Associations and implications of low health literacy in Parkinson's Disease

Predictors of quality of life in primary caregivers of patients with heart failure: A model of health literacy and caregiving burden

BACKGROUND

Heart Failure (HF) is a chronic disease that impairs patients' ability to care for themselves. The accumulation of caregiving activities by caregivers to patients creates stress.

OBJECTIVES

This study intends to investigate the mediating role of caregiving burden in the relationship between health literacy and quality of life of caregivers.

METHODS

This study is a cross-sectional research conducted through a questionnaire survey. A convenience sampling method was employed to select 410 primary caregivers for the study.

RESULTS

The overall mean score for quality of life for caregivers of patients with HF was (49.30±9.64). The results showed that the caregiving burden mediated the relationship between health literacy and quality of life, with the mediating effect accounting for 39.04 % (P < 0.05) of the total effect.

CONCLUSION

Caregiving burden is a mediating variable in the relationship between health literacy and quality of life. Therefore, we offer some recommendations for healthcare professionals: ①We suggest that healthcare professionals provide relevant education and training to caregivers, as this can enhance their knowledge and skills in effectively managing the health condition of patients;②Healthcare professionals can also proactively assess the caregiver's burden level and design personalized support plans based on the assessment results.

The Importance of Digital Health Literacy in an Evolving Parkinson's Disease Care System

Digital health technologies are growing at a rapid pace and changing the healthcare landscape. Our current understanding of digital health literacy in Parkinson's disease (PD) is limited. In this review, we discuss the potential challenges of low digital health literacy in PD with particular attention to telehealth, deep brain stimulation, wearable sensors, and smartphone applications. We also highlight inequities in access to digital health technologies. Future research is needed to better understand digital health literacy among individuals with PD and to develop effective solutions. We must invest resources to evaluate, understand, and enhance digital health literacy for individuals with PD.

Assessment Tools for Measuring Health Literacy and Digital Health Literacy in a Hospital Setting: A Scoping Review

Assessment of (digital) health literacy in the hospital can raise staff awareness and facilitate tailored communication, leading to improved health outcomes. Assessment tools should ideally address multiple domains of health literacy, fit to the complex hospital context and have a short administration time, to enable routine assessment. This review aims to create an overview of tools for measuring (digital) health literacy in hospitals. A search in Scopus, PubMed, WoS and CINAHL, following PRISMA guidelines, generated 7252 hits; 251 studies were included in which 44 assessment tools were used. Most tools (57%) were self-reported and 27% reported an administration time of <5 min. Almost all tools addressed the domain 'understanding' (98%), followed by 'access' (52%), 'apply' (50%), 'appraise' (32%), 'numeracy' (18%), and 'digital' (18%). Only four tools were frequently used: the Newest Vital Sign (NVS), the Short Test of Functional Health Literacy for Adults ((S)TOFHLA), the Brief Health Literacy Screener (BHLS), and the Health Literacy Questionnaire (HLQ). While the NVS and BHLS have a low administration time, they cover only two domains. HLQ covers the most domains: access, understanding, appraise, and apply. None of these four most frequently used tools measured digital skills. This review can guide health professionals in choosing an instrument that is feasible in their daily practice, and measures the required domains.

Association between physical activity and health literacy in patients with Parkinson's disease: an online web survey

BACKGROUND

For patients with Parkinson's disease (PwPD), promotion of habitual physical activity (PA) assists in the prevention of disease progression. Patients' health literacy (HL) is integral for meeting PA standards and turning it into a habit. This study evaluated the association between PA level and each HL domain in PwPD.

METHODS

Online web-based assessment instruments and self-administered questionnaires, including the PA Questionnaire (IPAQ) Short Form and the Functional, Communicative, and Critical Health Literacy (FCCHL) scale, were used to assess PA levels and health literacy domains of PwPD.

