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Kincaid H, Coyne CA, Hamadani R, Friel T. Validation of three health literacy screening questions compared with S-TOFHLA in a low-income diverse English- and Spanish-Speaking population. J Public Health (Oxf) 2024; 46:383-391. [PMID: 38609184 DOI: 10.1093/pubmed/fdae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 12/26/2023] [Accepted: 03/18/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Clinicians need a tool to gauge patients' ability to understand health conditions and treatment options. The Short-form Test of Functional Health Literacy in Adults (S-TOFHLA) is the gold standard for this, but its length is prohibitive for use in clinical settings. This study seeks to validate a novel three-item question set for predicting health literacy. METHODS This cross-sectional study utilized an in-person questionnaire alongside the S-TOFHLA. The sample included 2027 English- and Spanish-speaking adults (≥18 years) recruited from primary care practices serving a low-income eastern Pennsylvania community. Most patients (57.7%) identified as Hispanic. Diagnostic accuracy of each question and aggregated scores were assessed against the validated survey by calculating the area under the receiver operating characteristic (AUROC) curve. RESULTS Questions in the 'Problems Learning' and 'Help Reading' domains (AUROC 0.66 for each) performed better than the 'Confident Forms' question (AUROC 0.64). Summing all three scores resulted in an even higher AUROC curve (0.71). Cronbach's alpha of the combined items was 0.696. CONCLUSIONS Study results suggest that any of the three questions are viable options for screening health literacy levels of diverse patients in primary care clinical settings. However, they perform better as a summed score than when used individually.
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Affiliation(s)
- Hope Kincaid
- Network Office of Research and Innovation, Lehigh Valley Health Network, Allentown, PA 18103, USA
- Morsani College of Medicine, University of South Florida, Tampa, FL 33620 USA
| | - Cathy A Coyne
- Department of Nursing and Public Health, Moravian University, Bethlehem, PA 18018, USA
| | - Roya Hamadani
- Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA 18101, USA
| | - Timothy Friel
- Morsani College of Medicine, University of South Florida, Tampa, FL 33620 USA
- Department of Medicine, Lehigh Valley Health Network, Allentown, PA 18102, USA
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Baggio S, Gonçalves L, Heller P, Wolff H, Gétaz L. Refusal to participate in research among hard-to-reach populations: The case of detained persons. PLoS One 2023; 18:e0282083. [PMID: 36867614 PMCID: PMC9983841 DOI: 10.1371/journal.pone.0282083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 02/02/2023] [Indexed: 03/04/2023] Open
Abstract
Providing insights on refusal to participate in research is critical to achieve a better understanding of the non-response bias. Little is known on people who refused to participate, especially in hard-to-reach populations such as detained persons. This study investigated the potential non-response bias among detained persons, comparing participants who accepted or refused to sign a one-time general informed consent. We used data collected in a cross-sectional study primary designed to evaluate a one-time general informed consent for research. A total of 190 participants were included in the study (response rate = 84.7%). The main outcome was the acceptance to sign the informed consent, used as a proxy to evaluate non-response. We collected sociodemographic variables, health literacy, and self-reported clinical information. A total of 83.2% of the participants signed the informed consent. In the multivariable model after lasso selection and according to the relative bias, the most important predictors were the level of education (OR = 2.13, bias = 20.7%), health insurance status (OR = 2.04, bias = 7.8%), need of another study language (OR = 0.21, bias = 39.4%), health literacy (OR = 2.20, bias = 10.0%), and region of origin (not included in the lasso regression model, bias = 9.2%). Clinical characteristics were not significantly associated with the main outcome and had low relative biases (≤ 2.7%). Refusers were more likely to have social vulnerabilities than consenters, but clinical vulnerabilities were similar in both groups. The non-response bias probably occurred in this prison population. Therefore, efforts should be made to reach this vulnerable population, improve participation in research, and ensure a fair and equitable distribution of research benefits.
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Affiliation(s)
- Stéphanie Baggio
- Division of Prison Health, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- * E-mail:
| | - Leonel Gonçalves
- Division of Prison Health, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Patrick Heller
- Division of Prison Health, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Hans Wolff
- Division of Prison Health, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
| | - Laurent Gétaz
- Division of Prison Health, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
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Developing the HLS 19-YP12 for measuring health literacy in young people: a latent trait analysis using Rasch modelling and confirmatory factor analysis. BMC Health Serv Res 2022; 22:1485. [PMID: 36474283 PMCID: PMC9727937 DOI: 10.1186/s12913-022-08831-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Accurate and precise measures of health literacy (HL) is supportive for health policy making, tailoring health service design, and ensuring equitable access to health services. According to research, valid and reliable unidimensional HL measurement instruments explicitly targeted at young people (YP) are scarce. Thus, this study aims at assessing the psychometric properties of existing unidimensional instruments and developing an HL instrument suitable for YP aged 16-25 years. METHODS Applying the HLS19-Q47 in computer-assisted telephone interviews, we collected data in a representative sample comprising 890 YP aged 16-25 years in Norway. Applying the partial credit parameterization of the unidimensional Rasch model for polytomous data (PCM) and confirmatory factor analysis (CFA) with categorical variables, we evaluated the psychometric properties of the short versions of the HLS19-Q47; HLS19-Q12, HLS19-SF12, and HLS19-Q12-NO. A new 12-item short version for measuring HL in YP, HLS19-YP12, is suggested. RESULTS The HLS19-Q12 did not display sufficient fit to the PCM, and the HLS19-SF12 was not sufficiently unidimensional. Relative to the PCM, some items in the HLS19-Q12, the HLS19-SF12, and the HLS19-Q12-NO discriminated poorly between participants at high and at low locations on the underlying latent trait. We observed disordered response categories for some items in the HLS19-Q12 and the HLS19-SF12. A few items in the HLS19-Q12, the HLS19-SF12, and the HLS19-Q12-NO displayed either uniform or non-uniform differential item functioning. Applying one-factorial CFA, none of the aforementioned short versions achieved exact fit in terms of non-significant model chi-square statistic, or approximate fit in terms of SRMR ≤ .080 and all entries ≤ .10 that were observed in the respective residual matrix. The newly suggested parsimonious 12-item scale, HLS19-YP12, displayed sufficiently fit to the PCM and achieved approximate fit using one-factorial CFA. CONCLUSIONS Compared to other parsimonious 12-item short versions of HLS19-Q47, the HLS19-YP12 has superior psychometric properties and unconditionally proved its unidimensionality. The HLS19-YP12 offers an efficient and much-needed screening tool for use among YP, which is likely a useful application in processes towards the development and evaluation of health policy and public health work, as well as for use in clinical settings.
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Kuhn TA, Gathright EC, Dolansky MA, Gunstad J, Josephson R, Hughes JW. Health Literacy, Cognitive Function, and Mortality in Patients With Heart Failure. J Cardiovasc Nurs 2022; 37:50-55. [PMID: 34581712 PMCID: PMC8648929 DOI: 10.1097/jcn.0000000000000855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Health literacy has predicted mortality in heart failure. However, the role of cognitive functioning in this relationship has not been evaluated. We hypothesized that health literacy would predict all-cause mortality but that cognitive functioning would modify the relationship between health literacy and mortality in heart failure. OBJECTIVE The aim of this study was to examine the association between health literacy, cognitive functioning, and mortality in patients with heart failure. METHODS This secondary analysis of a larger study included 298 patients with heart failure with reduced ejection fraction (trial identifier: NCT01461629). Health literacy was evaluated using the Rapid Estimate of Adult Literacy in Medicine (REALM) and Medical Term Recognition Test (METER), and cognitive functioning was evaluated using the Modified Mini-Mental Status Examination (3MS). Cox proportional hazards regression was used with time-until-death as the dependent variable. RESULTS After controlling for age, sex, and race, neither METER nor REALM scores predicted mortality in heart failure (Ps ≥ .37). However, 3MS predicted mortality in models using the METER (Δχ2 = 9.20, P < .01; B = -.07; hazard ratio, 0.94 [95% confidence interval, 0.89-0.98]; P < .01) and REALM (Δχ2 = 9.77, P < .01; B = -0.07; hazard ratio, 0.94 [95% confidence interval, 0.90-0.97]; P < .01). Furthermore, adding the 3MS improved model fit. CONCLUSIONS Cognitive functioning predicted mortality in heart failure better than health literacy. Results suggest the need to further evaluate the contribution of cognitive functioning to increased risk of mortality in those with heart failure.
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Lorini C, Lastrucci V, Paolini D, Bonaccorsi G. Measuring health literacy combining performance-based and self-assessed measures: the roles of age, educational level and financial resources in predicting health literacy skills. A cross-sectional study conducted in Florence (Italy). BMJ Open 2020; 10:e035987. [PMID: 33020080 PMCID: PMC7537461 DOI: 10.1136/bmjopen-2019-035987] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 07/27/2020] [Accepted: 08/06/2020] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE The objective was to compare the results of performance-based and self-assessed measures of health literacy (HL) and to evaluate the contribution of their joint use in assessing some HL antecedents. DESIGN This was a cross-sectional study. SETTING The study was conducted on the general population in Florence (Italy). PARTICIPANTS This study is part of a larger one, where participants were randomly selected from the registries of 11 general practitioners working in the municipality of Florence. Inclusion criteria were the following: 18-69 years of age and Italian speaking. Exclusion criteria included cognitive impairment, severe psychiatric disease or end-stage disease. In this paper, 212 adults were included. OUTCOME MEASURES HL was measured using the European Health Literacy Survey Questionnaire (HLS-EU-Q16) and the Newest Vital Sign (NVS). The HL levels obtained by means of the two measurement tools were combined into a new variable that described three different levels of HL skills: low HL skills, partial HL skills and high HL skills. Multivariate ordinal logistic regression analysis was performed to assess the predictive roles of age class, educational level and financial resources with respect to HL skills. RESULTS Twenty-two per cent of the sample had high HL skills, 28.3% had low HL skills and 49.5% had partial HL skills. Educational level, age class and financial resources were significantly associated with HL skills, with OR values being higher than those obtained using the NVS or the HLS-EU-Q16 individually. CONCLUSION The combination of the results obtained using the NVS and the HLS-EU-Q16 improves the understanding of HL. The new variable generated by this combination could be considered as a different way to assess HL and its multidimensional contents.
