Self-Management Skills in Chronic Disease Management: What Role Does Health Literacy Have?

An Integrated Framework to Conceptualize and Develop the Vancouver Airways Health Literacy Tool (VAHLT)

There is currently no comprehensive tool to assess the functional health literacy (HL) skills of chronic airway disease (CAD) patients. The purpose of this article is to describe the development of a new HL measure, the Vancouver Airways Health Literacy Tool (VAHLT). The tool was developed through the following phases: (1) Tool conceptualization, consisting of: (A) a systematic review (SR), (B) focus group sessions with CAD patients to understand barriers and facilitators to CAD management, (C) a survey with key-informants to obtain strategies to mitigate self-management barriers and validate patient-derived topics, and (D) respiratory physicians' review of the topics; (2) Scenario and item development; and (3) Tool testing and content validation. The SR identified the lack of a valid HL measurement tool for CAD patients. Patients provided an initial shortlist of disease-related self-care topics. Key-informants helped to finalize topics for inclusion. Respiratory physicians and patients contributed to the development of a scenario-based questionnaire, which was refined during three rounds of testing to develop a 44-item instrument comprising nine self-management passages. We highlight the holistic process of integrating information from the literature with knowledge gained from key stakeholders into our tool framework. Our approach to stakeholder engagement may be of interest to researchers developing similar tools, and could facilitate the development and testing of HL-based interventions to ultimately improve patient outcomes and reduce the burden on the healthcare system.

Predictors of dementia knowledge in a rural general public sample

OBJECTIVES

To investigate dementia knowledge within a rural Australian general public cohort and understand demographic predictors of knowledge in this population.

DESIGN

A cross-sectional study comprising quantitative surveys.

SETTING

321 participants were recruited from the Tasmanian general public (February-September 2017).

PARTICIPANTS

28% of participants were from remote or outer regional postcodes; the remainder were from inner regional areas. The median age was 46 years; 35% were male. 30% had participated in prior dementia education, 29% had worked with people living with dementia, and 23% had no identified personal experience of people living with dementia.

INTERVENTIONS

No interventions were conducted as part of this study.

MAIN OUTCOME MEASURES

Dementia knowledge was assessed using the Dementia Knowledge Assessment Scale. Demographic variables were also collected.

RESULTS

Mean dementia knowledge was moderate and participants scored highest on the care considerations subscale. Those with personal experience with a person living with dementia scored significantly higher on all subscales, and overall, than those without. Dementia education, general education, and previous work, care or close relationship with people living with dementia were all significant predictors in a regression model explaining nearly a third of the variance in overall dementia knowledge.

CONCLUSION

While personal experience of dementia improves knowledge of the condition, dementia education is the most important predictor. Deficits identified in knowledge of risk factors, and incomplete knowledge about aspects important to quality care, suggest a need for further education for the general public, particularly in the light of the rising prevalence of dementia in ageing rural populations.

Impact of Physicians' Competence and Warmth on Chronic Patients' Intention to Use Online Health Communities

In China, medical resources are unevenly distributed, and hospitals are very congested. Online health communities (OHCs) provide a new way for patients to communicate and obtain health-related information, thereby alleviating the pressure of treatment in hospitals. However, little is known about how to increase individuals’ use intention for OHCs from the perspective of physicians. This study aims to investigate the impact of physicians’ competence and warmth on chronic patients’ intention to use physician-centered OHCs based on the technology acceptance model. A formal investigation was anonymously conducted through a web-based questionnaire survey addressed to participants, and 710 valid responses were received. A research model was constructed and the hypotheses were tested by structural equation modeling. The findings suggest that competence and warmth positively affect chronic patients’ behavioral intention to use (BIU) OHCs through the mediation of perceived usefulness (PU) and perceived ease of use (PEOU). All hypotheses were supported at the 0.05 significant level. Compared with competence, warmth has a slightly stronger impact on PU and PEOU. PEOU has a stronger impact on chronic patients’ BIU OHCs than PU. This study provides a comprehensive understanding of the impacts of physicians’ characteristics in physician-driven OHCs. Compared with competence, physicians’ warmth should be paid more attention to motivate more chronic patients to use OHCs. Enhancing physicians’ warmth and the ease of use are the preferred ways to improve chronic patients’ intention to use OHCs.

Conceptualizing Usability for the eHealth Context: Content Analysis of Usability Problems of eHealth Applications

BACKGROUND

Usability tests can be either formative (where the aim is to detect usability problems) or summative (where the aim is to benchmark usability). There are ample formative methods that consider user characteristics and contexts (ie, cognitive walkthroughs, interviews, and verbal protocols). This is especially valuable for eHealth applications, as health conditions can influence user-system interactions. However, most summative usability tests do not consider eHealth-specific factors that could potentially affect the usability of a system. One of the reasons for this is the lack of fine-grained frameworks or models of usability factors that are unique to the eHealth domain.

OBJECTIVE

In this study, we aim to develop an ontology of usability problems, specifically for eHealth applications, with patients as primary end users.

METHODS

We analyzed 8 data sets containing the results of 8 formative usability tests for eHealth applications. These data sets contained 400 usability problems that could be used for analysis. Both inductive and deductive coding were used to create an ontology from 6 data sets, and 2 data sets were used to validate the framework by assessing the intercoder agreement.

RESULTS

We identified 8 main categories of usability factors, including basic system performance, task-technology fit, accessibility, interface design, navigation and structure, information and terminology, guidance and support, and satisfaction. These 8 categories contained a total of 21 factors: 14 general usability factors and 7 eHealth-specific factors. Cohen κ was calculated for 2 data sets on both the category and factor levels, and all Cohen κ values were between 0.62 and 0.67, which is acceptable. Descriptive analysis revealed that approximately 69.5% (278/400) of the usability problems can be considered as general usability factors and 30.5% (122/400) as eHealth-specific usability factors.

CONCLUSIONS

Our ontology provides a detailed overview of the usability factors for eHealth applications. Current usability benchmarking instruments include only a subset of the factors that emerged from our study and are therefore not fully suited for summative evaluations of eHealth applications. Our findings support the development of new usability benchmarking tools for the eHealth domain.

The effect of high blood pressure-health literacy, self-management behavior, self-efficacy and social support on the health-related quality of life of Kazakh hypertension patients in a low-income rural area of China: a structural equation model

Background

Health-Related Quality of Life (HRQoL) of hypertensive patients is not only affected by the disease itself but also by some subjective factors. Low health literacy is prevalent among ethnic minorities. Considering the Kazakh-Chinese people have the highest prevalence of hypertension in Xinjiang, and the High Blood Pressure-Health Literacy (HBP-HL) has not been included in the study of HRQoL. The synergistic effects and the potential mechanism HBP-HL, self-management behavior, therapeutic adherence, self-efficacy, social support on HRQoL remain unclear. This study aimed to introduce the HBP-HL, and develop a structural equation model (SEM) to identify the factors influencing of the HRQoL among Kazakh hypertensive patients.

Methods

The data was obtained by questionnaire survey and physical examination in 2015. Patients with hypertension were recruited through random cluster sampling in Kazakh settlements in Xinjiang. Firstly, the blood pressure was measured. Then the one-for-one household interviews were conducted by Kazakh investigators. The questionnaires regarding HBP-HL, HRQoL, self-management behavior, therapeutic adherence, self-efficacy, and social support were used to collect data. Finally, SEM was constructed, and p ≤ 0.05 was taken as significant.

Results

The data was analysed by SPSS18.0 and AMOS18.0 software. 516 Kazakh hypertension patients were recruited, and 94.4% of them had a relatively low HBP-HL score. The mean standardized scores of HRQoL, self-management, therapeutic adherence were poor; they were 63.5, 66.2, and 64.4, respectively. But 96.1% and 98.3% of the participants had high levels of self-efficacy and social support. The SEM of the HRQoL had a good overall fit (χ²/df = 2.078, AGFI = 0.944, GFI = 0.968, CFI = 0.947, IFI = 0.949, RMSEA = 0.046). The model indicated that the HBP-HL has the highest correlation with HRQoL, following with self-management behavior, social support, and self-efficacy.

Conclusions

Low HBP-HL is a major influenced factor of HRQoL among Kazakh hypertensive patients. Future programs should consider HBP-HL as the breakthrough point when designing targeting intervention strategies.

Heterogeneity in Vison, Hand Function, Cognition, and Health Literacy Among Older Veterans: Impacts, Outcomes, and Clinical Recommendations for First-Time Hearing Aid Users

BACKGROUND

 Age-related changes (both normal and pathological), and health literacy are relevant to audiological practice. Changes associated with the musculoskeletal, vascular, and nervous systems drive manual, visual, and cognitive function. These in turn affect the capabilities required for effective hearing aid (HA) skill acquisition, use, and management. Meanwhile, health literacy influences the ability to gain access to, understand, and use information, which is important for promoting and maintaining HA use and management. Understanding the interindividual variability of these variables can help audiologists characterize those individuals who might have suboptimal HA outcomes. This knowledge can then inform better clinical practices and guide implementation of processes to improve care quality and outcomes.

