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Connell Bohlen L, Dunsiger SI, von Ash T, Larsen BA, Pekmezi D, Marquez B, Benitez TJ, Mendoza-Vasconez A, Hartman SJ, Williams DM, Marcus BH. Six-Month Outcomes of a Theory- and Technology-Enhanced Physical Activity Intervention for Latina Women (Pasos Hacia La Salud II): Randomized Controlled Trial. J Med Internet Res 2024; 26:e51708. [PMID: 38842930 PMCID: PMC11190618 DOI: 10.2196/51708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/10/2023] [Accepted: 03/01/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND More than half (55%) of Latina women do not meet aerobic physical activity (PA) guidelines, and frequently cite time, childcare, and transportation as barriers to PA. In addition to linguistic adaptations for this population, successful PA interventions for Latina women addressed these barriers through remote intervention delivery approaches (eg, mail, phone, or web delivery). OBJECTIVE We aimed to evaluate 6-month outcomes of a randomized trial comparing a Spanish-language, individually tailored, web-delivered PA intervention (original) to an enhanced version with text messages and additional features (enhanced). Further, we evaluated if increases in PA at 6 months were moderated by baseline activity status. METHODS In total, 195 Latina women aged 18-65 years participated in a trial comparing the efficacy of the enhanced versus original interventions at initiating PA behavior change. We examined minutes per week of accelerometer-measured PA in the enhanced versus original arms, and the proportion of each arm meeting aerobic PA guidelines (150 min/wk at 6 mo). For moderator analyses, participants were classified as inactive (0 min/wk) or low active (1-90 min/wk) at baseline, measured via the 7 Day Physical Activity Recall interview. RESULTS PA increased from 19.7 (SD 47.9) minutes per week at baseline to 46.9 (SD 66.2) minutes per week at 6 months in the enhanced arm versus 20.6 (SD 42.7) minutes per week to 42.9 (SD 78.2) minutes per week in the original arm (P=.78). Overall, 30% (31/103) of the enhanced group met aerobic PA guidelines at 6 months, compared to 21% (19/92) of the original group (odds ratio [OR] 1.75, 95% CI 0.87-3.55). Baseline PA (inactive vs low active) moderated treatment effects on PA. For inactive participants, there were no group differences at 6 months (b=7.1; SE 22.8; P=.75), while low-active participants increased more in enhanced than original (b=72.5; SE 27.9; P=.01). For low-active participants, 45% (46/103) of the enhanced group met PA guidelines at 6 months, versus 20% (18/92) of the original arm (OR 3.29, 95% CI 1.05-11.31). For inactive participants, there were no group differences (25/103, 24% vs n=19/92, 21% for enhanced vs original, respectively; OR 1.28, 95% CI 0.54-3.06). CONCLUSIONS Intervention effects were conditional on baseline PA. For low-active Latina women, the enhanced intervention was more effective at increasing PA. Additional tailored intervention enhancements may be necessary to increase PA for inactive Latina women. TRIAL REGISTRATION ClinicalTrials.gov NCT03491592; https://www.clinicaltrials.gov/study/NCT03491592. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-022-06575-4.
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Affiliation(s)
- Lauren Connell Bohlen
- Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Shira I Dunsiger
- Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Tayla von Ash
- Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Britta A Larsen
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, United States
| | - Dori Pekmezi
- Department of Health Behavior, The University of Alabama at Birmingham School of Public Health, Birmingham, AL, United States
| | - Becky Marquez
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, United States
| | - Tanya J Benitez
- Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Andrea Mendoza-Vasconez
- Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Sheri J Hartman
- Herbert Wertheim School of Public Health and Human Longevity Science, Moores Cancer Center, University of California San Diego, La Jolla, CA, United States
| | - David M Williams
- Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Bess H Marcus
- Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
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Brin M, Trujillo P, Jia H, Cioe P, Huang MC, Chen H, Qian X, Xu W, Schnall R. Pilot Testing of an mHealth App for Tobacco Cessation in People Living With HIV: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e49558. [PMID: 37856173 PMCID: PMC10623232 DOI: 10.2196/49558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/17/2023] [Accepted: 09/08/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND An estimated 40% of people living with HIV smoke cigarettes. Although smoking rates in the United States have been declining in recent years, people living with HIV continue to smoke cigarettes at twice the rate of the general population. Mobile health (mHealth) technology is an effective tool for people living with a chronic illness, such as HIV, as currently 84% of households in the United States report that they have a smartphone. Although many studies have used mHealth interventions for smoking cessation, few studies have recruited people living with HIV who smoke. OBJECTIVE The objective of the pilot randomized controlled trial (RCT) is to examine the feasibility, acceptability, and preliminary efficacy of the Sense2Quit App as a tool for people living with HIV who are motivated to quit smoking. METHODS The Sense2Quit study is a 2-arm RCT for people living with HIV who smoke cigarettes (n=60). Participants are randomized to either the active intervention condition, which consists of an 8-week supply of nicotine replacement therapy, standard smoking cessation counseling, and access to the Sense2Quit mobile app and smartwatch, or the control condition, which consists of standard smoking cessation counseling and a referral to the New York State Smokers' Quitline. The Sense2Quit app is a mobile app connected through Bluetooth to a smartwatch that tracks smoking gestures and distinguishes them from other everyday hand movements. In the Sense2Quit app, participants can view their smoking trends, which are recorded through their use of the smartwatch, including how often or how much they smoke and the amount of money that they are spending on cigarettes, watch videos with quitting tips, information, and distractions, play games, set reminders, and communicate with a study team member. RESULTS Enrollment of study participants began in March 2023 and is expected to end in October 2023. All data collection is expected to be completed by the end of January 2024. This RCT will test the difference in outcomes between the control and intervention arms. The primary outcome will be the percentage of participants with biochemically verified 7-day point prevalence smoking or tobacco abstinence at their 12-week follow-up. Results from this pilot study will be disseminated to the research community following the completion of all data collection. CONCLUSIONS The Sense2Quit study leverages mHealth so that it can help smokers improve their efforts at smoking cessation. Our research has the potential to not only increase quitting rates among people living with HIV who may need a prolonged, tailored intervention but also inform further development of mHealth for people living with HIV. This mHealth study will contribute significant findings to the greater mHealth research community, providing evidence as to how mHealth should be developed and tested among the target population. TRIAL REGISTRATION ClinicalTrials.gov NCT05609032; https://clinicaltrials.gov/study/NCT05609032. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/49558.
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Affiliation(s)
- Maeve Brin
- Columbia University School of Nursing, New York City, NY, United States
| | - Paul Trujillo
- Columbia University School of Nursing, New York City, NY, United States
| | - Haomiao Jia
- Columbia University School of Nursing, New York City, NY, United States
| | - Patricia Cioe
- Brown University School of Public Health, Providence, RI, United States
| | - Ming-Chun Huang
- Case Western Reserve University School of Engineering, Cleveland, OH, United States
| | - Huan Chen
- Case Western Reserve University School of Engineering, Cleveland, OH, United States
| | - Xiaoye Qian
- Case Western Reserve University School of Engineering, Cleveland, OH, United States
| | - Wenyao Xu
- Department of Computer Science and Engineering, University at Buffalo, the State University of New York, Buffalo, NY, United States
| | - Rebecca Schnall
- Columbia University School of Nursing, New York City, NY, United States
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Rollins A, Wandell G, Epstein S, Bonilla-Velez J. Evaluating Patient and Family Experience Among Spanish-Speaking and LatinX Patients: a Scoping Review of Existing Instruments. J Racial Ethn Health Disparities 2023; 10:1878-1898. [PMID: 35913545 PMCID: PMC10202136 DOI: 10.1007/s40615-022-01371-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/10/2022] [Accepted: 07/13/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION LatinX populations are rapidly growing in the USA, but still report lower levels of patient centered care and satisfaction when compared to their non-LatinX white counterparts. This review encompasses literature which describes patient experience instruments that (1) evaluate LatinX experience, (2) have validated Spanish versions, or (3) measure language-concordant care experiences. METHODS A scoping review of literature in Ovid Medline, CINAHL, and PsycINFO was conducted. Articles were excluded if they were not applicable to the health care industry, did not include a patient experience instrument, or did not include LatinX or Spanish-speaking individuals within their study population. Data extraction was performed for concepts measured, study size, population, health care setting, and languages validated. RESULTS This review identified 224 manuscripts. Of these, 81 met full inclusion criteria and represented 60 unique instruments. These covered six categories: general patient experience (43%, n = 26/60), experiences of discrimination/mistrust (12%, n = 7/60), cultural factors (10%, n = 6/60), patient-provider relationship (10%, n = 6/60), and communication (8%, n = 5/60). The remaining instruments measured multiple categories (17%, n = 10/60). Just over one third of instruments (n = 24, 5 pediatric, 19 adult) were validated in Spanish and an additional 14 (23%) were validated in English alone. Finally, 4 (7%) instruments were identified which were developed for use in a language concordant setting. CONCLUSION Many instruments were identified which evaluate LatinX patient experience; however, none was both validated in Spanish and measured in all key categories of experience described above. Additionally, few instruments were developed for holistic evaluation of patient experience in pediatric or language concordant care settings.
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Affiliation(s)
- Allison Rollins
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Grace Wandell
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Sherise Epstein
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Juliana Bonilla-Velez
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA.
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, 4800 Sand Point Way NE, Mail Stop OA.9.220, Seattle, WA, 98105, USA.
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA.
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Mendoza-Vasconez AS, Benitez T, Dunsiger S, Gans KM, Hartman SJ, Linke SE, Larsen BA, Pekmezi D, Marcus BH. Pasos Hacia La Salud II: study protocol for a randomized controlled trial of a theory- and technology-enhanced physical activity intervention for Latina women, compared to the original intervention. Trials 2022; 23:621. [PMID: 35915473 PMCID: PMC9341151 DOI: 10.1186/s13063-022-06575-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/20/2022] [Indexed: 12/04/2022] Open
Abstract
Background Latinas are at increased risk for many lifestyle-related chronic diseases and are one of the least physically active populations in the US Innovative strategies are needed to help Latinas achieve the health benefits associated with physical activity (PA). This manuscript describes the study protocol of the Pasos Hacia La Salud II Study, which builds upon our previous research to test an enhanced individually-tailored, text-message and website-delivered, Spanish-language intervention (enhanced intervention), in comparison to the original web-based Pasos Hacia La Salud Intervention (original intervention). Methods Sedentary Latinas between the ages of 18–65 will be recruited and will complete an orientation and baseline assessments. Participants will be subsequently randomized to the original intervention, or the Enhanced Intervention, which has greater targeting of theoretical constructs such as self-efficacy, enjoyment, and social support, and which uses text messages and more dynamic and refined website features to encourage increased website use. Using a linear mixed effects regression model, we will simultaneously estimate the intervention effects on mean accelerometer-measured hours/week of moderate-to-vigorous PA (MVPA) at 6, 12, 18, and 24 months, with a subject-specific intercept (intent-to-treat sample). Change in self-reported MVPA, measured via the 7-day Physical Activity Recall, will be assessed as a secondary outcome using a similar model. We will investigate potential mediators of the intervention effect using a multiple mediation approach, and potential moderators by evaluating potential interactions. As an exploratory outcome, we will study the differences (among both study arms) in cost, in US dollars, per minute increases in weekly mean MVPA. Discussion The original Pasos PA intervention showed efficacy in helping Latinas increase PA; we expect the Enhanced Intervention to help a larger proportion of participants to increase and maintain their PA long term. This web- and text-based enhanced intervention could have great reach and dissemination potential, which could be capitalized on in the future to help to advance health equity. Adaptations made in response to the COVID-19 pandemic are also described in this manuscript. Trial registration Clinical Trial Number: NCT03491592. First posted April 9, 2018.
