101
|
Annarumma C, Palumbo R. Contextualizing Health Literacy to Health Care Organizations. JOURNAL OF HEALTH MANAGEMENT 2016. [DOI: 10.1177/0972063416666348] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Parker, Ratzen and Lurie (2003) pointed out that a silent epidemic is affecting the health status of the American population, namely poor health literacy. Actually, inadequate health literacy is the main cause of the patients’ inability to navigate the health care environment, paving the way for inappropriateness in the provision of care as well as for poor health outcomes. Moreover, it has been esteemed that a third of the European population is not able to properly understand, process and use health information (HLS-EU Consortium, 2012). The same issue has been identified in several Asian countries (see, for example, Nakayama et al., 2015; Pednekar, Gupta & Gupta, 2011). What is striking is that—until today—the attention has been focused on the individual determinants of low health literacy, while studies concerning the organizational health literacy—that is to say, the ability of health care organization to establish friendly and comfortable relationships with the patients—are uncommon (Weaver, Wray, Zellin, Gautam & Jupka, 2012). This article is aimed at exploring the way health care organizations deal with patients living with inadequate health literacy. Drawing on the prevailing literature (Brach et al., 2012; DeWalt et al., 2013; Matthews & Sewell, 2002; Murphy-Knoll, 2007; Stableford & Mettger, 2007) the main approaches to improve organizational health literacy are examined. Then, a distinction between formal and informal tools to address organizational health literacy is suggested and the effectiveness of both of them is compared. The findings of the research suggest that informal tools are more common than formal tools, even though the former have lower perceived effectiveness as compared with the latter. Health care organizations seem to be still far from effectively activating comprehensive organizational health literacy pathways. There is a desperate need for systemic efforts to enhance the awareness of organizational health literacy and to encourage processes of change towards health literate organizational environments.
Collapse
Affiliation(s)
- Carmela Annarumma
- Research Fellow in Organizational Studies, University of Salerno, Fisciano (SA), Italy
| | - Rocco Palumbo
- Research Fellow in Organizational Studies, University of Salerno, Fisciano (SA), Italy
| |
Collapse
|
102
|
Spauwen PJJ, Martens RJH, Stehouwer CDA, Verhey FRJ, Schram MT, Sep SJS, van der Kallen CJH, Dagnelie PC, Henry RMA, Schaper NC, van Boxtel MPJ. Lower verbal intelligence is associated with diabetic complications and slower walking speed in people with Type 2 diabetes: the Maastricht Study. Diabet Med 2016; 33:1632-1639. [PMID: 26926848 DOI: 10.1111/dme.13105] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 12/19/2015] [Accepted: 02/25/2016] [Indexed: 12/16/2022]
Abstract
AIMS To determine the association of verbal intelligence, a core constituent of health literacy, with diabetic complications and walking speed in people with Type 2 diabetes. METHODS This study was performed in 228 people with Type 2 diabetes participating in the Maastricht Study, a population-based cohort study. We examined the cross-sectional associations of score on the vocabulary test of the Groningen Intelligence Test with: 1) determinants of diabetic complications (HbA1c , blood pressure and lipid level); 2) diabetic complications: chronic kidney disease, neuropathic pain, self-reported history of cardiovascular disease and carotid intima-media thickness; and 3) walking speed. Analyses were performed using linear regression and adjusted in separate models for potential confounders and mediators. Significant age- and sex-adjusted associations were additionally adjusted for educational level in a separate model. RESULTS After full adjustment, lower verbal intelligence was associated with the presence of neuropathic pain [odds ratio (OR) 1.18, 95% CI 1.02;1.36], cardiovascular disease (OR 1.14, 95% CI 1.01;1.30), and slower walking speed (regression coefficient -0.011 m/s, 95% CI -0.021; -0.002 m/s). These associations were largely explained by education. Verbal intelligence was not associated with blood pressure, glycaemic control, lipid control, chronic kidney disease or carotid intima-media thickness. CONCLUSIONS Lower verbal intelligence was associated with the presence of some diabetic complications and with a slower walking speed, a measure of physical functioning. Educational level largely explained these associations. This implies that clinicians should be aware of the educational level of people with diabetes and should provide information at a level of complexity tailored to the patient.
Collapse
Affiliation(s)
- P J J Spauwen
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - R J H Martens
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - C D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - F R J Verhey
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - M T Schram
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - S J S Sep
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - C J H van der Kallen
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - P C Dagnelie
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - R M A Henry
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - N C Schaper
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - M P J van Boxtel
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
103
|
Huang YM, Wang HP, Yang YHK, Lin SJ, Lin HW, Chen CS, Wu FLL. Effects of a National Health Education Program on the Medication Knowledge of the Public in Taiwan. Ann Pharmacother 2016; 40:102-8. [PMID: 16368924 DOI: 10.1345/aph.1g312] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: The inappropriate use of medication and inadequate medication knowledge among the general population has long been a concern in Taiwan. One reason for the deficiencies might be the lack of an active role of pharmacists in educating the public. To rectify the situation, in 2002, the Bureau of Pharmaceutical Affairs, Department of Health of Taiwan, began to sponsor a national effort, titled Community Education Program on Medication Use, to involve the expertise of pharmacists in public education. Objective: To evaluate the effects of this education program by analyzing the changes in knowledge of drug therapy among the participating public. Methods: This was a single-group pre- and post-comparison study. Between September 2003 and January 2004, a total of 955 community residents enrolled in the pharmacist-facilitated education program offered at 31 community universities. The medication knowledge of the participants was evaluated before and after the program. Demographic variables that might affect the education outcomes of the program were also examined. Results: Medication knowledge at baseline was positively correlated with education level and negatively correlated with age. Females were more aware of drug-related information than were males. The participants showed a significant improvement in medication knowledge (p < 0.001) at the end of the program. The baseline knowledge score was the most important determinant of the improvement of the posttest score. Conclusions: A national education program facilitated by pharmacists can improve the medication knowledge of the participants. Pharmacists should be encouraged to play a proactive role in large-scale health education programs.
Collapse
Affiliation(s)
- Yen-Ming Huang
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | | | | | | | | | | | | |
Collapse
|
104
|
Carbone ET, Lennon KM, Torres MI, Rosal MC. Testing the Feasibility of an Interactive Learning Styles Measure for U.S. Latino Adults with Type 2 Diabetes and Low Literacy. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2016; 25:315-35. [PMID: 17686705 DOI: 10.2190/88j7-1432-2377-55k7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study designed and piloted an interactive measure to assess learning preferences of Latinos in the United States with diabetes and limited literacy. The measure utilized interactive learning activities to represent four learning styles: visual (seeing), kinesthetic (doing), affective (feeling/sensing), and cognitive (thinking), targeting four diabetes self-management behaviors: choosing healthy foods; understanding portion sizes; distinguishing foods to eat often/sometimes/rarely; and limiting fat. Quantitative data were collected using the Spanish Short Test of Functional Health Literacy in Adults (S-TOFHLA). Individual, structured cognitive interview questions asked participants to identify learning activities that most reflected their own experience with diabetes. Participant observations provided additional qualitative data. Ten Spanish-speaking adults with type 2 diabetes and limited literacy participated in two randomly selected target behaviors and identified easiest and most difficult to understand learning activities. S-TOFHLA scores ranged from 0 to 21 points (mean 7.0) and identified eight participants with inadequate and two with marginal health literacy. Easiest to understand tasks were kinesthetic, most difficult to understand tasks were cognitive. This is one of the first known studies of its kind and offers insight for measuring learning styles of Latinos with diabetes and low health literacy.
Collapse
Affiliation(s)
- Elena T Carbone
- Department of Nutrition, Chenoweth Laboratory, University of Massachusetts, Amherst, MA 01003-9282, USA.
| | | | | | | |
Collapse
|
105
|
O'Conor R, Smith SG, Curtis LM, Benavente JY, Vicencio DP, Wolf MS. Mild Visual Impairment and Its Impact on Self-Care Among Older Adults. J Aging Health 2016; 30:327-341. [PMID: 27834286 DOI: 10.1177/0898264316676406] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the prevalence of mild visual impairment (MVI) among urban older adults in primary care settings, and ascertain whether MVI was a risk factor for inadequate performance on self-care health tasks. METHOD We used data from a cohort of 900 older adults recruited from primary care clinics. Self-management skills were assessed using the Comprehensive Health Activities Scale, and vision with corrective lenses was assessed with the Snellen. We modeled visual acuity predicting health task performance with linear regression. RESULTS Normal vision was associated with better overall health task performance ( p = .004). Individuals with normal vision were more likely to recall health information conveyed via multimedia ( p = .02) and during a spoken encounter ( p = .04), and were more accurate in dosing multi-drug regimens ( p = .05). DISCUSSION MVI may challenge the performance of self-care behaviors. Health care systems and clinicians should consider even subtle detriments in visual acuity when designing health information, materials, and devices.
Collapse
Affiliation(s)
| | - Samuel G Smith
- 2 Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | | | | |
Collapse
|
106
|
|
107
|
Charleston L, Heisler M. Headache Literacy-A Definition and Theory to Help Improve Patient Outcomes of Diverse Populations and Ameliorate Headache and Headache Care Disparities. Headache 2016; 56:1522-1526. [PMID: 27632948 DOI: 10.1111/head.12954] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Larry Charleston
- Department of Neurology, University Of Michigan, Ann Arbor, MI, USA.
| | - Michele Heisler
- Department of Internal Medicine and Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA.,Center for Clinical Management Research, Ann Arbor Veterans Affairs Health System, Ann Arbor, MI, USA
| |
Collapse
|
108
|
Rikard RV, Thompson MS, McKinney J, Beauchamp A. Examining health literacy disparities in the United States: a third look at the National Assessment of Adult Literacy (NAAL). BMC Public Health 2016; 16:975. [PMID: 27624540 PMCID: PMC5022195 DOI: 10.1186/s12889-016-3621-9] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 09/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the United States, disparities in health literacy parallel disparities in health outcomes. Our research contributes to how diverse indicators of social inequalities (i.e., objective social class, relational social class, and social resources) contribute to understanding disparities in health literacy. METHODS We analyze data on respondents 18 years of age and older (N = 14,592) from the 2003 National Assessment of Adult Literacy (NAAL) restricted access data set. A series of weighted Ordinary Least Squares (OLS) regression models estimate the association between respondent's demographic characteristics, socioeconomic status (SES), relational social class, social resources and an Item Response Theory (IRT) based health literacy measure. RESULTS Our findings are consistent with previous research on the social and SES determinants of health literacy. However, our findings reveal the importance of relational social status for understanding health literacy disparities in the United States. Objective indicators of social status are persistent and robust indicators of health literacy. Measures of relational social status such as civic engagement (i.e., voting, volunteering, and library use) are associated with higher health literacy levels net of objective resources. Social resources including speaking English and marital status are associated with higher health literacy levels. CONCLUSIONS Relational indicators of social class are related to health literacy independent of objective social class indicators. Civic literacy (e.g., voting and volunteering) are predictors of health literacy and offer opportunities for health intervention. Our findings support the notion that health literacy is a social construct and suggest the need to develop a theoretically driven conceptual definition of health literacy that includes a civic literacy component.