PURPOSE

 The aim of the study is to assess the variation in manual, visual, and cognitive function, and health literacy, among community-dwelling older individuals, and to determine whether and which of these variables are associated with reported HA outcome and/or the knowledge and skill to manage HAs.

RESEARCH DESIGN

 Data presented here were collected as part of an efficacy trial of four variants of HA orientation. The data were collected at baseline (prior to HA fitting) and after 4 to 8 weeks of HA use.

STUDY SAMPLE

 The study sample consists of 265 U.S. Veterans aged 51 to 87 years with no previous HA experience who were scheduled to receive their first pair of HAs from the Veterans Administration.

DATA COLLECTION AND ANALYSIS

 We assessed baseline measures of hand function, vision, cognition, and health literacy just prior to participants receiving their first pair of HAs. HA management skills and knowledge, and HA outcome were measured after 4 to 8 weeks of HA use using the Hearing Aid Skills and Knowledge (HASK) and International Outcomes Inventory for Hearing Aids (IOI-HA), respectively. Data collected here was compared with published norms to assess variation in baseline measures. Associations between baseline performance and outcomes data were examined using t-tests comparing participants who performed at or above age-based norms with those who performed below age-based norms.

RESULTS

 Participants' performance on the baseline measures was highly variable, with the proportions of individuals performing below norms varying by test measure. When combining data across the nine baseline measures, approximately 10% of participants performed below published norms on five or more measures, and 85% performed below norms on at least one measure. Poor manual dexterity, ability to learn a new task, and ability to draw inferences from spoken information negatively impacted HA management and outcome.

CONCLUSION

 There was a considerable heterogeneity among a community-dwelling sample of first time HA users in terms of sensory, cognitive, and motor function. Clinicians should consider modifying their clinical practice to account for such heterogeneity and best support their patients in adapting to new HAs.

Low Health Literacy is Associated with the Onset of CKD during the Life Course

BACKGROUND

Health literacy, the ability to deal with information related to one's health, is a predictor of health outcomes in CKD. However, research has not explored whether low health literacy predicts the onset of CKD.

METHODS

We used data from participants of Lifelines, a prospective population-based cohort study of individuals living in The Netherlands, to assess the share of individuals with low health literacy by eGFR category, whether low health literacy is associated with CKD onset in the general population and in the subgroup of older adults, and whether established CKD risk factors mediate this association.

RESULTS

In the total sample of 93,885 adults (mean follow-up 3.9 years), low health literacy was more likely among individuals in worse eGFR categories, increasing from 26.4% in eGFR category 1 to 50.0% in category 5 (P=0.02). Low health literacy, compared with adequate health literacy, was associated with the onset of CKD in the total sample (3.0% versus 2.1%) and in the subgroup of older adults (13.4% versus 11.3%), with odds ratios (ORs) of 1.44 (95% confidence interval (95% CI), 1.31 to 1.59) and 1.21 (95% CI, 1.04 to 1.41), respectively. After adjustment for sex, age, education, and income, health literacy was associated with CKD onset only in older adults (OR, 1.25; 95% CI, 1.04 to 1.50). This association was mediated by hypertension and high body mass index (BMI) in the crude model, but only by BMI after adjustment (with BMI explaining 18.8% of the association).

CONCLUSIONS

Low health literacy is a risk factor for CKD onset among older adults, which suggests that CKD prevention might benefit from strategies to address low health literacy.

Influence of Parental Health Literacy on Change over Time in the Oral Health of American Indian Children

In cross-sectional studies, parental health literacy (HL) is associated with children’s oral health. It is unclear, however, whether HL influences pediatric outcomes. We examined the relationship of HL with change over time in parental oral health knowledge, beliefs, and behaviors, as well as pediatric oral health outcomes. We used longitudinal data from a study designed to reduce dental decay in American Indian children (N = 579). At baseline and annually for three years, parents answered questions assessing HL; oral health knowledge, beliefs, and behaviors; and pediatric oral health status. The number of decayed, missing, and filled tooth surfaces (dmfs) was computed based on annual dental evaluations. Linear mixed models showed that HL was significantly associated with all constructs, except dmfs, at their reference time points and persistently across the three-year study period. HL predicted change over time in only one variable, parents’ belief that children’s oral health is determined by chance or luck. HL is strongly associated with oral health knowledge, beliefs, behaviors, and status prospectively but is not a key driver of change over time in these oral health constructs.

Do Uncontrolled Hypertension, Diabetes, Dyslipidemia, and Obesity Mediate the Relationship Between Health Literacy and Chronic Kidney Disease Complications?

Health literacy is the ability to deal with information related to one’s health. Patients with low health literacy and chronic diseases, such as chronic kidney disease (CKD), have poor disease-management skills, which could lead to complications. We used logistic regressions and structural equational modeling to assess whether low health literacy is associated with the development of cardiovascular disease and mortality in patients with CKD, and whether this association is mediated by the presence of uncontrolled hypertension, diabetes, dyslipidemia, obesity, or albuminuria. Data from 2742 adult participants with CKD from the Lifelines study were analyzed at baseline and after approximately four years. Low health literacy was associated with cardiovascular disease and mortality in the crude models, with OR and 95%CI of 1.93 (1.46 to 2.55) and 1.59 (1.08 to 2.36), respectively. After adjustment for age and sex, low health literacy was only associated with cardiovascular disease (OR 1.76 (1.31 to 2.23)). This association was mediated by uncontrolled diabetes (27.1%) and obesity (8.0%). Low health literacy is associated with the development of cardiovascular disease after adjustment for age and sex, and this association is mediated by uncontrolled diabetes and obesity.

Factors associated with self-management practices and self-efficacy among adults with cancer under treatment in Saudi Arabia

AIMS AND OBJECTIVES

To discover the current state of self-management practices and levels of self-efficacy among adults with cancer under treatment in Jeddah City, Saudi Arabia, and to identify their associated factors.

BACKGROUND

The prevalence of cancer and cancer treatment-related problems is increasing in Saudi Arabia. However, effective cancer care programmes are not provided in this country.

DESIGN

Cross-sectional correlational study.

METHODS

This study was conducted with a convenience sample of 130 adults with cancer under treatment from May 2020-August 2020 at the largest tertiary care hospital providing cancer care in the western region, Saudi Arabia. The study methods were compliant with the STROBE checklist. Data were collected by Self-Care Inventory, Strategies Used by People to Promote Health, and sociodemographic and clinical surveys. Descriptive statistics and stepwise linear regression analysis were performed.

RESULTS

The total score for self-management practices was 84.38 (SD = 13.66) and self-efficacy, as a strong associated factor of self-management, earned a total score of 104.24 (SD = 15.87). Stepwise regression analysis identified self-efficacy, age and education level as important associated variables, explaining 57.6% of the total variance in self-management practices. Significant effects of age, gender, marital status and duration of cancer on patients' self-efficacy were also found.

CONCLUSIONS

The levels of self-management practices and self-efficacy to manage cancer treatment-related problems demonstrated by patients with cancer in this study were rated as a medium. Self-efficacy, age and education level were the significant factors associated with self-management practices of patients in Saudi Arabia. Age, gender, marital status and duration of cancer were identified as associated factors of self-efficacy.

RELEVANCE TO CLINICAL PRACTICE

Enhancing patient's adherence to self-management practices and increase patient's self-efficacy through adopting educational intervention programmes, considering patient's sociodemographic and disease-related characteristics, and continuous patient education must be taken into consideration in the cancer management plan.

Health-Related Quality of Life and Psychological Features in Post-Stroke Patients with Chronic Pain: A Cross-Sectional Study in the Neuro-Rehabilitation Context of Care

This study aims at exploring disability, health-related quality of life (HrQoL), psychological distress, and psychological features in post-stroke patients with chronic pain. An observational cross-sectional study involving 50 post-stroke patients (25 with chronic pain and 25 without pain) was conducted. The primary outcome was the self-reported level of disability and HrQoL which were both assessed through the Stroke Impact Scale 3.0. Both psychological distress and specific psychological features (i.e., self-efficacy, coping strategies, psychological flexibility, perceived social support) were examined. Post-stroke patients with chronic pain reported statistically significant higher levels of disability and worse HrQoL, higher psychological distress and inflexibility, as well as a lower level of self-efficacy and problem-oriented coping strategies than patients without pain (p < 0.001). Finally, correlation analysis in the group of stroke survivors with pain showed that higher levels of disability were significantly related to higher psychological distress. This study confirms the negative influence of chronic pain on disability and HrQoL in post-stroke patients and presents preliminary insights on the association between chronic pain, disability, HrQoL, psychosocial distress, and the patient’s approach in dealing with personal difficulties and emotions. These findings carry further implications for multidisciplinary management of post-stroke patients with chronic pain.

