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Warr R, Ruggiano N, Daquin J, Anderson Herzog M, Jiang Z, Gray J. Health Information Seeking Using Tech and Non-Tech Sources Among a Diverse Sample of Caregivers in the Deep South. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024; 67:605-620. [PMID: 38662939 DOI: 10.1080/01634372.2024.2339960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 04/03/2024] [Indexed: 05/24/2024]
Abstract
Caregivers of people living with dementia (PLWD) are often tasked with making decisions about their loved one's daily care and healthcare treatment, causing stress and decision-making fatigue. Many caregivers engage in health information seeking to improve their health literacy for optimal decision-making, though there is limited knowledge about the strategies used to increase their health literacy. This study involved a survey of caregivers in Alabama, most of whom were African American and/or living in rural communities that have historically underserved. The findings shed light on caregivers' experiences in seeking out health-related information and their perceptions of various sources of information.
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Affiliation(s)
- Retisha Warr
- School of Social Work, University of Alabama, Tuscaloosa, Alabama, USA
| | - Nicole Ruggiano
- School of Social Work, University of Alabama, Tuscaloosa, Alabama, USA
| | - Jane Daquin
- Department of Criminology and Criminal Justice, University of Alabama, Tuscaloosa, Alabama, USA
| | - Monica Anderson Herzog
- Department of Computer Science, College of Engineering, University of Alabama, Tuscaloosa, Alabama, USA
| | - Zhe Jiang
- Computer & Information Science & Engineering, University of Florida, Gainesville, Florida, USA
| | - Jeff Gray
- Department of Computer Science, College of Engineering, University of Alabama, Tuscaloosa, Alabama, USA
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Christie V, Riley L, Green D, Amin J, Skinner J, Pyke C, Gwynne K. Improving Breast Cancer Outcomes for Indigenous Women in Australia. Cancers (Basel) 2024; 16:1736. [PMID: 38730687 PMCID: PMC11083011 DOI: 10.3390/cancers16091736] [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: 04/04/2024] [Revised: 04/26/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
In Australia, the incidence rate of breast cancer is lower in Indigenous* women than non-Indigenous women; however, the mortality rate is higher, with Indigenous women 1.2 times more likely to die from the disease. This paper provides practical and achievable solutions to improve health outcomes for Indigenous women with breast cancer in Australia. This research employed the Context-Mechanism-Outcome (CMO) framework to reveal potential mechanisms and contextual factors that influence breast cancer outcomes for Indigenous women, stratified into multiple levels, namely, micro (interpersonal), meso (systemic) and macro (policy) levels. The CMO framework allowed us to interpret evidence regarding Indigenous women and breast cancer and provides nine practical ways to improve health outcomes and survival rates.
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Affiliation(s)
- Vita Christie
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Heart Research Institute, Sydney, NSW 2042, Australia; (J.S.); (K.G.)
| | - Lynette Riley
- Sydney School of Education & Social Work, The University of Sydney, Camperdown, NSW 2006, Australia;
| | - Deb Green
- Armajun Aboriginal Health Service, Armidale, NSW 2350, Australia;
| | - Janaki Amin
- Department of Health Sciences, Macquarie University, Sydney, NSW 2109, Australia;
| | - John Skinner
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Heart Research Institute, Sydney, NSW 2042, Australia; (J.S.); (K.G.)
| | - Chris Pyke
- Royal Australasian College of Surgeons, Melbourne, VIC 3002, Australia;
| | - Kylie Gwynne
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Heart Research Institute, Sydney, NSW 2042, Australia; (J.S.); (K.G.)
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Morse E, Odigie E, Gillespie H, Rameau A. The Readability of Patient-Facing Social Media Posts on Common Otolaryngologic Diagnoses. Otolaryngol Head Neck Surg 2024; 170:1051-1058. [PMID: 38018504 DOI: 10.1002/ohn.584] [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: 07/26/2023] [Revised: 10/09/2023] [Accepted: 10/28/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE To assess the readability of patient-facing educational information about the most common otolaryngology diagnoses on popular social media platforms. STUDY DESIGN Cross-sectional study. SETTING Social media platforms. METHODS The top 5 otolaryngologic diagnoses were identified from the National Ambulatory Medical Care Survey Database. Facebook, Twitter, TikTok, and Instagram were searched using these terms, and the top 25 patient-facing posts from unique accounts for each search term and poster type (otolaryngologist, other medical professional, layperson) were identified. Captions, text, and audio from images and video, and linked articles were extracted. The readability of each post element was calculated with multiple readability formulae. Readability was summarized and was compared between poster types, platforms, and search terms via Kruskal-Wallis testing. RESULTS Median readability, by grade level, by grade level, was greater than 10 for captions, 5 for image-associated text, and 9 for linked articles. Captions and images in posts by laypeople were significantly more readable than captions by otolaryngologists or other medical professionals, but there was no difference for linked articles. All post components were more readable in posts about cerumen than those about other search terms. CONCLUSIONS When examining the readability of posts on social media regarding the most common otolaryngology diagnoses, we found that many posts are less readable than recommended for patients, and found that posts by laypeople were significantly more readable than those by medical professionals. Medical professionals should work to make educational social media posts more readable to facilitate patient comprehension.
