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Yunita SL, Yang HW, Chen YC, Kao LT, Lu YZ, Wen YL, To SY, Huang YL. Knowledge and practices related to antibiotic use among women in Malang, Indonesia. Front Pharmacol 2022; 13:1019303. [PMID: 36353493 PMCID: PMC9637850 DOI: 10.3389/fphar.2022.1019303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/10/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Antimicrobial resistance is a public health problem that threatens the efficacy of antibiotics. Incorrect knowledge of antibiotics may lead to their inappropriate use, hinder their effectiveness, and cause antibiotic resistance. Population-based educational campaigns have been found to have either mixed or no effect on improving knowledge and appropriate antibiotic practices, suggesting the need for more targeted approaches in tailoring education for specific subpopulations. Women are the primary caregivers of their families and are more willing to contact healthcare providers. They had greater knowledge of antibiotics and better adherence to the completion of the antibiotic regimen. Therefore, they are suitable for prioritization in a campaign program. Objective: This study examined the knowledge and practices of female visitors to health centers in Malang, Indonesia with respect to antibiotic use. Methods: This cross-sectional study was conducted in Malang, Indonesia, in July and August 2018. Data were collected from 677 women. Multivariate logistic regression was performed to identify the potential factors associated with antibiotic knowledge, self-medication, and completion of antibiotic regimens. Results: Overall, 82.7% of respondents were aware that antibiotics are used against bacteria, while 38.4% reported self-medication with antibiotics and 51.7% reported completing antibiotic regimens. Women with higher education, previous antibiotic use experience, and very easy accessibility to primary doctors were more likely to have high antibiotic knowledge than those with primary education, no antibiotic use in the previous year, and easy/other level of accessibility to primary doctors. Subjects residing in urban areas and with less accessibility to primary doctors were more likely to self-medicate with antibiotics. Additionally, the completion of antibiotic regimens was positively associated with access to a primary care doctor and high antibiotic knowledge. Conclusion: IF Policymakers tend to reduce inappropriate antibiotic use among women. Priority advocates are recommended for urban residents who have experiences of antibiotic use in the previous year. It is therefore important to increase their awareness, particularly regarding diseases against which antibiotics are effective, and activities such as unnecessary use of antibiotics in healthy animals, which may affect their overall effectiveness among humans. More communication channels should be included in the overall scheme to improve the public awareness and accessibility of health professionals.
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Affiliation(s)
- Sendi Lia Yunita
- Pharmacy Department, Faculty of Health Science, University of Muhammadiyah Malang, Malang, Indonesia
| | - Hui-Wen Yang
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Chun Chen
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Li-Ting Kao
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
- Department of Pharmacy Practice, Tri-Service General Hospital, Taipei, Taiwan
| | - Yi-Zi Lu
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Yuan-Liang Wen
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Sheng-Yin To
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Ya-Li Huang
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- *Correspondence: Ya-Li Huang,
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Svalestuen S, Svendsen K, Eggen AE, Småbrekke L. Association of area-level education with the regional growth trajectories of rates of antibacterial dispensing to patients under 3 years in Norway: a longitudinal retrospective study. BMJ Open 2022; 12:e058491. [PMID: 36691217 PMCID: PMC9462082 DOI: 10.1136/bmjopen-2021-058491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 08/19/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To examine the association between area-level education and the local growth trajectories in antibacterial dispensing rates in Norwegian municipalities among children under 3 years old. DESIGN Retrospective, longitudinal study using individual primary care prescription data from the Norwegian Prescription Database for the period 2006-2016. Data were collected on the date of dispensing, the type and amount of antibiotic, the patient's age, sex and municipality of residence and linked to municipality-level statistics on education available from Statistics Norway. We used multilevel growth curve modelling, with a linear trend variable modelled as a random effect and a cross-level interaction between linear trends and the proportion of the population in the municipality having received a university or college education. SETTING The local government level in Norway. The sample includes all municipalities over the study period. OUTCOME MEASURE Number of dispensed antibacterial prescriptions per 100 children in individual primary care by municipality and year. RESULTS We identified a significant negative linear trend in the square root of the dispensing rate for children under 3 years old during the period. This trend varied between municipalities. A negative cross-level interaction term between population education levels and random trends showed that municipalities with an average level of population education saw a reduction in their square root dispensing rates of -0.053 (95% CI -0.066 to -0.039) prescriptions per 100 children. Each additional percentage point in population education contributed a further -0.0034 (95% CI -0.006 to -0.001) reduction to the square root dispensing rate. CONCLUSIONS Municipalities in which a larger proportion of the local population have high educational achievements have been more successful in reducing antibacterial dispensing rates in children under 3 years old. Adopting area-level strategies and addressing local community disadvantages may help to optimise practices and prescribing patterns across local communities.
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Affiliation(s)
- Sigbjørn Svalestuen
- Department of Social Science, UiT The Arctic University of Norway, Tromso, Troms og Finnmark, Norway
| | - Kristian Svendsen
- Department of Pharmacy, UiT The Arctic University of Norway, Tromso, Troms og Finnmark, Norway
| | - Anne Elise Eggen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromso, Troms og Finnmark, Norway
| | - Lars Småbrekke
- Department of Pharmacy, UiT The Arctic University of Norway, Tromso, Troms og Finnmark, Norway
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3
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Shebehe J, Ottertun E, Carlén K, Gustafson D. Knowledge about infections is associated with antibiotic use: cross-sectional evidence from the health survey Northern Ireland. BMC Public Health 2021; 21:1041. [PMID: 34078338 PMCID: PMC8170648 DOI: 10.1186/s12889-021-11018-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 05/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antibiotic overuse is the main modifiable driver of antibiotic resistance. Factors associated with overuse have been inconsistently reported and vary across populations. Given the burgeoning occurrence of infectious diseases around the world, there remains a great need to identify barriers and solutions to the control of infections. We examined whether knowledge about infections and antibiotic resistance is associated with antibiotic use in a northern European population sample. METHODS The Health Survey Northern Ireland 2014/15 was completed by a cross-sectional sample of 4135 participants aged > 16 years. Participants were asked whether they had taken an antibiotic in the past 12 months; and six questions were asked concerning knowledge about infections and antibiotic resistance. Correct answers to the six knowledge questions defined a knowledge score (score range 0-6 correct answers). We used multivariable logistic regression to estimate odds of self-reported antibiotic use during the last 12 months in association with knowledge score (lowest score, 0/6, as referent), and response to each knowledge question. Covariates included sex, age group, smoking, alcohol drinking, deprivation index, self-rated health, and satisfaction with life. Results were outputted as Odds Ratios (OR) and 95% Confidence Intervals (CI). RESULTS Antibiotic use in the past 12 months was reported by 39.0% (1614/4135); and 84.2% (3482/4135) scored < 6/6 correct on knowledge statements. Compared to the lowest knowledge score (0/6 correct), the highest knowledge score (6/6 correct) was associated with higher odds of antibiotic use (adjusted OR 2.03, 95% CI [1.46, 2.81], p < 0.001), with a P-value < 0.001 for trend with increasing knowledge score. Female sex, age, high deprivation, and poor general health, were independently associated with higher odds of antibiotic use. Stratified analyses showed sex and age group differences. CONCLUSION Knowledge, and other modifiable and non-modifiable risk factors, were positively associated with antibiotic use in the past 12 months. While the causal direction of these associations could not be determined, given the high prevalence of lesser knowledge, as well as independent contributions of other factors including socioeconomic characteristics, health literacy campaigns to raise awareness of antibiotic resistance should take a multi-pronged approach.
