Impact of health literacy on medication adherence: a systematic review and meta-analysis

Discussing the Effects of Poor Health Literacy on Patients Facing HIV: A Narrative Literature Review

BACKGROUND

Scholars describe poor health literacy as a "silent epidemic," which is challenging the functioning of healthcare systems all over the world. Health literacy is mainly meant as an individual trait which concerns the ability to obtain, process, and understand basic health information in order to effectively navigate the health system. Low health literate patients perceive poor self-efficacy dealing with their health conditions, are not willing to be involved in the provision of care, show larger risks of hospitalization and mortality, and are not aware about the determinants of well-being. Hence, limited health literacy has been associated with inadequate management of long-term conditions; nonetheless, several authors argue that health literacy has been an overlooked factor dealing with HIV.

METHODS

This study is aimed at discussing the effects of poor health literacy on people living with HIV, drawing from the findings of a narrative literature review which involved 41 papers retrieved from the databases "Scopus-Elsevier" and "PubMed."

RESULTS

The scientific literature is not consistent dealing with the relationship between health literacy and HIV treatment. For example, health literate patients seem to better understand their health conditions; on the other hand, people living with poor health literacy are likely to report higher compliance with providers' prescriptions, blindly trusting healthcare professionals.

CONCLUSION

Poor health literacy is a social barrier to access healthcare services and to appropriate health treatment among patients living with HIV. Tailored interventions should be aimed at enhancing the health skills of patients affected by HIV infection to improve their ability to navigate the health system.

The Impact of Loneliness on Quality of Life and Patient Satisfaction Among Older, Sicker Adults

Objective: This study estimated prevalence rates of loneliness, identified characteristics associated with loneliness, and estimated the impact of loneliness on quality of life (QOL) and patient satisfaction. Method: Surveys were mailed to 15,500 adults eligible for care management programs. Loneliness was measured using the University of California Los Angeles (UCLA) three-item scale, and QOL using Veteran’s RAND 12-item (VR-12) survey. Patient satisfaction was measured on a 10-point scale. Propensity weighted multivariate regression models were utilized to determine characteristics associated with loneliness as well as the impact of loneliness on QOL and patient satisfaction. Results: Among survey respondents (N = 3,765), 28% reported severe and 27% moderate loneliness. The strongest predictor of loneliness was depression. Physical and mental health components of QOL were significantly reduced by loneliness. Severe loneliness was associated with reduced patient satisfaction. Discussion: Almost 55% of these adults experienced loneliness, negatively affecting their QOL and satisfaction with medical services. Screening for loneliness may be warranted.

Low health literacy predicts decline in physical function among older adults: findings from the LitCog cohort study

BACKGROUND

Limited health literacy is associated with worse physical function in cross-sectional studies. We aimed to determine if health literacy is a risk factor for decline in physical function among older adults.

METHODS

A longitudinal cohort of 529 community-dwelling American adults aged 55-74 years were recruited from an academic general internal medicine clinic and federally qualified health centres in 2008-2011. Health literacy (Newest Vital Sign), age, gender, race, education, chronic conditions, body mass index, alcohol consumption, smoking status and exercise frequency were included in multivariable analyses. The 10-item PROMIS (Patient-Reported Outcomes Measurement Information System) physical function scale was assessed at baseline and follow-up (mean=3.2 years, SD=0.39).

RESULTS

Nearly half of the sample (48.2%) had either marginal (25.5%) or low health literacy (22.7%). Average physical function at baseline was 83.2 (SD=16.6) of 100, and health literacy was associated with poorer baseline physical function in multivariable analysis (p=0.004). At follow-up, physical function declined to 81.9 (SD=17.3; p=0.006) and 20.5% experienced a meaningful decline (>0.5 SD of baseline score). In multivariable analyses, participants with marginal (OR 2.62; 95%CI 1.38 to 4.95; p=0.003) and low (OR 2.57; 95%CI 1.22 to 5.44; p=0.013) health literacy were more likely to experience meaningful decline in physical function than the adequate health literacy group. Entering cognitive abilities to these models did not substantially attenuate effect sizes. Health literacy attenuated the relationship between black race and decline in physical function by 32.6%.

