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Loman L, Brands MJ, Politiek K, Schuttelaar MLA. Health Literacy and Associated Factors in Subjects with Hand Eczema: A Dutch Population-based Study. Acta Derm Venereol 2024; 104:adv40079. [PMID: 38751179 PMCID: PMC11110806 DOI: 10.2340/actadv.v104.40079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/07/2024] [Indexed: 05/24/2024] Open
Abstract
Abstract is missing (Short communication)
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Affiliation(s)
- Laura Loman
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marjolein J Brands
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Klaziena Politiek
- Department of Dermatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Marie L A Schuttelaar
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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Waumans RC, Muntingh ADT, Veldwijk J, W Hoogendoorn A, van Balkom AJLM, Batelaan NM. Treatment Preferences of Adolescents and Young Adults with Depressive Symptoms: A Discrete Choice Experiment. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:401-413. [PMID: 38109008 DOI: 10.1007/s40258-023-00857-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Depression in adolescents and young adults is common and causes considerable disease burden while hampering their development, leading to adverse consequences in later life. Although treatment is available, young people are a vulnerable group regarding uptake and completion of treatment. To improve this, insight into youth's preferences for treatment is essential. OBJECTIVE The aim of this study was to investigate patient preferences for depression treatment in a Dutch sample aged 16-24 years using a discrete choice experiment (DCE). METHODS The study was conducted in The Netherlands between October 2018 and June 2019, and included 236 adolescents and young adults with current depressive symptoms or previous treatment. The DCE included five attributes (treatment type, frequency of appointment, waiting time, effectiveness, evaluation of therapeutic alliance) with corresponding levels. Results were analysed using latent class analysis. RESULTS Results show a general preference for individual psychotherapy, treatment with high frequency, high effectiveness, short waiting time and a standard evaluation of the therapeutic alliance ('click' with the therapist) early in treatment. Latent class analysis revealed three different patterns of preferences regarding treatment type and willingness to engage in therapy. The first class showed a strong preference for individual therapy. The second class, including relatively older, higher educated and treatment-experienced participants, preferred high frequency treatment and was more open to different forms of therapy. The third class, including lower educated, younger and treatment-naïve adolescents showed reluctance to engage in therapy overall and in group therapy specifically. CONCLUSION In this DCE, three classes could be identified that share similar preferences regarding treatment effectiveness, waiting time and evaluation of the therapeutic alliance, but varied considerably in their preference for treatment type (individual, group, or combined psychotherapy) and their willingness to engage. The results from this study may inform mental health care providers and institutions and help optimize professional care for adolescents and young adults with depressive symptoms, improving engagement in this vulnerable group.
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Affiliation(s)
- Ruth C Waumans
- Amsterdam Public Health Institute and GGZ inGeest Specialized Mental Health care, Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands.
| | - Anna D T Muntingh
- Amsterdam Public Health Institute and GGZ inGeest Specialized Mental Health care, Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands
| | - Jorien Veldwijk
- Erasmus School of Health Policy and Management, Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Adriaan W Hoogendoorn
- Amsterdam Public Health Institute and GGZ inGeest Specialized Mental Health care, Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands
| | - Anton J L M van Balkom
- Amsterdam Public Health Institute and GGZ inGeest Specialized Mental Health care, Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands
| | - Neeltje M Batelaan
- Amsterdam Public Health Institute and GGZ inGeest Specialized Mental Health care, Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands
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van Strien-Knippenberg IS, Arjangi-Babetti H, Timmermans DRM, Schrauwen L, Fransen MP, Melles M, Damman OC. Communicating the results of risk-based breast cancer screening through visualizations of risk: a participatory design approach. BMC Med Inform Decis Mak 2024; 24:78. [PMID: 38500098 PMCID: PMC10949766 DOI: 10.1186/s12911-024-02483-6] [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: 07/20/2023] [Accepted: 03/11/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Risk-based breast cancer (BC) screening raises new questions regarding information provision and risk communication. This study aimed to: 1) investigate women's beliefs and knowledge (i.e., mental models) regarding BC risk and (risk-based) BC screening in view of implications for information development; 2) develop novel informational materials to communicate the screening result in risk-based BC screening, including risk visualizations of both quantitative and qualitative information, from a Human-Centered Design perspective. METHODS Phase 1: Interviews were conducted (n = 15, 40-50 years, 5 lower health literate) on women's beliefs about BC risk and (risk-based) BC screening. Phase 2: In three participatory design sessions, women (n = 4-6 across sessions, 40-50 years, 2-3 lower health literate) made assignments and created and evaluated visualizations of risk information central to the screening result. Prototypes were evaluated in two additional sessions (n = 2, 54-62 years, 0-1 lower health literate). Phase 3: Experts (n = 5) and women (n = 9, 40-74 years) evaluated the resulting materials. Two other experts were consulted throughout the development process to ensure that the content of the information materials was accurate. Interviews were transcribed literally and analysed using qualitative thematic analysis, focusing on implications for information development. Notes, assignments and materials from the participatory design sessions were summarized and main themes were identified. RESULTS Women in both interviews and design sessions were positive about risk-based BC screening, especially because personal risk factors would be taken into account. However, they emphasized that the rationale of risk-based screening and classification into a risk category should be clearly stated and visualized, especially for higher- and lower-risk categories (which may cause anxiety or feelings of unfairness due to a lower screening frequency). Women wanted to know their personal risk, preferably visualized in an icon array, and wanted advice on risk reduction and breast self-examination. However, most risk factors were considered modifiable by women, and the risk factor breast density was not known, implying that information should emphasize that BC risk depends on multiple factors, including breast density. CONCLUSIONS The information materials, including risk visualizations of both quantitative and qualitative information, developed from a Human-Centered Design perspective and a mental model approach, were positively evaluated by the target group.
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Affiliation(s)
- Inge S van Strien-Knippenberg
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Hannah Arjangi-Babetti
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Danielle R M Timmermans
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Laura Schrauwen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Mirjam P Fransen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Marijke Melles
- Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Olga C Damman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
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Levic M, Bogavac-Stanojevic N, Lakic D, Krajnovic D. Predictors of Inadequate Health Literacy among Patients with Type 2 Diabetes Mellitus: Assessment with Different Self-Reported Instruments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5190. [PMID: 36982101 PMCID: PMC10049631 DOI: 10.3390/ijerph20065190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Obtaining, understanding, interpreting, and acting on health information enables people with diabetes to engage and make health decisions in various contexts. Hence, inadequate health literacy (HL) could pose a problem in making self-care decisions and in self-management for diabetes. By applying multidimensional instruments to assess HL, it is possible to differentiate domains of functional, communicative, and critical HL. OBJECTIVES Primarily, this study aimed to measure the prevalence of inadequate HL among type 2 diabetes mellitus patients and to analyze the predictors influencing health literacy levels. Secondly, we analyzed if different self-reported measures, unidimensional instruments (Brief Health Literacy instruments (BRIEF-4 and abbreviated version BRIEF-3), and multidimensional instruments (Functional, Communicative and Critical health literacy instrument (FCCHL)) have the same findings. METHODS The cross-sectional study was conducted within one primary care institution in Serbia between March and September 2021. Data were collected through Serbian versions of BRIEF-4, BRIEF-3, and FCCHL-SR12. A chi-square test, Fisher's exact test, and simple logistic regression were used to measure the association between the associated factors and health literacy level. Multivariate analyses were performed with significant predictors from univariate analyses. RESULTS Overall, 350 patients participated in the study. They were primarily males (55.4%) and had a mean age of 61.5 years (SD = 10.5), ranging from 31 to 82 years. The prevalence of inadequate HL was estimated to be 42.2% (FCCHL-SR12), 36.9% (BRIEF-3) and 33.8% (BRIEF-4). There are variations in the assessment of marginal and adequate HL by different instruments. The highest association was shown between BRIEF-3 and total FCCHL-SR12 score (0.204, p < 0.01). The total FCCHL-SR12 score correlates better with the abbreviated BRIEF instrument (BRIEF-3) than with BRIEF-4 (0.190, p < 0.01). All instruments indicated the highest levels for the communicative HL domain and the lowest for the functional HL domain with significant difference in functional HL between the functional HL of FCCHL-SR12 and both BRIEF-3 and BRIEF-4 (p = 0.006 and 0.008, respectively). Depending on applied instruments, we identified several variables (sociodemographic, access to health-related information, empowerment-related indicators, type of therapy, and frequency of drug administration) that could significantly predict inadequate HL. Probability of inadequate HL increased with older age, fewer children, lower education level, and higher consumption of alcohol. Only high education was associated with a lower probability of inadequate HL for all three instruments. CONCLUSIONS The results we obtained indicate that patients in our study may have been more functionally illiterate, but differences between functional level could be observed if assessed by unidimensional and multidimensional instruments. The proportion of patients with inadequate HL is approximately similar as assessed by all three instruments. According to the association between HL and educational level in DMT2 patients we should investigate methods of further improvement.