RESULTS

The mean age of PwPD (n = 114) was 65.9 (SD = 11.6) years; 59.6% female, and the mean duration of disease was 6.4 (SD = 5.1) years. Of participants, 47.4% met the recommended criteria for PA. When comparing each HL domain by PA level, participants with lower PA had significantly lower critical HL (p = 0.03). Logistic regression analysis revealed that PA level correlated with critical HL (OR = 2.46; 95% CI = 1.16-5.19; p = 0.02).

CONCLUSIONS

Adherence to recommended PA standards was associated with critical HL, but not other HL domains. Proactive attitudes to critically evaluate and utilize as well as understand health information may positively influence the promotion of PA.

Exploring public perceptions and awareness of Parkinson's disease: A scoping review

BACKGROUND

Parkinson's disease (PD) is a common neurological disease affecting around 1% of people above sixty years old. It is characterised by both motor and non-motor symptoms including tremor, slow movement, unsteady gait, constipation and urinary incontinence. As the disease progresses, individuals living with the disease are likely to lose their independence and autonomy, subsequently affecting their quality of life. People with PD should be supported to live well within their communities but there has been limited research regarding what the public know about PD. This review aims to develop an understanding of how the public view people living with PD, which has the potential to aid the development of an educational resource for the future to improve public awareness and understanding of PD. The purpose of this scoping review is to review and synthesise the literature on the public perception and attitudes towards people living with PD and identify and describe key findings.

AIM

This scoping review aims to explore public perceptions and awareness of Parkinson's Disease among diverse populations, encompassing beliefs, knowledge, attitudes, and the broader societal context influencing these perceptions.

METHODS

A scoping review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for ScR (PRISMA-ScR). Four electronic databases were searched systematically (CINAHL Plus, Medline, PsycINFO and International Bibliography of the Social Sciences). The Joanna Briggs Institute Critical Appraisal Tools (JBI) were used to assess the quality of primary studies, however, all relevant studies were considered regardless of their methodological quality. The 'Population-Concept-Context' framework was used in the screening process to identify eligible papers.

RESULTS

A total of 23 studies were included in the review representing global research in quantitative (n = 12) and mixed methods approaches (n = 11). All 23 studies adopted some aspect of cross-sectional design. Three themes emerged from the studies, the first being public knowledge of symptoms, causes and treatment of PD and this highlighted a lack of understanding about the disease. Secondly, the review identified public attitudes towards PD, highlighting the social consequences of the disease, including the association between PD and depression, isolation and loss of independence. Finally, the third theme highlighted that there was a paucity of educational resources available to help increase public understanding of PD.

CONCLUSION

Findings from this scoping review have indicated that public awareness of PD is a growing area of interest. To our knowledge, this is the first scoping review on this topic and review findings have indicated that public knowledge and attitudes towards PD vary internationally. The implications of this are that people with PD are more likely to be a marginalised group within their communities. Future research should focus on understanding the perception of the public from the perspective of people with PD, the development of interventions and awareness campaigns to promote public knowledge and attitude and further high-quality research to gauge public perceptions of PD.

Does Black vs. White race affect practitioners' appraisal of Parkinson's disease?

Black patients are diagnosed with Parkinson's disease (PD) at half the rate as White patients. The reasons for this large disparity are unknown. Here, we review evidence that practitioner bias may contribute. A key sign of PD is hypomimia or decreased facial expressivity. However, practitioner bias surrounding facial expressivity in Black people versus White people may lead practitioners to appraise Black patients with hypomimia as having higher levels of facial expressivity. Furthermore, practitioner bias may cause them to characterize reduced facial expressivity as being due to negative personality traits, as opposed to a medical sign, in Black patients with hypomimia. This racial bias in the evaluation of hypomimia in Black versus White patients could profoundly impact subsequent referral decisions and rates of diagnosis of PD. Therefore, exploring these differences is expected to facilitate addressing health care disparities through earlier and more accurate detection of PD in Black patients.

