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Bather JR, Cuevas AG, Harris A, Kaphingst KA, Goodman MS. Associations between perceived discrimination over the life course, subjective social status, and health literacy: A racial/ethnic stratification analysis. PEC INNOVATION 2024; 5:100334. [PMID: 39257628 PMCID: PMC11384512 DOI: 10.1016/j.pecinn.2024.100334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 08/03/2024] [Accepted: 08/18/2024] [Indexed: 09/12/2024]
Abstract
Objective To analyze the relationship between perceived discrimination over the life course, social status, and limited health literacy (HL). Methods 5040 adults who participated in the 2023 Survey of Racism and Public Health. We applied stratified multilevel models adjusted for sociodemographic characteristics. Results The average age was 47 years, 48% identified as White, 20% as Latinx, and 17% as Black. In the overall sample, we observed associations of perceived discrimination (b = 0.05, 95% CI: 0.01, 0.09), subjective social status (b = -0.16, 95% CI: -0.23, -0.10), and their interaction (b = 0.02, 95% CI: 0.01, 0.03). More perceived discrimination was associated with lower HL in the White and Multiracial participants. Higher subjective social status was associated with higher HL in the White and Latinx participants. There was a statistically significant interaction between perceived discrimination and subjective social status on HL among the White, Latinx, and Multiracial participants. Conclusion This analysis has implications for public health practice, indicating that multi-level interventions are needed to address limited HL. Innovation Our findings provide novel insights for identifying key SDOH indicators to assess in clinical settings to provide health literate care.
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Affiliation(s)
- Jemar R Bather
- Center for Anti-racism, Social Justice & Public Health, New York University School of Global Public Health, New York, NY 10003, USA
- Department of Biostatistics, New York University School of Global Public Health, New York, NY 10003, USA
| | - Adolfo G Cuevas
- Center for Anti-racism, Social Justice & Public Health, New York University School of Global Public Health, New York, NY 10003, USA
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY 10003, USA
| | - Adrian Harris
- Center for Anti-racism, Social Justice & Public Health, New York University School of Global Public Health, New York, NY 10003, USA
| | - Kimberly A Kaphingst
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
- Department of Communication, University of Utah, Salt Lake City, UT 84112, USA
| | - Melody S Goodman
- Center for Anti-racism, Social Justice & Public Health, New York University School of Global Public Health, New York, NY 10003, USA
- Department of Biostatistics, New York University School of Global Public Health, New York, NY 10003, USA
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Burney E, Arora M, Gaillard M, Herzig M, Lester L, Park S, Coleman C. A Game-Based Tool for Reducing Jargon Use by Medical Trainees. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2024; 20:11411. [PMID: 38957534 PMCID: PMC11219083 DOI: 10.15766/mep_2374-8265.11411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/04/2024] [Indexed: 07/04/2024]
Abstract
Introduction Physicians can be unaware that many US adults have intermediate or lower health literacy. Avoiding medical jargon in patient communication can improve poor outcomes associated with lower health literacy, but physicians may struggle to do so as health literacy education is neither standardized nor universal at US allopathic medical schools. As with other skills-based proficiencies in medical education, repeat exposure and active learning help build competency. Medical students developed the Patient Communication Challenge (PCC), an adaptation of the Hasbro game Taboo, to facilitate practice of patient-centered communication skills among medical trainees. Methods Hour-long workshops were held for groups of preclinical medical students. Students watched a communication exemplar video, played the PCC game, and completed a postworkshop survey. To play, two teams competed to earn points by identifying medical concepts as explained by a teammate who described the term without using medical jargon. Results Evaluations indicated that the game was enjoyable and reinforced didactic concepts through active learning, with self-reported participant satisfaction and competency gain. Overall, 59% of participants (53 of 90) completed postworkshop surveys; 91% (48 of 53) agreed they felt more proficient in avoiding jargon, 94% (50 of 53) would recommend the workshop to a classmate, and 100% (53 of 53) would play again. Discussion The PCC can help early medical trainees develop health communication skills through gamification with utilization of adult learning principles and adequate frequency for skill retention. Future applications include longitudinal assessment and expanding to later stages of medical training and other health professions.
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Affiliation(s)
- Emily Burney
- Fourth-Year Medical Student, Oregon Health & Science University School of Medicine
| | - Megha Arora
- Third-Year Medical Student, Oregon Health & Science University School of Medicine
| | - Mizan Gaillard
- Second-Year Medical Student, Oregon Health & Science University School of Medicine
| | - Maya Herzig
- First-Year Resident, Department of Otolaryngology, University of New Mexico School of Medicine
| | - Leo Lester
- Fourth-Year Medical Student, Oregon Health & Science University School of Medicine
| | - Su Park
- First-Year Resident, Department of Family Medicine, Natividad Medical Center
| | - Cliff Coleman
- Associate Professor and Clinical Thread Director for Professionalism, Ethics, and Communication, Office of the Dean, Oregon Health & Science University School of Medicine; Doris and Mark Storms Chair in Compassionate Communication, Center for Ethics in Healthcare
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Costello RS, Downing MG, Ponsford J. The experience of traumatic brain injury in a culturally and linguistically diverse sample in Australia. Disabil Rehabil 2024; 46:2069-2078. [PMID: 37237438 DOI: 10.1080/09638288.2023.2216473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
PURPOSE Individuals from culturally and linguistically diverse (CALD) backgrounds experience poorer outcomes following traumatic brain injury (TBI), including poorer quality of life. The reasons for these poorer outcomes are unclear. Therefore, this study aimed to qualitatively investigate the experience of injury, rehabilitation, and recovery amongst individuals from a CALD background following TBI. MATERIALS AND METHODS Fifteen semi-structured interviews were conducted, and qualitatively analysed using reflexive thematic analysis. RESULTS It was demonstrated that: (a) the cognitive and behavioural consequences of TBI were accompanied by stigma and loss of independence; (b) participants held many beliefs related to their TBI, ranging from bad luck to acceptance. Participants' personal values and beliefs provided strength and resilience, with many viewing the injury as a positive event in their lives; (c) participants were appreciative of the high standard of care they received in hospital and rehabilitation, although communication barriers were experienced; (d) many participants identified with Australian culture, and few believed their cultural background negatively impacted their experience of TBI; (e) external support, particularly from family, was considered central to recovery. CONCLUSION These findings offer insight into the challenges CALD individuals face and factors that may facilitate their recovery and improve functional outcomes.
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Affiliation(s)
- Reannon S Costello
- Monash Epworth Rehabilitation Research Centre (MERRC) and School of Psychological Sciences, Monash University, Australia
| | - Marina G Downing
- Monash Epworth Rehabilitation Research Centre (MERRC) and School of Psychological Sciences, Monash University, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Australia
| | - Jennie Ponsford
- Monash Epworth Rehabilitation Research Centre (MERRC) and School of Psychological Sciences, Monash University, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Australia
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Lazarus M, Yew TW, Tan WH, Venkataraman K, Valderas JM, Young DYL, Tai ES, Loh VWK. Personalised care and support planning in Singapore: qualitative interviews with people living with diabetes. BJGP Open 2024; 8:BJGPO.2023.0055. [PMID: 37945006 PMCID: PMC11169985 DOI: 10.3399/bjgpo.2023.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/20/2023] [Accepted: 08/24/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Personalised care and support planning (CSP) is a person-centred approach for the care of people living with long-term conditions. Patient Activation through Community Empowerment/Engagement for Diabetes Management (PACE-D) adapts the Year of Care Partnerships (YOCP) approach to CSP in the UK for people living with diabetes at Singapore polyclinics. Polyclinics are multi-storey primary care hubs that provide affordable, multidisciplinary, comprehensive, and high-throughput public health care for the multi-ethnic, multilingual Singapore population. AIM To explore the experience of PACE-D-enrolled people living with diabetes with personalised CSP at Singapore polyclinics. DESIGN & SETTING Qualitative interviews of people living with diabetes who experienced personalised CSP at National University Polyclinics (NUP) in Singapore between July 2020 and November 2021. METHOD PACE-D-enrolled people living with diabetes who experienced personalised CSP were purposively sampled. In-depth semi-structured interviews were recorded, transcribed, and analysed using Braun and Clarke's reflexive thematic analysis. RESULTS Fifty-two patients participated in the study. Four main themes were identified. Theme 1 was the importance of the care-planning letter. Patients reported that the CPL prompted reflection and patient preparation for CSP conversations. Theme 2 was the role of the programme coordinator. PACE-D programme coordinators amplified self-management by playing advocate and confidant beyond administrative duties. Theme 3 was the value of the personalised CSP conversation. CSP providers were perceived as partners in care, with more time to listen compared with usual consultations. Patient engagement was affected by language confidence. Theme 4 was agency in self-management. With adequate time and support, patients increased in confidence and agency both in CSP engagement and diabetes self-management. CONCLUSION While language confidence may affect patient engagement, personalised CSP shows promise for strengthening patient engagement and self-management among people living with diabetes at Singapore polyclinics.
