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McDonald CE, Voutier C, Govil D, D’Souza AN, Truong D, Abo S, Remedios LJ, Granger CL. Do health service waiting areas contribute to the health literacy of consumers? A scoping review. Health Promot Int 2023; 38:daad046. [PMID: 37440256 PMCID: PMC10340083 DOI: 10.1093/heapro/daad046] [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] [Indexed: 07/14/2023] Open
Abstract
Health service waiting areas commonly provide health information, resources and supports for consumers; however, the effect on health literacy and related outcomes remains unclear. This scoping review of the literature aimed to explore the use of waiting areas as a place to contribute to the health literacy and related outcomes of consumers attending health appointments. Articles were included if they focussed on health literacy or health literacy responsiveness (concept) in outpatient or primary care health service waiting areas (context) for adult consumers (population) and were published after 2010. Ten bibliographic databases, one full-text archive, dissertation repositories and web sources were searched. The search yielded 5095 records. After duplicate removal, 3942 title/abstract records were screened and 360 full-text records assessed. Data were charted into a standardized data extraction tool. A total of 116 unique articles (published empirical and grey literature) were included. Most articles were set in primary and community care (49%) waiting areas. A diverse range of health topics and resource types were available, but results demonstrated they were not always used by consumers. Outcomes measured in intervention studies were health knowledge, intentions and other psychological factors, self-reported and observed behaviours, clinical outcomes and health service utilization. Intervention studies overall demonstrated positive trends in health literacy-related outcomes, although the benefit declined after 3-6 months. Research on using waiting areas for health literacy purposes is increasing globally. Future research investigating the needs of consumers to inform optimal intervention design is needed.
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Affiliation(s)
- Cassie E McDonald
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010, Australia
- Allied Health - Physiotherapy, The Royal Melbourne Hospital, Parkville, VIC 3052, Australia
- Allied Health, Alfred Health, Melbourne, VIC 3004, Australia
| | - Catherine Voutier
- Health Sciences Library, The Royal Melbourne Hospital, Parkville, VIC 3052, Australia
| | - Dhruv Govil
- Department of Business Intelligence and Reporting, Bass Coast Health, Wonthaggi, VIC 3995, Australia
| | - Aruska N D’Souza
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010, Australia
- Allied Health - Physiotherapy, The Royal Melbourne Hospital, Parkville, VIC 3052, Australia
| | - Dominic Truong
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Shaza Abo
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010, Australia
- Allied Health - Physiotherapy, The Royal Melbourne Hospital, Parkville, VIC 3052, Australia
| | - Louisa J Remedios
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010, Australia
- Department of Physiotherapy, Federation University, Churchill, VIC 3842, Australia
| | - Catherine L Granger
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010, Australia
- Allied Health - Physiotherapy, The Royal Melbourne Hospital, Parkville, VIC 3052, Australia
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Enard KR, Coleman AM, Yakubu RA, Butcher BC, Tao D, Hauptman PJ. Influence of Social Determinants of Health on Heart Failure Outcomes: A Systematic Review. J Am Heart Assoc 2023; 12:e026590. [PMID: 36695317 PMCID: PMC9973629 DOI: 10.1161/jaha.122.026590] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Prior research suggests an association between clinical outcomes in heart failure (HF) and social determinants of health (SDoH). Because providers should identify and address SDoH in care delivery, we evaluated how SDoH have been defined, measured, and evaluated in studies that examine HF outcomes. Methods and Results Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, databases were searched for observational or interventional studies published between 2009 and 2021 that assessed the influence of SDoH on outcomes. Selected articles were assessed for quality using a validated rating scheme. We identified 1373 unique articles for screening; 104 were selected for full-text review, and 59 met the inclusion criteria, including retrospective and prospective cohort, cross-sectional, and intervention studies. The majority examined readmissions and hospitalizations (k=33), mortality or survival (k=29), and success of medical devices and transplantation (k=8). SDoH examined most commonly included race, ethnicity, age, sex, socioeconomic status, and education or health literacy. Studies used a range of 1 to 9 SDoH as primary independent variables and 0 to 7 SDoH as controls. Multiple data sources were employed and frequently were electronic medical records linked with national surveys and disease registries. The effects of SDoH on HF outcomes were inconsistent because of the heterogeneity of data sources and SDoH constructs. Conclusions Our systematic review reveals shortcomings in measurement and deployment of SDoH variables in HF care. Validated measures need to be prospectively and intentionally collected to facilitate appropriate analysis, reporting, and replication of data across studies and inform the design of appropriate, evidence-based interventions that can ameliorate significant HF morbidity and societal costs.