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Affiliation(s)
- Chiara Lorini
- Department of Health Sciences, University of Florence, Firenze, FI, Italy
| | - Vieri Lastrucci
- Department of Health Sciences, University of Florence, Firenze, FI, Italy
| | - Diana Paolini
- Department of Health Sciences, University of Florence, Firenze, FI, Italy
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Dahlman D, Ekefäll M, Garpenhag L. Health Literacy among Swedish Patients in Opioid Substitution Treatment: A Mixed-Methods Study. Drug Alcohol Depend 2020; 214:108186. [PMID: 32721789 DOI: 10.1016/j.drugalcdep.2020.108186] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/29/2020] [Accepted: 07/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Poor health and unmet healthcare needs is common among people with substance use disorder (SUD) including patients in opioid substitution treatment (OST). Low health literacy (HL) is associated with poverty, low education and physical limitations, but is unexplored in an OST context. METHODS Mixed-methods were used. Participants were consecutively recruited by clinic staff or researcher, from five OST clinics in Malmö, Sweden, during September - November 2019. HL level was measured through HLS-EU-Q16 (n?=?286). Self-reported socioeconomic correlates of HL were analyzed through logistic regression. Patients' experiences of HL-related problems were assessed through six focus group interviews (n?=?23) moderated by an OST employee. RESULTS While 46% had sufficient HL (13-16 points of maximum 16), 32% did not receive a HL score due to too many missing answers. No correlates of sufficient HL level were found. Missing HL level was associated with low educational attainment (Ajusted odds ratio [AOR] 1.94; 95% Confidence interval [CI] 1.13-3.32) and negatively associated with employment (AOR 0.28; 95% CI 0.11-0.71). Qualitative data revealed a diversity in participants' self-assessed capabilities, and problems associated with access, comprehension, trust and dependency on addiction-specific services. CONCLUSIONS This study highlights that HL level is low, and identifies a number of concrete problems related to HL in the studied population. The results implicate a need for tailored interventions regarding health information among OST patients.
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Affiliation(s)
- Disa Dahlman
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Malmö, Sweden.
| | - Malin Ekefäll
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Malmö, Sweden
| | - Lars Garpenhag
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Malmö, Sweden
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Tabler J, Mykyta L, Chernenko A, Flores P, Marquez A, Saenz N, Stocker R. Hispanic Health Paradox at the Border: Substance, Alcohol, and Tobacco Use among Latinx Immigrants Seeking Free or Reduced-Cost Care in Southernmost Texas. South Med J 2020; 113:183-190. [PMID: 32239231 DOI: 10.14423/smj.0000000000001087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Although substantial research has explored the Hispanic health paradox (HHP) and suggests that Latinx immigrants experience positive health outcomes relative to those born in the United States, less research has assessed the role of immigration status. Our aim was to examine this role in Latinx health. METHODS Using survey data collected at two free/reduced-cost clinics in southernmost Texas, we examined differences in the mental and self-rated health, substance, alcohol, and tobacco use of low-income patients by undocumented/documented immigrant and US-born/naturalized citizen status (N = 588). RESULTS Based on ordinary least squares regression results, undocumented Latinx immigrants report lower negative self-rated health (coefficient -0.27, 95% confidence interval -0.50 to -0.01) and lower depressive symptoms (coefficient -0.34, 95% confidence interval -0.67 to -0.02]) compared with their US citizen peers (P < 0.05). Logistic regression results suggest that undocumented and documented Latinx immigrants do not differ in alcohol, tobacco, or substance use relative to their citizen peers. CONCLUSIONS Despite facing potentially adverse social environments, undocumented Latinx immigrants experience positive health outcomes relative to US-born/naturalized citizen peers.
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Affiliation(s)
- Jennifer Tabler
- From the Department of Criminal Justice and Sociology, University of Wyoming, Laramie, the Department of Sociology and Anthropology, University of Texas Rio Grande Valley, Edinburg, the Department of Sociology, University of Utah, Salt Lake City, the School of Medicine, Texas Tech University Health Sciences Center, Lubbock, the Department of Education, University of Texas Rio Grande Valley, Edinburg, and Hope Family Health Center, McAllen, Texas
| | - Laryssa Mykyta
- From the Department of Criminal Justice and Sociology, University of Wyoming, Laramie, the Department of Sociology and Anthropology, University of Texas Rio Grande Valley, Edinburg, the Department of Sociology, University of Utah, Salt Lake City, the School of Medicine, Texas Tech University Health Sciences Center, Lubbock, the Department of Education, University of Texas Rio Grande Valley, Edinburg, and Hope Family Health Center, McAllen, Texas
| | - Alla Chernenko
- From the Department of Criminal Justice and Sociology, University of Wyoming, Laramie, the Department of Sociology and Anthropology, University of Texas Rio Grande Valley, Edinburg, the Department of Sociology, University of Utah, Salt Lake City, the School of Medicine, Texas Tech University Health Sciences Center, Lubbock, the Department of Education, University of Texas Rio Grande Valley, Edinburg, and Hope Family Health Center, McAllen, Texas
| | - Paloma Flores
- From the Department of Criminal Justice and Sociology, University of Wyoming, Laramie, the Department of Sociology and Anthropology, University of Texas Rio Grande Valley, Edinburg, the Department of Sociology, University of Utah, Salt Lake City, the School of Medicine, Texas Tech University Health Sciences Center, Lubbock, the Department of Education, University of Texas Rio Grande Valley, Edinburg, and Hope Family Health Center, McAllen, Texas
| | - Alvaro Marquez
- From the Department of Criminal Justice and Sociology, University of Wyoming, Laramie, the Department of Sociology and Anthropology, University of Texas Rio Grande Valley, Edinburg, the Department of Sociology, University of Utah, Salt Lake City, the School of Medicine, Texas Tech University Health Sciences Center, Lubbock, the Department of Education, University of Texas Rio Grande Valley, Edinburg, and Hope Family Health Center, McAllen, Texas
| | - Nancy Saenz
- From the Department of Criminal Justice and Sociology, University of Wyoming, Laramie, the Department of Sociology and Anthropology, University of Texas Rio Grande Valley, Edinburg, the Department of Sociology, University of Utah, Salt Lake City, the School of Medicine, Texas Tech University Health Sciences Center, Lubbock, the Department of Education, University of Texas Rio Grande Valley, Edinburg, and Hope Family Health Center, McAllen, Texas
| | - Rebecca Stocker
- From the Department of Criminal Justice and Sociology, University of Wyoming, Laramie, the Department of Sociology and Anthropology, University of Texas Rio Grande Valley, Edinburg, the Department of Sociology, University of Utah, Salt Lake City, the School of Medicine, Texas Tech University Health Sciences Center, Lubbock, the Department of Education, University of Texas Rio Grande Valley, Edinburg, and Hope Family Health Center, McAllen, Texas
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Reid M, Nel M, Janse van Rensburg-Bonthuyzen E. Development of a Sesotho health literacy test in a South African context. Afr J Prim Health Care Fam Med 2019; 11:e1-e13. [PMID: 31038342 PMCID: PMC6495000 DOI: 10.4102/phcfm.v11i1.1853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/19/2018] [Accepted: 11/19/2018] [Indexed: 11/05/2022] Open
Abstract
Background Research shows that poor health literacy (HL) can be a threat to health and health care. Health literacy is under-researched and poorly understood in developing countries, including South Africa, because of the absence of language and context-specific HL tests. Aim The researchers aimed to develop an appropriate HL test for use among South African public health service users with Sesotho as their first language. Setting The test was developed in the Free State Province of South Africa, for use among Sesotho speakers. Methods Mixed methods were employed to develop the Sesotho Health Literacy Test (SHLT). The process of developing the test was carried out in distinctive methodological steps. Results The stepwise process set out by identifying abstracts (n = 206) referring to HL tests. Sourcing of HL tests followed a tapered process resulting in the use of 17 HL tests. Elements within a conceptual framework guided HL test item selection (n = 47). Two Delphi sessions assisted in reaching consensus regarding final HL test items (n = 40). The readability testing of the SHLT tested 4.19 on the Coleman–Liau Index score. A context-suitable and comprehensive SHLT ensued from this work. Conclusion The SHLT assessment instrument development creates a platform for HL testing among Sesotho first language speakers in South Africa. The context-sensitive methodology is entrenched in a theoretical framework, distributing HL test items between identified competencies and related skill dimensions and domains. The methodology can be applied to the development of HL tests for other languages and population groups in developing countries. Keywords health literacy assessment; primary health care; South Africa; developing countries; public health service; context-sensitive assessment.
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Affiliation(s)
- Marianne Reid
- School of Nursing, Faculty of Health Sciences, University of the Free State, Bloemfontein.
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Elbashir M, Awaisu A, El Hajj MS, Rainkie DC. Measurement of health literacy in patients with cardiovascular diseases: A systematic review. Res Social Adm Pharm 2019; 15:1395-1405. [PMID: 30709731 DOI: 10.1016/j.sapharm.2019.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 01/10/2019] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND While many instruments have been developed, validated, and used to assess health literacy skills, their use and appropriateness among patients with cardiovascular diseases (CVDs) are not widely studied. OBJECTIVE To identify, appraise, and synthesize available health literacy assessment instruments used in patients with CVDs. METHODS Electronic databases were searched for studies that used validated measures to assess health literacy in patients with CVDs. Included studies were assessed for risk of bias and the identified instruments were evaluated based on their psychometric properties. Data were synthesized using a narrative approach. RESULTS Forty-three studies were included in the review, of which 20 were cross-sectional studies and 12 were randomized controlled trials. Eleven health literacy assessment instruments were identified, of which only one was disease-specific. The Abbreviated version of the Test of Functional Health Literacy in Adults (S-TOFHLA) (n = 19) and the Rapid Estimate of Adult Literacy in Medicine (REALM) (n = 13) were found to be the most commonly used instruments to assess health literacy in CVDs. CONCLUSIONS The S-TOFHLA and the REALM are the most widely used instruments to evaluate health literacy in CVD population. More CVD-specific health literacy screening instruments are warranted. Assessment of health literacy should be a standard of care in patients with CVDs and effective interventions should be developed to improve the impact of limited health literacy on health outcomes in this population.
