONCLUSION Many parents have difficulty answering questions related to basic infant care tasks. NICUs should ensure that communication and discharge planning are mindful of health literacy.
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