Collapse
Affiliation(s)
- R. V. Rikard
- Department of Media & Information, Michigan State University, 409 Comm Arts, 404 Wilson Road, East Lansing, MI 48824 USA
| | - Maxine S. Thompson
- Department of Sociology & Anthropology, North Carolina State University, Raleigh, NC USA
| | | | - Alison Beauchamp
- Deakin Population Health SRC, Faculty of Health, Deakin University, Melbourne, VIC Australia
| |
Collapse
|
109
|
Waverijn G, Heijmans M, Spreeuwenberg P, Groenewegen PP. Associations Between Neighborhood Social Capital, Health Literacy, and Self-Rated Health Among People With Chronic Illness. JOURNAL OF HEALTH COMMUNICATION 2016; 21:36-44. [PMID: 27548376 DOI: 10.1080/10810730.2016.1179369] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Health literacy skills are important for health and self-management for people with chronic illness. Neighborhood social capital can provide resources, such as access to information and informal social control over unhealthy behavior. The benefit of these resources, and the access people have to these resources, might depend on levels of health literacy. We investigated whether neighborhood social capital is differentially related to the health of people with chronic illness according to health literacy skills. This study focused on health literacy skills in 4 domains related to the ability to access and understand health information and to the ability to perform self-management. We found a significant positive interaction between social capital and health literacy skills for accessing and understanding health information. This suggests that health literacy enhances people's ability to gain access to and use neighborhood resources to benefit health. There was no interaction effect between social capital and health literacy skills in the other 2 domains. More research is needed to investigate how people with chronic illness can benefit from knowledge, support, and other social resources for health and self-management also whether they have limited health literacy skills.
Collapse
Affiliation(s)
- Geeke Waverijn
- a Netherlands Institute for Health Services Research , Utrecht , The Netherlands
| | - Monique Heijmans
- a Netherlands Institute for Health Services Research , Utrecht , The Netherlands
| | - Peter Spreeuwenberg
- a Netherlands Institute for Health Services Research , Utrecht , The Netherlands
| | - Peter P Groenewegen
- a Netherlands Institute for Health Services Research , Utrecht , The Netherlands
- b Department of Sociology and Department of Human Geography , Utrecht University , Utrecht , The Netherlands
| |
Collapse
|
110
|
Hibbard JH, Peters E, Dixon A, Tusler M. Consumer Competencies and the Use of Comparative Quality Information. Med Care Res Rev 2016; 64:379-94. [PMID: 17684108 DOI: 10.1177/1077558707301630] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
While consumers are increasingly expected to use complex health care information to make informed decisions, it is unclear how many have the skills to do so. In this investigation we examine health literacy, numeracy, and patient activation, assessing the contribution of each to the comprehension of comparative health care performance reports and their use in making an informed choice. A convenience sample of 303 employed-age adults participated in the study. The findings indicate that numeracy skill is the strongest predictor of comprehension, followed by health literacy. Higher activation helps those low in literacy and numeracy compensate for their lower skills and achieve higher levels of comprehension. In addition, making good choices, when trade-offs are necessary, is related to activation separate from comprehension. This is important as many real-life choices involve trade-offs. Results indicate that choice is not just about literacy or comprehension, it also has to do with activation.
Collapse
|
111
|
Education Level, Primary Language, and Comprehension of the Informed Consent Process. J Empir Res Hum Res Ethics 2016; 2:69-79. [DOI: 10.1525/jer.2007.2.4.69] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To obtain information on how persons from diverse backgrounds experience the informed consent process, we surveyed adults with a wide variety of educational levels and different primary languages (English, Spanish, or Vietnamese) who had recently enrolled in a study requiring written informed consent. Of the 100 participants, 62 were non-White, 43 had less than a high school education, and 60 had a primary language other than English. The median score for comprehension was 62% (IQR 50–76%); the median satisfaction score was 86% (IQR 71–100%). In multivariate analysis, only educational level was significantly associated with comprehension and satisfaction with the informed consent process ( p < 0.001). Comprehension and satisfaction with the informed consent process were markedly lower among persons with lower educational levels.
Collapse
|
112
|
Demoly P, Passalacqua G, Pfaar O, Sastre J, Wahn U. Patient engagement and patient support programs in allergy immunotherapy: a call to action for improving long-term adherence. Allergy Asthma Clin Immunol 2016; 12:34. [PMID: 27478445 PMCID: PMC4966171 DOI: 10.1186/s13223-016-0140-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 07/13/2016] [Indexed: 01/27/2023] Open
Abstract
Allergy immunotherapy (AIT) is acknowledged to produce beneficial mid- and long-term clinical and immunologic effects and increased quality of life in patients with allergic respiratory diseases (such as allergic rhinoconjunctivitis and allergic asthma). However, poor adherence to AIT (due to intentional and/or non-intentional factors) is still a barrier to achieving these benefits. There is an urgent need for patient support programs (PSPs) that encompass communication, educational and motivational components. In the field of AIT, a PSP should be capable of (1) improving adherence, (2) boosting patient engagement, (3) explaining how AIT differs from pharmacological allergy treatments; (4) increasing health literacy about chronic, progressive, immunoglobulin-E-mediated immune diseases, (5) helping the patient to understand and manage local or systemic adverse events, and (6) providing and/or predicting local data on aeroallergen levels. We reviewed the literature in this field and have identified a number of practical issues to be addressed when implementing a PSP for AIT: the measurement of adherence, the choice of technologies, reminders, communication channels and content, the use of "push" messaging and social networks, interactivity, and the involvement of caregivers and patient leaders. A key issue is "hi-tech" (i.e. approaches based mainly on information technology) vs. "hi-touch" (based mainly on interaction with humans, i.e. family members, patient mentors and healthcare professionals). We conclude that multistakeholder PSPs (combining patient-, provider and society-based actions) must now be developed and tested with a view to increasing adherence, efficacy and safety in the field of AIT.
Collapse
Affiliation(s)
- Pascal Demoly
- Department of Pulmonology, Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France ; Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, Paris, France
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS San Martino-IST, University of Genoa, Genoa, Italy
| | - Oliver Pfaar
- Center for Rhinology and Allergology, Wiesbaden, Germany ; Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Joaquin Sastre
- Allergy Department, Fundación Jimenez Díaz, Madrid, Spain ; CIBERES, Instituto de Salud Carlos III, Universidad Autonoma de Madrid, Madrid, Spain
| | - Ulrich Wahn
- Department of Pediatric Pulmonology and Immunology, Charité Virchow-Klinikum, Humboldt University, Berlin, Germany
| |
Collapse
|
113
|
Psychometric Properties of the Spanish Consumer Assessment of Health Plans Survey (CAHPS). HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2016. [DOI: 10.1177/0739986303256916] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study describes the psychometric properties of the Consumer Assessments of Health Plans Survey (CAHPS) in 279 persons who completed it in Spanish and 439 persons who completed it in English. We found negatively skewed distributions of responses and significant ceiling effects in both English and Spanish surveys. Cronbach’s alphas for English and Spanish multiple-item composites were 0.69 or higher. Correlations between the CAHPS measures and willingness of individuals to recommend their doctor and health plan to family and friends were all moderately strong and statistically significant except for one global rating. There were significant differences in the patterns of correlations between global ratings and composites for English and Spanish surveys. This study suggests that the Spanish CAHPS 2.0 core survey has acceptable psychometric properties.
Collapse
|
114
|
Fernandez DM, Larson JL, Zikmund-Fisher BJ. Associations between health literacy and preventive health behaviors among older adults: findings from the health and retirement study. BMC Public Health 2016; 16:596. [PMID: 27430477 PMCID: PMC4949886 DOI: 10.1186/s12889-016-3267-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 06/23/2016] [Indexed: 12/29/2022] Open
Abstract
Background While the association between inadequate health literacy and adverse health outcomes has been well documented, less is known about the impact of health literacy on health perceptions, such as perceptions of control over health, and preventive health behaviors. Methods We identified a subsample of participants (N = 707) from the Health and Retirement Study (HRS), a nationally representative sample of older adults, who participated in health literacy testing. Self-reported health literacy was measured with a literacy screening question, and objective health literacy with a summed score of items from the Test of Functional Health Literacy. We compared answers on these items to those related to participation in health behaviors such as cancer screening, exercise, and tobacco use, as well as self-referencing health beliefs. Results In logistic regression models adjusted for gender, education, race, and age, participants with adequate self-reported health literacy (compared to poorer levels of health literacy) had greater odds of participation in mammography within the last 2 years (Odds ratio [OR] = 2.215, p = 0.01) and participation in moderate exercise two or more times per week (OR = 1.512, p = 0.03). Participants with adequate objective health literacy had reduced odds of participation in monthly breast self-exams (OR = 0.369, p = 0.004) and reduced odds of current tobacco use (OR = 0.456, p = 0.03). In adjusted linear regression analyses, self-reported health literacy made a small but significant contribution to explaining perceived control of health (β 0.151, p = <0.001) and perceived social standing (β 0.112, p = 0.002). Conclusion In a subsample of older adult participants of the HRS, measures of health literacy were positively related to several health promoting behaviors and health-related beliefs and non-use of breast self-exams, a screening behavior of questionable benefit. These relationships varied however, between self-reported and objectively-measured health literacy. Further investigation into the specific mechanisms that lead higher literacy people to pursue health promoting actions appears clearly warranted.