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Affiliation(s)
- Marija Levic
- PhD Program of Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, 11221 Belgrade, Serbia
| | - Natasa Bogavac-Stanojevic
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, 11221 Belgrade, Serbia
| | - Dragana Lakic
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, 11221 Belgrade, Serbia
| | - Dusanka Krajnovic
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, 11221 Belgrade, Serbia
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Limited Health Literacy and Its Associated Health Outcomes Among Adults With at Least 2 Atopic Diseases. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1429-1438.e6. [PMID: 36634845 DOI: 10.1016/j.jaip.2022.12.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Health literacy (HL) is essential for patients with multiple atopic diseases to improve their health, given the complexity of their disease and treatment regimens. OBJECTIVE To estimate the proportion of adults with multiple atopic diseases (at least 2 of atopic dermatitis, asthma, allergic rhinitis, and food allergy) in the Dutch general population and to evaluate the prevalence of limited HL, and its association with socioeconomic status (SES), lifestyle factors, and health-related quality of life (HR-QoL) in this patient population. METHODS This cross-sectional study was conducted within the Lifelines Cohort Study via sending an add-on digital questionnaire, including (among others) questions on atopic dermatitis, to all adult participants (n = 135,950) between February and May 2020. Data on asthma, allergic rhinitis, lifestyle factors, HR-QoL, and SES were extracted from baseline assessment between 2006 and 2013. Functional, communicative, and critical HL were measured by validated items from Chew and the Dutch Functional Communicative and Critical Health Literacy questionnaires between 2012 and 2016. Food allergy was measured by the Food Allergy Questionnaire between 2014 and 2016. RESULTS In total, 11.8% of the overall study population reported ever having multiple atopic diseases; of those, 23.6% reported having limited functional HL, with a higher prevalence among those with a low SES. Limited functional HL showed positive associations with smoking, obesity, chronic stress, a low diet quality, and decreased HR-QoL among subjects with multiple atopic diseases. CONCLUSIONS We identified an HL deficit, and its association with a low SES and poor health outcomes among patients with multiple atopic diseases. Further research is warranted to utilize a more extensive assessment to measure HL and include more health outcomes, such as treatment adherence and disease control.
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Huls SPI, de Bekker-Grob EW. Can healthcare choice be predicted using stated preference data? The role of model complexity in a discrete choice experiment about colorectal cancer screening. Soc Sci Med 2022; 315:115530. [PMID: 36434890 DOI: 10.1016/j.socscimed.2022.115530] [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: 04/21/2022] [Revised: 10/17/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The validity of discrete choice experiments (DCEs) is crucial to its usage in healthcare decision-making, but there is only a limited number of health contexts in which external validity is demonstrated. This study aims to assess the internal and external validity of the DCE in the context of colorectal cancer (CRC) screening, and gather insights into the discrepancy between stated and revealed preferences. METHODS Stated and revealed preferences were elicited on an individual level from Dutch residents eligible for CRC screening in a DCE and a field experiment, respectively (N = 568). To identify the determinants of CRC screening participation and their relative importance, five random utility maximisation models that varied in complexity were used. We assessed the accuracy with which the models based on stated preferences predict individual-level screening choice in a holdout task (internal validity) and in the actual screening choice (external validity). Insights into the discrepancy between stated and revealed preferences were gathered by comparing groups of respondents. RESULTS Our findings show high internal and external validity. Choices could be accurately predicted for 95% of the respondents in the holdout task, and 90% in the actual screening choice. When scale and preference heterogeneity were taken into account model fit improved; individual-level prediction accuracy slightly increased for the holdout task but not for the actual screening choice. Respondents for whom stated preferences matched revealed preferences were generally in better health and found the GP's support for their screening decision more important. DISCUSSION Evidence was found that revealed preferences can be predicted accurately on an individual level. Incorporating heterogeneity improved internal validity but not external validity. Differences between stated and revealed preferences can be attributed to respondents' health and the support of their GP. We suggest researchers to continue investigating the internal and external validity of discrete choice experiments, and the role of model complexity.
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Affiliation(s)
- Samare P I Huls
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, the Netherlands.
| | - Esther W de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, the Netherlands
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Huls SPI, Veldwijk J, Swait JD, Viberg Johansson J, Ancillotti M, de Bekker-Grob EW. Preference Variation: Where Does Health Risk Attitude Come Into the Equation? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:2044-2052. [PMID: 35750590 DOI: 10.1016/j.jval.2022.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/24/2022] [Accepted: 05/02/2022] [Indexed: 05/25/2023]
Abstract
OBJECTIVES Decisions about health often involve risk, and different decision makers interpret and value risk information differently. Furthermore, an individual's attitude toward health-specific risks can contribute to variation in health preferences and behavior. This study aimed to determine whether and how health-risk attitude and heterogeneity of health preferences are related. METHODS To study the association between health-risk attitude and preference heterogeneity, we selected 3 discrete choice experiment case studies in the health domain that included risk attributes and accounted for preference heterogeneity. Health-risk attitude was measured using the 13-item Health-Risk Attitude Scale (HRAS-13). We analyzed 2 types of heterogeneity via panel latent class analyses, namely, how health-risk attitude relates to (1) stochastic class allocation and (2) systematic preference heterogeneity. RESULTS Our study did not find evidence that health-risk attitude as measured by the HRAS-13 distinguishes people between classes. Nevertheless, we did find evidence that the HRAS-13 can distinguish people's preferences for risk attributes within classes. This phenomenon was more pronounced in the patient samples than in the general population sample. Moreover, we found that numeracy and health literacy did distinguish people between classes. CONCLUSIONS Modeling health-risk attitude as an individual characteristic underlying preference heterogeneity has the potential to improve model fit and model interpretations. Nevertheless, the results of this study highlight the need for further research into the association between health-risk attitude and preference heterogeneity beyond class membership, a different measure of health-risk attitude, and the communication of risks.
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Affiliation(s)
- Samare P I Huls
- Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Jorien Veldwijk
- Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands; Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Joffre D Swait
- Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jennifer Viberg Johansson
- Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Department of New Technologies and the Human Future, The Institute for Future Studies, Stockholm, Sweden
| | - Mirko Ancillotti
- Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Esther W de Bekker-Grob
- Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Puello SDCP, Silva-Júnior MF, de Sousa MDLR, Batista MJ. Criterion validity of 14-item Health Literacy Scale (HLS-14) questionnaire in Brazilian adults and older people. Health Promot Int 2022; 37:6749054. [DOI: 10.1093/heapro/daac142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Summary
The objective of this study was to evaluate the criterion validity of the 14-item Health Literacy Scale (HLS-14) in Brazilian adults and older adults. The cross-sectional study performed in an oral health (OH) prospective cohort was conducted in 2017 in Piracicaba, Brazil. The HLS-14 questionnaire was applied to evaluate Health Literacy (HL) by dimensions: Functional literacy (FunL), Communicative literacy (ComL) and Critical literacy (CriL). An evaluation protocol (EP) was proposed to evaluate the criterion validity of HLS-14 considering HL dimensions (FunL: reading of the drug information leaflets; ComL: reading of the medical prescription and CriL: identification of OH conditions). HL (total) was dichotomized by the median in high (≥35 point) or low (<35 point) HL. Kendall’s rank correlation coefficient (p < 0.05) and chi-squared test (p < 0.05) were applied. There was agreement between EP and HLS-14 for FunL (p < 0.01). There was association between high HL, measured through the HLS-14 questionnaire, assessing the reading of the drug information leaflets (p < 0.01) and the need for help to read them (p < 0.01). EP showed association between high HL and being able to read the drug information leaflet (p < 0.01), not needing help to read (p < 0.01), having found in the prescription all the information to take the medicine (p < 0.01) and knowing two or more health and OH information in the educational material (p < 0.01). The HSL-14 questionnaire showed criterion validity to measure FunL, and for some items of ComL and CriL evaluation. HL evaluation in a practical and multidimensional way could have an effect on the communication between health professional and patient, motivation and health outcomes.
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Affiliation(s)
- Sthefanie del Carmen Perez Puello
- Department of Health Sciences and Pediatric Dentistry of the Piracicaba Dental School, State University of Campinas , Piracicaba, São Paulo , Brazil
- Department of Research, Faculty of Dentistry, Universidad de Cartagena , Cartagena, Bolívar , Colombia
| | | | - Maria da Luz Rosário de Sousa
- Department of Health Sciences and Pediatric Dentistry of the Piracicaba Dental School, State University of Campinas , Piracicaba, São Paulo , Brazil
| | - Marília Jesus Batista
- Department of Health Sciences and Pediatric Dentistry of the Piracicaba Dental School, State University of Campinas , Piracicaba, São Paulo , Brazil
- Department of Community Health, Medical School of Jundiaí , Jundiaí, São Paulo , Brazil
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Swait J, de Bekker-Grob EW. A discrete choice model implementing gist-based categorization of alternatives, with applications to patient preferences for cancer screening and treatment. JOURNAL OF HEALTH ECONOMICS 2022; 85:102674. [PMID: 36041269 DOI: 10.1016/j.jhealeco.2022.102674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/28/2022] [Accepted: 08/16/2022] [Indexed: 05/20/2023]
Abstract
The rational microeconomic decision model is hard-coded into usual econometric specifications such as the Multinomial Logit and Probit models, inter alia. There is a very tight link between utility maximization and the apparatus of welfare theory that underlies economic policy analysis, which creates a tension around the possibility of representing other decision rules. We propose a less restrictive model of choice, built on the concept of gist-based categorization judgments that are assumed to precede (thus, condition) the maximization-driven selection process in decision making. This categorization facilitates decision making by allowing adoption of certain simpler decision rules under appropriate conditions, the drivers of which are endogenously determined. We demonstrate that the proposed model provides better fit than traditional choice models, using cancer screening and treatment choice data from two discrete choice experiments. In addition, we show that the model provides a deeper, more nuanced and insightful perspective on (healthcare) decision making.
