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Bakker MM, Luttikhuis T, Putrik P, Jansen I, Rademakers J, de Wit M, Boonen A. Consideration of health literacy in patient information: a mixed-methods study of COVID-19 crisis communication in Dutch rheumatology. BMC Rheumatol 2022; 6:52. [PMID: 36068591 PMCID: PMC9449268 DOI: 10.1186/s41927-022-00283-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 06/07/2022] [Indexed: 11/27/2022] Open
Abstract
Background The rapid spread of COVID-19 required swift action to provide people with rheumatic and musculoskeletal diseases (RMDs) with reliable information. People with limited health literacy constitute a vulnerable group that might have difficulty accessing, understanding and applying health information, particularly in times of crisis.
Objectives This study explored (a) key aspects of crisis communication and (b) explicit consideration of people’s health literacy needs in communication to people with RMDs during the first wave of COVID-19 in the Netherlands. Methods We conducted a convergent, qualitatively driven mixed-methods study comprising seven qualitative interviews with professional representatives of organisations responsible for information provision to people with RMDs, and quantitative analysis of 15 patient information materials distributed by these organisations. The study was guided by principles of crisis communication and health literacy. We assessed understandability and actionability of information materials using the Dutch version of the Patient Education Materials Assessment Tool (PEMAT, resulting in a percentage of quality criteria met), and language difficulty level using an online application (assessing difficult words, jargon, passive, complex and long sentences, long paragraphs, and difficulty levels according to the Common European Framework of Reference for Languages (CEFR, from A1 (basic) to C2 (proficient))). Results Respondents reported lack of preparedness, challenges related to scientific uncertainty and reaching the target group, difficulty simplifying information, and uncertainty regarding adequacy of the communication approach. Patient information materials (written and video) showed variation in actionability (range 60–100%) and understandability (range 58–100%), and 69% of written materials were too difficult, mostly due to the use of long sentences and difficult words. The quantitative findings were in coherence with the limitations in communication reported by respondents. Several potential improvements were formulated in ‘lessons learned’. Conclusions Although rheumatology organisations mostly adhered to principles of crisis communication and made efforts to adapt information to their audience’s needs, we propose recommendations to improve preparedness, strategy, content, reach and consideration of health literacy needs in future crisis communication. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-022-00283-x. Rheumatology organisations reported efforts to align with principles of crisis communication and health literacy. Patients’ health literacy needs were insufficiently considered and patient information materials were too difficult. Improving preparedness, collaboration between organisations and disciplines, and adaptation to patients’ needs is necessary.
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Affiliation(s)
- Mark Matthijs Bakker
- Department of Internal Medicine, Division of Rheumatology, Maastricht UMC, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. .,CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
| | - Tess Luttikhuis
- Department of Internal Medicine, Division of Rheumatology, Maastricht UMC, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Polina Putrik
- Department of Internal Medicine, Division of Rheumatology, Maastricht UMC, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Isabelle Jansen
- Department of Internal Medicine, Division of Rheumatology, Maastricht UMC, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Jany Rademakers
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Nivel Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Maarten de Wit
- Tools2Use Patient Association, Amsterdam, The Netherlands
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht UMC, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Elemam NM, Maghazachi AA, Hannawi S. COVID-19 infection and rheumatoid arthritis: mutual outburst cytokines and remedies. Curr Med Res Opin 2021; 37:929-938. [PMID: 33754931 PMCID: PMC8040489 DOI: 10.1080/03007995.2021.1906637] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/14/2021] [Indexed: 02/08/2023]
Abstract
In March 2020, COVID-19 infection caused by SARS-CoV-2 has been declared to be a global pandemic, where its complications, severity and mortality are reported to be due to the released inflammatory cytokines or the so-called cytokine storm. This is quite similar to that observed in the autoimmune and chronic inflammatory rheumatic disease, rheumatoid arthritis (RA). It was hypothesized that RA patients are at a higher risk of acquiring COVID-19; however, recent studies reported that they are not when compared to the rest of the population. In this review, we aim to highlight the mutual pathological features, cytokine profiles and risk factors between COVID-19 and RA. Also, many researchers are currently working to explore therapeutic agents that could aid in the eradication of COVID-19 infection. Due to the similarity between the inflammation status in COVID-19 and RA, many anti-rheumatic drugs such as hydroxychloroquine, tocilizumab, baricitinib and anakinra were proposed to be therapeutic modalities for COVID-19 infection.