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Affiliation(s)
- Andrea S Mendoza-Vasconez
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, USA.
| | - Tanya Benitez
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, USA
| | - Shira Dunsiger
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, USA
| | - Kim M Gans
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, USA.,Human Development and Family Sciences, College of Liberal Arts and Sciences, University of Connecticut, Storrs, USA
| | - Sheri J Hartman
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, USA
| | - Sarah E Linke
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, USA
| | - Britta A Larsen
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, USA
| | - Dorothy Pekmezi
- Department of Health Behavior, The University of Alabama at Birmingham School of Public Health, Birmingham, USA
| | - Bess H Marcus
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, USA
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Chakraverty D, Baumeister A, Aldin A, Seven ÜS, Monsef I, Skoetz N, Woopen C, Kalbe E. Gender differences of health literacy in persons with a migration background: a systematic review and meta-analysis. BMJ Open 2022; 12:e056090. [PMID: 37667874 PMCID: PMC9301804 DOI: 10.1136/bmjopen-2021-056090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 07/03/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate gender differences of health literacy in individuals with a migration background. DESIGN Systematic review and meta-analysis. OVID/MEDLINE, PsycINFO and CINAHL were searched in March 2018 and July 2020. SETTING Studies had to provide health literacy data for adult women and men with a migration background, collected with a standardised instrument, or report results that demonstrated the collection of such data. Health literacy data were extracted from eligible studies or requested from the respective authors. Using a random-effects model, a meta-analysis was conducted to assess standardised mean differences (SMDs) of health literacy in men and women. Two researchers independently assessed risk of bias for each included study using the Appraisal Tool for Cross-Sectional Studies. RESULTS Twenty-four studies were included in this systematic review. Thereof, 22 studies (8012 female and 5380 male participants) were included in the meta-analyses. In six studies, gender-specific health literacy scores were reported. The authors of additional 15 studies provided their data upon request and for one further study data were available online. Women achieved higher health literacy scores than men: SMD=0.08, 95% CI 0.002 to 0.159, p=0.04, I2=65%. Another 27 studies reported data on female participants only and could not be included due to a lack of comparable studies with male participants only. Authors of 56 other eligible studies were asked for data, but without success. CONCLUSION Men with a migration background-while being much less frequently examined-may have lower health literacy than women. As heterogeneity between studies was high and the difference became statistically insignificant when excluding studies with a high risk of bias, this result must be interpreted with caution. There is a paucity of research on the social and relational aspects of gender in relation to health literacy among people with a migration background, especially for men. PROSPERO REGISTRATION NUMBER CRD42018085555.
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Affiliation(s)
- Digo Chakraverty
- Medical Psychology | Neuropsychology and Gender Studies and Centre for Neuropsychological Diagnostics and Intervention (CeNDI), University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Annika Baumeister
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (CERES),University of Cologne and Research Unit Ethics, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Angela Aldin
- Evidence-Based Oncology, Department I of Internal Medicine, University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Ümran Sema Seven
- Medical Psychology | Neuropsychology and Gender Studies and Centre for Neuropsychological Diagnostics and Intervention (CeNDI), University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Ina Monsef
- Evidence-Based Oncology, Department I of Internal Medicine, University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Nicole Skoetz
- Evidence-Based Oncology, Department I of Internal Medicine, University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Christiane Woopen
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (CERES),University of Cologne and Research Unit Ethics, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Elke Kalbe
- Medical Psychology | Neuropsychology and Gender Studies and Centre for Neuropsychological Diagnostics and Intervention (CeNDI), University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
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Abraham KM, Vu T, Chavis CD, Dykhuis KE, Sata MJ. An examination of predisposing and enabling factors that predict dental utilization among individuals with serious mental illness in Detroit, Michigan. Community Dent Oral Epidemiol 2022; 51:399-407. [PMID: 35607884 DOI: 10.1111/cdoe.12762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/14/2022] [Accepted: 05/12/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study evaluated which predisposing and enabling factors prospectively predicted dental utilization over 6 months among people with serious mental illness. METHODS A sample of individuals with serious mental illness (86.3% African American; 97.4% with public health insurance) was recruited from community mental health centres in Detroit, Michigan, and responded to questionnaires at baseline and at least one follow-up visit at 3 or 6 months (N = 190). Baseline assessments included demographic and clinical information, established measures of health literacy, health insurance literacy, stigma related to mental illness, experiences of racial discrimination and medical mistrust. Insurance coverage for dental care and the availability of dental services at the participants' mental health centres was recorded. At follow-up visits, participants reported healthcare utilization, including dental and primary care, since baseline. RESULTS Three factors emerged as meaningful predictors of having a dental visit in bivariate and multivariate analyses: more medical comorbidities and dental care co-located with mental health care predicted increased likelihood of a dental visit, whereas having experienced racial discrimination in a medical setting predicted lower odds of having a dental visit in the follow-up period. Co-location of dental care with mental health care was the strongest predictor of having a dental visit. CONCLUSIONS Co-locating dental care with mental health care may increase dental utilization among people with serious mental illness, possibly by mitigating known barriers to dental care for this population. Among African Americans, the co-location of dental care with mental health care may also attenuate the negative effect of prior racial discrimination in a medical setting on dental utilization.
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Affiliation(s)
| | - Tiffany Vu
- University of Detroit Mercy Detroit Michigan USA
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Physical activity outcomes from a randomized trial of a theory- and technology-enhanced intervention for Latinas: the Seamos Activas II study. J Behav Med 2021; 45:1-13. [PMID: 34379236 DOI: 10.1007/s10865-021-00246-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/17/2021] [Indexed: 10/20/2022]
Abstract
Latina women report disproportionately high and increasing prevalence of chronic health conditions (obesity, diabetes) related to low physical activity levels. Efforts to date at addressing high rates of physical inactivity in this at-risk population have shown modest success. The original Seamos Saludables (sample size N = 266) was a culturally and linguistically adapted, print-based physical activity intervention that showed significant increases in moderate to vigorous physical activity (MVPA) from baseline to 6 months. However, only 11% of intervention participants reached the national PA guidelines of ≥ 150 min/week of aerobic MVPA. The current study tests the original Seamos Saludables intervention (Original Intervention) against an enhanced iteration Seamos Activas II (Enhanced Intervention). Study aims and intervention refinements focus on increasing the percentage of Latinas meeting national aerobic PA guidelines. For the current study (Seamos Activas II), a randomized controlled trial with (N = 199 participants) of two PA interventions (original intervention, N = 102; vs. enhanced intervention, N = 97) was conducted. Intervention refinements involved further targeting key constructs of the Social Cognitive Theory and incorporating text-message-based strategies for self-monitoring, in response to participant feedback for greater interactivity and accountability. PA assessments were conducted at baseline and 6 months. The sample was predominantly Mexican American (89%) with average age of 43.8 years (SD = 10.11) and mean BMI at baseline was 30.6 (SD = 7.56). There were significant within group increases in MVPA from baseline to 6 months (p < .05) in both Original and Enhanced Intervention arms. However, quantile regression models did not indicate significant differences in 6-month outcomes between conditions controlling for baseline, p = 0.73. There were significant differences between conditions with respect to meeting national guidelines for aerobic MVPA at 6 months, with 57% of Enhanced Intervention participants meeting guidelines compared to 44% of Original Intervention participants, OR = 1.66, 95% CI: 1.09 -2.89. Models suggest trends favoring the enhanced condition for improvements in biomarkers over 6 months. Findings indicate that the intervention enhancements likely helped more Latinas achieve nationally recommended, health enhancing PA levels than the original intervention and showed promise for improving physiological response to exercise.Trial Registration ClinicalTrials.Gov; NCT02630953. Registered 14 December 2015. https://clinicaltrials.gov/ct2/show/NCT02630953 .
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Gans KM, Dulin A, Palomo V, Benitez T, Dunsiger S, Dionne L, Champion G, Edgar R, Marcus B. A Tailored Web- and Text-Based Intervention to Increase Physical Activity for Latino Men: Protocol for a Randomized Controlled Feasibility Trial. JMIR Res Protoc 2021; 10:e23690. [PMID: 33512327 PMCID: PMC7880809 DOI: 10.2196/23690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 12/03/2022] Open
Abstract
Background Latino men in the United States report low physical activity (PA) levels and related health conditions (eg, diabetes and obesity). Engaging in regular PA can reduce the risk of chronic diseases and yield many health benefits; however, there is a paucity of interventions developed exclusively for Latino men. Objective To address the need for culturally relevant PA interventions, this study aims to develop and evaluate Hombres Saludables, a 6-month theory-based, tailored web- and text message-based PA intervention in Spanish for Latino men. This protocol paper describes the study design, intervention, and evaluation methods for Hombres Saludables. Methods Latino men aged 18-65 years were randomized to either the individually tailored PA internet intervention arm or the nutrition and wellness internet control arm. The PA intervention included 2 check-in phone calls; automated SMS text messages; a pedometer; a 6-month gym membership; access to a private Facebook group; and an interactive website with PA tracking, goal setting, and individually tailored PA content. The primary outcomes were feasibility, acceptability, and efficacy (minutes per week of total moderate-to-vigorous PA assessed via the ActiGraph GT3X+ accelerometer worn at the waist and 7-day physical activity recall at baseline and 6 months). Secondary outcomes examined potential moderators (eg, demographics, acculturation, and environmental variables) and mediators (eg, self-efficacy and cognitive and behavioral processes of change) of treatment effects at 6 months post randomization. Results This study was funded in September 2016. Initial institutional review board approval was received in February 2017, and focus groups and intervention development were conducted from April 2017 to January 2018. Recruitment for the clinical trial was carried out from February 2018 to July 2019. Baseline data collection was carried out from February 2018 to October 2019, with a total of 43 participants randomized. Follow-up data were collected through April 2020. Data cleaning and analysis are ongoing. Conclusions We developed and tested protocols for a highly accessible, culturally and linguistically relevant, theory-driven PA intervention for Latino men. Hombres Saludables used an innovative, interactive, web- and text message–based intervention for improving PA among Latino men, an underserved population at risk of low PA and related chronic disease. If the intervention demonstrates feasibility, acceptability, and preliminary efficacy, we will refine and evaluate it in a larger randomized control trial. Trial Registration Clinicaltrials.gov: NCT03196570; https://clinicaltrials.gov/ct2/show/NCT03196570 International Registered Report Identifier (IRRID) DERR1-10.2196/23690
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Affiliation(s)
- Kim M Gans
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, United States.,Department of Behavioral And Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Akilah Dulin
- Department of Behavioral And Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Vanessa Palomo
- Cardiovascular Center for Research and Innovation, Tufts University Medical Center, Boston, MA, United States
| | - Tanya Benitez
- Department of Behavioral And Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Shira Dunsiger
- Department of Behavioral And Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Laura Dionne
- Department of Behavioral And Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Gregory Champion
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, United States
| | - Rachelle Edgar
- Department of Behavioral And Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Bess Marcus
- Department of Behavioral And Social Sciences, Brown University School of Public Health, Providence, RI, United States
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Health Literacy in Female – Association with Socioeconomic Factors and Effects on Reproductive Health. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2020. [DOI: 10.2478/sjecr-2018-0055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The aim of the study is to assess the health literacy of women who are using health services within the Gynecology Obstetric Clinic “Narodni Front” in Belgrade. Testing of health literacy was conducted as a cross-sectional study in the period October-November 2012. As instruments of research the following questionnaires are used: Short Test of Functional Health Literacy in Adults and General information questionnaire of respondents who referred to the demographic, social and economic characteristics of respondents, self-assessment of health, use of health services, health knowledge and behavior in the area of reproductive health. Inadequate health literacy level is registered in every ten respondents. The education level of the respondents proved to be a significant predictor of health literacy. Demographic and socio-economic characteristics of the patients (age, occupation, marital status) as well as self-evaluation of the health status were not significantly related to the health literacy. Health literacy respondents did not significantly dependent on risk behaviors related to reproductive health. The level of health literacy is consistent with the knowledge of subjects in the field of protection of reproductive health. Health literacy as the ability to function within the health care system is equally certain by individual characteristics and skills, characteristics of the health and education systems as well as a wide range of social and cultural factors. Health literacy is more systematic than individual problem, so it requires a broader social action.
