Instruments assessing medication literacy in adult recipients of care: A systematic review of measurement properties

Toward a Medication Information Literacy Indicator System for Older Adults: A Delphi Study

BACKGROUND

The safety of medication use among older adults is a growing concern, given the aging population. Despite widespread attention, the exploration of medication literacy in older adults, particularly from the perspective of information literacy, is in its nascent stages.

METHODS

This study utilized the existing literature to define medication information literacy (MIL) as a theoretical framework. A two-round Delphi survey was conducted to identify the essential components of a MIL indicator system for older adults. The analytic hierarchy process (AHP) was then used to assign weights to each indicator.

RESULTS

The study observed relatively high response rates in both rounds of the questionnaire, which, along with expert authority coefficients (Cr) of 0.86 and 0.89, underscores the credibility and expertise of the panellists. Additionally, Kendall's coefficient of concordance (Kendall's W) ranging from 0.157 to 0.33 (p < 0.05) indicates a consensus among experts on the identified indicators. Utilizing the Delphi process, a MIL indicator system for older adults was developed, comprising five primary and 23 secondary indicators. These indicators were weighted, with medication information cognition and acquisition emerging as pivotal factors in enhancing medication literacy among older adults.

CONCLUSIONS

This study developed a MIL indicator system tailored for older adults using the Delphi approach. The findings can inform healthcare professionals in providing customized medication guidance and assist policymakers in crafting policies to enhance medication safety among older adults.

PATIENT OR PUBLIC CONTRIBUTION

Patient and public engagement played a pivotal role in the development of our medication information literacy indicator system for older adults. Their involvement contributed to shaping research questions, facilitating study participation, and enriching evidence interpretation. Collaborations with experts in geriatric nursing, medicine, and public health, along with discussions with caregivers and individuals with lived experience, provided invaluable insights into medication management among older adults. Their input guided our research direction and ensured the relevance and comprehensiveness of our findings.

Psychometric properties of instruments used to measure the informatics competence of nurses: A systematic review

AIM

This systematic review aimed to assess the psychometric properties of existing nursing informatics scales of competence and provide an evidence-based basis for selecting the most appropriate assessment instruments for specific populations.

BACKGROUND

Informatics competency is one of the fundamental competencies that nurses should have. Using an informatics competency assessment instrument is an effective way to identify competency gaps and develop a professional development plan to address them. However, no systematic reviews summarizing and assessing the psychometric properties of all nursing informatics competency assessment instruments exist.

DESIGN

This study systematically reviews measurement properties using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology.

METHODS

Eight electronic databases (PubMed, Embase, Web of Science, CINAHL Complete, MEDLINE, PsychInfo, China National Knowledge Infrastructure and WanFang Data) were systematically searched from inception until January 10, 2024. Methodological quality was assessed using the COSMIN Risk of Bias Checklist. We used the COSMIN criteria to summarize and rate the psychometric properties.

RESULTS

Twenty-seven studies reported twenty-five various versions of the instruments. Eighteen instruments assessed only one to three psychometric properties. No studies report cross-cultural effectiveness/measurement invariance and measurement error. The quality of evidence for structural validity or internal consistency for the three instruments failed to satisfy the COSMIN criteria. The SANICS-C has moderate to high-quality evidence of adequate content validity and internal consistency. In the end, the SANICS-C was an A recommendation, three instruments were C recommendations and the rest were B recommendations.

CONCLUSION

The Nursing Informatics Competencies Scale for Nursing Students, SANICS-C and ICAT can be used to assess the informatics competencies of undergraduate, graduate and doctoral nursing students, respectively. The C-NICAS-FR is recommended for the assessment of nurses' informatics competence. The Self-Assessment Questionnaire for Nursing Informatics Competencies of Nursing Manager can be recommended for assessing nurse leaders' informatics competencies. Future research needs to validate these instruments' cross-cultural applicability further and comprehensively assess their psychometric properties. Along with emerging technologies, researchers should continually revisit and revise existing assessment instruments and develop instruments to assess the informatics competencies of nursing teachers.

Medication Literacy Test for Older Adults: psychometric analysis and standardization of the new instrument

BACKGROUND

Low medication literacy is prevalent among older adults and is associated with adverse drug events. The Medication Literacy Test for Older Adults (TELUMI) was developed and content validated in a previously published study.