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Affiliation(s)
| | - Ahmed Awaisu
- College of Pharmacy, Qatar University, Doha, Qatar.
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Du S, Zhou Y, Fu C, Wang Y, Du X, Xie R. Health literacy and health outcomes in hypertension: An integrative review. Int J Nurs Sci 2018; 5:301-309. [PMID: 31406840 PMCID: PMC6626246 DOI: 10.1016/j.ijnss.2018.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/14/2018] [Accepted: 06/08/2018] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE The aim of this study was to summarize the evidence of health literacy and health outcomes in hypertensive patients. METHODS Articles published in English were searched from six databases: MEDLINE, CINAHL, Embase, ERIC, psycINFO, and SCOPUS. The articles published up to September 2017 were included. RESULTS Nineteen publications were included in the review. There was quality and consistent evidence that hypertensive patients with lower literacy had poorer knowledge. There was inconsistent evidence to show the relationship between health literacy and clinical outcomes, of systolic and diastolic blood pressure, and blood pressure control; behavioral outcomes, of self-care, self-efficacy, adherence; patient-physician interactions outcomes, of patient-physician communication, patient trust, involvement in decision making and other outcomes. CONCLUSION The person with low health literacy is likely to have poor knowledge of hypertension. However, there is insufficient evidence to suggest that health literacy is associated with outcomes of hypertension independently.
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Affiliation(s)
| | | | | | - Yan Wang
- School of Nursing, Hebei University, Hebei, China
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Housten AJ, Lowenstein LM, Hoover DS, Leal VB, Kamath GR, Volk RJ. Limitations of the S-TOFHLA in measuring poor numeracy: a cross-sectional study. BMC Public Health 2018; 18:405. [PMID: 29587709 PMCID: PMC5870805 DOI: 10.1186/s12889-018-5333-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 03/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Although the Short Test of Functional Health Literacy in Adults (S-TOFHLA) is widely used, misidentification of individuals with low health literacy (HL) in specific HL dimensions, like numeracy, is a concern. We examined the degree to which individuals scored as “adequate” HL on the S-TOFHLA would be considered as having low HL by two additional numerical measures. Methods English-speaking adults aged 45–75 years were recruited from a large, urban academic medical center and a community foodbank in the United States. Participants completed the S-TOFHLA, the Subjective Numeracy Scale (SNS), and the Graphical Literacy Measure (GL), an objective measure of a person’s ability to interpret numeric information presented graphically. Established cut-points or a median split classified participants and having high and low numeracy. Results Participants (n = 187), on average were: aged 58 years; 63% female; 70% Black/African American; and 45% had a high school degree or less. Of those who scored “adequate” on the S-TOFHLA, 50% scored low on the SNS and 40% scored low on GL. Correlation between the S-TOFHLA and the SNS Total was moderate (r = 0.22, n = 186, p = 0.01), while correlation between the S-TOFHLA and the GL Total was large (r = 0.53, n = 187, p ≤ 0.01). Conclusions Findings suggest that the S-TOFHLA may not capture an individuals’ HL in the dimension of numeracy. Efforts are needed to develop more encompassing and practical strategies for identifying those with low HL for use in research and clinical practice. Trial registration NCT02151032 (retrospectively registered: May 30, 2014).
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Affiliation(s)
- Ashley J Housten
- Department of Health Services Research, Division of Cancer Prevention & Population Sciences, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd.Unit 1444, Houston, TX, 77030, USA.
| | - Lisa M Lowenstein
- Department of Health Services Research, Division of Cancer Prevention & Population Sciences, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd.Unit 1444, Houston, TX, 77030, USA
| | - Diana S Hoover
- Department of Health Disparities Research, Division of Cancer Prevention & Population Sciences, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd.Unit 1440, Houston, TX, 77030, USA
| | - Viola B Leal
- Department of Health Services Research, Division of Cancer Prevention & Population Sciences, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd.Unit 1444, Houston, TX, 77030, USA
| | - Geetanjali R Kamath
- School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St., Houston, TX, 77030, USA
| | - Robert J Volk
- Department of Health Services Research, Division of Cancer Prevention & Population Sciences, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd.Unit 1444, Houston, TX, 77030, USA
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Abstract
This article reviews current literature on the role of pharmacists in the transition of care (TOC) for patients with heart failure (HF) and the impact of their contributions on therapeutic and economic outcomes. Optimizing the TOC for patients with HF from the hospital to the community/home is crucial for improving outcomes and decreasing high rates of hospital readmissions, which are associated with increased morbidity, mortality, and costs. A multidisciplinary team approach to the management of patients with HF facilitates the transition from the hospital to the ambulatory care setting, allowing for the consideration of medical, pharmacological, and lifestyle variables that impact the care of individual patients. Pharmacist participation on both inpatient and outpatient teams can provide a variety of services that have been shown to reduce hospital readmission rates and benefit patient management and treatment. These include medication reconciliation, patient education, medication dosage titration and adjustment, patient monitoring, development of disease management pathways, promotion of medication adherence, and postdischarge follow-up. In addition, as new pharmacologic treatments for HF become available, pharmacists can raise awareness of optimal drug use by maximizing education related to efficacy (e.g., adherence) and safety (e.g., potential side effects and drug interactions). Improving understanding of HF and its treatment will enable increased pharmacist involvement in the TOC that should lead to improved outcomes and reduced healthcare costs. FUNDING Novartis.
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Affiliation(s)
- Sarah L Anderson
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
| | - Joel C Marrs
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
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Vaughan B, Mulcahy J, Coffey A, Addinsall L, Ryan S, Fitzgerald K. A Mokken analysis of the literacy in musculoskeletal problems questionnaire. Health Qual Life Outcomes 2017; 15:245. [PMID: 29268754 PMCID: PMC5740964 DOI: 10.1186/s12955-017-0826-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 12/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Limited health literacy is known to impact on medication adherence, hospital readmission and potentially poorer health outcomes. The literature on the health literacy of those with musculoskeletal conditions suggests greater functional limitations and increased pain levels. There are a number of measures of health literacy. One that specifically relates to musculoskeletal complaints is the Literacy in Musculoskeletal Problems (LiMP) questionnaire. The LiMP contains 9 multiple choice items that cover anatomy, musculoskeletal conditions and the diagnosis of musculoskeletal complaints. The aim of the study was to evaluate the dimensionality and internal structure of the LiMP in patients attending for osteopathy care at a student-led clinic, as a potential measure of musculoskeletal health literacy. METHOD Three hundred and sixty-one (n = 361) new patients attending the Victoria University Osteopathy Clinic completed the LiMP and a demographic and health information questionnaire prior to their initial consultation. Mokken scale analysis, a nonparametric item response theory approach, was used to evaluate the dimensionality and structure of the LiMP in this population, to ascertain whether the questionnaire was measuring a single latent construct - musculoskeletal health literacy. McDonald's omega and Cronbach's alpha were calculated as the reliability estimations. The relationship between the LiMP and a single item screen of health literacy was also undertaken. RESULTS The 9 items on the LiMP did not form a Mokken scale and the reliability estimations were below an acceptable level (alpha and omega <0.45). LiMP items 5 and 8 were more likely to be answered correctly by those with higher health literacy (p < 0.05), however the effect sizes were small (<0.20). CONCLUSION Calculation of a total score for the LiMP, as advocated by the original authors, is not supported based on data in the present study. Further research is required to explore the relationship of the LiMP items to demographic and clinical data, and to other broader measures of health literacy. Further research may also develop a health literacy measure that is specific to patients seeking manual therapy care for musculoskeletal complaints.
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Affiliation(s)
- Brett Vaughan
- College of Health & Biomedicine, Victoria University, Melbourne, Australia
- Institute for Sport, Exercise and Active Living, Victoria University, Melbourne, Australia
| | - Jane Mulcahy
- College of Health & Biomedicine, Victoria University, Melbourne, Australia
| | - Amy Coffey
- College of Health & Biomedicine, Victoria University, Melbourne, Australia
| | - Laura Addinsall
- College of Health & Biomedicine, Victoria University, Melbourne, Australia
| | - Stephanie Ryan
- College of Health & Biomedicine, Victoria University, Melbourne, Australia
| | - Kylie Fitzgerald
- College of Health & Biomedicine, Victoria University, Melbourne, Australia
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Cayci HM, Erdogdu UE, Demirci H, Ardic A, Topak NY, Taymur İ. Effect of Health Literacy on Help-seeking Behavior in Morbidly Obese Patients Agreeing to Bariatric Surgery. Obes Surg 2017; 28:791-797. [DOI: 10.1007/s11695-017-2882-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Sawyer T, Nelson MJ, McKee V, Bowers MT, Meggitt C, Baxt SK, Washington D, Saladino L, Lehman EP, Brewer C, Locke SC, Abernethy A, Gilliss CL, Granger BB. Implementing Electronic Tablet-Based Education of Acute Care Patients. Crit Care Nurse 2017; 36:60-70. [PMID: 26830181 DOI: 10.4037/ccn2016541] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Poor education-related discharge preparedness for patients with heart failure is believed to be a major cause of avoidable rehospitalizations. Technology-based applications offer innovative educational approaches that may improve educational readiness for patients in both inpatient and outpatient settings; however, a number of challenges exist when implementing electronic devices in the clinical setting. Implementation challenges include processes for "on-boarding" staff, mediating risks of cross-contamination with patients' device use, and selling the value to staff and health system leaders to secure the investment in software, hardware, and system support infrastructure. Strategies to address these challenges are poorly described in the literature. The purpose of this article is to present a staff development program designed to overcome challenges in implementing an electronic, tablet-based education program for patients with heart failure.
