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Gimeno A, Krause K, D’Souza S, Walsh CG. Completeness and readability of GPT-4-generated multilingual discharge instructions in the pediatric emergency department. JAMIA Open 2024; 7:ooae050. [PMID: 38957592 PMCID: PMC11216721 DOI: 10.1093/jamiaopen/ooae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 05/16/2024] [Accepted: 05/28/2024] [Indexed: 07/04/2024] Open
Abstract
Objectives The aim of this study was to assess the completeness and readability of generative pre-trained transformer-4 (GPT-4)-generated discharge instructions at prespecified reading levels for common pediatric emergency room complaints. Materials and Methods The outputs for 6 discharge scenarios stratified by reading level (fifth or eighth grade) and language (English, Spanish) were generated fivefold using GPT-4. Specifically, 120 discharge instructions were produced and analyzed (6 scenarios: 60 in English, 60 in Spanish; 60 at a fifth-grade reading level, 60 at an eighth-grade reading level) and compared for completeness and readability (between language, between reading level, and stratified by group and reading level). Completeness was defined as the proportion of literature-derived key points included in discharge instructions. Readability was quantified using Flesch-Kincaid (English) and Fernandez-Huerta (Spanish) readability scores. Results English-language GPT-generated discharge instructions contained a significantly higher proportion of must-include discharge instructions than those in Spanish (English: mean (standard error of the mean) = 62% (3%), Spanish: 53% (3%), P = .02). In the fifth-grade and eighth-grade level conditions, there was no significant difference between English and Spanish outputs in completeness. Readability did not differ across languages. Discussion GPT-4 produced readable discharge instructions in English and Spanish while modulating document reading level. Discharge instructions in English tended to have higher completeness than those in Spanish. Conclusion Future research in prompt engineering and GPT-4 performance, both generally and in multiple languages, is needed to reduce potential for health disparities by language and reading level.
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Affiliation(s)
- Alex Gimeno
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN 37232, United States
| | - Kevin Krause
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Starina D’Souza
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN 37232, United States
| | - Colin G Walsh
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN 37232, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN 37203, United States
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Dijkman EM, ter Brake WWM, Drossaert CHC, Doggen CJM. Assessment Tools for Measuring Health Literacy and Digital Health Literacy in a Hospital Setting: A Scoping Review. Healthcare (Basel) 2023; 12:11. [PMID: 38200917 PMCID: PMC10778720 DOI: 10.3390/healthcare12010011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
Assessment of (digital) health literacy in the hospital can raise staff awareness and facilitate tailored communication, leading to improved health outcomes. Assessment tools should ideally address multiple domains of health literacy, fit to the complex hospital context and have a short administration time, to enable routine assessment. This review aims to create an overview of tools for measuring (digital) health literacy in hospitals. A search in Scopus, PubMed, WoS and CINAHL, following PRISMA guidelines, generated 7252 hits; 251 studies were included in which 44 assessment tools were used. Most tools (57%) were self-reported and 27% reported an administration time of <5 min. Almost all tools addressed the domain 'understanding' (98%), followed by 'access' (52%), 'apply' (50%), 'appraise' (32%), 'numeracy' (18%), and 'digital' (18%). Only four tools were frequently used: the Newest Vital Sign (NVS), the Short Test of Functional Health Literacy for Adults ((S)TOFHLA), the Brief Health Literacy Screener (BHLS), and the Health Literacy Questionnaire (HLQ). While the NVS and BHLS have a low administration time, they cover only two domains. HLQ covers the most domains: access, understanding, appraise, and apply. None of these four most frequently used tools measured digital skills. This review can guide health professionals in choosing an instrument that is feasible in their daily practice, and measures the required domains.
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Affiliation(s)
- Eline M. Dijkman
- Department of Health Technology and Services Research (HTSR), Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (E.M.D.)
- Department of Surgery, Isala Hospital, 8025 AB Zwolle, The Netherlands
| | - Wouter W. M. ter Brake
- Department of Health Technology and Services Research (HTSR), Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (E.M.D.)
| | | | - Carine J. M. Doggen
- Department of Health Technology and Services Research (HTSR), Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (E.M.D.)