AIM

To evaluate the psychometric properties and provide norms for TELUMI scores.

METHOD

This was a cross-sectional methodological study with older adults selected from the community and from two outpatient services. Descriptive item-analysis, exploratory factor analysis (EFA), item response theory (IRT), reliability, and validity analysis with schooling and health literacy were performed to test the psychometric properties of the TELUMI. The classification of the TELUMI scores was performed using percentile norms.

RESULTS

A total of 344 participants, with a mean age of 68.7 years (standard deviation = 6.7), were included; most were female (66.6%), black/brown (61.8%), had low schooling level (60.2%) and low income (55.2%). The EFA pointed to the one-dimensional structure of TELUMI. A three-parameter logistic model was adopted for IRT. All items had an adequate difficulty index. One item had discrimination < 0.65, and three items had an unacceptable guessing index (< 0.35) and were excluded. The 29-item version of TELUMI had excellent internal consistency (KR20 = 0.89). There was a positive and strong association between TELUMI scores and health literacy and education level. The scores were classified as inadequate medication literacy (≤ 10.0 points), medium medication literacy (11-20 points), and adequate medication literacy (≥ 21 points).

CONCLUSION

The results suggest that the 29-item version of TELUMI is psychometrically adequate for measuring medication literacy in older adults.

Instruments for assessing the spiritual needs of cancer patients: A systematic review of psychometric properties

AIMS AND OBJECTIVES

To identify available instruments for assessing cancer patients' spiritual needs and to examine their psychometric properties using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology.

BACKGROUND

Cancer patients frequently have significant spiritual needs. The nurse plays an integral role in assessing the patient's spiritual needs as part of providing holistic care. It is crucial to assess these needs using appropriate and reliable instruments.

DESIGN

A systematic review based on COSMIN methodology.

METHODS

Seven electronic databases (PubMed, EMBASE, CINAHL, Web of Science, ProQuest, CNKI and WANFANG) were systematically searched from inception until 14 February 2023. Two authors independently screened eligible literature, extracted data and evaluated methodological and psychometric quality. This systematic review was conducted following the PRISMA checklist.

RESULTS

Sixteen studies have reported 16 different versions of the instruments. None of the instruments were properly assessed for all psychometric properties, nor were measurement error, responsiveness and cross-cultural validity/measurement invariance reported. All of the instruments failed to meet the COSMIN quality criteria for content validity. The quality of evidence for structural validity and/or internal consistency in five instruments did not meet the COSMIN criteria. Eventually, five instruments were not recommended, and 11 were only weakly recommended.

CONCLUSION

Instruments to assess spiritual needs exhibited limited reliability and validity. The Spiritual Care Needs Scale is provisionally recommended for research and clinical settings, but its limitations regarding content validity and cross-cultural application must be considered in practice. Future research should further revise the content of available instruments and comprehensively and correctly test their psychometric properties.

RELEVANCE TO CLINICAL PRACTICE

The review findings will provide evidence for healthcare professionals to select instruments for recognising spiritual needs in cancer patients.

NO PATIENT OR PUBLIC CONTRIBUTION

This study is a systematic review with no patient or public participation.

Development and content validation of the medication literacy test for older adults (TELUMI)

OBJECTIVES

Medication literacy comprises the skills needed to access, understand, and act on medication information. Low medication literacy is frequent among older adults, making them more susceptible to negative health outcomes. The aim of this study was to develop and evaluate the content validity of an instrument to measure medication literacy in this population.

METHOD

Multistage methodological study. Items were generated according to a conceptual model and a literature review. The instrument was submitted to a panel of experts to assess item's relevance, clarity, and theoretical classification. Subsequently, the instrument was applied to the target population to assess its comprehensibility.

RESULTS

Content Validity Index results indicated excellent agreement among experts on the instrument's relevance (0.98) and clarity (0.91). Overall agreement between experts regarding the theoretical subdimensions was moderate [Fleiss' kappa=0.57 (p = 0.00)]. Items were reported to be fully understood by most representatives of the target population. The final version of the instrument had 33 items divided into eight scenarios of medication use.