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Affiliation(s)
- Monica Lazarus
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Tong Wei Yew
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
- Department of Medicine, National University Hospital (NUH), Singapore, Singapore
| | - Wee Hian Tan
- National University Polyclinics (NUP), Singapore, Singapore
| | - Kavita Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), Singapore, Singapore
| | - Jose Maria Valderas
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
- Department of Family Medicine, National University Health System (NUHS), Singapore, Singapore
| | - Doris Yee Ling Young
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - E Shyong Tai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
- Department of Medicine, National University Hospital (NUH), Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), Singapore, Singapore
| | - Victor Weng Keong Loh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
- Department of Family Medicine, National University Health System (NUHS), Singapore, Singapore
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5
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Pilch M, van Rietschoten T, Ortiz-Catalan M, Lendaro E, van der Sluis CK, Hermansson L. Interplay Between Innovation and Intersubjectivity: Therapists Perceptions of Phantom Motor Execution Therapy and Its Effect on Phantom Limb Pain. J Pain Res 2023; 16:2747-2761. [PMID: 37577161 PMCID: PMC10422994 DOI: 10.2147/jpr.s412895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose Interpersonal processes, including therapeutic alliance, may modulate the impact of interventions on pain experience. However, the role of interpersonal context on the effects of technology-enhanced interventions remains underexplored. This study elicited therapists' perspectives on how a novel rehabilitative process, involving Phantom Motor Execution (PME), may impact phantom limb pain. The mediating role of therapeutic alliance, and the way PME influenced its formation, was investigated. Methods A qualitative descriptive design, using a framework method, was used to explore therapists' (n=11) experiences of delivering PME treatment. Semi-structured online-based interviews were conducted. Results A 3-way interaction between therapist, patient, and the PME device was an overarching construct tying four themes together. It formed the context for change in phantom limb experience. The perceived therapeutic effects (theme 1) extended beyond those initially hypothesised and highlighted the mediating role of the key actors and context (theme 2). The therapeutic relationship was perceived as a transformative journey (theme 3), creating an opportunity for communication, collaboration, and bonding. It was seen as a cause and a consequence of therapeutic effects. Future directions, including the role of expertise-informed adaptations and enabling aspects of customised solutions, were indicated (theme 4). Conclusion This study pointed to intrapersonal, interpersonal, and contextual factors that should be considered in clinical implementation of novel rehabilitative tools. The results demonstrated that therapists have unique insights and a crucial role in facilitating PME treatment. The study highlighted the need to consider the biopsychosocial model of pain in designing, evaluating, and implementing technology-supported interventions.
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Affiliation(s)
- Monika Pilch
- Centre for Health Policy & Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Tijn van Rietschoten
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
- University of Groningen, Faculty of Medical Sciences, Groningen, the Netherlands
| | - Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal, Sweden
- Bionics Institute, Melbourne, VC, Australia
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Eva Lendaro
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Corry K van der Sluis
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Liselotte Hermansson
- Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Coleman C, Birk S, DeVoe J. Health Literacy and Systemic Racism-Using Clear Communication to Reduce Health Care Inequities. JAMA Intern Med 2023; 183:753-754. [PMID: 37358860 DOI: 10.1001/jamainternmed.2023.2558] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
This Viewpoint describes why people need health information that is easy to understand to make informed decisions about health care and why this is necessary to avoid systemic racism.
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Affiliation(s)
- Cliff Coleman
- Department of Family Medicine, Oregon Health & Science University, Portland
- Center for Ethics in Health Care, Oregon Health & Science University, Portland
| | - Samantha Birk
- Center for Ethics in Health Care, Oregon Health & Science University, Portland
| | - Jennifer DeVoe
- Department of Family Medicine, Oregon Health & Science University, Portland
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7
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Lluch C, O'Mahony J, D'Souza M, Hawa R. Health Literacy of Healthcare Providers and Mental Health Needs of Immigrant Perinatal Women in British Columbia: A Critical Ethnography. Issues Ment Health Nurs 2023; 44:746-757. [PMID: 37437242 DOI: 10.1080/01612840.2023.2227267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
AIMS This research explores how health care providers determine the mental health needs of immigrant women in the perinatal phase of childbirth. The contextual factors that affect the mental health of these women and influence their engagement with the British Columbian communities in which they reside are investigated. METHOD Using a critical ethnographic approach, eight health care providers were interviewed to gain insight into health care provider's health literacy and immigrant perinatal women's mental health. Each participant was interviewed for 45-60 min in the period from January to February 2021 to obtain relevant data. RESULTS Three themes emerged from the data analysis: the health care provider's role and his/her health literacy, the health literacy of the participant, and the impact of the ongoing COVID-19 pandemic on the participant's situation. CONCLUSIONS The findings indicate that a healthy working relationship between the health care provider and an immigrant woman in the perinatal phase of childbirth is essential to facilitate an effective interchange of health information.
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Affiliation(s)
- Conchitina Lluch
- School of Nursing, Thompson Rivers University, Kamloops, BC, Canada
| | - Joyce O'Mahony
- School of Nursing, Thompson Rivers University, Kamloops, BC, Canada
| | - Melba D'Souza
- School of Nursing, Thompson Rivers University, Kamloops, BC, Canada
| | - Roula Hawa
- Family Studies & Human Development, School of Behavioural and Social Sciences, Brescia University College at Western, London, ON, Canada
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Burk-Rafel J, Sebok-Syer SS, Santen SA, Jiang J, Caretta-Weyer HA, Iturrate E, Kelleher M, Warm EJ, Schumacher DJ, Kinnear B. TRainee Attributable & Automatable Care Evaluations in Real-time (TRACERs): A Scalable Approach for Linking Education to Patient Care. PERSPECTIVES ON MEDICAL EDUCATION 2023; 12:149-159. [PMID: 37215538 PMCID: PMC10198229 DOI: 10.5334/pme.1013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 04/30/2023] [Indexed: 05/24/2023]
Abstract
Competency-based medical education (CBME) is an outcomes-based approach to education and assessment that focuses on what competencies trainees need to learn in order to provide effective patient care. Despite this goal of providing quality patient care, trainees rarely receive measures of their clinical performance. This is problematic because defining a trainee's learning progression requires measuring their clinical performance. Traditional clinical performance measures (CPMs) are often met with skepticism from trainees given their poor individual-level attribution. Resident-sensitive quality measures (RSQMs) are attributable to individuals, but lack the expeditiousness needed to deliver timely feedback and can be difficult to automate at scale across programs. In this eye opener, the authors present a conceptual framework for a new type of measure - TRainee Attributable & Automatable Care Evaluations in Real-time (TRACERs) - attuned to both automation and trainee attribution as the next evolutionary step in linking education to patient care. TRACERs have five defining characteristics: meaningful (for patient care and trainees), attributable (sufficiently to the trainee of interest), automatable (minimal human input once fully implemented), scalable (across electronic health records [EHRs] and training environments), and real-time (amenable to formative educational feedback loops). Ideally, TRACERs optimize all five characteristics to the greatest degree possible. TRACERs are uniquely focused on measures of clinical performance that are captured in the EHR, whether routinely collected or generated using sophisticated analytics, and are intended to complement (not replace) other sources of assessment data. TRACERs have the potential to contribute to a national system of high-density, trainee-attributable, patient-centered outcome measures.
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Affiliation(s)
- Jesse Burk-Rafel
- Division of Hospital Medicine, NYU Langone Health, and assistant director of Precision Medical Education, Institute for Innovations in Medical Education, NYU Grossman School of Medicine, New York, USA
| | - Stefanie S. Sebok-Syer
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Sally A. Santen
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Joshua Jiang
- University of California Los Angeles, Los Angeles, California. At the time of this work he was a medical student, NYU Grossman School of Medicine, New York, USA
| | - Holly A. Caretta-Weyer
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | | | - Matthew Kelleher
- Internal Medicine and Pediatrics, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Eric J. Warm
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Daniel J. Schumacher
- Department of Pediatrics, director of Education Research Unit, Cincinnati Children’s Hospital Medical Center/ University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Benjamin Kinnear
- Internal Medicine and Pediatrics, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Xu J, Xia C, Ding X. Does health literacy affect older people's avoidance of medical care? The sense of medical care policy alienation and perceptions of control. Geriatr Nurs 2023; 51:202-208. [PMID: 37011492 DOI: 10.1016/j.gerinurse.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 04/04/2023]
Abstract
We aimed to clarify whether health literacy (HL) impacts medical care avoidance through an underexplored mediator: a sense of policy alienation towards medical care policy for residents (SPA-M). A moderated mediation model with control perception as a moderator was used to analyze the inner relationship between HL and SPA-M. A cross-sectional survey of 470 people ≥ 60 years old, revealed a significant negative association between HL and medical care avoidance intention, which bootstrapped moderated mediation analysis confirmed is partially mediated by SPA-M. When older people's control perception was high, HL had a significant negative impact on medical care avoidance intention through SPA-M; for low control perception, the effect was insignificant. This study elucidates HL's impact of HL on medical care avoidance, highlighting control perception's relevance to medical care policymaking for older people.
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Budesa Z, Klar M, Datta S, Moore E, Lamsen L. Evaluating first year residents' communication skills: a health literacy curriculum needs assessment. JOURNAL OF COMMUNICATION IN HEALTHCARE 2023; 16:30-37. [PMID: 36919812 DOI: 10.1080/17538068.2022.2026054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND High quality communication skills are necessary for competent and ethical practice. When patients present with low health literacy, physicians' skills may be lacking, which can put patients' safety and satisfaction at risk. The authors' developed and executed a simulation-based needs assessment following conflicting internal reports about the communications skills of new residents. METHODS The current study recruited first year residents (N = 30) during the 2019 first post-graduate year (PGY-1) orientation at a southeastern university hospital simulation center. The residents completed an Objective Structured Clinical Examination (OSCE) which focused on obtaining informed consent from a patient's health care proxy who presented with limited literacy and health literacy and poor communication skills. After completing the OSCE, the residents, simulated patients (SP), and independent observers assessed the residents' performance. RESULTS Residents assessed their performance higher when compared with the ratings from independent observers and patient raters. Residents who spent more time with SPs were given higher ratings by the SPs and independent observers. Finally, residents' ratings of themselves had a positive correlation with their reported confidence, but no correlation between self-confidence and the ratings provided by SPs or observers. CONCLUSION PGY-1 residents demonstrate a continued need for health literacy and informed consent education, despite faculty believing that these skills were covered enough in medical school. These residents also demonstrated limited self-assessment ability or skills below the expectations of health literacy experts. Curriculum changes included improving the focus on health literacy, communication skills, and additional practice opportunities throughout their internship year.