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Affiliation(s)
- Kimberly R. Enard
- College for Public Health and Social JusticeSaint Louis UniversitySaint LouisMO
| | - Alyssa M. Coleman
- College for Public Health and Social JusticeSaint Louis UniversitySaint LouisMO
| | - R. Aver Yakubu
- College for Public Health and Social JusticeSaint Louis UniversitySaint LouisMO
| | | | - Donghua Tao
- Medical Center LibrarySaint Louis UniversitySaint LouisMO
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Huesken A, Hoffmann R, Ayed S. Persistent effect of nurse-led education on self-care behavior and disease knowledge in heart failure patients. Int J Nurs Sci 2021; 8:161-167. [PMID: 33997129 PMCID: PMC8105549 DOI: 10.1016/j.ijnss.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 01/23/2021] [Accepted: 03/04/2021] [Indexed: 11/08/2022] Open
Abstract
Purpose The guidelines on the management of patients with heart failure support intensive patient education on self-care. The present study aimed to evaluate the short-term and long-term impacts of a structured education provided by a qualified heart failure nurse on patients’ self-care behavior and disease knowledge. Methods One hundred fifty patients (66 ± 12 years) hospitalized for heart failure participated in a structured one-hour educational session by a heart failure nurse. Patients completed a questionnaire comprising 15 questions (nine questions from the European Heart Failure Self-Care Behavior Scale [EHFScB-9] and six on the patients’ disease knowledge) one day before and one day and six months after the educational session. Possible responses for each question ranged from 1 (complete agreement) to 5 (complete disagreement). Results After the educational session, the total EHFScB-9 score improved from 24.31 ± 6.98 to 14.94 ± 6.22, and the disease knowledge score improved from 18.03 ± 5.44 to 10.74 ± 4.30 (both P < 0.001). Scores for individual questions ranged from 1.26 ± 0.81 (adherence to the medication protocol) to 3.66 ± 1.58 (everyday weighing habits) before the education. The greatest improvement after education was observed on response to weight gain (−2.00±1.57), daily weight control (−1.77 ± 1.64), and knowledge on the cause of patients’ heart failure (−1.53 ± 1.43). At 6-month follow-up, EHFScB-9 score was 17.33 ± 7.23 and knowledge score was 12.34 ± 5.30 (both P < 0.001 compared with baseline). No factor was predictive of an insufficient teaching effect. Conclusions The educational program led by a qualified nurse improves patients’ self-care behavior and disease knowledge with a persistent effect at 6-month follow-up. There are no patient characteristics which preclude the implementation of an educational session.