Hopamine as Personalized Medicine for Persons with Parkinson's Disease

Prescribing dopamine replacement therapy remains the most common approach used by physicians who strive to support persons with Parkinson's disease. In this viewpoint, we argue that instead of merely prescribing dopamine, healthcare professionals should particularly encourage and enable persons with Parkinson's disease to draft their own personalized prescription of "hopamine". The term hopamine is a self-invented neologism representing the uniquely personal set of hopes, desires, experiences, and skills of each individual with a dopamine deficit. As such, the concept of hopamine-as a reflection of the unique personal characteristics of each person with Parkinson's disease-really supplements that of dopamine-as a reflection of each person's unique physical characteristics. Whereas a prescription of dopamine replacement medication necessitates the diagnosed individual to lay his or her fate in the hands of medical professionals, adding a personalized dose of hopamine to the therapeutic mix empowers persons to self-manage daily life with Parkinson's disease. In this viewpoint, we argue that hopamine is a prerequisite for personalized medicine and offer several practical recommendations for how medical professionals can introduce the concept of hopamine in daily clinical practice.

Impact of the COVID-19 pandemic on perceived access and quality of care in German people with parkinsonism

Due to the heterogeneous clinical presentation, people with Parkinsonism (PwP) develop individual healthcare needs as their disease progresses. However, because of limited health resources during the COVID-19 pandemic, many patients were put at risk of inadequate care. All this occurred in the context of inequitable healthcare provision within societies, especially for such vulnerable populations. This study aimed to investigate factors influencing satisfaction and unmet need for healthcare among PwP during the COVID-19 pandemic in Germany. Analyses relied on an anonymous online survey with a 49-item questionnaire. We aimed at describing access to health services before and during the early stages of the pandemic. To this end, a generalized linear model was used to derive significant predictors and a stepwise regression to subsummarize the main factors of perceived inadequate care. In total, 551 questionnaires showed that satisfaction with Parkinsonism-related care decreased significantly during the pandemic (p < 0.001). In particular, factors such as lower educational level, lower perceived expertise of healthcare providers, less confidence in remote care, difficulties in obtaining healthcare, and restricted access to care before the pandemic but also lower densities of neurologists at residence and less ability to overcome barriers were indicative of higher odds to perceive unmet needs (p < 0.05). The results unveil obstacles contributing to reduced access to healthcare during the COVID-19 pandemic for PwP. These findings enable considerations for improved provision of healthcare services to PwP.

Using the Concept of Health Literacy to Understand How People Living with Motor Neurone Disease and Carers Engage in Healthcare: A Longitudinal Qualitative Study

The growing body of information-seeking and decision-making literature in motor neurone disease (MND) has not yet explored the impact of health literacy. Health literacy relates to the skills people have to access, understand, and use health information and is influenced by motivation to engage with healthcare. We aimed to better understand how people affected by MND engage in healthcare by examining longitudinal interview data using the construct of health literacy. Semi-structured interviews were conducted with 19 persons living with MND and 15 carers recruited from a specialist MND clinic using maximum variation sampling. Transcripts were deductively coded using a framework of health literacy behaviours. The analysis used a matrix-based approach for thematic analysis of longitudinal data. People living with MND and carers sought nuanced information dependent on their priorities and attitudes. Information uptake was influenced by perceived relevancy and changed over time. Time allowed opportunity to reflect on and understand the significance of information provided. The findings indicate that persons living with MND and carers benefit when information and consultations are adapted to meet their communication needs. The results highlight the potential benefits of gaining an early understanding of and accommodating the communication needs, personal preferences, and emotional readiness for information for persons living with MND and their carers.

