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Chow BC, Jiao J, Duong TV, Hassel H, Kwok TCY, Nguyen MH, Liu H. Health literacy mediates the relationships of cognitive and physical functions with health-related quality of life in older adults. Front Public Health 2024; 12:1355392. [PMID: 38550320 PMCID: PMC10976439 DOI: 10.3389/fpubh.2024.1355392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/16/2024] [Indexed: 04/02/2024] Open
Abstract
Background Declining cognitive function (CF) and physical function (PF) relate to poorer health-related quality of life (HRQoL) in older adults. As health literacy (HL) facilitates health information utilization, it may mediate links between functionality and HRQoL appraisals. This study examined HL as an intermediary between joint CF and PF contributions and HRQoL in Hong Kong older adults. Methods 490 older adults aged 50-80 years completed assessments from March to July 2021. Health Literacy Survey Questionnaire Short Form 12 questions (HLS-SF12), Montreal Cognitive Assessment (MoCA), Senior Fitness Test (SFT) and 12-Item Short-Form Health Survey version 2 (SF-12v2) were used to assess HL, CF, PF and HRQoL, respectively. Path analysis tested a model with HL mediating CF/PF predictors and HRQoL outcome. Results Results for direct effects indicated that CF significantly associated with PF (β = 0.115, SE = 0.012, p < 0.001), PF significantly connected to HL (β = 0.101, SE = 0.022, p < 0.001), and HL significantly related to HRQoL (β = 0.457, SE = 0.049, p < 0.001). Meanwhile, PF significantly linked to HRQoL directly (β = 0.156, SE = 0.025, p < 0.001) as well as indirectly (β = 0.046, 95% CI [0.028, 0.067]). Significant mediating effect of HL was found on the relationship of PF and HRQoL. Conclusion Findings confirm CF and PF joint impacts on HL and HRQoL in older adults, elucidating HL's mediating role in translating functionality levels into HRQoL. Fostering enduring health knowledge access may thus buffer effects of age-related declines on well-being. Results can inform interventions leveraging this pathway to promote resilient trajectories.
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Affiliation(s)
- Bik C. Chow
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China
- Dr. Stephen Hui Research Centre for Physical Recreation and Wellness, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China
| | - Jiao Jiao
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China
- Dr. Stephen Hui Research Centre for Physical Recreation and Wellness, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China
| | - Tuyen V. Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
- International PhD Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Holger Hassel
- Institute for Applied Health Sciences, Coburg University of Applied Sciences and Arts, Coburg, Germany
- Berlin Institute for Health and Social Affairs, Berlin, Germany
| | - Timothy C. Y. Kwok
- Department of Medicine & Therapeutic and School of Public Health, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Minh H. Nguyen
- International PhD Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Huaxuan Liu
- School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, Fujian, China
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Lima ACP, Maximiano-Barreto MA, Martins TCR, Luchesi BM. Factors associated with poor health literacy in older adults: A systematic review. Geriatr Nurs 2024; 55:242-254. [PMID: 38070263 DOI: 10.1016/j.gerinurse.2023.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 02/06/2024]
Abstract
OBJECTIVES To identify factors associated with poor health literacy in older adults. METHODS A systematic literature review was conducted, employing the descriptors "Aged" and "Health Literacy". PROSPERO - CRD 42022350140. RESULTS Out of 23,500 articles screened, 176 were selected. Several factors associated with poor health literacy in older adults were identified, such as sociodemographic (e.g., advanced age, low educational level, non-white population, and others), social (e.g., poor family/social support, loneliness, social isolation, few social activities, and others), economic (e.g., lower income and/or lower socioeconomic status) and health aspects (e.g., poor health, chronic conditions, mental health challenges, hospitalizations, frailty, physical inactivity, cognitive impairment, and others). CONCLUSIONS The factors associated with poor health literacy in older adults identified in this review could contribute to future research, support interventions to improve health literacy, and assist professionals in planning educational activities and public policies.
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Affiliation(s)
- Ana Caroline Pinto Lima
- Campus de Três Lagoas, Programa de Pós-Graduação em Enfermagem, Federal University of Mato Grosso do Sul, Três Lagoas, MS, Brazil
| | | | - Tatiana Carvalho Reis Martins
- Campus de Três Lagoas, Programa de Pós-Graduação em Enfermagem, Federal University of Mato Grosso do Sul, Três Lagoas, MS, Brazil; Instituto Integrado de Saúde, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Bruna Moretti Luchesi
- Campus de Três Lagoas, Programa de Pós-Graduação em Enfermagem, Federal University of Mato Grosso do Sul, Três Lagoas, MS, Brazil; Research Group on Mental Health, Cognition and Aging, Federal University of São Carlos, São Carlos, SP, Brazil.
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Todd S, Reagan L, Laguerre R. Health Literacy, Cognitive Impairment, and Diabetes Knowledge Among Incarcerated Persons Transitioning to the Community: Considerations for Intervention Development. JOURNAL OF FORENSIC NURSING 2023; 19:262-270. [PMID: 35482339 DOI: 10.1097/jfn.0000000000000396] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the relationships of health literacy (HL; Short Test of Functional Health Literacy), cognitive impairment (CI), and diabetes knowledge (DK) among incarcerated persons transitioning to the community. METHODS Using preintervention data from a quasi-experimental nonequivalent control group study evaluating the feasibility of a six-session literacy-tailored Diabetes Survival Skills intervention for incarcerated men transitioning to the community, we conducted correlational analyses among the Short Test of Functional Health Literacy, Montreal Cognitive Assessment, and Spoken Knowledge in Low Literacy in Diabetes Scale using the SPSS PROCESS macro and bias-corrected bootstrapping to test the meditational hypothesis: HL mediates the relationship between CI and DK. RESULTS Participants ( N = 73) were incarcerated for 1-30 years with a mean age of 47 (9.9) years, 40% Black, 19% White, and 30% Hispanic, with 78% having high school/GED or less education. Most (70%) screened positive for CI and had low DK, and 20% had marginal or inadequate HL. HL, CI, and DK were positively associated with each other. Controlling for race, age, and group (control/experimental), cognitive function had a significant direct effect on HL ( b = 0.866, p = 0.0003) but not on DK ( b = 0.119, p = 0.076). Results indicated a significant indirect effect of cognitive functioning on DK via HL, 95% confidence interval [0.300, 0.1882]. CONCLUSION Intervention approaches aimed at increasing HL or tailored to low HL in the presence of CI may be effective in increasing DK in this population. IMPLICATIONS Given the low risk to high benefit of implementing literacy-tailored approaches to persons in prison and the population demographics from studies supporting a high degree of CI, nurses should consider implementing literacy-tailored approaches and screening for CI before participation in all educational programs.