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Affiliation(s)
- Astrid Huesken
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen, Germany
| | - Rainer Hoffmann
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen, Germany
| | - Sofien Ayed
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen, Germany
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Collins SP, Liu D, Jenkins CA, Storrow AB, Levy PD, Pang PS, Chang AM, Char D, Diercks DJ, Fermann GJ, Han JH, Hiestand B, Hogan C, Kampe CJ, Khan Y, Lee S, Lindenfeld J, Martindale J, McNaughton CD, Miller KF, Miller-Reilly C, Moser K, Peacock WF, Robichaux C, Rothman R, Schrock J, Self WH, Singer AJ, Sterling SA, Ward MJ, Walsh C, Butler J. Effect of a Self-care Intervention on 90-Day Outcomes in Patients With Acute Heart Failure Discharged From the Emergency Department: A Randomized Clinical Trial. JAMA Cardiol 2021; 6:200-208. [PMID: 33206126 DOI: 10.1001/jamacardio.2020.5763] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Up to 20% of patients who present to the emergency department (ED) with acute heart failure (AHF) are discharged without hospitalization. Compared with rates in hospitalized patients, readmission and mortality are worse for ED patients. Objective To assess the impact of a self-care intervention on 90-day outcomes in patients with AHF who are discharged from the ED. Design, Setting, and Participants Get With the Guidelines in Emergency Department Patients With Heart Failure was an unblinded, parallel-group, multicenter randomized trial. Patients were randomized 1:1 to usual care vs a tailored self-care intervention. Patients with AHF discharged after ED-based management at 15 geographically diverse EDs were included. The trial was conducted from October 28, 2015, to September 5, 2019. Interventions Home visit within 7 days of discharge and twice-monthly telephone-based self-care coaching for 3 months. Main Outcomes and Measures The primary outcome was a global rank of cardiovascular death, HF-related events (unscheduled clinic visit due to HF, ED revisit, or hospitalization), and changes in the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) summary score (SS) at 90 days. Key secondary outcomes included the global rank outcome at 30 days and changes in the KCCQ-12 SS score at 30 and 90 days. Intention-to-treat analysis was performed for the primary, secondary, and safety outcomes. Per-protocol analysis was conducted including patients who completed a home visit and had scheduled outpatient follow-up in the intervention arm. Results Owing to slow enrollment, 479 of a planned 700 patients were randomized: 235 to the intervention arm and 244 to the usual care arm. The median age was 63.0 years (interquartile range, 54.7-70.2), 302 patients (63%) were African American, 305 patients (64%) were men, and 178 patients (37%) had a previous ejection fraction greater than 50%. There was no significant difference in the primary outcome between patients in the intervention vs usual care arm (hazard ratio [HR], 0.89; 95% CI, 0.73-1.10; P = .28). At day 30, patients in the intervention arm had significantly better global rank (HR, 0.80; 95% CI, 0.64-0.99; P = .04) and a 5.5-point higher KCCQ-12 SS (95% CI, 1.3-9.7; P = .01), while at day 90, the KCCQ-12 SS was 2.7 points higher (95% CI, -1.9 to 7.2; P = .25). Conclusions and Relevance The self-care intervention did not improve the primary global rank outcome at 90 days in this trial. However, benefit was observed in the global rank and KCCQ-12 SS at 30 days, suggesting that an early benefit of a tailored self-care program initiated at an ED visit for AHF was not sustained through 90 days. Trial Registration ClinicalTrials.gov Identifier: NCT02519283.
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Affiliation(s)
- Sean P Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dandan Liu
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cathy A Jenkins
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Phillip D Levy
- Department of Emergency Medicine, Detroit Medical Center, Detroit, Michigan
| | - Peter S Pang
- Department of Emergency Medicine, Indiana University Medical Center, Indianapolis
| | - Anna Marie Chang
- Department of Emergency Medicine, Thomas Jefferson University Medical Center, Philadelphia, Pennsylvania
| | - Douglas Char
- Department of Emergency Medicine, Washington University Medical Center in St Louis, St Louis, Missouri
| | - Deborah J Diercks
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Gregory J Fermann
- Department of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Jin H Han
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brian Hiestand
- Department of Emergency Medicine, Wake Forest University Medical Center, Winston-Salem, North Carolina
| | - Christopher Hogan
- Department of Emergency Medicine, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Christina J Kampe
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yosef Khan
- Department of Emergency Medicine, American Heart Association
| | - Sangil Lee
- Department of Emergency Medicine, University of Iowa Medical Center, Iowa City
| | - JoAnn Lindenfeld
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jennifer Martindale
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Candace D McNaughton
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Karen F Miller
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Kelly Moser
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Russell Rothman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jon Schrock
- Department of Emergency Medicine, Metro Health Medical Center, Cleveland, Ohio
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adam J Singer
- Department of Emergency Medicine, Stony Brook University Medical Center, Stony Brook, New York
| | - Sarah A Sterling
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Michael J Ward
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson
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