Collapse
Affiliation(s)
- Dena M Fernandez
- Department of Internal Medicine, Division of General Medicine, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-2029, USA. .,Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, 400 North Ingalls Building, Ann Arbor, MI, 48109-5482, USA.
| | - Janet L Larson
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, 400 North Ingalls Building, Ann Arbor, MI, 48109-5482, USA
| | - Brian J Zikmund-Fisher
- Department of Internal Medicine, Division of General Medicine, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-2029, USA.,Department of Health Behavior & Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA.,Institute for Healthcare Policy and Innovation, Center for Bioethics and Social Sciences in Medicine, 2800 Plymouth Road, Ann Arbor, MI, 48109-2800, USA
| |
Collapse
|
115
|
Beatty CR, Flynn LA, Costello TJ. The Impact of Health Literacy Level on Inhaler Technique in Patients With Chronic Obstructive Pulmonary Disease. J Pharm Pract 2016; 30:25-30. [PMID: 26033793 DOI: 10.1177/0897190015585759] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Inhaled medications are recommended as first-line treatment for chronic obstructive pulmonary disease (COPD) and can reduce exacerbations and hospitalizations. Low health literacy is associated with poor inhaler technique. OBJECTIVE This study examined whether handouts written specifically for patients with low health literacy are more effective in showing patients how to use their medications when compared to standard education materials. METHODS A prospective, experimental study was performed at a community-based hospital. Patients included in the study were admitted to the hospital with a diagnosis of COPD, taking at least 1 inhaled medication and identified as having low health literacy based on a Rapid Estimate of Adult Literacy in Medicine-Short Form. Low health literacy handouts were compared against the standard hospital educational materials for inhalers. Correct technique during each demonstration was evaluated using a standardized checklist. RESULTS Mean baseline scores for inhaler technique were 12.2 ± 2.2 steps correct for the control group and 13.4 ± 1.3 for the low health-literacy group of the 18 maximum points ( P = nonsignificant). The mean change in inhaler technique score for the control group was 1.0 ± 1.8, while the mean change in inhaler technique score for the low health-literacy group was 2.1 ± 2.7 ( P = .03).
Collapse
Affiliation(s)
| | - Laura A Flynn
- 2 PGY-1 Pharmacy Resident, NorthShore University Health System, Evanston, IL, USA
| | - Tracy J Costello
- 3 College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN, USA.,4 Community Health Network, Indianapolis, IN, USA
| |
Collapse
|
116
|
Miller TA. Health literacy and adherence to medical treatment in chronic and acute illness: A meta-analysis. PATIENT EDUCATION AND COUNSELING 2016; 99:1079-1086. [PMID: 26899632 PMCID: PMC4912447 DOI: 10.1016/j.pec.2016.01.020] [Citation(s) in RCA: 337] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/12/2016] [Accepted: 01/27/2016] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To use meta-analytic techniques to assess average effect sizes in studies of: (1) the correlation between patient health literacy and both medication and non-medication adherence, and (2) the efficacy of health literacy interventions on improving health literacy and treatment adherence. METHODS PsychINFO and PubMed databases were searched (1948-2012). A total of 220 published articles met the criteria for inclusion; effect sizes were extracted and articles were coded for moderators. RESULTS Health literacy was positively associated with adherence (r=0.14), and this association was significantly higher among non-medication regimens and in samples with cardiovascular disease. Health literacy interventions increased both health literacy (r=0.22) and adherence outcomes (r=0.16). Moderator analyses revealed greater intervention efficacy when health literacy and adherence were assessed using subjective measures compared to objective measures. Health literacy interventions had a greater effect on adherence in samples of lower income and of racial-ethnic minority patients than in non-minority and higher income samples. CONCLUSION This is the first study to synthesize both correlational and intervention studies examining the relationship between health literacy and adherence to both medication and non-medication regimens. IMPLICATIONS These findings demonstrate the importance of health literacy and the efficacy of health literacy interventions especially among more vulnerable patient groups.
Collapse
Affiliation(s)
- Tricia A Miller
- University of California Riverside, Department of Psychology, 900 University Avenue, Riverside, CA 92521, United States.
| |
Collapse
|
117
|
Health Literacy and Social Support Among Elderly Medicare Enrollees in a Managed Care Plan. J Appl Gerontol 2016. [DOI: 10.1177/0733464806291314] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study examined health literacy, social support, and their relations to health status and health care use among older adults. The survey design and data were from a project that examined the prevalence of low health literacy among community-dwelling Medicare beneficiaries enrolled in a national managed care organization. Results indicate that compared to the high health literacy group, enrollees with low health literacy were more likely to receive medical information support and health reminder support. However, they were less likely to receive tangible support for their health care needs. In both health literacy groups, medical information support and health reminder support were associated with lower physical health and mental health status. Tangible support was associated with higher physical and mental health status. Health reminder support was associated with more doctor visits and a lower likelihood of hospitalization in the high health literacy group. Implications for reducing the adverse health consequences of low health literacy among older adults are discussed.
Collapse
|
118
|
Owen-Smith AA, Smith DH, Rand CS, Tom JO, Laws R, Waterbury A, Williams A, Vollmer WM. Difference in Effectiveness of Medication Adherence Intervention by Health Literacy Level. Perm J 2016; 20:15-200. [PMID: 27352409 DOI: 10.7812/tpp/15-200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
CONTEXT There is little research investigating whether health information technologies, such as interactive voice recognition, are effective ways to deliver information to individuals with lower health literacy. OBJECTIVE Determine the extent to which the impact of an interactive voice recognition-based intervention to improve medication adherence appeared to vary by participants' health literacy level. DESIGN Promoting Adherence to Improve Effectiveness of Cardiovascular Disease Therapies (PATIENT) was a randomized clinical trial designed to test the impact, compared with usual care, of 2 technology-based interventions that leveraged interactive voice recognition to promote medication adherence. A 14% subset of participants was sent a survey that included questions on health literacy. This exploratory analysis was limited to the 833 individuals who responded to the survey and provided data on health literacy. MAIN OUTCOME MEASURES Adherence to statins and/or angiotensin-converting enzyme inhibitors and/or angiotensin II receptor blockers. RESULTS Although intervention effects did not differ significantly by level of health literacy, the data were suggestive of differential intervention effects by health literacy level. CONCLUSIONS The differences in intervention effects for high vs low health literacy in this exploratory analysis are consistent with the hypothesis that individuals with lower health literacy may derive greater benefit from this type of intervention compared with individuals with higher health literacy. Additional studies are needed to further explore this finding.
Collapse
Affiliation(s)
- Ashli A Owen-Smith
- Assistant Professor of Health Management and Policy at the Georgia State University School of Public Health in Atlanta.
| | - David H Smith
- Senior Investigator at The Kaiser Permanente Center for Health Research in Portland, OR.
| | - Cynthia S Rand
- Professor of Medicine in the Department of Medicine at the Johns Hopkins School of Medicine in Baltimore, MD.
| | - Jeffrey O Tom
- Assistant Clinical Professor in the Department of Pediatrics at the University of Hawaii John A Burns School of Medicine in Honolulu.
| | - Reesa Laws
- Research and Data Analytics Center Manager and Technical Research Program Manager at The Kaiser Permanente Center for Health Research in Portland, OR.
| | - Amy Waterbury
- Research Program Manager at The Kaiser Permanente Center for Health Research in Portland, OR.
| | - Andrew Williams
- Faculty Scientist in the Center for Outcomes Research and Evaluation at the Maine Medical Center Research Institute in Scarborough.
| | - William M Vollmer
- Senior Investigator at The Kaiser Permanente Center for Health Research in Portland, OR.
| |
Collapse
|
119
|
Youmans SL, Schillinger D. Functional Health Literacy and Medication Use: The Pharmacist's Role. Ann Pharmacother 2016; 37:1726-9. [PMID: 14565798 DOI: 10.1345/aph.1d070] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Sharon L Youmans
- Department of Clinical Pharmacy, School of Pharmacy, University of California-San Francisco, San Francisco, CA 94143-0622, USA.
| | | |
Collapse
|
120
|
Botermann L, Monzel K, Krueger K, Eickhoff C, Wachter A, Kloft C, Laufs U, Schulz M. Evaluating patients’ comprehensibility of a standardized medication plan. Eur J Clin Pharmacol 2016; 72:1229-1237. [DOI: 10.1007/s00228-016-2082-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 06/07/2016] [Indexed: 11/30/2022]
|
121
|
Koster ES, Philbert D, Blom L, Bouvy ML. “These patients look lost” – Community pharmacy staff’s identification and support of patients with limited health literacy. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2016; 24:403-410. [DOI: 10.1111/ijpp.12272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 04/12/2016] [Accepted: 04/13/2016] [Indexed: 11/28/2022]
Abstract
Abstract
Objective
To date, routine use of health literacy assessment in clinical settings is limited. The objective of this study was to explore if community pharmacy staff can identify patients with limited health literacy, how they identify patients and how they support patients to improve medication use. In addition, perceived barriers in providing care for patients with limited health literacy were assessed.
Methods
Structured face-to-face interviews with pharmacy staff were performed in 27 community pharmacies. Questions concerned pharmacy staff’s experiences with limited health literacy during their work, e.g. recognition of patients, communication strategies and possible interventions for this patient group to improve medication use.
Key findings
Results from 74 interviews were included for analysis. Sixty-eight interviewees (92%) mentioned to identify patients with limited health literacy during their work, mostly based on intuition. Suggested strategies to improve medication use included tailored education and information, intensive support or use of aids such as a multidose drug dispensing system. Pharmacy staff indicated lack of time as a barrier to provide tailored pharmaceutical care.
Conclusions
Most participants mentioned to recognize patients with limited health literacy merely on intuition or based on certain patient characteristics. Thus, an unknown number of patients with limited health literacy might be missed. This underlines the need to create more awareness of health literacy among pharmacy professionals. Moreover, training of pharmacy staff and use of aids to identify limited health literacy may help to identify more patients who need additional counselling.