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Affiliation(s)
- Tenita Sawyer
- Tenita Sawyer is a clinical nurse at the Duke Heart Center, Duke University Health System, Durham, North Carolina.Monica J. Nelson is a nurse at the University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina.Vickie McKee is a clinical nurse at the Duke Heart Center, Duke University Health System.Margaret T. Bowers is an assistant professor at the Duke University School of Nursing and Duke University Health System, Durham, North Carolina.Corilin Meggitt is a nurse at the Duke University School of Nursing.Sarah K. Baxt is a nurse at the Duke University School of Nursing.Delphine Washington is nurse manager, education, cardiology nursing, Duke Heart Center, Duke University Health System.Louise Saladino is clinical operations director, cardiology nursing, Duke Heart Center, Duke University Health System.E. Philip Lehman IV is a fellow in cardiovascular disease at the Department of Medicine, Duke University School of Medicine, Durham, North Carolina.Cheryl Brewer is manager of clinical trials operations and project management, Duke Cancer Care Research Program/Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina.Susan C. Locke is senior scientist and project leader at the Center for Learning Health Care, Duke Clinical Research Institute.Amy Abernethy is director of the Duke Center for Learning Health Care and a professor in the Duke University Department of Medicine and School of Nursing.Catherine L. Gilliss is dean of the Duke University School of Nursing.Bradi B. Granger is director of the Duke Heart Center Nursing Research Program and an associate professor in the Duke University School of Nursing
| | - Monica J Nelson
- Tenita Sawyer is a clinical nurse at the Duke Heart Center, Duke University Health System, Durham, North Carolina.Monica J. Nelson is a nurse at the University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina.Vickie McKee is a clinical nurse at the Duke Heart Center, Duke University Health System.Margaret T. Bowers is an assistant professor at the Duke University School of Nursing and Duke University Health System, Durham, North Carolina.Corilin Meggitt is a nurse at the Duke University School of Nursing.Sarah K. Baxt is a nurse at the Duke University School of Nursing.Delphine Washington is nurse manager, education, cardiology nursing, Duke Heart Center, Duke University Health System.Louise Saladino is clinical operations director, cardiology nursing, Duke Heart Center, Duke University Health System.E. Philip Lehman IV is a fellow in cardiovascular disease at the Department of Medicine, Duke University School of Medicine, Durham, North Carolina.Cheryl Brewer is manager of clinical trials operations and project management, Duke Cancer Care Research Program/Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina.Susan C. Locke is senior scientist and project leader at the Center for Learning Health Care, Duke Clinical Research Institute.Amy Abernethy is director of the Duke Center for Learning Health Care and a professor in the Duke University Department of Medicine and School of Nursing.Catherine L. Gilliss is dean of the Duke University School of Nursing.Bradi B. Granger is director of the Duke Heart Center Nursing Research Program and an associate professor in the Duke University School of Nursing
| | - Vickie McKee
- Tenita Sawyer is a clinical nurse at the Duke Heart Center, Duke University Health System, Durham, North Carolina.Monica J. Nelson is a nurse at the University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina.Vickie McKee is a clinical nurse at the Duke Heart Center, Duke University Health System.Margaret T. Bowers is an assistant professor at the Duke University School of Nursing and Duke University Health System, Durham, North Carolina.Corilin Meggitt is a nurse at the Duke University School of Nursing.Sarah K. Baxt is a nurse at the Duke University School of Nursing.Delphine Washington is nurse manager, education, cardiology nursing, Duke Heart Center, Duke University Health System.Louise Saladino is clinical operations director, cardiology nursing, Duke Heart Center, Duke University Health System.E. Philip Lehman IV is a fellow in cardiovascular disease at the Department of Medicine, Duke University School of Medicine, Durham, North Carolina.Cheryl Brewer is manager of clinical trials operations and project management, Duke Cancer Care Research Program/Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina.Susan C. Locke is senior scientist and project leader at the Center for Learning Health Care, Duke Clinical Research Institute.Amy Abernethy is director of the Duke Center for Learning Health Care and a professor in the Duke University Department of Medicine and School of Nursing.Catherine L. Gilliss is dean of the Duke University School of Nursing.Bradi B. Granger is director of the Duke Heart Center Nursing Research Program and an associate professor in the Duke University School of Nursing
| | - Margaret T Bowers
- Tenita Sawyer is a clinical nurse at the Duke Heart Center, Duke University Health System, Durham, North Carolina.Monica J. Nelson is a nurse at the University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina.Vickie McKee is a clinical nurse at the Duke Heart Center, Duke University Health System.Margaret T. Bowers is an assistant professor at the Duke University School of Nursing and Duke University Health System, Durham, North Carolina.Corilin Meggitt is a nurse at the Duke University School of Nursing.Sarah K. Baxt is a nurse at the Duke University School of Nursing.Delphine Washington is nurse manager, education, cardiology nursing, Duke Heart Center, Duke University Health System.Louise Saladino is clinical operations director, cardiology nursing, Duke Heart Center, Duke University Health System.E. Philip Lehman IV is a fellow in cardiovascular disease at the Department of Medicine, Duke University School of Medicine, Durham, North Carolina.Cheryl Brewer is manager of clinical trials operations and project management, Duke Cancer Care Research Program/Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina.Susan C. Locke is senior scientist and project leader at the Center for Learning Health Care, Duke Clinical Research Institute.Amy Abernethy is director of the Duke Center for Learning Health Care and a professor in the Duke University Department of Medicine and School of Nursing.Catherine L. Gilliss is dean of the Duke University School of Nursing.Bradi B. Granger is director of the Duke Heart Center Nursing Research Program and an associate professor in the Duke University School of Nursing
| | - Corilin Meggitt
- Tenita Sawyer is a clinical nurse at the Duke Heart Center, Duke University Health System, Durham, North Carolina.Monica J. Nelson is a nurse at the University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina.Vickie McKee is a clinical nurse at the Duke Heart Center, Duke University Health System.Margaret T. Bowers is an assistant professor at the Duke University School of Nursing and Duke University Health System, Durham, North Carolina.Corilin Meggitt is a nurse at the Duke University School of Nursing.Sarah K. Baxt is a nurse at the Duke University School of Nursing.Delphine Washington is nurse manager, education, cardiology nursing, Duke Heart Center, Duke University Health System.Louise Saladino is clinical operations director, cardiology nursing, Duke Heart Center, Duke University Health System.E. Philip Lehman IV is a fellow in cardiovascular disease at the Department of Medicine, Duke University School of Medicine, Durham, North Carolina.Cheryl Brewer is manager of clinical trials operations and project management, Duke Cancer Care Research Program/Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina.Susan C. Locke is senior scientist and project leader at the Center for Learning Health Care, Duke Clinical Research Institute.Amy Abernethy is director of the Duke Center for Learning Health Care and a professor in the Duke University Department of Medicine and School of Nursing.Catherine L. Gilliss is dean of the Duke University School of Nursing.Bradi B. Granger is director of the Duke Heart Center Nursing Research Program and an associate professor in the Duke University School of Nursing
| | - Sarah K Baxt
- Tenita Sawyer is a clinical nurse at the Duke Heart Center, Duke University Health System, Durham, North Carolina.Monica J. Nelson is a nurse at the University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina.Vickie McKee is a clinical nurse at the Duke Heart Center, Duke University Health System.Margaret T. Bowers is an assistant professor at the Duke University School of Nursing and Duke University Health System, Durham, North Carolina.Corilin Meggitt is a nurse at the Duke University School of Nursing.Sarah K. Baxt is a nurse at the Duke University School of Nursing.Delphine Washington is nurse manager, education, cardiology nursing, Duke Heart Center, Duke University Health System.Louise Saladino is clinical operations director, cardiology nursing, Duke Heart Center, Duke University Health System.E. Philip Lehman IV is a fellow in cardiovascular disease at the Department of Medicine, Duke University School of Medicine, Durham, North Carolina.Cheryl Brewer is manager of clinical trials operations and project management, Duke Cancer Care Research Program/Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina.Susan C. Locke is senior scientist and project leader at the Center for Learning Health Care, Duke Clinical Research Institute.Amy Abernethy is director of the Duke Center for Learning Health Care and a professor in the Duke University Department of Medicine and School of Nursing.Catherine L. Gilliss is dean of the Duke University School of Nursing.Bradi B. Granger is director of the Duke Heart Center Nursing Research Program and an associate professor in the Duke University School of Nursing
| | - Delphine Washington
- Tenita Sawyer is a clinical nurse at the Duke Heart Center, Duke University Health System, Durham, North Carolina.Monica J. Nelson is a nurse at the University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina.Vickie McKee is a clinical nurse at the Duke Heart Center, Duke University Health System.Margaret T. Bowers is an assistant professor at the Duke University School of Nursing and Duke University Health System, Durham, North Carolina.Corilin Meggitt is a nurse at the Duke University School of Nursing.Sarah K. Baxt is a nurse at the Duke University School of Nursing.Delphine Washington is nurse manager, education, cardiology nursing, Duke Heart Center, Duke University Health System.Louise Saladino is clinical operations director, cardiology nursing, Duke Heart Center, Duke University Health System.E. Philip Lehman IV is a fellow in cardiovascular disease at the Department of Medicine, Duke University School of Medicine, Durham, North Carolina.Cheryl Brewer is manager of clinical trials operations and project management, Duke Cancer Care Research Program/Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina.Susan C. Locke is senior scientist and project leader at the Center for Learning Health Care, Duke Clinical Research Institute.Amy Abernethy is director of the Duke Center for Learning Health Care and a professor in the Duke University Department of Medicine and School of Nursing.Catherine L. Gilliss is dean of the Duke University School of Nursing.Bradi B. Granger is director of the Duke Heart Center Nursing Research Program and an associate professor in the Duke University School of Nursing
| | - Louise Saladino