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Affiliation(s)
- J Swait
- Erasmus School of Health Policy and Management and Erasmus Choice Modeling Centre, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam 3000 DR, the Netherlands.
| | - E W de Bekker-Grob
- Erasmus School of Health Policy and Management and Erasmus Choice Modeling Centre, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam 3000 DR, the Netherlands
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Levic M, Bogavac-Stanojevic N, Krajnovic D. Cross-Cultural Adaptation and Validation of the Functional, Communicative and Critical Health Literacy Instrument (FCCHL-SR) for Diabetic Patients in Serbia. Healthcare (Basel) 2022; 10:healthcare10091667. [PMID: 36141279 PMCID: PMC9498457 DOI: 10.3390/healthcare10091667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/20/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
Thoroughly validated instruments can provide a more accurate and reliable picture of how the instrument works and of the level of health literacy in people with type 2 diabetes mellitus (T2DM). The present work aimed at cross-cultural adaptation and validation of the Functional, Communicative and Critical Health Literacy Instrument (FCCHL) in patients with T2DM in Serbia. After translation and back-translation, views from an expert group, one cognitive interview study (n = 10) and one survey study (n = 130) were conducted among samples of diabetic patients. Item analysis, internal consistency, content validity, confirmatory factor analysis (CFA) and reliability testing were performed. When all 14 items were analyzed, loading factors were above 0.55, but without adequate model fit. After removing two items with the lowest loadings FHL1 and IHL2 the fit indexes indicated a reasonable normed χ2 (SB scaled χ2/df = 1.90). CFI was 0.916 with SRMR = 0.0676 and RMSEA = 0.0831. To determine internal consistency, Cronbach’s alpha coefficient was 0.796 for the whole FCCHL-SR12. With only minor modifications compared to the English version, the 12-item FCCHL instrument is valid and reliable and can be used to measure health literacy among Serbian diabetic patients. However, future research on a larger population in Serbia is necessary for measuring the levels of HL and their relationship with other determinants in this country.
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Affiliation(s)
- Marija Levic
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Belgrade 11221, Serbia
| | - Natasa Bogavac-Stanojevic
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade 11221, Serbia
| | - Dusanka Krajnovic
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Belgrade 11221, Serbia
- Correspondence:
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Veldwijk J, Swait JD. The Role of Attribute Screening and Choice Set Formation in Health Discrete Choice Experiments: Modeling the Impact of Benefit and Risk Attributes. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1416-1427. [PMID: 35599111 DOI: 10.1016/j.jval.2022.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 01/31/2022] [Accepted: 02/08/2022] [Indexed: 05/20/2023]
Abstract
OBJECTIVES This study aimed to demonstrate the econometric modeling of benefit/risk-based choice set formation (CSF) within health-related discrete choice experiments. METHODS In 4 different case studies, first, a trade-off model was fitted; building on this, a screening model was fitted; and finally, a full CSF model was estimated. This final model allows for attributes to be used first to screen out alternatives from choice tasks before respondents' trade-off attributes and make a choice among feasible alternatives. Educational level and health literacy of respondents were accounted for in all models. RESULTS Model fit in terms of log likelihood, pseudo-R2, Akaike information criterion, and Bayesian information criterion improved from using only trade-off or screening models compared with CSF models in 3 of the 4 case studies. In those studies, significant screening behavior was identified that (1) affected trade-off inferences, (2) rejects the pure trade-off model, and (3) supports the existence of screening on the basis of benefit-risk profiles, and other attributes. Educational level and health literacy showed significant interactions with multiple attributes in all case studies. CONCLUSIONS Choice modelers should pay close attention to noncompensatory respondent behavior when they include benefit or risk attributes in their discrete choice experiment. Further studies should investigate why and when respondents undertake screening behavior. Screening behavior in choice data analysis is always a possibility, so researchers should explore extensions of econometric models to reflect noncompensatory behavior. Assuming that benefit and risk attributes will only affect trade-off behavior is likely to lead to biased conclusions about benefit or risk-based behavior.
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Affiliation(s)
- Jorien Veldwijk
- Erasmus School of Health Policy and Management and Erasmus Choice Modeling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands.
| | - Joffre D Swait
- Erasmus School of Health Policy and Management and Erasmus Choice Modeling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
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Tavousi M, Mohammadi S, Sadighi J, Zarei F, Kermani RM, Rostami R, Montazeri A. Measuring health literacy: A systematic review and bibliometric analysis of instruments from 1993 to 2021. PLoS One 2022; 17:e0271524. [PMID: 35839272 PMCID: PMC9286266 DOI: 10.1371/journal.pone.0271524] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 07/04/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND It has been about 30 years since the first health literacy instrument was developed. This study aimed to review all existing instruments to summarize the current knowledge on the development of existing measurement instruments and their possible translation and validation in other languages different from the original languages. METHODS The review was conducted using PubMed, Web of Science, Scopus, and Google Scholar on all published papers on health literacy instrument development and psychometric properties in English biomedical journals from 1993 to the end of 2021. RESULTS The findings were summarized and synthesized on several headings, including general instruments, condition specific health literacy instruments (disease & content), population- specific instruments, and electronic health. Overall, 4848 citations were retrieved. After removing duplicates (n = 2336) and non-related papers (n = 2175), 361 studies (162 papers introducing an instrument and 199 papers reporting translation and psychometric properties of an original instrument) were selected for the final review. The original instruments included 39 general health literacy instruments, 90 condition specific (disease or content) health literacy instruments, 22 population- specific instruments, and 11 electronic health literacy instruments. Almost all papers reported reliability and validity, and the findings indicated that most existing health literacy instruments benefit from some relatively good psychometric properties. CONCLUSION This review highlighted that there were more than enough instruments for measuring health literacy. In addition, we found that a number of instruments did not report psychometric properties sufficiently. However, evidence suggest that well developed instruments and those reported adequate measures of validation could be helpful if appropriately selected based on objectives of a given study. Perhaps an authorized institution such as World Health Organization should take responsibility and provide a clear guideline for measuring health literacy as appropriate.
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Affiliation(s)
- Mahmoud Tavousi
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Samira Mohammadi
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Jila Sadighi
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Fatemeh Zarei
- Faculty of Medical Sciences, Department of Health Education, Tarbiat Modares University, Tehran, Iran
| | - Ramin Mozafari Kermani
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Rahele Rostami
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Ali Montazeri
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
- Faculty of Humanity Sciences, University of Science and Culture, Tehran, Iran
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13
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Visser LNC, van der Velden NCA, Smets EMA, van der Lelie S, Nieuwenbroek E, van Vliet LM, Hillen MA. Methodological choices in experimental research on medical communication using vignettes: The impact of gender congruence and vignette modality. PATIENT EDUCATION AND COUNSELING 2022; 105:1634-1641. [PMID: 34686382 DOI: 10.1016/j.pec.2021.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/15/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Experimental vignette designs are used to systematically test the effects of medical communication. We tested the impact of two methodological choices -gender congruence and vignette modality- on analogue patient reported outcomes. METHODS In an online experiment using a vignette portraying an oncological bad news consultation, we manipulated (1) gender congruence between the analogue and the vignette patient, and (2) vignette modality, i.e., text, audio, or video. Cancer-naïve students acting as analogue patients (N = 209, 22 ± 3 years old, 75% F) were assigned one randomly-selected vignette variant and completed questionnaires. Using 3 × 2 (repeated-measures) ANOVAs, we tested main and interaction effects of gender congruence and modality on self-reported engagement, recall, trust, satisfaction and anxiety. RESULTS We found no main effects of gender congruence or modality on any of the outcomes, nor any interaction effects between modality and congruence. CONCLUSION Our results indicate that researchers may needlessly create gender-congruent vignettes at considerable cost and effort. Also, the currently assumed superiority of videos over other modalities for experimental vignette-based research may be inaccurate. PRACTICE IMPLICATIONS Although further testing in an offline format and among different populations is warranted, decisions regarding gender congruence and modality for future vignette-based studies should be based primarily on their specific aims.