Collapse
Affiliation(s)
- Ellen S Koster
- Utrecht Pharmacy Practice network for Education and Research, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Daphne Philbert
- Utrecht Pharmacy Practice network for Education and Research, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Lyda Blom
- Utrecht Pharmacy Practice network for Education and Research, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Marcel L Bouvy
- Utrecht Pharmacy Practice network for Education and Research, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
122
|
Kobayashi LC, Wardle J, Wolf MS, von Wagner C. Aging and Functional Health Literacy: A Systematic Review and Meta-Analysis. J Gerontol B Psychol Sci Soc Sci 2016; 71:445-57. [PMID: 25504637 PMCID: PMC4834761 DOI: 10.1093/geronb/gbu161] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 10/16/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To review the evidence on the association between age and limited health literacy, overall and by health literacy test, and to investigate the mediating role of cognitive function. METHOD The Embase, MEDLINE, and PsycINFO databases were searched. Eligible studies were conducted in any country or language, included participants aged ≥50 years, presented a measure of association between age and health literacy, and were published through September 2013. RESULTS Seventy analyses in 60 studies were included in the systematic review; 29 of these were included in the meta-analysis. Older age was strongly associated with limited health literacy in analyses that measured health literacy as reading comprehension, reasoning, and numeracy skills (random-effects odds ratio [OR] = 4.20; 95% confidence interval [CI]: 3.13-5.64). By contrast, older age was weakly associated with limited health literacy in studies that measured health literacy as medical vocabulary (random-effects OR = 1.19; 95% CI: 1.03-1.37). Evidence on the mediating role of cognitive function was limited. DISCUSSION Health literacy tests that utilize a range of fluid cognitive abilities and mirror everyday health tasks frequently observe skill limitations among older adults. Vocabulary-based health literacy skills appear more stable with age. Researchers should select measurement tests wisely when assessing health literacy of older adults.
Collapse
Affiliation(s)
- Lindsay C Kobayashi
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, UK.
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, UK
| | - Michael S Wolf
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Illinois. Department of Learning Sciences, School of Education and Social Policy, Northwestern University, Evanston, Illinois
| | - Christian von Wagner
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, UK
| |
Collapse
|
123
|
Puente-Maestu L, Calle M, Rodríguez-Hermosa JL, Campuzano A, de Miguel Díez J, Álvarez-Sala JL, Puente-Andues L, Pérez-Gutiérrez MJ, Lee SYD. Health literacy and health outcomes in chronic obstructive pulmonary disease. Respir Med 2016; 115:78-82. [PMID: 27215508 DOI: 10.1016/j.rmed.2016.04.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 04/24/2016] [Accepted: 04/26/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is little information worldwide about the impact of health literacy (HL) on clinical outcomes of COPD. Our aim was to quantify inadequate HL in Spain, as measured by the Short Assessment of Health Literacy for Spanish Adults questionnaire, and to examine the associations between HL and both COPD outcomes and health status. METHODS 296 COPD patients of 68(SD = 9) years and a FEV1%predicted of 53%(SD = 18%) were enrolled and followed-up for one year. 59% showed "inadequate" HL. RESULTS Individuals with inadequate HL were older (70[SD = 9] vs 65[SD = 8] years; p < 0.001) and had less knowledge of their disease, as measured by the low HL-COPD questionnaire, (6.9[SD = 2.3] vs 7.5[SD = 1.9]; p < 0.001). While their lung function was no different, they reported significant differences in mMRC (1.6[SD = 1] vs 1.4[SD = 1]; p < 0.001), CAT (19.2[SD = 8.1] vs 18.3[SD = 7.5]; p = 0.049), and EQ-5 (3.1[SD = 2.2] vs 2.3[SD = 1.9]; p < 0.00). Those with inadequate HL had also higher risk of having ≥2 comorbidities (OR = 1.87; 95%CI = 1.14-3.08), need of assistance (OR = 2.5; 95%CI = 1.5-4.2), anxiety/depression (OR = 1.9; 95%CI = 1.2-3.0), admissions or visits to the emergency department (OR = 1.70; 95%CI = 1.1-2.7), and all-cause deaths in the following year (3.8% (SE = 1.1%) vs 0%; p = 0.051). CONCLUSIONS Inadequate HL is prevalent among COPD patients and it is related to health status and relevant clinical outcomes of the disease. HL needs to be considered when planning the care for COPD patients.
Collapse
Affiliation(s)
- Luis Puente-Maestu
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Instituto de investigación Sanitaria Gregorio Marañón, Facultad de Medicina Universidad Complutense, Madrid, Spain.
| | - Myriam Calle
- Servicio de Neumología, Hospital Clínico San Carlos, Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Juan Luis Rodríguez-Hermosa
- Servicio de Neumología, Hospital Clínico San Carlos, Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | | | - Javier de Miguel Díez
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Instituto de investigación Sanitaria Gregorio Marañón, Facultad de Medicina Universidad Complutense, Madrid, Spain
| | - Jose Luis Álvarez-Sala
- Servicio de Neumología, Hospital Clínico San Carlos, Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | | | | | - Shoou-Yih D Lee
- Department of Health Policy and Management, School of Global Public Health, University of North Carolina, Chapel Hill, USA
| |
Collapse
|
124
|
Rosenbaum AJ, Uhl RL, Rankin EA, Mulligan MT. Social and Cultural Barriers: Understanding Musculoskeletal Health Literacy: AOA Critical Issues. J Bone Joint Surg Am 2016; 98:607-15. [PMID: 27053590 DOI: 10.2106/jbjs.o.00718] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The Institute of Medicine considers limited health literacy a "silent epidemic," as approximately half of Americans lack the competencies necessary for making informed decisions regarding their health. Limited health literacy substantially impedes the effective dissemination and comprehension of relevant health information, and also complicates communication, compromises care, and leads to worse patient outcomes. Poor health, early death, and worse control of chronic conditions have also been associated with limited health literacy. Unfortunately, physicians often struggle to identify those with limited health literacy, which can have adverse effects on the physician-patient relationship. In this article, we discuss the meaning of health literacy,the risk factors for and consequences of limited health literacy, orthopaedic-specific implications and investigations, and the strategies orthopaedic surgeons can utilize to improve health literacy and communication.
Collapse
Affiliation(s)
- Andrew J Rosenbaum
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, New York
| | - Richard L Uhl
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, New York
| | | | - Michael T Mulligan
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, New York
| |
Collapse
|
125
|
Adams J, Mytton O, White M, Monsivais P. Why Are Some Population Interventions for Diet and Obesity More Equitable and Effective Than Others? The Role of Individual Agency. PLoS Med 2016; 13:e1001990. [PMID: 27046234 PMCID: PMC4821622 DOI: 10.1371/journal.pmed.1001990] [Citation(s) in RCA: 228] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Jean Adams and colleagues argue that population interventions that require individuals to use a low level of agency to benefit are likely to be most effective and most equitable.
Collapse
Affiliation(s)
- Jean Adams
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
- * E-mail:
| | - Oliver Mytton
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Martin White
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Pablo Monsivais
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
126
|
Sivakumar H, Hanoch Y, Barnes AJ, Federman AD. Cognition, Health Literacy, and Actual and Perceived Medicare Knowledge Among Inner-City Medicare Beneficiaries. JOURNAL OF HEALTH COMMUNICATION 2016; 21:155-163. [PMID: 27676124 DOI: 10.1080/10810730.2016.1193921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Poor Medicare knowledge is associated with worse health outcomes, especially in low-income patients. We examined the association of health literacy and cognition with actual and perceived Medicare knowledge in a sample of inner-city older adults. We conducted a cross-sectional analysis of data on 336 adults ages 65 years and older with Medicare coverage recruited from senior centers and low-income housing facilities in Manhattan, New York. Actual Medicare knowledge was determined by a summary score of 9 true/false questions about the Medicare program and perceived Medicare knowledge with a single item. Validated measures were used to assess health literacy and general cognition. Among respondents, 63.1% had high actual Medicare knowledge, and 36.0% believed that they knew what they needed to know about Medicare. Actual and perceived Medicare knowledge were poorly correlated (r = -.01, p > .05). In multivariable models, low health literacy was significantly associated with actual Medicare knowledge (β = -8.30, SE = 2.71, p < .01) but not perceived Medicare knowledge (β = 0.37, SE = 0.22, p = .09). Individuals with low health literacy were more likely to perceive their Medicare knowledge as adequate when actual Medicare knowledge was low (adjusted odds ratio = 3.30, 95% confidence interval [1.20, 9.05], p < .05). These results show that older adults with low health literacy are more likely to have poor understanding of the Medicare program and yet more likely to believe that their understanding of the program is adequate. This combination of factors may place them at increased risk for poor access to information about the Medicare program and diminish their ability to make fully informed choices.
Collapse
Affiliation(s)
- Haran Sivakumar
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , New York , USA
| | - Yaniv Hanoch
- b Department of Healthcare Behavior and Policy , Virginia Commonwealth University School of Medicine , Richmond , Virginia , USA
| | - Andrew J Barnes
- c School of Psychology , Plymouth University , Plymouth , United Kingdom
| | - Alex D Federman
- d Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , New York , USA
| |
Collapse
|
127
|
Abstract
BACKGROUND Little is known about the functional health literacy (FHL) associated with medication adherence in elderly patients. The aim of this study was to examine the FHL among older adults and identify influencing factors that can predict medication adherence. METHODS This was a cross-sectional survey. Participants (n=160) aged 65 years and older were selected from outpatient clinics of 3 tertiary care hospitals, 6 community pharmacies, and 2 senior centers between November 1 and 30, 2014. The participants' FHL was measured using the Korean Functional Health Literacy Test, which consists of 15 items including 8 numeracy and 7 reading comprehension items. Medication adherence was measured by the Adherence to Refills and Medication Scale. Descriptive statistics, chi-square or Fisher's exact test, and multiple regression analyses were used to analyze the data. RESULTS The mean score of the total FHL was 7.72±3.51 (range 0-15). The percentage of the total number of correct answers for the reading comprehension subtest and numeracy subtest were 48.1% and 54.4%, respectively. Among 160 participants, 52.5% showed low adherence to medication. The factors affecting medication adherence included the patient's degree of satisfaction with the service (β=-0.215, P=0.022), sufficient explanation of medication counseling (β=-0.335, P=0.000), education level (β=-0.153, P=0.045), health-related problems (β=-0.239, P=0.004), and dosing frequency (β=0.189, P=0.018). CONCLUSION In this study, we found medication adherence of elderly patients was associated with education level, health-related problems, dosing frequency, satisfaction with patient counseling, and explanation of medication, but no association was found with FHL. Pharmacists should consider elderly patients' individual characteristics such as educational background and specific patient-related health problems, provide sufficient information and explanation of medication, and ensure patient satisfaction with the counseling.