CONCLUSIONS

Lower health literacy increases the risk of exhibiting faster physical decline over time among older adults. Strategies that reduce literacy disparities should be designed and evaluated.

Determinants of Low Health Literacy Among Asian-American and Pacific Islanders in California

BACKGROUND

Health literacy is a marker for how patients obtain, comprehend, communicate, and apply complex health information. Few studies exist on determinants of low health literacy among Asian-American and Pacific Islanders. The purpose of this exploratory study was to identify key determinants of low health literacy in this population using the 2007 California Health Interview Survey, a population-based survey.

METHODS

Low health literacy was defined as reporting either prescription bottle or written information from the doctor as being "somewhat difficult" or "very difficult" to understand, or reporting having a hard time understanding their doctor. Survey weighted univariate and multivariable regression analyses were conducted.

RESULTS

A total of 4045 participants were included in the study, representing 3,156,711 Asian-American and Pacific Islander adults in California. Factors associated with low health literacy were being male, low socioeconomic status, limited English language proficiency, and being foreign born.

CONCLUSION

Results of this study highlight the current burden of low health literacy among Asian-American and Pacific Islander population and the associated factors. Targeted public health efforts to improve health literacy are needed among Asian-American and Pacific Islanders.

Development of a conceptual model of cancer caregiver health literacy

Caregivers play a vital role in caring for people diagnosed with cancer. However, little is understood about caregivers' capacity to find, understand, appraise and use information to improve health outcomes. The study aimed to develop a conceptual model that describes the elements of cancer caregiver health literacy. Six concept mapping workshops were conducted with 13 caregivers, 13 people with cancer and 11 healthcare providers/policymakers. An iterative, mixed methods approach was used to analyse and synthesise workshop data and to generate the conceptual model. Six major themes and 17 subthemes were identified from 279 statements generated by participants during concept mapping workshops. Major themes included: access to information, understanding of information, relationship with healthcare providers, relationship with the care recipient, managing challenges of caregiving and support systems. The study extends conceptualisations of health literacy by identifying factors specific to caregiving within the cancer context. The findings demonstrate that caregiver health literacy is multidimensional, includes a broad range of individual and interpersonal elements, and is influenced by broader healthcare system and community factors. These results provide guidance for the development of: caregiver health literacy measurement tools; strategies for improving health service delivery, and; interventions to improve caregiver health literacy.

Advocating for a Population-Specific Health Literacy for People With Visual Impairments

Health literacy, the ability to access, process, and understand health information, is enhanced by the visual senses among people who are typically sighted. Emotions, meaning, speed of knowledge transfer, level of attention, and degree of relevance are all manipulated by the visual design of health information when people can see. When consumers of health information are blind or visually impaired, they access, process, and understand their health information in a multitude of methods using a variety of accommodations depending upon their severity and type of impairment. They are taught, or they learn how, to accommodate their differences by using alternative sensory experiences and interpretations. In this article, we argue that due to the unique and powerful aspects of visual learning and due to the differences in knowledge creation when people are not visually oriented, health literacy must be considered a unique construct for people with visual impairment, which requires a distinctive theoretical basis for determining the impact of their mind-constructed representations of health.

Blending Health Literacy With an English as a Second Language Curriculum: A Systematic Literature Review

About 21% of the U.S. population ages 5 and older speaks a language other than English at home, and many of them cannot communicate in English fluently. A possible intervention to improve health literacy for people with limited English proficiency is the use of an English as a second language curriculum. The purpose of this systematic review is to assess the characteristics (e.g., theoretical framework, developing processes, classroom activities, goals and topics) and effectiveness of English as a second language health literacy curricula that are currently available in English-dominant countries. We searched the online databases of ERIC, Sage, Springer, PubMed, Medline, and Scopus, identifying 7 curricula within 18 published reports. We synthesize the strengths and weaknesses of the reviewed curricula and provide recommendations for improving future health literacy interventions and research.

Development of the Health Literacy of Caregivers Scale - Cancer (HLCS-C): item generation and content validity testing

BACKGROUND

Health literacy refers to an individual's ability to engage with health information and services. Cancer caregivers play a vital role in the care of people with cancer, and their capacity to find, understand, appraise and use health information and services influences how effectively they are able to undertake this role. The aim of this study was to develop an instrument to measure health literacy of cancer caregivers.