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Affiliation(s)
- J Shebehe
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
| | - E Ottertun
- School of Health Sciences, University of Skövde, Skövde, Sweden
| | - K Carlén
- School of Health Sciences, University of Skövde, Skövde, Sweden
| | - D Gustafson
- School of Health Sciences, University of Skövde, Skövde, Sweden
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
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Vaidya S. The impact of premium subsidies on health plan choices in Switzerland: Who responds to the incentives set by in-kind as opposed to cash transfers? Health Policy 2021; 125:675-684. [PMID: 33823984 DOI: 10.1016/j.healthpol.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/03/2021] [Accepted: 03/19/2021] [Indexed: 11/15/2022]
Abstract
Mandatory health insurance in Switzerland operates on a community-based premium scheme. This can lead to a high financial burden on lower income individuals. Until 2014, premium subsidies were paid as cash transfer or in-kind transfer, providing different incentives to individuals for choosing their health plans. Using a difference-in-differences strategy, the impact of in-kind subsidy transfers on deductible choice and the choice of a cost-saving health plan was evaluated to understand effect heterogeneity based on individual background characteristics. The results indicate that eligible individuals from in-kind transfer cantons in general are incentivized to choose a low deductible plan compared to eligible individuals from cash transfer cantons. This effect is found strongest among female, middle-aged and healthy individuals who have most flexibility in adjusting their health plan choices in response to the financial incentives. Additionally, eligible individuals are less likely to choose a cost-saving health plan compared to a cash transfer canton.
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Affiliation(s)
- Shalvaree Vaidya
- University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland.
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Cytomegalovirus infection in pregnancy - An update. Eur J Obstet Gynecol Reprod Biol 2020; 258:216-222. [PMID: 33454510 DOI: 10.1016/j.ejogrb.2020.12.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/01/2020] [Accepted: 12/08/2020] [Indexed: 12/25/2022]
Abstract
Cytomegalovirus (CMV) is a ubiquitous DNA virus with a global seroprevalence of 83 %. It is the most common pathogen causing teratogenic congenital infection. It is therefore a major public health concern. Maternal infection is associated with congenital CMV (cCMV), the leading cause of non-genetic sensorineural hearing loss. cCMV also causes impairment of cognitive development and cerebral palsy. Transmission of CMV occurs through direct contact with bodily fluids such as saliva, urine or semen from someone who is actively shedding the virus. Transmission rates are higher after primary infection with the rate of transmission increasing with gestational age. Severe fetal effects are however more common when infection occurs before 20weeks. Past infection does not confer immunity to mother or protect the fetus. cCMV may present with cerebral or extracerebral abnormalities on ultrasound, fetal growth restriction and fetal loss. Diagnosis of primary maternal CMV in pregnancy should be based on seroconversion in pregnancy (de novo appearance of virus-specific immunoglobulin G (IgG) in the serum of pregnant women who were previously seronegative) or on detection of specific immunoglobulin M (IgM) and IgG antibodies in association with low IgG avidity. Prenatal diagnosis of fetal CMV is imperfect and based on amniocentesis performed at least 8 weeks after presumed maternal infection and after 17 weeks of gestation. Hygiene information and education of pregnant women is currently the most effective strategy for prevention of CMV infection. The role of vaccines, antiviral drugs and immunoglobulins remains unproven.
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Ciobanu AM, Gica N, Gica C, Botezatu R, Furtuna M, Peltecu G, Panaitescu AM. Cytomegalovirus Infection in Pregnancy - Counselling Challenges in the Setting of Generalised Testing. MAEDICA 2020; 15:253-257. [PMID: 32952692 PMCID: PMC7482684 DOI: 10.26574/maedica.2020.15.2.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Cytomegalovirus (CMV) is the most common cause of perinatal viral infection, affecting 0.2-2.2% of all neonates, with variation among different study populations. It can cause serious long-term neurological sequelae, being the leading cause of non-genetic congenital hearing loss. The risk of congenital infection is highest after primary maternal infection, varying between 30-70% and depending on the gestational age at the time of infection. Although CMV can have serious neurodevelopmental consequences, in most developed countries current guidelines do not recommend routine screening for CMV in pregnancy, since current tests have a low predictive value for cases with serious adverse outcome and efficient therapeutic options are not standardized yet. In Romania there is a routine clinical practice to offer screening for most common causes of infections, including CMV, in the first trimester of pregnancy In these settings, this review summarizes the current methods of diagnosis and management of CMV infection in pregnancy.