Collapse
Affiliation(s)
| | - Yeonhee Kim
- Center for Excellence in Teaching & Learning
| | - Sandy Jeong Rhie
- College of Pharmacy
- Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
- Correspondence: Sandy Jeong Rhie, College of Pharmacy, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Republic of Korea, Tel +82 2 3277 3023, Fax +82 2 3277 2851, Email
| |
Collapse
|
128
|
Botermann L, Krueger K, Eickhoff C, Kloft C, Schulz M. Patients' handling of a standardized medication plan: a pilot study and method development. Patient Prefer Adherence 2016; 10:621-30. [PMID: 27175062 PMCID: PMC4854253 DOI: 10.2147/ppa.s96431] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
PURPOSE The Action Plan for Medication Safety by the German Federal Ministry of Health introduced a standardized medication plan (MP), a printable document for the patient. The practical handling needs to be tested before the nationwide implementation in Germany. Therefore, the aims of our study were 1) to develop an instrument to evaluate the usage of the standardized MP, 2) to assess if patients can locate, and 3) understand important information. Moreover, we explored patients' opinion and suggestions regarding the standardized MP template. PATIENTS AND METHODS We conducted a cross-sectional study to evaluate the practical handling of the standardized MP. We interviewed 40 adult patients in seven community pharmacies in Germany, who took at least five medicines regularly and gave their written informed consent. The interview consisted of questions regarding finding and understanding information provided on a mock-up MP, patients' opinion and the execution of the information on the MP by filling pill boxes. We eventually developed a new evaluation method to quantify the practical handling of the MP by rating the pill boxes filled by the patients. RESULTS Overall, the participants rated the MP positively. Thirty-nine (98%) participants found important information on a mock-up standardized MP. Patients were questioned to identify if they understood information on medical intake as it relates to meals. In particular, they were questioned about medicine intake "1 hour before a meal", which 98% (n=39) interpreted correctly, and "during a meal", which 100% (n=40) interpreted correctly. The less precise advice of "before a meal" was interpreted correctly by 73% (n=29), and only 15% (n=6) correctly interpreted the term "after the meal". The evaluation of the filled pill boxes resulted in the "Evaluation Tool to test the handling of the Medication Plan" (ET-MP) - a weighted scoring system. CONCLUSION The standardized MP is clearly arranged, and patients are able to find important information. The findings of this study resulted in minor but important revisions of the standardized MP template. The developed evaluation tool ET-MP may serve as an objective instrument to assess patients' ability to transfer written information on the MP into practical handling of medicines.
Collapse
Affiliation(s)
- Lea Botermann
- Department of Medicine, ABDA – Federal Union of German Associations of Pharmacists, Berlin, Germany
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universitaet Berlin, Berlin, Germany
| | - Katrin Krueger
- Department of Medicine, ABDA – Federal Union of German Associations of Pharmacists, Berlin, Germany
| | - Christiane Eickhoff
- Department of Medicine, ABDA – Federal Union of German Associations of Pharmacists, Berlin, Germany
| | - Charlotte Kloft
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universitaet Berlin, Berlin, Germany
| | - Martin Schulz
- Department of Medicine, ABDA – Federal Union of German Associations of Pharmacists, Berlin, Germany
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universitaet Berlin, Berlin, Germany
- Department of Pharmacology, Goethe-University Frankfurt, Frankfurt am Main, Germany
- Correspondence: Martin Schulz, Department of Medicine, ABDA – Federal Union of German Associations of Pharmacists, Unter den Linden 19-23, 10117 Berlin, Germany, Tel +49 30 4000 4511, Fax +49 30 4000 4513, Email
| |
Collapse
|
129
|
Fleisher JE, Shah K, Fitts W, Dahodwala NA. Associations and implications of low health literacy in Parkinson's Disease. Mov Disord Clin Pract 2015; 3:250-256. [PMID: 27331078 DOI: 10.1002/mdc3.12272] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Low health literacy (HL) indicates a limited ability to understand and use basic information to make appropriate healthcare decisions. While low HL is associated with higher morbidity, mortality, and healthcare costs in multiple chronic conditions, little is known about HL and its associations in Parkinson's disease (PD). METHODS Cross-sectional study of non-demented adults with PD participating in the National Parkinson Foundation Parkinson's Outcomes Project at the University of Pennsylvania. Subjects were administered two brief HL assessments-the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF), a word-recognition test, and the Newest Vital Sign (NVS), a test of literacy, numeracy and understanding of health information-as well as demographic and clinical questionnaires. Adverse outcomes included falls in the 3 months preceding the study visit, and hospital admissions, emergency room visits, infections, or injuries in the preceding year. Caregiver burden was measured using the Multidimensional Caregiver Strain Index. RESULTS 168 subjects completed both HL screens (mean 65.8 years, 65.5% male, 65.2% Hoehn & Yahr Stage 2). Using the REALM-SF, 97.6% of subjects had adequate HL. Using the NVS, however, 29.8% had low HL, which was associated with older age, lower education, male gender, greater disease severity, and poorer cognition. Low HL was associated with hospital admission and increased caregiver burden. CONCLUSIONS Low HL is common and associated with greater caregiver burden and a higher likelihood of hospitalization in patients with PD. Since HL is associated with both disease severity and adverse outcomes, it may be an important, modifiable contributor to morbidity.
Collapse
Affiliation(s)
- Jori E Fleisher
- Department of Neurology, New York University Langone School of Medicine, New York, New York, USA
| | - Krunal Shah
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Whitney Fitts
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nabila A Dahodwala
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| |
Collapse
|
130
|
Ragland D, Payakachat N. Health Literacy in Obstetric Patients: A Pharmacist's Experience with The Newest Vital Sign. PHARMACY 2015; 3:372-378. [PMID: 28975922 PMCID: PMC5597114 DOI: 10.3390/pharmacy3040372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/25/2015] [Accepted: 12/10/2015] [Indexed: 11/16/2022] Open
Abstract
Health literacy can greatly impact patients' self-management of medical conditions and adherence to treatment recommendations. This study aimed to assess the health literacy of obstetric patients at a university-based women's clinic using the Newest Vital Sign (NVS). A clinical pharmacist or student pharmacist utilized the instrument to interview women during a routine clinic visit. This project is a cross-sectional, retrospective study using the de-identified survey data. Descriptive statistics were used to provide a summary of the NVS scores in this population. The average age of the 140 participants was 27 years (SD = 6) with the range from 16 to 49 years old. The majority (78%) of the patients was ≤ 30 years old; 50% were white and 39% were black. The average NVS score was 3 (SD = 2.2). 49% had scores ≤ 3 which indicates limited literacy. This pilot study yielded preliminary data for future investigations of health literacy in this population while identifying a potential role for pharmacists. Due to its ease of use and quick administration, it is feasible to use the NVS instrument to routinely screen health literacy in an obstetric clinic setting.
Collapse
Affiliation(s)
- Denise Ragland
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences College of Pharmacy, 4301 W. Markham Street, #522, Little Rock, AR 72205, USA.
| | - Nalin Payakachat
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences College of Pharmacy, 4301 W. Markham Street, #522, Little Rock, AR 72205, USA.
| |
Collapse
|
131
|
Siswandari Y, Xiong S. Eye movements and brain oscillations to symbolic safety signs with different comprehensibility. J Physiol Anthropol 2015; 34:42. [PMID: 26653248 PMCID: PMC4676193 DOI: 10.1186/s40101-015-0081-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 12/08/2015] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to investigate eye movements and brain oscillations to symbolic safety signs with different comprehensibility. Methods Forty-two young adults participated in this study, and ten traffic symbols consisting of easy-to-comprehend and hard-to-comprehend signs were used as stimuli. During the sign comprehension test, real-time eye movements and spontaneous brain activity [electroencephalogram (EEG) data] were simultaneously recorded. Results The comprehensibility level of symbolic traffic signs significantly affects eye movements and EEG spectral power. The harder to comprehend the sign is, the slower the blink rate, the larger the pupil diameter, and the longer the time to first fixation. Noticeable differences on EEG spectral power between easy-to-comprehend and hard-to-comprehend signs are observed in the prefrontal and visual cortex of the human brain. Conclusions Sign comprehensibility has significant effects on real-time nonintrusive eye movements and brain oscillations. These findings demonstrate the potential to integrate physiological measures from eye movements and brain oscillations with existing evaluation methods in assessing the comprehensibility of symbolic safety signs.
Collapse
Affiliation(s)
- Yohana Siswandari
- Department of Human and Systems Engineering, School of Design and Human Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, 689-798, South Korea.
| | - Shuping Xiong
- Department of Human and Systems Engineering, School of Design and Human Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, 689-798, South Korea. .,Department of Industrial and Systems Engineering, College of Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, South Korea.
| |
Collapse
|
132
|
Erickson SR, LeRoy B. Health literacy and medication administration performance by caregivers of adults with developmental disabilities. J Am Pharm Assoc (2003) 2015; 55:169-77. [PMID: 25615819 DOI: 10.1331/japha.2015.14101] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To measure health literacy (HL) of caregivers of adults with intellectual/developmental disabilities (IDDs); to determine the association between HL and a medication administration task (MAT) assessment; and to identify caregiver characteristics associated with higher HL and MAT scores. DESIGN Cross-sectional study. SETTING Southeastern Michigan. PARTICIPANTS Caregivers, aged 18 years or older, who provided supportive care of adults with IDDs. INTERVENTIONS Survey and demonstration. MAIN OUTCOME MEASURES Short Test of Functional Health Literacy in Adults (STOFHLA); a MAT assessment consisting of interpretation of five sets of medication instructions followed by demonstration of understanding using a pill box; and a survey of caregivers' demographics, medication-related experiences, education, characteristics of persons for whom they provide care, and care-related activities performed. RESULTS A total of 47 caregivers provided data. Caregivers had a mean age of 45.7 ± 14.6 years; 41 (87.2%) were women and 38 (80.9%) had education beyond high school. Caregivers were involved in obtaining medication from pharmacies, reminded the person with IDD to take medications and/or administered them to the person, documented medication and health information, and accompanied persons with IDD to physician offices. Most did not conduct monitoring procedures. The STOFHLA mean score was 34.5 ± 2.5 (median, 35; range, 22-36), while the MAT mean score was 12.0 ± 2.2 (median, 12; range, 6-15). Compared with family caregivers, direct support staff more frequently had undergone some medication training and had other people with whom they could discuss medication questions, but they had worked with the person with IDD a significantly shorter amount of time. No significant differences in STOFHLA and MAT scores between the family caregivers and direct support staff were observed. Caregiver education was significantly correlated with the STOFHLA score. MAT scores were not significantly correlated with caregiver characteristics. CONCLUSION Caregivers are involved in the medication use process for people who have IDD. Ensuring caregiver understanding of medication regimens and/or improving medication-related HL may be an important step to ensure safe and effective use of medications by people with IDD.