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Affiliation(s)
- Elliot Morse
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Eseosa Odigie
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, USA
- Sean Parker Institute for the Voice, Weill Cornell Medicine, New York, New York, USA
| | - Helen Gillespie
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, USA
- Sean Parker Institute for the Voice, Weill Cornell Medicine, New York, New York, USA
| | - Anaïs Rameau
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, USA
- Sean Parker Institute for the Voice, Weill Cornell Medicine, New York, New York, USA
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Wang H, Pathak M, Takami T, Wiener RC, Shen C, Sambamoorthi U. Ethnic Disparities in Patient-Centered Communication with Healthcare Providers: A Comparison of Non-Hispanic Asians and Non-Hispanic Whites. J Racial Ethn Health Disparities 2024:10.1007/s40615-023-01898-7. [PMID: 38228862 DOI: 10.1007/s40615-023-01898-7] [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: 09/24/2023] [Revised: 12/09/2023] [Accepted: 12/15/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Patient-centered communication (PCC) is an important metric related to patient health outcomes. Non-Hispanic Asian (NHA) individuals reported lower PCC scores with healthcare providers than individuals of other races and ethnicities. We aim to determine the ethnic disparities in PCC and further investigate the association between PCC, individual's confidence in obtaining health-related information (health literacy), and confidence in taking care of themselves (health self-efficacy) among NHA in comparison to the Non-Hispanic White (NHW) population. METHODS This is a cross-sectional study. We used data from the Health Information National Trends Survey 5 (HINTS) cycles 1 and 3. PCC was measured using seven validated survey questions with scores ranging from 7 to 28. Individuals' health literacy and self-efficacy were accessed using two-item survey questions. Multivariable logistic regression analyses were performed to determine the association of independent factors (e.g., self-efficacy, health literacy, and race and ethnicity) with PCC. RESULTS We included 3,831 participants. Fewer NHAs (35.43%) reported high PCC scores compared to NHWs (48.99%, p = 0.0184). In fully adjusted logistic regression model, although NHAs were less likely to have high PCC scores (aOR = 0.78, 95% CI 0.46-1.32) compared to NHWs, the association was not statistically significant (p = 0.350). However, the aOR of confidence in self-efficacy associated with high PCC scores was 2.27 (95% CI 1.68-3.07, p < 0.001) and the aOR of confidence in health literacy with high PCC scores was 2.13 (95% CI 1.64-2.76, p < 0.001). CONCLUSIONS High PCC scores reported by NHA were not significantly different from those of NHW individuals in adjusted comparisons. Individual's confidence in self-efficacy and health literacy was positively associated with high PCC regardless of race and ethnicity.
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Affiliation(s)
- Hao Wang
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA.
| | - Mona Pathak
- Department of Pharmacotherapy, College of Pharmacy, Texas Center for Health Disparities, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Trevor Takami
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - R Constance Wiener
- Department of Dental Public Health and Professional Practice, School of Dentistry, West Virginia University, Morgantown, WV, USA
| | - Chan Shen
- Department of Health Services Research, Penn State College of Medicine, Hershey, PA, USA
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, College of Pharmacy, Texas Center for Health Disparities, University of North Texas Health Science Center, Fort Worth, TX, USA
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Suresh U, Ancker JS, Zikmund-Fisher BJ, Benda NC. Designing Support to help Health Communication Professionals Convey Numbers Clearly to the Public - A Needs Assessment and Formative Usability Evaluation. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2024; 2023:1277-1286. [PMID: 38222428 PMCID: PMC10785911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Communicating health-related probabilities to patients and the public presents challenges, although multiple studies have demonstrated that we can promote comprehension and appropriate application of numbers by matching presentation formats (e.g., percentage, bar charts, icon arrays) to communication goal (e.g., improving recall, decreasing worry, taking action). We used this literature to create goal-driven, evidence-based guidance to support health communicators in conveying probabilities. We then conducted semi-structured interviews with 39 health communicators to understand: communicators' goals for expressing probabilities, formats they choose to convey probabilities, and perceptions of prototypes of our "communicating numbers clearly" guidance. We found that communicators struggled to articulate granular goals for their communication, impeding their ability to select appropriate guidance. Future work should consider how best to support health communicators in selecting granular, differentiable goals to support broadly comprehensible information design.
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Affiliation(s)
- Uday Suresh
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, Department of Internal Medicine, and the Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
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Wilandika A, Pandin MGR, Yusuf A. The roles of nurses in supporting health literacy: a scoping review. Front Public Health 2023; 11:1022803. [PMID: 37663836 PMCID: PMC10469320 DOI: 10.3389/fpubh.2023.1022803] [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: 08/19/2022] [Accepted: 04/10/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction The importance of health literacy in achieving optimum health is highly significant, particularly in the nursing profession where it is an integral part of the roles and functions of nurses. Therefore, this scoping review aims to describe the roles of nurses in promoting patient health literacy and identify the determinant factors of health literacy in nursing practices. Methods An integrative search was conducted through four databases, namely, ScienceDirect, ProQuest, SAGE Journal, and PubMed, using various keyword combinations such as "health literacy," "health information," "patient health literacy," "patient literacy," and "nurses." Furthermore, the inclusion criteria employed were peer-reviewed articles focused on the nursing profession, explicitly discussing health literacy related to nursing, and including original studies, such as cross-sectional, quasi-experimental, and qualitative studies. The selected review articles were all published between 2017 and 2022. Results In total, 13 articles met the criteria and were applied in this scoping review. Most of these discuss health literacy related to nursing practice in clinical and community settings, as well as educational institutions. Health literacy is an essential aspect of professional nursing practice. Consequently, the supportive roles of nurses include acting as caregivers, facilitators, and educators to help patients overcome their literacy limitations and attain improved wellbeing. Conclusion Nurses can improve the health literacy skills of patients by making health information related to their illnesses easier to access, understand, evaluate, and use. They must also recognize various factors influencing health literacy and use the factors as opportunities to optimize health literacy improvement. A health literacy approach can be applied by nurses to solve health problems and improve the quality of care for patients.