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Affiliation(s)
- Noha Mousaad Elemam
- Sharjah Institute for Medical Research, College of Medicine, University of Sharjah, Sharjah, UAE
| | - Azzam A. Maghazachi
- Sharjah Institute for Medical Research, College of Medicine, University of Sharjah, Sharjah, UAE
| | - Suad Hannawi
- Department of Rheumatology, Ministry of Health and Prevention, Dubai, UAE
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Berkovic D, Ackerman IN, Briggs AM, Ayton D. Tweets by People With Arthritis During the COVID-19 Pandemic: Content and Sentiment Analysis. J Med Internet Res 2020; 22:e24550. [PMID: 33170802 PMCID: PMC7746504 DOI: 10.2196/24550] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Emerging evidence suggests that people with arthritis are reporting increased physical pain and psychological distress during the COVID-19 pandemic. At the same time, Twitter's daily usage has surged by 23% throughout the pandemic period, presenting a unique opportunity to assess the content and sentiment of tweets. Individuals with arthritis use Twitter to communicate with peers, and to receive up-to-date information from health professionals and services about novel therapies and management techniques. OBJECTIVE The aim of this research was to identify proxy topics of importance for individuals with arthritis during the COVID-19 pandemic, and to explore the emotional context of tweets by people with arthritis during the early phase of the pandemic. METHODS From March 20 to April 20, 2020, publicly available tweets posted in English and with hashtag combinations related to arthritis and COVID-19 were extracted retrospectively from Twitter. Content analysis was used to identify common themes within tweets, and sentiment analysis was used to examine positive and negative emotions in themes to understand the COVID-19 experiences of people with arthritis. RESULTS In total, 149 tweets were analyzed. The majority of tweeters were female and were from the United States. Tweeters reported a range of arthritis conditions, including rheumatoid arthritis, systemic lupus erythematosus, and psoriatic arthritis. Seven themes were identified: health care experiences, personal stories, links to relevant blogs, discussion of arthritis-related symptoms, advice sharing, messages of positivity, and stay-at-home messaging. Sentiment analysis demonstrated marked anxiety around medication shortages, increased physical symptom burden, and strong desire for trustworthy information and emotional connection. CONCLUSIONS Tweets by people with arthritis highlight the multitude of concurrent concerns during the COVID-19 pandemic. Understanding these concerns, which include heightened physical and psychological symptoms in the context of treatment misinformation, may assist clinicians to provide person-centered care during this time of great health uncertainty.
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Affiliation(s)
- Danielle Berkovic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Darshini Ayton
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Mancuso CA, Duculan R, Jannat-Khah D, Barbhaiya M, Bass AR, Mehta B. Rheumatic Disease-Related Symptoms During the Height of the COVID-19 Pandemic. HSS J 2020; 16:36-44. [PMID: 32982613 PMCID: PMC7500497 DOI: 10.1007/s11420-020-09798-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Systemic rheumatic diseases are characterized by diverse symptoms that are exacerbated by stressors. QUESTIONS/PURPOSES Our goal was to identify COVID-19-related stressors that patients associated with worsening rheumatic disease symptoms. METHODS With approval of their rheumatologists, patients at an academic medical center were interviewed with open-ended questions about the impact of COVID-19 on daily life. Responses were analyzed with qualitative methods using grounded theory and a comparative analytic approach to generate categories of stressors. RESULTS Of 112 patients enrolled (mean age 50 years, 86% women, 34% non-white or Latino, 30% with lupus, 26% with rheumatoid arthritis), 2 patients had SARS-CoV-2 infection. Patients reported that coping with challenges due to the pandemic both directly and indirectly worsened their rheumatic disease symptoms. Categories associated with direct effects were increased fatigue (i.e., from multitasking, physical work, and taking precautions to avoid infection) and worsening musculoskeletal and cognitive function. Categories associated with indirect effects were psychological worry (i.e., about contracting SARS-COV-2, altering medications, impact on family, and impact on job and finances) and psychological stress (i.e., at work, at home, from non-routine family responsibilities, about uncertainty related to SARS-CoV-2, and from the media). Patients often reported several effects coalesced in causing more rheumatic disease symptoms. CONCLUSION Coping with the COVID-19 pandemic was associated with rheumatic disease-related physical and psychological effects, even among patients not infected with SARS-CoV-2. According to patients, these effects adversely impacted their rheumatic diseases. Clinicians will need to ascertain the long-term sequelae of these effects and determine what therapeutic and psychological interventions are indicated.
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Affiliation(s)
- Carol A. Mancuso
- Research Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY USA
- Department of Medicine, Weill Cornell Medicine, New York, NY USA
| | - Roland Duculan
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY USA
| | - Deanna Jannat-Khah
- Department of Medicine, Weill Cornell Medicine, New York, NY USA
- Division of Rheumatology, Hospital for Special Surgery, New York, NY USA
- Research Division, Biostatistics Core, Hospital for Special Surgery, New York, NY USA
| | - Medha Barbhaiya
- Department of Medicine, Weill Cornell Medicine, New York, NY USA
- Division of Rheumatology, Hospital for Special Surgery, New York, NY USA
| | - Anne R. Bass
- Department of Medicine, Weill Cornell Medicine, New York, NY USA
- Division of Rheumatology, Hospital for Special Surgery, New York, NY USA
| | - Bella Mehta
- Department of Medicine, Weill Cornell Medicine, New York, NY USA
- Division of Rheumatology, Hospital for Special Surgery, New York, NY USA
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Howren A, Aviña-Zubieta JA, Rebić N, Dau H, Gastonguay L, Shojania K, Davidson E, De Vera MA. Virtual rheumatology appointments during the COVID-19 pandemic: an international survey of perspectives of patients with rheumatic diseases. Clin Rheumatol 2020; 39:3191-3193. [PMID: 32803570 PMCID: PMC7429087 DOI: 10.1007/s10067-020-05338-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/29/2020] [Accepted: 08/08/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Alyssa Howren
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada.,Arthritis Research Canada, Richmond, BC, Canada
| | - J Antonio Aviña-Zubieta
- Arthritis Research Canada, Richmond, BC, Canada.,Department of Medicine, Division of Rheumatology, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - Nevena Rebić
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada.,Arthritis Research Canada, Richmond, BC, Canada
| | - Hallie Dau
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada
| | - Louise Gastonguay
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada
| | - Kam Shojania
- Arthritis Research Canada, Richmond, BC, Canada.,Department of Medicine, Division of Rheumatology, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | | | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada. .,Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada. .,Arthritis Research Canada, Richmond, BC, Canada.
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