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Affiliation(s)
- Zach Budesa
- Center for Advanced Medical Simulation, Graduate School of Medicine, University of Tennessee, Knoxville, Knoxville, Tennessee
| | - Melinda Klar
- Center for Advanced Medical Simulation, Graduate School of Medicine, University of Tennessee, Knoxville, Knoxville, Tennessee
| | - Sujata Datta
- Department of Anaesthesia, University of Maryland Medical Center, Baltimore, Maryland, United States
| | - Emily Moore
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Knoxville, Tennessee, United States
| | - Leonard Lamsen
- Center for Advanced Medical Simulation, Graduate School of Medicine, University of Tennessee, Knoxville, Knoxville, Tennessee
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Keene Woods N, Ali U, Medina M, Reyes J, Chesser AK. Health Literacy, Health Outcomes and Equity: A Trend Analysis Based on a Population Survey. J Prim Care Community Health 2023; 14:21501319231156132. [PMID: 36852725 PMCID: PMC10071098 DOI: 10.1177/21501319231156132] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Health literacy continues to be an issue among minority groups. Population surveys are one strategy used to help better understand health disparities. The Behavioral Risk Factor Surveillance System (BRFSS) in Kansas added health literacy questions to the survey in 2012. This study examined population health literacy levels and health trends from 2012 to 2018. The health status variables included health care coverage status, general health rating, presence of chronic conditions, and length of time since the last check-up. The percentage of individuals reporting low health literacy decreased from 67% in 2012 to 51% in 2018. The percentage of participants with income levels less than $15 000 was 9% in 2012 and 7% in 2018. Health literacy was lowest among the age group 18 to 24-year-olds, those who identified as multiracial, separated, not graduated from high school, out of work for more than 1 year, income less than $10 000, with other living arrangements, and living in a suburban county of metropolitan statistical area. Additionally, many health conditions improved, and those reporting health insurance increased slightly. The study demonstrates how health literacy continues to be an issue, and how education and primary prevention are necessary to improve limited health literacy and health outcomes. Findings from both state-level and national BRFSS population surveys can help educate the public health and clinical health services workforce to provide better care and address health disparities for highrisk populations.
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Affiliation(s)
| | - Umama Ali
- Wichita State University, Wichita, KS, USA
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Chang AA, Siropaides CH, Chou CL. Improving Communication Skills: A Roadmap for Humanistic Health Care. Med Clin North Am 2022; 106:727-737. [PMID: 35725237 DOI: 10.1016/j.mcna.2022.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This article outlines frameworks that enable health care providers to take steps to improve their health care communication skills, including not only outward-facing conversational tools but also personal awareness. Such awareness includes recognition of bias and emotional reactions, their behavioral consequences, and how to intervene when necessary. The authors describe the intrinsic and extrinsic motivators to improving communication skills, followed by a review of foundational communication microskills and suggestions on how to improve them through the perspectives of the clinician as a self-learner, the clinician with external coaching, and the administrator/leader.
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Affiliation(s)
- Andrew A Chang
- Department of Medicine, State University of New York Downstate, NYC Health + Hospitals/Kings County, 451 Clarkson Avenue, E Building 7th Floor Adult Primary Care, Brooklyn, NY 11203, USA.
| | - Caitlin H Siropaides
- Department of Internal Medicine, Section of Supportive and Palliative Care, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Calvin L Chou
- Department of Medicine, University of California and Veterans Affairs Healthcare System, VA Medical Center, 4150 Clement St (136MP), San Francisco, CA 94121, USA
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Pinho S, Sampaio R. Behaviour Change Interventions in Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7055. [PMID: 35742302 PMCID: PMC9223025 DOI: 10.3390/ijerph19127055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 12/04/2022]
Abstract
In September 2021, the Special Issue "Evidence-based Behaviour Change Interventions in Healthcare" was proposed as the manifestation of a will to compile multidisciplinary works of academic research focused on the effect of health education, psychology, and socio-cultural dimensions on the improvement in health habits in the population [...].
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Affiliation(s)
- Simão Pinho
- Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- São João Universitary Hospital Centre, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Rute Sampaio
- Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- CINTESIS—Center for Research in Health Technologies and Services, R. Dr. Plácido da Costa, 4200-450 Porto, Portugal
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Curbach J, Lander J, Dierks ML, Grepmeier EM, von Sommoggy J. How do health professionals translate evidence on early childhood allergy prevention into health literacy-responsive practice? A protocol for a mixed-method study on the views of German health professionals. BMJ Open 2021; 11:e047733. [PMID: 34785543 PMCID: PMC8596052 DOI: 10.1136/bmjopen-2020-047733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 10/13/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Paediatricians, general practitioners (GPs) and midwives in primary care are important sources of information for parents on early childhood allergy prevention (ECAP). Research has shown that preventive counselling by health professionals can be effective in improving patients' health literacy (HL) and health behaviour. Providing effective advice relies on two factors. First, health professionals need be up-to-date with research evidence on ECAP, to consider popular misconceptions and fears and to translate this knowledge into clear recommendations for parents (knowledge translation). Second, they need to know and apply counselling techniques and create a practice setting which accommodates parental HL needs (health literacy-responsive care). The objective of this study is to explore and assess how German health professionals take up and translate ECAP evidence into appropriate recommendations for parents, how they consider HL in counselling and practice organisation and what barriers and enablers they find in their performance of HL-responsive ECAP. METHODS AND ANALYSIS The study has a sequential mixed-method design, in two phases. In the first phase, qualitative semi-structured expert interviews will be conducted with health professionals (paediatricians, GPs and midwives) at primary care level and professional policy level. Data collection is ongoing until January 2022. In the second phase, based on the qualitative results, a standardised questionnaire will be developed, and pilot-tested in a wider population of German health professionals. The findings of both phases will be integrated. ETHICS AND DISSEMINATION The study has received ethical approval from the Ethics Committee of the University of Regensburg (18-1205-101). The results will be published in international peer-reviewed open access journals and via presentations at scientific conferences. The results will also be shared with German health professionals, decision-makers and potential funders of interventions.
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Affiliation(s)
- Janina Curbach
- Department of Epidemiology and Preventive Medicine/Medical Sociology, University of Regensburg Faculty of Medicine, Regensburg, Germany
- Faculty of Businesss Studies, Ostbayerische Technische Hochschule (OTH) Regensburg, Regensburg, Germany
| | - Jonas Lander
- Department of Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Marie Luise Dierks
- Department of Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Eva-Maria Grepmeier
- Department of Epidemiology and Preventive Medicine/Medical Sociology, University of Regensburg Faculty of Medicine, Regensburg, Germany
| | - Julia von Sommoggy
- Department of Epidemiology and Preventive Medicine/Medical Sociology, University of Regensburg Faculty of Medicine, Regensburg, Germany
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Keers G, Yamada K, Pickles K, Bell K, Black K, Bateson D, Dodd RH. Understanding women's choices for management of cervical intraepithelial neoplasia 2 (CIN2): Qualitative analysis of a randomised experimental study. Aust N Z J Obstet Gynaecol 2021; 62:125-132. [PMID: 34625954 DOI: 10.1111/ajo.13440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/14/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Active surveillance for cervical intraepithelial neoplasia 2 (CIN2) would allow time for most cases to regress naturally and in turn avoid potentially unnecessary and harmful treatment. AIM To determine reasons for choosing active surveillance over surgery among women given a hypothetical diagnosis of CIN2. MATERIALS AND METHODS Women residing in Australia aged 25-40 years with no prior diagnosis of cervical cancer, cervical abnormality CIN2 or above, and/or previous hysterectomy, were randomised to one of four identical hypothetical scenarios of testing human papillomavirus (HPV)-positive: high-grade cytology and a diagnosis of CIN2 that used alternate terminology to describe resolution of abnormal cells and/or inclusion of an overtreatment statement. Participants selected active surveillance or surgery after viewing the scenario and free-text reason/s for their choice were thematically analysed. RESULTS Of the 1638 women randomised, 79% (n = 1293) opted for active surveillance. The most common reasons for choosing active surveillance included concerns about surgery and associated risks, preferring to 'wait and see', trusting the doctor's recommendations and having an emotional response toward surgery. For women who chose surgery, being risk-averse, addressing the issue straight away and perceiving surgery to be the better option for them were the most common themes identified. CONCLUSION When presented with balanced information on the benefits and harms of different management options for CIN2 and given a choice, most women in this hypothetical situation chose active surveillance over surgery. Addressing women's concerns about active surveillance may open up the possibility that if deemed safe, it could be an acceptable alternative for women.
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Affiliation(s)
- Gemma Keers
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kozue Yamada
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kristen Pickles
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Katy Bell
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten Black
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Deborah Bateson
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Family Planning New South Wales, Sydney, New South Wales, Australia
| | - Rachael H Dodd
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Physician Communication in Injectable Opioid Agonist Treatment: Collecting Patient Ratings With the Communication Assessment Tool. J Addict Med 2021; 14:480-488. [PMID: 32032213 DOI: 10.1097/adm.0000000000000631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Patient ratings of physician communication in the setting of daily injectable opioid agonist treatment are reported. Associations between communication items and demographic, health, drug use, and treatment characteristics are explored. METHODS Participants (n = 121) were patients receiving treatment for opioid use disorder with hydromorphone (an opioid analgesic) or diacetylmorphine (medical grade heroin). Ratings of physician communication were collected using the 14-item Communication Assessment Tool. Items were dichotomized and associations were explored using univariate and multivariable logistic regression models for each of the 14 items. RESULTS Ratings of physician communication were lower than reported in other populations. In nearly all of the 14 multivariable models, participants with more physical health problems and with lower scores for treatment drug liking had lower odds of rating physician communication as excellent. CONCLUSIONS In physician interactions with patients with opioid use disorder, there is a critical need to address comorbid physical health problems and account for patient medication preferences. PRACTICE IMPLICATIONS Findings reinforce the role physicians can play in communicating with patients about their comorbid conditions and about medication preferences. In the patient-physician interaction efforts to meet patients' evolving treatment needs and preferences can be made by offering patients access to all available evidence-based treatments.