Toward Improved Treatment and Empowerment of Individuals With Parkinson Disease: Design and Evaluation of an Internet of Things System

Background

Parkinson disease (PD) is a chronic degenerative disorder that causes progressive neurological deterioration with profound effects on the affected individual’s quality of life. Therefore, there is an urgent need to improve patient empowerment and clinical decision support in PD care. Home-based disease monitoring is an emerging information technology with the potential to transform the care of patients with chronic illnesses. Its acceptance and role in PD care need to be elucidated both among patients and caregivers.

Objective

Our main objective was to develop a novel home-based monitoring system (named EMPARK) with patient and clinician interface to improve patient empowerment and clinical care in PD.

Methods

We used elements of design science research and user-centered design for requirement elicitation and subsequent information and communications technology (ICT) development. Functionalities of the interfaces were the subject of user-centric multistep evaluation complemented by semantic analysis of the recorded end-user reactions. The ICT structure of EMPARK was evaluated using the ICT for patient empowerment model.

Results

Software and hardware system architecture for the collection and calculation of relevant parameters of disease management via home monitoring were established. Here, we describe the patient interface and the functional characteristics and evaluation of a novel clinician interface. In accordance with our previous findings with regard to the patient interface, our current results indicate an overall high utility and user acceptance of the clinician interface. Special characteristics of EMPARK in key areas of interest emerged from end-user evaluations, with clear potential for future system development and deployment in daily clinical practice. Evaluation through the principles of ICT for patient empowerment model, along with prior findings from patient interface evaluation, suggests that EMPARK has the potential to empower patients with PD.

Conclusions

The EMPARK system is a novel home monitoring system for providing patients with PD and the care team with feedback on longitudinal disease activities. User-centric development and evaluation of the system indicated high user acceptance and usability. The EMPARK infrastructure would empower patients and could be used for future applications in daily care and research.

Scoping review: Influence of cisgender male and female genders on health literacy of the elderly people

This scoping review mapped out the relevant literature, identified gaps and made suggestions on the influence of cisgender on the health literacy (HL) of the elderly people. This scoping review was guided by the PRISMA-ScR checklist. The databases Wiley Online Library™ and Elsevier™ were searched for academic articles published in the English language between February 2011 and February 2021 that met a pre-set criteria of content. The process of selection of sources of evidence based on screening and eligibility of evidence reduced the initially identified 153 sources of evidence in the searched databases to 14 sources of evidence. The content of these 14 sources of evidence was mapped out on a charting table where data was summarised and synthesised individually and collectively by the authors. Repetitive and irrelevant data were deleted. Identified gaps include the lack of extensive exploration of male and female genders alone as a determinant of HL, how gender may be utilised to encourage elderly men and women to apply HL, how different sociocultural and sociodemographic backgrounds of elderly men and women would require separate academic research, the scarcity of social sciences based research and qualitative research methodologies on the subject as well as the use of mixed-methodologies and longitudinal studies. Future research directions were suggested and limitations of this scoping review are addressed in the discussion.

Barriers to Accessing Healthcare Services for People with Parkinson's Disease: A Scoping Review

Parkinson's disease is a complex condition that affects many different aspects of a person's health. Because of its complexity, people with Parkinson's disease require access to a variety of healthcare services. The aim of the present study was to identify the barriers to access healthcare services for people with Parkinson's disease. We conducted a scoping review according to guidelines posed by Arksey & O'Malley (2005). A search of MEDLINE, Embase, CINHAL, and PsycINFO databases was conducted, and 38 articles were selected based on the inclusion criteria. The review findings identified person-level and system-level barriers. The person-level barriers included skills required to seek healthcare services, ability to engage in healthcare and cost for services. The system-level barriers included the availability of appropriate healthcare resources. Based on the existing barriers elucidated in the scope review, we have discussed potential areas in healthcare that require improvement for people with Parkinson's disease to manage their healthcare needs more equitably.