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Affiliation(s)
| | | | - Rick Laguerre
- Department of Psychological Sciences, University of Connecticut
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4
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Babak M, Majid B, Rashid H, Leili T, Shahryar P. The factors in older adults' health literacy in the field of physical activity: a qualitative study. BMC Geriatr 2022; 22:630. [PMID: 35907800 PMCID: PMC9339178 DOI: 10.1186/s12877-022-03320-z] [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: 03/09/2021] [Accepted: 07/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older adults are one of the most vulnerable groups to the undesirable effects of low health literacy. Inadequate health literacy in older adults is associated with decreased physical activity, deviation from the path of health, and suffering from various diseases. Considering the role and importance of health literacy in promoting physical activity and improving health in older adults and the hypothesis that there are certain factors associated with health literacy in the field of physical activity, this study is aimed at understanding the factors related to older adults' health literacy about physical activity. METHODS This study is a qualitative study on older adults 60 to 75 years old in retirement centers in Kermanshah, Iran, in 2020. Totally, 25 participants were recruited through purposeful sampling with maximum variation until data saturation. The data were collected through in-depth semi-structured interviews and analyzed using directed qualitative content analysis. RESULTS By analyzing the manuscripts obtained from the interviews, 59 initial codes were extracted, which were reduced to 32 main codes after careful assessment. The main codes were grouped into 13 subcategories under 5 categories. Subcategories are the detected factors that are related to health literacy and categories are the five aspects of health literacy including access, reading skill, comprehension, evaluation and decision-making, and application of information. Health literacy was the main theme that encompassed the categories. CONCLUSION This study provided a comprehensive understanding of beliefs, opinions and factors related to older adults' health literacy about physical activity. According to these findings, physical problems and diseases are not obstacles to making decisions and applying physical activity information in older adults who have a high understanding and proper evaluation of physical activity recommendations. Support, advertising, and organizational facilities are related to all dimensions of older adults' health literacy about physical activity, while socio-economic factors are related to the dimensions of access, comprehension, decision-making, and application of information. The factors related to older adults' health literacy about physical activity that were identified in this study, can be used by organizations that are responsible for policy-making, decision-making, and implementing physical activity promotion programs to improve the health in older adults.
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Affiliation(s)
- Moeini Babak
- Social Determinants of Health Research Center and Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Barati Majid
- Social Determinants of Health Research Center and Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Heidarimoghadam Rashid
- Research Center for Health Sciences and Department of Ergonomics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Tapak Leili
- Department of Biostatistics, School of Public Health, Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Parsamajd Shahryar
- Department of Public Health, School of Public Health and Student Research Committee, Health Faculty, Hamadan University of Medical Science, Shahid Fahmide Boulevard, Hamadan, 8138380509, Iran.
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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: 3] [Impact Index Per Article: 1.5] [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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Kimzey M, Howe CJ, Martin C, McLarty J, Baucham R. Development of health literacy in persons and caregivers living with dementia: A qualitative directed content analysis. DEMENTIA 2021; 21:540-555. [PMID: 34654330 DOI: 10.1177/14713012211049691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Persons living with dementia and their caregivers need health information to understand and manage daily life. Previous studies focused on the associations of health literacy and cognitive impairment with less exploring if and how individuals develop health literacy during the course of the disease. PURPOSE This descriptive qualitative study aimed to explore the development of health literacy competencies among persons living with dementia and their caregivers. METHODS Directed content analysis of six focus groups conducted in the community setting (15 persons living with dementia and 28 caregivers) was completed, using predetermined categories from the Integrated Model of Health Literacy: access, understand, appraise, and apply health information. FINDINGS Participants described developing health literacy competencies over time, moving from a dependence on health care providers to becoming their own experts. Although health care providers were involved in the diagnosis and medication management, most participants admitted that they provided very little information on how to manage their daily life with dementia and often failed to inform them of community resources. CONCLUSION Participants seemed to find dementia resources on their own for both education and support, often stumbling upon them by accident. Health care providers should promote the health literacy competencies of their patients and caregivers by more intentionally providing dementia health and community resource information.
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Affiliation(s)
- Michelle Kimzey
- Harris College of Nursing and Health Sciences, 16049Texas Christian University, Fort Worth, TX, USA
| | - Carol J Howe
- Harris College of Nursing and Health Sciences, 16049Texas Christian University, Fort Worth, TX, USA
| | - Chelsea Martin
- Harris College of Nursing and Health Sciences, 16049Texas Christian University, Fort Worth, TX, USA
| | - Jim McLarty
- Harris College of Nursing and Health Sciences, 16049Texas Christian University, Fort Worth, TX, USA
| | - Ramona Baucham
- Harris College of Nursing and Health Sciences, 16049Texas Christian University, Fort Worth, TX, USA
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7
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O'Shea DM, Davis JD, Tremont G. Verbal memory is associated with adherence to COVID-19 protective behaviors in community dwelling older adults. Aging Clin Exp Res 2021; 33:2043-2051. [PMID: 34131881 PMCID: PMC8204921 DOI: 10.1007/s40520-021-01905-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/01/2021] [Indexed: 11/27/2022]
Abstract
Background Adherence to protective behaviors is central to limiting the spread of COVID-19 and associated risk of serious illness and mortality in older populations. Whether cognition predicts adherence to protective behaviors has not been examined in older adults. Aims To examine whether specific cognitive abilities predict adherence to COVID-19 protective behaviors in older adults, independent of other relevant factors. Methods Data from 431 older adults (i.e., ≥ 65 years) who took part in the COVID-19 module of the Health and Retirement Study were included in the present study. Separate binary logistic regression models were used to examine whether performance on measures of immediate and delayed recall and working memory predicted adherence to COVID-19 protective behaviors, controlling for demographics, level of COVID-19 concern, depressive symptoms, and medical conditions. Results For every unit increase in immediate and delayed recall, the probability of adhering to COVID-19 protective behaviors increased by 47% and 69%, respectively. There was no association between the measure of working memory and adherence. Discussion It is of public interest to understand the factors that reduce adherence to protective behaviors so that we can better protect those most vulnerable and limit community spread. Our findings demonstrate that reduced memory predicts non-adherence to COVID-19 protective behaviors, independent of virus concern, and other relevant demographic and health factors. Conclusions Public health strategies aimed at increasing adherence to COVID-19 protective behaviors in community dwelling older adults, should account for the role of reduced cognitive function in limiting adherence.