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Affiliation(s)
- Leonie N C Visser
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden; Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC (location AMC), PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Naomi C A van der Velden
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC (location AMC), PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC (location AMC), PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Samantha van der Lelie
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC (location AMC), PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Eva Nieuwenbroek
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC (location AMC), PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Liesbeth M van Vliet
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, PO Box 9555, 2300 RB Leiden, The Netherlands; Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, PO Box 9600, 2300 RB Leiden, The Netherlands
| | - Marij A Hillen
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC (location AMC), PO Box 22660, 1100 DD Amsterdam, The Netherlands.
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Rodon C, Chin J, Chevalier A. Assessing COVID-19 Health Literacy (CoHL) and its relationships with sociodemographic features, locus of control and compliance with social distancing rules during the first lockdown in France. HEALTH EDUCATION RESEARCH 2022; 37:143-154. [PMID: 35581167 PMCID: PMC9384039 DOI: 10.1093/her/cyac009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 03/05/2022] [Accepted: 05/10/2022] [Indexed: 05/09/2023]
Abstract
Health literacy (HL) is critical to find, understand and use health information for adopting appropriate health behavior, especially during a pandemic crisis in which people can be exposed to an overwhelming amount of information from different media. To this end, we conducted an online study to first validate the measure of COronaVIrus Disease appeared in 2019 (COVID-19) health literacy (CoHL) and then investigated its relationships with locus of control (LoC), news information search and the adoption of protective behaviors (PBs) during the first lockdown in France. We first showed the good structural and psychometric qualities of the CoHL scale on a 3-dimensional structure: the Critical dimension, the Extraction/Communicative and the Application/Communicative dimension. We then found that CoHL was associated with the adoption of PBs suggesting that people with higher CoHL tended to adopt more PBs during the first lockdown, regardless of their LoC. However, people with low CoHL would be more likely to adopt PBs if they believe that they may get COVID-19 due to the behavior and health conditions of others (high external LoC). The study has implications for the design of public health campaigns for people with inadequate HL and with a different LoC.
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Affiliation(s)
| | - Jessie Chin
- School of Information Sciences (MC 387), University of Illinois at Urbana-Champaign, 614 E Daniel St (#5139), Champaign, IL 61820, USA
| | - Aline Chevalier
- UFR de Psychologie, Département de Psychologie Cognitive et Ergonomie, Laboratoire Cognition, Langues, Langage, Ergonomie (CLLE, UT2J & CNRS), Université Toulouse Jean Jaurés (UT2J), Maison de la recherche, 5 allées Antonio Machado, Toulouse, F-31058 Cedex 9, France
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15
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van Strien-Knippenberg IS, Boshuizen MCS, Determann D, de Boer JH, Damman OC. Cocreation with Dutch patients of decision-relevant information to support shared decision-making about adjuvant treatment in breast cancer care. Health Expect 2022; 25:1664-1677. [PMID: 35579109 PMCID: PMC9327829 DOI: 10.1111/hex.13510] [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: 08/24/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 11/30/2022] Open
Abstract
Background To support patients in shared decision‐making about treatment options, patient decision aids (PtDAs) usually provide benefit/harm information and value clarification methods (VCMs). Recently, personalized risk information from prediction models is also being integrated into PtDAs. This study aimed to design decision‐relevant information (i.e., personalized survival rates, harm information and VCMs) about adjuvant breast cancer treatment in cocreation with patients, in a way that suits their needs and is easily understandable. Methods Three cocreation sessions with breast cancer patients (N = 7–10; of whom N = 5 low health literate) were performed. Participants completed creative assignments and evaluated prototypes of benefit/harm information and VCMs. Prototypes were further explored through user testing with patients (N = 10) and healthcare providers (N = 10). The researchers interpreted the collected data, for example, creative and homework assignments, and participants' presentations, to identify key themes. User tests were transcribed and analysed using ATLAS.ti to assess the understanding of the prototypes. Results Important information needs were: (a) need for overview/structure of information directly after diagnosis and; (b) need for transparent benefit/harm information for all treatment options, including detailed harm information. Regarding VCMs, patients stressed the importance of a summary/conclusion. A bar graph seemed the most appropriate way of displaying personalized survival rates; the impact of most other formats was perceived as too distressful. The concept of ‘personalization’ was not understood by multiple patients. Conclusions A PtDA about adjuvant breast cancer treatment should provide patients with an overview of the steps and treatment options, with layers for detailed information. Transparent information about the likelihood of benefits and harm should be provided. Given the current lack of information on the likelihood of side effects/late effects, efforts should be made to collect and share these data with patients. Further quantitative studies are needed to validate the results and to investigate how the concept of ‘personalization’ can be communicated. Patient or Public Contribution Ten breast cancer patients participated in three cocreation sessions to develop decision‐relevant information. Subsequent user testing included 10 patients. The Dutch Breast Cancer Association (BVN) was involved as an advisor in the general study design.
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Affiliation(s)
- Inge S van Strien-Knippenberg
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Jasmijn H de Boer
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Olga C Damman
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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A tailored approach to informing relatives at risk of inherited cardiac conditions: results of a randomised controlled trial. Eur J Hum Genet 2022; 30:203-210. [PMID: 34815540 PMCID: PMC8821591 DOI: 10.1038/s41431-021-00993-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 10/26/2021] [Indexed: 02/03/2023] Open
Abstract
If undetected, inherited cardiac conditions can lead to sudden cardiac death, while treatment options are available. Predictive DNA testing is therefore advised for at-risk relatives, and probands are currently asked to inform relatives about this. However, fewer than half of relatives attend genetic counselling. In this trial, we compared a tailored approach to informing relatives, in which probands were asked whether they preferred relatives to be informed by themselves or by the genetic counsellor, with current practice. Our primary outcome was uptake of genetic counselling in relatives in the first year after test result disclosure. Secondary outcomes were evaluation of the approach and impact on psychological/family functioning measured 3 (T1) and 9 (T2) months post-disclosure via telephone interviews and questionnaires. We included 96 probands; 482 relatives were eligible for counselling and genetic testing. We observed no significant difference in uptake of genetic counselling between the control (38%) and the intervention (37%) group (p = 0.973). Nor were there significant differences between groups in impact on family/psychological functioning. Significantly more probands in the tailored group were satisfied (p = 0.001) and felt supported (p = 0.003) by the approach, although they also felt somewhat coerced to inform relatives (p < 0.001) and perceived room for improvement (p < 0.001). To conclude, we observed no differences in uptake and impact on family/psychological functioning between the current and tailored approach, but probands in the tailored group more often felt satisfied. Further research on barriers to relatives attending genetic counselling and on how to optimize the provision of a tailored approach is needed.
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An implantable device to treat multiple sclerosis: A discrete choice experiment on patient preferences in three European countries. J Neurol Sci 2021; 428:117587. [PMID: 34364148 DOI: 10.1016/j.jns.2021.117587] [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: 03/17/2021] [Revised: 06/27/2021] [Accepted: 07/21/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Persons with multiple sclerosis (MS) take their treatment via pills, injections or infusions. A novel mode of disease-modifying treatment administration, an implantable device, is under development. This study determined MS patient preferences for three modes of first-line treatment administration (implant, pills, injectables), and trade-offs regarding treatment characteristics. METHODS A survey including a discrete choice experiment was conducted among MS patients in the Netherlands, France, and the United Kingdom. Respondents had to repeatedly choose between various treatment scenarios with four treatment characteristics: risk of relapse, reduction of disease progression, risk of side effects and mode of administration. Data was analysed using a panel latent class logit model. RESULTS Based on the preferences of 753 MS patients (response rate 7%: 753/11202), two latent classes were identified (class probability of 74% vs 26%). Persons with relapsing-remitting MS and who administered medication via injections generally preferred any treatment over no treatment. Patients who could walk without an aid were more likely to prefer no treatment. Reducing disease progression was the most important treatment characteristic class 1. Mode of administration was the most important characteristic in class 2. Patients were willing to accept an increase in risk of relapse and disease progression to get their treatment via an implant rather than injections. Predicted uptake was the highest for the implant, followed by pills, injections, and no treatment. CONCLUSION We found that a drug-delivery implant could be a potential addition to the MS treatment landscape: MS patients are willing to trade-off risk of relapse and disease progression for an implant, and predicted uptake for an implant is relatively high.