- Tenita Sawyer is a clinical nurse at the Duke Heart Center, Duke University Health System, Durham, North Carolina.Monica J. Nelson is a nurse at the University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina.Vickie McKee is a clinical nurse at the Duke Heart Center, Duke University Health System.Margaret T. Bowers is an assistant professor at the Duke University School of Nursing and Duke University Health System, Durham, North Carolina.Corilin Meggitt is a nurse at the Duke University School of Nursing.Sarah K. Baxt is a nurse at the Duke University School of Nursing.Delphine Washington is nurse manager, education, cardiology nursing, Duke Heart Center, Duke University Health System.Louise Saladino is clinical operations director, cardiology nursing, Duke Heart Center, Duke University Health System.E. Philip Lehman IV is a fellow in cardiovascular disease at the Department of Medicine, Duke University School of Medicine, Durham, North Carolina.Cheryl Brewer is manager of clinical trials operations and project management, Duke Cancer Care Research Program/Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina.Susan C. Locke is senior scientist and project leader at the Center for Learning Health Care, Duke Clinical Research Institute.Amy Abernethy is director of the Duke Center for Learning Health Care and a professor in the Duke University Department of Medicine and School of Nursing.Catherine L. Gilliss is dean of the Duke University School of Nursing.Bradi B. Granger is director of the Duke Heart Center Nursing Research Program and an associate professor in the Duke University School of Nursing
| | - E Philip Lehman
- Tenita Sawyer is a clinical nurse at the Duke Heart Center, Duke University Health System, Durham, North Carolina.Monica J. Nelson is a nurse at the University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina.Vickie McKee is a clinical nurse at the Duke Heart Center, Duke University Health System.Margaret T. Bowers is an assistant professor at the Duke University School of Nursing and Duke University Health System, Durham, North Carolina.Corilin Meggitt is a nurse at the Duke University School of Nursing.Sarah K. Baxt is a nurse at the Duke University School of Nursing.Delphine Washington is nurse manager, education, cardiology nursing, Duke Heart Center, Duke University Health System.Louise Saladino is clinical operations director, cardiology nursing, Duke Heart Center, Duke University Health System.E. Philip Lehman IV is a fellow in cardiovascular disease at the Department of Medicine, Duke University School of Medicine, Durham, North Carolina.Cheryl Brewer is manager of clinical trials operations and project management, Duke Cancer Care Research Program/Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina.Susan C. Locke is senior scientist and project leader at the Center for Learning Health Care, Duke Clinical Research Institute.Amy Abernethy is director of the Duke Center for Learning Health Care and a professor in the Duke University Department of Medicine and School of Nursing.Catherine L. Gilliss is dean of the Duke University School of Nursing.Bradi B. Granger is director of the Duke Heart Center Nursing Research Program and an associate professor in the Duke University School of Nursing
| | - Cheryl Brewer
- Tenita Sawyer is a clinical nurse at the Duke Heart Center, Duke University Health System, Durham, North Carolina.Monica J. Nelson is a nurse at the University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina.Vickie McKee is a clinical nurse at the Duke Heart Center, Duke University Health System.Margaret T. Bowers is an assistant professor at the Duke University School of Nursing and Duke University Health System, Durham, North Carolina.Corilin Meggitt is a nurse at the Duke University School of Nursing.Sarah K. Baxt is a nurse at the Duke University School of Nursing.Delphine Washington is nurse manager, education, cardiology nursing, Duke Heart Center, Duke University Health System.Louise Saladino is clinical operations director, cardiology nursing, Duke Heart Center, Duke University Health System.E. Philip Lehman IV is a fellow in cardiovascular disease at the Department of Medicine, Duke University School of Medicine, Durham, North Carolina.Cheryl Brewer is manager of clinical trials operations and project management, Duke Cancer Care Research Program/Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina.Susan C. Locke is senior scientist and project leader at the Center for Learning Health Care, Duke Clinical Research Institute.Amy Abernethy is director of the Duke Center for Learning Health Care and a professor in the Duke University Department of Medicine and School of Nursing.Catherine L. Gilliss is dean of the Duke University School of Nursing.Bradi B. Granger is director of the Duke Heart Center Nursing Research Program and an associate professor in the Duke University School of Nursing
| | - Susan C Locke
- Tenita Sawyer is a clinical nurse at the Duke Heart Center, Duke University Health System, Durham, North Carolina.Monica J. Nelson is a nurse at the University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina.Vickie McKee is a clinical nurse at the Duke Heart Center, Duke University Health System.Margaret T. Bowers is an assistant professor at the Duke University School of Nursing and Duke University Health System, Durham, North Carolina.Corilin Meggitt is a nurse at the Duke University School of Nursing.Sarah K. Baxt is a nurse at the Duke University School of Nursing.Delphine Washington is nurse manager, education, cardiology nursing, Duke Heart Center, Duke University Health System.Louise Saladino is clinical operations director, cardiology nursing, Duke Heart Center, Duke University Health System.E. Philip Lehman IV is a fellow in cardiovascular disease at the Department of Medicine, Duke University School of Medicine, Durham, North Carolina.Cheryl Brewer is manager of clinical trials operations and project management, Duke Cancer Care Research Program/Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina.Susan C. Locke is senior scientist and project leader at the Center for Learning Health Care, Duke Clinical Research Institute.Amy Abernethy is director of the Duke Center for Learning Health Care and a professor in the Duke University Department of Medicine and School of Nursing.Catherine L. Gilliss is dean of the Duke University School of Nursing.Bradi B. Granger is director of the Duke Heart Center Nursing Research Program and an associate professor in the Duke University School of Nursing
| | - Amy Abernethy
- Tenita Sawyer is a clinical nurse at the Duke Heart Center, Duke University Health System, Durham, North Carolina.Monica J. Nelson is a nurse at the University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina.Vickie McKee is a clinical nurse at the Duke Heart Center, Duke University Health System.Margaret T. Bowers is an assistant professor at the Duke University School of Nursing and Duke University Health System, Durham, North Carolina.Corilin Meggitt is a nurse at the Duke University School of Nursing.Sarah K. Baxt is a nurse at the Duke University School of Nursing.Delphine Washington is nurse manager, education, cardiology nursing, Duke Heart Center, Duke University Health System.Louise Saladino is clinical operations director, cardiology nursing, Duke Heart Center, Duke University Health System.E. Philip Lehman IV is a fellow in cardiovascular disease at the Department of Medicine, Duke University School of Medicine, Durham, North Carolina.Cheryl Brewer is manager of clinical trials operations and project management, Duke Cancer Care Research Program/Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina.Susan C. Locke is senior scientist and project leader at the Center for Learning Health Care, Duke Clinical Research Institute.Amy Abernethy is director of the Duke Center for Learning Health Care and a professor in the Duke University Department of Medicine and School of Nursing.Catherine L. Gilliss is dean of the Duke University School of Nursing.Bradi B. Granger is director of the Duke Heart Center Nursing Research Program and an associate professor in the Duke University School of Nursing
| | - Catherine L Gilliss
- Tenita Sawyer is a clinical nurse at the Duke Heart Center, Duke University Health System, Durham, North Carolina.Monica J. Nelson is a nurse at the University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina.Vickie McKee is a clinical nurse at the Duke Heart Center, Duke University Health System.Margaret T. Bowers is an assistant professor at the Duke University School of Nursing and Duke University Health System, Durham, North Carolina.Corilin Meggitt is a nurse at the Duke University School of Nursing.Sarah K. Baxt is a nurse at the Duke University School of Nursing.Delphine Washington is nurse manager, education, cardiology nursing, Duke Heart Center, Duke University Health System.Louise Saladino is clinical operations director, cardiology nursing, Duke Heart Center, Duke University Health System.E. Philip Lehman IV is a fellow in cardiovascular disease at the Department of Medicine, Duke University School of Medicine, Durham, North Carolina.Cheryl Brewer is manager of clinical trials operations and project management, Duke Cancer Care Research Program/Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina.Susan C. Locke is senior scientist and project leader at the Center for Learning Health Care, Duke Clinical Research Institute.Amy Abernethy is director of the Duke Center for Learning Health Care and a professor in the Duke University Department of Medicine and School of Nursing.Catherine L. Gilliss is dean of the Duke University School of Nursing.Bradi B. Granger is director of the Duke Heart Center Nursing Research Program and an associate professor in the Duke University School of Nursing
| | - Bradi B Granger
- Tenita Sawyer is a clinical nurse at the Duke Heart Center, Duke University Health System, Durham, North Carolina.Monica J. Nelson is a nurse at the University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina.Vickie McKee is a clinical nurse at the Duke Heart Center, Duke University Health System.Margaret T. Bowers is an assistant professor at the Duke University School of Nursing and Duke University Health System, Durham, North Carolina.Corilin Meggitt is a nurse at the Duke University School of Nursing.Sarah K. Baxt is a nurse at the Duke University School of Nursing.Delphine Washington is nurse manager, education, cardiology nursing, Duke Heart Center, Duke University Health System.Louise Saladino is clinical operations director, cardiology nursing, Duke Heart Center, Duke University Health System.E. Philip Lehman IV is a fellow in cardiovascular disease at the Department of Medicine, Duke University School of Medicine, Durham, North Carolina.Cheryl Brewer is manager of clinical trials operations and project management, Duke Cancer Care Research Program/Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina.Susan C. Locke is senior scientist and project leader at the Center for Learning Health Care, Duke Clinical Research Institute.Amy Abernethy is director of the Duke Center for Learning Health Care and a professor in the Duke University Department of Medicine and School of Nursing.Catherine L. Gilliss is dean of the Duke University School of Nursing.Bradi B. Granger is director of the Duke Heart Center Nursing Research Program and an associate professor in the Duke University School of Nursing.
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Jones J, Rosaasen N, Taylor J, Mainra R, Shoker A, Blackburn D, Wilson J, Mansell H. Health Literacy, Knowledge, and Patient Satisfaction Before Kidney Transplantation. Transplant Proc 2016; 48:2608-2614. [DOI: 10.1016/j.transproceed.2016.07.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/26/2016] [Indexed: 10/20/2022]
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Rosenbaum AJ, Uhl RL, Rankin EA, Mulligan MT. Social and Cultural Barriers: Understanding Musculoskeletal Health Literacy: AOA Critical Issues. J Bone Joint Surg Am 2016; 98:607-15. [PMID: 27053590 DOI: 10.2106/jbjs.o.00718] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The Institute of Medicine considers limited health literacy a "silent epidemic," as approximately half of Americans lack the competencies necessary for making informed decisions regarding their health. Limited health literacy substantially impedes the effective dissemination and comprehension of relevant health information, and also complicates communication, compromises care, and leads to worse patient outcomes. Poor health, early death, and worse control of chronic conditions have also been associated with limited health literacy. Unfortunately, physicians often struggle to identify those with limited health literacy, which can have adverse effects on the physician-patient relationship. In this article, we discuss the meaning of health literacy,the risk factors for and consequences of limited health literacy, orthopaedic-specific implications and investigations, and the strategies orthopaedic surgeons can utilize to improve health literacy and communication.