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Affiliation(s)
- Deirdre M O'Shea
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI, 02912, USA.
| | - Jennifer D Davis
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI, 02912, USA
| | - Geoffrey Tremont
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI, 02912, USA
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Crespo TS, Andrade JMO, Lelis DDF, Ferreira AC, Souza JGS, Martins AMEDBL, Santos SHS. Adherence to medication, physical activity and diet among older people living with diabetes mellitus: Correlation between cognitive function and health literacy. IBRO Rep 2020; 9:132-137. [PMID: 33336106 PMCID: PMC7733141 DOI: 10.1016/j.ibror.2020.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023] Open
Abstract
Background Diabetes mellitus (DM) is a public health problem, which requires enhanced self-care in order to avoid complications. However, cognitive impairment can reduce these abilities and may affect health literacy (HL) of patients in terms to understand and apply information. Therefore, this study evaluated the correlation between cognitive condition and HL related to medication adherence, physical activity and nutritional status among people living with DM. Methods A cross-sectional study was carried out among elderly people (≥ 60 years old) with DM. The cognitive condition was evaluated using the Mini-Mental State Examination (MMSE) and the HL using the following questionnaires: Literacy Assessment for Diabetes (LAD-60), Nutritional Literacy among People with Diabetes (NLD), Health Literacy on the Practice of Physical Activities among Diabetics (HLPPA - D), and Health Literacy regarding Drug Adherence among Diabetics (HLDA-D). Sociodemographic and biochemical profile was also evaluated. Spearman correlation was used (p < 0.05). Results 187 individuals with DM were included. Regarding laboratory analyses, insulin dosage had a mean value of 12.3 microUI/mL (SD: ±15.7), mean blood glucose was 148.1 mg/dl (SD: ±59.7) and mean HbA1c was 7.54 % (SD: ±1.8). In the correlation analysis, higher age and lower income were weakly correlated with lower cognitive level. No correlation was identified for biochemical variables and cognitive condition. A positive and weak correlation between cognition and HL was observed in the studied population. Conclusions In older people living with DM the cognitive condition is correlated to specific topics of HL (nutritional status, physical activity and medication adherence).
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Affiliation(s)
- Thaísa Soares Crespo
- Laboratory of Health Sciences, Montes Claros State University, Montes Claros, Minas Gerais, Brazil.,Department of Physiopathology, Center of Health and Biological Sciences, Montes Claros State University, Montes Claros, Minas Gerais, Brazil
| | - João Marcus Oliveira Andrade
- Laboratory of Health Sciences, Montes Claros State University, Montes Claros, Minas Gerais, Brazil.,Department of Nursing, Center of Health and Biological Sciences, Montes Claros State University, Montes Claros, Minas Gerais, Brazil
| | - Deborah de Farias Lelis
- Laboratory of Health Sciences, Montes Claros State University, Montes Claros, Minas Gerais, Brazil
| | - Alice Crespo Ferreira
- Laboratory of Health Sciences, Montes Claros State University, Montes Claros, Minas Gerais, Brazil
| | | | - Andréa Maria Eleutério de Barros Lima Martins
- Laboratory of Health Sciences, Montes Claros State University, Montes Claros, Minas Gerais, Brazil.,Department of Dentistry, Center of Health and Biological Sciences, Montes Claros State University, Montes Claros, Minas Gerais, Brazil
| | - Sérgio Henrique Sousa Santos
- Laboratory of Health Sciences, Montes Claros State University, Montes Claros, Minas Gerais, Brazil.,Department of Dentistry, Center of Health and Biological Sciences, Montes Claros State University, Montes Claros, Minas Gerais, Brazil.,Institute of Agricultural Sciences. Food Engineering College, Federal University of Minas Gerais (UFMG), Montes Claros, Minas Gerais, Brazil
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9
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Guo XM, Zhai X, Hou BR. Adequacy of health literacy and its effect on diabetes self-management: a meta-analysis. Aust J Prim Health 2020; 26:458-465. [PMID: 33296622 DOI: 10.1071/py20079] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/28/2020] [Indexed: 11/23/2022]
Abstract
This study evaluated the role of health literacy (HL) in the self-management of diabetes. A literature search was conducted in electronic databases and studies were selected using precise eligibility criteria. A meta-analysis was conducted to estimate the HL adequacy rate, factors affecting the adequacy of HL and correlations between HL and diabetes self-management variables. Thirty-three studies were included in the analysis. The HL adequacy rate was 67% (95% confidence interval (CI) 57, 76). Compared with patients with inadequate HL, patients with adequate HL were younger (mean difference -5.2 years; 95% CI -7.2, -3.2; P<0.00001), more likely to have a high school or higher level of education (odds ratio (OR) 8.39; 95% CI 5.03, 13.99]; P<0.00001) and were less likely to belong to a low-income group (OR 0.36; 95% CI 0.23, 0.56; P<0.00001). HL was positively correlated with self-monitoring (r=0.19; 95% CI 0.11, 0.27; P<0.00001), dietary and physical care (r=0.12; 95% CI 0.07, 0.18; P=0.009), diabetes knowledge (r=0.29; 95% CI 0.09, 0.45; P<0.001), self-efficacy (r=0.28; 95% CI 0.15, 0.41; P<0.00001), self-care (0.24; 95% CI 0.16, 0.31; P<0.00001), formal education (r=0.35; 95% CI 0.18, 0.53; P<0.00001) and social support (r=0.2; 95% CI 0.07, 0.33; P<0.00001). Patient age (r=-0.28; 95% CI -0.39, -0.17; P<0.00001) was inversely correlated with HL. In conclusion, 67% of diabetes patients had adequate HL, with a higher rate among better educated and higher income groups. HL had a statistically significant but weak positive correlation with diabetes self-management variables.
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Affiliation(s)
- Xiu-Mei Guo
- Department of Outpatient, Lanzhou University Second Hospital, Lanzhou, No. 82, Cuiyingmen, Chengguan District, Gansu 730030, China
| | - Xia Zhai
- Department of Outpatient, Lanzhou University Second Hospital, Lanzhou, No. 82, Cuiyingmen, Chengguan District, Gansu 730030, China
| | - Bo-Ru Hou
- Department of Neurosurgery, Lanzhou University Second Hospital, No. 82, Cuiyingmen, Chengguan District, Lanzhou, Gansu 730030, China; and Corresponding author.