Estimating the Economic Burden of Low Health Literacy in the Blacktown Community in Sydney, Australia: A Population-Based Study

Evidence shows that inadequate or low health literacy (LHL) levels are significantly associated with economic ramifications at the individual, employer, and health care system levels. Therefore, this study aims to estimate the economic burden of LHL among a culturally and linguistically diverse (CALD) community in Blacktown: a local government area (LGA) in Sydney, Australia. This study is a secondary analysis of cross-sectional data from publicly available datasets, including 2011 and 2016 census data and National Health Survey (NHS) data (2017–2018) from the Australian Bureau of Statistics (ABS), and figures on Disease Expenditure in Australia for 2015–2016 provided by the Australian Institute of Health and Welfare (AIHW). This study found that 20% of Blacktown residents reported low levels of active engagement with health care providers (Domain 6 of the Health Literacy Questionnaire (HLQ)), with 14% reporting a limited understanding of the health information required to take action towards improving health or making health care decisions (Domain 9 of the HLQ). The overall extra/delta cost (direct and indirect health care costs) associated with LHL in the Blacktown LGA was estimated to be between $11,785,528 and $15,432,239 in 2020. This is projected to increase to between $18,922,844 and $24,191,911 in 2030. Additionally, the extra disability-adjusted life year (DALY) value in 2020, for all chronic diseases and age-groups—comprising the extra costs incurred due to years of life lost (YLL) and years lived with disability (YLD)—was estimated at $414,231,335. The findings of our study may enable policymakers to have a deeper understanding of the economic burden of LHL in terms of its impact on the health care system and the production economy.

Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study

BACKGROUND

Successful management of chronic diseases requires a trustful collaboration between health care professionals, patients, and family members. Scalable conversational agents, designed to assist health care professionals, may play a significant role in supporting this collaboration in a scalable way by reaching out to the everyday lives of patients and their family members. However, to date, it remains unclear whether conversational agents, in such a role, would be accepted and whether they can support this multistakeholder collaboration.

OBJECTIVE

With asthma in children representing a relevant target of chronic disease management, this study had the following objectives: (1) to describe the design of MAX, a conversational agent-delivered asthma intervention that supports health care professionals targeting child-parent teams in their everyday lives; and (2) to assess the (a) reach of MAX, (b) conversational agent-patient working alliance, (c) acceptance of MAX, (d) intervention completion rate, (e) cognitive and behavioral outcomes, and (f) human effort and responsiveness of health care professionals in primary and secondary care settings.

METHODS

MAX was designed to increase cognitive skills (ie, knowledge about asthma) and behavioral skills (ie, inhalation technique) in 10-15-year-olds with asthma, and enables support by a health professional and a family member. To this end, three design goals guided the development: (1) to build a conversational agent-patient working alliance; (2) to offer hybrid (human- and conversational agent-supported) ubiquitous coaching; and (3) to provide an intervention with high experiential value. An interdisciplinary team of computer scientists, asthma experts, and young patients with their parents developed the intervention collaboratively. The conversational agent communicates with health care professionals via email, with patients via a mobile chat app, and with a family member via SMS text messaging. A single-arm feasibility study in primary and secondary care settings was performed to assess MAX.

RESULTS

Results indicated an overall positive evaluation of MAX with respect to its reach (49.5%, 49/99 of recruited and eligible patient-family member teams participated), a strong patient-conversational agent working alliance, and high acceptance by all relevant stakeholders. Moreover, MAX led to improved cognitive and behavioral skills and an intervention completion rate of 75.5%. Family members supported the patients in 269 out of 275 (97.8%) coaching sessions. Most of the conversational turns (99.5%) were conducted between patients and the conversational agent as opposed to between patients and health care professionals, thus indicating the scalability of MAX. In addition, it took health care professionals less than 4 minutes to assess the inhalation technique and 3 days to deliver related feedback to the patients. Several suggestions for improvement were made.

CONCLUSIONS

This study provides the first evidence that conversational agents, designed as mediating social actors involving health care professionals, patients, and family members, are not only accepted in such a "team player" role but also show potential to improve health-relevant outcomes in chronic disease management.

Feasibility and acceptability of using information visualizations to improve HIV-related communication in a limited-resource setting: a short report

Infographics (visualizations that present information) can assist clinicians to offer health information to patients with low health literacy in an accessible format. In response, we developed an infographic intervention to enhance clinical, HIV-related communication. This study reports on its feasibility and acceptability at a clinical setting in the Dominican Republic. We conducted in-depth interviews with physicians who administered the intervention and patients who received it. We conducted audio-recorded interviews in Spanish using semi-structured interview guides. Recordings were professionally transcribed verbatim then analyzed using descriptive content analysis. Physician transcripts were deductively coded according to constructs of Bowen et al.'s feasibility framework and patient transcripts were inductively coded. Three physicians and 26 patients participated. Feasibility constructs endorsed by physicians indicated that infographics were easy to use, improved teaching, and could easily be incorporated into their workflow. Coding of patient transcripts identified four categories that indicated the intervention was acceptable and useful, offered feedback regarding effective clinical communication, and recommended improvements to infographics. Taken together, these data indicate our intervention was a feasible and acceptable way to provide clinical, HIV-related information and provide important recommendations for future visualization design as well as effective clinical communication with similar patient populations.

Building a House of Skills-A Study of Functional Health Literacy and Numeracy among Patients with Type 2 Diabetes in Hungary

The purpose of this study is to explore functional health literacy (FHL) and numeracy skills in an insulin-treated, type 2 diabetes mellitus (T2DM) patient population, and their impact on diabetes self-care activities. A non-experimental, cross-sectional quantitative design was used for this study. The sample consisted of 102 T2DM patients on insulin therapy, including 42 males and 60 females, with a mean age of 64.75 years (SD = 9.180) and an average diabetes duration of 10.76 years (SD = 6.702). Independent variables were sociodemographic variables (e.g., age, educational level, etc.) and diabetes and health-related factors (e.g., duration of diabetes (years), the frequency of blood glucose testing/day, etc.). For this study, the participants completed the reading comprehension exercise from the Short Test of Functional Health Literacy (S-TOFHLA) and the Shortened Version of the Diabetes Numeracy Test (DNT-15), which specifically evaluates the numeracy skills of patients living with diabetes. The associations between the variables were examined with Spearman’s rank correlation. Multivariate regression analysis was performed to examine whether measured FHL skills impact diabetes self-care activities. We found that DNT-15 test (β = 0.174, t(96) = 2.412, p < 0.018) had significant effect on the frequency of blood glucose testing/day. Moreover, the problem areas for patients with T2DM mostly included multi-step calculations according to food label interpretations, and adequate insulin dosage based on current blood glucose levels and carbohydrate intake. The results of regression analyses and Spearman’s rank correlation indicated that limited FHL and diabetes numeracy skills not only influenced the participants’ behaviors related to self-management, but they also affected their health outcomes. Thus, besides the personalization of insulin treatment, it is indispensable to provide more precise information on different types of insulin administration and more refined educational materials based on medical nutrition therapy.

Association of health checkups with health-related quality of life among public servants: a nationwide survey in Taiwan

BACKGROUND

Preventive health checkups have gained in importance over the last decade. The association of health checkups and the number of diseases with health-related quality of life (HRQoL), including physical and mental health, remains unclear. We sought to investigate the aforementioned association among Taiwanese public servants.

METHODS

A cross-sectional survey was conducted using randomized and multistage stratified cluster sampling based on proportional probabilistic sampling. The questionnaires addressed demographics, job characteristics, health behaviors, health status, 3 types of health checkups during the preceding 3 years (government-paid health checkup [GPHC], self-paid health checkup [SPHC], and no health checkup [NOHC]), and physical component summary (PCS) and mental component summary (MCS) scores of the Short-Form Health Survey. In total 11,454 middle-aged public servants were analyzed. A multivariate general linear model (GLM) was used to estimate PCS and MCS scores by using least square means.

RESULTS

Health checkup types were associated with a significant difference in PCS scores among the public servants. Scores of PCS and MCS were both significantly higher in the GPHC group than in the NOHC group for those with no chronic diseases (51.20 vs. 50.66 [P = 0.008] and 46.23 vs. 45.58 [P = 0.02], respectively). Compared with the NOHC group, both scores of GPHC and SPHC groups were significantly associated with higher PCS scores for public servants with ≥ 2 chronic diseases (46.93 vs. 45.13 [P = 0.002] and 46.52 vs. 45.13 [P = 0.009], respectively).