- Clinical Research Center, Rijnstate Hospital, 6815 AD Arnhem, The Netherlands
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Nwanaji-Enwerem JC, Smith-Wilkerson M, Gordon B, Okpere H, Jones T, Gizaw R, Husain I. Universal Precautions Plus: Physician-Directed Strategies for Improving Patient Health Literacy in the Emergency Department. West J Emerg Med 2023; 24:110-113. [PMID: 36602487 PMCID: PMC9897242 DOI: 10.5811/westjem.2022.10.57697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/07/2022] [Indexed: 01/06/2023] Open
Abstract
Working on the frontlines with safety-net populations, emergency physicians are uniquely positioned to take on a greater role in addressing the current health literacy crisis and specific barriers that may exist. Here, we review the concept of universal health literacy precautions and explore the application of these universal precautions in conjunction with other patient-centered strategies. More specifically, to improve patient understanding and outcomes, emergency physicians can pair universal health literacy precautions with strategies including multiple learning techniques, dual-code theory, empowerment counseling, family buy-in, and hands-on practice. We provide two examples of emergency department encounters where this combined approach was used differently yet successfully and efficiently. Ultimately, we aim to highlight the value of emergency physicians being equipped with basic skills in health literacy educational strategies.
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Affiliation(s)
- Jamaji C. Nwanaji-Enwerem
- Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia,Emory Rollins School of Public Health, Gangarosa Department of Environmental Health, Atlanta, Georgia
| | | | - Brittney Gordon
- Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia
| | - Helene Okpere
- Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia
| | - Terrell Jones
- Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia
| | - Rahel Gizaw
- Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia
| | - Irfan Husain
- Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia
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Improving Communication with Patients Discharged from the Emergency Department with Noncardiac Chest Pain: A Scoping Review with Narrative Synthesis. Emerg Med Int 2021; 2021:6695210. [PMID: 34513092 PMCID: PMC8426084 DOI: 10.1155/2021/6695210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 01/05/2023] Open
Abstract
Background This scoping review with narrative synthesis aimed to analyze scholarly peer-reviewed articles reporting on improving communication with patients discharged from the emergency department with noncardiac chest pain and qualitatively narrate on and summarize items that can be used in guiding communication with patients discharged from the emergency department with noncardiac chest pain. Methods The databases of EMBASE/PubMed, Scopus, COCHRANE, CInAHL/EBESCO, UW libraries, and Google Scholar were searched using relevant MeSH and key terms up to February 06, 2020. The selected articles were analyzed for their contents. Items guiding discharge communication were summarized qualitatively. Results Twenty-five articles were eligible for full review. These were published in between 1994 and 2020. Of those, 16 (64.0%) originated from the United States and 4 (16%) used some interventional design. A total of 45 different items that could be used in guiding discharge communication with patients presenting to the emergency department with chest pain were identified from the studies included in this review. Items were grouped under 6 categories that were related to initial assessment (8 items), information on diagnosis (7 items), information on discharge (9 items), follow-up suggestions (7 items), symptoms that promote return to the emergency department (7 items), and treatment plan (7 items). Conclusion Communication with patients discharged from the emergency department with noncardiac chest pain can be improved. Results of this investigation might be helpful in guiding quality improvement projects aimed for further improvement of communication with patients discharged from the emergency department with noncardiac chest pain.