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Affiliation(s)
- Angga Wilandika
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
- Faculty of Health Sciences, Universitas Aisyiyah Bandung, Bandung, Indonesia
| | | | - Ah Yusuf
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
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Wu J, Tao Z, Gao N, Shen J, Chen ZL, Zhou H, Zheng S. The Use of Multidimensional Nomial Logistic Model and Structural Equation Model in the Validation of the 14-Item Health-Literacy Scale in Chinese Patients Living with Type 2 Diabetes. Risk Manag Healthc Policy 2023; 16:1567-1579. [PMID: 37602365 PMCID: PMC10439802 DOI: 10.2147/rmhp.s419879] [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: 05/23/2023] [Accepted: 08/04/2023] [Indexed: 08/22/2023] Open
Abstract
Objective To evaluate the psychometric properties of the 14-item health literacy scale (HL-14) in patients living with type 2 diabetes mellitus (T2DM) in clinical setting. Methods Cross-sectional study using item response theory and structural equation modeling (SEM) for testing the item difficulty and three dimensional-HL configurations was adopted in this study. Chinese patients living with T2DM admitted to endocrinology department of Huadong hospital were evaluated by the HL-14 including communication, functional and critical health literacy from August to December 2021. Results The multidimensional random coefficients multinomial logistic model indicated the difficulty settings of the scale are appropriate for the study populations, and differential item functioning was not observed for sex in the study. SEM demonstrated that the three-dimensional configuration of the scale is good in the study population (x2/df=2.698, Comparative Fit Index = 0.965, Root Mean Square Error of Approximation = 0.076, standard residual mean root = 0.042). Conclusion The HL-14 scale is a reliable and valid measurement, which can perform equitably across sex in evaluating the health literacy in Chinese patients living with T2DM. Moreover, the scale may help fill the gaps of multidimensional health literacy assessment and rapid screening of health literacy ability for clinical practice.
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Affiliation(s)
- JianBo Wu
- Department of Pharmacy, Huadong Hospital, Fudan University, Shanghai, People’s Republic of China
| | - ZhuJun Tao
- Department of Pharmacy, Huadong Hospital, Fudan University, Shanghai, People’s Republic of China
| | - NingZhou Gao
- Department of Pharmacy, Huadong Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Jie Shen
- Department of Pharmacy, Huadong Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Zhi-Long Chen
- Department of Pharmacy, Huadong Hospital, Fudan University, Shanghai, People’s Republic of China
| | - HaiFeng Zhou
- Department of Pharmacy, Huadong Hospital, Fudan University, Shanghai, People’s Republic of China
| | - SongBai Zheng
- Department of Geriatrics, Huadong Hospital, Fudan University, Shanghai, People’s Republic of China
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Odigie E, Andreadis K, Chandra I, Mocchetti V, Rives H, Cox S, Rameau A. Are Mobile Applications in Laryngology Designed for All Patients? Laryngoscope 2023; 133:1540-1549. [PMID: 36317789 PMCID: PMC10149562 DOI: 10.1002/lary.30465] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/19/2022] [Accepted: 10/10/2022] [Indexed: 02/24/2023]
Abstract
OBJECTIVES Mobile applications (apps) are multiplying in laryngology, with little standardization of content, functionality, or accessibility. The purpose of this study is to evaluate the quality, functionality, health literacy, readability, accessibility, and inclusivity of laryngology mobile applications. METHODS Of the 3230 apps identified from the Apple and Google Play stores, 28 patient-facing apps met inclusion criteria. Apps were evaluated using validated scales assessing quality and functionality: the Mobile App Rating Scale (MARS) and the Institute for Healthcare Informatics App Functionality Scale. The Clear Communication Index (CDC) Institute of Medicine Strategies for Creating Health Literate Mobile Applications, and Patient Education Materials Assessment Tool (PEMAT) were used to evaluate apps health literacy level. Readability was assessed using established readability formulas. Apps were evaluated for language, accessibility features, and representation of a diverse population. RESULTS Twenty-six apps (92%) had adequate quality (MARS score > 3). The mean PEMAT score was 89% for actionability and 86% for understandability. On average, apps utilized 25/33 health literate strategies. Twenty-two apps (79%) did not pass the CDC index threshold of 90% for health literacy. Twenty-four app descriptions (86%) were above an 8th grade reading level. Only 4 apps (14%) showed diverse representation, 3 (11%) had non-English language functions, and 2 (7%) offered subtitles. Inter-rater reliability for MARS was adequate (CA-ICC = 0.715). CONCLUSION While most apps scored well in quality and functionality, many laryngology apps did not meet standards for health literacy. Most apps were written at a reading level above the national average, lacked accessibility features, and did not represent diverse populations. Laryngoscope, 133:1540-1549, 2023.