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10
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Yusuf MYA, Kirubakaran R, Albadwi AMM, Saad AE, Mjahed AHS, Saleh SH. Levels and Determinants of Health Literacy in Bahrain's Community Context. Oman Med J 2020; 35:e195. [PMID: 33204521 PMCID: PMC7642644 DOI: 10.5001/omj.2020.88] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 04/14/2020] [Indexed: 11/03/2022] Open
Abstract
Objectives We sought to assess health literacy (HL) and its associated factors in the Bahraini community using a validated HL scale and address its deficient domains to inform policy. Methods We carried out a conveniently sampled, cross-sectional survey using the All Aspects of Health Literacy Scale in the Bahraini community. The scale has three key aspects: basic or functional HL (FUN-4 items), which corresponds to basic reading and writing skills, and knowledge of health conditions and health systems; communicative or interactive HL (COM-3 items) on communicative and social skills to extract information from different forms of communication; and critical HL (CR-4 items), the advanced cognitive and social skills to critically analyze information and exert greater control over life events and situations relating to individual and community level wellbeing goals. We examined the association between sociodemographic and health information for the survey tool items using the chi-square test. The relationship between total scale score and subscale scores of the three domains of the survey tool to sociodemographic and health information was investigated using the t-test and ANOVA. Results Of the 836 participants (mean age = 26.6 years), single (64.0%) and university students (76.6%) were predominant; 15.6% reported long-term sickness and visited the general physician often. The highest mean item scores were for empowerment (1.8) and lowest for functional HL (0.1). The significant domain-specific responses to the survey tool items were 12 for critical HL, 10 for functional HL, six for communicative HL, and five for empowerment. Participants aged < 30 years old, female, married, pursuing/completed Master's program, employed, and whose self-rating of health was excellent had higher total HL scores. Conclusions Older, less educated respondents with a poor self-rating of health had low HL scores. We recommend further studies to address the relative importance of functional, interactive, and critical HL in the community to promote health outcomes.
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Affiliation(s)
| | - Mohamed Yaqoob Ali Yusuf
- Nursing Program, WHO Collaborating Centre for Nursing Development, College of Health Sciences, University of Bahrain, Salmanya Medical Complex, Salmanya, Bahrain
| | - Richard Kirubakaran
- South Asian Cochrane Centre and Network, Christian Medical College and Hospital, Vellore, India
| | - Abdulaziz Mohamed Muqbel Albadwi
- Nursing Program, WHO Collaborating Centre for Nursing Development, College of Health Sciences, University of Bahrain, Salmanya Medical Complex, Salmanya, Bahrain
| | - Ahmed Ebrahim Saad
- Nursing Program, WHO Collaborating Centre for Nursing Development, College of Health Sciences, University of Bahrain, Salmanya Medical Complex, Salmanya, Bahrain
| | - Ahmed Hussain S Mjahed
- Nursing Program, WHO Collaborating Centre for Nursing Development, College of Health Sciences, University of Bahrain, Salmanya Medical Complex, Salmanya, Bahrain
| | - Saleh Hamad Saleh
- Nursing Program, WHO Collaborating Centre for Nursing Development, College of Health Sciences, University of Bahrain, Salmanya Medical Complex, Salmanya, Bahrain
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Miller-Matero LR, Hecht L, Patel S, Martens KM, Hamann A, Carlin AM. The Influence of Health Literacy and Health Numeracy on Weight Loss Outcomes Following Bariatric Surgery. Surg Obes Relat Dis 2020; 17:384-389. [PMID: 33082073 DOI: 10.1016/j.soard.2020.09.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Although cognitive functioning and health literacy are related to weight loss 1year following bariatric surgery, the influence of health numeracy (i.e., health-related mathematical abilities) is unknown. In addition, further research is needed to examine the impact of all these factors on longer-term weight loss outcomes to determine if they influence the ability to maintain weight loss. SETTING Single bariatric center. METHODS Patients (N = 567) who underwent bariatric surgery from 2014-2017 completed a brief survey including current weight. Retrospective chart reviews were conducted to gather information from the presurgical evaluation including weight, body mass index (BMI), health literacy, health numeracy and score on a cognitive screener. RESULTS Among participants in the weight loss period (< 2 years postsurgery), health literacy, health numeracy and cognitive functioning were not related to change in BMI (ΔBMI), percent total weight loss (%TWL) or percent excess weight loss (%EWL). However, for participants in the weight maintenance period (2-4 years postsurgery), higher health literacy scores were related to greater change in ΔBMI, and higher health numeracy scores were related to greater ΔBMI, %TWL, and %EWL. DISCUSSION Although health literacy and health numeracy did not predict weight loss outcomes for those in the initial weight loss period, they were related to weight outcomes for participants in the weight maintenance period. This suggests that health literacy and health numeracy may play a role in facilitating longer-term weight maintenance among patients who undergo bariatric surgery. Clinicians conducting presurgical psychosocial evaluations should consider routinely screening for health literacy and health numeracy.
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Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health System, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan.
| | - Leah Hecht
- Behavioral Health, Henry Ford Health System, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan
| | - Shivali Patel
- Behavioral Health, Henry Ford Health System, Detroit, Michigan
| | - Kellie M Martens
- Behavioral Health, Henry Ford Health System, Detroit, Michigan; Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Aaron Hamann
- Behavioral Health, Henry Ford Health System, Detroit, Michigan; Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, Michigan
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12
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The association of diabetes literacy with self-management among older people with type 2 diabetes mellitus: a cross-sectional study. BMC Nurs 2019; 18:34. [PMID: 31427896 PMCID: PMC6696697 DOI: 10.1186/s12912-019-0354-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Diabetes has become one of public health problem up until now. As the disease progressed, it might lead to increasing complication as well as death related to them. Diabetes as chronic disease in older people can lead to more vulnerable conditions if they fail to carry out a proper diabetes self-management. Diabetes literacy is an internal factor affecting how the older people go about their diabetes management routines. This study aimed to describe diabetes literacy of the older people and identify the relation of diabetes literacy to diabetes self-management of the older people with T2DM in selected areas of Depok City, West Java, Indonesia. Method A cross-sectional observational study was utilized and used 106 samples of older people individuals with T2DM, all of whom were chosen via cluster sampling. This research took place in five selected areas under the supervision of three public health center in Depok City. The data were analyzed using a bivariate t-independent test, the Pearson product-moment correlation, and logistic regression for multivariate analysis to determine the relationship of independent and dependent variable. Result This research shows a significant correlation between diabetes literacy and diabetes self-management (p = 0,011). Conclusion Diabetes self management is associated with diabetes literacy in older people with type 2 diabetes mellitus. Diabetes literacy should be considered when assessing and addressing diabetes-specific health education needs.