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Affiliation(s)
- Anca Maria Ciobanu
- Filantropia Clinical Hospital, Bucharest, Romania, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Nicolae Gica
- Filantropia Clinical Hospital, Bucharest, Romania, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Corina Gica
- Filantropia Clinical Hospital, Bucharest, Romania, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Radu Botezatu
- Filantropia Clinical Hospital, Bucharest, Romania, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Mirona Furtuna
- Filantropia Clinical Hospital, Bucharest, Romania, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Gheorghe Peltecu
- Filantropia Clinical Hospital, Bucharest, Romania, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Anca Maria Panaitescu
- Filantropia Clinical Hospital, Bucharest, Romania, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Hermsen ED, MacGeorge EL, Andresen ML, Myers LM, Lillis CJ, Rosof BM. Decreasing the Peril of Antimicrobial Resistance Through Enhanced Health Literacy in Outpatient Settings: An Underrecognized Approach to Advance Antimicrobial Stewardship. Adv Ther 2020; 37:918-932. [PMID: 31953805 PMCID: PMC6999167 DOI: 10.1007/s12325-019-01203-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Indexed: 01/27/2023]
Abstract
Globally, antimicrobial resistance (AMR) is a serious problem causing 700,000 deaths annually. By 2050, AMR is expected to cause approximately 10 million deaths globally each year if allowed to increase at the present rate. Many individuals have limited knowledge regarding appropriate antibiotic use and AMR. Most antibiotic use occurs in the outpatient setting, with approximately 30% of antibiotics prescribed deemed unnecessary. Antimicrobial stewardship (AMS) is a means to reduce inappropriate antibiotic use and AMR. While existing AMS efforts generally focus on the inpatient setting, a significant gap is present in the outpatient setting. A common theme across various national action plans to reduce AMR is the need for education and awareness. The importance of communicating information in a manner easily comprehended by the patient in addition to productive clinician-patient dialogue cannot be overestimated. Enhancing the public's and patients' AMS health literacy is an underrecognized approach to help address AMR. We describe Four Core Elements of Enhancing AMS Health Literacy in the Outpatient Setting, utilizing the Centers for Disease Control and Prevention's framework: (1) leadership commitment, (2) intervention/action, (3) tracking/reporting, and (4) education/expertise. We call upon leaders in outpatient settings to embrace this approach to curb inappropriate antimicrobial use.
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Affiliation(s)
| | | | | | | | | | - Bernard M Rosof
- QHC Advisory Group, Lloyd Harbor, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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8
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Wang J, Sheng Y, Ni J, Zhu J, Zhou Z, Liu T, Zhang X, Zhao Q. Shanghai Parents' Perception And Attitude Towards The Use Of Antibiotics On Children: A Cross-Sectional Study. Infect Drug Resist 2019; 12:3259-3267. [PMID: 31802917 PMCID: PMC6802538 DOI: 10.2147/idr.s219287] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/28/2019] [Indexed: 12/26/2022] Open
Abstract
Background Parents play an important role in the management of their children’s illnesses, including in decisions concerning how and whether to use antibiotics. This study aims to assess the knowledge and attitude towards antibiotics usage among young parents from different areas in Shanghai and to identify contributing factors of antibiotics usage that are comprehensible for parents. Methods A cross-sectional study was conducted at vaccination clinics of three community health centers from April to June 2017. Primary guardians who took children for vaccination under the national expanded immunization program were invited to participate. Results Of the 1368 young parents interviewed, 78.4% of them have taken their children for medical treatment, and 68.9% of their children have taken antibiotics. Parents with education level of senior high school (OR=1.850, 95% CI: 1.214–2.818), or university/college, or above (OR=3.950, 95% CI: 2.604–5.991), and parents with high-income (OR=1.360, 95% CI: 1.013–1.827) have better comprehension of antibiotics. It is found that parents who deny the existence of antibiotic abuse in China (OR=1.857, 95% CI: 1.100–3.135), who have lower income (OR=1.536, 95% CI: 1.074–2.197) and who have antibiotics prescribed by doctors (OR=1.473, 95% CI: 1.048–2.070) are associated with those incorrect practices. Conclusion Lack of knowledge and poor perception of antibiotics usage are found among young parents in Shanghai. Intervention should be conducted to publicize the rational use of antibiotics, reduce the rate of inappropriate behaviors and limit the sale of antibiotics.
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Affiliation(s)
- Jian Wang
- Department of General Practice, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yuchao Sheng
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, People's Republic of China.,The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, People's Republic of China
| | - Jun Ni
- Vaccination Clinics, Gangyan Community Health Service Center, Shanghai, People's Republic of China
| | - Jianyu Zhu
- Vaccination Clinics, Tangqiao Community Health Service Center, Shanghai, People's Republic of China
| | - Zhigang Zhou
- Vaccination Clinics, Tangqiao Community Health Service Center, Shanghai, People's Republic of China
| | - Tianwei Liu
- Vaccination Clinics, Tangqiao Community Health Service Center, Shanghai, People's Republic of China
| | - Xiaoying Zhang
- Vaccination Clinics, Huacao Community Health Service Center, Shanghai, People's Republic of China
| | - Qi Zhao
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, People's Republic of China.,The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, People's Republic of China
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Lor M, Koleck TA, Bakken S, Yoon S, Dunn Navarra AM. Association Between Health Literacy and Medication Adherence Among Hispanics with Hypertension. J Racial Ethn Health Disparities 2019; 6:517-524. [PMID: 30607576 DOI: 10.1007/s40615-018-00550-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Poor adherence to prescribed antihypertensive medication is a major contributor to disparities in effective blood pressure control among Hispanics. The purpose of this study was to investigate the association between health literacy level and adherence to antihypertensive medications among Hispanic adults, who self-reported hypertension, controlling for potential covariates of adherence and/or health literacy. METHODS We conducted a cross-sectional survey of 1355 Hispanic adults, primarily Dominicans, who self-reported hypertension. Antihypertensive medication adherence and health literacy were evaluated along with covariates, including sociodemographic characteristics, depression, anxiety, and sleep disturbance. Linear regression models were created for health literacy, each covariate, and adherence. Factors found to be significantly associated with adherence in the individual regression models at a p value of < 0.20 were included in a hierarchical multiple linear regression model. RESULTS Overall, the majority of participants had low adherence levels to antihypertensive medications (88.4%; n = 1026) and inadequate health literacy (84.9%; n = 1151). When controlling for age, sex, birth country, education level, recruitment location, depression, anxiety, and sleep disturbance, having adequate as compared to inadequate health literacy was associated with a higher adherence score (b = 0.378, p = 0.043). The full model explained 13.6% of the variance in medication adherence (p value < 0.001), but the unique contribution of health literacy to the model was minimal (R2 change = 0.003). CONCLUSIONS Tailored interventions considering health literacy are needed to support medication adherence in order to improve hypertension outcomes of Hispanics. Additional studies are needed to identify and prioritize factors in the development of targeted and effective adherence interventions for Hispanics with hypertension.