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Affiliation(s)
- Eseosa Odigie
- Sean Parker Institute for the Voice, Department of Otolaryngology, Weill Cornell Medical College, New York, USA
| | - Katerina Andreadis
- Sean Parker Institute for the Voice, Department of Otolaryngology, Weill Cornell Medical College, New York, USA
| | - Iyra Chandra
- Sean Parker Institute for the Voice, Department of Otolaryngology, Weill Cornell Medical College, New York, USA
| | - Valentina Mocchetti
- Sean Parker Institute for the Voice, Department of Otolaryngology, Weill Cornell Medical College, New York, USA
| | - Hal Rives
- Sean Parker Institute for the Voice, Department of Otolaryngology, Weill Cornell Medical College, New York, USA
| | - Steven Cox
- Department of Communication Sciences and Disorders, Adelphi University, Garden City, USA
| | - Anaïs Rameau
- Sean Parker Institute for the Voice, Department of Otolaryngology, Weill Cornell Medical College, New York, USA
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Ishikawa H, Ogawa R, Otsuki A, Saito J, Yaguchi-Saito A, Kuchiba A, Fujimori M, Fukuda Y, Shimazu T. Effect modification by geographic area on the association between health literacy and self-rated health: a nationwide cross-sectional study in Japan. BMC Public Health 2023; 23:952. [PMID: 37231363 DOI: 10.1186/s12889-023-15897-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/16/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Health literacy (HL) has gained increasing attention as a factor related to health behaviors and outcomes. This study aimed to investigate geographic differences in HL levels and effect modification by geographic area on their relationship with self-rated health in the Japanese population using a nationwide sample. METHODS Data for this study were derived from a nationally representative cross-sectional survey on health information access for consumers in Japan using a mailed self-administered questionnaire in 2020 (INFORM Study 2020). Valid responses from 3,511 survey participants, selected using two-stage stratified random sampling, were analyzed in this study. HL was measured using the Communicative and Critical Health Literacy Scale (CCHL). Multiple regression and logistic regression analyses were conducted to examine the associations between geographic characteristics and HL and effect modification on the association between HL and self-rated health by geographic area, controlling for sociodemographic characteristics. RESULTS The mean HL score was 3.45 (SD = 0.78), somewhat lower compared with previous studies on the Japanese general population. HL was higher in Kanto area than in Chubu area, after controlling for sociodemographic factors and municipality size. Furthermore, HL was positively associated with self-rated health after controlling for sociodemographic and geographic factors; however, this association was more evident in eastern areas than in western areas. CONCLUSION The findings indicate geographic differences in HL levels and effect modification by geographic area on the relationship between HL and self-rated health in the general Japanese population. HL was more strongly associated with self-rated health in eastern areas than in western areas. Further investigation is needed to explore the moderating effects of areal features, including the distribution of primary care physicians and social capital, when formulating strategies to improve HL in different contexts.
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Affiliation(s)
- Hirono Ishikawa
- Teikyo University Graduate School of Public Health, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8605, Japan.
| | - Runa Ogawa
- Teikyo University Graduate School of Public Health, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8605, Japan
| | - Aki Otsuki
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Junko Saito
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Akiko Yaguchi-Saito
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
- Faculty of Human Sciences, Tokiwa University, 1-430-1 Miwa, Mito-Shi, Ibaraki, 310-8585, Japan
| | - Aya Kuchiba
- Graduate School of Health Innovation, Kanagawa University of Human Services, 3-25-10 Tonomachi, Kawasaki-Ku, Kawasaki-Shi, Kanagawa, 210-0821, Japan
- Division of Biostatistical Research, Institute for Cancer Control/Biostatistics Division, Center for Research Administration and Support, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Maiko Fujimori
- Division of Survivorship Research, National Cancer Center Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yoshiharu Fukuda
- Teikyo University Graduate School of Public Health, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8605, Japan
| | - Taichi Shimazu
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
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Jiang Y, Nuerdawulieti B, Chen Z, Guo J, Sun P, Chen M, Li J. Effectiveness of patient decision aid supported shared decision-making intervention in in-person and virtual hybrid pulmonary rehabilitation in older adults with chronic obstructive pulmonary disease: A pilot randomized controlled trial. J Telemed Telecare 2023:1357633X231156631. [PMID: 36919365 DOI: 10.1177/1357633x231156631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Tele-pulmonary rehabilitation is increasingly advocated but cannot completely substitute for in-person services for chronic conditions. Adherence to Pulmonary rehabilitation (PR) remains low in chronic obstructive pulmonary disease (COPD) patients. Shared decision-making (SDM) promotes patients' participation in PR decisions and helps patients and healthcare providers to jointly make decisions that patients are informed and aligned with patient preferences and values, which are critical for patient adherence to PR. OBJECTIVE This study aimed to develop a hybrid in-person and virtual model of home-based PR services for older COPD patients and study the effectiveness of the patient decision aid (PDA)-supported recurring SDM intervention on patient adherence to PR, rehabilitation outcomes, and decision-related outcomes, as well as to explore the mechanisms of the intervention on PR adherence. METHODS A total of 78 older COPD patients were