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Kanu C, Brown CM, Rascati K, Moczygemba LR, Mackert M, Wilfong L. Are Health Literacy and Patient Activation Related to Health Outcomes in Breast Cancer Patients? Health Lit Res Pract 2021; 5:e171-e178. [PMID: 34260317 PMCID: PMC8279019 DOI: 10.3928/24748307-20210524-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Assessing health literacy and patient activation at the beginning of care could facilitate the provision of appropriate information to patients with breast cancer and increase the effectiveness of interventions geared toward improving patient involvement in self-managing their health and, consequently, their quality of life. Objective: The aim of this study was to evaluate cancer health literacy and patient activation in patients with breast cancer as well as examine their relationships to health-related quality of life (HRQoL) and resource use. Methods: Patients with breast cancer positive for human epidermal growth factor receptor 2 (HER2+) receiving care at 12 oncology clinics in Texas were offered participation in the study via convenience sampling. The survey consisted of the 6-item Cancer Health Literacy Tool, the 13-item Patient Activation Measure, the 27-item Functional Assessment of Cancer Therapy – General (version 4), and single-item measures for number of emergency department visits and hospitalizations as well as clinical and demographic characteristics. Key Results: The mean age of the 146 study participants was 57.1 ± 10.8 years; 92% (n = 134) had a high probability (≥0.7) of adequate cancer health literacy whereas 68% percent (n = 99) had high patient activation (level 3 or 4). Cancer health literacy had significant positive relationships with education and household income. Patient activation, education, and number of treatment types received explained 23% of the variation in HRQoL, and all except cancer health literacy were positive and significant predictors. No bivariate/multivariate analysis was conducted for emergency department visits and hospitalizations because there were few reported incidents. Conclusions: Interventions that aim to improve HRQoL in patients with breast cancer could target modifiable factors like patient activation. The homogeneity of cancer health literacy among study participants might have influenced its nonsignificant relationship with HRQoL and patient activation. Further assessments of health literacy and patient activation in larger and more diverse populations of patients with breast cancer are warranted. [HLRP: Health Literacy Research and Practice. 2021;5(3):e171–e178.] Plain Language Summary: In this study, the majority of patients with breast cancer were found to have high levels of cancer health literacy, patient activation, and health-related quality of life (HRQoL). The significant relationship between patient activation and HRQoL implies that patients with breast cancer who are able to actively participate in managing their health and health care are more likely to have higher HRQoL. Interventions that aim to improve HRQoL in patients with breast cancer could target modifiable factors like patient activation.
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Affiliation(s)
- Chisom Kanu
- Address correspondence to Chisom Kanu, PhD, 1724 Pattenson Trail, Haslet, TX 76052;
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6
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Huang LY, Lin YP, Glass GF, Chan EY. Health literacy and patient activation among adults with chronic diseases in Singapore: A cross-sectional study. Nurs Open 2021; 8:2857-2865. [PMID: 33942559 PMCID: PMC8363362 DOI: 10.1002/nop2.873] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 01/08/2021] [Accepted: 02/15/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS Increased patient activation levels can improve health outcomes. Hence, this study aims to examine the relationships between sociodemographic variables and domain-specific health literacies with patient activation. DESIGN A cross-sectional design. METHODS 200 outpatient adults with chronic diseases completed a survey that assessed their domain-specific health literacy and patient activation levels. Univariate and multivariate analysis of the variables were conducted on patient activation with 95% confidence interval (CI). RESULTS Multiple linear regression analyses observed a positive linear relationship between the following domain-specific health literacy variables-"actively manage my health" (p < .0001, 95% CI: 0.89-2.29), "understanding health information" (p = .008, 95% CI: 0.28-1.85), and "finding good health information" (p = .02, 95% CI 0.13-1.51) with patient activation. The other sociodemographic and clinical variables were not statistically significant. Increased focus from healthcare professionals is needed on helping patients better find and understand health information and encouraging them to actively manage their health; elements which would raise their activation levels.
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Affiliation(s)
- Laura Yuqi Huang
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Yongxing Patrick Lin
- Nursing Research Unit, Nursing Service, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Ee-Yuee Chan
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore.,Nursing Research Unit, Nursing Service, Tan Tock Seng Hospital, Singapore, Singapore
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7
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González-De Paz L, Gálvez-Henández P, Navarro-Rubio MD. Development and psychometric study of a simple instrument to assess patient communication and comprehension skills: the AsCkS. Fam Pract 2020; 37:568-573. [PMID: 31796958 DOI: 10.1093/fampra/cmz087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Instruments to examine patients' communication skills are impractical for daily clinical practice in primary health care, and it is assumed that health care professionals are always aware of the communication and comprehension status of patients. OBJECTIVE To design and examine the psychometric properties of a new questionnaire (AsCkS) to screen patients' risk of low communication and comprehension skills. METHODS Designing the new questionnaire involved: (i) a content validity study to generate a set of items, (ii) administration of a questionnaire in a sample of patients and (iii) study of the psychometric properties using a Rasch probabilistic model. The test probability function was used to detect patients at risk of having low communication and comprehension skills, and the associated factors were studied using multivariate logistic regression. RESULTS Five items were generated and 369 patients screened. In the Rasch analysis, one item was removed due to a lack of goodness-of-fit (Outfit = 3.64). The final set of four items showed good reliability (person separation index = 0.90). Convergent validity was moderate for the health literacy construct (r = 0.53) and low for the patient activation (r = 0.38): 77 patients (20.86%) were at risk of having low communication and comprehension skills. After adjustment, the associated factors were age (p < 0.001) and lower educational level (p < 0.001). CONCLUSION The AsCkS is a reliable and valid instrument and may be used to detect patients requiring a greater effort by the physician to communicate health care messages.