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Affiliation(s)
- Maichou Lor
- School of Nursing, Columbia University, New York City, NY, USA
| | | | - Suzanne Bakken
- School of Nursing, Columbia University, New York City, NY, USA.,Biomedical Informatics, Columbia University, New York City, NY, USA.,Data Science Institute, Columbia University, New York City, NY, USA
| | - Sunmoo Yoon
- School of Nursing, Columbia University, New York City, NY, USA
| | - Ann-Margaret Dunn Navarra
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York City, NY, 10010, USA.
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Ellbrant J, Åkeson J, Eckner J, Karlsland Åkeson P. Influence of social characteristics on use of paediatric emergency care in Sweden - a questionnaire based study. BMC Emerg Med 2018; 18:59. [PMID: 30587134 PMCID: PMC6307227 DOI: 10.1186/s12873-018-0210-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 12/06/2018] [Indexed: 11/28/2022] Open
Abstract
Background Parental social characteristics influence the use of emergency departments (ED) in the USA, but less is known about paediatric ED care-seeking in countries with national health insurance. This prospective study was designed to evaluate associations between parental care-seeking and social characteristics, with emphasis on impact of non-native origin, at a paediatric ED in Sweden, a European country providing paediatric healthcare free of charge. Methods Parents attending a paediatric ED at a large urban university hospital filled out a questionnaire on social characteristics and reasons for care-seeking. Information on patient characteristics and initial management was obtained from ED registers and patient records. Paediatric ED physicians assessed the medical appropriateness of each patient visit triaged for ED care. Results In total, 962 patient visits were included. Telephone healthline service before the paediatric ED visit was less often used by non-native parents (63/345 vs. 249/544, p < 0.001). Low-aquity visits, triaged away from the ED, were more common among non-native parents (80/368 vs. 67/555, OR = 1.66; p = 0.018), and among those reporting lower abilities in the Swedish language (23/82 vs. 120/837, OR = 2.66; p = 0.003). Children of non-native parents were more often assessed by physicians not to require ED care (122/335 vs. 261/512, OR = 0.70; p = 0.028). Conclusions This study confirms more direct and less urgent use of paediatric ED care by parents of non-native origin or with limited abilities in the Swedish language, proposing that parental social characteristics influence paediatric ED care-seeking, also in a country with healthcare free of charge, and that specific needs of these groups should be better met by prehospital medical services. Electronic supplementary material The online version of this article (10.1186/s12873-018-0210-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julia Ellbrant
- Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care Medicine, Lund University, Skåne University Hospital, SE-20502, Malmö, Sweden. .,Department of Clinical Sciences Malmö, Surgery, Lund University, Skåne University Hospital, Jan Waldenströms gata 11 A, SE-20502, Malmö, Sweden.
| | - Jonas Åkeson
- Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care Medicine, Lund University, Skåne University Hospital, SE-20502, Malmö, Sweden
| | - Jenny Eckner
- Department of Clinical Sciences Malmö, Surgery, Lund University, Skåne University Hospital, Jan Waldenströms gata 11 A, SE-20502, Malmö, Sweden
| | - Pia Karlsland Åkeson
- Department of Clinical Sciences Malmö, Paediatrics, Lund University, Skåne University Hospital, SE-20502, Malmö, Sweden
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11
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Hickey KT, Masterson Creber RM, Reading M, Sciacca RR, Riga TC, Frulla AP, Casida JM. Low health literacy: Implications for managing cardiac patients in practice. Nurse Pract 2018; 43:49-55. [PMID: 30028773 PMCID: PMC6391993 DOI: 10.1097/01.npr.0000541468.54290.49] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
There are limited data on racial and ethnic disparities related to quality of life (QoL) and health literacy in adults with multiple cardiac conditions. This article evaluates the relationship between health literacy and QoL among patients with cardiac conditions in a multiethnic community in New York City.
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Affiliation(s)
- Kathleen T Hickey
- Kathleen T. Hickey is a professor of nursing and an NP at Columbia University School of Nursing, New York, N.Y. Ruth M. Masterson Creber is an associate research scientist at Columbia University School of Nursing, New York, N.Y. Meghan Reading is a doctoral student at Columbia University School of Nursing, New York, N.Y. Robert R. Sciacca is a variable hours officer at Columbia University, New York, N.Y. Teresa C. Riga is a clinical research coordinator at Columbia University Medical Center, New York, N.Y. Ashton P. Frulla is a dermatology NP in New York, N.Y. Jesus M. Casida is an assistant professor at the University of Michigan, School of Nursing, Ann Arbor, Mich
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12
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King AJ, Jensen JD, Guntzviller LM, Perez D, Krakow M. Ethnic newspapers and low-income Spanish-speaking adults: influence of news consumption and health motivation on cancer prevention behaviors. ETHNICITY & HEALTH 2018; 23:410-424. [PMID: 28116925 PMCID: PMC6096336 DOI: 10.1080/13557858.2017.1280133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Ethnic newspapers have the potential to reach and influence various cultural and ethnic subpopulations traditionally underserved in the United States. The current study sought to explore how ethnic news consumption interacts with health motivation to predict cancer prevention behaviors in a sample of Spanish-speaking adults. DESIGN Participants (N = 100) completed a survey in Spanish, with items measuring demographics, acculturation, health literacy, health motivation, ethnic newspaper consumption (for two papers: La Viva and La Raza), and cancer prevention behaviors. RESULTS Results indicated consumption of ethnic newspapers correlated positively to acculturation, and cancer screening utilization. In hierarchical regression analyses, the interaction of consumption of an ethnic newspaper (La Raza) and health motivation predicted two of the six prevention behaviors assessed: avoidance of fatty foods and screening behavior. CONCLUSION The study provides evidence that consumption of Spanish-language newspapers enhances the likelihood that individuals with high levels of health motivation will engage in healthy behaviors. This finding highlights the utility of utilizing Spanish-language newspapers to reach underserved populations.