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Benitez TJ, Dunsiger SI, Pekmezi DJ, Larsen BA, Mendoza-Vasconez AS, Linke SE, Bock BC, Gans KM, Hartman SJ, Marcus BH. Design and rationale for a randomized trial of a theory- and technology- enhanced physical activity intervention for Latinas: The Seamos Activas II study. Contemp Clin Trials 2020; 96:106081. [PMID: 32687974 DOI: 10.1016/j.cct.2020.106081] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/23/2020] [Accepted: 07/06/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Latina women report disproportionately high rates of physical inactivity and related chronic health conditions. Physical activity (PA) efforts to date have shown modest success in this at-risk population; thus, more effective interventions are necessary to help Latinas reach national PA guidelines and reduce related health disparities. This paper describes the design, rationale, and baseline findings from the Seamos Activas II intervention. METHODS/DESIGN The ongoing RCT will test the efficacy of the Seamos Saludables PA print intervention vs. a theory-and technology-enhanced version (Seamos Activas II). The purpose of the study is to increase the percentage of Latinas meeting the national PA guidelines compared to the prior trial, improve biomarkers related to disease, and extend generalizability to a broader and more representative population of Latinas (i.e. Mexican/Mexican-Americans). Intervention refinements included further targeting key constructs of Social Cognitive Theory, and incorporating interactive text message-based self-monitoring strategies. The primary outcome is change in minutes per week of MVPA measured by ActiGraph GT3X+ accelerometers at 6- and 12-months. Secondary PA outcomes assessed by the 7-Day PA Recall will be used to corroborate findings. RESULTS Participants (N = 199) are Latinas 18-65 years (mean = 43.8) of predominantly Mexican origin (89%). At baseline, objectively measured MVPA was 39.51 min/week (SD = 71.20, median = 10) and self-reported MVPA was 12.47 min/week (SD = 22.54, median = 0).Participants reported generally low self-efficacy and higher cognitive vs. behavioral processes of change. CONCLUSION Addressing interactivity and accountability through text messaging, and more rigorously targeting theoretical constructs may be key to helping Latinas achieve nationally recommended PA levels and thereby reducing health disparities.
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Affiliation(s)
- Tanya J Benitez
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
| | - Shira I Dunsiger
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
| | - Dori J Pekmezi
- Department of Health Behavior, School of Public Health at University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Britta A Larsen
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla, CA, United States of America
| | | | - Sarah E Linke
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla, CA, United States of America
| | - Beth C Bock
- Department of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, RI, United States of America
| | - Kim M Gans
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America; Department of Human Development and Family Studies, University of Connecticut, Storrs, CT, United States of America
| | - Sheri J Hartman
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla, CA, United States of America
| | - Bess H Marcus
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America.
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Chan S, Spina SP, Zuk DM, Dahri K. Hospital pharmacists understanding of available health literacy assessment tools and their perceived barriers for incorporation in patient education - a survey study. BMC Health Serv Res 2020; 20:401. [PMID: 32393241 PMCID: PMC7212601 DOI: 10.1186/s12913-020-05269-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/29/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Patients with low health literacy experience difficulty in understanding their medications leading to worse health outcomes. Pharmacists need to use formal assessment tools to be able to identify these patients, so they can better tailor their patient education. The objective of the study was to characterize hospital pharmacists understanding of health literacy and their use of screening and counselling strategies before and after completion of an educational module and to identify barriers that hospital pharmacists perceive to exist that prevent them from using health literacy tools. METHODS Pharmacists in three health authorities were administered a pre-survey and then given access to an online 11 min educational video. The post-survey was distributed 1 month later. Descriptive statistics were used to quantify survey responses with comparisons made between pre and post responses. The main outcome measure was pharmacists' understanding of health literacy and their current practice related to health literacy. RESULTS There were 131 respondents for the pre-survey and 39 for the post-survey. In the pre-module survey, 84% of pharmacists felt they understood what health literacy was, but only 53% currently assessed patients for their health literacy status and 40% were aware of what strategies to use in low health literacy patients. Lack of time (74%) was the biggest barrier in assessing patients' health literacy. In the post-module survey, 87% felt they understood what health literacy was and 64% incorporated health literacy status evaluation into their clinical practice. The educational module was helpful to the clinical practice of 74% of respondents. CONCLUSION As health literacy can affect a patient's ability to adhere to their medications it is important for pharmacists to assess this in their patients. While pharmacists self-reported a high degree of understanding of health literacy, they are not regularly assessing their patients' health literacy status and are unaware of what strategies to use for low literacy patients.
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Affiliation(s)
- Sara Chan
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada
| | - Sean P. Spina
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada
- Department of Pharmacy, Royal Jubilee Hospital, Island Health, 1952 Bay St, Victoria, BC V8R 1J8 Canada
| | - Dalyce M. Zuk
- Alberta Health Services, 3#308, 3031 Hospital Drive NW, Calgary, AB T2N 2T8 Canada
| | - Karen Dahri
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada
- Vancouver General Hospital, Vancouver Coastal Health, 855 West 12th Avenue, Vancouver, BC V5Z 1M9 Canada
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Schapira MM, Faghri A, Jacobs EA, Fletcher KE, Ganschow PS, Gil D, Smallwood AJ, Walker CM, Neuner JM. Communication and Shared Decision Making in the Breast Cancer Treatment Consultation: A Comparative Analysis of English- and Spanish-Speaking Patients. MDM Policy Pract 2019; 4:2381468319881651. [PMID: 31696154 PMCID: PMC6820186 DOI: 10.1177/2381468319881651] [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] [Received: 03/20/2018] [Accepted: 09/10/2019] [Indexed: 12/17/2022] Open
Abstract
Background. Communication in the breast cancer treatment consultation is complex. Language barriers may increase the challenge of achieving patient-centered communication and effective shared decision making. Design. We conducted a prospective cohort study among Spanish- and English-speaking women with stage 0 to 3 breast cancer in two urban medical centers in the Midwestern United States. Patient centeredness of care and decisional conflict were compared between Spanish- and English-speaking participants using the Interpersonal Processes of Care (IPC) and Decision Conflict Scale (DCS), respectively. Clinician behaviors of shared decision making were assessed from consultation audio-recordings using the 12-item Observing Patient Involvement in Decision Making (OPTION) scale. Multivariate regression analyses were conducted to control for differences in baseline characteristics and clinician specialty. Results. Fifteen Spanish-speaking and 35 English-speaking patients were enrolled in the study. IPC scores (median, interquartile range [IQR]) were higher (less patient centered) in Spanish- versus English-speaking participants in the domains of lack of clarity (2.5, 1-3 v. 1.5, 1-2), P = 0.028; perceived discrimination (1.1, 1-1 v. 1.0, 1-1), P = 0.047; and disrespectful office staff (1.25, 1-2 v. 1.0, 1-1), P < 0.0005 (Wilcoxon rank-sum test). OPTION scores (median, IQR) were lower in Spanish- versus English-speaking participants (21.9, 17.7-27.1 v. 31.3, 26.6-39.6), P = 0.001 (Wilcoxon rank-sum test). In multivariate analysis, statistically significant differences persisted in the IPC lack of clarity and disrespectful office staff between Spanish- and English-speaking groups. Conclusions. Our findings highlight challenges in cancer communication for Spanish-speaking patients, particularly with respect to perceived patient centeredness of communication. Further cross-cultural studies are needed to ensure effective communication and shared decision making in the cancer consultation.
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Affiliation(s)
- Marilyn M Schapira
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Arshia Faghri
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | | | | | | | - Denise Gil
- Rush University Medical Center, Chicago, Illinois
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Abstract
BACKGROUND Rehospitalization soon after discharge can be distressing for persons with heart failure (HF) and places a heavy burden on the healthcare system. OBJECTIVE We investigated and explored the association of self-care decision making variables with (1) rehospitalization within 30 days of discharge and (2) delay in seeking medical assistance (delayed decision making). METHODS A cross-sectional, explanatory sequential mixed methods design (quan > qual) was used to survey 127 hospitalized HF patients and interview 15 of these participants to explain their survey responses. The survey assessed rehospitalization within 30 days of discharge, delayed decision making, HF self-care, and psychosocial factors influencing self-care. RESULTS The likelihood of delaying the decision to be hospitalized was more than 5 times higher among those with high depressive symptoms (odds ratio, 5.33; 95% confidence interval, 2.14-13.28). Those who delayed going to the hospital were uncertain about their prognosis and did not feel their symptoms were urgent. The likelihood of being rehospitalized within 30 days was more than doubled among those with high depressive symptoms (OR, 2.31; 95% confidence interval, 1.01-5.31). Those who were rehospitalized within 30 days were less likely to consult healthcare professionals in their decision making and wanted immediate relief from their symptoms. CONCLUSIONS We recommend a patient-centered approach to help HF patients identify and adequately self-manage symptoms. The strong association between high depressive symptoms and rehospitalization within 30 days as well as delayed decision making highlights the critical need for clinicians to carefully assess and address depression among HF patients.
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Hashimoto H, Yanagisawa S. Development of health literacy scale among Brazilian mothers in Japan. Health Promot Int 2018; 32:1034-1040. [PMID: 27209049 DOI: 10.1093/heapro/daw040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Japanese-Brazilians were the third largest immigrant group in Japan in 2011. Their health issues have caused concern, as their limited language made them vulnerable by hindering access to health services. Upon considering child health, mothers' health literacy (HL) is very important. This study aimed to develop a health literacy scale among Brazilian mothers (HLSBM) in Japan. Questionnaires in Portuguese were distributed to 1474 mothers from December 2011 to March 2012. Among 698 collected, 558 questionnaires were analyzed. We prepared 29 candidate items for HLSBM based on Nutbeam's concept of functional, interactive and critical literacy. The dimensional structure was determined statistically using confirmatory factor analysis. Validity was also analyzed by Pearson's correlation with Ishikawa's scale and Kendall's coefficient of concordance among researchers. Cronbach's α coefficients were calculated to examine internal consistency. The confirmatory factor analysis revealed a two-factor model (five items for basic literacy and five items for critical literacy) with sufficient goodness of fit (GFI 969, AGFI 945, NFI 959, CFI 972, RMSEA 060). The internal consistency values of the total score, basic and critical literacy sub-scales were 0.819, 0.889 and 0.667, respectively. Kendall's coefficient of concordance showed good agreement of researchers (p < 0.001). Pearson's correlation coefficients with Ishikawa's scale were 0.554 for total score, 0.446 for basic literacy and 0.472 for critical literacy. The HLSBM consisting of two factors was confirmed to be valid and reliable. The HLSBM must be useful for understanding this vulnerable group's health literacy and its associated factors.