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Affiliation(s)
- Luis González-De Paz
- Transverse Group for Research in Primary Care, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,Les Corts Primary Healthcare Center, Consorci d'Atenció Primària de Salut Barcelona Esquerra, Barcelona, Spain.,University Institute for Patient Care, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Pablo Gálvez-Henández
- University Institute for Patient Care, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
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8
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Bahrom NH, Ramli AS, Isa MR, Abdul-Hamid H, Badlishah-Sham SF, Baharudin N, Mohamed-Yassin MS. Factors Associated with High Patient Activation Level among Individuals with Metabolic Syndrome at a Primary Care Teaching Clinic. J Prim Care Community Health 2020; 11:2150132720931301. [PMID: 32507012 PMCID: PMC7278304 DOI: 10.1177/2150132720931301] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: High activation level has been associated with higher education background, better self-rated health status, and having adequate health literacy. However, there is a gap in the literature regarding the level of activation and the factors associated with it among patients with metabolic syndrome (MetS) in the Malaysian primary care setting. Objectives: This study aims to determine activation levels and the factors associated with high activation among individuals with MetS in primary care. Methods: A cross-sectional study was conducted at a university primary care clinic. Patient activation was measured using the Patient Activation Measure®-13 Malay version. Activation levels were dichotomized into "low activation" (levels 1 and 2) and "high activation" (levels 3 and 4). To determine the factors associated with high activation, simple logistic regressions (SLogR) followed by multiple logistic regressions (MLogR) were performed. Results: Of 333 participants, 280 (84.1%) were included in the final analysis. The mean activation score was 59.4 (SD ±10.20) and 61.8% had high activation level. Two variables were found to be significant on MLogR. Those who were employed have the odds of 3.135 (95% CI 1.442-6.816) of having high activation compared with those who were unemployed. Those with good self-reported health status have the odds of 6.482 (95% CI 1.243-33.792) of having high activation compared to those with poor self-reported health status. Conclusions: The majority of participants had high activation levels. Those who were employed and those who had good self-reported health status were more likely to have high activation levels. Findings of this study could be used to develop patient activation interventions to improve self-management skills among individuals with MetS in primary care. These may include problem solving support, individualized care plans, peer or family support, and skill building. Those in high activation group can be trained to become mentors to support their peers who have low activation level.
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9
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Kim HS, Courtney DM, McCarthy DM, Cella D. Patient-reported Outcome Measures in Emergency Care Research: A Primer for Researchers, Peer Reviewers, and Readers. Acad Emerg Med 2020; 27:403-418. [PMID: 31945245 DOI: 10.1111/acem.13918] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/04/2020] [Accepted: 01/06/2020] [Indexed: 01/07/2023]
Abstract
Patient-reported outcomes (PROs) are of increasing importance in clinical research because they capture patients' experience with well-being, illness, and their interactions with health care. Because PROs tend to focus on specific symptoms (e.g., pain, anxiety) or general assessments of patient functioning and quality of life that offer unique advantages compared to traditional clinical outcomes (e.g., mortality, emergency department revisits), emergency care researchers may benefit from incorporation of PRO measures into their research design as a primary or secondary outcome. Patients may also benefit from the ability of PROs to inform clinical practice and facilitate patient decision making, as PROs are obtained directly from the lived experience of other patients with similar conditions or health status. This review article introduces and defines key terminology relating to PROs, discusses reasons for utilizing PROs in clinical research, outlines basic psychometric and practical assessments that can be used to select a specific PRO measure, and highlights examples of commonly utilized PRO measures in emergency care research.