CONCLUSION

The instrument seems to have adequate content validity and good suitability for the target population. Therefore, it can help health professionals to identify older adults with low medication literacy, aiming to improve their medication use skills.

Developing Medication Therapy Management Training for Community Health Professionals Serving Low-Income Patients

BackgroundEach year, medication-related adverse events account for over 1 million emergency department visits according to the Office of Disease Prevention and Health Promotion. Medication therapy management (MTM), a service most commonly performed by health professionals, identifies and resolves medication-related problems and has been shown to both reduce healthcare costs and improve clinical outcomes. Objective: The objective of our project was to expand the use of MTM by developing a training program for health professionals to increase medication adherence for low-income patients at Federally Qualified Health Centers (FQHCs) specifically targeting individuals with hypertension and diabetes. Methods: A needs assessment survey was developed and administered to licensed pharmacists across the state of Florida. Based on the results of the survey, an MTM training program was developed to support pharmacists who serve patients with hypertension and diabetes. The second phase included a pre-assessment administered to the FQHC. The training program was modified based on responses to the pre-assessment. Results: Based on the FQHC pre-assessment, the team developed MTM support training for health professionals that included 7 modules. These modules were Principles of Chronic Disease Self-Management, Team-Based Care, Client Self-Advocacy, Health Equity, Cultural Competency, Social Determinants of Health, and the Benefits of MTM Services. Conclusion: Expanding MTM support training to other health professionals is expected to provide greater access to chronic disease management support, improve patient outcomes and reduce the cost of care for patients. It is also expected over time to reduce the demand for additional chronic disease-related services.

The Mediating Effect of Self-Efficacy on the Relationship Between Medication Literacy and Medication Adherence Among Patients with Type 2 Diabetes

Background

Patients with type 2 diabetes have poor medication adherence. Medication literacy is one of the influencing factors of medication adherence among patients with type 2 diabetes. However, the mechanism by which medication literacy affects medication adherence among patients with type 2 diabetes is unclear. The aim of this study was to verify the mediating role of self-efficacy in the relationship between medication literacy and medication adherence.

Methods

A total of 402 patients with type 2 diabetes were enrolled in this study. The Chinese versions of the Medication Literacy Scale, the Self-Efficacy for Appropriate Medication Use Scale and the Morisky Medication Adherence Scale-8 were used in the survey. Pearson correlation analysis was used to find correlations among medication literacy, self-efficacy and medication adherence. The PROCESS macro (Version 4.1) with Model 4 for SPSS was used to verify the mediating role of self-efficacy.

Results

Twenty-four percent of the participants had poor medication adherence. Self-efficacy and medication literacy (r=0.499, p < 0.01) and medication adherence (r=0.499, p < 0.01) were significantly and positively correlated. Self-efficacy partially mediated the relationship between medication knowledge and medication adherence among patients with type 2 diabetes, accounting for 36.7% of the total effect.

Conclusion

Self-efficacy had a partial mediating effect on the relationship between medication literacy and medication adherence among patients with type 2 diabetes. Self-efficacy should be improved through effective measures to increase patients' confidence in adherence to antihyperglycemic drugs.

Association between medication literacy and medication adherence and the mediating effect of self-efficacy in older people with multimorbidity

BACKGROUND

Multimorbidity has a significant impact on public health and primary care. Medication adherence is recognized as the most effective measure for managing and preventing multimorbidity. Studies have shown that medication literacy has a positive effect on medication adherence in patients with multimorbidity. However, limited knowledge exists regarding the underlying mechanisms of this relationship in older adults with multimorbidity. Therefore, the aim of this study was to investigate the mediating role of self-efficacy in the association between medication literacy and medication adherence in this population.

METHODS

This study employed a cross-sectional design and convenience sampling method to survey older patients with multimorbidity in six communities in Zhengzhou, China, from July 12, 2021, to December 15, 2021. Participants were assessed using a demographic questionnaire, the Chinese Version of the Medication Literacy Scale (C-MLS), the Self-Efficacy for Appropriate Medication Use Scale (SEAMS), and the Chinese Version of the Morisky Medication Adherence Scale-8 (C-MMAS-8). Data were analyzed using descriptive statistics, t-tests, one-way analysis of variance, Pearson correlation analysis, and mediation analysis.