randomly assigned to the PR group (n = 39) or PDA-PR group (n = 39). Both groups were conducted hybrid in-person and virtual PR intervention for 3 months. The primary outcomes were patients' quality of life and PR adherence. The secondary outcomes were dyspnea symptoms, exercise self-efficacy, knowledge, and decision-related outcomes. RESULTS A total of 72 participants completed the 3-month PR program. There were statistically significant differences in PR adherence (p = 0.033), COPD assessment test (CAT) scores (p = 0.016), PR knowledge (p < 0.001), decision self-efficacy (p < 0.001), decision conflict (p < 0.001), and decision regret scores (p = 0.027) between the two groups. The modified Medical Research Council Dyspnoea scale (mMRC) score was significantly decreased only in PDA-PR group (p = 0.011). No statistically significant differences were observed in St George's Respiratory Questionnaire (SGRQ) score (p = 0.078), Exercise Self-Regulatory Efficacy Scale (Ex-SRES) score (p = 0.29) and COPD knowledge (p = 0.086) between the two groups. PR value score had a significant effect on adherence to PR (p = 0.007) and CAT score (p = 0.028). CONCLUSIONS PDA supported recurring SDM intervention was helpful in maintaining older COPD patients' PR adherence and had advantages in improving quality of life, enhancing PR knowledge, decision self-efficacy, and reducing decision conflict and decision regret, but did not improve SGRQ and Ex-SRES. PR value score influenced patients' rehabilitation adherence and quality of life. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR): ChiCTR1900028563; http://apps.who.int/trialsearch/default.aspx.
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Affiliation(s)
- Yuyu Jiang
- Department of Nursing, Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, 66374Jiangnan University, Wuxi, China
| | - Baiyila Nuerdawulieti
- Department of Nursing, Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, 66374Jiangnan University, Wuxi, China
| | - Zhongyi Chen
- Department of Nursing, Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, 66374Jiangnan University, Wuxi, China
| | - Jianlan Guo
- Department of Nursing, Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, 66374Jiangnan University, Wuxi, China
| | - Pingping Sun
- Department of Nursing, Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, 66374Jiangnan University, Wuxi, China
| | - Mengjie Chen
- Department of Nursing, Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, 66374Jiangnan University, Wuxi, China
| | - Jinping Li
- Department of Public Health and Preventive Medicine, Wuxi School of Medicine, 66374Jiangnan University, Wuxi, China
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DeWitt A, Kientz J, Liljenquist K. Quality of Mobile Apps for Child Development Support: Search in App Stores and Content Analysis. JMIR Pediatr Parent 2022; 5:e38793. [PMID: 36346656 PMCID: PMC9682452 DOI: 10.2196/38793] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 09/01/2022] [Accepted: 09/17/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Following increases in smartphone access, more parents seek parenting advice through internet sources, including blogs, web-based forums, or mobile apps. However, identifying quality apps (ones that respond to the diverse experiences of families) for guidance on child development can be challenging. OBJECTIVE This review of mobile health apps aimed to document the landscape, design, and content of apps in the United States available to parents as they promote their child's developmental health. METHODS To understand the availability and quality of apps for early childhood health promotion, we completed a content analysis of apps in 2 major app stores (Google Play and Apple App stores). RESULTS We found that most apps do not provide tailored experiences to parents, including cultural considerations, and instead promote generic guidance that may be useful to parents in some contexts. We discuss the need for an evaluative framework to assess apps aimed to support parents on child development topics. CONCLUSIONS Future work is needed on how to support designers in this area, specifically related to avoiding potential burdens on users and providing culturally informed and equity-driven experiences.
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Affiliation(s)
- Akeiylah DeWitt
- Department of Human-Centered Design and Engineering, Seattle, WA, United States
| | - Julie Kientz
- Department of Human-Centered Design and Engineering, Seattle, WA, United States
| | - Kendra Liljenquist
- Department of Pediatrics, University of Washington, Seattle, WA, United States
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12
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Kim S. Relationship between Health Literacy and Simulation Learning in Korean Nursing Students. Clin Simul Nurs 2022. [DOI: 10.1016/j.ecns.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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13
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Chen P, Callisaya M, Wills K, Greenaway T, Winzenberg T. Cognition, educational attainment and diabetes distress predict poor health literacy in diabetes: A cross-sectional analysis of the SHELLED study. PLoS One 2022; 17:e0267265. [PMID: 35442990 PMCID: PMC9020687 DOI: 10.1371/journal.pone.0267265] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 04/05/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives
To identify factors that predict poor health literacy amongst people with diabetes.
Design
Cross-sectional analysis of baseline data from a prospective study of diabetic foot disease.
Setting
Patients attending a tertiary hospital diabetes outpatient clinic in Tasmania, Australia.
Participants
222 people with diabetes mellitus, aged >40 years, with no history of foot ulceration, psychotic disorders or dementia.
Outcome measures
Health literacy was measured using the short form Test of Functional Health Literacy in Adults (functional health literacy), and the Health Literacy Questionnaire (HLQ), which measures nine domains of health literacy. Predictors included demographic characteristics, cognition, diabetes distress, depression, and educational attainment.