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Affiliation(s)
- Howard S. Kim
- Department of Emergency Medicine Northwestern University Feinberg School of Medicine Chicago IL
- Center for Health Services & Outcomes Research Northwestern University Feinberg School of Medicine Chicago IL
| | - D. Mark Courtney
- Department of Emergency Medicine University of Texas Southwestern Medical School Dallas TX
| | - Danielle M. McCarthy
- Department of Emergency Medicine Northwestern University Feinberg School of Medicine Chicago IL
- Center for Health Services & Outcomes Research Northwestern University Feinberg School of Medicine Chicago IL
| | - David Cella
- Department of Medical Social Sciences Northwestern University Feinberg School of Medicine Chicago IL
- Center for Patient‐Centered Outcomes Northwestern University Feinberg School of Medicine Chicago IL
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10
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Merchant RC, Marks SJ, Clark MA, Carey MP, Liu T. Limited Ability of Three Health Literacy Screening Items to Identify Adult English- and Spanish-Speaking Emergency Department Patients With Lower Health Literacy. Ann Emerg Med 2020; 75:691-703. [PMID: 32200999 DOI: 10.1016/j.annemergmed.2020.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 01/11/2020] [Accepted: 01/15/2020] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE Brief, easily administered, and valid health literacy assessment tools are needed to optimize health care delivery in the emergency medicine setting. Three health literacy screening items have been proposed to assess health literacy in outpatient settings. We investigated their ability to identify English- and Spanish-speaking adult emergency department (ED) patients with lower health literacy. METHODS Participants were Spanish- or English-speaking adult patients randomly selected from 4 geographically spread, US, urban, safety-net EDs. Participants completed the 3 health literacy screening items, as well as the Short Assessment of Health Literacy-Spanish and English (SAHL-S&E). Test performance characteristics, including receiver operating characteristics area under the curve, of the 3 health literacy screening items were estimated, as compared with the SAHL-S&E. RESULTS According to the SAHL-S&E, 36% of the 1,165 English speakers and 35% of the 1,605 Spanish speakers had lower health literacy. Areas under the curve for each health literacy screening item individually were: needing others to help read materials (English 0.59, 95% confidence interval [CI] 0.56 to 0.62; Spanish 0.58, 95% CI 0.56 to 0.61), problems learning because of difficulty reading (English 0.63, 95% CI 0.60 to 0.66; Spanish 0.59, 95% CI 0.56 to 0.62), and confidence with completing forms (English 0.62, 95% CI 0.59 to 0.65; Spanish 0.60, 95% CI 0.57 to 0.63). Areas under the curve for the 3 screening items combined were: English 0.66 (95% CI 0.63 to 0.70) and Spanish 0.62 (95% CI 0.59 to 0.64). CONCLUSION The 3 health literacy screening items performed poorly in identifying adult ED patients with lower health literacy. Higher-validity screening measures are needed to better serve the health care needs of this vulnerable population in the ED setting.