CONCLUSION

In Taiwan, public servants undergoing GPHCs are more likely to report higher PCS scores than are those undergoing SPHCs. It is crucial that encourage periodically using the health checkup to improve health status and HRQoL.

Reaching adulthood with Hirschsprung's disease: Patient experiences and recommendations for transitional care

BACKGROUND/PURPOSE

The need for transitional care has gained increased focus in the treatment of patients with congenital colorectal disorders. We aimed to acquire in-depth knowledge about the experiences of adult patients with Hirschsprung's disease (HD) and their suggestions for transitional care.

METHODS

Binational study applying gender equal focus group interviews (FGI).

RESULTS

Seventeen (9 men) of 52 invited patients with median age 29 (19-43) years participated. Three themes evolved from the FGI. "Scarred body and soul" describes the somatic and psychosocial challenges the patients experienced and "limited health literacy on HD" refers to the patients' lack of HD knowledge. "Absent transition" depicts missing transitional care and the patients' inability to find adult HD specialists. The adult HD patients strongly recommended transitional care from early teens with focus on information about HD and establishment of a peer-to-peer program. They also emphasized the possibility of being referred to a pelvic floor center.

CONCLUSIONS

HD negatively influences patients' somatic and psychosocial health in childhood, adolescence and adulthood. Adult HD patients strongly recommend transitional care from early teens and the possibility for referral to a center working with pelvic floor dysfunctions.

LEVEL OF EVIDENCE

IV TYPE OF RESEARCH: Clinical.

Health literacy and diabetes self-care in individuals with type 2 diabetes in Turkey

AIM

The aim of this study was to examine the relationship between health literacy and diabetes self-care in individuals with type 2 diabetes.

METHODS

This cross-sectional study was conducted with 207 individuals with Type 2 diabetes at a diabetes outpatient clinic of a foundation university hospital in Istanbul, Turkey. The data were collected using a sociodemographic and illness characteristics questionnaire, the Turkish version of the European Health Literacy Survey Questionnaire (HLS-EU-Q-TR), and the Diabetes Self-Care Scale (DSCS). Data were analyzed using descriptive statistics, one-way ANOVA, Student's t-test, Pearson correlation test, and multiple regression analysis.

RESULTS

It was found that 81.5% of individuals with type 2 diabetes were at an inadequate or limited and problematic level of health literacy. The DSCS mean scores of patients with an inadequate health literacy level were significantly lower than that of patients at other levels of health literacy. It was determined that education level, exercise status, and HLS-EU-Q-TR scores were significantly related to diabetes self-care (R² = 0.245, p < 0.001).

CONCLUSION

The study found that individuals with type 2 diabetes had higher diabetes self-care if they had a high education level, regularly exercised, or had high HLS-EU-Q-TR mean scores.

A conceptual model of functional health literacy to improve chronic airway disease outcomes

Background

Current conceptual models of health literacy (HL) illustrate the link between HL and health outcomes. However, these models fail to recognize and integrate certain elements of disease management, health system factors, and socio-demographic factors into their framework. This article outlines the development of Chronic Airway Disease (CAD) Management and Health Literacy (CADMaHL) conceptual model that integrates the aforementioned elements and factors into a single framework.

Methods

Information obtained during the following stages informed the development of our model: (1) a systematic review of existing CAD HL measurement tools that apply core HL domains; (2) patient-oriented focus group sessions to understand HL barriers to CAD self-management practices; (3) key-informant interviews to obtain potential strategies to mitigate CAD management barriers, and validate disease self-management topics; (4) elicited the perspectives of Canadian respirologist’s on the ideal functional HL skills for asthma and COPD patients.

Results

Throughout the study process many stakeholders (i.e., patients, key-informants, and an international HL advisory panel) contributed to and reviewed the model. The process enabled us to organize the CADMaHL model into 6 primary modules, including: INPUT, consisting of four HL core components (access, understand, communicate, evaluate,) and numeracy skills; OUTPUT, including application of the obtained information; OUTCOME, covering patient empowerment in performing self-management practices by applying HL skills; ASSESSMENT, consisting of information about functionality and relevancy of CADMaHL; IMPACT, including mediators between HL and health outcomes; CROSSCUTTING FACTORS, consisting of diverse socio-demographics and health-system factors with applicability across the HL domains.

Conclusions

We developed the CADMaHL model, with input from key-stakeholders, which addresses a knowledge gap by integrating various disease management, health-system and socio-demographic factors absent from previous published frameworks. We anticipate that our model will serve as the backbone for the development of a comprehensive HL measurement tool, which may be utilized for future HL interventions for CAD patients.

Trial registration

NCT01474928- Date of registration: 11/26/2017.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10313-x.

A psychometric evaluation of the Health Literacy Questionnaire for Chinese immigrants: Linguistic and cultural considerations

OBJECTIVE

Health literacy is an important predictor of health outcomes. The Health Literacy Questionnaire has been widely adopted to measure health literacy and has been translated into multiple languages including Chinese. This study aims to evaluate the psychometric properties of the simplified Chinese Health Literacy Questionnaire.

METHODS

Data were obtained from a sample of 362 Chinese immigrants from Chinese community organizations in New South Wales, Australia. Statistical analyses include descriptive and exploratory factor analyses.

RESULTS

A seven-factor solution was derived from 39 of the original 44 items, all with acceptable to excellent internal consistency but differing from the original construction. The health literacy subscale scores were negatively associated with age and with age at immigration, but positively associated with duration of stay (years) in Australia, better English proficiency and current employment. Differing interpretations of the questions based on Chinese culture could possibly explain the variations between the two versions.

CONCLUSION

The simplified Chinese Health Literacy Questionnaire measures some central concepts of health literacy well. However, the questionnaire may require further development, especially in linguistic and cultural aspects.

Health literacy impacts self-management, quality of life and fear of recurrence in head and neck cancer survivors

PURPOSE

Little is known about whether health literacy is associated with affects certain key outcomes in head and neck cancer (HNC) survivors. We investigated (i) the socio-demographic and clinical profile of health literacy and (ii) associations among between health literacy and self-management behaviours, health-related quality of life (HRQL) and fear of recurrence (FoR) in HNC survivors.

METHODS

A population-based survey was conducted in Ireland. Health literacy was assessed using a validated single-item question. Socio-demographic, clinical and psychosocial outcome variables (FoR, self-management behaviours, HRQL) were collected. Multivariable linear regression was performed to estimate associations between health literacy and each psychosocial outcome.

RESULTS

Three hundred ninety-five (50%) individuals responded to the survey. Inadequate health literacy was evident among 47% of the sample. In adjusted models, HNC survivors with inadequate health literacy had significantly lower levels of self-management behaviours in the domains of health-directed behaviour, positive and active engagement in life, self-monitoring and insight, constructive attitudes and approaches and skills and technique acquisition. Inadequate health literacy was independently associated with lower functional well-being and HNC disease-specific HRQL. FoR was also significantly higher among those with inadequate health literacy.

CONCLUSIONS

HNC survivors with inadequate health literacy have lower levels of self-management behaviours, lower functional HRQL and increased FoR compared to those with adequate health literacy.

IMPLICATIONS FOR CANCER SURVIVORS

Clinicians, healthcare providers and those developing interventions should consider how inadequate health literacy among HNC survivors might affect post-treatment outcomes when developing services and providing support for this group.

Using the Brief Health Literacy Screen in Chronic Care in French Hospital Settings: Content Validity of Patient and Healthcare Professional Reports

Person-centered care has led healthcare professionals (HCPs) to be more attentive to patients' ability to understand and apply health-related information, especially those with chronic conditions. The concept of health literacy (HL) is essential in understanding patients' needs in routine care, but its measurement is still controversial, and few tools are validated in French. We therefore considered the brief health literacy screen (BHLS) for assessing patient-reported HL in chronic care settings, and also developed an HCP-reported version of the BHLS with the aim of using it as a research instrument to assess HCPs' evaluation of patients' HL levels. We assessed the content validity of the French translation of both the patient-reported and HCP-reported BHLS in chronic care within hospital settings, through cognitive interviews with patients and HCPs. We performed qualitative analysis on interview data using the survey response Tourangeau model. Our results show that the BHLS is easy and quick to administer, but some terms need to be adapted to the French chronic care settings. Health-related information was observed to be mainly communicated orally, hence a useful direction for future literacy measures would be to also address verbal HL.

Health literacy assessment: Translation and cultural adaptation to the Portuguese population

RATIONALE, AIMS, AND OBJECTIVES

Health literacy (HL) has been widely referenced as a determinant of health outcomes, making the assessment of low HL a fundamental step to plan educational interventions. This study aimed to translate and adapt the Short Assessment of Health Literacy-Spanish and English (SAHL-S&E) questionnaire into European Portuguese.