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Affiliation(s)
- Hidemi Hashimoto
- Faculty of Nursing, Doshisha Women's College of Liberal Arts, Kyotanabe, Kyoto, Japan
| | - Satoko Yanagisawa
- School of Nursing and Health, Aichi Prefectural University, Nagoya, Aichi, Japan
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Murphy JE, Smock L, Hunter-Adams J, Xuan Z, Cochran J, Paasche-Orlow MK, Geltman PL. Relationships Between English Language Proficiency, Health Literacy, and Health Outcomes in Somali Refugees. J Immigr Minor Health 2018; 21:451-460. [DOI: 10.1007/s10903-018-0765-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Jacobson AF, Sumodi V, Albert NM, Butler RS, DeJohn L, Walker D, Dion K, Tai HLL, Ross DM. Patient activation, knowledge, and health literacy association with self-management behaviors in persons with heart failure. Heart Lung 2018; 47:447-451. [PMID: 29910065 DOI: 10.1016/j.hrtlng.2018.05.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/26/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND More evidence is needed about factors that influence self-management behaviors in persons with heart failure. OBJECTIVE To test a correlational mediation model of the independent variables of health literacy, patient activation, and heart failure knowledge with heart failure self-management behaviors. METHODS The study used a prospective, cross-sectional, correlational design. Correlation and multiple regression were used to analyze associations among variables. RESULTS Of 151 participants, 57% were male, and mean age was 68 years. Heart failure self-management behaviors was positively correlated with patient activation level (p = .0008), but not with health literacy or heart failure knowledge. CONCLUSIONS Persons with heart failure may better manage their condition if sufficiently activated, regardless of their level of health literacy or knowledge of heart failure disease and management processes.
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Affiliation(s)
- Ann F Jacobson
- Cleveland Clinic Hillcrest Chronic Care, 6801 Mayfield Rd., Mayfield Heights, OH 44124.
| | - Veronica Sumodi
- Cleveland Clinic Hillcrest Chronic Care, 6801 Mayfield Rd., Mayfield Heights, OH 44124
| | - Nancy M Albert
- Cleveland Clinic, 9500 Euclid Avenue, Mail code J3-4, Cleveland OH 44195
| | - Robert S Butler
- Cleveland Clinic Quantitative Health Sciences, 9500 Euclid Avenue/JJN3-01, Cleveland, OH 44195
| | - Lori DeJohn
- Cleveland Clinic Hillcrest Chronic Care, 6801 Mayfield Rd., Mayfield Heights, OH 44124
| | - Donna Walker
- Cleveland Clinic Euclid Hospital Chronic Care, 18901 Lakeshore Blvd, Euclid, OH 44119
| | - Kelly Dion
- Cleveland Clinic South Pointe Hospital Chronic Care, 20000 Harvard Ave, Warrensville Heights, OH 44122
| | - Hua-Li Lin Tai
- Cleveland Clinic South Pointe Hospital Chronic Care, 20000 Harvard Ave, Warrensville Heights, OH 44122
| | - Donna M Ross
- Cleveland Clinic Lakewood Chronic Care, 14519 Detroit Ave., Lakewood, OH 44107
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King AJ, Jensen JD, Guntzviller LM, Perez D, Krakow M. Ethnic newspapers and low-income Spanish-speaking adults: influence of news consumption and health motivation on cancer prevention behaviors. ETHNICITY & HEALTH 2018; 23:410-424. [PMID: 28116925 PMCID: PMC6096336 DOI: 10.1080/13557858.2017.1280133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Ethnic newspapers have the potential to reach and influence various cultural and ethnic subpopulations traditionally underserved in the United States. The current study sought to explore how ethnic news consumption interacts with health motivation to predict cancer prevention behaviors in a sample of Spanish-speaking adults. DESIGN Participants (N = 100) completed a survey in Spanish, with items measuring demographics, acculturation, health literacy, health motivation, ethnic newspaper consumption (for two papers: La Viva and La Raza), and cancer prevention behaviors. RESULTS Results indicated consumption of ethnic newspapers correlated positively to acculturation, and cancer screening utilization. In hierarchical regression analyses, the interaction of consumption of an ethnic newspaper (La Raza) and health motivation predicted two of the six prevention behaviors assessed: avoidance of fatty foods and screening behavior. CONCLUSION The study provides evidence that consumption of Spanish-language newspapers enhances the likelihood that individuals with high levels of health motivation will engage in healthy behaviors. This finding highlights the utility of utilizing Spanish-language newspapers to reach underserved populations.
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Affiliation(s)
- Andy J. King
- Department of Public Relations, Texas Tech University
| | - Jakob D. Jensen
- Department of Communication, University of Utah
- Cancer Control & Population Science Core, Huntsman Cancer Institute
| | | | - Debora Perez
- Department of Communication, University of California – Santa Barbara
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Mantwill S, Allam A, Camerini AL, Schulz PJ. Validity of Three Brief Health Literacy Screeners to Measure Functional Health Literacy - Evidence from Five Different Countries. JOURNAL OF HEALTH COMMUNICATION 2018; 23:153-161. [PMID: 29319424 DOI: 10.1080/10810730.2017.1417515] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Self-reported health literacy measures have seen increased application throughout the last years, among those are the brief health literacy screeners (BHLS) developed by Chew and colleagues (2004). There has been little systematic research on the performance of these measures across different contexts, including countries and languages, to draw conclusions about their predictive power outside of the United States. This study aimed at replicating the original validation of the BHLS. Receiver operating characteristic (ROC) analysis was applied to data from Hungary, Italy, Lebanon, Switzerland, and Turkey. In addition, logistic regression models incorporating ROC analysis using BHLS as predictors were compared to models using socio-demographics only to identify individuals with inadequate and inadequate or marginal health literacy as measured with the Short Test of Functional Health Literacy in Adults. Analyses showed that in all cases the BHLS were not sufficiently able to identify individuals with different health literacy levels. Logistic regression models using socio-demographics only as predictors outperformed models using the BHLS. The findings highlight the limitations of using the BHLS outside the United States. Further, they question in how far self-reported health literacy measures are comparable across different contexts and whether thresholds for different health literacy levels are universally applicable.
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Affiliation(s)
- Sarah Mantwill
- a Department of Health Sciences & Health Policy , University of Lucerne , Lucerne Switzerland
| | - Ahmed Allam
- b Department of Pathology , Yale University School of Medicine , New Haven , CT , USA
| | - Anne-Linda Camerini
- c Institute of Communication and Health Università della Svizzera italiana , Lugano Switzerland
| | - Peter J Schulz
- c Institute of Communication and Health Università della Svizzera italiana , Lugano Switzerland
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Chakkalakal RJ, Venkatraman S, White RO, Kripalani S, Rothman R, Wallston K. Validating Health Literacy and Numeracy Measures in Minority Groups. Health Lit Res Pract 2017; 1:e23-e30. [PMID: 29888342 PMCID: PMC5991606 DOI: 10.3928/24748307-20170329-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Validation studies of existing health literacy or numeracy tools among racial/ethnic minorities are limited. Objective: This study assessed the validity of the Subjective Numeracy Scale (SNS), the Diabetes Numeracy Test (DNT-5), the Brief Health Literacy Screen (BHLS), and the Short Test of Functional Health Literacy in Adults (S-TOFHLA) by trait (health literacy or numeracy) and by method (subjective or objective) among non-Hispanic white (NHW), non-Hispanic black (NHB), and Hispanic patients with type 2 diabetes mellitus (T2DM). Methods: We conducted a secondary analysis of baseline data from the Partnering to Improve Diabetes Education (PRIDE) study, a clustered randomized controlled trial testing the efficacy of a health communication intervention on T2DM outcomes at state Department of Health clinics in middle Tennessee. PRIDE participants with race/ethnicity data available (n = 398) were included in this study. Most patients identified as NHW (59%), 18% identified as NHB, and 23% identified as Hispanic. Pearson correlations among the 4 measures were compared for each racial/ethnic group by trait and method. The convergent validity of each measure with education was also assessed using Pearson correlation analyses. Key Results: Significant correlations were observed across all 3 subgroups for the numeracy measures (SNS and DNT-5) and the objective measures (DNT-5 and S-TOFHLA). Nonsignificant correlations were observed among Hispanic participants for the health literacy measures (BHLS and S-TOFHLA, correlation coefficient = 0.13) and among NHB and Hispanic participants for the subjective measures (SNS and BHLS, correlations coefficients = 0.15 and 0.09, respectively). A significant positive correlation was noted between education and each measure across all 3 subgroups. Conclusions: Subjective and health literacy measures demonstrate weaker correlations than objective and numeracy measures, respectively, among minority patients in this study. Our findings highlight the need to further evaluate the appropriateness of these tools for use with minority populations, particularly the BHLS for Hispanic patients. [Health Literacy Research and Practice. 2017;1(2):e23–e30.] Plain Language Summary: Few studies have tested the validity of health literacy and numeracy measures in minority groups. This study highlights racial/ethnic differences in the results of validity testing of the Subjective Numeracy Scale, the Diabetes Numeracy Test, the Brief Health Literacy Screen, and the Short Test of Functional Health Literacy in Adults among adults with type 2 diabetes.
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Affiliation(s)
- Rosette J Chakkalakal
- Division of General Internal Medicine and Public Health, Department of Internal Medicine, Vanderbilt University Medical Center
| | | | - Richard O White
- Division of Community Internal Medicine and Family Medicine, Mayo Clinic Florida
| | - Sunil Kripalani
- Division of General Internal Medicine and Public Health, Center for Health Services Research, Vanderbilt University Medical Center
| | - Russell Rothman
- Division of General Internal Medicine and Public Health, Center for Health Services Research, Vanderbilt University Medical Center
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Kilfoyle KA, Vrees R, Raker CA, Matteson KA. Nonurgent and urgent emergency department use during pregnancy: an observational study. Am J Obstet Gynecol 2017; 216:181.e1-181.e7. [PMID: 27773714 DOI: 10.1016/j.ajog.2016.10.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 10/03/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Emergency department use is common among pregnant women. Nonurgent emergency department use may represent care that would be better provided by an established obstetric provider in an ambulatory setting. OBJECTIVE The objective of the study was to identify sociodemographic factors associated with nonurgent emergency department use in pregnancy. STUDY DESIGN This is a cross-sectional study of women recruited during their postpartum hospitalization. Data regarding prenatal care and emergency department visits were collected from medical records; participants completed a survey with questions regarding demographics and emergency department use. Urgency of an emergency department visit was prespecified based on a priori criteria abstracted from medical record review. Women with any nonurgent emergency department use were compared with women without nonurgent emergency department use. Logistic regression was performed to identify factors associated with nonurgent emergency department use. RESULTS Two hundred thirty-three women participated in this study; 197 (84%) received care in the emergency department during pregnancy. Eighty-three women (35.6%) had at least 1 visit to the emergency department that was nonurgent. In a regression analysis, the increased odds of nonurgent emergency department use was associated with a preferred language other than English (odds ratio, 2.02; 95% confidence interval,1.01-4.05) and lack of private insurance (odds ratio, 5.55; 95% confidence interval, 2.54-12.12). The 2 most common reasons for presentation to the emergency department were concern that there was an emergency (45%) or being referred by a health care provider (36%). CONCLUSION Women frequently use the emergency department during pregnancy, including visits for nonurgent indications. Identifying risk factors for nonurgent emergency department use in pregnancy is important for identifying women likely to use the emergency department, including for nonurgent visits, and the development of strategies to decrease nonurgent emergency department utilization in pregnancy.