RESULTS

A total of 350 elderly patients met the inclusion criteria, and 328 valid questionnaires were collected. The mean age of the participants was 74.90 ± 7.37 years, with a slightly higher proportion of males (55.8%) than females (44.2%). The mean score for medication adherence was 4.85 ± 1.57, indicating poor medication adherence among the participants. Medication adherence scores varied significantly among participants of different ages, education levels, employment statuses and kinds of medication (p < 0.01). Scores for medication literacy and self-efficacy showed a significant positive correlation with medication adherence scores (all p < 0.001). The standardized coefficient for the total effect and direct effect of medication literacy on medication adherence was 0.268 (95% CI: 0.201, 0.335) and 0.187 (95% CI: 0.123, 0.252), respectively. After introducing self-efficacy into the model, the standardized coefficient for the indirect effect was 0.081 (95% CI: 0.049, 0.120), indicating that self-efficacy partially mediated the relationship between medication literacy and medication adherence, accounting for 30.22% of the total effect.

CONCLUSION

This study might suggest that medication literacy indirectly affected medication adherence in older people with multimorbidity through self-efficacy. Health care providers should be aware of the importance of improving medication literacy and implement strategies aimed at increasing self-efficacy to achieve the goal of improving medication adherence in older adults with multimorbidity.

Cross-cultural adaptation and validation of the Recognizing And Addressing Limited Pharmaceutical Literacy (RALPH) interview guide in community pharmacies

BACKGROUND

The RALPH (Recognizing and Addressing Limited PHarmaceutical Literacy) interview guide makes it possible to identify patients with limited pharmaceutical knowledge and to assess their skills in the functional, communicative, and critical health literacy domains.

OBJECTIVE

(s): To perform a cross-cultural validation of the RALPH interview guide in Spanish population; to conduct a descriptive analysis based on patients' responses.

METHODS

A cross-sectional study of patients' pharmaceutical literacy skills was conducted in three stages: systematic translation, administration of the interview and analysis of psychometric properties. The target population included adult patients (≥18 years) who attend one of the participating community pharmacies in Barcelona (Spain). Content validity was evaluated by an expert committee. Viability was assessed in the pilot test, and reliability was assessed using internal consistency and intertemporal stability. Construct validity was assessed by factor analysis.

RESULTS

A total of 103 patients were interviewed at 20 pharmacies. Cronbach's alpha values based on standardized items ranged between 0.720 and 0.764. For the longitudinal component, the ICC test-retest reliability was 0.924. The factor analysis was verified by KMO (0.619) and Bartlett's test of sphericity (P-value <0.05). The definitive RALPH guide translated into Spanish maintains the same structure as the original. Some expressions were simplified, and the questions on the comprehension of warnings or specific instructions for use, contradictory information and shared decision-making were reformulated. Pharmaceutical literacy skills were seen to be most limited with regard to the critical domain. The responses of the Spanish patients were in agreement with the original results of the RALPH interview guide.

CONCLUSIONS

The RALPH interview guide in Spanish complies with the requirements viability, validity, and reliability. This tool may be able to identify the low pharmaceutical literacy skills of patients coming to community pharmacies in Spain, and its use may also be extended to other Spanish-speaking countries.

Development of a medication literacy assessment instrument (MELIA) for older people receiving home care

AIM

To develop a consensus-based instrument [MELIA] to assess the medication literacy of older home care patients to ultimately optimize medication safety.

DESIGN

This study was part of the project 'Study of Medication Safety in Home Care' (doMESTIC), which took place from 2016 to 2020 in Switzerland. The development process for the medication literacy assessment instrument encompassed six steps.

METHOD

First, a scoping literature search was conducted in the Pubmed, CINAHL, EMBASE and Cochrane Library databases as 2) a basis for the development of assessment items. This was followed by 3) a cognitive interview with home care patients and 4) the first round of a Delphi process. Then, 5) a focus group interview with home care experts was conducted before 6) the second Delphi round. The project took place between August 2020 and June 2021. With these different steps, perspectives of both patients and various home care and medication safety experts were included in the development of the assessment instrument.

RESULTS

A detailed instrument consisting of 20 items as well as a 7-item short version were developed. The short version is intended for efficient preliminary screening to identify patients at high risk for medication management-related problems.