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Affiliation(s)
- Andy J. King
- Department of Public Relations, Texas Tech University
| | - Jakob D. Jensen
- Department of Communication, University of Utah
- Cancer Control & Population Science Core, Huntsman Cancer Institute
| | | | - Debora Perez
- Department of Communication, University of California – Santa Barbara
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Abstract
PURPOSE OF REVIEW Until recently, management options in congenital cytomegalovirus (cCMV) infection have been either conservative or termination of pregnancy. However, medical therapies aimed at reducing the risk of infection and/or its severity have recently been investigated. RECENT FINDINGS In a phase 2 open label, nonrandomized trial, valaciclovir (ValACV) was given to women carrying a CMV-infected fetus. ValACV was associated with a greater proportion of asymptomatic neonates when compared with a historical cohort (82 vs. 43%). However, the study design and the small number of treated women limit its applicability. Even though initial observational data suggested that hyperimmune globulin (HIG) therapy in pregnancy was associated with a significantly lower risk of cCMV, its efficacy has not been borne out in a subsequent phase 2 randomized, placebo controlled, double-blind study [cCMV 30% in the HIG group, 44% in the placebo group (P = 0.13)]. Furthermore, 11% of fetuses in the HIG group had transient or permanent abnormalities, compared with 16% in the placebo group. SUMMARY ValACV might have a promising role in the antenatal treatment of cCMV infection, but definitive recommendations require further research. The use of HIG should currently be limited to the research setting.Video abstract http://links.lww.com/COID/A18.
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Ritchie SR, Jayanatha KJ, Duffy EJ, Chancellor J, Allport Z, Thomas MG. Previous antibiotic-related adverse drug reactions do not reduce expectations for antibiotic treatment of upper respiratory tract infections. J Glob Antimicrob Resist 2017; 10:256-260. [PMID: 28732785 DOI: 10.1016/j.jgar.2017.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/12/2017] [Accepted: 05/15/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patients' expectations may influence prescribers' decisions about antibiotic prescribing for upper respiratory tract infection (URTI). We examined whether a history of an antibiotic related adverse drug reaction (aADR) influenced a person's perception about the safety of antibiotics or their expectation of receiving an antibiotic prescription for an URTI. METHODS We developed a questionnaire and surveyed 103 hospital inpatients, 38 of whom (37%) reported past experience of aADR. RESULTS Of the 88 participants who reported recent antibiotic use, participants with a history of aADR reported increased perception of harm from their last antibiotic treatment (P<0.05). Overall, 41/103 (40%) participants expected their doctors to prescribe antibiotics to treat an URTI. Participants' perceptions of antibiotic safety or expectation of antibiotic treatment for an URTI did not differ between those who had personal experience of an aADR compared with those with no history of aADR. CONCLUSIONS The almost universal belief that antibiotics are safe, beneficial medications, even among people with prior aADR, helps to explain the strong patient expectations for antibiotic treatment in a range of conditions. Educational campaigns about the prescription of antibiotics for viral URTI should include information that the risk of harm far outweighs any potential benefits.
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Affiliation(s)
- Stephen R Ritchie
- Department of Infectious Disease, Auckland City Hospital, New Zealand; Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand.
| | - Kalpa J Jayanatha
- Department of Infectious Disease, Auckland City Hospital, New Zealand
| | - Eamon J Duffy
- Department of Infectious Disease, Auckland City Hospital, New Zealand
| | - James Chancellor
- Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Zarah Allport
- Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Mark G Thomas
- Department of Infectious Disease, Auckland City Hospital, New Zealand; Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
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15
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Cross-cultural adaptation and validation of the Newest Vital Sign (NVS) health literacy instrument in general population and highly educated samples of Brazilian adults. Public Health Nutr 2017; 20:1907-1913. [DOI: 10.1017/s1368980017000787] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveThe present work aimed at cross-cultural adaptation and validation of the health literacy assessment tool Newest Vital Sign (NVS) in general population (GP) and highly educated (HE) samples of Brazilian adults.DesignAn expert committee reviewed the translation and back-translation processes and the cultural adaptation. The construct validity was analysed with confirmatory factor analysis and via associations with features of the study population.SettingThe final validation test was performed in two different populations from Londrina, a large town in southern Brazil.SubjectsBrazilian adults: GP (adult clients of community pharmacies;n189) and HE (public school teachers;n301).ResultsThe tool under validation showed good cross-cultural adaptation and internal consistency, with Cronbach’sαof 0·75 for GP and 0·74 for HE. Confirmatory factor analysis showed acceptable models and identified two independent factors according to the relationship between components and numeracy for both GP and HE data. According to the Brazilian Portuguese version of the NVS instrument (NVS-BR), 48·7 % of GP and 33·5 % of HE presented adequate health literacy; this condition was inversely associated with age for both populations and directly correlated with educational level for GP.ConclusionsThe NVS-BR showed good validity in two different populations of Brazilian adults and can be considered an alternative in screening for inadequate health literacy.
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Yin HS, Gupta RS, Mendelsohn AL, Dreyer B, van Schaick L, Brown CR, Encalada K, Sanchez DC, Warren CM, Tomopoulos S. Use of a low-literacy written action plan to improve parent understanding of pediatric asthma management: A randomized controlled study. J Asthma 2017; 54:919-929. [PMID: 28045551 DOI: 10.1080/02770903.2016.1277542] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The objective of the study was to determine whether parents who use a low-literacy, pictogram- and photograph-based written asthma action plan (WAAP) have a better understanding of child asthma management compared to parents using a standard plan. METHODS A randomized controlled study was carried out in 2 urban pediatric outpatient clinics. Inclusion criteria were English- and Spanish-speaking parents of 2- to 12-year-old asthmatic children. Parents were randomized to receive a low-literacy or standard asthma action plan (American Academy of Allergy, Asthma and Immunology) for a hypothetical patient on controller and rescue medications. A structured questionnaire was used to assess whether there was an error in knowledge of (1) medications to give everyday and when sick, (2) need for spacer use, and (3) appropriate emergency response to give albuterol and seek medical help. Multiple logistic regression analyses were performed, adjusting for parent age, health literacy (Newest Vital Sign); child asthma severity, medications; and site. RESULTS 217 parents were randomized (109 intervention and 108 control). Parents who received the low-literacy plan were (1) less likely to make an error in knowledge of medications to take everyday and when sick compared to parents who received the standard plan (63.0 vs. 77.3%, p = 0.03; adjusted odds ratio [AOR] = 0.5[95% confidence interval: 0.2-0.9]) and (2) less likely to make an error regarding spacer use (14.0 vs. 51.1%, p < 0.001; AOR = 0.1 [0.06-0.3]). No difference in error in appropriate emergency response was seen (43.1 vs. 48.1%, p = 0.5). CONCLUSIONS Use of a low-literacy WAAP was associated with better parent understanding of asthma management. Further study is needed to assess whether the use of this action plan improves child asthma outcomes.