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van der Hout A, Holtmaat K, Jansen F, Lissenberg-Witte BI, van Uden-Kraan CF, Nieuwenhuijzen GAP, Hardillo JA, Baatenburg de Jong RJ, Tiren-Verbeet NL, Sommeijer DW, de Heer K, Schaar CG, Sedee RJE, Bosscha K, van den Brekel MWM, Petersen JF, Westerman M, Honings J, Takes RP, Houtenbos I, van den Broek WT, de Bree R, Jansen P, Eerenstein SEJ, Leemans CR, Zijlstra JM, Cuijpers P, van de Poll-Franse LV, Verdonck-de Leeuw IM. The eHealth self-management application 'Oncokompas' that supports cancer survivors to improve health-related quality of life and reduce symptoms: which groups benefit most? Acta Oncol 2021; 60:403-411. [PMID: 33345659 DOI: 10.1080/0284186x.2020.1851764] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Oncokompas is a web-based self-management application that supports cancer survivors to monitor their health-related quality of life (HRQOL) and symptoms, and to obtain personalised feedback and tailored options for supportive care. In a large randomised controlled trial among survivors of head and neck cancer, colorectal cancer, and breast cancer and (non-)Hodgkin lymphoma, Oncokompas proved to improve HRQOL, and to reduce several tumour-specific symptoms. Effect sizes were however small, and no effect was observed on the primary outcome patient activation. Therefore, this study aims to explore which subgroups of cancer survivors may especially benefit from Oncokompas. MATERIALS AND METHODS Cancer survivors (n = 625) were randomly assigned to the intervention group (access to Oncokompas, n = 320) or control group (6 months waiting list, n = 305). Outcome measures were HRQOL, tumour-specific symptoms, and patient activation. Potential moderators included socio-demographic (sex, age, marital status, education, employment), clinical (tumour type, stage, time since diagnosis, treatment modality, comorbidities), and personal factors (self-efficacy, personal control, health literacy, Internet use), and patient activation, mental adjustment to cancer, HRQOL, symptoms, and need for supportive care, measured at baseline. Linear mixed models were performed to investigate potential moderators. RESULTS The intervention effect on HRQOL was the largest among cancer survivors with low to moderate self-efficacy, and among those with high personal control and those with high health literacy scores. Cancer survivors with higher baseline symptom scores benefitted more on head and neck (pain in the mouth, social eating, swallowing, coughing, trismus), and colorectal cancer (weight) specific symptoms. DISCUSSION Oncokompas seems most effective in reducing symptoms in head and neck cancer and colorectal cancer survivors who report a higher burden of tumour-specific symptoms. Oncokompas seems most effective in improving HRQOL in cancer survivors with lower self-efficacy, and in cancer survivors with higher personal control, and higher health literacy.
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Affiliation(s)
- A. van der Hout
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
| | - K. Holtmaat
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
- Department of Otolaryngology – Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - F. Jansen
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
- Department of Otolaryngology – Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - B. I. Lissenberg-Witte
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C. F. van Uden-Kraan
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
| | | | - J. A. Hardillo
- Department of Otolaryngology and Head and Neck Surgery, Erasmus MC Cancer Centre, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R. J. Baatenburg de Jong
- Department of Otolaryngology and Head and Neck Surgery, Erasmus MC Cancer Centre, Erasmus Medical Center, Rotterdam, The Netherlands
| | - N. L. Tiren-Verbeet
- Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - D. W. Sommeijer
- Department of Internal Medicine, Flevoziekenhuis, The Netherlands
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - K. de Heer
- Department of Internal Medicine, Flevoziekenhuis, The Netherlands
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C. G. Schaar
- Department of Internal Medicine, Gelre Ziekenhuis, Apeldoorn, The Netherlands
| | - R. J. E. Sedee
- Department of Otolaryngology, Head and Neck Surgery, Haaglanden MC, The Hague, The Netherlands
| | - K. Bosscha
- Department of Surgery, Jeroen Bosch Ziekenhuis, Den Bosch, The Netherlands
| | - M. W. M. van den Brekel
- Department of Head and Neck Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J. F. Petersen
- Department of Head and Neck Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M. Westerman
- Department of Hematology, Northwest Clinics, Alkmaar, The Netherlands
| | - J. Honings
- Department of Otorhinolaryngology – Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R. P. Takes
- Department of Otorhinolaryngology – Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - I. Houtenbos
- Department of Hematology, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | | | - R. de Bree
- Department of Head and Neck Surgical Oncology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - P. Jansen
- Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - S. E. J. Eerenstein
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
- Department of Otolaryngology – Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C. R. Leemans
- Department of Otolaryngology – Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J. M. Zijlstra
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - P. Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - L. V. van de Poll-Franse
- CoRPS – Center of Research on Psychological and Somatic disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Department of Research, Netherlands Comprehensive Cancer Organisation, Eindhoven, The Netherlands
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - I. M. Verdonck-de Leeuw
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
- Department of Otolaryngology – Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Veldhuijzen G, Klemt-Kropp M, Terhaar Sive Droste JS, van Balkom B, van Esch AAJ, Drenth JPH. Computer-based patient education is non-inferior to nurse counselling prior to colonoscopy: a multicenter randomized controlled trial. Endoscopy 2021; 53:254-263. [PMID: 32702759 DOI: 10.1055/a-1225-8708] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Optimal patient education prior to colonoscopy improves adherence to instructions for bowel preparation and leads to cleaner colons. We developed computer-based education (CBE) supported by video and 3 D animations. We hypothesized that CBE could replace nurse counselling without loss of bowel preparation quality during colonoscopy. METHODS We conducted a prospective, multicenter, endoscopist-blinded, non-inferiority randomized controlled trial. The primary outcome was adequate bowel preparation, evaluated using the Boston Bowel Preparation Scale (BBPS). Secondary outcome measures were: sickness absence for outpatient clinic visits; patient anxiety/satisfaction scores; and information recall. We included patients in four endoscopy units (rural, urban, and tertiary). RESULTS We screened 1035 eligible patients and randomized 845. After evaluation, 684 were included in the intention-to-treat (ITT) group. Subsequently, 497 patients were included in the per-protocol analysis, 217 in the nurse counselling and 280 in the CBE group. Baseline characteristics were similarly distributed among the groups. On per-protocol analysis, adequate bowel cleansing was achieved in 93.2 % (261/280) of CBE patients, which was non-inferior to nurse-counselled patients (94.0 %; 204/217), with a difference of -0.8 % (95 % confidence interval [CI] -5.1 % to 3.5 %). Non-inferiority was confirmed in the ITT population. Sickness absence was significantly more frequent in nurse-counselled patients (28.0 % vs. 4.8 %). In CBE patients, 21.5 % needed additional information, with 3.0 % needing an extra outpatient visit. CONCLUSION CBE is non-inferior to nurse counselling in terms of bowel preparation during colonoscopy, with lower patient sickness leave. CBE may serve as an efficient educational tool to inform patients before colonoscopy in routine clinical practice.
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Affiliation(s)
- Govert Veldhuijzen
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Michael Klemt-Kropp
- Department of Gastroenterology and Hepatology, Northwest Hospital Group, Alkmaar, The Netherlands
| | | | - Bas van Balkom
- Department of Gastroenterology and Hepatology, Bernhoven Hospital, Uden, The Netherlands
| | - Aura A J van Esch
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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de Bekker-Grob EW, Donkers B, Veldwijk J, Jonker MF, Buis S, Huisman J, Bindels P. What Factors Influence Non-Participation Most in Colorectal Cancer Screening? A Discrete Choice Experiment. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 14:269-281. [PMID: 33150461 PMCID: PMC7884368 DOI: 10.1007/s40271-020-00477-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 12/24/2022]
Abstract
Background and Objective Non-participation in colorectal cancer (CRC) screening needs to be decreased to achieve its full potential as a public health strategy. To facilitate successful implementation of CRC screening towards unscreened individuals, this study aimed to quantify the impact of screening and individual characteristics on non-participation in CRC screening. Methods An online discrete choice experiment partly based on qualitative research was used among 406 representatives of the Dutch general population aged 55–75 years. In the discrete choice experiment, respondents were offered a series of choices between CRC screening scenarios that differed on five characteristics: effectiveness of the faecal immunochemical screening test, risk of a false-negative outcome, test frequency, waiting time for faecal immunochemical screening test results and waiting time for a colonoscopy follow-up test. The discrete choice experiment data were analysed in a systematic manner using random-utility-maximisation choice processes with scale and/or preference heterogeneity (based on 15 individual characteristics) and/or random intercepts. Results Screening characteristics proved to influence non-participation in CRC screening (21.7–28.0% non-participation rate), but an individual’s characteristics had an even higher impact on CRC screening non-participation (8.4–75.5% non-participation rate); particularly the individual’s attitude towards CRC screening followed by whether the individual had participated in a cancer screening programme before, the decision style of the individual and the educational level of the individual. Our findings provided a high degree of confidence in the internal–external validity. Conclusions This study showed that although screening characteristics proved to influence non-participation in CRC screening, a respondent’s characteristics had a much higher impact on CRC screening non-participation. Policy makers and physicians can use our study insights to improve and tailor their communication plans regarding (CRC) screening for unscreened individuals.