Training physiotherapists to be responsive to their clients' health literacy needs

Objective: To evaluate health literacy learning modules designed specifically for physiotherapists in private practice.Methods: Mixed-method design was used, evaluating pre-post physiotherapist health literacy knowledge and competencies using questionnaires and semi-structured interviews. One rural and one metropolitan private physiotherapy practice were recruited.Participants: Clients, physiotherapists, and other clinic staff. The OPHELIA (Optimizing Health Literacy and Access) process was applied to identify the health literacy needs of clients; co-design interventions; and implement and evaluate the interventions. The health literacy learning modules were co-designed with the physiotherapists and included one 3-h face-to-face workshop, followed by two 1-h videoconference workshops. Health literacy knowledge (rated 1-5 for 10 items, max score 50) and skills (rated 1-5 for 5 items, max score 25) were assessed before and after the workshops. Data were analyzed by paired t-test. Interviews were recorded, transcribed, and thematically analyzed.Results: Health literacy knowledge of 19 health professionals improved after the workshop by 63% (pre 26.0 (7.5), post 41.0 (2.7), p < .001). Health literacy skills improved by 65% (pre 4.2 (3.3), post 21.8 (2.3), p < .001). We identified three themes from interview data: 1) 'the multi-faceted nature of health literacy requires multiple strategies'; 2) 'changing practice to promote understanding'; and 3) 'reflection on roles of multidisciplinary private practice.'Practice Implications: Improvements in health literacy knowledge and skills are possible through post-graduate professional development.Conclusion: Workshops changed physiotherapists' understanding of their role in promoting health literacy.

Novel Outreach Program and Practical Strategies for Patients with Parkinsonism in the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has upended daily life and neurologic care for most patients, including those with Parkinson's disease and parkinsonism. Disruptions to routine care, high volumes of patient and caregiver calls, and our patients' risk of infection and complications inspired a proactive COVID-19 outreach program. This program targets patients with advanced Parkinson's disease and related disorders, specifically those who are homebound, receiving or eligible for palliative care, and/or lacking support networks. We describe the program and practical strategies providers can implement to support wellbeing and successful telehealth uptake during this time of social isolation and gradual reopening.

Health literacy among neurosurgery and other surgical subspecialties: Readability of online patient materials found with Google

OBJECTIVE

To both determine whether the most high-yield online patient materials for surgical specialties meet the 6th grade readability level recommended by the National Institutes of Health (NIH) and American Medical Association (AMA), and to discover differences in readability across specialties. We hypothesize average readability scores will exceed an 11th grade level.

METHODS

The top five most common procedures for each of seven surgical specialties (neurological, orthopedic, plastic, general, thoracic, pediatric, and vascular) were searched using an incognito Google query to minimize location bias. The text from the top five patient-relevant links per procedure, excluding Wikipedia, journal articles, and videos, was extracted and inserted into Readability Studio Software for analysis.

RESULTS

The combined average grade level of materials (± standard deviation) was: 10.47 ± 2.51 Flesh-Kincaid Grade Level (FKGL), 11-12 New Dale-Chall (NDC), 10.09 ± 1.97 Simple Measure of Gobbledygook (SMOG), 12 Fry Graph (FG). Thoracic, neurologic, vascular, plastic, and orthopedic were least readable (grade level 10+ by all metrics).

CONCLUSIONS

High readability of procedure materials for patients is not unique to neurosurgery: all specialties exceeded the recommended 6th grade level by three or more grades. Online patient education materials related to surgical subspecialties must be written more comprehensibly.

Evidence-Based Decision Aid for Patients With Parkinson Disease: Protocol for Interview Study, Online Survey, and Two Randomized Controlled Trials

BACKGROUND

Shared decision making is particularly important in situations with different treatment alternatives. For the treatment of idiopathic Parkinson disease, both pharmacological and surgical approaches can be applied.

OBJECTIVE

In this research project, a series of studies will be conducted to investigate how decision aids for patients with idiopathic Parkinson disease should be designed in order to support the decision-making process.