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Sudore RL, Barnes DE, Le GM, Ramos R, Osua SJ, Richardson SA, Boscardin J, Schillinger D. Improving advance care planning for English-speaking and Spanish-speaking older adults: study protocol for the PREPARE randomised controlled trial. BMJ Open 2016; 6:e011705. [PMID: 27401363 PMCID: PMC4947727 DOI: 10.1136/bmjopen-2016-011705] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 04/27/2016] [Accepted: 05/18/2016] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Advance care planning (ACP) is a process that allows patients to identify their goals for medical care. Traditionally, ACP has focused on completing advance directives; however, we have expanded the ACP paradigm to also prepare patients to communicate their wishes and make informed decisions. To this end, we created an ACP website called PREPARE (http://www.prepareforyourcare.org) to prepare diverse English-speaking and Spanish-speaking older adults for medical decision-making. Here, we describe the study protocol for a randomised controlled efficacy trial of PREPARE in a safety-net setting. The goal is to determine the efficacy of PREPARE to engage diverse English-speaking and Spanish-speaking older adults in a full spectrum of ACP behaviours. METHODS AND ANALYSIS We include English-speaking and Spanish-speaking adults from an urban public hospital who are ≥55 years old, have ≥2 chronic medical conditions and have seen a primary care physician ≥2 times in the last year. Participants are randomised to the PREPARE intervention (review PREPARE and an easy-to-read advance directive) or the control arm (only the easy-to-read advance directive). The primary outcome is documentation of an advance directive and/or ACP discussion. Secondary outcomes include ACP behaviour change processes measured with validated surveys (eg, self-efficacy, readiness) and a broad range of ACP actions (eg, choosing a surrogate, identifying goals for care, discussing ACP with clinicians and/or surrogates). Using blinded outcome ascertainment, outcomes will be measured at 1 week and at 3, 6 and 12 months, and compared between study arms using mixed-effects logistic regression and mixed-effects linear, Poisson or negative binomial regression. ETHICS AND DISSEMINATION This study has been approved by the appropriate Institutional Review Boards and is guided by input from patient and clinical advisory boards and a data safety monitoring board. The results of this study will be disseminated to academic and community stakeholders. TRIAL REGISTRATION NUMBERS NCT01990235; NCT02072941; Pre-results.
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Affiliation(s)
- Rebecca L Sudore
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA San Francisco Veterans Affairs Medical Center, San Francisco, California, USA Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, University of California, San Francisco, Department of Medicine, San Francisco, California, USA
| | - Deborah E Barnes
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA Departments of Epidemiology & Biostatistics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Gem M Le
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, University of California, San Francisco, Department of Medicine, San Francisco, California, USA Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Roberto Ramos
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA Northern California Institute for Research and Education, San Francisco, California, USA
| | - Stacy J Osua
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA Northern California Institute for Research and Education, San Francisco, California, USA
| | - Sarah A Richardson
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA Northern California Institute for Research and Education, San Francisco, California, USA
| | - John Boscardin
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA Departments of Epidemiology & Biostatistics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Dean Schillinger
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, University of California, San Francisco, Department of Medicine, San Francisco, California, USA Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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Kobayashi LC, Wardle J, Wolf MS, von Wagner C. Aging and Functional Health Literacy: A Systematic Review and Meta-Analysis. J Gerontol B Psychol Sci Soc Sci 2016; 71:445-57. [PMID: 25504637 PMCID: PMC4834761 DOI: 10.1093/geronb/gbu161] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 10/16/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To review the evidence on the association between age and limited health literacy, overall and by health literacy test, and to investigate the mediating role of cognitive function. METHOD The Embase, MEDLINE, and PsycINFO databases were searched. Eligible studies were conducted in any country or language, included participants aged ≥50 years, presented a measure of association between age and health literacy, and were published through September 2013. RESULTS Seventy analyses in 60 studies were included in the systematic review; 29 of these were included in the meta-analysis. Older age was strongly associated with limited health literacy in analyses that measured health literacy as reading comprehension, reasoning, and numeracy skills (random-effects odds ratio [OR] = 4.20; 95% confidence interval [CI]: 3.13-5.64). By contrast, older age was weakly associated with limited health literacy in studies that measured health literacy as medical vocabulary (random-effects OR = 1.19; 95% CI: 1.03-1.37). Evidence on the mediating role of cognitive function was limited. DISCUSSION Health literacy tests that utilize a range of fluid cognitive abilities and mirror everyday health tasks frequently observe skill limitations among older adults. Vocabulary-based health literacy skills appear more stable with age. Researchers should select measurement tests wisely when assessing health literacy of older adults.
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Affiliation(s)
- Lindsay C Kobayashi
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, UK.
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, UK
| | - Michael S Wolf
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Illinois. Department of Learning Sciences, School of Education and Social Policy, Northwestern University, Evanston, Illinois
| | - Christian von Wagner
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, UK
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Schnall R, John RM, Carballo-Dieguez A. Do High-Risk Young Adults Use the HIV Self-Test Appropriately? Observations from a Think-Aloud Study. AIDS Behav 2016; 20:939-48. [PMID: 26518679 DOI: 10.1007/s10461-015-1240-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to understand high-risk young adults' use of the rapid human immunodeficiency virus (HIV) self-test. The highest rate of new HIV infections occurs in people between 15 and 24 years. Improving identification of young people infected with HIV is a critical public health priority. The first rapid HIV self-testing kit was approved in the US in 2012. Despite the product's promise, its use by untrained young adults is not well-understood. We conducted a mixed methods study using surveys, a think-aloud protocol, observations, and in-depth interviews. A systematic checklist was developed to assess participants' use of the test. A total of 21 racial and/or ethnic minority young adults aged 18-24 participated in this study. Analysis of our interview data was guided by the theory of reasoned action (TRA). Participants completed the initial procedures of the test with a mean time of 8:36 min (range of 2:04'-16:33'). On a 14-point checklist, participants had a mean score of 10.8 (SD 2.26, range 3-14). In the qualitative analysis of the participants' interviews, guided by the theoretical constructs of the TRA, the following themes emerged: "Did I use it correctly?", "Can I trust the results?" (attitude); "How will my partner react?!", "What will people think?" (subjective norm); "Quick, easy and blood free," and "Avoids the hassle of dealing with the healthcare system" (behavioral intention). This study provided evidence of the usefulness of the test perceived by young adults, especially in light of their concerns about lack of privacy in medical settings. Since many participants did not follow all of the instructions while using the test, it is not evident that young adults can correctly use the HIV self-test. Development of instructions manuals that are understandable and guide proper use of medical devices is a great need, especially in the context of home testing technology.
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Affiliation(s)
- Rebecca Schnall
- Columbia University, School of Nursing, 617 W. 168th Street, New York, NY, 10032, USA.
| | - Rita Marie John
- Columbia University, School of Nursing, 617 W. 168th Street, New York, NY, 10032, USA
| | - Alex Carballo-Dieguez
- Columbia University Medical Center, HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute, Unit 15, 1051 Riverside Drive, New York, NY, 10032, USA
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Carden MA, Newlin J, Smith W, Sisler I. Health literacy and disease-specific knowledge of caregivers for children with sickle cell disease. Pediatr Hematol Oncol 2016; 33:121-33. [PMID: 26934177 DOI: 10.3109/08880018.2016.1147108] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study was conducted to measure the health literacy (HL) and disease-specific knowledge (DSK) of caregivers for children with sickle cell disease (SCD) and relate them to their child's health care utilization. The authors conducted a cross-sectional study of caregiver-child dyads attending an urban pediatric sickle cell clinic. Caregivers were administered the Shortened Test of Functional Health Literacy (S-TOFHLA) and a locally developed DSK questionnaire. Retrospective review of the child's electronic medical record (EMR) was performed to determine annual emergency department (ED) visits and hospitalizations. A total of 142 caregiver-child dyads were recruited for the study. Less than 5% of caregivers had limited HL, with less education (P =.03) and primary language other than English (P =.04) being the only risk factors. Although caregiver HL was not associated with ED visits or hospitalizations, surprisingly DSK was. Caregivers with higher DSK scores had children with higher annual rates of ED utilization (P =.002) and hospitalizations (P =.001), and these children were also more likely to be classified as high ED utilizers (≥4 visits per year; P =.01). Further, caregiver adherence to medication and clinic visits was associated with their child's age (P =.01). Although HL and DSK are both constructs that measure basic health understanding, they differently affect caregivers' ability to navigate and understand the health care system of children with chronic illnesses. This study suggests that the DSK/health care utilization relationship may be a more important measure than HL for programs following children with sickle cell disease and could also have applications in other pediatric chronic diseases.
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Affiliation(s)
- Marcus A Carden
- a Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine , Atlanta , GA , USA
| | - Jennifer Newlin
- b Division of Hematology and Oncology, Children's Hospital of Richmond at Virginia Commonwealth University , Richmond , VA , USA
| | - Wally Smith
- c Division of General Internal Medicine, Virginia Commonwealth University , Richmond , VA , USA
| | - India Sisler
- b Division of Hematology and Oncology, Children's Hospital of Richmond at Virginia Commonwealth University , Richmond , VA , USA
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Evaluation of instruments to assess health literacy in Arabic language among Iraqis. Res Social Adm Pharm 2015; 11:803-13. [DOI: 10.1016/j.sapharm.2015.02.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 02/09/2015] [Accepted: 02/10/2015] [Indexed: 11/21/2022]
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Duell P, Wright D, Renzaho AMN, Bhattacharya D. Optimal health literacy measurement for the clinical setting: A systematic review. PATIENT EDUCATION AND COUNSELING 2015; 98:1295-1307. [PMID: 26162954 DOI: 10.1016/j.pec.2015.04.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 12/05/2014] [Accepted: 04/04/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To identify the optimal measurement instrument for assessing health literacy in a clinical setting. METHODS Seven databases were searched for studies evaluating health literacy instruments used with patients. Standardised systematic review methods were used by two reviewers independently assessing eligibility, extracting data and evaluating study quality. A narrative summary was produced. RESULTS The searches identified 626 articles of which 64 were eligible. Forty-three different health literacy instruments were identified. The quality of these instruments, based on their psychometric properties, varied considerably. The majority of health literacy instruments were found to only assess communicative health literacy of which the numeracy element was often not represented. The NVS instrument was found to be the most practical health literacy instrument to use. CONCLUSION There is an urgent need to develop and psychometrically test a more encompassing health literacy instrument applicable in clinical settings as well as health promotion in general. PRACTICE IMPLICATIONS In the absence of a more comprehensive health literacy instrument, the NVS is a practical instrument to quickly assess for health literacy in a clinical setting.