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Affiliation(s)
- Andrew J Rosenbaum
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, New York
| | - Richard L Uhl
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, New York
| | | | - Michael T Mulligan
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, New York
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Stonbraker S, Schnall R, Larson E. Tools to measure health literacy among Spanish speakers: An integrative review of the literature. PATIENT EDUCATION AND COUNSELING 2015; 98:S0738-3991(15)30020-3. [PMID: 26227578 PMCID: PMC4721943 DOI: 10.1016/j.pec.2015.07.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 07/13/2015] [Accepted: 07/15/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Health literacy measurement can help inform healthcare service delivery. The objective of this study is to identify validated tools to measure health literacy among Spanish speakers and to summarize characteristics that are relevant when selecting tools for use in clinical or research settings. METHODS An English and Spanish search of 9 databases was conducted between October 2014 and May 2015. Inclusion criteria were peer-reviewed articles presenting initial validation and psychometric properties of a tool to measure health literacy among Spanish speaking patients. Characteristics relevant to tool selection were reviewed and presented. RESULTS Twenty articles validating 19 instruments met inclusion criteria. Instruments were designed for use with Spanish speakers in numerous contexts and measured different health literacy skills such as reading comprehension or numeracy. Methods used to validate tools were inconsistent across instruments. CONCLUSION Although tools have inconsistencies and inefficiencies, many can be used for assessment of health literacy among Spanish speakers. PRACTICE IMPLICATIONS Healthcare providers, organizations, and researchers can use this review to select effective health literacy tools to indicate patient's ability to understand and use health information so that services and materials can be more appropriately tailored to Spanish speaking patients.
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Affiliation(s)
| | | | - Elaine Larson
- Columbia University School of Nursing, New York, NY, USA; Mailman School of Public Health, Department of Epidemiology, New York, NY, USA.
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Health literacy in hand surgery patients: a cross-sectional survey. J Hand Surg Am 2015; 40:798-804.e2. [PMID: 25746142 DOI: 10.1016/j.jhsa.2015.01.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 01/07/2015] [Accepted: 01/08/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the prevalence of and factors associated with limited health literacy among outpatients presenting to an urban academic hospital-based hand surgeon. METHODS A cohort of 200 English- and Spanish-speaking patients completed the Newest Vital Sign (NVS) health literacy assessment tool, a sociodemographic survey, and 2 Patient-Reported Outcomes Measurement Information System-based computerized adaptive testing questionnaires: Patient-Reported Outcomes Measurement Information System Pain Interference and Upper-Extremity Function. The NVS scores were divided into limited (0-3) and adequate (4-6) health literacy. Multivariable regression modeling was used to identify independent predictors of limited health literacy. RESULTS A total of 86 patients (43%) had limited health literacy (English-speaking: 33%; Spanish-speaking: 100%). Factors associated with limited health literacy were advanced age, lower income, and being publicly insured or uninsured. Increasing years of education was a protective factor. Primary language was not included in the logistic regression model because all Spanish-speaking patients had limited health literacy. When evaluating health literacy on a continuum, primary language was the factor that most influenced the NVS scores, accounting for 14% of the variability. CONCLUSIONS Limited health literacy was commonplace among patients seeing a hand surgeon, more so in elderly and disadvantaged individuals. We hope our study raises awareness of this issue among hand surgeons and encourages providers to simplify messages and improve communication strategies. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Wong PKK, Christie L, Johnston J, Bowling A, Freeman D, Joshua F, Bird P, Chia K, Bagga H. How well do patients understand written instructions?: health literacy assessment in rural and urban rheumatology outpatients. Medicine (Baltimore) 2014; 93:e129. [PMID: 25437024 PMCID: PMC4616379 DOI: 10.1097/md.0000000000000129] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to assess health literacy (word recognition and comprehension) in patients at a rural rheumatology practice and to compare this to health literacy levels in patients from an urban rheumatology practice.Inclusion criteria for this cross-sectional study were as follows: ≥18-year-old patients at a rural rheumatology practice (Mid-North Coast Arthritis Clinic, Coffs Harbour, Australia) and an urban Sydney rheumatology practice (Combined Rheumatology Practice, Kogarah, Australia). Exclusion criteria were as follows: ill-health precluding participation; poor vision/hearing, non-English primary language. Word recognition was assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM). Comprehension was assessed using the Test of Functional Health Literacy in Adults (TOFHLA). Practical comprehension and numeracy were assessed by asking patients to follow prescribing instructions for 5 common rheumatology medications.At the rural practice (Mid-North Coast Arthritis Clinic), 124/160 patients agreed to participate (F:M 83:41, mean age 60.3 ± 12.2) whereas the corresponding number at the urban practice (Combined Rheumatology Practice) was 99/119 (F:M 69:30, mean age 60.7 ± 17.5). Urban patients were more likely to be born overseas, speak another language at home, and be employed. There was no difference in REALM or TOFHLA scores between the 2 sites, and so data were pooled. REALM scores indicated 15% (33/223) of patients had a reading level ≤Grade 8 whereas 8% (18/223) had marginal or inadequate functional health literacy as assessed by the TOFHLA. Dosing instructions for ibuprofen and methotrexate were incorrectly understood by 32% (72/223) and 21% (46/223) of patients, respectively.Up to 15% of rural and urban patients had low health literacy and <1/3 of patients incorrectly followed dosing instructions for common rheumatology drugs.There was no significant difference in word recognition, functional health literacy, and numeracy between rural and urban rheumatology patients.
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Affiliation(s)
- Peter K K Wong
- From the Mid-North Coast Arthritis Clinic (PKKW, DF, HB); Rural Clinical School, University of New South Wales (PKKW, LC, KC); School of Education, Southern Cross University, Coffs Harbour (JJ); School of Health and Human Sciences, Southern Cross University, Coffs Harbour (AB); Combined Rheumatology Practice, Kogarah (FJ, PB); and Department of Rheumatology, Prince of Wales Hospital, Randwick (FJ), New South Wales, Australia
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Ownby RL, Acevedo A, Waldrop-Valverde D, Jacobs RJ, Caballero J. Abilities, skills and knowledge in measures of health literacy. PATIENT EDUCATION AND COUNSELING 2014; 95:211-7. [PMID: 24637163 PMCID: PMC4040019 DOI: 10.1016/j.pec.2014.02.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 01/21/2014] [Accepted: 02/06/2014] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Health literacy has been recognized as an important factor in patients' health status and outcomes, but the relative contribution of demographic variables, cognitive abilities, academic skills, and health knowledge to performance on tests of health literacy has not been as extensively explored. The purpose of this paper is to propose a model of health literacy as a composite of cognitive abilities, academic skills, and health knowledge (ASK model) and test its relation to measures of health literacy in a model that first takes demographic variables into account. METHODS A battery of cognitive, academic achievement, health knowledge and health literacy measures was administered to 359 Spanish- and English-speaking community-dwelling volunteers. The relations of health literacy tests to the model were evaluated using regression models. RESULTS Each health literacy test was related to elements of the model but variability existed across measures. CONCLUSION Analyses partially support the ASK model defining health literacy as a composite of abilities, skills, and knowledge, although the relations of commonly used health literacy measures to each element of the model varied widely. PRACTICE IMPLICATIONS Results suggest that clinicians and researchers should be aware of the abilities and skills assessed by health literacy measures when choosing a measure.
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Affiliation(s)
- Raymond L Ownby
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale, USA.
| | - Amarilis Acevedo
- Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, USA
| | | | - Robin J Jacobs
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Joshua Caballero
- College of Pharmacy, Department of Pharmacy Practice, Nova Southeastern University, Fort Lauderdale, USA
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Sørensen K, Van den Broucke S, Pelikan JM, Fullam J, Doyle G, Slonska Z, Kondilis B, Stoffels V, Osborne RH, Brand H. Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q). BMC Public Health 2013; 13:948. [PMID: 24112855 PMCID: PMC4016258 DOI: 10.1186/1471-2458-13-948] [Citation(s) in RCA: 550] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 09/26/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several measurement tools have been developed to measure health literacy. The tools vary in their approach and design, but few have focused on comprehensive health literacy in populations. This paper describes the design and development of the European Health Literacy Survey Questionnaire (HLS-EU-Q), an innovative, comprehensive tool to measure health literacy in populations. METHODS Based on a conceptual model and definition, the process involved item development, pre-testing, field-testing, external consultation, plain language check, and translation from English to Bulgarian, Dutch, German, Greek, Polish, and Spanish. RESULTS The development process resulted in the HLS-EU-Q, which entailed two sections, a core health literacy section and a section on determinants and outcomes associated to health literacy. The health literacy section included 47 items addressing self-reported difficulties in accessing, understanding, appraising and applying information in tasks concerning decisions making in healthcare, disease prevention, and health promotion. The second section included items related to, health behaviour, health status, health service use, community participation, socio-demographic and socio-economic factors. CONCLUSIONS By illuminating the detailed steps in the design and development process of the HLS-EU-Q, it is the aim to provide a deeper understanding of its purpose, its capability and its limitations for others using the tool. By stimulating a wide application it is the vision that HLS-EU-Q will be validated in more countries to enhance the understanding of health literacy in different populations.
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Affiliation(s)
- Kristine Sørensen
- Department of International Health, CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, P,O, Box 616, 6200, Maastricht, MD, the Netherlands.