METHODS

The SAHL-S&E questionnaire was translated using the recommendations of the International Society for Pharmacoeconomics and Outcomes Research. One hundred fifty-three Portuguese native speakers aged over 18 years old were included in this study, enrolled among users of community pharmacies in the Algarve region (Portugal).

RESULTS

The translation of the questionnaire used showed a good internal consistency (Cronbach α: .812), and a statistically significant (F = 5.05 P < .001) interrater reliability. Over a third of subjects (37.9%) achieved a score less than or equal to 14, which is indicative of low HL.

CONCLUSION

This tool, intended to be used in the European Portuguese population, can be used for low HL screening.

Key components of successful transition for adolescents born with anorectal malformations-a Nordic focus group study

Objectives Transitional care for adolescents with congenital malformations, such as anorectal malformations (ARM), is described sparsely in the literature and referred to as being inadequate. In order to organize future successful healthcare structures, knowledge of patient-reported important aspects of transition is required. The aim of the study was therefore to explore the needs and expectations of transitional- and adult healthcare among adolescents and adults born with ARM. Methods Two tertiary paediatric surgical centres, in collaboration with two tertiary pelvic floor centres, in Sweden and Norway, conducted a qualitative study, involving adolescents and adults born with ARM in focus group discussions regarding transitional care. Discussions were analyzed by qualitative content analysis. Ethical approval was obtained. Results Sixteen participants (10 women) with a median age of 24 (19-47) years, born with mixed subtypes of ARM were included in gender-divided focus groups. Participants emphasized a need for improved knowledge of ARM, both among patients and adult care providers. Participants identified a need for support with coping strategies regarding challenging social- and intimate situations due to impaired bowel function. Participants pin-pointed well-functioning communication between the patient and the paediatric- and adult care providers as a key factor for a successful transitional process. Further, participants emphasized the importance of easy access to specialized adult healthcare when needed, suggested to be facilitated by appointed patient navigators. Conclusion Adolescents and adults born with ARM identify improved knowledge of ARM, well-functioning communication and easy access to specialized adult care as key components of a successful transition.

Health Literacy Gaps in Online Resources for Cirrhotic Patients

Background

The average readability level in the USA is a sixth grade level and for patients with chronic disease it is lower. Cirrhosis is a prevalent chronic disease that requires complex knowledge and instructions to manage. No research has been done about the understandability of online educational content for cirrhotic patients. Patients can find online materials curated by both general health platforms and high-volume liver transplant centers, and thus these materials were analyzed.

Methods

After determining exclusion criteria, the websites of the top 20 general health platform results and the websites of the top 20 high-volume hepatology centers were analyzed. Readability was assessed using the Patient Education Materials Assessment Tool (Audiovisual Materials) (PEMAT-A/V), Flesch-Kincaid Grade Level tests, word counts, sentence counts, words per sentence, and time for an average sixth grader to read.

Results

The mean grade level readabilities were 12.3 and 11.3 for the general resources and the transplant center resources, respectively. The online resources ranged from 9 to 389 sentences requiring an average of 9.8 min to read. The mean PEMAT-A/V scores were 70.05% for the general resources and 72.45% for the transplant center resources. There was a statistically significant difference in the Flesch-Kincaid grade level, sentence number, words per sentence, word count, and time for an average sixth grader to read the general resources and transplant center resources (P < 0.05).

Conclusions

The online resources both from health platforms and hepatology centers available to patients with cirrhosis are too long and complex and underscore the need for simpler and shorter resources.

Exploring health literacy in patients with chronic kidney disease: a qualitative study

Background

Patients with chronic kidney disease make day-to-day decisions about how to self-manage their disease. Chronic kidney disease (CKD) includes a risk for progression towards end-stage renal disease and the development of comorbidities, such as cardiovascular disease, which represents the leading cause of death among these patients. To reduce these risks, CKD patients are recommended to follow a healthy lifestyle with physical activity, food and fluid restrictions, and adherence to complex medication regimes throughout all phases of the disease. To manage the complexity of this health situation, health literacy (HL) is considered essential. The current prevailing understanding is that HL is a multidimensional concept and comprises a range of cognitive, affective, social, and personal skills that determine the motivation and ability to gain access to, understand, and use health information. Recently, we investigated multiple aspects of HL in CKD patients in a quantitative cross-sectional study utilizing the Health Literacy Questionnaire (HLQ) and observed that finding good health information and appraising health information were the most challenging aspects of HL. This study aimed to explore CKD patients’ lived experiences of different dimensions of HL presented in the HLQ.

Methods

This qualitative study utilized in-depth semistructured interviews. Twelve patients with different levels of HL were included. The interviews were analyzed using thematic analysis as described by Braun and Clarke.

Results

We identified three main themes that were significant for CKD patients’ HL: 1. Variation in people’s attitudes and behavior as health information seekers, 2. The problem of fragmented healthcare in the context of multimorbidity makes the healthcare system challenging to navigate, and 3. The value of a good relationship with healthcare providers.

Conclusion

CKD patients take different approaches to health information. Limiting or avoiding health information may be a strategy used by some individuals to cope with the disease and does not necessarily mean that health information is inaccessible or difficult to understand. Comorbidity and a fragmented healthcare system can make the healthcare system challenging to navigate. A good and trusting relationship with healthcare providers seems to promote several aspects of HL and should be promoted to optimize CKD patients’ HL.

Simple contents and good readability: Improving health literacy for LEP populations

Accessing and receiving quality healthcare in an unfamiliar health system is a significant challenge for many new immigrants and refugees. This study aims to provide a three-phase model to develop a web-based health information website that helps populations with limited English proficiency (LEP) increase health literacy and improve healthcare service access.

METHOD

First, we conducted a needs assessment from community leaders and service providers. Second, we developed contents from credible sources and tested each item using multiple readability tests. Last, we revised each item to lower the readability and retest its readability.

RESULTS

The average reading level for the original 99 topics was assessed at 10.84 (SD= 3.26). After revisions, we were able to lower the readability to 8.56 (SD= 2.96), which was around two grade levels lower, on average.

CONCLUSION

the main purpose for building an English based health information website was to assist the population with LEP. By using simple English with lower readability, it will ease the translation process. This study demonstrates a process to develop suitable contents for populations in need. In the future, incorporating visual aid and other multimedia will be beneficial in user engagement and knowledge retention.

Health literacy, nutrition knowledge, and health care transition readiness in youth with chronic kidney disease or hypertension: A cross-sectional study

This study evaluates the associations of nutrition knowledge and health literacy with health care transition (HCT) readiness and self-management in adolescents and young adults (AYAs) with chronic kidney disease (CKD) or hypertension. Chronically ill AYAs with poor HCT or self-management skills are less likely to achieve favorable health outcomes as they enter adulthood. Health literacy and nutrition knowledge, which are identified as important contributors to health outcomes, may suggest important points of interventions to improve self-management skills. For the study, we enrolled 59 consecutive patients ages 12-29, with a diagnosis of CKD or hypertension at pediatric- and adult-focused clinics in the United States. Participants completed measures of nutrition knowledge, health literacy, and the Self-management and Transition to Adulthood with R_x = treatment (STAR_x) questionnaire. Correlation tests and multivariate regressions were employed for data analysis. The findings show that health literacy was positively associated with self-management skills (p = .050), communication with providers (p = .002) and overall HCT (p = .001) after adjusting for key variables. Disease-specific nutrition knowledge positively predicted communication with providers (p = .002) and overall HCT (p < .001) after adjusting for key variables. Therefore, health literacy and nutrition knowledge predicted self-management and transition readiness. Testing for these skills should be considered in clinics and HCT preparation for AYAs with chronic conditions.

Facilitators and Barriers to the Development of Health Literacy Capacities Over Time for Self-Management

BACKGROUND

Health literacy is a dynamic construct that is content and context specific. An understanding of the facilitators and barriers involved in the development of health literacy over time can provide important insights for the health care providers (HCP) in supporting patients with chronic illness.

OBJECTIVE

The study was conducted to expand an understanding of how health literacy development can be supported through exploration of the main facilitators and barriers in the process.

METHODS

This study used a longitudinal qualitative study design involving repeat interviews at three separate time points over a 12-month period. A purposive sample of 26 participants attending a structured cardiovascular disease risk-reduction program participated in the study, 17 of whom completed all three interviews. The European Health Literacy Survey measure was used to determine health literacy levels at the beginning and end of the 12-month period. Employing qualitative thematic analysis and a longitudinal-specific question framework, a trajectory approach was applied to explore individual cases longitudinally.