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Kinnear B, Kelleher M, Sall D, Schauer DP, Warm EJ, Kachelmeyer A, Martini A, Schumacher DJ. Development of Resident-Sensitive Quality Measures for Inpatient General Internal Medicine. J Gen Intern Med 2021; 36:1271-1278. [PMID: 33105001 PMCID: PMC8131459 DOI: 10.1007/s11606-020-06320-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/20/2020] [Accepted: 10/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Graduate medical education (GME) training has long-lasting effects on patient care quality. Despite this, few GME programs use clinical care measures as part of resident assessment. Furthermore, there is no gold standard to identify clinical care measures that are reflective of resident care. Resident-sensitive quality measures (RSQMs), defined as "measures that are meaningful in patient care and are most likely attributable to resident care," have been developed using consensus methodology and piloted in pediatric emergency medicine. However, this approach has not been tested in internal medicine (IM). OBJECTIVE To develop RSQMs for a general internal medicine (GIM) inpatient residency rotation using previously described consensus methods. DESIGN The authors used two consensus methods, nominal group technique (NGT) and a subsequent Delphi method, to generate RSQMs for a GIM inpatient rotation. RSQMs were generated for specific clinical conditions found on a GIM inpatient rotation, as well as for general care on a GIM ward. PARTICIPANTS NGT participants included nine IM and medicine-pediatrics (MP) residents and six IM and MP faculty members. The Delphi group included seven IM and MP residents and seven IM and MP faculty members. MAIN MEASURES The number and description of RSQMs generated during this process. KEY RESULTS Consensus methods resulted in 89 RSQMs with the following breakdown by condition: GIM general care-21, diabetes mellitus-16, hyperkalemia-14, COPD-13, hypertension-11, pneumonia-10, and hypokalemia-4. All RSQMs were process measures, with 48% relating to documentation and 51% relating to orders. Fifty-eight percent of RSQMs were related to the primary admitting diagnosis, while 42% could also be related to chronic comorbidities that require management during an admission. CONCLUSIONS Consensus methods resulted in 89 RSQMs for a GIM inpatient service. While all RSQMs were process measures, they may still hold value in learner assessment, formative feedback, and program evaluation.
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Affiliation(s)
- Benjamin Kinnear
- Department of Pediatrics, University of Cincinnati College of Medicine, , Cincinnati, OH, USA. .,Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Matthew Kelleher
- Department of Pediatrics, University of Cincinnati College of Medicine, , Cincinnati, OH, USA.,Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Dana Sall
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Daniel P Schauer
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Eric J Warm
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrea Kachelmeyer
- Department of Pediatrics, University of Cincinnati College of Medicine, , Cincinnati, OH, USA
| | - Abigail Martini
- Department of Pediatrics, University of Cincinnati College of Medicine, , Cincinnati, OH, USA
| | - Daniel J Schumacher
- Department of Pediatrics, University of Cincinnati College of Medicine, , Cincinnati, OH, USA
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Odero A, Pongy M, Chauvel L, Voz B, Spitz E, Pétré B, Baumann M. Core Values that Influence the Patient-Healthcare Professional Power Dynamic: Steering Interaction towards Partnership. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228458. [PMID: 33203162 PMCID: PMC7696821 DOI: 10.3390/ijerph17228458] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/06/2020] [Accepted: 11/10/2020] [Indexed: 02/03/2023]
Abstract
Healthcare has long been marked by the authoritative-physician–passive-patient interaction, with patients seeking help and physicians seeking to restore patients back to health. However, globalisation, social movements, and technological advancements are transforming the nature of this relationship. We aim to identify core values that influence the power dynamic between patients and healthcare professionals, and determine how to steer these interactions towards partnership, a more suitable approach to current healthcare needs. Patients with chronic diseases (10 men, 18 women) and healthcare professionals (11 men, 12 women) were interviewed, sessions transcribed, and the framework method used to thematically analyse the data. Validation was done through analyst triangulation and member check recheck. Core values identified as influencing the patient-healthcare professional power dynamic include: (A) values that empower patients (acceptance of diagnosis and autonomy); (B) values unique to healthcare professionals (HCPs) (acknowledging patients experiential knowledge and including patients in the therapeutic process); and (C) shared capitals related to their interactions (communication, information sharing and exchange, collaboration, and mutual commitment). These interdependent core values can be considered prerequisites to the implementation of the patient-as-partner approach in healthcare. Partnership would imply a paradigm shift such that stakeholders systematically examine each other’s perspective, motivations, capabilities, and goals, and then adapt their interactions in this accord, for optimal outcome.
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Affiliation(s)
- Angela Odero
- Department of Social Sciences, Institute for Research on Sociology and Economic Inequalities (IRSEI), University of Luxembourg, 4365 Esch-sur-Alzette, Luxembourg
| | - Manon Pongy
- Department of Social Sciences, Institute for Research on Sociology and Economic Inequalities (IRSEI), University of Luxembourg, 4365 Esch-sur-Alzette, Luxembourg
- Department of Health Psychology, Metz Saulcy Campus, University of Lorraine, 54395 Grand Est, France
| | - Louis Chauvel
- Department of Social Sciences, Institute for Research on Sociology and Economic Inequalities (IRSEI), University of Luxembourg, 4365 Esch-sur-Alzette, Luxembourg
| | - Bernard Voz
- Department of Public Health, University of Liège, 4000 Liège, Belgium
| | - Elisabeth Spitz
- Department of Health Psychology, Metz Saulcy Campus, University of Lorraine, 54395 Grand Est, France
| | - Benoit Pétré
- Department of Public Health, University of Liège, 4000 Liège, Belgium
| | - Michèle Baumann
- Department of Social Sciences, Institute for Research on Sociology and Economic Inequalities (IRSEI), University of Luxembourg, 4365 Esch-sur-Alzette, Luxembourg
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Schumacher DJ, Holmboe E, Carraccio C, Martini A, van der Vleuten C, Busari J, Sobolewski B, Byczkowski TL. Resident-Sensitive Quality Measures in the Pediatric Emergency Department: Exploring Relationships With Supervisor Entrustment and Patient Acuity and Complexity. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1256-1264. [PMID: 32101934 DOI: 10.1097/acm.0000000000003242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE This study explores the associations between resident-sensitive quality measures (RSQMs) and supervisor entrustment as well as between RSQMs and patient acuity and complexity for encounters in the pediatric emergency department (PED) in which residents are caring for patients. METHOD Pediatric residents rotating through Cincinnati Children's Hospital Medical Center PED as well as supervising pediatric emergency medicine faculty and fellows were recruited during the 2017-2018 academic year for the purpose of collecting the following data from the residents' patient encounters for 3 illnesses (acute asthma exacerbation, bronchiolitis, and closed head injury [CHI]): supervisor entrustment decision rating, RSQMs relevant to the care provided, and supervisor patient acuity and complexity ratings. To measure the association of RSQM composite scores with the other variables of interest, mixed models were used. RESULTS A total of 83 residents cared for 110 patients with asthma, 112 with bronchiolitis, and 77 with CHI. Entrustment decision ratings were positively associated with asthma RSQM composite scores (beta coefficient = 0.03; P < .001). There was no significant association between RSQM composite scores and entrustment decision ratings for bronchiolitis or CHI. RSQM composite scores were significantly higher when acuity was also higher and significantly lower when acuity was also lower for both asthma (P < .001) and bronchiolitis (P = .01). However, RSQM composite scores were almost identical between levels of acuity for CHI (P = .94). There were no significant differences in RSQM composite scores when complexity varied. CONCLUSION This study found limited associations between RSQM composite scores and entrustment decision ratings but offers insight into how RSQMs could be used for the purposes of resident assessment and feedback.
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Affiliation(s)
- Daniel J Schumacher
- D.J. Schumacher is associate professor of pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Eric Holmboe
- E. Holmboe is senior vice president for milestones development and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Carol Carraccio
- C. Carraccio is vice president of competency-based assessment, American Board of Pediatrics, Chapel Hill, North Carolina
| | - Abigail Martini
- A. Martini is a clinical research coordinator, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Cees van der Vleuten
- C. van der Vleuten is professor of education, Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences, and scientific director, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Jamiu Busari
- J. Busari is associate professor of medical education, Maastricht University, Maastricht, The Netherlands
| | - Brad Sobolewski
- B. Sobolewski is associate professor of pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Terri L Byczkowski
- T.L. Byczkowski is associate professor of pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
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20
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Schumacher DJ, Martini A, Holmboe E, Carraccio C, van der Vleuten C, Sobolewski B, Busari J, Byczkowski TL. Initial Implementation of Resident-Sensitive Quality Measures in the Pediatric Emergency Department: A Wide Range of Performance. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1248-1255. [PMID: 31913878 DOI: 10.1097/acm.0000000000003147] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE A lack of quality measures aligned with residents' work led to the development of resident-sensitive quality measures (RSQMs). This study sought to describe how often residents complete RSQMs, both individually and collectively, when they are implemented in the clinical environment. METHOD During academic year 2017-2018, categorical pediatric residents in the Cincinnati Children's Hospital Medical Center pediatric emergency department were assessed using RSQMs for acute asthma exacerbation (21 RSQMs), bronchiolitis (23 RSQMs), and closed head injury (19 RSQMs). Following eligible patient encounters, all individual RSQMs for the illnesses of interest were extracted from the health record. Frequencies of 3 performance classifications (opportunity and met, opportunity and not met, or no opportunity) were detailed for each RSQM. A composite score for each encounter was calculated by determining the proportion of individual RSQMs performed out of the total possible RSQMs that could have been performed. RESULTS Eighty-three residents cared for 110 patients with asthma, 112 with bronchiolitis, and 77 with closed head injury during the study period. Residents had the opportunity to meet the RSQMs in most encounters, but exceptions existed. There was a wide range in the frequency of residents meeting RSQMs in encounters in which the opportunity existed. One closed head injury measure was met in all encounters in which the opportunity existed. Across illnesses, some RSQMs were met in almost all encounters, while others were met in far fewer encounters. RSQM composite scores demonstrated significant range and variation as well-asthma: mean = 0.81 (standard deviation [SD] = 0.11) and range = 0.47-1.00, bronchiolitis: mean = 0.62 (SD = 0.12) and range = 0.35-0.91, and closed head injury: mean = 0.63 (SD = 0.10) and range = 0.44-0.89. CONCLUSIONS Individually and collectively, RSQMs can distinguish variations in the tasks residents perform across patient encounters.