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13
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Lamar M, Wilson RS, Yu L, James BD, Stewart CC, Bennett DA, Boyle PA. Associations of literacy with diabetes indicators in older adults. J Epidemiol Community Health 2018; 73:250-255. [PMID: 30530520 DOI: 10.1136/jech-2018-210977] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/01/2018] [Accepted: 11/19/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Literacy, the ability to access, understand and utilise information and concepts from diverse sources in ways that promote good outcomes is key to successful ageing. Domain-specific health and financial literacy are particularly relevant to older adults as they face increasingly complex health and financial demands including those related to chronic conditions like type 2 diabetes. We therefore investigated the associations of literacy, including health and financial literacy, with diabetes indicators (ie, haemoglobin A1c and blood glucose) in a community-based cohort study of ageing. METHODS Participants were 908 non-demented older adults (age ~81 years;75% women) from the Rush Memory and Aging Project. Literacy was measured using questions designed to assess comprehension of health and financial information and concepts and yielded a total score and domain-specific health and financial literacy scores. Non-fasting haemoglobin A1c and blood glucose samples were collected, participants were queried about diabetes status and medications for diabetes were visually inspected and coded. Participants also underwent a cognitive assessment, medical history and depressive symptom screening. RESULTS In separate multivariable linear regression models, total (p values <0.03) and health (p values <0.009) literacy were inversely associated with haemoglobin A1c and blood glucose levels after adjusting for age, sex, education, hypertension, global cognitive functioning and depressive symptoms. Financial literacy was inversely associated with haemoglobin A1c levels in adjusted models (p=0.04). Sensitivity analyses conducted among individuals without diabetes revealed similar results. CONCLUSION Lower literacy levels are associated with higher diabetes indicators, particularly haemoglobin A1c which is suggestive of longer-term glycaemic instability.
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Affiliation(s)
- Melissa Lamar
- Rush Alzheimer's Disease Center, Chicago, Illinois, USA.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Robert S Wilson
- Rush Alzheimer's Disease Center, Chicago, Illinois, USA.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Lei Yu
- Rush Alzheimer's Disease Center, Chicago, Illinois, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Bryan D James
- Rush Alzheimer's Disease Center, Chicago, Illinois, USA.,Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Christopher C Stewart
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Chicago, Illinois, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Patricia A Boyle
- Rush Alzheimer's Disease Center, Chicago, Illinois, USA.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
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14
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Choi SK, Rose ID, Friedman DB. How Is Literacy Being Defined and Measured in Dementia Research? A Scoping Review. Gerontol Geriatr Med 2018; 4:2333721418812246. [PMID: 30505890 PMCID: PMC6256312 DOI: 10.1177/2333721418812246] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 10/14/2018] [Accepted: 10/18/2018] [Indexed: 01/22/2023] Open
Abstract
Literacy plays an important role in Alzheimer's disease and related dementias (ADRD); however, less is known about how literacy is being used and defined in ADRD studies. This study reviewed terminology being used to describe types and definitions of literacy and instruments used to assess literacy in ADRD research. Among the 219 studies retrieved from 3 databases, 50 met our inclusion criteria. Literacy terms used in ADRD studies varied: literacy (n = 28), health literacy (n = 9), and dementia literacy (n = 7) were the most often used terms, followed by financial literacy (n = 4), dementia knowledge (n = 3), AD knowledge (n = 2), mental health literacy (n = 2), AD literacy, digital literacy, health literacy about incontinence, and financial knowledge (n = 1 each). Thirty studies did not define literacy terms used. Among the 20 studies defining literacy, definitions were inconsistent across studies even when they used the same term. Surveys (n = 30), open-ended questions, vignettes, or focus groups (n = 10), self-perceived (n = 3) or interviewer assessed (n = 1) literacy levels were used to assess literacy. Ten studies did not specify literacy measurement. Various literacies have been examined in ADRD research with unclear definitions and some inadequate measures. Well-defined terms with valid measures are needed to better understand the role of literacies in ADRD research.
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Affiliation(s)
| | - India D Rose
- Health Research Informatics and Technology Division, Atlanta, GA, USA
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15
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Burke SL, Cadet T, Maddux M. Chronic Health Illnesses as Predictors of Mild Cognitive Impairment Among African American Older Adults. J Natl Med Assoc 2018; 110:314-325. [PMID: 30126555 PMCID: PMC6108440 DOI: 10.1016/j.jnma.2017.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 06/14/2017] [Accepted: 06/21/2017] [Indexed: 12/19/2022]
Abstract
Approximately 5.5 million individuals are diagnosed with Alzheimer's disease (AD) dementia, a number which includes those with mild cognitive impairment and asymptomatic individuals with biomarkers of AD. There is a higher incidence of mild cognitive impairment (MCI) in African American populations as compared to White populations, even when controlling for sociodemographic factors. The existing body of ethnically/racially targeted research on MCI has been limited by few studies with the ability to generalize to African American communities. This study sought to examine whether medical conditions which occur at a higher rate in African American individuals increase the hazard of subsequent MCI development. A secondary data analysis of the National Alzheimer's Coordinating Center Uniform Data Set was employed to examine the associations between health conditions (congestive heart failure, traumatic brain injury, diabetes, hypertension, hypercholesterolemia, B12 deficiency, thyroid disease) and their relationship to MCI. The analytic sample included 2847 participants with 9872 observations. Binary logistic generalized estimating equation modeling was used to examine repeated measures over the course of 1-11 observations. Education was associated with MCI development, specifically those with some college or college graduates (p < 0.001) and more than college (p = 0.002). Female sex was associated with development of MCI (p < 0.001). African Americans with traumatic brain injury (TBI) were more likely to develop MCI (p < 0.001) compared to those with no reports of a TBI. Inactive thyroid conditions decreased the risk of MCI development (p = 0.005) compared to those without thyroid disease. Though vascular factors are often attributed to higher mortality and neurodegeneration in African Americans, congestive heart failure, diabetes, high cholesterol, hypertension, diabetes, nor seizures were associated with an increased risk of MCI development. Findings from this study provide formative data to develop targeted interventions for subsets of the African American community, including those with higher educational levels, those with TBI, and those with a history of thyroid disease. While it may not be possible to prevent MCI development, it is possible to modify lifestyle behaviors contributing to these health conditions, such as falls that are often experienced by older adults. Practitioners can increase awareness, knowledge, and resources relevant to clients.