KEY RESULTS

Facilitators and barriers to health literacy capacity development were identified. Participants demonstrated increased perceptions of having control and being empowered over time. However, this was also found to be affected by external life events. Study participants were also found to be embedding health knowledge, motivation, and behaviors over time within the everyday contexts of their lives. The relationship with the HCP permeated all aspects of health literacy capacity development, including aspects of treatment decision-making. Participants identified the need for psychological supports and the increased importance of looking after their mental health.

CONCLUSIONS

Positive developments in health literacy capacities are important for the self-management of illness. Longitudinal findings underscore the importance of the HCP in supporting the development of health literacy capacities over time. These findings lend support to the need to integrate health literacy into medical and other HCP curricula to raise awareness of the concept of health literacy. [HLRP: Health Literacy Research and Practice. 2020;4(2):e104-e118.] PLAIN LANGUAGE SUMMARY: Using a longitudinal qualitative study design, this study proposes that health literacy capacities develop over time and that the health care provider (HCP) plays a central role in this process. Findings from this study support the need to embed health literacy training into medical and other applied HCP curricula to raise awareness of the concept of health literacy.

The Relationship Between Health Literacy and Illness Self-Care Management in Turkish Patients With Cancer

OBJECTIVES

To determine the relationship between health literacy and illness self-care management in individuals with cancer.

SAMPLE & SETTING

207 individuals with cancer undergoing treatment in the chemotherapy unit of a university hospital in Istanbul, Turkey.

METHODS & VARIABLES

Data were collected using a sociodemographic and illness characteristics questionnaire, the European Health Literacy Survey Questionnaire-Turkish Version (HLS-EU-Q-TR), and the Self-Care Management Process in Chronic Illness. Data were analyzed using descriptive statistics, one-way analysis of variance, student t test, Pearson correlation test, and multiple regression analysis.

RESULTS

86% of individuals displayed an inadequate or problematic to limited level of health literacy. Extended family status and HLS-EU-Q-TR score were significant predictors of self-care management.

IMPLICATIONS FOR NURSING

Nurses can organize health programs designed to improve the level of health literacy in the population, but they should take into consideration the health literacy levels of their patients.

Understanding Facilitators and Barriers of Online Cancer Information Utilization among Cancer Survivors and their Families: Focus on the Theory of Planned Behavior

Objective:

Cancer survivors have various health care needs and are willing to be proactive with their health maintenance. Online information would be a useful resource to guide cancer survivors and their family members. Therefore, identifying the factors that influence Internet searching behaviors among cancer survivors and their family members is a first step toward providing better health care services for cancer care.

Methods:

We performed focus group interviews that were based on the Theory of Planned Behavior, with thirty-one participants to explore factors related to Internet search behaviors among cancer survivors and their family members.

Results:

Six themes were identified in the analysis of participant interviews. Attitudes toward searching for health information on the Internet included the themes “Fulfilling unmet needs” and “Confirmation through second opinion.” Themes related to social norms included “a required step for sure” and “helping each other.” In terms of perceived behavioral control, themes included “difficult to choose because of being ‘overwhelmed with information,’” and “complex searching milieu.”

Conclusion:

It was clear that cancer survivors and their family members had unmet needs for maintaining their health status. They wanted to be informed and actively involved in the decision-making process regarding health management. Consultation and education provided to patients by doctors should not only include information on diet and nutrition but also information on the resulting complications to satisfy their need for reliable health information.

Patient education materials on pressure injury prevention in hospitals and health services in Victoria, Australia: Availability and content analysis

Pressure injuries (PIs) are a common quality indicator for hospital care, and preventing PIs often requires patient engagement; as such, Australian consensus research has recommended that high-quality education materials be made to patients for PIs via hospital networks. The purpose of the present study was to assess the availability and accuracy of patient education materials on PIs in publicly available hospital websites in Victoria, Australia. Two independent coders assessed 212 websites for content on PI prevention and management, analysing availability and accuracy of PI definitions, risk factors, preventive strategies, referral, visual tools, consumer endorsement, information for family/carers, and translation on community languages. A greater proportion of hospitals did not have any patient education materials on PI prevention publicly available, with private hospitals (compared with public) and metropolitan hospitals (compared to rural) more likely to have materials available on their sites. The available materials contained accurate messages on PI defining characteristics and risk factors for PIs, although there was considerable variability on the availability of other information. Our findings suggest a significant deficit in the availability of educational materials for acute care patients and their families. There is a need for evidence-based, consumer-endorsed, uniform materials on all hospital websites to prevent PIs in acute care.

Health Literacy Among In-Care Older HIV Diagnosed Persons with Multimorbidity: MMP NYS (Excluding NYC)

Older persons living with diagnosed HIV (PLWDH) are also at risk for age-related chronic conditions. With conflicting results on studies assessing health literacy and durable viral suppression, this study is the first in assessing this relationship using representative data on older in-care HIV-diagnosed persons with multimorbidity. Weighted data collected 2009-2014 from the Medical Monitoring Project (MMP) was used. Health literacy was assessed using the three-item Brief Health Literacy Screen (BHLS). The mean health literacy score was 11.22 (95% CI 10.86-11.59), and the mean multimorbidity was 4.75 (SE = 0.32). After adjusting, health literacy (OR 0.87, 95% CI 0.77-0.99) was found to be significantly associated with durable viral suppression. Adequate health literacy can help with achieving durable viral suppression. For these persons, addressing health literacy might increase their ability to access and navigate the healthcare system, thereby helping them stay engaged and maintain adherence to HIV care.

Health Literacy: From a Property of Individuals to One of Communities

Health literacy (HL) is increasingly hailed as a strategy to improve the control individuals have over their health. A central critic of HL intervention is its overemphasis on individual level factors, something recognised in the 2008 report of the Commission of Social Determinants of Health (SDoH) that recommended expanding the scope of HL to cover the SDoH. The objective of our study was to assess the extent to which recent progress on HL captures the need for collective action on the SDoH. We conducted a scoping review on PubMed looking for review papers published between 2013–2018 in English and French. Definitions of HL were analysed against two main dimensions (i.e., locus of change of HL strategies and foreseen outcome of HL improvements). Despite a number of authors calling for more research on HL interventions at the community level and an expansion of the definition to cover the SDoH, we found that the recommendation of the Commission has yet to be implemented. Even when the definitions include the capacities of individuals on distal determinants, both the locus of change and outcomes of HL improvement do not go beyond intra individual factors (knowledge, skills, etc.). It is noteworthy that communities were either framed as a setting outside of health care services or as an aggregate of individuals. We found no instance of HL intervention regarding communities as complex systems of actors sharing a common space and dynamic. We conclude by suggesting a new definition of HL and by drawing attention to the research gap in addressing the upstream SDoH through HL actions.

What quality factors matter in enhancing the perceived benefits of online health information sites? Application of the updated DeLone and McLean Information Systems Success Model

BACKGROUND

Despite a growing need for designing and monitoring health information sites through comprehensive examination of the various elements of website quality, there is little research that systematically models and presents such examinations.

OBJECTIVES

Applying the updated DeLone and McLean Model of Information Systems Success, this research aimed to examine how health information sites' information quality, system quality, and service quality lead to user satisfaction and perceived benefits.

METHODS

This research was conducted in a specific context of the National Health Information Portal (NHIP), a governmental health information site in South Korea. We conducted online survey in 2017, with 506 adults from the NHIP consumer panel. Data were analyzed using a confirmatory factor analysis, hierarchical ordinary least squares regression, and bootstrapping approach for a mediation test.

RESULTS

Of the three quality factors, information quality had significant associations with all outcome variables: user satisfaction, intention to reuse the site, and perceived benefits of site use in health settings. There were also indirect paths from information quality to perceived benefits, one mediated through intention and the other mediated through satisfaction and then intention. Service quality had a significant association with user satisfaction, and its impact on perceived benefits occurred indirectly through user satisfaction and intention in serial. By contrast, the role of system quality received no empirical support.

IMPLICATIONS

The results offer theoretical and practical implications for how to enhance the effectiveness of online health information sites.

Self-management across chronic diseases: Targeting education and support needs

OBJECTIVES

Among Canadian adults with chronic disease: 1) to identify groups that differ in self-management task frequency and self-efficacy; 2) to compare group characteristics and preferences for self-management support.

METHODS

Using data from an online survey, cluster analysis was used to identify groups that differed in self-management task frequency and self-efficacy. Multivariable regression was used to explore relationships with patient characteristics and preferences.

RESULTS

Cluster analysis (n = 247) revealed three groups:Vulnerable Self-Managers (n = 55), with the highest task frequency and lowest self-efficacy; Confident Self-Managers (n = 73), with the lowest task frequency and highest self-efficacy; and Moderate Needs Self-Managers (n = 119), with intermediate task frequency and self-efficacy. Vulnerable Self-Managers, when compared with the Confident group, were more often: on illness-related employment disability or unemployed; less well educated; diagnosed with emotional problems or hypertension, and had greater multimorbidity. They participated less often in self-management programs, and differed in support preferences.