CONCLUSION

Medication literacy in patients 65 years and older receiving professional home care is a key issue in preventing medication errors. A targeted assessment, starting with an efficient short version of MELIA, allows for prioritization of patients for interventions to optimize medication safety while ensuring their independence as much as possible.

IMPACT

Systematic assessment of patients' medication literacy helps to provide them with targeted and individual support in their medication management to avoid medication errors and increase patient safety. The development of MELIA is a first step in providing an assessment instrument specifically for the home care setting.

PATIENT OR PUBLIC CONTRIBUTION

Patient participation was an integral part of the instrument development. The initial 23 items were optimized based on cognitive interviews with four home care patients. The next steps of the instrument development were based on feedback of health care professionals-encompassing advance practice nurses, regular nurses, pharmacists and general practitioners-during a two-step Delphi process as well as a focus group discussion.

Psychometric properties and validation of the revised Chinese Medication Literacy Scale for Hypertensive Patients (C-MLSHP-R)

Background

Medication literacy is one of the key indicators that can affect the self-management of medications and medication safety. This study aimed to revise the Chinese Medication Literacy Scale for hypertensive patients (C-MLSHP) and test the reliability and validity of the revised scale.

Methods

We revised the C-MLSHP by several methods, i.e., focus group discussion, expert consultation, patient interview, and pilot study, based on the established evaluation index system of medication literacy for hypertensive patients. Then, a formal survey using the revised Chinese Medication Literacy Scale for hypertensive patients (C-MLSHP-R) was carried out on hypertensive patients from hospitals and community healthcare centers in Changsha city of China to test its reliability and validity. The reliability was evaluated with Cronbach's α coefficient, split-half reliability, and test–retest reliability. The validity was evaluated with content validity, construct validity, convergent validity, discriminant validity, and criterion-related validity.

Results

The C-MLSHP-R contained 18 items within four domains, i.e., the knowledge domain included four items, the attitude domain had three items, the skill domain involved seven items, and the practice domain included four items. A total of 339 hypertensive patients participated in the formal survey. The results showed that the Cronbach's α coefficient of C-MLSHP-R was 0.802, and for each domain ranged from 0.639 to 0.815. The split-half reliability coefficient of C-MLSHP-R was 0.709, and for each domain ranged from 0.648 to 0.792. The test–retest reliability coefficient of C-MLSHP-R was 0.851, and for each domain ranged from 0.655 to 0.857. The I-CVI of each item ranged from 0.833 to 1.000, the S-CVI/Ave of C-MLSHP-R was 0.981, the S-CVI/UA was 0.889, and for each domain ranged from 0.958 to 1.000. Confirmatory factor analysis results showed that the model fitted well. The convergent validity of C-MLSHP-R was acceptable, and the discriminant validity was good. The criterion coefficient between C-MLSHP-R and C-MLSHP was 0.797, and for each domain ranged from 0.609 to 0.755.

Conclusion

Compared with C-MLSHP, the C-MLSHP-R with 18 items was much shorter for measuring, and had decreased reliability within the acceptable range and better validity, which was more appropriate and time-saving to assess the medication literacy level for hypertensive patients scientifically and conveniently.

Conceptualization and content validation of the MEDication literacy assessment of geriatric patients and informal caregivers (MED-fLAG)

Background

The assessment of patients’ medication literacy skills (i.e., abilities to access, comprehend and interact with medication-related information) is an important step in assisting clinicians to plan for appropriate care. Despite several attempts by researchers to develop measures of medication literacy, an instrument tailored to the specific needs of older adults remains a significant shortfall. Therefore, an interprofessional team that included a citizen co-researcher conceptualized a new standardised measure of medication literacy—the MEDedication Literacy Assessment of Geriatric patients and informal caregivers (MED-fLAG). MED-fLAG was designed as a three-dimensional self-reported measure of functional, interactive and critical skills. This study describes the conceptualization process and provides the results of an evaluation of MED-fLAG’s content validity, acceptability, and feasibility during a hospital stay.

Methods

MED-fLAG was developed in accordance with the guidance on scale development and standards for good content validity, by using the following steps: (I) conceptualization of a provisional version of MED-fLAG; (II) iterative qualitative evaluation of its content validity by older adults, informal caregivers and healthcare professionals.