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Affiliation(s)
- Hsiang Shonna Yin
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA.,c Department of Population Health , NYU School of Medicine , New York , NY , USA
| | - Ruchi S Gupta
- b Department of Pediatrics , Northwestern University School of Medicine , Chicago , IL , USA
| | - Alan L Mendelsohn
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA.,c Department of Population Health , NYU School of Medicine , New York , NY , USA
| | - Benard Dreyer
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA
| | - Linda van Schaick
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA
| | - Christina R Brown
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA
| | - Karen Encalada
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA
| | - Dayana C Sanchez
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA
| | - Christopher M Warren
- b Department of Pediatrics , Northwestern University School of Medicine , Chicago , IL , USA
| | - Suzy Tomopoulos
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA
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Powell V, Saloner B, Sabik LM. Cost Sharing in Medicaid: Assumptions, Evidence, and Future Directions. Med Care Res Rev 2016; 73:383-409. [PMID: 26602175 PMCID: PMC4879115 DOI: 10.1177/1077558715617381] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 10/23/2015] [Indexed: 12/29/2022]
Abstract
Several states have received waivers to expand Medicaid to poor adults under the Affordable Care Act using more cost sharing than the program traditionally allows. We synthesize literature on the effects of cost sharing, focusing on studies of low-income U.S. populations from 1995 to 2014. Literature suggests that cost sharing has a deterrent effect on initiation of treatments, and can reduce utilization of ongoing treatments. Furthermore, cost sharing may be difficult for low-income populations to understand, patients often lack sufficient information to choose medical treatment, and cost sharing may be difficult to balance within the budgets of poor adults. Gaps in the literature include evidence of long-term effects of cost sharing on health and financial well-being, evidence related to effectiveness of cost sharing combined with patient education, and evidence related to targeted programs that use financial incentives for wellness. Literature underscores the need for evaluation of the effects of cost sharing on health status and spending, particularly among the poorest adults.
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Affiliation(s)
- Victoria Powell
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brendan Saloner
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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18
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Olives TD, Patel RG, Thompson HM, Joing S, Miner JR. Seventy-two-hour antibiotic retrieval from the ED: a randomized controlled trial of discharge instructional modality. Am J Emerg Med 2016; 34:999-1005. [PMID: 26969079 DOI: 10.1016/j.ajem.2016.02.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/15/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Limited health literacy is a risk factor for poor outcomes in numerous health care settings. Little is known about the impact of instructional modality and health literacy on adherence to emergency department (ED) discharge instructions. PURPOSE To examine the impact of instructional modality on 72-hour antibiotic retrieval among ED patients prescribed outpatient antibiotics for infections. METHODS English-speaking ED patients diagnosed as having acute infections and prescribed outpatient antibiotics were randomized to standard discharge instructions, standard instructions plus text-messaged instructions, or standard instructions plus voicemailed instructions targeting ED prescriptions. Health literacy was determined by validated instrument. Seventy-two-hour antibiotic retrieval, 30-day report of prescription completion, and discharge instructional modality preference were assessed. RESULTS Nearly one-quarter of the 2521 participants demonstrated low health literacy. Low health literacy predicted decreased 72-hour antibiotic retrieval (χ(2) = 9.56, P=.008). No significant association with antibiotic retrieval was noted across the 3 treatment groups (χ(2) = 5.112, P=.078). However, patients randomized to the text message group retrieved antibiotic prescriptions within 72 hours more frequently than did those randomized to the voicemail treatment group (χ(2) = 4.345, P=.037), and patients with low health literacy randomized to voicemailed instructions retrieved their antibiotic prescriptions less frequently than did those randomized to standard of care instructions (χ(2) = 5.526, P=.019). Reported instructional modality preferences were inconsistent with the primary findings of the study. CONCLUSIONS Discharge instructional modality impacts antibiotic retrieval in patients with low health literacy. Preference for discharge instructional modality varies by degree of health literacy, but does not predict which modality will optimize 72-hour antibiotic retrieval.
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Affiliation(s)
- Travis D Olives
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN.
| | - Roma G Patel
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN; University of Minnesota-Twin Cities, Minneapolis, MN
| | - Hannah M Thompson
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN; University of Minnesota-Twin Cities, Minneapolis, MN
| | - Scott Joing
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - James R Miner
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN
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19
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Health literacy and infectious diseases: why does it matter? Int J Infect Dis 2016; 43:103-110. [PMID: 26751238 DOI: 10.1016/j.ijid.2015.12.019] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/14/2015] [Accepted: 12/24/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Multifactorial interventions are crucial to arrest the threat posed by infectious diseases. Public involvement requires adequate information, but determinants such as health literacy can impact on the effective use of such knowledge. The influence of health literacy on infectious diseases is examined in this paper. METHODS Databases were searched from January 1999 through July 2015 seeking studies reporting on health literacy and infections such tuberculosis, malaria, and influenza, and infection-related behaviours such as vaccination and hand hygiene. HIV was excluded, as comprehensive reviews have already been published. RESULTS Studies were found on antibiotic knowledge and use, the adoption of influenza and MMR immunizations, and screening for sexually transmitted and viral hepatitis infections. There was a lack of investigations on areas such as tuberculosis, malaria, hand hygiene, and diarrhoeal diseases. CONCLUSIONS Limited or insufficient health literacy was associated with reduced adoption of protective behaviours such as immunization, and an inadequate understanding of antibiotics, although the relationship was not consistent. Large gaps remain in relation to infectious diseases with a high clinical and societal impact, such as tuberculosis and malaria.