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Affiliation(s)
- Daniel J Schumacher
- D.J. Schumacher is associate professor of pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Abigail Martini
- A. Martini is a clinical research coordinator, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Eric Holmboe
- E. Holmboe is chief research, milestone development, and evaluation officer, Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Carol Carraccio
- C. Carraccio is vice president of competency-based assessment, American Board of Pediatrics, Chapel Hill, North Carolina
| | - Cees van der Vleuten
- C. van der Vleuten is professor of education, Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences, and scientific director, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Brad Sobolewski
- B. Sobolewski is associate professor of pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jamiu Busari
- J. Busari is consultant pediatrician and associate professor of medical education, Maastricht University, Maastricht, The Netherlands
| | - Terri L Byczkowski
- T.L. Byczkowski is associate professor of pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
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The Mediating Role of the Patient Health Engagement Model on the Relationship Between Patient Perceived Autonomy Supportive Healthcare Climate and Health Literacy Skills. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051741. [PMID: 32155975 PMCID: PMC7084351 DOI: 10.3390/ijerph17051741] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 02/03/2023]
Abstract
Individuals with low health literacy (HL) are known to have poorer health outcomes and to have higher mortality rates compared to individuals with higher HL; hence, the improvement of HL is a key outcome in modern healthcare systems. Healthcare providers are therefore asked to support patients in becoming more and more engaged in their healthcare, thus augmenting their literacy skills. Our main hypothesis is that the well-known relationship between patients’ perceived autonomy supportive healthcare climate and HL skills is mediated by the Patient Health Engagement Model (PHE-model) which describes the patients’ progressive maturation of a psychological readiness to become active players in their healthcare. The purpose of this study was to formulate a hypothetical structural equation model (SEM) linking an autonomy-supportive healthcare climate to PHE-model and HL. A cross-sectional survey design was employed involving 1007 Italian chronic patients. The hypothetical model was tested using SEM to verify the hypothesized mediation of the PHE-model between autonomy-supportive healthcare climate and HL. Results show that the theoretical model has a good fit indexes and that PHE-model fully mediates the relationship between autonomy-supportive healthcare climate and HL. This finding suggests healthcare systems to implement a new paradigm where patients are supported to play an autonomous role in their own healthcare.
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Nurash P, Kasevayuth K, Intarakamhang U. Learning programmes and teaching techniques to enhance oral health literacy or patient-centred communication for healthcare providers: A systematic review. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2020; 24:134-144. [PMID: 31675468 DOI: 10.1111/eje.12477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/07/2019] [Accepted: 10/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the learning programmes and teaching techniques used in interventions to enhance oral health literacy (OHL) or patient-centred communication (PCC) for healthcare providers. MATERIALS AND METHODS A systematic review of OHL and PCC were obtained from four electronic databases (PubMed, ScienceDirect, ProQuest and Scopus) was undertaken. These searches covered the period from January 2008 to December 2017. The quality assessment tool was the Joanna Briggs Institute Critical Appraisal tool for systematic reviews of effectiveness. RESULTS The final review included nine studies amongst a total of 1475 studies. They showed three learning programmes (workshops, training and community-based rotation) and 17 related teaching techniques to promote OHL and PCC. The most commonly used learning programmes to enhance OHL and PCC for healthcare providers were workshops, and the teaching techniques included feedback and reflection. The intervention periods of the programmes took 20 minutes to half a day. The three studies did not have a follow-up, whilst the rest showed a follow-up range of 2 months to 3 years. Interestingly, there was one study, which applied double follow-ups to show the effectiveness of the programme. CONCLUSION Either workshops or training programmes with a combination of teaching techniques were effective in terms of enhancing their OHL or PCC. The more frequent follow-up might increase the long-term effectiveness of the learning programme.
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Affiliation(s)
- Pariyawit Nurash
- Behavioral Science Research Institute, Srinakharinwirot University, Bangkok, Thailand
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Communication skills training for physicians improves health literacy and medical outcomes among patients with hypertension: a randomized controlled trial. BMC Health Serv Res 2020; 20:60. [PMID: 31973765 PMCID: PMC6979365 DOI: 10.1186/s12913-020-4901-8] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 01/09/2020] [Indexed: 12/29/2022] Open
Abstract
Background Improving the training of physicians about communication skills and patient health literacy (HL) is a major priority that remains an open question. We aimed to examine the effectiveness of communication skills training for physicians on the hypertension outcomes and the health literacy skills, self-efficacy and medication adherence in patients with uncontrolled blood pressure (BP). Methods A randomized, controlled trial method was conducted on 240 hypertensive patients and 35 physicians presenting to healthcare clinics in the Mashhad, Iran, from 2013 to 2014. Using stratified blocking with block sizes of 4 and 6, eligible patients with uncontrolled blood pressure were randomly allocated to the intervention and control groups. Physicians in the intervention group received educational training over 3 sessions of Focus –Group Discussion and 2 workshops. The control group received the routine care. The primary outcome was a reduction in systolic and diastolic BP from baseline to 6 months. The secondary outcome was promoting HL skills in hypertensive patients. Data were analyzed using the regression model and bivariate tests. Results After the physician communication training, there was a significant improvement in physicians-patient communication skills, hypertension outcomes, medication adherence, and self-efficacy among the patients being managed by the physicians receiving training, compared to the control group. Conclusion The educational intervention leads to better BP control; it may have been sufficient training of physicians change to impact counseling, HL and self-efficacy and adherence. The quality of physician-patient communication is an important modifiable element of medical communication that may influences health outcomes in hypertensive Iranian patients. Trial registration Iranian Registry of Clinical Trials (IRCT), IRCT20160710028863N24. Registered April 4, 2018 [retrospectively registered].
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Zabar S, Hanley K, Wilhite JA, Altshuler L, Kalet A, Gillespie C. In the room where it happens: do physicians need feedback on their real-world communication skills? BMJ Qual Saf 2019; 29:182-184. [PMID: 31704892 DOI: 10.1136/bmjqs-2019-010384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Sondra Zabar
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Kathleen Hanley
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Jeffrey A Wilhite
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Lisa Altshuler
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Adina Kalet
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Colleen Gillespie
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
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Abstract
Health literacy is a concept discussed in the literature of many disciplines, but the definitions used are varied. Using the Walker and Avant method of concept analysis, the authors explore health literacy in relation to health outcomes-the defining attributes, antecedents, consequences, and empirical referents. In addition, cases are provided that illustrate health literacy in relation to health outcomes. This concept analysis allows for colleagues in nursing to have a better understanding of this concept and facilitates further development of tools to assess and improve health literacy and ultimately improve health outcomes overall.
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Affiliation(s)
- Melanie Sierra
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Rosina Cianelli
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
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Smirnova A, Sebok-Syer SS, Chahine S, Kalet AL, Tamblyn R, Lombarts KMJMH, van der Vleuten CPM, Schumacher DJ. Defining and Adopting Clinical Performance Measures in Graduate Medical Education: Where Are We Now and Where Are We Going? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:671-677. [PMID: 30720528 DOI: 10.1097/acm.0000000000002620] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Assessment and evaluation of trainees' clinical performance measures is needed to ensure safe, high-quality patient care. These measures also aid in the development of reflective, high-performing clinicians and hold graduate medical education (GME) accountable to the public. Although clinical performance measures hold great potential, challenges of defining, extracting, and measuring clinical performance in this way hinder their use for educational and quality improvement purposes. This article provides a way forward by identifying and articulating how clinical performance measures can be used to enhance GME by linking educational objectives with relevant clinical outcomes. The authors explore four key challenges: defining as well as measuring clinical performance measures, using electronic health record and clinical registry data to capture clinical performance, and bridging silos of medical education and health care quality improvement. The authors also propose solutions to showcase the value of clinical performance measures and conclude with a research and implementation agenda. Developing a common taxonomy of uniform specialty-specific clinical performance measures, linking these measures to large-scale GME databases, and applying both quantitative and qualitative methods to create a rich understanding of how GME affects quality of care and patient outcomes is important, the authors argue. The focus of this article is primarily GME, yet similar challenges and solutions will be applicable to other areas of medical and health professions education as well.