METHOD

Content areas for the new instrument were identified from a conceptual model of cancer caregiver health literacy. Item content was guided by statements provided by key stakeholders during consultation activities and selected to be representative across the range of cancer caregiver experiences. Content validity of items was assessed through expert review (n = 7) and cognitive interviews with caregivers (n = 16).

RESULTS

An initial pool of 82 items was generated across 10 domains. Two categories of response options were developed for these items: agreement with statements, and difficulty undertaking presented tasks. Expert review revealed that the majority of items were relevant and clear (Content Validity Index > 0.78). Cognitive interviews with caregivers suggested that all except three items were well understood.

CONCLUSION

A resultant 88 item questionnaire was developed to assess cancer caregiver health literacy. Further work is required to assess the construct validity and reliability of the new measure, and to remove poorly performing and redundant items, which will result in a shorter, final measure. The new measure has the potential to inform the development and evaluation of interventions and the improvement of health service delivery to cancer caregivers.

Development of patient-centric linguistically tailored psychoeducational messages to support nutrition and medication self-management in type 2 diabetes: a feasibility study

PURPOSE

This study evaluated the feasibility of developing linguistically tailored educational messages designed to match the linguistic styles of patients segmented into types with the Descriptor™, and to determine patient preferences for tailored or standard messages based on their segments.

PATIENTS AND METHODS

Twenty patients with type 2 diabetes (T2DM) were recruited from a diabetes health clinic. Participants were segmented using the Descriptor™, a language-based questionnaire, to identify patient types based on their control orientation (internal/external), agency (high/low), and affect (positive/negative), which are well studied constructs related to T2DM self-management. Two of the seven self-care behaviors described by the American Association of Diabetes Educators (healthy eating and taking medication) were used to develop standard messages and then linguistically tailored using features of the six different construct segment types of the Descriptor™. A subset of seven participants each provided feedback on their preference for standard or linguistically tailored messages; 12 comparisons between standard and tailored messages were made.

RESULTS

Overall, the tailored messages were preferred to the standard messages. When the messages were matched to specific construct segment types, the tailored messages were preferred over the standard messages, although this was not statistically significant.

CONCLUSION

Linguistically tailoring messages based on construct segments is feasible. Furthermore, tailored messages were more often preferred over standard messages. This study provides some preliminary evidence for tailoring messages based on the linguistic features of control orientation, agency, and affect. The messages developed in this study should be tested in a larger more representative sample. The present study did not explore whether tailored messages were better understood. This research will serve as preliminary evidence to develop future studies with the ultimate goal to design intervention studies to investigate if linguistically tailoring communication within the context of patient education influences patient knowledge, motivation, and activation toward making healthy behavior changes in T2DM self-management.

Health literacy and its association with perception of teratogenic risks and health behavior during pregnancy

OBJECTIVE

Investigate the association between health literacy and perception of medication risk, beliefs about medications, use and non-adherence to prescribed pharmacotherapy during pregnancy, and whether risk perception and beliefs may mediate an association between health literacy and non-adherence.

METHODS

This multinational, cross-sectional, internet-based study recruited pregnant woman between 1 October 2011 and 29 February 2012. Data on maternal socio-demographics, medication use, risk perception, beliefs, and non-adherence were collected via an on-line questionnaire. Health literacy was measured via a self-assessment scale. Mann-Whitney U test, Spearman's rank correlation, Generalized Estimating Equations and mediation analysis were utilized.

RESULTS

4999 pregnant women were included. Low-health literacy women reported higher risk perception for medications, especially penicillins (Rho: -0.216) and swine flu vaccine (Rho: -0.204) and more negative beliefs about medication. Non-adherence ranged from 19.2% (high-health literacy) to 25.0% (low-health literacy). Low-health literacy women were more likely to be non-adherent to pharmacotherapy than their high-level counterparts (adjusted OR: 1.30; 95% CI: 1.02-1.66). Risk perception and beliefs appeared to mediate the association between health literacy and non-adherence.

CONCLUSION

Health literacy was significantly associated with maternal health behaviors regarding medication non-adherence.

PRACTICE IMPLICATIONS

Clinicians should take time to inquire into their patients' ability to understand health information, perception and beliefs, in order to promote adherence during pregnancy.