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Affiliation(s)
- Shanna L Burke
- Florida International University, Robert Stempel College of Public Health and Social Work, School of Social Work, 11200 S.W. 8th Street, AHC5 564 Miami, FL 33199, USA.
| | - Tamara Cadet
- Simmons College School of Social Work, HSDM-Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, USA
| | - Marlaina Maddux
- Florida International University, Robert Stempel College of Public Health and Social Work, School of Social Work, 11200 S.W. 8th Street, AHC5 564 Miami, FL 33199, USA
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16
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Mahdizadeh M, Solhi M. Relationship between self-care behaviors and health literacy among elderly women in Iran, 2015. Electron Physician 2018; 10:6462-6469. [PMID: 29765570 PMCID: PMC5942566 DOI: 10.19082/6462] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 02/22/2017] [Indexed: 11/20/2022] Open
Abstract
Background and aim Self-care is a basic concept in health promotion, regarding the importance of health literacy as a key factor in self-care. This study aimed to identify the relationship between self-care behaviors and health literacy among elderly women in Iran. Methods This descriptive and analytic study was performed between October and December 2015. A total of 360 participants were selected from elderly women referred to health centers. Data was collected by test of functional health literacy in adults (S-TOFHLA) and a checklist for assessment of self-care behaviors, and health information seeking. Data were analyzed by SPSS software (version 22) with One-Way Analysis of Variance, and the Pearson correlation coefficient, t-test and regression test. Results The mean score of functional health literacy was 41.30±6.29. Of the participants, 73.6% had inadequate health literacy, 20.8% borderline health literacy, and 5.6% enough health literacy. The mean score of health information seeking was 1.791. Also, 31.9% of elderly women had poor self-care behaviors, 56.9% moderate, and 11.1% high. A significant difference was observed in mean score of health literacy between different levels of self-care (F=30.087, p<0.001). Based on regression analysis, health literacy and health information seeking predicted 19.9% of the variance of self-care behaviors. Conclusion This study highlights the necessity of promoting health literacy and attention to its influencing factors to improve self-care ability of elderly women. In conclusion, Planning interventions to improve health literacy is essential for health promotion among elderly women.
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Affiliation(s)
- Mehrsadat Mahdizadeh
- PhD Candidate in Health Education and Health Promotion, Department of Health Services and Health Education, School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Solhi
- PhD., Associate Professor of Health Education and Health Promotion, Department of Health Services and Health Education, School of Health, Iran University of Medical Sciences, Tehran, Iran
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17
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Geboers B, Uiters E, Reijneveld SA, Jansen CJM, Almansa J, Nooyens ACJ, Verschuren WMM, de Winter AF, Picavet HSJ. Health literacy among older adults is associated with their 10-years' cognitive functioning and decline - the Doetinchem Cohort Study. BMC Geriatr 2018; 18:77. [PMID: 29558890 PMCID: PMC5859753 DOI: 10.1186/s12877-018-0766-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 03/12/2018] [Indexed: 11/11/2022] Open
Abstract
Background Many older adults have low levels of health literacy which affects their ability to participate optimally in healthcare. It is unclear how cognitive decline contributes to health literacy. To study this, longitudinal data are needed. The aim of this study was therefore to assess the associations of cognitive functioning and 10-years’ cognitive decline with health literacy in older adults. Methods Data from 988 participants (mean age = 65.3) of the Doetinchem Cohort Study were analyzed. Health literacy was measured by the Brief Health Literacy Screening. Memory, mental flexibility, information processing speed, and global cognitive functioning were assessed at the same time as health literacy and also 10 years earlier. Logistic regression analyses were performed, adjusted for age, gender, and educational level. Results Higher scores on tests in all cognitive domains were associated with a lower likelihood of having low health literacy after adjustment for confounders (all ORs < 0.70, p-values<.001). Similar associations were found for past cognitive functioning (all ORs < 0.75, p-values<.05). Before adjustment, stronger cognitive decline was associated with a greater likelihood of having low health literacy (all ORs > 1.37, p-values<.05). These associations lost significance after adjustment for educational level, except for the association of memory decline (OR = 1.40, p = .023, 95% CI: 1.05 to 1.88). Conclusion Older adults with poorer cognitive functioning and stronger cognitive decline are at risk for having low health literacy, which can affect their abilities to promote health and self-manage disease. Low health literacy and declining cognitive functioning might be a barrier for person-centered care, even in relatively young older adults.
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Affiliation(s)
- Bas Geboers
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, FA10, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
| | - Ellen Uiters
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, FA10, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Carel J M Jansen
- Department of Communication and Information Studies, Faculty of Arts, University of Groningen, Groningen, the Netherlands
| | - Josué Almansa
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, FA10, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Astrid C J Nooyens
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - W M Monique Verschuren
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Andrea F de Winter
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, FA10, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
| | - H Susan J Picavet
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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18
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van Zwieten A, Wong G, Ruospo M, Palmer SC, Barulli MR, Iurillo A, Saglimbene V, Natale P, Gargano L, Murgo M, Loy CT, Tortelli R, Craig JC, Johnson DW, Tonelli M, Hegbrant J, Wollheim C, Logroscino G, Strippoli GFM. Prevalence and patterns of cognitive impairment in adult hemodialysis patients: the COGNITIVE-HD study. Nephrol Dial Transplant 2017; 33:1197-1206. [DOI: 10.1093/ndt/gfx314] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 10/08/2017] [Indexed: 12/20/2022] Open
Affiliation(s)
- Anita van Zwieten
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Marinella Ruospo
- Diaverum Medical-Scientific Office, Lund, Sweden
- Division of Nephrology and Transplantation, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Maria Rosaria Barulli
- Neurodegenerative Diseases Unit, Department of Clinical Research in Neurology, University of Bari ‘A. Moro’, ‘Pia Fondazione Cardinale G. Panico’, Tricase, Lecce, Italy
| | - Annalisa Iurillo