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Affiliation(s)
- Alina Smirnova
- A. Smirnova is a PhD researcher, School of Health Professions Education, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands, and Professional Performance Research Group, Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. S.S. Sebok-Syer is instructor, Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California. S. Chahine is assistant professor and scientist, Centre for Educational Research and Innovation (CERI), Western University, London, Ontario, Canada. A.L. Kalet is professor of medicine and surgery, director of research on medical education outcomes (ROMEO), Unit of the Division of General Internal Medicine and Clinical Innovation, Department of Medicine, and director of research, Program on Medical Education and Technology, NYU School of Medicine, New York, New York. R. Tamblyn is professor, Department of Medicine and Department of Epidemiology and Biostatistics, McGill University, medical scientist, McGill University Health Center Research Institute, scientific director, Clinical and Health Informatics Research Group, McGill University, and scientific director, Canadian Institutes of Health Research-Institute of Health Services and Policy Research, Montreal, Quebec, Canada. K.M.J.M.H. Lombarts is professor and lead investigator, Professional Performance Research Group, Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. C.P.M. van der Vleuten is professor and scientific director, School of Health Professions Education, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. D.J. Schumacher is associate professor, Division of Emergency Medicine, and pediatric emergency physician, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio
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Schumacher DJ, Martini A, Holmboe E, Varadarajan K, Busari J, van der Vleuten C, Carraccio C. Developing Resident-Sensitive Quality Measures: Engaging Stakeholders to Inform Next Steps. Acad Pediatr 2019; 19:177-185. [PMID: 30268426 DOI: 10.1016/j.acap.2018.09.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 09/11/2018] [Accepted: 09/24/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Despite the need for quality measures relevant to the work residents complete, few attempts have been made to address this gap. Resident-sensitive quality measures (RSQMs) can help fill this void. This study engaged resident and supervisor stakeholders to develop and inform next steps in creating such measures. METHODS Two separate nominal group techniques (NGTs), one with residents and one with faculty and fellow supervisors, were used to generate RSQMs for 3 specific illnesses (asthma, bronchiolitis, and closed head injury) as well as general care for the pediatric emergency department. Two separate Delphi processes were then used to prioritize identified RSQMs. The measures produced by each group were compared side by side, illuminating similarities and differences that were explored through focus groups with residents and supervisors. These focus groups also probed future settings in which to develop RSQMs. RESULTS In the NGT and Delphi groups, residents and supervisors placed considerable focus on measures in 3 areas across the illnesses of interest: 1) appropriate medication dosing, 2) documentation, and 3) information provided at patient discharge. Focus groups highlighted hospital medicine and general pediatrics as priority areas for developing future RSQMs but also noted contextual variables that influence the application of similar measures in different settings. Residents and supervisors had both similar as well as unique insights into developing RSQMs. CONCLUSIONS This study continues to pave the path forward in developing future RSQMs by exploring specific settings, measures, and stakeholders to consider when undertaking this work.
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Affiliation(s)
- Daniel J Schumacher
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center (DJ Schumacher and A Martini); Office of the Chief Medical Officer, UCHealth (K Varadarajan), Cincinnati, Ohio.
| | - Abigail Martini
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center (DJ Schumacher and A Martini); Office of the Chief Medical Officer, UCHealth (K Varadarajan), Cincinnati, Ohio
| | - Eric Holmboe
- Accreditation Council for Graduate Medical Education (E Holmboe), Chicago, Ill
| | - Kartik Varadarajan
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center (DJ Schumacher and A Martini); Office of the Chief Medical Officer, UCHealth (K Varadarajan), Cincinnati, Ohio
| | - Jamiu Busari
- School of Health Professions Education (J Busari), Maastricht University, Maastricht, The Netherlands
| | - Cees van der Vleuten
- Department of Educational Development and Research in the Faculty of Health, Medicine, and Life Sciences and School of Health Professions Education (SHE) (C van der Vleuten), Maastricht University, Maastricht, The Netherlands
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Qiu C, Chen S, Yao Y, Zhao Y, Xin Y, Zang X. Adaption and validation of Nijmegen continuity questionnaire to recognize the influencing factors of continuity of care for hypertensive patients in China. BMC Health Serv Res 2019; 19:79. [PMID: 30696430 PMCID: PMC6352379 DOI: 10.1186/s12913-019-3915-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 01/17/2019] [Indexed: 12/05/2022] Open
Abstract
Background Continuity of care (COC) has become a primary point of concern for care providers in both developed and developing countries, which is regarded as the “cornerstone of care” and an “essential element” of good health care. A robust and proper instrument is of necessity to identify problems and evaluate intervention aimed at improving continuity of care. This study aimed to adapt Nijmegen continuity questionnaire (NCQ) into a Chinese version (NCQ-C) and to delineate the status of COC as well as explore its influencing factors for hypertensive patients in China. Methods A forward-back-translation procedure was adopted for the determination of the adaption of NCQ. Then a total of 448 patients completed questionnaires and 24-h ambulatory blood pressure monitoring (ABPM). Proper indexes were calculated to test the reliability and validity of NCQ-C. Logistic analysis were used to detect the influencing factors of COC. Results The NCQ-C had excellent intraclass correlation coefficient of 0.855 and internal consistency of seven dimensions varied from 0.907 to 0.944. The item-content validity index ranged from 0.71 to 1.00. For construct validity, seven-factor structure was confirmed as original questionnaire and all the fit indices indicated acceptable levels. Gender, education level, medical insurance and frequency of family visits, blood pressure level, depression status as well as general health perception were demonstrated to be statistically related to COC. Conclusions In addition, all the parameters of ABPM were negatively significant with COC. The NCQ-C has shown acceptable level of reliability and validity. The related factors of COC should arouse care providers’ attention.
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Affiliation(s)
- Chen Qiu
- School of Nursing, Tianjin Medical University, Qixiangtai Road, Heping District, Tianjin, China
| | - Shixiang Chen
- School of Nursing, Tianjin Medical University, Qixiangtai Road, Heping District, Tianjin, China
| | - Ying Yao
- Department of Emergency, Tianjin Medical University General Hospital, Tianjin, China
| | - Yue Zhao
- School of Nursing, Tianjin Medical University, Qixiangtai Road, Heping District, Tianjin, China
| | - Yi Xin
- Department of Cardiology, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiaoying Zang
- School of Nursing, Tianjin Medical University, Qixiangtai Road, Heping District, Tianjin, China.
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Degan TJ, Kelly PJ, Robinson LD, Deane FP. Health literacy in substance use disorder treatment: A latent profile analysis. J Subst Abuse Treat 2019; 96:46-52. [DOI: 10.1016/j.jsat.2018.10.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/22/2018] [Accepted: 10/22/2018] [Indexed: 02/07/2023]
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Schumacher DJ, Holmboe ES, van der Vleuten C, Busari JO, Carraccio C. Developing Resident-Sensitive Quality Measures: A Model From Pediatric Emergency Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1071-1078. [PMID: 29215378 DOI: 10.1097/acm.0000000000002093] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To begin closing the gap with respect to quality measures available for use among residents, the authors sought to identify and develop resident-sensitive quality measures (RSQMs) for use in the pediatric emergency department (PED) setting. METHOD In May 2016, the authors reviewed National Quality Measures Clearinghouse (NQMC) measures to identify resident-sensitive measures. To create additional measures focused on common, acute illnesses (acute asthma exacerbation, bronchiolitis, closed head injury [CHI]) in the PED, the authors used a nominal group technique (NGT) and Delphi process from September to December 2016. To achieve a local focus for developing these measures, all NGT and Delphi participants were from Cincinnati Children's Hospital Medical Center. Delphi participants rated measures developed through the NGT in two areas: importance of measure to quality care and likelihood that measure represents the work of a resident. RESULTS The review of NQMC measures identified 28 of 183 as being potentially resident sensitive. The NGT produced 67 measures for asthma, 46 for bronchiolitis, and 48 for CHI. These were used in the first round of the Delphi process. After two rounds, 18 measures for asthma, 21 for bronchiolitis, and 21 for CHI met automatic inclusion criteria. In round three, participants categorized the potential final measures by their top 10 and next 5. CONCLUSIONS This study describes a template for identifying and developing RSQMs that may promote high-quality care delivery during and following training. Next steps should include implementing and seeking validity evidence for the locally developed measures.
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Affiliation(s)
- Daniel J Schumacher
- D.J. Schumacher is assistant professor, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0001-5507-8452. E.S. Holmboe is senior vice president for milestones development and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois. C. van der Vleuten is professor of education, Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences, and scientific director, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands. J.O. Busari is consultant pediatrician and associate professor of medical education, Maastricht University, Maastricht, The Netherlands. C. Carraccio is vice president of competency-based assessment, American Board of Pediatrics, Chapel Hill, North Carolina
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Moving towards a Comprehensive Approach for Health Literacy Interventions: The Development of a Health Literacy Intervention Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061268. [PMID: 29914065 PMCID: PMC6025600 DOI: 10.3390/ijerph15061268] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/06/2018] [Accepted: 06/12/2018] [Indexed: 11/16/2022]
Abstract
Low health literacy (HL) is associated with many negative health outcomes, and is a major challenge in public health and healthcare. Interventions to improve outcomes associated with HL are needed. In this paper, we aim to develop a comprehensive HL intervention model. We used a multimethod approach, consisting of (1) a literature review of articles listed in MEDLINE, presenting HL intervention models, (2) online consultation of international HL experts, and (3) two consensus meetings with members (n = 36 and 27) of a consortium studying HL among older adults (50+) in Europe. In our literature review, we identified twenty-two HL models, only a few of which focused explicitly on interventions. Sixty-eight health literacy experts took part in the online survey. The results from all three methods came together in a comprehensive HL intervention model. This model conceptualized interventions as potentially targeting five factors affecting HL outcomes: (1) individuals’ personal characteristics, (2) individuals’ social context, (3) communication between individuals and health professionals, (4) health professionals’ HL capacities, and (5) health systems. Our model is the first comprehensive HL model focused specifically on interventions. The model can support the further development of HL interventions to improve the health outcomes of people with low HL.
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Marques SRL, Lemos SMA. LETRAMENTO EM SAÚDE E FATORES ASSOCIADOS EM ADULTOS USUÁRIOS DA ATENÇÃO PRIMÁRIA. TRABALHO, EDUCAÇÃO E SAÚDE 2018. [DOI: 10.1590/1981-7746-sol00109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo O objetivo da pesquisa foi investigar o letramento em saúde e associação com fatores sociodemográficos, autopercepção da saúde e qualidade de vida em adultos. Tratou-se de estudo transversal com adultos entre 20 e 59 anos, usuários da atenção primária à saúde, realizado em unidades básicas de saúde, de fevereiro a maio de 2015 – amostra probabilística. O letramento em saúde foi avaliado pelo Short Assessment of Health Literacy for Portuguese-Speaking Adults. Realizou-se análise estatística descritiva, análise bivariada (p ≤ 0,20) e regressão logística múltipla (p ≤ 0,05). O letramento em saúde inadequado foi frequente e inicialmente associado a sexo, escolaridade, última série cursada com aprovação, estudo formal mínimo, Critério de Classificação Econômica Brasil, plano de saúde, arranjo familiar, importância atribuída à saúde, nota atribuída à própria saúde, frequência de comparecimento à unidade básica de saúde e aos domínios relações sociais e ambiental do teste World Health Organization Quality of Life. No modelo final da regressão logística, somente a escolaridade permaneceu associada ao letramento em saúde, e indivíduos com menor escolaridade tiveram mais chance de ter letramento em saúde inadequado. Os achados sugerem a necessidade do desenvolvimento de estratégias de educação em saúde para os adultos usuários da atenção primária.