METHODS

In Study 1a, qualitative interviews will be conducted to determine which needs frequently occur for patients with idiopathic Parkinson disease. In Study 1b, the identified needs will then be rated for personal relevance by an independent group of patients in an online survey. In Study 2, a randomized controlled trial will be used to pretest different decision aids in a sample group of people who do not have a medical background and who do not have Parkinson disease. In Study 3, a randomized controlled trial will be used to investigate the effect of the decision aids that had been evaluated as positive in Study 2 with patients who have idiopathic Parkinson disease.

RESULTS

This series of studies received ethical approval in January 2020. As of June 2020, data collection for Study 1a has started, and it is estimated that Studies 1a, 1b, 2, and 3 will take approximately 4, 4, 6, and 6 months to complete, respectively. It is planned to present the results and analyses at international conferences and to submit the results to peer-reviewed journals for publication, once the studies have been completed. The findings will also be shared with clinicians and patients through presentations at information events.

CONCLUSIONS

This series of studies is intended to result in an evidence-based decision aid for patients with idiopathic Parkinson disease in order to support the informed and reflected shared decision-making process. We further intend to contribute to a deeper understanding of the individual preferences of patients with idiopathic Parkinson disease and the impact of those preferences on treatment decisions.

Disease severity and quality of life in homebound people with advanced Parkinson disease: A pilot study

Background

As Parkinson disease (PD) progresses, symptoms increase, quality of life (QoL) declines, and individuals may become homebound, often losing access to neurologic care. We aimed to determine whether facilitating expert in-home care could improve our understanding of disease progression, treatment options, and unmet needs in this vulnerable population, and whether such a model could mitigate decline in QoL.

Methods

Patients with PD meeting Medicare homebound criteria were eligible for quarterly interdisciplinary home visits over 12 months. Each visit entailed an evaluation by a movement disorders neurologist, social worker, and nurse, including history, examination, medication reconciliation, psychosocial evaluation, pharmacologic and nonpharmacologic management, and service referrals. Disease severity, as measured by the Unified Parkinson's Disease Rating Scale (UPDRS), and QoL using the Neuro-QoL were measured at visits 1 and 4.

Results

Of 27 enrolled patients, 23 completed 4 visits, with high retention and high patient- and caregiver-reported satisfaction. The mean age at baseline was 80.9 years (SD 7.8) with a mean total UPDRS of 65.0 (SD 20.0). After one year of home visits, total UPDRS worsened by a mean of 11.8 points (p < 0.01) without a change in any of 8 QoL domains (p = 0.19-0.95).

Conclusions

Homebound individuals with advanced PD receiving interdisciplinary home visits experienced no significant decline in QoL over 1 year, despite disease progression. Our findings highlight the disease severity and impaired QoL of the advanced, homebound PD population, and the potential for novel approaches to foster continuity of care.

Disease severity and quality of life in homebound people with advanced Parkinson disease: A pilot study

Background

As Parkinson disease (PD) progresses, symptoms increase, quality of life (QoL) declines, and individuals may become homebound, often losing access to neurologic care. We aimed to determine whether facilitating expert in-home care could improve our understanding of disease progression, treatment options, and unmet needs in this vulnerable population, and whether such a model could mitigate decline in QoL.

Methods

Patients with PD meeting Medicare homebound criteria were eligible for quarterly interdisciplinary home visits over 12 months. Each visit entailed an evaluation by a movement disorders neurologist, social worker, and nurse, including history, examination, medication reconciliation, psychosocial evaluation, pharmacologic and nonpharmacologic management, and service referrals. Disease severity, as measured by the Unified Parkinson's Disease Rating Scale (UPDRS), and QoL using the Neuro-QoL were measured at visits 1 and 4.

Results

Of 27 enrolled patients, 23 completed 4 visits, with high retention and high patient- and caregiver-reported satisfaction. The mean age at baseline was 80.9 years (SD 7.8) with a mean total UPDRS of 65.0 (SD 20.0). After one year of home visits, total UPDRS worsened by a mean of 11.8 points (p < 0.01) without a change in any of 8 QoL domains (p = 0.19-0.95).