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Affiliation(s)
- Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Sarah J Marks
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Melissa A Clark
- Department of Health Services Policy and Practice, School of Public Health, Brown University, Providence, RI; Department of Obstetrics and Gynecology, Alpert Medical School, Brown University, Providence, RI
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI
| | - Tao Liu
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, RI
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Ho MH, Wang CH, Joo JY, Chang HC(R, Chang CC, Liu MF. Predictors of Emergency Department Use Among Community-Dwelling Older Adults. J Gerontol Nurs 2019; 45:31-38. [DOI: 10.3928/00989134-20190404-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 03/19/2019] [Indexed: 11/20/2022]
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David D, Barnes DE, McMahan RD, Shi Y, Katen MT, Sudore RL. Patient Activation: A Key Component of Successful Advance Care Planning. J Palliat Med 2018; 21:1778-1782. [PMID: 30129808 DOI: 10.1089/jpm.2018.0096] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Patient activation-or knowledge, confidence, and skill managing overall health-is associated with improved health behaviors such as exercise; it is unknown whether it is associated with advance care planning (ACP). Objective: To determine whether patient activation is associated with ACP. Design: This is a cross-sectional study. Setting/Subjects: A total of 414 veterans (≥60 years) with serious and chronic illness enrolled in an ACP trial. Measures: Patient characteristics and self-report surveys included the validated 13-item patient activation measure (PAM, five-point Likert) (e.g., "Taking an active role in your own healthcare is the most important factor…") categorized into four levels (e.g., Level 1: "disengaged and overwhelmed" to Level 4: "maintaining behaviors"). ACP was measured with the ACP Engagement Survey including 57-item process scores (i.e., knowledge, contemplation, self-efficacy, readiness, 5-point Likert scale) and 25-item action scores (i.e., surrogate designation, yes/no items). Associations were determined with linear regression. Results: Participants were 71.1 ± 7.8 years of age, 43% were non-white, 9% were women, and 20% had limited health literacy. Higher PAM levels were associated with higher finances, having adult children, lower comorbidity, and more social support (p < 0.05). After adjusting for these characteristics, higher PAM (Level 4 vs. Level 1) was associated with higher ACP engagement (ACP process scores, 2.8 ± 0.7 vs. 3.8 ± 0.7 and action scores 9.7 ± 4.4 vs. 15.1 ± 6.0, p < 0.001). Conclusions: Higher patient activation to manage one's overall healthcare is associated with higher engagement in ACP. Interventions designed to foster general patient activation and self-efficacy to engage in health behaviors and disease management may also improve engagement in the ACP process.
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Affiliation(s)
- Daniel David
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California
- Department of Medicine, Division of Geriatrics and Palliative Care, University of California, San Francisco, San Francisco, California
- Veterans Affairs Medical Center, San Francisco, California
| | - Deborah E Barnes
- Veterans Affairs Medical Center, San Francisco, California
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | | | - Ying Shi
- Department of Medicine, Division of Geriatrics and Palliative Care, University of California, San Francisco, San Francisco, California
- Veterans Affairs Medical Center, San Francisco, California
| | - Mary T Katen
- Department of Medicine, Division of Geriatrics and Palliative Care, University of California, San Francisco, San Francisco, California
- Veterans Affairs Medical Center, San Francisco, California
| | - Rebecca L Sudore
- Department of Medicine, Division of Geriatrics and Palliative Care, University of California, San Francisco, San Francisco, California
- Veterans Affairs Medical Center, San Francisco, California
- UCSF School of Medicine, San Francisco, California
- Innovation and Implementation Center in Aging and Palliative Care, University of California, San Francisco, San Francisco, California
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Bastas-Bratkic D, Weismuller PC, Brady M. Assessing Clinicians' Endorsement of Patient Activation in Health Management. J Nurse Pract 2018. [DOI: 10.1016/j.nurpra.2018.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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14
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Couture ÉM, Chouinard MC, Fortin M, Hudon C. The relationship between health literacy and patient activation among frequent users of healthcare services: a cross-sectional study. BMC FAMILY PRACTICE 2018; 19:38. [PMID: 29523095 PMCID: PMC5845227 DOI: 10.1186/s12875-018-0724-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/01/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Frequent users of healthcare services are a vulnerable population that deserves attention due to high costs and negative outcomes such as lower quality of life and higher mortality. Healthcare systems should offer interventions tailored to their needs and to their level of health literacy, including strategies to promote activation. The relationship between health literacy and patient activation remains to be explored. The aim of this study was to examine the association between health literacy and patient activation in a population of frequent users of healthcare services with chronic diseases. METHODS Cross-sectional data were collected (before randomization) through a clinical trial evaluating a case management intervention in primary care. Participants (n = 247) were recruited from the list of frequent users of 4 Family Medicine Groups (FMG) in the Saguenay-Lac-St-Jean region of Québec (Canada). They completed questionnaires by self-report during an encounter with a research assistant: (1) the Newest Vital Sign (NVS) to evaluate health literacy (independent variable); and (2) the Patient Activation Measure-13 (PAM-13) to evaluate patient activation (dependent variable). The relationship between health literacy and activation was examined using biserial correlations. RESULTS No association was found between health literacy (independent variable) and patient activation (rb = 0.075, ρ = 0.07) for this population of frequent users of healthcare services. CONCLUSIONS This study suggests that there is no relationship between health literacy and patient activation among frequent users of healthcare services. TRIAL REGISTRATION NCT01719991 . Registered October 25, 2012.