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Affiliation(s)
- Paul Duell
- University of East Anglia, School of Pharmacy, Norwich Research Park, Norwich, UK.
| | - David Wright
- University of East Anglia, School of Pharmacy, Norwich Research Park, Norwich, UK
| | - Andre M N Renzaho
- School of Social Sciences and Psychology, University of Western Sydney, Sydney, Australia
| | - Debi Bhattacharya
- University of East Anglia, School of Pharmacy, Norwich Research Park, Norwich, UK
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Stonbraker S, Schnall R, Larson E. Tools to measure health literacy among Spanish speakers: An integrative review of the literature. PATIENT EDUCATION AND COUNSELING 2015; 98:S0738-3991(15)30020-3. [PMID: 26227578 PMCID: PMC4721943 DOI: 10.1016/j.pec.2015.07.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 07/13/2015] [Accepted: 07/15/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Health literacy measurement can help inform healthcare service delivery. The objective of this study is to identify validated tools to measure health literacy among Spanish speakers and to summarize characteristics that are relevant when selecting tools for use in clinical or research settings. METHODS An English and Spanish search of 9 databases was conducted between October 2014 and May 2015. Inclusion criteria were peer-reviewed articles presenting initial validation and psychometric properties of a tool to measure health literacy among Spanish speaking patients. Characteristics relevant to tool selection were reviewed and presented. RESULTS Twenty articles validating 19 instruments met inclusion criteria. Instruments were designed for use with Spanish speakers in numerous contexts and measured different health literacy skills such as reading comprehension or numeracy. Methods used to validate tools were inconsistent across instruments. CONCLUSION Although tools have inconsistencies and inefficiencies, many can be used for assessment of health literacy among Spanish speakers. PRACTICE IMPLICATIONS Healthcare providers, organizations, and researchers can use this review to select effective health literacy tools to indicate patient's ability to understand and use health information so that services and materials can be more appropriately tailored to Spanish speaking patients.
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Affiliation(s)
| | | | - Elaine Larson
- Columbia University School of Nursing, New York, NY, USA; Mailman School of Public Health, Department of Epidemiology, New York, NY, USA.
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Ramirez-Zohfeld V, Rademaker AW, Dolan NC, Ferreira MR, Eder M“M, Liu D, Wolf MS, Cameron KA. Comparing the Performance of the S-TOFHLA and NVS Among and Between English and Spanish Speakers. JOURNAL OF HEALTH COMMUNICATION 2015; 20:1458-1464. [PMID: 26147770 PMCID: PMC4729300 DOI: 10.1080/10810730.2015.1018629] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Given the growing body of evidence demonstrating the significant implications of health literacy on a myriad of outcomes, researchers continue to incorporate health literacy metrics in studies. With this proliferation in measurement of health literacy in research, it has become increasingly important to understand how various health literacy tools perform in specific populations. Our objective was to compare the performance of two widely used tests, the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the Newest Vital Sign (NVS) among and between a sample of English and Spanish-speaking patients. Adults (N = 402) ages 50-75 years participating in a trial to promote colorectal cancer screening completed in-person interviews which included both measures of health literacy. In the full sample, the tests were moderately correlated (r = 0.69, p < .0001); however, there was a stronger correlation among those completing the test in Spanish (r = 0.83) as compared with English (r = 0.58, p < .0001). English speakers more often were categorized as having adequate literacy by the S-TOFHLA as compared with the NVS, whereas Spanish speakers scored consistently low on both instruments. These findings indicate that the categorization of participants into levels of literacy is likely to vary, depending on whether the NVS or S-TOFHLA is used for assessment, a factor which researchers should be aware of when selecting literacy assessments.
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Affiliation(s)
- Vanessa Ramirez-Zohfeld
- Division of General Internal Medicine & Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alfred W. Rademaker
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nancy C. Dolan
- Division of General Internal Medicine & Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- Northwestern Medical Faculty Foundation, Chicago, IL
| | - M. Rosario Ferreira
- Division of General Internal Medicine & Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- Northwestern Medical Faculty Foundation, Chicago, IL
- Jesse Brown Veterans Affairs Medical Center, Chicago, IL
| | | | - Dachao Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael S. Wolf
- Division of General Internal Medicine & Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kenzie A. Cameron
- Division of General Internal Medicine & Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- Center for Advancing Equity in Clinical Preventive Services, Northwestern University, Chicago, IL
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Mantwill S, Schulz PJ. Health literacy in Mainland China: Validation of a functional health literacy test in simplified Chinese. Health Promot Int 2015; 31:742-748. [PMID: 26071605 DOI: 10.1093/heapro/dav043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Health literacy tests in the Chinese-speaking parts of the world have been mainly developed in traditional Chinese to be used in Hong Kong or Taiwan. So far no validated tool in simplified Chinese to assess functional health literacy in Mainland China has been developed. The aim of the study was to validate the simplified Chinese version of the Short Test of Functional Health Literacy in Adults (S-TOFHLA). The traditional Chinese version was translated into simplified Chinese and 150 interviews in an outpatient department of a public hospital in Mainland China were conducted. Predictive validity was assessed by known predictors for health literacy and convergent validity by three health literacy screening questions. The Cronbach's α for the reading comprehension part was 0.94 and 0.90 for the numeracy items. Participants with lower education and men had significantly lower levels of health literacy. The reading comprehension part was significantly correlated with two of the health literacy screening questions. Our results indicate that the simplified Chinese version of the S-TOFHLA is a reliable measure of health literacy to be used in Mainland China.
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Affiliation(s)
- Sarah Mantwill
- Institute of Communication and Health, University of Lugano, Via Giuseppe Buffi 13, Lugano 6900, Switzerland
| | - Peter J Schulz
- Institute of Communication and Health, University of Lugano, Via Giuseppe Buffi 13, Lugano 6900, Switzerland
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Kern AS, Watts KD, Rychlik K, McColley SA. Disparities in Parental Health Literacy at a Pediatric Cystic Fibrosis Center. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2015. [DOI: 10.1089/ped.2014.0396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Andrew S. Kern
- Division of Pulmonary Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Kimberly D. Watts
- Department of Pediatric Pulmonology, Advocate Children's Hospital, Park Ridge, Illinois
| | - Karen Rychlik
- Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Susanna A. McColley
- Division of Pulmonary Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Ownby RL, Acevedo A, Jacobs RJ, Caballero J, Waldrop-Valverde D. Quality of life, health status, and health service utilization related to a new measure of health literacy: FLIGHT/VIDAS. PATIENT EDUCATION AND COUNSELING 2014; 96:404-410. [PMID: 24856447 PMCID: PMC4700512 DOI: 10.1016/j.pec.2014.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 04/08/2014] [Accepted: 05/01/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Researchers have identified significant limitations in some currently used measures of health literacy. The purpose of this paper is to present data on the relation of health-related quality of life, health status, and health service utilization to performance on a new measure of health literacy in a nonpatient population. METHODS The new measure was administered to 475 English- and Spanish-speaking community-dwelling volunteers along with existing measures of health literacy and assessments of health-related quality of life, health status, and healthcare service utilization. Relations among measures were assessed via correlations and health status and utilization was tested across levels of health literacy using ANCOVA models. RESULTS The new health literacy measure is significantly related to existing measures of health literacy as well as to participants' health-related quality of life. Persons with lower levels of health literacy reported more health conditions, more frequent physical symptoms, and greater healthcare service utilization. CONCLUSION The new measure of health literacy is valid and shows relations to measures of conceptually related constructs such as quality of life and health behaviors. PRACTICE IMPLICATIONS FLIGHT/VIDAS may be useful to researchers and clinicians interested in a computer administered and scored measure of health literacy.
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Affiliation(s)
- Raymond L Ownby
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale, USA.
| | - Amarilis Acevedo
- Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, USA
| | - Robin J Jacobs
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Joshua Caballero
- College of Pharmacy, Department of Pharmacy Practice, Nova Southeastern University, Fort Lauderdale, USA
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Ownby RL, Acevedo A, Waldrop-Valverde D, Jacobs RJ, Caballero J. Abilities, skills and knowledge in measures of health literacy. PATIENT EDUCATION AND COUNSELING 2014; 95:211-7. [PMID: 24637163 PMCID: PMC4040019 DOI: 10.1016/j.pec.2014.02.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 01/21/2014] [Accepted: 02/06/2014] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Health literacy has been recognized as an important factor in patients' health status and outcomes, but the relative contribution of demographic variables, cognitive abilities, academic skills, and health knowledge to performance on tests of health literacy has not been as extensively explored. The purpose of this paper is to propose a model of health literacy as a composite of cognitive abilities, academic skills, and health knowledge (ASK model) and test its relation to measures of health literacy in a model that first takes demographic variables into account. METHODS A battery of cognitive, academic achievement, health knowledge and health literacy measures was administered to 359 Spanish- and English-speaking community-dwelling volunteers. The relations of health literacy tests to the model were evaluated using regression models. RESULTS Each health literacy test was related to elements of the model but variability existed across measures. CONCLUSION Analyses partially support the ASK model defining health literacy as a composite of abilities, skills, and knowledge, although the relations of commonly used health literacy measures to each element of the model varied widely. PRACTICE IMPLICATIONS Results suggest that clinicians and researchers should be aware of the abilities and skills assessed by health literacy measures when choosing a measure.
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Affiliation(s)
- Raymond L Ownby
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale, USA.
| | - Amarilis Acevedo
- Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, USA
| | | | - Robin J Jacobs
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Joshua Caballero
- College of Pharmacy, Department of Pharmacy Practice, Nova Southeastern University, Fort Lauderdale, USA
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Heerman WJ, Perrin EM, Yin HS, Sanders LM, Eden SK, Shintani A, Coyne-Beasley T, Bronaugh AB, Barkin SL, Rothman RL. Health literacy and injury prevention behaviors among caregivers of infants. Am J Prev Med 2014; 46:449-56. [PMID: 24745634 PMCID: PMC4040284 DOI: 10.1016/j.amepre.2014.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 12/09/2013] [Accepted: 01/08/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Unintentional injury is a leading cause of infant mortality. PURPOSE To examine the role of caregiver health literacy in infant injury prevention behaviors. METHODS A cross-sectional analysis of data collected in 2010-2012 from a randomized trial at four pediatric clinics was performed in 2012-2013. Caregiver health literacy was assessed with the Short Test of Functional Health Literacy in Adults. Caregiver-reported adherence to American Academy of Pediatrics-recommended injury prevention behaviors was assessed across seven domains: (1) car seat position; (2) car seat use; (3) sleeping safety; (4) fire safety; (5) hot water safety; (6) fall prevention; and (7) firearm safety. RESULTS Data were analyzed from 844 English- and Spanish-speaking caregivers of 2-month-old children. Many caregivers were non-adherent with injury prevention guidelines, regardless of health literacy. Notably, 42.6% inappropriately placed their children in the prone position to sleep, and 88.6% did not have their hot water heater set <120°F. Eleven percent of caregivers were categorized as having low health literacy. Low caregiver health literacy, compared to adequate health literacy, was significantly associated with increased odds of caregiver non-adherence with recommended behaviors for car seat position (AOR=3.4, 95% CI=1.6, 7.1) and fire safety (AOR=2.0, 95% CI=1.02, 4.1) recommendations. Caregivers with low health literacy were less likely to be non-adherent to fall prevention recommendations (AOR=0.5, 95% CI=0.2, 0.9). CONCLUSIONS Non-adherence to injury prevention guidelines was common. Low caregiver health literacy was significantly associated with some injury prevention behaviors. Future interventions should consider the role of health literacy in promoting injury prevention.