- Neurodegenerative Diseases Unit, Department of Clinical Research in Neurology, University of Bari ‘A. Moro’, ‘Pia Fondazione Cardinale G. Panico’, Tricase, Lecce, Italy
| | - Valeria Saglimbene
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Diaverum Medical-Scientific Office, Lund, Sweden
| | | | | | - Marco Murgo
- Diaverum Medical-Scientific Office, Lund, Sweden
| | - Clement T Loy
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Huntington Disease Service, Westmead Hospital, Westmead, New South Wales, Australia
| | - Rosanna Tortelli
- Neurodegenerative Diseases Unit, Department of Clinical Research in Neurology, University of Bari ‘A. Moro’, ‘Pia Fondazione Cardinale G. Panico’, Tricase, Lecce, Italy
| | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- Department of Nephrology, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Translational Research Institute, University of Queensland, Woolloongabba, Queensland, Australia
| | - Marcello Tonelli
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Giancarlo Logroscino
- Neurodegenerative Diseases Unit, Department of Clinical Research in Neurology, University of Bari ‘A. Moro’, ‘Pia Fondazione Cardinale G. Panico’, Tricase, Lecce, Italy
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari ‘A. Moro’, Bari, Italy
| | - Giovanni F M Strippoli
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Diaverum Medical-Scientific Office, Lund, Sweden
- Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare, Bari, Italy
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19
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O'Lone E, Connors M, Masson P, Wu S, Kelly PJ, Gillespie D, Parker D, Whiteley W, Strippoli GFM, Palmer SC, Craig JC, Webster AC. Cognition in People With End-Stage Kidney Disease Treated With Hemodialysis: A Systematic Review and Meta-analysis. Am J Kidney Dis 2016; 67:925-35. [PMID: 26919914 DOI: 10.1053/j.ajkd.2015.12.028] [Citation(s) in RCA: 165] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 12/28/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cognitive impairment is associated with poorer quality of life, risk for hospitalization, and mortality. Cognitive impairment is common in people with end-stage kidney disease treated with hemodialysis, yet the severity and specific cognitive deficits are uncertain. STUDY DESIGN Systematic review and meta-analysis. SETTING & POPULATION Adults receiving hemodialysis compared with the general population, people with non-dialysis-dependent chronic kidney disease (NDD-CKD), people receiving peritoneal dialysis, or people with nondialyzed chronic kidney failure. SELECTION CRITERIA FOR STUDIES Randomized controlled trials, cohort or cross-sectional studies without language restriction. INDEX TESTS Validated neuropsychological tests of cognition. OUTCOMES Cognitive test scores, aggregated by cognitive domain: orientation and attention, perception, memory, language, construction and motor performance, concept formation and reasoning, and executive functions. RESULTS 42 studies of 3,522 participants. Studies were of high or uncertain risk of bias, assessed by the Newcastle-Ottawa Scale. People treated with hemodialysis had worse cognition than the general population, particularly in attention (n=22; standardized mean difference [SMD], -0.93; 95% CI, -1.18 to -0.68). Hemodialysis patients performed better than nondialyzed patients with chronic kidney failure in attention (n=6; SMD, 0.70; 95% CI, 0.45 to 0.96) and memory (n=6; SMD, 0.36; 95% CI, 0.08 to 0.63), but had poorer memory than the general population (n=16; SMD, -0.41; 95% CI, -0.91 to 0.09) and people with NDD-CKD (n=5; SMD, -0.40; 95% CI, -0.60 to -0.21). There were insufficient data to show other differences among people receiving hemodialysis and those receiving peritoneal dialysis or with NDD-CKD. LIMITATIONS Potentially biased studies, not wholly adjusted for education. High heterogeneity, mainly due to the large variety of tests used to assess cognition. CONCLUSIONS People treated with hemodialysis have impaired cognitive function compared to the general population, particularly in the domains of orientation and attention and executive function. Cognitive deficits in specific domains should be further explored in this population and should be considered when approaching education and chronic disease management.
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Affiliation(s)
- Emma O'Lone
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.
| | - Michael Connors
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia; Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, Australia; ARC Centre of Excellence in Cognition and Its Disorders, Sydney, Australia; Department of Cognitive Science, Macquarie University, Sydney, Australia
| | - Philip Masson
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; University of Edinburgh, Edinburgh, United Kingdom
| | - Sunny Wu
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Patrick J Kelly
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | | | | | | | - Giovanni F M Strippoli
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia; University of Bari, Bari, Italy; Diaverum Academy, Lund, Sweden
| | | | - Jonathan C Craig
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Angela C Webster
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Centre for Transplant and Renal Research, Westmead Millennium Institute, University of Sydney at Westmead, Sydney, Australia
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20
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van der Heide I, Heijmans M, Schuit AJ, Uiters E, Rademakers J. Functional, interactive and critical health literacy: Varying relationships with control over care and number of GP visits. PATIENT EDUCATION AND COUNSELING 2015; 98:998-1004. [PMID: 25956070 DOI: 10.1016/j.pec.2015.04.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 04/08/2015] [Accepted: 04/12/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The aim of this study is to examine the extent to which functional, interactive and critical health literacy are associated with patients' perceived control over care and frequency of GP visits. METHODS Data from the Dutch 'National Panel of People with Chronic Illness or Disability' was used (N=2508). Health literacy was assessed by the Functional, Communicative and Critical Health Literacy measure. Perceived control over care was indicated by perceived ability to organize care, interact with providers and to perform self-care. By multivariate linear and logistic regression analyses, associations between health literacy and perceived control over care and subsequently frequency of GP visits were studied. RESULTS Mainly interactive health literacy was associated with patients' perceived ability to organize care, interact with healthcare providers and perform self-care, whereas only functional health literacy was associated with number of GP visits. CONCLUSION The results imply that some patients' may be less able to exert control over their care because of lower health literacy. Functional, interactive and critical health literacy vary in their relevance for patients' ability to exert control. PRACTICE IMPLICATIONS Initiatives for strengthening patients' role in healthcare may be improved by paying attention to patients' health literacy, specifically functional and interactive health literacy.
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Affiliation(s)
- Iris van der Heide
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, Netherlands.