Results

The qualitative assessment of the initial 54-item MED-fLAG was conducted in 36 participants, namely 13 home-dwelling older adults and/or informal caregivers and 23 healthcare professionals. Six rounds of revisions were performed to achieve content validity and to propose a 56-item revised MED-fLAG. Participants reported benefits of using a standardized assessment of medication literacy during a hospital stay but warned about certain limitations and prerequisites. The extent to which MED-fLAG could be integrated into discharge planning needs to be further investigated.

Conclusions

MED-fLAG is the first medication literacy measure tailored to the specific needs of older patients and informal caregivers. A unique feature of this measure is that it includes prescribed and non-prescribed medications, irrespective of the galenic form. Additional studies are required to evaluate the other measurement properties of MED-fLAG, and to reduce the number of items before considering its clinical application.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41687-022-00495-2.

On the basis of what has been written about medication literacy and the experiences of experts, we developed a new questionnaire to measure medication literacy (MED-fLAG) in older adults and/or informal caregivers. MED-fLAG was then submitted to older adults, informal caregivers and healthcare professionals to retrieve their feedback concerning the relevance, comprehensibility and exhaustiveness of the proposed items. In future, MED-fLAG will allow health professionals to evaluate medication literacy skills in older patients during hospitalization and/or in their informal caregivers when they are responsible for preparing or administering the medications, and then propose individualised support.

Status of medication literacy and its related factors among undergraduate students in Shanxi Province, China: A cross-sectional study

WHAT IS KNOWN AND OBJECTIVE

Medication safety problem has always been the focus of healthcare providers and public health community scholars. As the backbone of the future society, the mastery of college students' knowledge to use medicine will directly affect the level of medication literacy (ML) of the public in the future. The purpose of this study was to investigate the current ML of college students in Shanxi Province and to identify its related factors.

METHODS

A cluster random sampling method was utilized to select 800 college students from 10 universities in Shanxi province as participants from 21 March to 10 April 2020. After quality control, 763 valid questionnaires were collected (effective rate 95.4%). This study applied the ML scale adapted from the 14-item health literacy scale (HLS-14) to estimate ML, which contains functional ML, communicative ML and critical ML dimensions to estimate the ML situation. Then, we used structural equation modelling (SEM) to test the hypothesized relationship among three dimensions of ML, self-evaluated health status and safety medication science popularization activities on campus.

RESULTS AND DISCUSSION

The results showed that the reliability and validity of the ML scale were good. The average score of ML level of college students in Shanxi Province was 44 points, and the interquartile range was 40-48 points (full score is 65 points). The proportion of high ML level was estimated at as low as 26.7%. 73.1% participants had an average level, and only 1 participant (0.1%) had a low level of ML. Univariate analysis showed that the ML level was significantly influenced by gender, universities, field of study, academic performance and ethnic group (p < 0.05). SEM showed that functional ML (λ = 0.01) and communicative ML (λ = 0.75) had a direct positive association with critical ML. Meanwhile, the model also had a mediating effect. Functional ML had an indirect positive association with critical ML through the mediating effect of communicative ML (λ = 0.11). In addition, both self-evaluated health status and safety medication science popularization activities on campus had an indirect positive association with critical ML through the mediating effect of functional ML and communicative ML.

WHAT IS NEW AND CONCLUSION

The study revealed that the ML of most college students in Shanxi Province was at the average level. Among them, medical college student (including pharmacy, nursing, public health, preventive medicine, basic medicine and clinical medicine students), the Han nationality students (the students of China's majority ethnic group), students of good self-evaluated health status, and students who were more exposed to safety medication science popularization activities had a relatively higher ML level. Moreover, it highlighted the importance of self-evaluated health status and safety medication science popularization activities on campus to ML.

Instruments to assess self-neglect among older adults: A systematic review of measurement properties

OBJECTIVE

To critically appraise, compare, and summarize the measurement properties of existing instruments that assess self-neglect among older adults.

METHODS

Eight electronic databases (PubMed, Scopus, Embase, CINAHL Plus with Full Text, Web of Science, PsycINFO, China National Knowledge Infrastructure, and WanFang Data) were searched from their inception to September 6, 2020. The methodological qualities of the included studies on measurement properties were assessed by using the COnsensus-based Standards for selection of health Measurement INstruments (COSMIN) methodology for systematic reviews of Patient-Reported Outcome Measures (PROMs).