CONCLUSIONS

Knowing the characteristics of vulnerable self-managers can help in targeting those in greater need for self-management support that matches their preferences.

PRACTICE IMPLICATIONS

Different approaches are needed to support self-management in the vulnerable population.

Self-management of patients with advanced cancer: A systematic review of experiences and attitudes

BACKGROUND

Patients with advanced cancer are increasingly expected to self-manage. Thus far, this topic has received little systematic attention.

AIM

To summarise studies describing self-management strategies of patients with advanced cancer and associated experiences and personal characteristics. Also, to summarise attitudes of relatives and healthcare professionals towards patient self-management.

DESIGN

A systematic review including non-experimental quantitative and qualitative studies. Data were analysed using critical interpretive synthesis. Included studies were appraised on methodological quality and quality of reporting.

DATA SOURCES

MEDLINE, Embase, Cochrane Central, PsycINFO, CINAHL, Web of Science and Google Scholar (until 11 June 2019).

RESULTS

Of 1742 identified articles, 31 moderate-quality articles describing 8 quantitative and 23 qualitative studies were included. Patients with advanced cancer used self-management strategies in seven domains: medicine and pharmacology, lifestyle, mental health, social support, knowledge and information, navigation and coordination and medical decision-making (29 articles). Strategies were highly individual, sometimes ambivalent and dependent on social interactions. Older patients and patients with more depressive symptoms and lower levels of physical functioning, education and self-efficacy might have more difficulties with certain self-management strategies (six articles). Healthcare professionals perceived self-management as desirable and achievable if based on sufficient skills and knowledge and solid patient-professional partnerships (three articles).

CONCLUSION

Self-management of patients with advanced cancer is highly personal and multifaceted. Strategies may be substitutional, additional or even conflicting compared to care provided by healthcare professionals. Self-management support can benefit from an individualised approach embedded in solid partnerships with relatives and healthcare professionals.

Rehabilitation From Addiction and Chronic Illnesses: A Comparative Analysis of the Narratives of Hungarian Patients

BACKGROUND

In Hungary the psychological care provided during the rehabilitation of patients with chronic illnesses is insufficient. Patients with addiction, on the other hand, appear to make more use of psychological services. Narratives of patients recovering from addiction and patients with various chronic illnesses were examined in order to gain a better understanding of psychological phenomena during rehabilitation.

METHODS

Semi-structured interviews were carried out. Narrative and thematic analysis was used in order to determine the structure and characteristics of patients' narratives.

RESULTS

The narratives of patients recovering from addiction were found to be more structured and uniform; they identified with their illness and played an active role in their recovery. Patients with a chronic illness mainly recounted passive events and physical difficulties. Stigmatization was mentioned by both groups.

IMPLICATIONS FOR PRACTICE

The level of stigmatization experienced by patients with a chronic illness may be one of the reasons why they use healthcare services more frequently than patients with an addiction. The authors believe that teaching patients to provide good narratives about suffering from and recovering from chronic illnesses may aid them in the rehabilitation process. An adaptive mixture of different illnesses and addiction narratives might be beneficial in the recovery process of various patient groups.

Associations Between Health Literacy and Medication Self-Management Among Community Health Center Patients with Uncontrolled Hypertension

PURPOSE

Examine associations between health literacy and several medication self-management constructs among a population of adults with uncontrolled hypertension.

PATIENTS AND METHODS

Cross-sectional study of health center patients from the Chicago area with uncontrolled hypertension enrolled between April 2012 and February 2015. Medication self-management constructs-applied to hypertension medications, chronic condition medications and all medications-included: 1) medication reconciliation, 2) knowledge of drug indications, 3) understanding instructions and dosing, and 4) self-reported adherence over 4 days (no missed doses). We determined associations between health literacy and self-management outcomes using multivariable generalized linear regression.

RESULTS

There were 1460 patients who completed screening interviews; 62.9% enrolled and had complete baseline data collected, and were included in the analysis. Of 919 participants, 47.4% had likely limited (low), 33.2% possibly limited, and 19.4% likely adequate health literacy. Compared to participants with likely adequate health literacy, participants with low health literacy were less likely to have chronic medications reconciled (18.0% versus 29.6%, p=0.007), know indications for chronic medications (64.1% versus 83.1%, p<0.001), and demonstrate understanding of instructions and dosing (68.1% versus 82.9%, p=0.001). Self-reported adherence to hypertension medications was higher among the low health literacy group (65.6% versus 56.0%, p=0.010). In multivariable models, health literacy was strongly associated with knowledge of drug indications, and understanding of instructions and dosing.

CONCLUSION

Low health literacy was associated with worse medication self-management in several domains. However, non-adherence was greatest in the most health literate in unadjusted analysis. Among a population of patients with uncontrolled hypertension, the drivers of poor control may vary by health literacy.

Promoting self-efficacy in patients with chronic disease beyond traditional education: A literature review

Aim

To examine barriers to self-efficacy and strategies beyond traditional education that promote self-efficacy for patients living with chronic disease. The review questions were as follows: (a) What are barriers to self-efficacy in patients experiencing chronic disease? and (b) What non-traditional strategies and programmes can be implemented by healthcare leaders to promote self-efficacy in patients with chronic disease?

Design

Integrative review.

Method

Data sources searched were CINAHL, Google Scholar, Health Source, Academic Search Complete and PsycARTICLES published between January 2014-January 2018. Synthesis and thematic analyses were conducted on 24 articles.

Results

Three themes were identified as barriers to self-efficacy: health literacy, access and support. Four prominent strategies were found to promote self-efficacy: self-management programmes, telehealth, mobile applications, gaming and social media. The findings indicate self-efficacy for patients with chronic conditions can improve with new interventions. Enhancing traditional education and boosting self-efficacy could increase treatment adherence and decrease cost.

Hidradenitis suppurativa on Facebook: thematic and content analyses of patient support group

Online support groups present a sheltered and partially anonymous zone where patients can unload that which disturbs and preoccupies them. In this qualitative study, we explored the use of a Facebook support group for Hidradenitis Suppurativa (HS) patients, and analyzed the contents of shared posts. By evaluating the post's themes, we aim to contribute a deeper understanding of HS patients' needs and possible ways of engaging them. We analyzed more than 730 posts and 8500 comments posted on the "Hidradenitis Suppurativa Israel'' Facebook group. Content analysis was performed, categorizing all posts into 20 topics, assembled into 5 main themes. The most popular theme among all posts was requests for treatment information. The most commented on theme was posts with emotional text, particularly pessimistic ones. Annual activity was analyzed by month, and peaks were found in some months. This article demonstrates that online social networks can lead to the identification of unmet requirements.

Associations between disease education, self-management support, and health literacy in psoriasis

BACKGROUND

Patients' ability to perform self-management may be compromised if they are unable to fully comprehend their diagnosis and treatments. Weaknesses in health literacy (HL) pose a considerable health concern and may negatively influence SM, as well as interactions with health care professionals (HCP) and peers.

OBJECTIVES

To investigate possible associations between comprehensive HL and psoriasis education from HCPs in a cohort of patients with psoriasis. Another aim was to examine essential sources for psoriasis information and how these are evaluated.

METHODS

Cross-sectional questionnaire data, including the comprehensive Health Literacy Questionnaire (HLQ) from 825 patients with psoriasis who had participated in Climate Helio Therapy (CHT).

RESULTS

Participants having received HCP education scored significantly better in all HLQ scales compared to participants who did not receive such education (Cohen's effect size: 0.24 to 0.44). The CHT program, peers, and dermatologists were the most important sources of psoriasis information. People having participated more than once in CHT presented better HL scores and also higher self-management (skill and technique acquisition) and more psoriasis knowledge (effect-size: 0.75).

CONCLUSIONS

Psoriasis education by HCP seems important for HL and psoriasis knowledge. Patients may need multiple approaches and repetitions over time to be health literate and effective self-managers.

The relation between self-efficacy in patients with chronic obstructive pulmonary disease and caregiver burden

AIM

The study was conducted to examine the relation between self-efficacy in patients with chronic obstructive pulmonary disease (COPD) and caregiver burden.

MATERIAL AND METHODS

This descriptive, cross-sectional study included 200 patients with stage II and III COPD presenting to hospital between June and November in 2017 and their caregivers. Data were gathered with a questionnaire, COPD Assessment Test and COPD Self-Efficacy Scale from the patients. A questionnaire and Caregiver Burden Scale was used to collect data from the caregivers. Obtained data were analysed with the descriptive statistics numbers, percentages, mean, median and standard deviation. Spearman's correlation analysis was utilised to examine the relation between paired groups.