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Jorm C, Roberts C. Using Complexity Theory to Guide Medical School Evaluations. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:399-405. [PMID: 28678103 DOI: 10.1097/acm.0000000000001828] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Contemporary medical school evaluations are narrow in focus and often do not consider the wider systems implications of the relationship between learning and teaching, research, clinical care, and community engagement. The result is graduates who lack the necessary knowledge and skills for the modern health care system and an educational system that is limited in its ability to learn and change.To address this issue, the authors apply complexity theory to medical school evaluation, using four key factors-nesting, diversity, self-organization, and emergent outcomes. To help medical educators apply this evaluation approach in their own settings, the authors offer two tools-a modified program logic model and sensemaking. In sensemaking, they use the organic metaphor of the medical school as a neuron situated within a complex neural network to enable medical educators to reframe the way they think about program evaluation. The authors then offer practical guidance for applying this model, including describing the example of addressing graduates' engagement in the health care system. The authors consider the input of teachers, the role of culture and curriculum, and the clinical care system in this example.Medical school evaluation is reframed as an improvement science for complex social interventions (medical school is such an intervention) in this model. With complexity theory's focus on emergent outcomes, evaluation takes on a new focus, reimagining medical students as reaching their future potential as change agents, who transform health systems and the lives of patients.
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Affiliation(s)
- Christine Jorm
- C. Jorm is honorary associate professor, Sydney Medical School, Sydney, Australia. C. Roberts is associate professor in primary care and medical education, Sydney Medical School, Sydney, Australia
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Tavakoly Sany SB, Peyman N, Behzhad F, Esmaeily H, Taghipoor A, Ferns G. Health providers' communication skills training affects hypertension outcomes. MEDICAL TEACHER 2018; 40:154-163. [PMID: 29183178 DOI: 10.1080/0142159x.2017.1395002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Hypertension is a common cardiovascular risk factor within the Iranian population, and this may be improved through changes in lifestyle. We aimed at improving hypertension outcomes and health literacy skills among hypertensive patients through communication skills training targeting health providers. METHODS A randomized controlled trial method was used to enroll 35 health providers and 240 hypertensive patients attending community-based healthcare practices in the Mashhad, Iran. We evaluated the effects of a communication skills intervention for primary care providers compared to usual care controls, on the hypertension outcomes, patient medication adherence, and self-efficacy, assessed at baseline and post-intervention. Bivariate analysis and the regression model were used to assess whether the health provider training improved outcomes. RESULTS Majority of participating patients were female (77.3%), less than high school education (80.3%), married (82.3%), and low income (82.3%), with mean age of 37 years. Following the educational intervention, there was a significant improvement (p < 0.05) in patient communication skills, self-efficacy, adherence to medication, and hypertension outcomes in the intervention compared to the control group. CONCLUSIONS The brief communication skills training for health care providers appear to be an efficient way to improve patient-provider communication skills and hypertension outcome among patients with uncontrolled BP.
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Affiliation(s)
- Seyedeh Belin Tavakoly Sany
- a Social Determinants of Health Research Center , Mashhad University of Medical Sciences , Mashhad , Iran
- b Department of Health Education and Health Promotion, School of Health , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Nooshin Peyman
- a Social Determinants of Health Research Center , Mashhad University of Medical Sciences , Mashhad , Iran
- b Department of Health Education and Health Promotion, School of Health , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Fatemeh Behzhad
- a Social Determinants of Health Research Center , Mashhad University of Medical Sciences , Mashhad , Iran
- b Department of Health Education and Health Promotion, School of Health , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Habibollah Esmaeily
- a Social Determinants of Health Research Center , Mashhad University of Medical Sciences , Mashhad , Iran
- c Department of Biostatistics and Epidemiology, School of Health , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Ali Taghipoor
- a Social Determinants of Health Research Center , Mashhad University of Medical Sciences , Mashhad , Iran
- c Department of Biostatistics and Epidemiology, School of Health , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Gordon Ferns
- d Brighton and Sussex Medical School , Division of Medical education, Falmer , Brighton, Sussex , UK
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Meggetto E, Ward B, Isaccs A. What’s in a name? An overview of organisational health literacy terminology. AUST HEALTH REV 2018; 42:21-30. [DOI: 10.1071/ah17077] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 08/26/2017] [Indexed: 11/23/2022]
Abstract
Organisational health literacy (OHL) is a relatively new concept and its role in improving population health outcomes is gaining recognition. There are several terms being used in relation to OHL but there is no consensus about the definition of OHL nor agreement on a single approach to its application within health services. This contested space continues to create discussion and debate between health literacy researchers worldwide. Increasingly, health service accreditation standards are moving towards including OHL and so services need to clearly define their roles and responsibilities in this area. Inherent in this is the need to develop and validate quantifiable measures of OHL change. This is not to say it needs a ‘one-size-fits-all’ approach but rather that terminology needs to be fit for purpose. This paper reviews the literature on OHL, describing and contrasting OHL terminology to assist practitioners seeking OHL information and health services clarifying their roles and responsibilities in this area. What is known about the topic? Organisational health literacy (OHL) is a new and emerging field. Currently there is no agreed definition or approach to OHL. As a result there is a large number of terms being used to describe OHL and this can make it difficult for practitioners and health services to understand the meanings of the different terms and how they can be used when seeking OHL information and its application to health service policy. What does this paper add? This paper provides an overview of 19 different OHL terms currently in use and how they apply in a range of health service contexts. What are the implications for practitioners? This paper provides practitioners with an overview of OHL terms currently in use and how they can be used to seek information and evidence to inform practice or develop health service OHL policy. This will allow health services to ensure they can clearly define their roles and responsibilities in OHL for accreditation purposes by ensuring that terminology use is fit for purpose. Lastly, the paper provides an inventory of terminology to be used when searching for evidence-based practices in OHL. This ensures all relevant papers can be captured, leading to robust and thorough reviews of the evidence most relevant to the OHL area of focus.
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Coleman C, Peterson-Perry S, Sachdeva B, Kobus A, Garvin R. Long-term Effects of a Health Literacy Curriculum for Family Medicine Residents. PRIMER : PEER-REVIEW REPORTS IN MEDICAL EDUCATION RESEARCH 2017; 1:22. [PMID: 32944708 DOI: 10.22454/primer.2017.703541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Introduction Improving education about health literacy for health care professionals has been recommended, and many US family medicine residency programs have developed such curricula. Few studies have evaluated the effectiveness of health literacy curricula for health care professionals. This pilot study aimed to determine whether a longitudinal health literacy curriculum for family medicine residents could achieve long-term sustained improvements in health literacy knowledge and clear communication practices. Methods Self-reported pre- and postassessments were conducted for a series of four health literacy didactic and experiential trainings over 11 months with a cohort of 12 first-year family medicine residents (study adequately powered for cohort of 10 or more). Results Five out of five health literacy knowledge items showed sustained significant improvement immediately after the initial didactic training. Two out of eight clear communication behaviors (eliciting patients' questions through an open-ended approach, and using a teach-back method to check for patients' understanding) showed sustained significant improvements in the 11-month follow-up period. The remaining six behaviors demonstrated a saw-tooth pattern, wherein each training session produced improvements in planned behaviors, which were, however, not maintained at subsequent follow-up assessments. Conclusions These data suggest that residents learned the cognitive material related to health literacy and clear communication easily, but had difficulty integrating many trained skills into clinical practice, despite the use of experiential learning techniques. Future studies should use an observational design to assess clear communication behaviors, and should include assessment of potential barriers to implementing clear communication skills in clinical practice.
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Affiliation(s)
- Cliff Coleman
- Oregon Health & Science University, Department of Family Medicine
| | | | - Bhavaya Sachdeva
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University
| | - Amy Kobus
- Department of Psychiatry, Oregon Health & Science University
| | - Roger Garvin
- Department of Family Medicine, Oregon Health & Science University
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Hwang SS, Rybin DV, Kerr SM, Heeren TC, Colson ER, Corwin MJ. Predictors of Maternal Trust in Doctors About Advice on Infant Care Practices: The SAFE Study. Acad Pediatr 2017; 17:762-769. [PMID: 28315416 DOI: 10.1016/j.acap.2017.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/06/2017] [Accepted: 03/07/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To determine predictors of maternal trust in doctors about advice on infant care practices. METHODS Using probability sampling methods, we recruited mothers from 32 US maternity hospitals. Mothers completed a survey 2 to 6 months postpartum that included questions about maternal trust in doctors regarding 6 infant care practices and physician characteristics (doctor asked mother's opinion, doctor is qualified, infant sees 1 main doctor who is/is not of the same ethnicity/race). Prevalence estimates and 95% confidence intervals were calculated for maternal trust in physician advice for each infant care practice. Multivariate logistic regression was used to calculate the independent association of maternal and physician characteristics and trust for each infant care practice, controlling for sociodemographic characteristics. RESULTS Of the 3983 mothers enrolled from January 2011 to March 2014, 3297 (83%) completed the follow-up survey. Maternal trust in the doctor varied according to infant care practice with highest trust for vaccination (89%) and lowest trust for pacifier use (56%). In the adjusted analyses, for all infant care practices, mothers were more likely to trust their doctors if they reported that the doctors were qualified (adjusted odds ratio [AOR], >3.0 for all practices) or if the doctor had asked their opinion (AOR, 1.76-2.43). For mothers who reported seeing 1 main doctor, white mothers were more likely to trust physicians for almost all infant care practices if they reported the doctor was the same race (AOR, 1.54-2.19). CONCLUSIONS Physician characteristics and ways of communication were significantly associated with maternal trust in doctors about advice on infant care practices.