Conclusions

Homebound individuals with advanced PD receiving interdisciplinary home visits experienced no significant decline in QoL over 1 year, despite disease progression. Our findings highlight the disease severity and impaired QoL of the advanced, homebound PD population, and the potential for novel approaches to foster continuity of care.

'Draw your pelvis' test for assessing pelvic schema in people with Parkinson's disease: a validity and reliability study

Aim: Body schema (i.e., the mental representation of the body and its parts) is important for cognitive and motor functions, with the pelvis constituting a core element in such schema. Although people with Parkinson's disease exhibit misperceptions and deficits in body schema, there are currently no published tools available for assessing pelvic schema in this population. This study aimed to develop and establish feasibility, reliability, and validity of a novel drawing test - 'Draw Your Pelvis' - for assessing pelvic schema in people with Parkinson's disease. Materials and methods: Twenty people with idiopathic Parkinson's disease (Hoehn &Yahr stages I-III; M age: 65.75 ± 10.13) volunteered and were asked to manually draw a picture of their pelvis. Drawings were assessed and scored by 13 blinded raters over two sessions. Intra- and inter-rater reliability and content and criterion validity were investigated. Results: The 'Draw Your Pelvis' test is shown to be feasible and quick to administer, with excellent inter-rater reliability for consistency (0.954-0.968) and absolute agreement (0.946-0.961). It also demonstrates good-excellent (0.614-0.950) intra-rater reliability, and is content valid. Conclusions: The 'Draw Your Pelvis' test holds potential for clinicians and researchers in assessing pelvic schema and its deficits in people with Parkinson's disease. In addition, this test could be used for investigating the effect of therapeutic interventions on body schema in this population. Future studies should explore this test in additional populations.

Educational Needs and Considerations for a Visual Educational Tool to Discuss Parkinson's Disease

Background

In our clinical experience, people with Parkinson's disease (PwP) and their caregivers have difficulty understanding the complexities of the disease, which has a multitude of symptoms and involved therapies. We undertook a needs assessment to understand the need for, and to guide the development of, an educational tool.

Methods

We invited PwP, caregivers and health care providers (HCP) from across Canada to participate in an online survey to determine the need and desired content for such a tool.

Results

Respondents included 450 PwP, 335 caregivers, and 96 HCP from across Canada. 86.5% of HCP reported that it was "very important" for patients to understand issues in PD and 84.4% would use a visual aid to explain these issues. Results showed that 81.9-95.7% of caregivers and PwP were not "very satisfied" with the explanations of all domains in PD. Non-motor symptoms and cognitive issues were highly ranked by all groups as difficult to understand or explain. Older PwP (those with PD for less than 5 years and those who reported that their HCP spent less than 15 minutes counselling in each clinic visit) were less likely to fully understand and be satisfied with the explanations of most issues in PD.

Interpretation

There is a need for better patient education when discussing PD issues in the clinical setting. Older PwP that have been recently diagnosed have the greatest educational needs. Potential users indicate that a visual aid would help and non-motor symptoms, particularly cognitive issues, need to be a focus of such a tool.

Is the Newest Vital Sign a Useful Measure of Health Literacy in HIV Disease?

BACKGROUND

Limited health literacy is common among persons infected with HIV and has been linked to poor mental and physical health outcomes, but there are no well-validated screening measures of health literacy in this vulnerable clinical population. The present study evaluates the usefulness of the Newest Vital Sign (NVS) as a brief measure of health literacy in HIV disease.

METHODS

Seventy-eight HIV+ adults were administered the NVS, Rapid Estimate of Adult Literacy in Medicine (REALM), and Single Item Literacy Screener (SILS). Main criterion variables included plasma HIV viral load, medication management capacity, self-efficacy for medication management, and perceived relationships with healthcare providers.