| | - Monique Heijmans
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - A Jantine Schuit
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands; Department of Health Sciences and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, Netherlands
| | - Ellen Uiters
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Jany Rademakers
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, Netherlands
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21
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O'Conor R, Wolf MS, Smith SG, Martynenko M, Vicencio DP, Sano M, Wisnivesky JP, Federman AD. Health literacy, cognitive function, proper use, and adherence to inhaled asthma controller medications among older adults with asthma. Chest 2015; 147:1307-1315. [PMID: 25275432 DOI: 10.1378/chest.14-0914] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND We sought to investigate the degree to which cognitive skills explain associations between health literacy and asthma-related medication use among older adults with asthma. METHODS Patients aged ≥ 60 years receiving care at eight outpatient clinics (primary care, geriatrics, pulmonology, allergy, and immunology) in New York, New York, and Chicago, Illinois, were recruited to participate in structured, in-person interviews as part of the Asthma Beliefs and Literacy in the Elderly (ABLE) study (n = 425). Behaviors related to medication use were investigated, including adherence to prescribed regimens, metered-dose inhaler (MDI) technique, and dry powder inhaler (DPI) technique. Health literacy was measured using the Short Test of Functional Health Literacy in Adults. Cognitive function was assessed in terms of fluid (working memory, processing speed, executive function) and crystallized (verbal) ability. RESULTS The mean age of participants was 68 years; 40% were Hispanic and 30% non-Hispanic black. More than one-third (38%) were adherent to their controller medication, 53% demonstrated proper DPI technique, and 38% demonstrated correct MDI technique. In multivariable analyses, limited literacy was associated with poorer adherence to controller medication (OR, 2.3; 95% CI, 1.29-4.08) and incorrect DPI (OR, 3.51; 95% CI, 1.81-6.83) and MDI (OR, 1.64; 95% CI, 1.01-2.65) techniques. Fluid and crystallized abilities were independently associated with medication behaviors. However, when fluid abilities were added to the model, literacy associations were reduced. CONCLUSIONS Among older patients with asthma, interventions to promote proper medication use should simplify tasks and patient roles to overcome cognitive load and suboptimal performance in self-care.
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Affiliation(s)
- Rachel O'Conor
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Michael S Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Samuel G Smith
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Melissa Martynenko
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Daniel P Vicencio
- Department of Medicine, Mercy Hospital and Medical Center, Chicago, IL
| | - Mary Sano
- Division of Pulmonary, Critical Care and Sleep Medicine, James J. Peters VA Medical Center, Bronx, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Juan P Wisnivesky
- Department of Medicine, Mercy Hospital and Medical Center, Chicago, IL
| | - Alex D Federman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
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de Vries McClintock HF, Morales KH, Small DS, Bogner HR. Patterns of Adherence to Oral Hypoglycemic Agents and Glucose Control among Primary Care Patients with Type 2 Diabetes. Behav Med 2014; 42:63-71. [PMID: 24673362 PMCID: PMC4177523 DOI: 10.1080/08964289.2014.904767] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Researchers sought to examine whether there are patterns of oral hypoglycemic-agent adherence among primary-care patients with type 2 diabetes that are related to patient characteristics and clinical outcomes. Longitudinal analysis via growth curve mixture modeling was carried out to classify 180 patients who participated in an adherence intervention according to patterns of adherence to oral hypoglycemic agents across 12 weeks. Three patterns of change in adherence were identified: adherent, increasing adherence, and nonadherent. Global cognition and intervention condition were associated with pattern of change in adherence (p < .05). Patients with an increasing adherence pattern were more likely to have an Hemoglobin A1c (HbA1c) < 7%; adjusted odds ratio = 14.52, 95% CI (2.54, 82.99) at 12 weeks, in comparison with patients with the nonadherent pattern. Identification of patients with type 2 diabetes at risk of nonadherence is important for clinical prognosis and the development and delivery of interventions.
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Affiliation(s)
- Heather F. de Vries McClintock
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 423 Guardian Drive, 921 Blockley Hall, Philadelphia, PA 19104, U.S.A., Department of Family Medicine and Community Health, 3400 Spruce St., 2 Gates, University of Pennsylvania, Philadelphia, PA, U.S.A
| | - Knashawn H. Morales
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, 423 Guardian Drive, 626 Blockley Hall, Philadelphia, PA 19104, U.S.A
| | - Dylan S. Small
- Department of Statistics, The Wharton School, The University of Pennsylvania, 400 Huntsman Hall, 3730 Walnut St., Philadelphia, PA, U.S.A
| | - Hillary R. Bogner
- Department of Family Medicine and Community Health, 3400 Spruce St., 2 Gates, University of Pennsylvania, Philadelphia, PA, U.S.A.; Secondary Affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 423 Guardian Drive, 928 Blockley Hall, Philadelphia, PA 19104, U.S.A
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23
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Cognitive predictors of limited health literacy in adults with heterogeneous socioeconomic backgrounds. J Health Psychol 2014; 20:1613-25. [DOI: 10.1177/1359105313520337] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The purpose of this study was to explore the relationship between health literacy and specific cognitive abilities in hospital users. A neuropsychological battery was administered and the Short Test of Functional Health Literacy in Adults was used to classify individuals as having adequate or limited functional health literacy. Of the 322 participants, 102 (31.7%) presented limited health literacy. Even after adjusting for demographics, years of education, and quality of education, health literacy was strongly associated with measures of cognitive performance, but the strength of association was variable across different cognitive abilities.
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24
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Choi S, Song M, Chang SJ, Kim SA. Strategies for enhancing information, motivation, and skills for self-management behavior changes: a qualitative study of diabetes care for older adults in Korea. Patient Prefer Adherence 2014; 8:219-26. [PMID: 24627626 PMCID: PMC3931579 DOI: 10.2147/ppa.s58631] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To describe strategies for enhancing information, motivation, and skills related to changes in diabetes self-management behavior among community-dwelling older adults in Korea. PATIENTS AND METHODS A total of five focus group interviews (three separate focus groups) were conducted with 12 older adults with type 2 diabetes and five diabetes educators. Qualitative content analysis was used. RESULTS "One's own willingness and ability" emerged as a fundamental belief about the strategies for diabetes self-management. Six major themes under three categories were identified. Under the information category, the recurrent themes were: 1) repeatedly offering detailed knowledge regarding self-management, 2) providing information about current health status, and 3) identifying experiential knowledge of blood glucose control. The recurrent themes in the motivation category were: 1) ensuring a positive attitude regarding self-management, and 2) encouragement or feedback from significant others. Furthermore, in the skills category, we found that the following theme emerged: hands-on skills training with numerical standards. CONCLUSION This study identified six tailored strategies for enhancing information, motivation, and skills for diabetes self-management behavior changes. These strategies can be used in the development of a culturally sensitive diabetes self-management program for older adults.
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Affiliation(s)
- Suyoung Choi
- College of Nursing, Jeju National University, Jeju, Korea
| | - Misoon Song
- College of Nursing, and The Research Institute of Nursing Science, Seoul National University, Seoul, Korea
- Correspondence: Misoon Song, College of Nursing, Seoul National University, 28 Yeongun-Dong, Chongno-Gu, Seoul 110-799, Korea, Tel +82 2 740 8826, Fax +82 2 764 8457, Email
| | - Sun Ju Chang
- Department of Nursing Science, Chungbuk National University, Cheongju, Korea
| | - Se-an Kim
- College of Nursing, Seoul National University, Seoul, Korea
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