Results
In multivariable analysis, greater educational attainment (OR 0.88, 95% CI 0.76, 0.99) and poorer cognition (OR 0.71, 95% CI 0.63, 0.79) were associated with poorer functional health literacy. Age was negatively associated with domains of appraisal of health information and ability to find good health information (both beta = -0.01). Educational attainment was positively associated with four domains, namely having sufficient information to manage my health, actively managing my health, appraisal of and ability to find good health information (beta ranging from +0.03 to 0.04). Diabetes distress was negatively associated with five domains: having sufficient information to manage my health, social support for health, ability to actively engage with healthcare providers, navigating the healthcare system and ability to find good health information (beta ranging from -0.14 to -0.18).
Conclusion
Poorer cognition and poorer educational attainment may be detrimental for an individual’s functional health literacy, and education, diabetes distress and older age detrimental across multiple health literacy domains. Clinicians and policy makers should be attuned to these factors when communicating with people with diabetes and in designing healthcare systems to be more health-literacy friendly in order to improve diabetes outcomes.
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Affiliation(s)
- Pamela Chen
- School of Medicine, University of Tasmania, Hobart, Australia
- * E-mail:
| | - Michele Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Karen Wills
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | | | - Tania Winzenberg
- School of Medicine, University of Tasmania, Hobart, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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Lima RIM, Parente MA, Ferreira TISP, Coelho AAS, Loureiro EVSD, Barbosa TM, Lustosa SB, Damasceno OC, Teixeira FB. Letramento funcional em saúde de usuários da atenção primária de Altamira, Pará. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2022. [DOI: 10.5712/rbmfc17(44)2763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introdução: O Letramento Funcional em Saúde (LFS) está associado à capacidade dos pacientes em compreender e utilizar seus conhecimentos em saúde no âmbito do autocuidado e na promoção a saúde. Por isso, torna-se essencial reconhecer o nível de LFS e identificar os fatores que o influenciam. Objetivo: Analisar o nível de letramento funcional em saúde (LFS) de usuários de Unidades de Saúde da Família (USF) na área urbana de Altamira (PA). Métodos: Estudo transversal no qual a coleta de dados ocorreu entre agosto de 2018 e dezembro de 2019 em 12 USF da área urbana. O cálculo amostral foi realizado com base na população urbana de Altamira registrada pelo Censo de 2010. Utilizou-se intervalo de confiança de 95% com margem de erro de 5% e prevalência de achados de 50% em uma população semelhante, encontrando-se assim o valor de 382. Os participantes foram entrevistados a fim de se coletarem informações sobre dados sociodemográficos, e posteriormente foi aplicado um questionário baseado na versão brasileira do Short Test of Functional Health Literacy (S-TOFHLA), instrumento utilizado para a mensuração do LFS. O coeficiente de correlação de Pearson, o teste qui-quadrado, o teste G e a odds ratio foram utilizados para verificar a relação entre a pontuação do S-TOFHLA e os dados sociodemográficos. Além disso, uma análise de regressão múltipla foi realizada para predizer os fatores que interferem no LFS. Por fim, o teste ANOVA buscou diferenças entre os níveis de LFS dos usuários nas USF analisadas. Resultados: Foram incluídos no estudo 400 participantes, dos quais 59% apresentaram LFS adequado, 16,5% limítrofe e 24,5% inadequado. As variáveis, grau de escolaridade, idade e renda foram associadas ao LFS na população estudada, predizendo, respectivamente, em 46, 26 e 17% o desempenho no teste S-TOFHLA. Baixa escolaridade e baixa renda aumentam o risco de indivíduos possuírem LFS insatisfatório em cinco e quatro vezes, nessa ordem. Por fim, foram encontradas diferenças entre os níveis de LFS dos usuários das USF analisadas. Conclusões: A população da área urbana de Altamira apresentou alta prevalência de LFS insatisfatório. Sendo assim, no intuito de aumentar os resultados satisfatórios em saúde, os profissionais da região devem adequar as suas formas de comunicação e linguagem às necessidades dos usuários das USF, observando que a adequação da equipe pode trazer melhorias para o entendimento das informações e oportunizar melhores condições de recuperação e autocuidado em saúde.
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15
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Barakat M, A. AlSalamat H, Jirjees F, Al-Obaidi H, k. Hussain Z, El Hadidi S, Mansour S, Malaeb D, Hosseini H. Factors Associated with Knowledge and Awareness of Stroke Among the Jordanian Population: A Cross-Sectional Study. F1000Res 2021; 10:1242. [PMID: 34987775 PMCID: PMC8672222 DOI: 10.12688/f1000research.74492.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 01/01/2023] Open
Abstract
Background and objective: Stroke is the second leading cause of death in Jordan and over the world. Knowledge and awareness towards stroke play a crucial role in the management and prevention of its complications. This study aims to assess the knowledge and awareness about stroke among the Jordanian population and determine factors associated with stroke awareness. Methods: This cross-sectional study through a web-based anonymous questionnaire that needed 10 minutes to be completed. It examined sociodemographic characteristics and recognition of the risk factors, warning signs, stroke consequences, and early response to stroke symptoms. Logistic regression analysis identified the factors associated with poor knowledge of stroke. Results: A total of 573 Jordanian adults participated in this study. The participant's ability to identify at least one early symptom of stroke and the proper response to the symptoms were significantly correlated with the educational level (OR of 3.4 and 2.5, respectively). At least one consequence of stroke was significantly associated with different demographic factors such as gender, socioeconomic income, females versus males and those with medium income versus low income had significantly higher odds (OR of 6.6 and 4.1, respectively). Conclusion: This study revealed a good knowledge and awareness level about stroke among Jordanians correlated mainly with their educational level. Therefore, new strategies should be considered to decrease the prevalence of stroke in Jordan, including the need for engagement in enhanced awareness campaigns.