Collapse
|
133
|
Ward KE, Cohen LB. Promoting Safe Use of Medications: Providing Medication Education to Seniors Receiving Meals on Wheels. ACTA ACUST UNITED AC 2015; 30:616-22. [PMID: 26450144 DOI: 10.4140/tcp.n.2015.616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVES To assess whether pharmacist-provided medication education and counseling to Meals on Wheels (MOW) participants decreases medication-related preventable harm and improves adherence. DESIGN Prospective, quasi-experiment. SETTING Ambulatory congregrate dining centers. PATIENTS Persons 60 years of age and older participating in MOW receiving prescription, nonprescription, or complementary products were eligible. In total, 42 patients consented. Five patients did not complete the first visit, and 13 patients did not complete the six-month follow-up visit. INTERVENTIONS Pharmacists provided comprehensive medication education about prescription, nonprescription, and complementary products at baseline. Additional resources to enhance adherence and avoid medication-related preventable harm were provided and discussed. MAIN OUTCOME MEASURES Medication-related preventable harm and medication adherence were assessed before pharmacist intervention and six months after intervention. Adherence was assessed and compared with baseline using the Morisky scale and pill counts. RESULTS Women constituted the majority of participants (94.4%) with an average age of 74.5 ± 8.2 years. Mean difference in Morisky score from baseline to six months was 0.28 (-0.11 to 0.56). After adjustment for age and living situation, the change in Morisky score was associated with a 14% improvement in adherence. Mean differences in drug-drug and drug-supplement interactions, and medication-related harm were not significantly reduced from baseline to study end. CONCLUSION Pharmacist intervention with MOW participants appeared to improve medication adherence rates but had limited effect on medication-related preventable harm. No findings reached statistical significance as the sample size was inadequate. Larger studies are needed to confirm these findings.
Collapse
Affiliation(s)
- Kristina E Ward
- Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston, Rhode Island, USA
| | | |
Collapse
|
134
|
Patel S, Dowse R. Understanding the medicines information-seeking behaviour and information needs of South African long-term patients with limited literacy skills. Health Expect 2015; 18:1494-507. [PMID: 24112215 PMCID: PMC5060885 DOI: 10.1111/hex.12131] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2013] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Although much health information-seeking behaviour (HISB) research has been reported in patients with good literacy skills, little is known about HISB in patients with limited literacy skills served by under-resourced health-care systems. OBJECTIVE To investigate medicine information-seeking behaviour and information needs in patients with limited literacy. METHODS Using a question guide, four focus group discussions (FGDs) were conducted to explore themes related to information needs, information-seeking practices and awareness of and ability to utilize information sources. Twenty-two isiXhosa-speaking long-term patients with limited formal education were recruited from a primary health-care clinic in South Africa. Discussions were audio-recorded and transcribed verbatim. NVivo(®) was used for initial coding of transcripts. Codes were analysed, and potential themes and subthemes in the entire data set were identified and refined. FINDINGS The results of this study reflect a passive, disempowered patient. Poor awareness of information sources, lack of health-related knowledge and stigma contributed to a lack of information-seeking practice, thus potentially adversely influencing patient-provider interactions. Patients neither asked questions nor were encouraged to ask questions. All expressed an unmet need for information and a desire for receiving the illustrated written medicines-related information displayed in the FGDs. The main sources of information were health-care professionals, followed by family and friends. CONCLUSION The significant level of patient disempowerment and passivity reported amongst patients underpinned their inability to actively seek information. Neither sources of information nor types of appropriate medicines information could be identified. Unmet information needs and a desire for information were reported.
Collapse
Affiliation(s)
- Sonal Patel
- Faculty of PharmacyRhodes UniversityGrahamstownSouth Africa
| | - Ros Dowse
- Faculty of PharmacyRhodes UniversityGrahamstownSouth Africa
| |
Collapse
|
135
|
Tiller D, Herzog B, Kluttig A, Haerting J. Health literacy in an urban elderly East-German population - results from the population-based CARLA study. BMC Public Health 2015; 15:883. [PMID: 26357978 PMCID: PMC4566302 DOI: 10.1186/s12889-015-2210-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 09/02/2015] [Indexed: 11/25/2022] Open
Abstract
Background Health literacy (HL) has gained increasing attention in public health research. However, until now research was mainly focused on clinical settings rather than on the general population. Due its relation to social determinants and health outcomes, HL is of special interest in epidemiological studies. The aim of the present study was therefore to describe HL among an elderly general high-risk population, to analyze the potential contributing factors of HL, and to analyze the impact of HL on health-related outcomes. Methods We used data from the CARLA Study, which is a prospective population-based cohort study of the elderly general population of the city of Halle (Saale) in Eastern Germany. The short version of the HLS-EU Questionnaire (HLS-EU-Q16) was administered with 1,107 subjects aged between 55 and 91 year old. A HL score ranging from 0 to 50 points was computed and classified according to the recommendation of the HLS-EU project. Socio-economic as well as health-related variables were determined during the standardized interview and clinical examination. We calculated linear as well as logistic regression models in order to analyze the association between HL and health-related outcomes as well as potential influencing factors of HL. Results Overall, the HL score was 36.9 (SD 6.9). Among all subjects, 4 % showed inadequate HL, 23 % problematic HL, 50 % sufficient HL, and 23 % excellent HL. HL was positively associated with educational level, net household income, and self-perceived social position. Further, we found an increase of HL with age (β = 0.10; 95 % CL 0.05; 0.15) and a lower HL score among women compared with men (Diff = -1.4; 95 % CL −2.2; −0.6). An inverse association was observed between HL and diabetes among both sexes (OR 0.93; 95 % CL 0.93; 0.98), between HL and myocardial infarction among women, and between HL and stroke among men. Conclusions In this elderly general Eastern German population, we found higher HL score values compared with previous studies using the same questionnaire. HL was associated with socio-economic status. Furthermore, this cross-sectional study could show associations between HL and different health-related outcomes even after adjustment for educational level. However, further research is needed in order to evaluate the impact of HL on health-related outcomes using longitudinal data derived from the general population.
Collapse
Affiliation(s)
- Daniel Tiller
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin Luther University of Halle-Wittenberg, Magdeburger Straße 8, Halle (Saale), Germany.
| | - Beatrice Herzog
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin Luther University of Halle-Wittenberg, Magdeburger Straße 8, Halle (Saale), Germany.
| | - Alexander Kluttig
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin Luther University of Halle-Wittenberg, Magdeburger Straße 8, Halle (Saale), Germany.
| | - Johannes Haerting
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin Luther University of Halle-Wittenberg, Magdeburger Straße 8, Halle (Saale), Germany.
| |
Collapse
|
136
|
Assessing Health Literacy in Urban Patients With Implantable Cardioverter Defibrillators and Pacemakers. J Cardiovasc Nurs 2015; 30:428-34. [DOI: 10.1097/jcn.0000000000000184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
137
|
Santos MIPDO, Portella MR, Scortegagna HDM, Santos PCSD. Letramento funcional em saúde na perspectiva da Enfermagem Gerontológica: revisão integrativa da literatura. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2015. [DOI: 10.1590/1809-9823.2015.14080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objetivo: Realizar uma revisão integrativa da literatura sobre o letramento funcional em saúde, na perspectiva da produção da Enfermagem Gerontológica.Método: Foram pesquisadas as bases de dados MEDLINE, PubMed, LILACS, IBECS, BDENF e CidSaúde, incluídos estudos publicados em periódicos nacionais e internacionais, no período de 2005-2014. Os estudos foram selecionados pelo assunto principal, como educação de pacientes, alfabetização em saúde, escolaridade, idoso, educação em saúde e autocuidado.Resultados: Foram encontrados 58 estudos, pré-selecionados 33, porém somente 17 compuseram a amostra final, sendo 15 internacionais e dois nacionais. Conclusões: Os resultados apontam a integração de saberes sobre a avaliação do letramento funcional em saúde de idosos. O inadequado letramento foi evidente, demostrando impactar sobremaneira a gestão em saúde, principalmente aqueles com doença crônica de longa duração, além da compreensão inadequada de horários e dosagens de medicamentos, destacando que novas estratégias podem ser pensadas para o empoderamento e melhor controle da saúde.
Collapse
|
138
|
Goltz HH, Kowalkowski MA, Chen GJ, Latini DM. Impact of health services on compliance and outcomes. Bladder Cancer 2015. [DOI: 10.1002/9781118674826.ch33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
139
|
Busch EL, Martin C, DeWalt DA, Sandler RS. Functional health literacy, chemotherapy decisions, and outcomes among a colorectal cancer cohort. Cancer Control 2015; 22:95-101. [PMID: 25504283 DOI: 10.1177/107327481502200112] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Functional health literacy is essential for the self-management of chronic diseases and preventive health behaviors. Patients with cancer who have a low level of health literacy may be at greater risk for poor care and poor outcomes. METHODS We assessed health literacy using the Short Test of Functional Health Literacy in Adults in 347 participants with colorectal cancer who were nested within a prospective observational study of system, health care provider, and participant characteristics influencing cancer outcomes. RESULTS Having adequate health literacy increased the likelihood that participants with stage 3/4 disease received chemotherapy (odds ratio, 3.29; 95% confidence interval, 1.23-8.80) but had no effect on cancer stage at diagnosis or vital status at last observation during postenrollment follow-up. No difference was seen in health literacy status regarding participant beliefs and preferences about chemotherapy among those with stage 3/4 disease, nor in participant roles in deciding whether to receive chemotherapy. CONCLUSIONS Patients with lower levels of health literacy were less likely to receive chemotherapy compared with participants with higher levels of health literacy. Therefore, clear communication related to key health care decisions may lead to fewer disparities due to a patient's level of health literacy.