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Al Sayah F, Majumdar SR, Williams B, Robertson S, Johnson JA. Health literacy and health outcomes in diabetes: a systematic review. J Gen Intern Med 2013; 28:444-52. [PMID: 23065575 PMCID: PMC3579965 DOI: 10.1007/s11606-012-2241-z] [Citation(s) in RCA: 233] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Revised: 07/02/2012] [Accepted: 09/20/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Low health literacy is considered a potential barrier to improving health outcomes in people with diabetes and other chronic conditions, although the evidence has not been previously systematically reviewed. OBJECTIVE To identify, appraise, and synthesize research evidence on the relationships between health literacy (functional, interactive, and critical) or numeracy and health outcomes (i.e., knowledge, behavioral and clinical) in people with diabetes. METHODS English-language articles that addressed the relationship between health literacy or numeracy and at least one health outcome in people with diabetes were identified by two reviewers through searching six scientific databases, and hand-searching journals and reference lists. FINDINGS Seven hundred twenty-three citations were identified and screened, 196 were considered, and 34 publications reporting data from 24 studies met the inclusion criteria and were included in this review. Consistent and sufficient evidence showed a positive association between health literacy and diabetes knowledge (eight studies). There was a lack of consistent evidence on the relationship between health literacy or numeracy and clinical outcomes, e.g., A1C (13 studies), self-reported complications (two studies), and achievement of clinical goals (one study); behavioral outcomes, e.g., self-monitoring of blood glucose (one study), self-efficacy (five studies); or patient-provider interactions (i.e., patient-physician communication, information exchange, decision-making, and trust), and other outcomes. The majority of the studies were from US primary care setting (87.5 %), and there were no randomized or other trials to improve health literacy. CONCLUSIONS Low health literacy is consistently associated with poorer diabetes knowledge. However, there is little sufficient or consistent evidence suggesting that it is independently associated with processes or outcomes of diabetes-related care. Based on these findings, it may be premature to routinely screen for low health literacy as a means for improving diabetes-related health-related outcomes.
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Affiliation(s)
- Fatima Al Sayah
- />School of Public Health, University of Alberta, Edmonton, AB T6G 2E1 Canada
- />Alliance for Canadian Health Outcomes Research in Diabetes (ACHORD), University of Alberta, Edmonton, AB Canada
- />Faculty of Nursing, University of Alberta, Edmonton, AB Canada
| | - Sumit R. Majumdar
- />Alliance for Canadian Health Outcomes Research in Diabetes (ACHORD), University of Alberta, Edmonton, AB Canada
- />Faculty of Medicine, University of Alberta, Edmonton, AB Canada
| | - Beverly Williams
- />Faculty of Nursing, University of Alberta, Edmonton, AB Canada
| | - Sandy Robertson
- />Faculty of Nursing, University of Alberta, Edmonton, AB Canada
| | - Jeffrey A. Johnson
- />School of Public Health, University of Alberta, Edmonton, AB T6G 2E1 Canada
- />Alliance for Canadian Health Outcomes Research in Diabetes (ACHORD), University of Alberta, Edmonton, AB Canada
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Rodríguez V, Andrade AD, García-Retamero R, Anam R, Rodríguez R, Lisigurski M, Sharit J, Ruiz JG. Health literacy, numeracy, and graphical literacy among veterans in primary care and their effect on shared decision making and trust in physicians. JOURNAL OF HEALTH COMMUNICATION 2013; 18 Suppl 1:273-89. [PMID: 24093361 PMCID: PMC3815195 DOI: 10.1080/10810730.2013.829137] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Studies reveal high levels of inadequate health literacy and numeracy in African Americans and older veterans. The authors aimed to investigate the distribution of health literacy, numeracy, and graph literacy in these populations. They conducted a cross-sectional survey of veterans receiving outpatient care and measured health literacy, numeracy, graph literacy, shared decision making, and trust in physicians. In addition, the authors compared subgroups of veterans using analyses of covariance. Participants were 502 veterans (22-82 years). Low, marginal, and adequate health literacy were found in, respectively, 29%, 26%, and 45% of the veterans. The authors found a significant main effect of race qualified by an age and race interaction. Inadequate health literacy was more common in African Americans than in Whites. Younger African Americans had lower health literacy (p <.001), graph literacy (p <.001), and numeracy (p <.001) than did Whites, even after the authors adjusted for covariates. Older and younger participants did not differ in health literacy, objective numeracy, or graph literacy after adjustment. The authors found no health literacy or age-related differences regarding preferences for shared decision making. African Americans expressed dissatisfaction with their current role in decision making (p =.03). Older participants trusted their physicians more than younger participants (p =.01). In conclusion, African Americans may be at a disadvantage when reviewing patient education materials, potentially affecting health care outcomes.
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Affiliation(s)
| | - Allen D. Andrade
- Laboratory of E-Learning and Multimedia Research, Bruce W. Carter Miami VA Geriatric Research Education and Clinical Center (GRECC), and the University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Ramanakumar Anam
- Laboratory of E-Learning and Multimedia Research, Bruce W. Carter Miami VA Geriatric Research Education and Clinical Center (GRECC), Miami, Florida, USA
| | | | - Miriam Lisigurski
- Laboratory of E-Learning and Multimedia Research, Bruce W. Carter Miami VA Geriatric Research Education and Clinical Center (GRECC), Miami, Florida, USA
| | - Joseph Sharit
- Laboratory of E-Learning and Multimedia Research, Bruce W. Carter Miami VA Geriatric Research Education and Clinical Center (GRECC); the University of Miami Miller School of Medicine; and the University of Miami College of Engineering, Miami, Florida, USA
| | - Jorge G. Ruiz
- Laboratory of E-Learning and Multimedia Research, Bruce W. Carter Miami VA Geriatric Research Education and Clinical Center (GRECC), and the University of Miami Miller School of Medicine, Miami, Florida, USA
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Press VG, Shapiro MI, Mayo AM, Meltzer DO, Arora VM. More than meets the eye: relationship between low health literacy and poor vision in hospitalized patients. JOURNAL OF HEALTH COMMUNICATION 2013; 18 Suppl 1:197-204. [PMID: 24093356 PMCID: PMC3807095 DOI: 10.1080/10810730.2013.830346] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Patient-centered care includes involving patients and their families in self-management of chronic diseases. Identifying and addressing barriers to self-management, including those related to health literacy and vision limitations, may enhance one's ability to self-manage. A set of brief verbal screening questions (BVSQ) that does not rely on sufficient vision to assess health literacy was developed by Chew and colleagues in the outpatient setting. The authors aimed to evaluate the usefulness of this tool for hospitalized patients and to determine the prevalence of poor vision among inpatients. In a prospective study, the BVSQ and the Rapid Estimate of Adult Learning in Medicine-Revised (REALM-R; among participants with sufficient vision, ≥ 20/50 Snellen) were administered to general medicine inpatients. Of 893 participants, 79% were African American, and 57% were female; the mean age was 53 years. Among 668 participants who completed both tools, the proportion with low health literacy was 38% with the BVSQ versus 47% with the REALM-R (p = .0001). Almost one fourth of participants had insufficient vision; participants with insufficient vision were more likely to be identified as having low health literacy by the BVSQ, compared with those with sufficient vision (59% vs. 38%, p < .001).
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Affiliation(s)
- Valerie G. Press
- Section of Hospital Medicine, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
- Address correspondence to Valerie G. Press, Section of Hospital Medicine, Department of Medicine, University of Chicago Medicine, 5841 S. Maryland Ave MC 5000, Chicago, IL 60637, USA. E-mail:
| | | | - Ainoa M. Mayo
- Section of Hospital Medicine, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - David O. Meltzer
- Section of Hospital Medicine, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Vineet M. Arora
- Section of General Internal Medicine, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
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Sharp LK, Ureste PJ, Torres LA, Bailey L, Gordon HS, Gerber BS. Time to sign: The relationship between health literacy and signature time. PATIENT EDUCATION AND COUNSELING 2013; 90:18-22. [PMID: 23154148 DOI: 10.1016/j.pec.2012.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 10/05/2012] [Accepted: 10/19/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To evaluate the relationship between amount of time taken to sign one's name and health literacy. METHODS A prospective, one time assessment was conducted on a convenience sample of 98 patients recruited in an inner-city outpatient internal medicine clinic. The amount of time required to sign (i.e. initiation to completion of writing) was measured by stopwatch. Health literacy was measured with the REALM. RESULTS The sample averaged 54.1 (SD 16.2) years of age. Twenty-seven percent had less than high school education and 33% had a terminal general equivalency diploma or high school degree. The time required to sign ranged from 0.91 to 21.3s. Sixty-two percent of the sample had health literacy challenges. Signature time was longest for those with inadequate health literacy (mean 10.0 s), compared with marginal (7.3s) and adequate (4.7s, p ≤ 0.001). Signature time remained significant in a logistic regression model after controlling for education and age (AOR = 0.785, CI = 0.661-0.932). CONCLUSION Individuals with signatures completed in six seconds or less were highly likely to display adequate health literacy. PRACTICE IMPLICATIONS Signature time may offer a practical and quick approach to health literacy screening in the health care setting.
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Affiliation(s)
- Lisa K Sharp
- Section of Health Promotion Research, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago 60608, USA.
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Al Sayah F, Williams B, Johnson JA. Measuring health literacy in individuals with diabetes: a systematic review and evaluation of available measures. HEALTH EDUCATION & BEHAVIOR 2012; 40:42-55. [PMID: 22491040 DOI: 10.1177/1090198111436341] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To identify instruments used to measure health literacy and numeracy in people with diabetes; evaluate their use, measurement scope, and properties; discuss their strengths and weaknesses; and propose the most useful, reliable, and applicable measure for use in research and practice settings. METHODS A systematic literature review was conducted to identify the instruments. Nutbeam's domains of health literacy and a diabetes health literacy skill set were used to evaluate the measurement scope of the identified instruments and to evaluate their applicability in people with diabetes. RESULTS Fifty-six studies were included, from which one diabetes-specific (LAD) and eight generic measures of health literacy (REALM, REALM-R, TOFHLA, s-TOFHLA, NVS, 3-brief SQ, 3-level HL Scale, SILS) and one diabetes-specific (DNT) and two generic measures of numeracy (SNS, WRAT) were identified. These instruments were categorized into direct measures, that is, instruments that assess the performance of individuals on health literacy skills and indirect measures that rely on self-report of these skills. The most commonly used instruments measure selective domains of health literacy, focus mainly on reading and writing skills, and do not address other important skills such as verbal communication, health care system navigation, health-related decision making, and numeracy. The structure, mode, and length of administration and measurement properties were found to affect the applicability of these instruments in clinical and research settings. Indirect self- or clinician-administered measures are the most useful in both clinical and research settings. CONCLUSION This review provides an evaluation of available health literacy measures and guidance to practitioners and researchers for selecting the appropriate measures for use in clinical settings and research applications.