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Affiliation(s)
- Sunah S Hwang
- Section of Neonatology, Children's Hospital Colorado, Aurora; Pediatrics, University of Colorado School of Medicine, Aurora.
| | - Denis V Rybin
- Data Coordinating Center, Boston University School of Public Health, Mass
| | - Stephen M Kerr
- Data Coordinating Center, Boston University School of Public Health, Mass; Slone Epidemiology Center, Boston University, Mass
| | | | - Eve R Colson
- Pediatrics, Yale University School of Medicine, New Haven, Conn
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Coleman C, Hudson S, Pederson B. Prioritized Health Literacy and Clear Communication Practices For Health Care Professionals. Health Lit Res Pract 2017; 1:e91-e99. [PMID: 31294254 PMCID: PMC6607795 DOI: 10.3928/24748307-20170503-01] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 05/02/2017] [Indexed: 11/20/2022] Open
Abstract
Background Health care professionals need more and better training about health literacy and clear communication to provide optimal care to populations with low health literacy. A large number of health literacy and clear communication practices have been identified in the literature, but health professions educators, administrators, and policymakers have lacked guidance regarding which practices should be prioritized among members of the health care workforce. Objective This study sought to prioritize recommended health literacy and clear communication practices for health care professionals. Methods A Q-sort consensus method was used among 25 health literacy experts to rank a previously identified list of 32 health literacy and clear communication practices for health care professionals. Mean ratings for each of the 32 practices were compared using t-tests. Key Results Mean ratings for the 32 practices fell along a spectrum from higher to lower importance. The eight top-rated practices formed a cluster, and seven of these items demonstrated clear consensus, whereas one item may have been influenced by one or more outlier rankings. Conclusions Although a large number of health literacy and clear communication practices have been recommended in the literature for health care professionals, this is the first known study to rank such practices in terms of importance. The top-rated items can be considered a core set of practices that all health care professionals should learn and routinely use in clinical settings. These consensus opinion results will help health professions educators, administrators, and policymakers to direct potentially limited resources toward improving training in patient-centered communication, and when designing curricula, practice standards, care delivery models, and policies for health care professionals and systems to improve patient outcomes. Future studies should empirically confirm the relative value of the ranked items in terms of patient-centered outcomes. [Health Literacy Research and Practice. 2017;1(3):e90-e99.]. Plain Language Summary This is the first study to rank the most important things that health care workers can do to communicate more clearly with patients. A group of 25 experts ranked 32 items in order of importance. The list can be used to improve training for health care workers.
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Affiliation(s)
- Cliff Coleman
- Address correspondence to Cliff Coleman, MD, MPH, Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239;
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Weaver S, Ashby J, Kamimura A. Self-Reported Diagnosis of Type 1 and Type 2 Diabetes and Lifestyle Change Among Uninsured Primary Care Patients. Health Serv Res Manag Epidemiol 2017; 4:2333392816689528. [PMID: 28508013 PMCID: PMC5415281 DOI: 10.1177/2333392816689528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 12/15/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction: The purpose of this study is to examine self-reported diagnosis of type 1 and type 2 diabetes and lifestyle change among uninsured primary care patients utilizing a free clinic. Methods: Free clinic patients participated in a self-administered survey in May and June 2016. Patients with the following self-reported diagnoses were analyzed: type 2 diabetes only (n = 84), and type 1 diabetes only or both (n = 43). Results: Participants who reported having type 2 diabetes only and/or were patients of the diabetes clinic were less likely to have modified diet and/or physical activity to manage diabetes compared to those with type 1 diabetes and/or those who were not patients of the diabetes clinic. Participants with hypertension were more likely to have changed diet and/or physical activity compared to those without hypertension. Conclusion: Uninsured primary care patients may not know whether they have type 1 or type 2 diabetes. This is problematic as type 1 and type 2 diabetes require different prevention and self-management strategies. Future studies should examine the impact of misunderstanding the 2 types of diabetes on health behaviors and outcomes and explore the context of the misunderstanding.
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Affiliation(s)
- Shannon Weaver
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | | | - Akiko Kamimura
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
- Akiko Kamimura, Department of Sociology, University of Utah, 380 S, 1530 E, Salt Lake City, Utah 84112, USA.
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Shonna Yin H. Health Literacy and Child Health Outcomes: Parental Health Literacy and Medication Errors. SPRINGERBRIEFS IN PUBLIC HEALTH 2017. [DOI: 10.1007/978-3-319-50799-6_3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Capsule Commentary on Bloom-Feshbach et al., Health Literacy in Transitions of Care: An Innovative Objective Structured Clinical Examination for Fourth Year Medical Students in an Internship Preparation Course. J Gen Intern Med 2016; 31:227. [PMID: 26563221 PMCID: PMC4720654 DOI: 10.1007/s11606-015-3541-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Yin HS, Parker RM, Sanders LM, Dreyer BP, Mendelsohn A, Bailey S, Patel DA, Jimenez JJ, Kim KYA, Jacobson K, Hedlund L, Landa R, Maness L, Raythatha PT, McFadden T, Wolf MS. Effect of Medication Label Units of Measure on Parent Choice of Dosing Tool: A Randomized Experiment. Acad Pediatr 2016; 16:734-741. [PMID: 27155289 PMCID: PMC5077678 DOI: 10.1016/j.acap.2016.04.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/24/2016] [Accepted: 04/26/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Some experts recommend eliminating "teaspoon" and "tablespoon" terms from pediatric medication dosing instructions, because these terms could inadvertently encourage use of nonstandard tools (ie, kitchen spoons), which are associated with dosing errors. We examined whether use of "teaspoon" or "tsp" on prescription labels affects parents' choice of dosing tools, and the role of health literacy and language. METHODS Analysis of data collected as part of a controlled experiment (SAFE Rx for Kids [Safe Administration For Every Prescription for Kids] study), which randomized English- and Spanish-speaking parents (n = 2110) of children 8 years of age and younger to 1 of 5 groups, which varied in unit of measurement pairings on medication labels and dosing tools. Outcome assessed was parent self-reported choice of dosing tool. Parent health literacy was measured using the Newest Vital Sign. RESULTS Seventy-seven percent had limited health literacy (36.0% low, 41.0% marginal); 35.0% completed assessments in Spanish. Overall, 27.7% who viewed labels containing either "tsp" or "teaspoon" units (alone or with "mL") chose nonstandard dosing tools (ie, kitchen teaspoon, kitchen tablespoon), compared with 8.3% who viewed "mL"-only labels (adjusted odds ratio [AOR] = 4.4 [95% confidence interval (CI), 3.3-5.8]). Odds varied based on whether "teaspoon" was spelled out or abbreviated ("teaspoon"-alone: AOR = 5.3 [95% CI, 3.8-7.3]); "teaspoon" with mL: AOR = 4.7 [95% CI, 3.3-6.5]; "tsp" with mL: AOR = 3.3 [95% CI, 2.4-4.7]; P < .001). Similar findings were noted across health literacy and language groups. CONCLUSIONS Use of teaspoon units ("teaspoon" or "tsp") on prescription labels is associated with increased likelihood of parent choice of nonstandard dosing tools. Future studies might be helpful to examine the real-world effect of eliminating teaspoon units from medication labels, and identify additional strategies to promote the safe use of pediatric liquid medications.
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Affiliation(s)
- H. Shonna Yin
- Pediatrics, NYU School of Medicine - Bellevue Hospital, 550 First Avenue, New York, NY, 10016, United States,Population Health, NYU School of Medicine, 550 First Avenue, New York, NY, 10016, United States
| | - Ruth M. Parker
- Medicine, Emory University School of Medicine, 1518 Clifton Road, Atlanta, GA, 30322, United States
| | - Lee M. Sanders
- Pediatrics, Stanford University School of Medicine, 117 Encina Commons, Stanford, CA, CA, 94305, United States
| | - Benard P. Dreyer
- Pediatrics, NYU School of Medicine - Bellevue Hospital, 550 First Avenue, New York, NY, 10016, United States
| | - Alan Mendelsohn
- Pediatrics, NYU School of Medicine - Bellevue Hospital, 550 First Avenue, New York, NY, 10016, United States
| | - Stacy Bailey
- Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, 2204 Kerr Hall, Chapel Hill, NC, 27599, United States
| | - Deesha A. Patel
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, Chicago, IL, 60611, United States
| | - Jessica J. Jimenez
- Pediatrics, NYU School of Medicine - Bellevue Hospital, 550 First Avenue, New York, NY, 10016, United States
| | - Kwang-Youn A. Kim
- Preventive Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, Chicago, IL, 60611, United States
| | - Kara Jacobson
- Rollins School of Public Health Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States
| | - Laurie Hedlund
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, Chicago, IL, 60611, United States
| | - Rosa Landa
- Pediatrics, Stanford University School of Medicine, 117 Encina Commons, Stanford, CA, CA, 94305, United States
| | - Leslie Maness
- Pediatrics, NYU School of Medicine - Bellevue Hospital, 550 First Avenue, New York, NY, 10016, United States
| | - Purvi Tailor Raythatha
- Pediatrics, NYU School of Medicine - Bellevue Hospital, 550 First Avenue, New York, NY, 10016, United States
| | - Terri McFadden
- Pediatrics, Emory University School of Medicine, 1518 Clifton Road, Atlanta, GA, USA, 30322
| | - Michael S. Wolf
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, Chicago, IL, 60611, United States
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