Collapse
Affiliation(s)
- Evan L Busch
- Department of Medicine, University of North Carolina at Chapel Hill, 27599-7555.
| | | | | | | |
Collapse
|
140
|
Schmitz C, Ansmann L, Ernstmann N. Psychosocial Information Requirements for Multimorbid Breast Cancer Patients in Breast Centres in North Rhine Westphalia. Geburtshilfe Frauenheilkd 2015; 75:702-709. [PMID: 26257407 DOI: 10.1055/s-0035-1546271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 06/06/2015] [Accepted: 06/15/2015] [Indexed: 10/23/2022] Open
Abstract
Introduction: The importance of breast cancer patients (BPs) being supplied with sufficient information is well known. This study investigated the unfulfilled psychosocial information requirements of multimorbid BPs. Methods: This study records the unfulfilled psychosocial information requirements of 4166 patients, who were treated at one of the fifty breast centres in North Rhine Westphalia. The Cologne patient questionnaire for breast cancer 2.0 included in the postal survey following hospital stays records the information requirements using an adapted version of the "Cancer patient information needs" scale. Through a univariate analysis using the χ2 test, it was investigated whether multimorbid BPs had significantly different psychosocial information requirements than BPs without further concomitant illnesses. Results: In general, it transpired that BPs had relatively low unfulfilled information requirements regarding work (20.7 %), everyday life (26.8 %), illness (27.4 %) and treatment (35.7 %), though such requirements were higher when it came to health-related behaviour (54.2 %). Multimorbid BPs had significantly lower unfulfilled information requirements regarding work and significantly larger ones regarding treatment in comparison to BPs without concomitant illnesses. Renal diseases and concomitant mental illnesses were associated with particularly high information requirements (p < 0.05). Conclusion: The results of our study should clarify the complexity and heterogeneity of information requirements of breast cancer patients in oncological care and should help to design the supply of information to be more patient-oriented.
Collapse
Affiliation(s)
- C Schmitz
- IMVR - Institute of Medical Sociology, Health Services and Rehabilitation Science, University of Cologne, Cologne
| | - L Ansmann
- IMVR - Institute of Medical Sociology, Health Services and Rehabilitation Science, University of Cologne, Cologne
| | - N Ernstmann
- IMVR - Institute of Medical Sociology, Health Services and Rehabilitation Science, University of Cologne, Cologne
| |
Collapse
|
141
|
Thiel DD, Davidiuk AJ, Broderick GA, Arnold M, Diehl N, Tavlarides A, Custer K, Parker AS. Comparison of patient-reported quality of life outcome questionnaire response rates between patients treated surgically for renal cell carcinoma and prostate carcinoma. BMC Urol 2015; 15:58. [PMID: 26126615 PMCID: PMC4487850 DOI: 10.1186/s12894-015-0057-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 06/15/2015] [Indexed: 12/03/2022] Open
Abstract
Background We sought to examine differences in response rates to quality of life (QoL) surveys in patients treated surgically for renal cell carcinoma (RCC) and prostate cancer (PCa) and to analyze factors associated with non-response of the surveys. Methods Patients who underwent surgery for RCC or PCa between 2006 and 2012 were offered enrollment in respective prospective cancer registries that included baseline and annual QoL assessments. We identified 201 RCC patients and 616 PCa patients who completed a baseline QoL survey and were mailed annual QoL surveys [RCC: SF-36, FACT–G (73 questions), PCa: EPIC, IIEF, Max-PC (80 questions)]. We compared patient characteristics between responders and non-responders using a Wilcoxon rank-sum test for continuous variables and a Fisher’s Exact test for categorical variables. Results The overall response rates for the PCa and RCC groups were 63 and 48 % (p < 0.001), respectively. This difference in response rates remained when we limited analysis to only those with early stage disease (pT2 for PCa and pT1 RCC, 62 % vs. 52 %; p = 0.03). PCa characteristics associated with response included older age (64.1 vs 62.6 years, p = 0.032) and robotic versus open surgery (56 % vs 44 %; p = 0.009). There were no characteristics that were associated with response in RCC patients. Conclusions Surgically treated PCa patients have higher QoL mail-based survey response rates compared to patients treated surgically for RCC. This difference holds true for clinically localized cancers as well.
Collapse
Affiliation(s)
- David D Thiel
- Departments of Urology Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - Andrew J Davidiuk
- Departments of Urology Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - Gregory A Broderick
- Departments of Urology Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - Michelle Arnold
- Health Sciences Research at Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - Nancy Diehl
- Health Sciences Research at Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - Andrea Tavlarides
- Health Sciences Research at Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - Kaitlynn Custer
- Health Sciences Research at Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - Alexander S Parker
- Health Sciences Research at Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| |
Collapse
|
142
|
Kobayashi LC, Wardle J, Wolf MS, von Wagner C. Cognitive Function and Health Literacy Decline in a Cohort of Aging English Adults. J Gen Intern Med 2015; 30:958-64. [PMID: 25680352 PMCID: PMC4471026 DOI: 10.1007/s11606-015-3206-9] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 12/23/2014] [Accepted: 01/20/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Low health literacy is common among aging patients and is a risk factor for morbidity and mortality. We aimed to describe health literacy decline during aging and to investigate the roles of cognitive function and decline in determining health literacy decline. METHODS Data were from 5,256 non-cognitively impaired adults aged ≥ 52 years in the English Longitudinal Study of Ageing. Health literacy was assessed using a four-item reading comprehension assessment of a fictitious medicine label, and cognitive function was assessed in a battery administered in-person at baseline (2004-2005) and at follow-up (2010-2011). RESULTS Overall, 19.6% (1,032/5,256) of participants declined in health literacy score over the follow-up. Among adults aged ≥ 80 years at baseline, this proportion was 38.2% (102/267), compared to 14.8% (78/526) among adults aged 52-54 years (OR = 3.21; 95% CI: 2.26-4.57). Other sociodemographic predictors of health literacy decline were: male sex (OR = 1.20; 95% CI: 1.04-1.38), non-white ethnicity (OR = 2.42; 95% CI: 1.51-3.89), low educational attainment (OR = 1.58; 95% CI: 1.29-1.95 for no qualifications vs. degree education), and low occupational class (OR = 1.67; 95% CI: 1.39-2.01 for routine vs. managerial occupations). Higher baseline cognitive function scores protected against health literacy decline, while cognitive decline (yes vs. no) predicted decline in health literacy score (OR = 1.59; 95% CI: 1.35-1.87 for memory decline and OR = 1.56; 95% CI: 1.32-1.85 for executive function decline). CONCLUSIONS Health literacy decline appeared to increase with age, and was associated with even subtle cognitive decline in older non-impaired adults. Striking social inequalities were evident, whereby men and those from minority and deprived backgrounds were particularly vulnerable to literacy decline. Health practitioners must be able to recognize limited health literacy to ensure that clinical demands match the literacy skills of diverse patients.
Collapse
Affiliation(s)
- Lindsay C Kobayashi
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, 2nd floor, London, UK, WC1E 6BT,
| | | | | | | |
Collapse
|
143
|
Mantwill S, Schulz PJ. Health literacy in Mainland China: Validation of a functional health literacy test in simplified Chinese. Health Promot Int 2015; 31:742-748. [PMID: 26071605 DOI: 10.1093/heapro/dav043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Health literacy tests in the Chinese-speaking parts of the world have been mainly developed in traditional Chinese to be used in Hong Kong or Taiwan. So far no validated tool in simplified Chinese to assess functional health literacy in Mainland China has been developed. The aim of the study was to validate the simplified Chinese version of the Short Test of Functional Health Literacy in Adults (S-TOFHLA). The traditional Chinese version was translated into simplified Chinese and 150 interviews in an outpatient department of a public hospital in Mainland China were conducted. Predictive validity was assessed by known predictors for health literacy and convergent validity by three health literacy screening questions. The Cronbach's α for the reading comprehension part was 0.94 and 0.90 for the numeracy items. Participants with lower education and men had significantly lower levels of health literacy. The reading comprehension part was significantly correlated with two of the health literacy screening questions. Our results indicate that the simplified Chinese version of the S-TOFHLA is a reliable measure of health literacy to be used in Mainland China.
Collapse
Affiliation(s)
- Sarah Mantwill
- Institute of Communication and Health, University of Lugano, Via Giuseppe Buffi 13, Lugano 6900, Switzerland
| | - Peter J Schulz
- Institute of Communication and Health, University of Lugano, Via Giuseppe Buffi 13, Lugano 6900, Switzerland
| |
Collapse
|
144
|
Koster ES, Philbert D, Bouvy ML. Health literacy among pharmacy visitors in the Netherlands. Pharmacoepidemiol Drug Saf 2015; 24:716-21. [DOI: 10.1002/pds.3803] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 03/25/2015] [Accepted: 04/30/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Ellen S. Koster
- Utrecht Pharmacy Practice network for Education and Research (UPPER), Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht University; Utrecht The Netherlands
| | - Daphne Philbert
- Utrecht Pharmacy Practice network for Education and Research (UPPER), Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht University; Utrecht The Netherlands
| | - Marcel L. Bouvy
- Utrecht Pharmacy Practice network for Education and Research (UPPER), Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht University; Utrecht The Netherlands
- SIR Institute for Pharmacy Practice and Policy; Leiden The Netherlands
| |
Collapse
|
145
|
Cypress M. The times they are a-changin'. Diabetes Spectr 2015; 28:141-5. [PMID: 25987814 PMCID: PMC4433081 DOI: 10.2337/diaspect.28.2.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
146
|
Kobayashi LC, Smith SG, O'Conor R, Curtis LM, Park D, von Wagner C, Deary IJ, Wolf MS. The role of cognitive function in the relationship between age and health literacy: a cross-sectional analysis of older adults in Chicago, USA. BMJ Open 2015; 5:e007222. [PMID: 25908675 PMCID: PMC4410118 DOI: 10.1136/bmjopen-2014-007222] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To investigate how 3 measures of health literacy correlate with age and the explanatory roles of fluid and crystallised cognitive abilities in these relationships among older adults. DESIGN Cross-sectional baseline analysis of the 'LitCog' cohort study. SETTING 1 academic internal medicine clinic and 5 federally qualified health centres in Chicago, USA. PARTICIPANTS English-speaking adults (n=828) aged 55-74 years, recruited from August 2008 through October 2011. OUTCOME MEASURES Health literacy was measured by the Test of Functional Health Literacy in Adults (TOFHLA) and the Newest Vital Sign (NVS), both of which assess reading comprehension and numeracy in health contexts, and by the Rapid Estimate of Adult Literacy in Medicine (REALM), which assesses medical vocabulary. Fluid cognitive ability was assessed through the cognitive domains of processing speed, inductive reasoning, and working, prospective and long-term memories, and crystallised cognitive ability through the verbal ability domain. RESULTS TOFHLA and NVS scores were lower at ages 70-74 years compared with all other age groups (p<0.05 for both tests). The inverse association between age and TOFHLA score was attenuated from β=-0.39 (95% CI -0.55 to -0.22) to β=-0.06 (95% CI -0.20 to 0.08) for ages 70-74 vs 55-59 years when fluid cognitive ability was added to the model (85% attenuation). Similar results were seen with NVS scores (68% attenuation). REALM scores did not differ by age group (p=0.971). Crystallised cognitive ability was stable across age groups, and did not influence the relationships between age and TOFHLA or NVS performance. CONCLUSIONS Health literacy skills show differential patterns of age-related change, which may be explained by cognitive ageing. Researchers should select health literacy tests appropriate for their purposes when assessing the health literacy of older adults. Clinicians should be aware of this issue to ensure that health self-management tasks for older patients have appropriate cognitive and literacy demands.