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Matsuyama RK, Wilson-Genderson M, Kuhn L, Moghanaki D, Vachhani H, Paasche-Orlow M. Education level, not health literacy, associated with information needs for patients with cancer. PATIENT EDUCATION AND COUNSELING 2011; 85:e229-e236. [PMID: 21543182 DOI: 10.1016/j.pec.2011.03.022] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 03/25/2011] [Accepted: 03/28/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Cancer patients receiving adjuvant therapy encounter increasingly complex situations and decisions with each new procedure and therapy. To make informed decisions about care, they need to be able to access, process, and understand information. Individuals with limited health literacy may not be able to obtain or understand important information about their cancer and treatment. The rate of low health literacy has been shown to be higher among African Americans than among non-Hispanic Whites. This study examined the associations between race, health literacy, and self-reported needs for information about disease, diagnostic tests, treatments, physical care, and psychosocial resources. METHODS Measures assessing information needs were administered to 138 newly diagnosed cancer patients. Demographics were assessed by survey and health literacy was assessed with two commonly used measures: the Rapid Estimate Adult Literacy in Medicine (REALM) and the Short Test of Health Literacy in Adults (STOFHLA). RESULTS Study findings indicate that educational attainment, rather than health literacy, is a significant predictor of information needs. CONCLUSION Overcoming barriers to information needs may be less dependent on literacy considerations and more dependent on issues that divide across levels of educational attainment. PRACTICE IMPLICATIONS Oncologists and hospital staff should be attentive to the fact that many patients require additional assistance to meet their information needs.
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Affiliation(s)
- Robin K Matsuyama
- Department of Social & Behavioral Health, Virginia Commonwealth University, Richmond, VA, USA.
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van der Vaart R, van Deursen AJ, Drossaert CH, Taal E, van Dijk JA, van de Laar MA. Does the eHealth Literacy Scale (eHEALS) measure what it intends to measure? Validation of a Dutch version of the eHEALS in two adult populations. J Med Internet Res 2011; 13:e86. [PMID: 22071338 PMCID: PMC3222202 DOI: 10.2196/jmir.1840] [Citation(s) in RCA: 202] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 07/04/2011] [Indexed: 11/13/2022] Open
Abstract
Background The Internet increases the availability of health information, which consequently expands the amount of skills that health care consumers must have to obtain and evaluate health information. Norman and Skinner in 2006 developed an 8-item self-report eHealth literacy scale to measure these skills: the eHealth Literacy Scale (eHEALS). This instrument has been available only in English and there are no data on its validity. Objectives The objective of our study was to assess the internal consistency and the construct and predictive validity of a Dutch translation of the eHEALS in two populations. Methods We examined the translated scale in a sample of patients with rheumatic diseases (n = 189; study 1) and in a stratified sample of the Dutch population (n = 88; study 2). We determined Cronbach alpha coefficients and analyzed the principal components. Convergent validity was determined by studying correlations with age, education, and current (health-related) Internet use. Furthermore, in study 2 we assessed the predictive validity of the instrument by comparing scores on the eHEALS with an actual performance test. Results The internal consistency of the scale was sufficient: alpha = .93 in study 1 and alpha = .92 in study 2. In both studies the 8 items loaded on 1 single component (respectively 67% and 63% of variance). Correlations between eHEALS and age and education were not found. Significant, though weak, correlations were found between the eHEALS and quantity of Internet use (r = .24, P = .001 and r = .24, P = .02, respectively). Contrary to expectations, correlations between the eHEALS and successfully completed tasks on a performance test were weak and nonsignificant: r = .18 (P = .09). The t tests showed no significant differences in scores on the eHEALS between participants who scored below and above median scores of the performance test. Conclusions The eHEALS was assessed as unidimensional in a principal component analysis and the internal consistency of the scale was high, which makes the reliability adequate. However, findings suggest that the validity of the eHEALS instrument requires further study, since the relationship with Internet use was weak and expected relationships with age, education, and actual performance were not significant. Further research to develop a self-report instrument with high correlations with people’s actual eHealth literacy skills is warranted.
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Affiliation(s)
- Rosalie van der Vaart
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.
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Shin DW, Choi J, Miyashita M, Choi JY, Kang J, Baik YJ, Mo HN, Choi JS, Son YS, Lee HS. Measuring comprehensive outcomes in palliative care: validation of the Korean version of the Good Death Inventory. J Pain Symptom Manage 2011; 42:632-42. [PMID: 21477975 DOI: 10.1016/j.jpainsymman.2010.12.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 12/20/2010] [Accepted: 12/22/2010] [Indexed: 11/19/2022]
Abstract
CONTEXT No systematic or comprehensive attempts have yet been made to assess quality of death as an indicator of palliative care outcomes in Korea, and no validated instruments exist for the assessment of a good death in Koreans. OBJECTIVES This study examined the validity and reliability of the Korean version of the Good Death Inventory (GDI), which was developed in Japan to evaluate the quality of death from the perspective of bereaved family members. METHODS Forward and backward translations and a pilot test were conducted. In a multicenter cross-sectional survey, a questionnaire packet, including the GDI, overall quality of life during the last week, and overall satisfaction with care, was mailed to bereaved family members (n=501) of patients who had died from cancer two to six months before the study. Descriptive analyses were performed, including response rate, mean, median, skewness, and kurtosis for each item. The reliability of the GDI was tested by Cronbach's alpha. The dimensional structure was assessed using confirmatory factor analyses. Concurrent validity was tested by correlation with the overall quality of life and overall satisfaction with care. RESULTS Participants were able to complete the GDI, and the compliance rates were satisfactory. Cronbach's alpha coefficient for internal consistency was 0.93 overall and ranged from 0.69 to 0.94 for subdomains. The hypothesized 18-factor model of a good death appeared to fit the data (goodness of fit index [GFI]=0.964; adjusted GFI index=0.960; normal fit index=0.952). The overall scores on the GDI correlated with patients' quality of life (0.56; P<0.001) and overall satisfaction with care (0.44; P<0.001). CONCLUSION The Korean version of the GDI is a reliable and valid measure of the comprehensive outcomes of palliative care from the perspective of bereaved Korean family members.
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Affiliation(s)
- Dong Wook Shin
- National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
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A comparison of small monetary incentives to convert survey non-respondents: a randomized control trial. BMC Med Res Methodol 2011; 11:81. [PMID: 21615955 PMCID: PMC3126778 DOI: 10.1186/1471-2288-11-81] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 05/26/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maximizing response rates is critically important in order to provide the most generalizable and unbiased research results. High response rates reduce the chance of respondents being systematically different from non-respondents, and thus, reduce the risk of results not truly reflecting the study population. Monetary incentives are often used to improve response rates, but little is known about whether larger incentives improve response rates in those who previously have been unenthusiastic about participating in research. In this study we compared the response rates and cost-effectiveness of a $5 versus $2 monetary incentive accompanying a short survey mailed to patients who did not respond or refused to participate in research study with a face-to-face survey. METHODS 1,328 non-responders were randomly assigned to receive $5 or $2 and a short, 10-question survey by mail. Reminder postcards were sent to everyone; those not returning the survey were sent a second survey without incentive. Overall response rates, response rates by incentive condition, and odds of responding to the larger incentive were calculated. Total costs (materials, postage, and labor) and incremental cost-effectiveness ratios were also calculated and compared by incentive condition. RESULTS After the first mailing, the response rate within the $5 group was significantly higher (57.8% vs. 47.7%, p<.001); after the second mailing, the difference narrowed by 80%, resulting in a non-significant difference in cumulative rates between the $5 and $2 groups (67.3% vs. 65.4%, respectively, p=.47). Regardless of incentive or number of contacts, respondents were significantly more likely to be male, white, married, and 50-75 years old. Total costs were higher with the larger versus smaller incentive ($13.77 versus $9.95 per completed survey). CONCLUSIONS A $5 incentive provides a significantly higher response rate than a $2 incentive if only one survey mailing is used but not if two survey mailings are used.
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Green JA, Mor MK, Shields AM, Sevick MA, Palevsky PM, Fine MJ, Arnold RM, Weisbord SD. Prevalence and demographic and clinical associations of health literacy in patients on maintenance hemodialysis. Clin J Am Soc Nephrol 2011; 6:1354-60. [PMID: 21551025 DOI: 10.2215/cjn.09761110] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND OBJECTIVES Although limited health literacy is estimated to affect over 90 million Americans and is recognized as an important public health concern, there have been few studies examining this issue in patients with chronic kidney disease. We sought to characterize the prevalence of and associations of demographic and clinical characteristics with limited health literacy in patients receiving maintenance hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS As part of a prospective clinical trial of symptom management strategies in 288 patients treated with chronic hemodialysis, we assessed health literacy using the Rapid Estimate of Adult Literacy in Medicine (REALM). We defined limited health literacy as a REALM score ≤60 and evaluated independent associations of demographic and baseline clinical characteristics with limited health literacy using multivariable logistic regression. RESULTS Of the 260 patients who completed the REALM, 41 demonstrated limited health literacy. African-American race, lower educational level, and veteran status were independently associated with limited health literacy. There was no association of limited health literacy with age, gender, serologic values, dialysis adequacy, overall symptom burden, quality of life, or depression. CONCLUSIONS Limited health literacy is common among patients receiving chronic hemodialysis. African-American race and socioeconomic factors are strong independent predictors of limited health literacy. These findings can help inform the design and implementation of interventions to improve health literacy in the hemodialysis population.
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Affiliation(s)
- Jamie A Green
- Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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