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Affiliation(s)
- Esther W de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
- Erasmus Choice Modelling Centre, Erasmus University, Rotterdam, The Netherlands.
| | - Bas Donkers
- Erasmus Choice Modelling Centre, Erasmus University, Rotterdam, The Netherlands
- Erasmus School of Economics, Erasmus University, Rotterdam, The Netherlands
| | - Jorien Veldwijk
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University, Rotterdam, The Netherlands
| | - Marcel F Jonker
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University, Rotterdam, The Netherlands
| | - Sylvia Buis
- General Practice, Gezondheidscentrum Ommoord, Rotterdam, The Netherlands
| | - Jan Huisman
- General Practice, Het Doktershuis, Ridderkerk, The Netherlands
| | - Patrick Bindels
- Department of General Practice, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Zegers CA, Gonzales K, Smith LM, Pullen CH, De Alba A, Fiandt K. The psychometric testing of the functional, communicative, and critical health literacy tool. PATIENT EDUCATION AND COUNSELING 2020; 103:2347-2352. [PMID: 32622692 DOI: 10.1016/j.pec.2020.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The purpose of this study is to assess the validity and reliability of the English version of the FCCHL tool in urban and rural, socioeconomically vulnerable or unstable, chronic comorbid adults in the United States. METHODS A cross-sectional study measuring both validity and reliability. RESULTS A total of 276 participants were recruited. Internal consistency was measured using Cronbach's alpha of α = 0.87. External reliability was measured by test-retest methodology. Construct validity was measured using Confirmatory Factor Analysis that showed good fit. Criterion validity was measured by comparing the mean scores of the FCCHL tool sub-scales. Concurrent validity was measured by comparison of means of the FCCHL tool and education level compared to the NVS and s-TOFHLA. CONCLUSION The results demonstrated that the FCCHL tools is measuring three different concepts. Overall, the FCCHL tool was seen to have good validity and reliability in the identified population. PRACTICE IMPLICATIONS The FCCHL tool is a 14-item, self-report health literacy tool measuring more than functional health literacy. The tool can be used in practice to improve not only functional health literacy, but also communicative and critical which is highly applicable.
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Affiliation(s)
- Carli A Zegers
- School of Nursing and Health Studies, University Missouri - Kansas City, Kansas City, Missouri, United States.
| | - Kelly Gonzales
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Lynette M Smith
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Carol H Pullen
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Armando De Alba
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Kathryn Fiandt
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, United States
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Batista MJ, Marques ACDP, Silva Junior MF, Alencar GP, Sousa MDLRD. Translation, cross-cultural adaptation and psychometric evaluation of Brazilian Portuguese version of the 14-item Health Literacy Scale. CIENCIA & SAUDE COLETIVA 2020; 25:2847-2857. [PMID: 32667566 DOI: 10.1590/1413-81232020257.22282018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 11/26/2018] [Indexed: 12/12/2022] Open
Abstract
We evaluated the psychometric properties of the Health Literacy Scale - 14 (HLS-14), the Brazilian Portuguese version. In the methodological study with a cross-sectional design, the following were performed: translation, cross-cultural adaptation and evaluation of the psychometric properties. After being subjected to a committee of experts, translated and adapted, the instrument was pre-tested with 52 adults and applied to 143 adults and older people of Piracicaba-SP. Internal consistency was assessed based on the Kendall correlation coefficient and Cronbach's alpha (>0.70), and the confirmatory factor analysis (CFA) was conducted using the chi-square test, the Standardized Residual Mean Square Root (SRMR), the Root Mean Square Error of Approximation (RMSEA) (<0.05), the Comparative Fit Index (CFI) (>0.95) and the Tucker-Lewis Index (TLI) (>0.95). The analysis of operational equivalence showed agreement between most of the questions, exception questions 6, 8, 9 and 14. Cronbach's alpha was 0.82. There was reasonable adjustment in the CFA: CFI=0.886, TLI=0.86, RMSEA=0.085 (90%CI: 0.065-0.105), SRMR=0.071, chi-square (74 degrees of freedom) = 149.510, p<0.001. The exclusion of question 5 increased the adjustment level to satisfactory. The Brazilian Portuguese version of HLS-14 can be considered a valid health literacy assessment instrument.
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Affiliation(s)
- Marília Jesus Batista
- Departamento de Ciências da Saúde e Odontologia Infantil, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas. Av. Limeira 901, Bairro Areião. 13414-903 Piracicaba SP Brasil.
| | - Ana Carolina de Paula Marques
- Departamento de Ciências da Saúde e Odontologia Infantil, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas. Av. Limeira 901, Bairro Areião. 13414-903 Piracicaba SP Brasil.
| | | | - Gizelton Pereira Alencar
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo. São Paulo SP Brasil
| | - Maria da Luz Rosário de Sousa
- Departamento de Ciências da Saúde e Odontologia Infantil, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas. Av. Limeira 901, Bairro Areião. 13414-903 Piracicaba SP Brasil.
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Visscher BB, Steunenberg B, Heerdink ER, Rademakers J. Medication self-management support for people with diabetes and low health literacy: A needs assessment. PLoS One 2020; 15:e0232022. [PMID: 32330161 PMCID: PMC7182204 DOI: 10.1371/journal.pone.0232022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 04/06/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION An adequate level of health literacy is regarded as a prerequisite for adequate medication self-management. Low health literacy skills are relatively more common in people with Diabetes Mellitus type 2. The aim of this study was to explore the needs regarding medication self-management of people with type 2 diabetes and low (functional, communicative and critical) health literacy, and their preferences for medication self-management support. MATERIALS AND METHODS A two-stage qualitative needs assessment study was performed using in-depth individual interviews and focus groups. RESULTS The participants preferred to be supported with reliable and easily understandable information, adequate interactive communication with health care professionals and fellow people with diabetes and tools for medication self-management support. DISCUSSION Future interventions should be created in co-creation with people with low health literacy and fulfill the expressed needs on information, communication and tools to improve self-management.
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Affiliation(s)
- Boudewijn B. Visscher
- Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Bas Steunenberg
- Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Eibert R. Heerdink
- Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, The Netherlands
- Division Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jany Rademakers
- Research Department, NIVEL (Netherlands institute for health services research), Utrecht, The Netherlands
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
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24
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Miri MR, Moghadam HM, Eftekhari H, Yousefi A, Norozi E. Developing and Validating the Functional, Communicative, and Critical Health Literacy Questionnaire among the Iranian General Population. Oman Med J 2020; 35:e106. [PMID: 32181008 PMCID: PMC7066379 DOI: 10.5001/omj.2020.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/10/2019] [Indexed: 11/26/2022] Open
Abstract
Objectives Many scales have been developed to assess health literacy. These scales have been developed extensively in clinical populations in developed countries. Our study describes the process of development and validation of the Health Literacy Questionnaire to measure health literacy in the general Iranian population. Methods We followed the scale development process outlined by Schwab in 1980. After a comprehensive review of the research published on Nutbeam’s definition of health literacy and its measurement, two focus groups were considered to generate a pool of items. We then assessed the face validity and content validity of the items. The final version of the questionnaire was subject to independent exploratory and confirmatory factor analysis. The internal consistency of the questionnaire was evaluated using Cronbach’s alpha. Finally, construct validity was assessed using bivariate analysis between the total scores on the scale and theoretically relevant variables. Results The results of exploratory factor analysis revealed a three-factor 14-item structure for the scale. Confirmatory factor analysis provided a good statistical and conceptual fit for the data. The analysis of the internal consistency of the scale was satisfactory (α = 0.798). Further, health literacy was significantly associated with participants’ age, educational level, self-rated household income, smoking history, self-rated health, and self-rated health literacy. Conclusions The results we obtained indicate that this newly constructed health literacy tool is highly valid and reliable. Prospective studies are required to evaluate the predictive validity of the scale with regard to health outcomes.
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Affiliation(s)
- Mohammad Reza Miri
- Department of Public Health, Faculty of Health, Birjand University of Medical Sciences, Birjand, Iran
| | - Hakimeh Malaki Moghadam
- Department of Public Health, Faculty of Health, Birjand University of Medical Sciences, Birjand, Iran
| | | | - Azam Yousefi
- Student Research Committee, Birjand University of Medical Science, Birjand, Iran
| | - Ensiyeh Norozi
- Department of Public Health, Faculty of Health, Birjand University of Medical Sciences, Birjand, Iran
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25
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Dale JG, Lüthi A, Fundingsland Skaraas B, Rundereim T, Dale B. Testing Measurement Properties of the Norwegian Version of Electronic Health Literacy Scale (eHEALS) in a Group of Day Surgery Patients. J Multidiscip Healthc 2020; 13:241-247. [PMID: 32210568 PMCID: PMC7069557 DOI: 10.2147/jmdh.s242985] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/18/2020] [Indexed: 12/24/2022] Open
Abstract
Background and Aim In order to assess patients’ ability to search, understand, and benefit from Internet-based information, several screening tools have been developed. One of these tools, which has been widely used, is the eHealth Literacy Scale (eHEALS). The aim of this study was to examine the measurement properties of the Norwegian version of the eHEALS, as it was used in a group of patients undergoing day surgery. Methods A cross-sectional survey study was conducted among 119 patients scheduled for day surgical treatment in a Norwegian hospital. The questionnaire included the screening tool eHEALS, which contains 8 items for assessing a person’s information awareness skills, information seeking skills, and skills to evaluate and act based on the information. Cronbach’s alpha coefficients and item-total correlations were assessed for estimating reliability of the eHEALS. Exploratory factor analysis with Oblimin rotation was used for assessing the validity of the scale. Eigenvalue was set to 1.0. Results A Cronbach’s alpha coefficient of 0.89 for the total scale, values >0.82 for Alpha if Item Deleted, and moderate to high item-total correlations supported the homogeneity and internal consistency of the scale. A two-component solution explained a total of 74.8% of the variance, with the first component explaining 59.53% of the variance in the scale and included the items reflecting information awareness and seeking. The second component explained 15.23% of the variance, including items reflecting the ability to evaluate and act. Conclusion The reliability of the Norwegian version of eHEALS, used in a group of patients undergoing day surgery, was good. The internal structure, with two distinct factors, is in line with several previous studies. The eHEALS appears to be an appropriate tool for assessing eHealth literacy among this patient group.