RESULTS

Among the 1184 studies identified, 47 full-text studies were assessed further for their eligibilities. A total of 8 studies were eventually included. The methodological quality of content validity for relevance, comprehensiveness, and comprehensibility of all instruments in this review was doubtful or inadequate. The methodological quality of structural validities in the majority of the studies were very good, while the quality of hypothesis testing for construct validity was doubtful. The internal consistency was assessed by calculating Cronbach's alpha coefficient in all studies. Some measurement properties (e.g., cross-cultural validity/measurement invariance, measurement error, and responsiveness) were not assessed in the reviewed studies.

CONCLUSIONS

This systematic review provides a comprehensive overview of the measurement properties of elder self-neglect instruments. Among the eight instruments identified, none of them demonstrate better properties than any other. Future studies are suggested to use COSMIN methodology as guideline to examine the measurement properties of the developed instruments. Instruments with rigid measurement properties are urgently needed to assess self-neglect among older adults to provide the necessary and valuable information on this particular phenomenon.

Medication literacy: A conceptual model

BACKGROUND

Medication literacy reflects the specific literacy skills necessary to act on medication-related information. A comprehensive and clear conceptual model that reflects medication literacy is lacking. Conceptual models describe the components that represent a construct, allowing for its understanding and providing a rationale for its measurement.

OBJECTIVES

To propose a conceptual model to support the development of an instrument to measure medication literacy.

METHODS

This is a three-phase methodological study. A literature review was conducted to identify the components that should be part of the preliminary conceptual model. Subsequently, the importance of its components was judged on a Likert-5 scale. Then, the model was refined, and the dimensions and subdimensions of medication literacy were defined.

RESULTS

Forty-five experts were included, with a mean age of 39.9 (SD = 10.5) years, most of them females (86.7%) and pharmacists (80%). All components of the preliminary conceptual model were considered important to extremely important by most experts. "Dosing information", "medication name", and "processing the information received about their medication and acting upon medication instructions" were the components considered most important. In the refinement phase, we identified that the construct has four dimensions - functional literacy, communicative literacy, critical literacy, and numeracy, which include the subdimensions to access, understand, evaluate, calculate, and communicate medication-related information.

CONCLUSIONS

The conceptual model allowed identifying the components that represent medication literacy, which will support the development of an instrument for measuring the construct in Brazil.

Ideal instruments used to measure health literacy related to medication use: A systematic review

BACKGROUND

Prior studies showed the association between inadequate health literacy (HL) and poor medication-related skills, while none of the published studies have reviewed and compared the existing instruments used to measure medication-related HL. This systematic review comprehensively summarizes the existing instruments that assess medication-related HL.

OBJECTIVES

To identify appropriate HL instruments related to medication use as screening tools for enhancing patients' ability to use medications correctly.

METHODS

This review retrieved medication-related HL instruments that were published between 2000 and 2019 from three databases (i.e., PubMed, Scopus, EMBASE) and by hand-searching. The PRISMA procedure was followed as well as the SURGE guideline to assess the quality of studies. Psychometric properties, HL dimensions, and types of medication information gleaned from the items in three types of HL instruments (i.e., general, disease-specific, medication-specific) were compared to identify appropriate medication-related HL instruments.

RESULT

Forty-eight instruments were identified from 44 studies, whereas 70.8% instruments were either disease- or medication-specific HL instruments. Most instruments with different sample sizes showed certain an extent of reliability and validity. The distributions of HL dimensions and types of medication information among the relevant items were varied across different types of instruments. The five instruments (named as the 16SQ, AKQ-CQ, DHLKI, AKT, and ChMLM) were identified as the most appropriate instruments for three types of medication-related HL, respectively. These appropriate instruments consistently covered items related to HL dimensions of literacy and comprehension and medication-related information regarding dosing, treatment indication, and side effects/precautions.

CONCLUSION

Of 48 identified instruments mainly derived from disease- or medication-specific studies, the five most appropriate medication-related HL instruments were identified to support clinicians in facilitating patients' correct medication use. Further confirmation to explore the usefulness among these instruments are needed.