Health literacy in Canada and the ophthalmology patient

Relationship between health literacy and COVID-19 knowledge: A cross-sectional study

Background

Health literacy (HL) is a protective factor for some chronic diseases. However, its role in the Coronavirus Disease 2019 (COVID-19) pandemic has not been clarified. This study aims to explore the association between HL and COVID-19 knowledge among residents in Ningbo.

Methods

A total of 6,336 residents aged 15-69 years in Ningbo were selected by multi-stage stratified random sampling method. The "Health Literacy Questionnaire of Chinese Citizens (2020)" was used to evaluate the relationship between COVID-19 knowledge and HL. Chi-square test, Mann-Whitney U test and logistic regression were used to analyze the data.

Results

The HL and COVID-19 knowledge levels of Ningbo residents were 24.8% and 15.7%, respectively. After adjusting for confounding factors, people with adequate HL were the more likely to have adequate COVID-19 knowledge compared with those with limited HL (OR = 3.473, 95% CI = 2.974-4.057, P <0.001). Compared with the limited HL group, the adequate HL group had a higher rate of COVID-19 knowledge, a more positive attitude, and a more active behavior.

Conclusion

COVID-19 knowledge is significantly associated with HL. Improving HL may influence people's knowledge about COVID-19, thereby changing people's behaviors, and finally combating the pandemic.

The Readability of Ophthalmological Patient Education Materials Provided by Major Academic Hospitals

INTRODUCTION

The internet is an increasingly important resource for patients seeking health-related information. Because of this trend, the American Medical Association (AMA) and National Institutes of Health (NIH) recommend that online patient education materials (PEMs) be written between a third and seventh grade level. The present study evaluates the readability levels of ophthalmological PEMs provided by five major academic hospitals, quantifies the availability of accompanying videos and graphics, and examines the extent to which readability may be increased.

METHODS

In March 2021, 397 PEMs from five major academic hospitals were extracted for subsequent analysis by seven validated readability assessments. The presence of an accompanying video or graphic was noted. Statistical significance was assessed using the Kruskal-Wallis test with Dunn's multiple comparisons test and the chi-square test.

RESULTS

Nearly all articles were written above the recommended reading level of 7^th grade. After averaging the scales for each article, the median grade level was 11.7 (interquartile range [IQR], 10.7-12.7). The PEMs with the highest median reading level were provided by the Johns Hopkins University Wilmer Institute (12.6, IQR, 11.3 - 13.6). Only 13.6% and 13.1% of articles had an accompanying video and graphic, respectively. Reduction of sentence length beneath 15 words resulted in an improvement of readability by 2.7 grade levels.

CONCLUSIONS

The readability of online patient resources provided by major academic hospitals were above the literacy guidelines recommended by the NIH and AMA. Furthermore, most articles did not include a video or graphic, both of which could potentially improve patient understandability of educational materials. By altering these PEMs, as demonstrated here, institutions could increase the value these articles provide for patients and therefore the quality of the patient-physician relationship.

Readability of patient education materials in ophthalmology: a single-institution study and systematic review

Background

Patient education materials should be written at a level that is understandable for patients with low health literacy. The aims of this study are (1) to review the literature on readability of ophthalmic patient education materials and (2) to evaluate and revise our institution’s patient education materials about glaucoma using evidence-based guidelines on writing for patients with low health literacy.

Methods

A systematic search was conducted on the PubMed/MEDLINE database for studies that have evaluated readability level of ophthalmic patient education materials, and the reported readability scores were assessed. Additionally, we collected evidence-based guidelines for writing easy-to-read patient education materials, and these recommendations were applied to revise 12 patient education handouts on various glaucoma topics at our institution. Readability measures, including Flesch-Kincaid Grade Level (FKGL), and word count were calculated for the original and revised documents. The original and revised versions of the handouts were then scored in random order by two glaucoma specialists using the Suitability Assessment of Materials (SAM) instrument, a grading scale used to evaluate suitability of health information materials for patients. Paired t test was used to analyze changes in readability measures, word count, and SAM score between original and revised handouts. Finally, five glaucoma patients were interviewed to discuss the revised materials, and patient feedback was analyzed qualitatively.