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20
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Duell P, Wright D, Renzaho AMN, Bhattacharya D. Optimal health literacy measurement for the clinical setting: A systematic review. PATIENT EDUCATION AND COUNSELING 2015; 98:1295-1307. [PMID: 26162954 DOI: 10.1016/j.pec.2015.04.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 12/05/2014] [Accepted: 04/04/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To identify the optimal measurement instrument for assessing health literacy in a clinical setting. METHODS Seven databases were searched for studies evaluating health literacy instruments used with patients. Standardised systematic review methods were used by two reviewers independently assessing eligibility, extracting data and evaluating study quality. A narrative summary was produced. RESULTS The searches identified 626 articles of which 64 were eligible. Forty-three different health literacy instruments were identified. The quality of these instruments, based on their psychometric properties, varied considerably. The majority of health literacy instruments were found to only assess communicative health literacy of which the numeracy element was often not represented. The NVS instrument was found to be the most practical health literacy instrument to use. CONCLUSION There is an urgent need to develop and psychometrically test a more encompassing health literacy instrument applicable in clinical settings as well as health promotion in general. PRACTICE IMPLICATIONS In the absence of a more comprehensive health literacy instrument, the NVS is a practical instrument to quickly assess for health literacy in a clinical setting.
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Affiliation(s)
- Paul Duell
- University of East Anglia, School of Pharmacy, Norwich Research Park, Norwich, UK.
| | - David Wright
- University of East Anglia, School of Pharmacy, Norwich Research Park, Norwich, UK
| | - Andre M N Renzaho
- School of Social Sciences and Psychology, University of Western Sydney, Sydney, Australia
| | - Debi Bhattacharya
- University of East Anglia, School of Pharmacy, Norwich Research Park, Norwich, UK
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Shealy KM, Threatt TB. Utilization of the Newest Vital Sign (NVS) in Practice in the United States. HEALTH COMMUNICATION 2015; 31:679-687. [PMID: 26507669 DOI: 10.1080/10410236.2014.990079] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Health literacy refers to the ability of a patient to obtain, communicate, process, and understand basic information related to health and services. It is estimated that the majority of adult Americans may have difficulty understanding health information. In addition, limited health literacy of patients is linked to over $100 billion in health care costs. Measurement of health literacy may aid in improving communication with patients, and thus to improving outcomes and decreasing costs. The Newest Vital Sign (NVS) is a tool that has been used to assess health literacy in a variety of patients. It has been validated against other measures including the Test of Functional Health Literacy in Adults (TOFHLA). Patients are categorized as high likelihood of limited health literacy, possible limited health literacy, or adequate literacy. The NVS has been used in a variety of settings and tested among a wide range of patient groups. The most common setting for use is in primary care, probably due to the relatively quick assessment of health literacy (within 3 minutes). The NVS has been used in Caucasians, African Americans, Hispanics, and several other ethnicities. Assessment with the NVS has been conducted in adult patients across the age continuum, and with several different health conditions, including diabetes, kidney disease, and pain. This article seeks to review the published uses to date and to provide suggestions for potential uses of the NVS.
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Affiliation(s)
- Kayce M Shealy
- a Department of Pharmacy Practice , Presbyterian College School of Pharmacy
| | - Tiffaney B Threatt
- a Department of Pharmacy Practice , Presbyterian College School of Pharmacy
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Ramirez-Zohfeld V, Rademaker AW, Dolan NC, Ferreira MR, Eder M“M, Liu D, Wolf MS, Cameron KA. Comparing the Performance of the S-TOFHLA and NVS Among and Between English and Spanish Speakers. JOURNAL OF HEALTH COMMUNICATION 2015; 20:1458-1464. [PMID: 26147770 PMCID: PMC4729300 DOI: 10.1080/10810730.2015.1018629] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Given the growing body of evidence demonstrating the significant implications of health literacy on a myriad of outcomes, researchers continue to incorporate health literacy metrics in studies. With this proliferation in measurement of health literacy in research, it has become increasingly important to understand how various health literacy tools perform in specific populations. Our objective was to compare the performance of two widely used tests, the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the Newest Vital Sign (NVS) among and between a sample of English and Spanish-speaking patients. Adults (N = 402) ages 50-75 years participating in a trial to promote colorectal cancer screening completed in-person interviews which included both measures of health literacy. In the full sample, the tests were moderately correlated (r = 0.69, p < .0001); however, there was a stronger correlation among those completing the test in Spanish (r = 0.83) as compared with English (r = 0.58, p < .0001). English speakers more often were categorized as having adequate literacy by the S-TOFHLA as compared with the NVS, whereas Spanish speakers scored consistently low on both instruments. These findings indicate that the categorization of participants into levels of literacy is likely to vary, depending on whether the NVS or S-TOFHLA is used for assessment, a factor which researchers should be aware of when selecting literacy assessments.
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Affiliation(s)
- Vanessa Ramirez-Zohfeld
- Division of General Internal Medicine & Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alfred W. Rademaker
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nancy C. Dolan
- Division of General Internal Medicine & Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- Northwestern Medical Faculty Foundation, Chicago, IL
| | - M. Rosario Ferreira
- Division of General Internal Medicine & Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- Northwestern Medical Faculty Foundation, Chicago, IL
- Jesse Brown Veterans Affairs Medical Center, Chicago, IL
| | | | - Dachao Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael S. Wolf
- Division of General Internal Medicine & Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kenzie A. Cameron
- Division of General Internal Medicine & Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- Center for Advancing Equity in Clinical Preventive Services, Northwestern University, Chicago, IL
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Mackert M, Champlin S, Su Z, Guadagno M. The Many Health Literacies: Advancing Research or Fragmentation? HEALTH COMMUNICATION 2015; 30:1161-1165. [PMID: 26372026 DOI: 10.1080/10410236.2015.1037422] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Health literacy is the degree to which individuals can obtain, process, understand, and communicate about health-related information needed to make informed health decisions and is an important factor in patient health outcomes and resulting health care costs. Because of its importance across many areas of health, specific attention has been given to studying and measuring health literacy in recent years; however, the field lacks consensus on how health literacy should be defined and measured. As a result, numerous definitions and measures of health literacy exist. This fragmentation and inconsistency creates a barrier to conceptualizing, measuring, and understanding health literacy across health domains and fields. A directed literature search reveals a substantial body of work on health literacy; however, findings from studies often emphasize health literacy within specific health domains, populations, contexts, and languages, which makes the comparison of findings across studies difficult. While there is recognition that the measurement of health literacy should be improved, it is important to take into consideration what can be gained from a general health literacy focus and how this could be applied across domains.