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Affiliation(s)
- Jan Gunnar Dale
- University of Agder, Institute of Health and Nursing Science, Grimstad NO-4898, Norway
| | - Alexander Lüthi
- Lovisenberg Diaconal Hospital, Postoperative Unit, Oslo NO-0440, Norway
| | | | | | - Bjørg Dale
- Centre for Care Research, Southern Norway, University of Agder, Grimstad NO-4898, Norway
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26
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Finbråten HS, Guttersrud Ø, Nordström G, Pettersen KS, Trollvik A, Wilde-Larsson B. Validating the Functional, Communicative, and Critical Health Literacy Scale Using Rasch Modeling and Confirmatory Factor Analysis. J Nurs Meas 2019; 26:341-363. [PMID: 30567948 DOI: 10.1891/1061-3749.26.2.341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The functional, communicative, and critical health literacy (FCCHL) scale is widely used for assessing health literacy (HL) in people with chronic diseases, such as type 2 diabetes (T2DM). Despite related subscales, researchers continue to apply a consecutive modeling approach, treating the three subscales as independent. This article studies the psychometric characteristics of the FCCHL by applying multidimensional modeling approaches. METHODS Rasch modeling and confirmatory factor analyses were applied to responses (paper-and-pencil) from 386 adults with T2DM. RESULTS Using a six-point rating scale and a three-dimensional Rasch model, this study found that a 12-item version of the FCCHL reduced within-item bias and improved subscale reliability indexes. CONCLUSION This study suggests a parsimonious 12-item version of the FCCHL. The data fit a three-dimensional Rasch model best.
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Affiliation(s)
- Hanne Søberg Finbråten
- Inland Norway University of Applied Sciences, Elverum, Norway .,Karlstad University, Karlstad, Sweden
| | - Øystein Guttersrud
- Norwegian Centre for Science Education, University of Oslo, Oslo, Norway
| | - Gun Nordström
- Inland Norway University of Applied Sciences, Elverum, Norway
| | | | - Anne Trollvik
- Inland Norway University of Applied Sciences, Elverum, Norway
| | - Bodil Wilde-Larsson
- Karlstad University, Karlstad, Sweden.,Inland Norway University of Applied Sciences, Elverum, Norway
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27
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de Bekker-Grob EW, Swait JD, Kassahun HT, Bliemer MCJ, Jonker MF, Veldwijk J, Cong K, Rose JM, Donkers B. Are Healthcare Choices Predictable? The Impact of Discrete Choice Experiment Designs and Models. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1050-1062. [PMID: 31511182 DOI: 10.1016/j.jval.2019.04.1924] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 04/15/2019] [Accepted: 04/17/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND Lack of evidence about the external validity of discrete choice experiments (DCEs) is one of the barriers that inhibit greater use of DCEs in healthcare decision making. OBJECTIVES To determine whether the number of alternatives in a DCE choice task should reflect the actual decision context, and how complex the choice model needs to be to be able to predict real-world healthcare choices. METHODS Six DCEs were used, which varied in (1) medical condition (involving choices for influenza vaccination or colorectal cancer screening) and (2) the number of alternatives per choice task. For each medical condition, 1200 respondents were randomized to one of the DCE formats. The data were analyzed in a systematic way using random-utility-maximization choice processes. RESULTS Irrespective of the number of alternatives per choice task, the choice for influenza vaccination and colorectal cancer screening was correctly predicted by DCE at an aggregate level, if scale and preference heterogeneity were taken into account. At an individual level, 3 alternatives per choice task and the use of a heteroskedastic error component model plus observed preference heterogeneity seemed to be most promising (correctly predicting >93% of choices). CONCLUSIONS Our study shows that DCEs are able to predict choices-mimicking real-world decisions-if at least scale and preference heterogeneity are taken into account. Patient characteristics (eg, numeracy, decision-making style, and general attitude for and experience with the health intervention) seem to play a crucial role. Further research is needed to determine whether this result remains in other contexts.
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Affiliation(s)
- Esther W de Bekker-Grob
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Joffre D Swait
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | | | - Marcel F Jonker
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jorien Veldwijk
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Karen Cong
- Australian Rivers Institute, Griffith University, Brisbane, Queensland, Australia
| | - John M Rose
- Business School, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Bas Donkers
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands; Department of Business Economics, Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
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van den Heuvel LM, Hoedemaekers YM, Baas AF, van Tintelen JP, Smets EMA, Christiaans I. A tailored approach towards informing relatives at risk of inherited cardiac conditions: study protocol for a randomised controlled trial. BMJ Open 2019; 9:e025660. [PMID: 31289060 PMCID: PMC6615798 DOI: 10.1136/bmjopen-2018-025660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION In current practice, probands are asked to inform relatives about the possibility of predictive DNA testing when a pathogenic variant causing an inherited cardiac condition (ICC) is identified. Previous research on the uptake of genetic counselling and predictive DNA testing in relatives suggests that not all relatives are sufficiently informed. We developed a randomised controlled trial to evaluate the effectiveness of a tailored approach in which probands decide together with the genetic counsellor which relatives they inform themselves and which relatives they prefer to have informed by the genetic counsellor. Here, we present the study protocol of this randomised controlled trial. METHODS A multicentre randomised controlled trial with parallel-group design will be conducted in which an intervention group receiving the tailored approach will be compared with a control group receiving usual care. Adult probands diagnosed with an ICC in whom a likely pathogenic or pathogenic variant is identified will be randomly assigned to the intervention or control group (total sample: n=85 probands). Primary outcomes are uptake of genetic counselling and predictive DNA testing by relatives (total sample: n=340 relatives). Secondary outcomes are appreciation of the approach used and impact on familial and psychological functioning, which will be assessed using questionnaires. Relatives who attend genetic counselling will be asked to fill out a questionnaire as well. ETHICS AND DISSEMINATION Ethical approval was obtained from the Medical Ethical Committee of the Amsterdam University Medical Centres (MEC 2017-145), the Netherlands. All participants will provide informed consent prior to participation in the study. Results of the study on primary and secondary outcome measures will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NTR6657; Pre-results.
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Affiliation(s)
- Lieke M van den Heuvel
- Department of Clinical Genetics, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Yvonne M Hoedemaekers
- Department of Clinical Genetics, University Medical Centre Groningen, Groningen, The Netherlands
| | - Annette F Baas
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Peter van Tintelen
- Department of Clinical Genetics, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Imke Christiaans
- Department of Clinical Genetics, Amsterdam University Medical Centres, Amsterdam, The Netherlands
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Labrie N, van Dulmen S, Kersten MJ, de Haes HJ, Pieterse AH, van Weert JC, van Spronsen DJ, Smets EM. Effective Information Provision About the Side Effects of Treatment for Malignant Lymphoma: Protocol of a Randomized Controlled Trial Using Video Vignettes. JMIR Res Protoc 2019; 8:e12453. [PMID: 31045506 PMCID: PMC6521215 DOI: 10.2196/12453] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/30/2019] [Accepted: 02/24/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Informing patients with cancer about the possible implications of prospective treatment is a crucial yet challenging task. Unfortunately, patients' recall of medical information is generally poor and their information needs are not met. Effective information giving entails that oncologists help patients understand and recall the implications of their treatment, meanwhile fostering a trusting physician-patient relationship. Communication strategies that are often suggested to be effective are structuring and tailoring (cognition-oriented) but also are oncologists' expressions of caring or empathy (affect-oriented). OBJECTIVE The aim of this study is to provide evidence concerning the pathways linking physician communication to (improved) consultation outcomes for patients. More specifically, the aim is to determine the effects of information structuring and information tailoring, combined with physician caring, on information recall, satisfaction with information, and trust in the physician (primary objective) and on symptom distress (secondary objective). METHODS A randomized controlled trial, systematically testing the effects of information structuring and information tailoring, each combined with caring, in 2 video-vignette experiments (2×2 and 2×2×2 design). Using an online survey platform, participants will be randomly allocated (blinded) to 1 of 12 conditions in which they are asked to view a video vignette (intervention) in which an oncologist discusses a treatment plan for malignant lymphoma with a patient. The independent variables of interest are systematically varied across conditions. The outcome measures are assessed in a survey, using validated instruments. Study participants are (former) patients with cancer and their relatives recruited via online panels and patient organizations. This protocol discusses the trial design, including the video-vignette design, intervention pretesting, and a pilot study. RESULTS Data collection has now been completed, and preliminary analyses will be available in Spring 2019. A total of 470 participants completed the first part of the survey and were randomized to receive the intervention. CONCLUSIONS The results of the proposed trial will provide evidence concerning the pathways linking physician information, giving skills to (improved) consultation outcomes for patients. TRIAL REGISTRATION Netherlands Trial Register NTR6153; https://www.trialregister.nl/trial/6022 (Archived by Webcite at http://www.webcitation.org/76xVV9xC8). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/12453.