Collapse
Affiliation(s)
- Lindsay C Kobayashi
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London, UK
| | - Samuel G Smith
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London, UK Wolfson Institute of Preventive Medicine, Centre for Cancer Prevention, Queen Mary University of London, London, UK
| | - Rachel O'Conor
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Illinois, USA
| | - Laura M Curtis
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Illinois, USA
| | - Denise Park
- Center for Vital Longevity, The University of Texas at Dallas, Dallas, Texas, USA
| | - Christian von Wagner
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London, UK
| | - Ian J Deary
- Department of Psychology, Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, Edinburgh, UK
| | - Michael S Wolf
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Illinois, USA Department of Learning Sciences, School of Education and Social Policy, Northwestern University, Evanston, Illinois, USA
| |
Collapse
|
147
|
Surgical rehospitalization of the medicare fee-for-service patient: a state-level analysis exploring 30-day readmission factors. Prof Case Manag 2015; 20:130-7; quiz 138-9. [PMID: 25838047 DOI: 10.1097/ncm.0000000000000081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF STUDY Surgical readmissions are a concern to the integrity of the Medicare Trust Fund and gaining attention from policymakers concerned about solvency. This study explores factors associated with variation in surgical readmission rates across the states and provides implications for Medicare Case Management. PRIMARY PRACTICE SETTING(S) Acute inpatient hospital settings. METHODOLOGY AND SAMPLE Fifty state-level data and multivariate regression analysis are used. The dependent variable Surgical Discharge 30-day Readmission Rate is based on the Medicare Fee-For-Service beneficiary population with Medicare Part A and B insurance coverage and age 65 years or older, rehospitalized subsequent to an inpatient surgical procedure, occurring within 30 days of their last discharge. RESULTS Our 2 key explanatory variables-emergency room visit rate and total days of care-are each positively associated with 30-day surgical readmission rate. Age group 65-69 years, native language, physician density, and health care expenditures per capita also influence surgical readmission rate across the states. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Surgical readmission has an association with many different categories of variables-demographic, clinical process, hospital capacity, and patient need. This strongly suggests that Medicare case managers consider the wide range of elements contributing to surgical readmission and take a multifactorial approach to reducing the rehospitalization rate.
Collapse
|
148
|
Agree EM, King AC, Castro CM, Wiley A, Borzekowski DLG. "It's got to be on this page": age and cognitive style in a study of online health information seeking. J Med Internet Res 2015; 17:e79. [PMID: 25831483 PMCID: PMC4389106 DOI: 10.2196/jmir.3352] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 12/29/2014] [Accepted: 01/22/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The extensive availability of online health information offers the public opportunities to become independently informed about their care, but what affects the successful retrieval and understanding of accurate and detailed information? We have limited knowledge about the ways individuals use the Internet and the personal characteristics that affect online health literacy. OBJECTIVE This study examined the extent to which age and cognitive style predicted success in searching for online health information, controlling for differences in education, daily Internet use, and general health literacy. METHODS The Online Health Study (OHS) was conducted at Johns Hopkins School of Public Health and Stanford University School of Medicine from April 2009 to June 2010. The OHS was designed to explore the factors associated with success in obtaining health information across different age groups. A total of 346 men and women aged 35 years and older of diverse racial and ethnic backgrounds participated in the study. Participants were evaluated for success in searching online for answers to health-related tasks/questions on nutrition, cancer, alternative medicine, vaccinations, medical equipment, and genetic testing. RESULTS Cognitive style, in terms of context sensitivity, was associated with less success in obtaining online health information, with tasks involving visual judgment most affected. In addition, better health literacy was positively associated with overall success in online health seeking, specifically for tasks requiring prior health knowledge. The oldest searchers were disadvantaged even after controlling for education, Internet use, general health literacy, and cognitive style, especially when spatial tasks such as mapping were involved. CONCLUSIONS The increasing availability of online health information provides opportunities to improve patient education and knowledge, but effective use of these resources depends on online health literacy. Greater support for those who are in the oldest cohorts and for design of interfaces that support users with different cognitive styles may be required in an age of shared medical decision making.
Collapse
Affiliation(s)
- Emily M Agree
- Johns Hopkins University, Departments of Sociology and Population, Family, and Reproductive Health, Baltimore, MD, United States.
| | | | | | | | | |
Collapse
|
149
|
Zeballos-Palacios C, Quispe R, Mongilardi N, Diaz-Arocutipa C, Mendez-Davalos C, Lizarraga N, Paz A, Montori VM, Malaga G. Shared decision making in senior medical students: results from a national survey. Med Decis Making 2015; 35:533-8. [PMID: 25732722 DOI: 10.1177/0272989x15573746] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 01/20/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE To explore perceptions and experiences of Peruvian medical students about observed, preferred, and feasible decision-making approaches. METHODS We surveyed senior medical students from 19 teaching hospitals in 4 major cities in Peru. The self-administered questionnaire collected demographic information, current approach, exposure to role models for and training in shared decision making, and perceptions of the pertinence and feasibility of the different decision-making approaches in general as well as in challenging scenarios. RESULTS A total of 327 senior medical students (51% female) were included. The mean age was 25 years. Among all respondents, 2% reported receiving both theoretical and practical training in shared decision making. While 46% of students identified their current decision-making approach as clinician-as-perfect-agent, 50% of students identified their teachers with the paternalistic approach. Remarkably, 53% of students thought shared decision making should be the preferred approach and 50% considered it feasible in Peru. Among the 10 challenging scenarios, shared decision making reached a plurality (40%) in only one scenario (terminally ill patients). CONCLUSION Despite limited exposure and training, Peruvian medical students aspire to practice shared decision making but their current attitude reflects the less participatory approaches they see role modeled by their teachers.
Collapse
Affiliation(s)
- Claudia Zeballos-Palacios
- CONEVID-Universidad Peruana Cayetano Heredia, Lima, Peru (CZP, NM, RQ, VMM, GM),Knowledge and Evaluation Research Unit at Mayo Clinic, Rochester, MN (CZP, VMM)
| | - Renato Quispe
- CONEVID-Universidad Peruana Cayetano Heredia, Lima, Peru (CZP, NM, RQ, VMM, GM),CRONICAS Center of Excellence in Chronic Diseases-Universidad Peruana Cayetano Heredia, Lima, Peru (RQ)
| | - Nicole Mongilardi
- CONEVID-Universidad Peruana Cayetano Heredia, Lima, Peru (CZP, NM, RQ, VMM, GM)
| | | | | | | | - Aldo Paz
- Universidad Privada Antenor Orrego, Piura, Peru (AP)
| | - Victor M Montori
- CONEVID-Universidad Peruana Cayetano Heredia, Lima, Peru (CZP, NM, RQ, VMM, GM),Knowledge and Evaluation Research Unit at Mayo Clinic, Rochester, MN (CZP, VMM)
| | - German Malaga
- CONEVID-Universidad Peruana Cayetano Heredia, Lima, Peru (CZP, NM, RQ, VMM, GM)
| |
Collapse
|
150
|
Brigo F, Otte WM, Igwe SC, Tezzon F, Nardone R. Clearly written, easily comprehended? The readability of websites providing information on epilepsy. Epilepsy Behav 2015; 44:35-9. [PMID: 25601720 DOI: 10.1016/j.yebeh.2014.12.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 12/17/2014] [Accepted: 12/18/2014] [Indexed: 11/19/2022]
Abstract
There is a general need for high-quality, easily accessible, and comprehensive health-care information on epilepsy to better inform the general population about this highly stigmatized neurological disorder. The aim of this study was to evaluate the health literacy level of eight popular English-written websites that provide information on epilepsy in quantitative terms of readability. Educational epilepsy material on these websites, including 41 Wikipedia articles, were analyzed for their overall level of readability and the corresponding academic grade level needed to comprehend the published texts on the first reading. The Flesch Reading Ease (FRE) was used to assess ease of comprehension while the Gunning Fog Index, Coleman-Liau Index, Flesch-Kincaid Grade Level, Automated Readability Index, and Simple Measure of Gobbledygook scales estimated the corresponding academic grade level needed for comprehension. The average readability of websites yielded results indicative of a difficult-to-fairly-difficult readability level (FRE results: 44.0±8.2), with text readability corresponding to an 11th academic grade level (11.3±1.9). The average FRE score of the Wikipedia articles was indicative of a difficult readability level (25.6±9.5), with the other readability scales yielding results corresponding to a 14th grade level (14.3±1.7). Popular websites providing information on epilepsy, including Wikipedia, often demonstrate a low level of readability. This can be ameliorated by increasing access to clear and concise online information on epilepsy and health in general. Short "basic" summaries targeted to patients and nonmedical users should be added to articles published in specialist websites and Wikipedia to ease readability.
Collapse
Affiliation(s)
- Francesco Brigo
- Department of Neurological and Movement Sciences, Section of Clinical Neurology, University of Verona, Italy; Department of Neurology, Franz Tappeiner Hospital, Merano, Italy.
| | - Willem M Otte
- Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands; Biomedical MR Imaging and Spectroscopy Group, Image Sciences Institute, University Medical Center Utrecht, The Netherlands
| | - Stanley C Igwe
- Department of Neuro-Psychiatry, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Frediano Tezzon
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - Raffaele Nardone
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| |
Collapse
|