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Affiliation(s)
- Muna Barakat
- Department of Clinical Pharmacy and therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, 11931, Jordan
| | - Husam A. AlSalamat
- Department of Basic Medical Sciences, Faculty of Medicine, Al-Balqa Applied University, Al-Salt, 19117, Jordan
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, University of Jordan, Amman, 11942, Jordan
| | - Feras Jirjees
- College of Pharmacy, University of Sharjah, Sharjah, 27272, United Arab Emirates
| | - Hala Al-Obaidi
- College of pharmacy, Ajman University, Ajman, United Arab Emirates
| | - Zainab k. Hussain
- Department of Biology, College of Science, University of Baghdad, Baghdad, Iraq
| | - Seif El Hadidi
- Faculty of Pharmaceutical Sciences and Pharmaceutical Industries, Future University in Egypt, Cairo, Egypt
| | - Sara Mansour
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Diana Malaeb
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Hassan Hosseini
- Life Sciences and Health Department, Paris-Est University, Paris, France
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16
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Barakat M, A. AlSalamat H, Jirjees F, Al-Obaidi H, k. Hussain Z, El Hadidi S, Mansour S, Malaeb D, Hosseini H. Factors Associated with Knowledge and Awareness of Stroke Among the Jordanian Population: A Cross-Sectional Study. F1000Res 2021; 10:1242. [PMID: 34987775 PMCID: PMC8672222 DOI: 10.12688/f1000research.74492.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 10/20/2023] Open
Abstract
Background and objective: Stroke is the second leading cause of death in Jordan and over the world. Knowledge and awareness towards stroke play a crucial role in the management and prevention of its complications. This study aims to assess the knowledge and awareness about stroke among the Jordanian population and determine factors associated with stroke awareness. Methods: This cross-sectional study through a web-based anonymous questionnaire that needed 10 minutes to be completed. It examined sociodemographic characteristics and recognition of the risk factors, warning signs, stroke consequences, and early response to stroke symptoms. Logistic regression analysis identified the factors associated with poor knowledge of stroke. Results: A total of 573 Jordanian adults participated in this study. The participant's ability to identify at least one early symptom of stroke and the proper response to the symptoms were significantly correlated with the educational level (OR of 3.4 and 2.5, respectively). At least one consequence of stroke was significantly associated with different demographic factors such as gender, socioeconomic income, females versus males and those with medium income versus low income had significantly higher odds (OR of 6.6 and 4.1, respectively). Conclusion: This study revealed a good knowledge and awareness level about stroke among Jordanians correlated mainly with their educational level. Therefore, new strategies should be considered to decrease the prevalence of stroke in Jordan, including the need for engagement in enhanced awareness campaigns.
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Affiliation(s)
- Muna Barakat
- Department of Clinical Pharmacy and therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, 11931, Jordan
| | - Husam A. AlSalamat
- Department of Basic Medical Sciences, Faculty of Medicine, Al-Balqa Applied University, Al-Salt, 19117, Jordan
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, University of Jordan, Amman, 11942, Jordan
| | - Feras Jirjees
- College of Pharmacy, University of Sharjah, Sharjah, 27272, United Arab Emirates
| | - Hala Al-Obaidi
- College of pharmacy, Ajman University, Ajman, United Arab Emirates
| | - Zainab k. Hussain
- Department of Biology, College of Science, University of Baghdad, Baghdad, Iraq
| | - Seif El Hadidi
- Faculty of Pharmaceutical Sciences and Pharmaceutical Industries, Future University in Egypt, Cairo, Egypt
| | - Sara Mansour
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Diana Malaeb
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Hassan Hosseini
- Life Sciences and Health Department, Paris-Est University, Paris, France
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17
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Hicks A. The missing link: Towards an integrated health and information literacy research agenda. Soc Sci Med 2021; 292:114592. [PMID: 34839085 DOI: 10.1016/j.socscimed.2021.114592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/24/2021] [Accepted: 11/18/2021] [Indexed: 11/18/2022]
Abstract
Information forms one of the main commonalities shared between definitions of health literacy. However, information literacy research, which centres how people become informed within a specific setting, has been almost completely sidelined from health literacy scholarship. This oversight risks limiting understanding of how health literacy is practised as well as narrowing research discourses. It also forms a missed opportunity as the recent sociocultural turn creates a valuable point of synergy between each field. This paper carries out a narrative literature review to identify key areas where information literacy research could help to extend understanding about how people interact with information within health contexts. Centred on exploring theoretical and empirical work, the paper uses examples from literature to suggest that assumptions related to how information, models of information use, social dynamics of information environments, the outcomes of information activity and critical approaches to information practice are understood impact the scope and the reach of health literacy research and practice. The goal of this paper is to establish an initial, shared research agenda that places health and information literacy in dialogue rather than in isolation from each other.