RESULTS

The NVS showed good internal consistency and moderate correlations with the REALM and SILS. Rates of limited health literacy were highest on the NVS (30.3%) as compared to SILS (6.6%) and REALM (9.2%). A series of regressions controlling for education showed that the NVS was incrementally predictive of viral load, medication management capacity and self-efficacy, and relationships with healthcare providers, above and beyond the REALM and SILS.

CONCLUSION

The NVS shows evidence of reliability, convergent validity, and incremental criterion-related validity and thus may serve as useful screening tool for assessing health literacy in HIV disease.

The diagnostic pathway of Parkinson's disease: a cross-sectional survey study of factors influencing patient dissatisfaction

BACKGROUND

The diagnostic pathway of Parkinson's disease (PD) is often complicated. Experiences during this pathway can affect patients' satisfaction and their confidence and trust in healthcare providers. Although healthcare providers cannot influence the impact of the diagnosis, they can influence how patients experience the pathway. This study, therefore, aims to provide insight into PD patients' dissatisfaction with the diagnostic pathway and to describe the factors that influence it.

METHODS

We carried out a cross-sectional survey study among 902 patient members of the Dutch Parkinson's Disease Association, who were each asked to write an essay about their diagnostic pathway. A coding format was developed to examine the content of these essays. Inter-observer agreement on coding patient dissatisfaction was calculated using Cohen's kappa. The χ² test and a multivariable logistic regression analysis were performed to assess the relation between dissatisfaction and sex, level of education, duration of the pathway, communication with the general practitioner (GP) and the neurologist, the number of healthcare providers involved, whether or not a second opinion had taken place (including the person who initiated it) and diagnostic delay (taking into consideration who caused the delay according to the patient). A subgroup analysis was performed to gain insight into sex-related differences.

RESULTS

Of all patients, 16.4% explicitly described they were dissatisfied with the diagnostic pathway, whereas 4.8% were very satisfied. The inter-observer agreement on coding dissatisfaction was κ = 0.82. The chance of dissatisfaction increased with a lower level of education, the involvement of more than one additional healthcare provider, a second opinion initiated by the patient and delay caused by a healthcare provider. When only the GP and the neurologist were involved, women were more likely to be dissatisfied than men.

CONCLUSIONS

PD patients' dissatisfaction with the diagnostic pathway is related to a lower level of education, a second opinion initiated by the patient and experienced diagnostic delay. GPs can positively influence patients' experiences if they are aware of these risk factors for dissatisfaction and pay extra attention to communication and shared decision making. This will contribute to a trusting therapeutic relationship that is indispensable with progression of the disease.

Health literacy in the urgent care setting: What factors impact consumer comprehension of health information?

BACKGROUND

An increasing number of Americans are using urgent care (UC) clinics due to: improved health insurance coverage, the need to decrease cost, primary care offices with limited appointment availability, and a desire for convenient care. Patients are treated by providers they may not know for episodic illness or injuries while in pain or not feeling well. Treatment instructions and follow-up directions are provided quickly.

PURPOSE

To examine health literacy in the adult UC population and identify patient characteristics associated with health literacy risk.

METHODS

As part of a larger cross-sectional study, UC patients seen between October 2013 and January 2014 completed a demographic questionnaire and the Newest Vital Sign. Descriptive, nonparametric analyses, and a multinomial logistic regression were done to assess health literacy, associated and predictive factors.

RESULTS

A total of 57.5% of 285 participants had adequate health literacy. The likelihood of limited health literacy was associated with increased age (p < .001), less education (p < .001), and lower income (p = .006).

CONCLUSIONS/IMPLICATIONS

Limited health literacy is common in a suburban UC setting, increasing the risk that consumers may not understand vital health information. Clear provider communication and confirmation of comprehension of discharge instructions for self-management is essential to optimize outcomes for UC patients.