RESULTS

The mean age of the patients with COPD was 63.53 years and 51.1% of the patients were female. The mean age of the caregivers was 48.88 ± 14.09 years. 54.4% of the caregivers were aged 40-60 years, and 59.9% of the caregivers were female. The mean score was 26.97 ± 5.25 for COPD Assessment Test and 2.32 ± 0.43 for COPD Self-Efficacy Scale. Of all the caregivers, 64.8% had mild caregiving burden and 18.1% had moderate caregiving burden. The mean score for Caregiver Burden Scale had a significant, moderate relation with the mean score for the subscale physical effort in COPD Self-Efficacy Scale (r = -0.42; p < 0.01) and had a significant, weak, negative relation with the mean total score for COPD Self-Efficacy Scale and the mean scores for its subscales. There was a significant, moderate, positive relation between the mean scores for Caregiver Burden and COPD Assessment Test (r = 0.51; p < 0.001) and a significant, negative relation between the scores for COPD Self-Efficacy Scale and its subscales and the scores for CAT (r = -0.26 - r = -0.52; p < 0.05).

CONCLUSION

As self-efficacy in COPD patients increases, their health and daily lives are affected less by COPD and caregiver burden decreases.

Relationship of pneumococcal and influenza vaccination frequency with health literacy in the rural population in Turkey

INTRODUCTION

Vaccines have been shown to prevent illness, disability and death from vaccine-preventable diseases. The purpose of our study was to analyze the influenza and pneumococcal vaccination status of patients, the factors that influence the uptake of influenza/pneumococcal vaccination and the effects of health literacy (HL) on vaccination.

MATERIALS AND METHODS

In this cross-sectional study, demographic characteristics, comorbid diseases and the pneumococcal and influenza vaccination status in previous years were recorded for each patient. The Turkish version of the European Health Literacy Survey Questionnaire (HLS-EU-Q47) was used to assess HL.

RESULTS

A total of 350 patients were enrolled in the study. A total of 6.3% of patients had received both vaccines. 20% of subjects were vaccinated with influenza vaccine and 11.1% of the subjects were vaccinated with pneumococcal vaccine. Overall HL was insufficient for 70.9%, problematic for 20.6%, sufficient for 7.1% and excellent for 14.2% of patients. Patients who had pneumococcal and influenza vaccination had higher disease prevention HL scores (p = 0.013, p = 0.001; respectively).

DISCUSSION

An insufficient HL level was found to be much higher than previous studies. It was observed that an increase in disease prevention HL was associated with a rise in the rate of pneumococcal and influenza vaccination.

Validation of the Short-Form Health Literacy Questionnaire (HLS-SF12) and Its Determinants among People Living in Rural Areas in Vietnam

Background: Health literacy (HL) is an important factor in improving health inequalities in poor and marginalized groups. Assessing comprehensive HL is critical. In this study, we validated the use of a comprehensive short-form HL survey tool (HLS-SF12) and examined the determinants of HL among people in rural areas. Methods: A cross-sectional study was conducted in July 2019 on 440 people residing in mountainous areas in Vietnam. Health literacy was measured using the HLS-SF12. Personal characteristics were also collected. We analyzed data using confirmatory factor analysis, internal consistency analysis, and regression analysis. Results: The questionnaire demonstrated a good construct validity with satisfactory goodness-of-fit indices and item-scale convergent validity. The tool was reliable and homogeneous with Cronbach's alpha = 0.79, with no floor/ceiling effects. People who were married had lower HL (regression coefficient B = -3.12; 95% confidence interval (CI) = -5.69, -0.56; p = 0.017) compared with those who never married. Higher education attainment (B = 3.41 to 10.44; p < 0.001), a better ability to pay for medication (B = 4.17 to 9.89; p < 0.001), and a tendency to view health-related TV/radio more often (B = 5.23 to 6.15; p < 0.001) were associated with higher HL. Conclusions: The HLS-SF12 is a valid survey tool for the evaluation of HL in rural populations. A number of personal characteristics were strongly associated with HL.

Engaging Patients and Caregivers in Research for Pediatric Inflammatory Bowel Disease: Top 10 Research Priorities

INTRODUCTION

Including individuals with lived experience in pediatric inflammatory bowel disease (IBD) is essential to establishing a research agenda that is mutually impactful to both those treating and those experiencing the disease.

METHODS

Using the James Lind Alliance approach to research priority setting, a 10-member steering committee composed of current and former pediatric patients with IBD, caregivers, and clinicians was formed. A national survey, disseminated across Canada, elicited uncertainties which were divided into unanswered and answered research questions. Subsequently a research prioritization survey was disseminated where respondents ranked their top 20 research uncertainties. A final prioritization meeting was held to agree upon the top 10 uncertainties.

RESULTS

From 1209 research questions submitted by 363 participants, the list was reduced to 105 indicative questions that were within scope and deemed unanswered in the literature. Via the national research prioritization survey, this list was further reduced. The top 10 uncertainties identified at the final research consensus meeting, with 21 participants from all stakeholder groups, included "What are the causes of IBD?," "Can IBD be prevented?," "What role does diet have in the management of pediatric IBD?." Other questions concerned flare ups, biomarkers, optimal patient education, long-term effects of medication and early-diagnosis, role of psychological support, and optimal approach to diagnosis.

CONCLUSION

This research adds a unique perspective by deriving a list of pediatric IBD research uncertainties important by patients and caregivers and clinicians.

Therapy-based exercise from the perspective of adult patients: a qualitative systematic review conducted using an ethnographic approach

OBJECTIVES

Many patients do not meet recommended levels of therapy-based exercise. This review aims to explore how adult patients view being prescribed therapy-based exercise, the information/education they are given and receive and if/how they independently practise and adhere.

DESIGN

A qualitative systematic review conducted using an ethnographic approach and in accordance with the PRISMA statement.

SOURCES

PubMed, CINAHL, SCOPUS and EMBASE databases (01 January 2000-31 December 2018).

METHODS

Qualitative studies with a focus on engagement/adherence with therapy-based exercise were included. Data extraction and quality appraisal were undertaken by two reviewers. Results were discussed and data synthesized.

RESULTS

A total of 20,294 titles were screened, with data extracted from 39 full texts and data from 18 papers used to construct three themes. 'The Guidance received' suggests that the type of delivery desired to support and sustain engagement was context-dependent and individually situated. 'The Therapist as teacher' advocates that patients see independent therapy-based exercise as a shared activity and value caring, kind and professional qualities in their therapist. 'The Person as learner' proposes that when having to engage with and practise therapy-based exercise because of ill-health, patients often see themselves as new learners who experience fear and uncertainty about what to do. Patients may have unacknowledged ambivalences about learning that impact on engagement and persistence.

CONCLUSION

The quality of the interaction between therapists and patients appears integral to patients engaging with, and sustaining practice of, rehabilitation programmes. Programmes need to be individualized, and health care professionals need to take patients' previous experiences and ambivalences in motivation and empowerment into account.

Developing Infographics to Facilitate HIV-Related Patient-Provider Communication in a Limited-Resource Setting

BACKGROUND

Productive patient-provider communication is a recognized component of high-quality health care that leads to better health outcomes. Well-designed infographics can facilitate effective communication, especially when culture, language, or literacy differences are present.

OBJECTIVES

This study aimed to rigorously develop infographics to improve human immunodeficiency virus (HIV)-related patient-provider communication in a limited-resource setting. A secondary purpose was to establish through participant feedback that infographics convey intended meaning in this clinical and cultural context.

METHODS

We adapted a participatory design methodology, developed in a high-resource setting, for use in the Dominican Republic. Initially, content to include was established using a data-triangulation method. Then, infographics were iteratively generated and refined during five phases of design sessions with three stakeholder groups: (1) 25 persons living with HIV, (2) 8 health care providers, and (3) 5 domain experts. Suggestions for improvement were incorporated between design sessions and questions to confirm interpretability of infographics were included at the end of each session.

RESULTS

Each participant group focused on different aspects of infographic designs. Providers drew on past experiences with patients and offered clinically and contextually relevant recommendations of symbols and images to include. Domain experts focused on technical design considerations and interpretations of infographics. While it was difficult for patient participants to provide concrete suggestions, they provided feedback on the meaning of infographics and responded clearly to direct questions regarding possible changes. Fifteen final infographics were developed and all participant groups qualitatively confirmed that they displayed the intended content in a culturally appropriate and clinically meaningful way.

CONCLUSION

Incorporating perspectives from various stakeholders led to the evolution of designs over time and generated design recommendations that will be useful to others creating infographics for use in similar populations. Next steps are to assess the feasibility of using infographics to improve clinical communication and patient outcomes.