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Affiliation(s)
- Michael Mackert
- a Stan Richards School of Advertising and Public Relations , University of Texas at Austin
- b Center for Health Communication , University of Texas at Austin
- c School of Public Health , University of Texas Health Science Center at Houston
| | - Sara Champlin
- a Stan Richards School of Advertising and Public Relations , University of Texas at Austin
| | - Zhaohui Su
- a Stan Richards School of Advertising and Public Relations , University of Texas at Austin
| | - Marie Guadagno
- a Stan Richards School of Advertising and Public Relations , University of Texas at Austin
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Morrison AK, Schapira MM, Hoffmann RG, Brousseau DC. Measuring health literacy in caregivers of children: a comparison of the newest vital sign and S-TOFHLA. Clin Pediatr (Phila) 2014; 53:1264-70. [PMID: 25006116 PMCID: PMC4416472 DOI: 10.1177/0009922814541674] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We examined the performance of the Newest Vital Sign (NVS) and the Short Test of Functional Health Literacy in Adults (S-TOFHLA) in caregivers of children. METHOD Caregivers of children ≤12 years old seeking care for their child in a pediatric emergency department (ED) were tested using the NVS and the S-TOFHLA to measure health literacy. The results were compared with ED use outcomes. RESULT The S-TOFHLA was found to have a ceiling effect as compared to the NVS; few caregivers scored in low literacy categories (P < .0001). This finding was demonstrated in both lower (P = .01) and higher (P < .001) educational attainment groups. The NVS was predictive of ED use outcomes (P = .02 and P < .01) whereas the S-TOFHLA was not (P = .21 and P = .11). CONCLUSIONS The measures do not seem to function similarly nor predict health outcomes equally. The NVS demonstrates sensitivity in identifying limited health literacy in younger adult populations.
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Affiliation(s)
- Andrea K. Morrison
- Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
| | | | - Raymond G. Hoffmann
- Quantitative Health Sciences/Biostatistics, Children’s Hospital of Wisconsin/Medical College of Wisconsin, Milwaukee, WI
| | - David C. Brousseau
- Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
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Ackermann Rau S, Sakarya S, Abel T. When to see a doctor for common health problems: distribution patterns of functional health literacy across migrant populations in Switzerland. Int J Public Health 2014; 59:967-74. [PMID: 25012800 DOI: 10.1007/s00038-014-0583-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 06/19/2014] [Accepted: 06/26/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Knowing when to seek professional help for health problems is considered an important aspect of health literacy. However, little is known about the distribution of help-seeking knowledge in the general population or specific subpopulations. METHODS We analysed data from the "Health Monitoring of the Swiss Migrant Population 2010" and used a short survey tool to study the distribution of help-seeking knowledge. We sampled members of four migrant groups (from Portugal, Turkey, Serbia and Kosovo; n = 2,614). Our tool contained 12 items that addressed common physical and psychological health problems. A total sum score measured help-seeking knowledge. Two sub-scores analysed knowledge related to potential overuse (minor symptoms) or potential underuse (major symptoms). We applied linear regression to show variations in help-seeking knowledge by age, sex, region of origin and length of stay. RESULTS Controlling for self-rated health, we found that region of origin, higher education, female gender and younger age were significantly associated with higher knowledge scores. CONCLUSIONS We present empirical evidence of unequal distribution of help-seeking knowledge across four migrant populations in Switzerland. Our findings contribute to current conceptual developments in health literacy, and provide starting points for future research.
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26
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Stockwell MS, Catallozzi M, Larson E, Rodriguez C, Subramony A, Andres Martinez R, Martinez E, Barrett A, Meyer D. Effect of a URI-related educational intervention in early head start on ED visits. Pediatrics 2014; 133:e1233-40. [PMID: 24709931 PMCID: PMC4006431 DOI: 10.1542/peds.2013-2350] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of an educational intervention to decrease pediatric emergency department (PED) visits and adverse care practices for upper respiratory infections (URI) among predominantly Latino Early Head Start (EHS) families. METHODS Four EHS sites in New York City were randomized. Families at intervention sites received 3 1.5-hour education modules in their EHS parent-child group focusing on URIs, over-the-counter medications, and medication management. Standard curriculum families received the standard EHS curriculum, which did not include URI education. During weekly telephone calls for 5 months, families reported URI in family members, care sought, and medications given. Pre- and post-intervention knowledge-attitude surveys were also conducted. Outcomes were compared between groups. RESULTS There were 154 families who participated (76 intervention, 78 standard curriculum) including 197 children <4 years old. Families were primarily Latino and Spanish-speaking. Intervention families were significantly less likely to visit the PED when their young child (age 6 to <48 months) was ill (8.2% vs 15.7%; P = .025). The difference remained significant on the family level (P = .03). These families were also less likely to use an inappropriate over-the-counter medication for their <2-year-old child (odds ratio, 0.29; 95% confidence interval, 0.09-0.95; 12.2% vs 32.4%, P = .034) and/or incorrect dosing tool for their <4-year-old child (odds ratio, 0.24; 95% confidence interval, 0.08-0.74; 9.8% vs 31.1%; P < .01). The mean difference in Knowledge-Attitude scores for intervention families was higher. CONCLUSIONS A URI health literacy-related educational intervention embedded into EHS decreased PED visits and adverse care practices.
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Affiliation(s)
- Melissa S. Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics,,Department of Population and Family Health and,New York-Presbyterian Hospital, New York, New York
| | - Marina Catallozzi
- Division of Child and Adolescent Health, Department of Pediatrics,,Department of Population and Family Health and,New York-Presbyterian Hospital, New York, New York
| | - Elaine Larson
- Department of Epidemiology, Mailman School of Public Health, and,School of Nursing, Columbia University, New York, New York; and
| | | | - Anupama Subramony
- Division of Child and Adolescent Health, Department of Pediatrics,,New York-Presbyterian Hospital, New York, New York
| | | | - Emelin Martinez
- Division of Child and Adolescent Health, Department of Pediatrics
| | - Angela Barrett
- Division of Child and Adolescent Health, Department of Pediatrics
| | - Dodi Meyer
- Division of Child and Adolescent Health, Department of Pediatrics,,New York-Presbyterian Hospital, New York, New York
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