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Affiliation(s)
- William J Heerman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Eliana M Perrin
- Department of Pediatrics and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - H Shonna Yin
- Department of Pediatrics, New York University School of Medicine, New York, New York
| | - Lee M Sanders
- Department of Pediatrics and Center for Health Policy, Stanford University, Stanford, California
| | - Svetlana K Eden
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ayumi Shintani
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tamera Coyne-Beasley
- Department of Pediatrics and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Andrea B Bronaugh
- Department of Internal Medicine and Pediatrics and Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shari L Barkin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Russell L Rothman
- Department of Internal Medicine and Pediatrics and Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee
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Yi YJ. Health literacy and health information behavior of Florida public library users: A mixed methods study. JOURNAL OF LIBRARIANSHIP AND INFORMATION SCIENCE 2014. [DOI: 10.1177/0961000614531159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The study aimed to examine users’ self-perceived health information behavior according to their health literacy ability. The proficiency levels for health literacy were measured by scores on the Short Test of Functional Health Literacy Ability (S-TOFHLA). The study conducted self-administered surveys with 131 public library users and semi-structured intensive interviews with 20 users as a follow-up. Surveys found that most participants had proficient levels of health literacy, and there was an association between health literacy and some demographic characteristics such as gender and educational level. The majority assessed their health information behavior as high. Interviewees identified critical barriers to seeking, evaluating, and using health information delivered by public libraries. Findings provided insights into public libraries for better assistance for their users’ particular needs such as preferred resources or services. Above all, the findings acknowledged the challenges of current services, and suggested the strategies for coping with them.
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Sanders K, Schnepel L, Smotherman C, Livingood W, Dodani S, Antonios N, Lukens-Bull K, Balls-Berry J, Johnson Y, Miller T, Hodges W, Falk D, Wood D, Silliman S. Assessing the impact of health literacy on education retention of stroke patients. Prev Chronic Dis 2014; 11:E55. [PMID: 24721215 PMCID: PMC3984940 DOI: 10.5888/pcd11.130259] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Inadequate health literacy is a pervasive problem with major implications for reduced health status and health disparities. Despite the role of focused education in both primary and secondary prevention of stroke, the effect of health literacy on stroke education retention has not been reported. We examined the relationship of health literacy to the retention of knowledge after recommended stroke education. METHODS This prospective cross-sectional study was conducted at an urban safety-net hospital. Study subjects were patients older than 18 admitted to the hospital stroke unit with a diagnosis of acute ischemic stroke who were able to provide informed consent to participate (N = 100). Health literacy levels were measured by using the short form of Test of Functional Health Literacy in Adults. Patient education was provided to patients at an inpatient stroke unit by using standardized protocols, in compliance with Joint Commission specifications. The education outcomes for poststroke care education, knowledge retention, was assessed for each subject. The effect of health literacy on the Stroke Patient Education Retention scores was assessed by using univariate and multivariate analyses. RESULTS Of the 100 participating patients, 59% had inadequate to marginal health literacy. Stroke patients who had marginal health literacy (mean score, 7.45; standard deviation [SD], 1.9) or adequate health literacy (mean score, 7.31; SD, 1.76) had statistically higher education outcome scores than those identified as having inadequate health literacy (mean score, 5.58; SD, 2.06). Results from multivariate analysis indicated that adequate health literacy was most predictive of education outcome retention. CONCLUSIONS This study demonstrated a clear relationship between health literacy and stroke education outcomes. Studies are needed to better understand the relationship of health literacy to key educational outcomes for primary or secondary prevention of stroke and to refine stroke education for literacy levels of high-risk populations.
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Affiliation(s)
- Kalina Sanders
- 580 W. 8th St, Tower 1, 9th Floor, Jacksonville, FL 32209. E-mail:
| | - Loretta Schnepel
- University of Florida, College of Medicine, Gainesville, Florida
| | - Carmen Smotherman
- the Center for Health Equity and Quality Research, Jacksonville, Florida
| | - William Livingood
- University of Florida, College of Medicine, Gainesville, Florida, and the Center for Health Equity and Quality Research, Jacksonville, Florida
| | - Sunita Dodani
- University of Florida, College of Medicine, Gainesville, Florida, and the Center for Health Equity and Quality Research, Jacksonville, Florida
| | - Nader Antonios
- University of Florida, College of Medicine, Gainesville, Florida
| | | | - Joyce Balls-Berry
- the Center for Health Equity and Quality Research, Jacksonville, Florida
| | - Yvonne Johnson
- University of Florida Health Jacksonville, Jacksonville, Florida
| | - Terri Miller
- University of Florida Health Jacksonville, Jacksonville, Florida
| | - Wayne Hodges
- University of Florida, College of Medicine, Gainesville, Florida
| | - Diane Falk
- University of Florida, College of Medicine, Gainesville, Florida
| | - David Wood
- University of Florida, College of Medicine, Gainesville, Florida, and the Center for Health Equity and Quality Research, Jacksonville, Florida
| | - Scott Silliman
- University of Florida, College of Medicine, Gainesville, Florida
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Sauceda JA, Loya AM, Sias JJ, Taylor T, Wiebe JS, Rivera JO. Medication literacy in Spanish and English: psychometric evaluation of a new assessment tool. J Am Pharm Assoc (2003) 2013; 52:e231-40. [PMID: 23229985 DOI: 10.1331/japha.2012.11264] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the psychometric properties of a newly developed Medication Literacy Assessment in Spanish and English (MedLitR xSE). DESIGN Descriptive, nonexperimental, cross-sectional study. SETTING El Paso, TX, from December 2006 to June 2009. PARTICIPANTS 181 English- or Spanish speaking adults. INTERVENTION Survey administered in two phases. MAIN OUTCOME MEASURES Descriptive statistics, internal consistency, confirmatory factor analysis (CFA) and fit indices, and criterion-related validity. RESULTS The 20-item MedLitR xSE tool showed adequate internal consistency and reliability, and CFA revealed overall good model fit. In phase 2, the shorter 14-item MedLitR xSE showed good total test reliability and correlated well with the Short Test of Functional Health Literacy in Adults. Item response theory analyses showed no language bias and a one-dimensional (i.e., one factor) model of medication literacy. CONCLUSION The initial and latest shorter version of the MedLitR xSE tool demonstrated good psychometric properties. This tool may provide a new option to assess "medication literacy" in English and Spanish.
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Affiliation(s)
- John A Sauceda
- Department of Psychology, University of Texas at El Paso, 79902, USA.
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Williams KP, Templin TN. Bringing the real world to psychometric evaluation of cervical cancer literacy assessments with Black, Latina, and Arab women in real-world settings. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2013; 28:738-43. [PMID: 24072456 PMCID: PMC3848266 DOI: 10.1007/s13187-013-0549-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This research describes the development and evaluation of a new scale for assessing functional cervical cancer health literacy, the Cervical Cancer Literacy Assessment Tool (C-CLAT). In phase 1, 35 items in English, Spanish, and Arabic for C-CLAT were generated, taking into account three content domains-Awareness, Knowledge, and Prevention/Control. After content validation, 24 items were retained for psychometric evaluation. In phase 2, the 24-item C-CLAT was evaluated in three racial/ethnic populations of urban women (N = 543). Psychometric methods included item analysis, multifactor item response theory modeling, and concurrent correlations. The final C-CLAT consisted of 16 items, with an internal consistency reliability of 0.72. C-CLAT reliabilities in Black, Latina, and Arab women were 0.73, 0.76, and 0.60, respectively. The rank order correlations of item difficulties across racial/ethnic groups was high (r's = 0.97 to 0.98). The C-CLAT was positively related to educational level, and Arab women scored significantly higher than the Black and Latina participants. This study presents a psychometrically sound instrument that measures health literacy related to cervical cancer. The C-CLAT is a tool that can be orally administered by a lay person and used in a community-based health promotion intervention.
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Affiliation(s)
- Karen Patricia Williams
- Michigan State University, College of Human Medicine, Obstetrics, Gynecology & Reproductive Biology, 965 Fee Rd., Room 626B, East Lansing, MI 48824
| | - Thomas N. Templin
- Wayne State University, College of Nursing, 5557 Cass Avenue, 319 Cohn Building, Detroit, MI 48202
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Hernandez MY, Organista KC. Entertainment-education? A fotonovela? A new strategy to improve depression literacy and help-seeking behaviors in at-risk immigrant Latinas. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2013; 52:224-35. [PMID: 23907442 DOI: 10.1007/s10464-013-9587-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Research shows high risk for depression among immigrant Latinas known to increase during the acculturation process. Several barriers such as stigma and low health literacy result in an under-utilization of needed treatment among these women. In response, this study replicated the effectiveness of a Spanish language fotonovela, a form of Entertainment-Education (E-E), designed to increase depression literacy, decrease stigma, and increase help-seeking knowledge and behavior in Latinos. Specifically, this study evaluated a fotonovela delivered in a multifaceted approach to health education used by promotoras. A pretest-posttest randomized control group experimental design with 142 immigrant Latinas at risk for depression was employed. Results indicate significant posttest improvements in depression knowledge, self-efficacy to identify the need for treatment, and decreased stigma in experimental as compared to control group participants. Findings support the application of E-E health literacy tools such as fotonovelas, delivered in multifaceted approaches to health education used by promotoras, to Latinas at risk for mental health concerns.
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Affiliation(s)
- Maria Y Hernandez
- School of Social Welfare, University of California, Berkeley, 120 Haviland Hall #7400, Berkeley, CA, 94720-7400, USA,
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Ownby RL, Acevedo A, Waldrop-Valverde D, Jacobs RJ, Caballero J, Davenport R, Homs AM, Czaja SJ, Loewenstein D. Development and initial validation of a computer-administered health literacy assessment in Spanish and English: FLIGHT/VIDAS. PATIENT-RELATED OUTCOME MEASURES 2013; 4:21-35. [PMID: 23990736 PMCID: PMC3753170 DOI: 10.2147/prom.s48384] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Current measures of health literacy have been criticized on a number of grounds, including use of a limited range of content, development on small and atypical patient groups, and poor psychometric characteristics. In this paper, we report the development and preliminary validation of a new computer-administered and -scored health literacy measure addressing these limitations. Items in the measure reflect a wide range of content related to health promotion and maintenance as well as care for diseases. The development process has focused on creating a measure that will be useful in both Spanish and English, while not requiring substantial time for clinician training and individual administration and scoring. The items incorporate several formats, including questions based on brief videos, which allow for the assessment of listening comprehension and the skills related to obtaining information on the Internet. In this paper, we report the interim analyses detailing the initial development and pilot testing of the items (phase 1 of the project) in groups of Spanish and English speakers. We then describe phase 2, which included a second round of testing of the items, in new groups of Spanish and English speakers, and evaluation of the new measure’s reliability and validity in relation to other measures. Data are presented that show that four scales (general health literacy, numeracy, conceptual knowledge, and listening comprehension), developed through a process of item and factor analyses, have significant relations to existing measures of health literacy.
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Affiliation(s)
- Raymond L Ownby
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
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Flores BE, Acton GJ. Older Hispanic Women, Health Literacy, and Cervical Cancer Screening. Clin Nurs Res 2013; 22:402-15. [DOI: 10.1177/1054773813489309] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Approximately 90 million people in the United States lack basic literacy skills, which affect health behaviors. Cervical cancer is preventable and treatable, yet few older Hispanic women seek screening and continue to be a high-risk group for cervical cancer. A literature review was conducted to address the relationship between cervical cancer screening, health literacy, and older Hispanic women. Eighty studies were reviewed, and nine addressed health literacy and Hispanic women. One study addressed the association between functional health literacy and Pap smear screening among older Hispanic women. Few studies have explored the association between preventive cervical cancer screening and health literacy among older Hispanic women. Nurses must assess health literacy and be prepared to provide care, which is culturally, and linguistically appropriate to improve health outcomes. Further research is needed to be inclusive of all populations including older Hispanic women.