Results

Our literature search included 13 studies that evaluated a total of 950 educational materials. Among the mean FKGL readability scores reported in these studies, the median was 11 (representing an eleventh-grade reading level). At our institution, handouts’ readability averaged a tenth-grade reading level (FKGL = 10.0 ± 1.6), but revising the handouts improved their readability to a sixth-grade reading level (FKGL = 6.4 ± 1.2) (p < 0.001). Additionally, the mean SAM score of our institution’s handouts improved from 60 ± 7 % (adequate) for the original versions to 88 ± 4 % (superior) for the revised handouts (p < 0.001).

Conclusions

Our systematic review of the literature reveals that ophthalmic patient education materials are consistently written at a level that is too high for many patients to understand. Our institution’s experience suggests that applying guidelines on writing easy-to-understand material can improve the readability and suitability of educational materials for patients with low health literacy.

A survey for the need of translational aids among Canadian ophthalmologists

OBJECTIVE

To conduct a needs assessment survey of Canadian ophthalmologists to determine whether there is a requirement for translational aids in ophthalmology, and if so, the content, format, and languages to include.

DESIGN

Anonymous voluntary online needs assessment questionnaire.

PARTICIPANTS

A total of 139 ophthalmologists completed the online needs assessment questionnaire.

METHODS

An anonymous voluntary online survey in English and French was distributed to 700 active members (practicing Canadian ophthalmologists) of the Canadian Ophthalmological Society. Data were collected regarding the potential utility of translational aids, as well as the contents and languages that should be included if such aids were to be created. Level of support for translational aids, as well as the contents and languages of potential translational aids, was assessed.

RESULTS

The survey response rate was 19.9% (139/700). The majority of the respondents (130/139, 93.5%) have encountered difficulty in communicating with patients because of language barrier, and 88.5% (123/139) would benefit from having a list of ophthalmologic terms translated into several of Canada's most popular languages. The top 10 languages that the respondents indicated would be most beneficial are (in descending order): Chinese, Hindi, Spanish, Punjabi, Italian, Portuguese, Arabic, Greek, Cree, and Vietnamese. The survey responses provided a comprehensive list of the most useful ophthalmologic symptoms, instructions to patients, and diagnoses to be translated. Most respondents (120/139, 86.3%) believed that having basic information pamphlets on specific ocular conditions translated into several languages would benefit their practice; the top 3 conditions were cataract, glaucoma, and age-related macular degeneration. Producing the translational aids in both paper and electronic format was found to be the most favoured (89/139, 64.0%).

CONCLUSIONS

Canadian ophthalmologists believe they would benefit from translational aids. The results of this survey provide a framework for the creation of such aids.

'Are decisions about discharge of elderly hospital patients mainly about freeing blocked beds?' A qualitative observational study

OBJECTIVE

To explore the interactions concerning the frail and elderly patients having to do with discharge from acute hospital wards and their participation in medical decision-making. The views of the patients and the medical staff were both investigated.

DESIGN

A qualitative observational and interview study using the grounded theory.

SETTING AND PARTICIPANTS

The setting was three hospitals in rural and urban areas of two counties in Sweden of which one was a teaching hospital. The data comprised observations, healthcare staff interviews and patient interviews. The selected patients were all about to be informed that they were going to be discharged.

RESULTS

The patients were seldom invited to participate in the decision-making regarding discharge. Generally, most communications regarding discharge were between the doctor and the nurse, after which the patient was simply informed about the decision. It was observed that the discharge information was often given in an indirect way as if other, albeit absent, people were responsible for the decision. Interviews with the healthcare staff revealed their preoccupation with the need to free up beds: 'thinking about discharge planning all the time' was the core category. This focus not only failed to fulfil the complex needs of elderly patients, it also generated feelings of frustration and guilt in the staff, and made the patients feel unwelcome.

CONCLUSIONS

Frail elderly patients often did not participate in the medical decision-making regarding their discharge from hospital. The staff was highly focused on patients getting rapidly discharged, which made it difficult to fulfil the complex needs of these patients.