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Affiliation(s)
- Alison Hicks
- Department of Information Studies, University College, London (UCL), Foster Court, Gower Street, London, WC1E 6BT, UK.
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Abstract
PURPOSE OF REVIEW To provide an overview of the recent research publications on educational needs of patients with psoriatic arthritis (PsA) and the associated challenges. RECENT FINDINGS The rate of good treatment adherence in PsA can be as low as 57.7% and successful patient education can help improve treatment adherence. Also, 78.7% of patients who stopped their disease modifying anti-rheumatic drugs during the first wave of the COVID-19 pandemic did so without the advice of their clinician. In delivering educational needs, the aspects of disease process, treatment, self-help measures, managing pain, movement, psychological and social needs should all be addressed, whilst at the same time, recognising that PsA patients with multidomain disease, are likely to be dealing with more than just pain. Arthritis self-care management education is potentially beneficial, but up to 11% of educational YouTube videos may contain misleading patient opinion and many existing apps do not meet the needs of the patients with PsA. SUMMARY Significant room for improvement exists in treatment adherence in PsA and patient education addressing the relevant educational needs could assist with this issue. However, patients should be advised to be wary of internet videos and other educational aids that were not created by health professionals.
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Affiliation(s)
- Adewale O Adebajo
- Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield
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Glinert LH. Communicative and Discursive Perspectives on the Medication Experience. PHARMACY 2021; 9:pharmacy9010042. [PMID: 33671135 PMCID: PMC8006053 DOI: 10.3390/pharmacy9010042] [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: 12/01/2020] [Revised: 02/01/2021] [Accepted: 02/11/2021] [Indexed: 11/29/2022] Open
Abstract
Taking the ‘medication experience’ in the broad sense of what individuals hear and say about their medication, as well as how they experience it, this paper explores diverse research on medication information available to patients and their modes and capacities for interaction, including personal circles, doctors and pharmacists, labeling and promotion, websites, and the patient’s own inner conversations and self-expression. The goal is to illustrate, for nonspecialists in communication, how the actors, messages, mediums, genres, and contextual factors within a standard ethnographic and social semiotic model of discourse and communication are operating, not always effectively or beneficially, to mediate or construct a patient’s medication experience. We also suggest how disparate insights can be integrated through such a model and might generate new research questions.
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Affiliation(s)
- Lewis H Glinert
- Middle Eastern Studies and Linguistics, Dartmouth College, NH 03755, USA
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20
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Kostareva U, Albright CL, Berens EM, Levin-Zamir D, Aringazina A, Lopatina M, Ivanov LL, Sentell TL. International Perspective on Health Literacy and Health Equity: Factors That Influence the Former Soviet Union Immigrants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2155. [PMID: 32213891 PMCID: PMC7142703 DOI: 10.3390/ijerph17062155] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/07/2020] [Accepted: 03/16/2020] [Indexed: 12/19/2022]
Abstract
Among the world's 272 million international migrants, more than 25 million are from the former Soviet Union (FSU), yet there is a paucity of literature available about FSU immigrants' health literacy. Besides linguistic and cultural differences, FSU immigrants often come from a distinct healthcare system affecting their ability to find, evaluate, process, and use health information in the host countries. In this scoping review and commentary, we describe the health literacy issues of FSU immigrants and provide an overview of FSU immigrants' health literacy based on the integrated health literacy model. We purposefully consider the three most common locations where FSU immigrants have settled: the USA, Germany, and Israel. For context, we describe the healthcare systems of the three host countries and the two post-Soviet countries to illustrate the contribution of system-level factors on FSU immigrants' health literacy. We identify research gaps and set a future research agenda to help understand FSU immigrants' health literacy across countries. Amidst the ongoing global population changes related to international migration, this article contributes to a broad-scope understanding of health literacy among FSU immigrants related to the system-level factors that may also apply to other immigrants, migrants, and refugees.
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Affiliation(s)
- Uliana Kostareva
- School of Nursing and Dental Hygiene, University of Hawai’i at Mānoa, Honolulu, HI 96822, USA;
| | - Cheryl L. Albright
- School of Nursing and Dental Hygiene, University of Hawai’i at Mānoa, Honolulu, HI 96822, USA;
| | - Eva-Maria Berens
- Interdisciplinary Center for Health Literacy Research, Bielefeld University, 33699 Bielefeld, Germany;
| | - Diane Levin-Zamir
- Department of Health Education and Promotion, Clalit Health Services, School of Public Health, University of Haifa, Haifa 31000, Israel;
| | - Altyn Aringazina
- Kazakhstan School of Public Health, Medical University, Almaty 050000, Kazakhstan;
| | - Maria Lopatina
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of the Russian Federation, 101000 Moscow, Russia;
| | - Luba L. Ivanov
- Chamberlain College of Nursing, Chamberlain University, Downers Grove, 60515 IL, USA;
| | - Tetine L. Sentell
- Office of Public Health Studies, University of Hawai’i at Mānoa, Honolulu, HI 96822, USA;
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