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Affiliation(s)
- Bertha E. Flores
- The University of Texas at Austin, TX, USA
- The University of Texas Health Science Center San Antonio, TX, USA
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Connor M, Mantwill S, Schulz PJ. Functional health literacy in Switzerland--validation of a German, Italian, and French health literacy test. PATIENT EDUCATION AND COUNSELING 2013; 90:12-17. [PMID: 23089240 DOI: 10.1016/j.pec.2012.08.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 07/21/2012] [Accepted: 08/25/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE This study aimed to translate and validate German, Italian, and French versions of the Short-Test of Functional Health Literacy (S-TOFHLA), to be used in Switzerland and its neighboring countries. METHODS The original English version of the S-TOFHLA was translated by applying standardized translation methods and cultural adaptations. 659 interviews were conducted with Swiss residents in their preferred language (249 German, 273 Italian, and 137 French). To assess the validity of the measures, known predictors for health literacy (age, education, and presence of a chronic condition) were tested. RESULTS For all three language versions, results show that younger participants, participants with a higher education and participants with chronic medical conditions had significantly higher levels of health literacy. Furthermore, the three health literacy scales categorized participants into three health literacy levels with most people possessing either inadequate or adequate levels. The highest levels of health literacy were found in the Swiss-German sample (93%), followed by the Swiss-French (83%) and Swiss-Italian (67%) samples. CONCLUSION The German, Italian, and French versions of the S-TOFHLA provide valid measures of functional health literacy. PRACTICE IMPLICATIONS The translated versions can be used in the three different language regions of Switzerland as well as in neighboring countries following 'country specific' adjustments and validations.
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Affiliation(s)
- Melanie Connor
- Institute of Communication and Health, Faculty of Communication Sciences, University of Lugano, Lugano, Switzerland.
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Dunn-Navarra AM, Stockwell MS, Meyer D, Larson E. Parental health literacy, knowledge and beliefs regarding upper respiratory infections (URI) in an urban Latino immigrant population. J Urban Health 2012; 89:848-60. [PMID: 22707307 PMCID: PMC3462826 DOI: 10.1007/s11524-012-9692-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Parents who are recent immigrants and/or non-native English speakers are at increased risk for poor health literacy. For example, misconceptions regarding treatment for upper respiratory infections (URIs), including nonjudicious use of antibiotics, have been described among Latinos. We sought to assess the influence of health literacy on knowledge and beliefs surrounding URI care and to explore the correlation between two health literacy measures among Latino parents in northern Manhattan. A descriptive survey design was used, and a total of 154 Latino parents were enrolled from four early head start programs between September 2009 and December 2009. Health literacy was measured using the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and Newest Vital Sign (NVS); parental knowledge and beliefs regarding antibiotic treatment for URIs were also assessed. Analyses were conducted in 2010 with multivariable logistic regression performed to examine predictors of health literacy. Inadequate health literacy was observed in 83.8 % of respondents using NVS and 35.7 % with the S-TOFHLA. College education was significantly associated with adequate health literacy using either the NVS or S-TOFHLA; however, other results varied between measures. Using NVS, there was a greater likelihood of adequate health literacy with US birth status (AOR 13.8; 95 % CI, 1.99-95.1), >5 years US residency (AOR 7.6; 95 % CI, 1.3-43.1) and higher antibiotic knowledge scores (AOR 1.7; 95 % CI, 1.2-2.4). Using S-TOFHLA, the odds of adequate health literacy increased with access to a regular care provider (AOR 2.6; 95 % CI, 1.2-5.6). Scores consistent with adequate health literacy on the NVS, but not the S-TOFHLA, were associated with correct beliefs regarding antibiotic use for URIs in comparison to scores of participants with inadequate health literacy. Since health literacy levels were low in this population and the risk of viral URI was high during the first few years of life, targeted education to improve health literacy, knowledge, and beliefs about URI and related antibiotic treatment is needed.
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Affiliation(s)
- Ann-Margaret Dunn-Navarra
- Training in Interdisciplinary Research to Reduce Antimicrobial Resistance (TIRAR), Columbia University, School of Nursing, New York, NY, USA.
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Evaluation of health literacy among Spanish-speaking primary care patients along the US--Mexico border. South Med J 2012; 105:334-8. [PMID: 22766658 DOI: 10.1097/smj.0b013e31825b2468] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Health literacy (HL) is a measure of the communication skills that are needed by an individual to effectively navigate the healthcare system. Hispanic adults have lower average levels of HL than any other racial/ethnic group; however, the prevalence of adequate HL among Hispanics along the US-Mexico border is unknown. METHODS We performed a cross-sectional survey of 200 adult primary care patients who attended four low-income community clinics along the US-Mexico border. Patients were included in the study if they were self-described Hispanics whose first language was Spanish or bilingual patients who reported that they were primarily Spanish speakers. Adequate HL was defined as having a score of ≥38 on the Short Assessment of Health Literacy for Spanish Adults-50. RESULTS Three patients (1.5%) had inadequate HL. Because of the high proportion of patients having adequate HL, we found no statistical differences between patients with adequate HL versus inadequate HL by age, sex, educational attainment, health coverage, or self-reported health status; however, all three patients with inadequate HL were found to be 60 years old or older and had less than a high school education. CONCLUSIONS The results of HL assessment varied according to the tool and setting used in measuring Spanish-speaking Hispanics. In certain clinical scenarios, current tools may underestimate the actual prevalence of adequate HL. Further development and assessment of HL tools appropriate for Spanish-speaking Hispanics is needed as a first step in developing interventions to limit disparities in health care among all Americans.
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Pagán JA, Brown CJ, Asch DA, Armstrong K, Bastida E, Guerra C. Health literacy and breast cancer screening among Mexican American women in South Texas. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2012; 27:132-137. [PMID: 21573944 DOI: 10.1007/s13187-011-0239-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Breast cancer is the main cause of cancer deaths for Hispanic women. This study analyzes the role of functional health literacy on mammography screening behavior and adherence of Hispanic women. Survey data from 722 Mexican American women age 40 and over residing in the Lower Rio Grande Valley of Texas in 2008 were used to estimate logistic regression models to assess the role of functional health literacy on mammography screening behavior and adherence. About 51% of survey respondents had a functional health literacy level deemed as inadequate or marginally functional. After adjusting for other factors, women with adequate health literacy levels were more likely to report to have ever had a mammogram (odds ratio [OR] = 2.92; 95% confidence interval [CI] = 1.62-5.28), to have had a mammogram within the last 2 years (OR = 1.70; 95% CI = 1.14-2.53) or to have had one within the last year (OR = 2.30; 95% CI = 1.54-3.43), compared to women with inadequate or marginally adequate functional health literacy levels. Inadequate/marginal functional health literacy is strongly associated with lower mammography screening. Large improvements in breast cancer control in this population may come from either basic advances in health literacy or by tailored approaches to help women with low literacy navigate local health care systems.
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Affiliation(s)
- José A Pagán
- Department of Health Management and Policy, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX 76107, USA.
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McLeod-Sordjan R. Assessing Functional Health Literacy Among Hispanic Elders With Chronic Disease. J Nurse Pract 2011. [DOI: 10.1016/j.nurpra.2011.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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47
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McWhirter J, Todd L, Hoffman-Goetz L. Comparing written and oral measures of comprehension of cancer information by English-as-a-Second-Language Chinese immigrant women. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2011; 26:484-489. [PMID: 21445682 DOI: 10.1007/s13187-011-0219-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The Short Test of Functional Health Literacy for Adults (S-TOFHLA) and Cloze test are commonly used tools to measure comprehension of health information (i.e., health literacy); however, little is known about their use in English-as-a-Second-Language (ESL) populations. In this study, we compared written (Cloze test) and oral (Teach Back) measures of colon cancer information comprehension among ESL Chinese immigrant women to Canada. Performances on colon cancer-specific measures were compared to a general measure of health literacy (S-TOFHLA). On the S-TOFHLA, Cloze, and Teach Back, respectively, the following percentage of participants had adequate comprehension: 62.1%, 14.8%, and 89.7%. Correlation between performance on the Cloze and Teach Back was significant albeit weakly so (r = 0.38, p = 0.04); performances on the S-TOFHLA and Teach Back were not correlated. Measures of health literacy skill that require written English language skills may not be appropriate for measuring understanding of health information for ESL populations.
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Affiliation(s)
- Jennifer McWhirter
- Department of Health Studies and Gerontology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Coming to consensus on health literacy measurement: an online discussion and consensus-gauging process. Nurs Outlook 2011; 59:95-106.e1. [PMID: 21402205 DOI: 10.1016/j.outlook.2010.12.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 12/29/2010] [Accepted: 12/31/2010] [Indexed: 11/20/2022]
Abstract
Health literacy continues to experience the normal growing pains of an emerging field of inquiry and practice. The evolving concept of health literacy requires the development of new measurement tools to adequately study interventions and identify best practices. This article describes a multistage process of engaging the largest known international group of health literacy professionals in an online discussion about health literacy measurement. The goal was to gather input and identify important themes in the discussion using both quantitative and qualitative evaluation methods to gauge the strength of any consensus about health literacy measurement and start to identify topics that should be considered and addressed by those working to develop new tools to measure health literacy.
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O'Brien M, Shea J. Disparities in patient satisfaction among Hispanics: the role of language preference. J Immigr Minor Health 2011; 13:408-12. [PMID: 19626440 DOI: 10.1007/s10903-009-9275-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hispanic and Spanish-speaking patients experience lower satisfaction with their health care when compared to whites and English speakers. We attempt to clarify the relationship between language preference and patient satisfaction in Hispanics. Study participants were Hispanic patients recruited from two clinics that serve an exclusively Hispanic population. We compared baseline levels of patient satisfaction among English-speaking, Spanish-speaking, and bilingual participants. Multivariate linear regression was used to model the effect of language preference on patient satisfaction. Baseline comparisons revealed that bilingual patients experienced higher satisfaction with doctor-patient communication and the office staff than Spanish-speaking patients. Multivariate analysis demonstrated that language preference was not significantly associated with patient satisfaction. Patient language preference was not a consistent predictor of satisfaction in this cohort of Hispanic patients receiving linguistically competent primary care. The analysis of local data in this study provides a crude adjustment for healthcare quality that is missing from previous research.
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Affiliation(s)
- Matthew O'Brien
- Department of Internal Medicine, Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
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50
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Measuring health literacy among immigrants with a phonetic primary language: a case of Korean American women. J Immigr Minor Health 2011; 13:253-9. [PMID: 20585985 DOI: 10.1007/s10903-010-9366-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
While the need for understanding the issue of health literacy among ethnic minority groups with limited English skills is rapidly increasing in the US, it is difficult to find valid and useful health literacy tools for certain linguistic minorities. This study was designed to validate the Korean translation of Rapid Estimate of Adult Literacy in Medicine (REALM) and Test of Functional Health Literacy in Adults-Short form (S-TOFHLA). Korean REALM and S-TOFHLA were administered to 98 Korean American women, together with REALM-English. Participants were first-generation immigrants who were educated in Korea. Both Korean REALM and S-TOFHLA resulted in a negatively-skewed distribution. REALM-English yielded well-distributed groups with significant correlations with Korean REALM and S-TOFHLA (Spearman's rho = 0.30, P = 0.003 and 0.22, P = 0.03, respectively). Educational level was significantly correlated with REALM-English and Korean S-TOFHLA (Spearman's rho = 0.39, P = 0.000 and 0.25, P = 0.014), but not with REALM-Korean. The translation of REALM and S-TOFHLA into the Korean language did not lead to a valid assessment of health literacy. A more systematic approach is needed to assess health literacy in immigrants with limited English skills, particularly those with a phonetic primary language. Meanwhile, REALM-English could be used as a crude health literacy test for individuals with some English skills.
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