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Affiliation(s)
- Éva Marjorie Couture
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Québec J1H 5N4 Canada
| | - Maud-Christine Chouinard
- Département des sciences de la santé, Université du Québec à Chicoutimi, 555, boulevard de l’Université, Saguenay, Québec G7H 2B1 Canada
| | - Martin Fortin
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Québec J1H 5N4 Canada
| | - Catherine Hudon
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Québec J1H 5N4 Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Québec J1H 5N4 Canada
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15
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Wolf MS, Smith SG, Pandit AU, Condon DM, Curtis LM, Griffith J, O'Conor R, Rush S, Bailey SC, Kaplan G, Haufle V, Martin D. Development and Validation of the Consumer Health Activation Index. Med Decis Making 2018; 38:334-343. [PMID: 29436308 DOI: 10.1177/0272989x17753392] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although there has been increasing interest in patient engagement, few measures are publicly available and suitable for patients with limited health literacy. OBJECTIVE We sought to develop a Consumer Health Activation Index (CHAI) for use among diverse patients. METHODS Expert opinion, a systematic literature review, focus groups, and cognitive interviews with patients were used to create and revise a potential set of items. Psychometric testing guided by item response theory was then conducted among 301 English-speaking, community-dwelling adults. This included differential item functioning analyses to evaluate item performance across participant health literacy levels. To determine construct validity, CHAI scores were compared to scales measuring similar personality constructs. Associations between the CHAI and physical and mental health established predictive validity. A second study among 9,478 adults was used to confirm CHAI associations with health outcomes. RESULTS Exploratory factor analyses revealed a single-factor solution with a 10-item scale. The CHAI showed good internal consistency (alpha = 0.81) and moderate test-retest reliability (ICC = 0.53). Reading grade level was found to be at the 6th grade. Moderate to strong correlations were found with similar constructs (Multidimensional Health Locus of Control, r = 0.38, P < 0.001; Conscientiousness, r = 0.41, P < 0.001). Predictive validity was demonstrated through associations with functional health status measures (depression, r = -0.28, P < 0.001; anxiety, r = -0.22, P < 0.001; and physical functioning, r = 0.22, P < 0.001). In the validation sample, the CHAI was significantly associated with self-reported physical and mental health ( r = 0.31 and 0.32 respectively; both P < 0.001). CONCLUSIONS The CHAI appears to be a valid, reliable, and easily administered tool that can be used to assess health activation among adults, including those with limited health literacy. Future studies should test the tool in actual use and explore further applications.
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Affiliation(s)
- Michael S Wolf
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA.,Department of Learning Sciences, School of Education and Social Policy, Northwestern University, Evanston, IL, USA
| | - Samuel G Smith
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA.,Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, UK
| | - Anjali U Pandit
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - David M Condon
- Department of Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Laura M Curtis
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - James Griffith
- Department of Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Rachel O'Conor
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Steven Rush
- UnitedHealthcare and UnitedHealth Group, Minneapolis, MN, USA
| | - Stacy C Bailey
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, USA
| | - Gordon Kaplan
- Optum, Consumer Solutions Group, Minneapolis, MN, USA
| | | | - David Martin
- UnitedHealthcare and UnitedHealth Group, Minneapolis, MN, USA
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Salgado TM, Mackler E, Severson JA, Lindsay J, Batra P, Petersen L, Farris KB. The relationship between patient activation, confidence to self-manage side effects, and adherence to oral oncolytics: a pilot study with Michigan oncology practices. Support Care Cancer 2017; 25:1797-1807. [DOI: 10.1007/s00520-017-3584-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 01/09/2017] [Indexed: 11/28/2022]
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