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Affiliation(s)
- Nanon Labrie
- Medical Psychology, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands.,Athena Institute, Vrije Universiteit van Amsterdam, Amsterdam, Netherlands
| | - Sandra van Dulmen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands.,Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Marie José Kersten
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Hanneke Jcm de Haes
- Medical Psychology, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Julia Cm van Weert
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Netherlands
| | | | - Ellen Ma Smets
- Medical Psychology, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands
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Development and Psychometric Evaluation of the Cancer Health Literacy Scale in Newly Diagnosed Cancer Patients. Cancer Nurs 2019; 43:E291-E303. [PMID: 30998604 DOI: 10.1097/ncc.0000000000000711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Health literacy (HL) influences a patient's comprehension and judgment of health-related information. A rigorous assessment tool is needed to screen for low HL in order to improve it. OBJECTIVE The aim of this study was to develop and validate the Cancer Health Literacy Scale (C-HLS). METHODS The framework of the C-HLS is based on the Levels of Prevention model. The scale items were developed according to Nutbeam's 3 constructs of HL. We employed several procedures to develop the C-HLS, including focus group interviews, item generation, the expert Delphi process, and face validity. Various types of analysis, including reliability and split-half reliability testing, confirmatory factor analysis, and criterion-related validity testing, were performed; receiver operating characteristic curve analysis was also performed to confirm sensitivity and specificity. RESULTS There were 33 items included in the C-HLS for validation; 360 newly diagnosed cancer patients completed the survey. The administration time is only 10 to 15 minutes. Results showed that C-HLS had good reliability, split-half reliability, and validity. All confirmatory factor analysis model fit indices reached acceptable thresholds. The receiver operating characteristic curve analyses suggested that the C-HLS had an adequate combination of sensitivity and specificity to distinguish between high and low HL. CONCLUSIONS The C-HLS is a reliable, valid tool capable of discriminating levels of HL in the assessment of cancer patients and does not have an excessive administration time. IMPLICATIONS FOR PRACTICE This scale can aid our understanding of HL in newly diagnosed cancer patients and can serve as a basis for providing individual care interventions.
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Meppelink CS, Smit EG, Fransen ML, Diviani N. "I was Right about Vaccination": Confirmation Bias and Health Literacy in Online Health Information Seeking. JOURNAL OF HEALTH COMMUNICATION 2019; 24:129-140. [PMID: 30895889 DOI: 10.1080/10810730.2019.1583701] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
When looking for health information, many people turn to the Internet. Searching for online health information (OHI), however, also involves the risk of confirmation bias by means of selective exposure to information that confirms one's existing beliefs and a biased evaluation of this information. This study tests whether biased selection and biased evaluation of OHI occur in the context of early-childhood vaccination and whether people's health literacy (HL) level either prevents or facilitates these processes. Vaccination beliefs were measured for 480 parents of young children (aged 0-4 years) using an online survey, after which they were exposed to a list of ten vaccine-related message headers. People were asked to select those headers that interested them most. They also had to evaluate two texts which discussed vaccination positively and negatively for credibility, usefulness, and convincingness. The results showed that people select more belief-consistent information compared to belief-inconsistent information and perceived belief-confirming information as being more credible, useful, and convincing. Biased selection and biased perceptions of message convincingness were more prevalent among people with higher HL, and health communication professionals should be aware of this finding in their practice.
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Affiliation(s)
- Corine S Meppelink
- a Amsterdam School of Communication Research (ASCoR) , University of Amsterdam , Amsterdam , Netherlands
| | - Edith G Smit
- a Amsterdam School of Communication Research (ASCoR) , University of Amsterdam , Amsterdam , Netherlands
| | - Marieke L Fransen
- a Amsterdam School of Communication Research (ASCoR) , University of Amsterdam , Amsterdam , Netherlands
| | - Nicola Diviani
- b Department of Health Sciences and Health Policy , Universitat Luzern , Luzern , Switzerland
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Mock MS, Sethares KA. Concurrent validity and acceptability of health literacy measures of adults hospitalized with heart failure. Appl Nurs Res 2019; 46:50-56. [PMID: 30853076 DOI: 10.1016/j.apnr.2019.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/28/2018] [Accepted: 02/10/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To test concurrent validity and acceptability of the Single Item Literacy Screener (SILS), Test of Functional Health Literacy (S-TOFHLA) and the Newest Vital Sign (NVS) in hospitalized adults with heart failure (HF). BACKGROUND Health literacy is not routinely evaluated in adults hospitalized with HF. Low health literacy is linked to poor HF self-care and hospital readmissions. METHODS SILS, NVS and S-TOFHLA were completed by 85 patients with HF. Measures were examined for internal consistency reliability and acceptability. The NVS and S-TOFHLA were correlated with the SILS to establish concurrent validity. RESULTS The NVS (α = 0.70) and S-TOFHLA (α = 0.88) were reliable. The SILS significantly correlated with the S-TOFHLA (r = -0.308). The S-TOFHLA (M = 6.16) and NVS (M = 6.10) were acceptable measures. CONCLUSION The S-TOFHLA and NVS were reliable and acceptable measures of health literacy in hospitalized HF population. The SILS correlated with the S-TOFHLA and may predict low health literacy when hospitalized. NVS total scores in this population aligned with the recent NAAL survey. Hospitalized adults with HF agreed to share the health literacy scores with their providers.
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Affiliation(s)
- Margaret S Mock
- School of Nursing, Graduate Department, Rhode Island College, Providence, RI, United States of America.
| | - Kristen A Sethares
- Adult Nursing Department, University of Massachusetts Dartmouth, North Dartmouth, MA, United States of America
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Visser LNC, Tollenaar MS, van Doornen LJP, de Haes HCJM, Smets EMA. Does silence speak louder than words? The impact of oncologists' emotion-oriented communication on analogue patients' information recall and emotional stress. PATIENT EDUCATION AND COUNSELING 2019; 102:43-52. [PMID: 30224275 DOI: 10.1016/j.pec.2018.08.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 08/25/2018] [Accepted: 08/27/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The impact of two types of oncologists' emotion-oriented communication on participants' recall of medical information was investigated, and the potential mediation by a reduction in emotional stress. Additionally, moderation effects by personal characteristics were explored. METHODS An oncologist's communication in response to a patient's emotional expressions was manipulated during a videotaped, scripted bad-news consultation. Three conditions were created: 1) standard communication, 2) emotion-oriented silence, and 3) emotion-oriented speech. Participants (N = 217) were randomly allocated to one of the three conditions. Measurements included information recall (free recall and recognition), emotional stress (self-reported and physiological), and personal characteristics. RESULTS Emotion-oriented silence (p = .002) and speech (p = .019) enhanced information recognition compared to standard communication. No differences in free recall were found. Emotional stress did not mediate these relations. Poorer functional health literacy predicted poorer recognition, but this was counteracted by emotion-oriented communication. CONCLUSIONS By means of acknowledging, exploring, empathic and supportive statements, and attentive silence, the oncologist's communication resulted in better information recognition. How oncologists' communication impacts patients' information recall warrants further investigation, as this could not be explained by reducing emotional stress. PRACTICE IMPLICATIONS These insights will help educators to validate the relevance of emotion-oriented strategies, and encourage oncologists to adopt them.
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Affiliation(s)
- Leonie N C Visser
- Department of Medical Psychology/Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
| | | | | | - Hanneke C J M de Haes
- Department of Medical Psychology/Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology/Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Bröder J, Chang P, Kickbusch I, Levin-Zamir D, McElhinney E, Nutbeam D, Okan O, Osborne R, Pelikan J, Rootman I, Rowlands G, Nunes-Saboga L, Simmons R, Sørensen K, Van den Broucke S, Velardo S, Wills J. IUHPE Position Statement on Health Literacy: a practical vision for a health literate world. Glob Health Promot 2018. [DOI: 10.1177/1757975918814421] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The International Union for Health Promotion and Education (IUHPE) Position Statement on Health Literacy provides an overview of existing evidence and continuing debate on health literacy. Developed by the IUHPE Global Working Group on Health Literacy, including experts from around the globe, the Statement provides a basis for discussion and advocacy, by and with IUHPE, both within the health promotion community, and among stakeholders and partners in health promotion. The Statement offers a detailed introduction to the concept of health literacy, calling for global action to improve health literacy in populations. It positions health literacy as an important and modifiable social determinant of health, that plays a significant role in broadly-based strategies for health promotion. The Statement emphasises the necessity of a systems approach to health literacy, underpinned by global, national, regional and local policies. It summarises key evidence to guide practice and policy development, recognising the importance of continued investment in intervention research, in professional and consumer capacity building, and in the transfer of research findings into frontline health promotion practice. In summary, health literacy is understood as an important cross-cutting issue in health promotion throughout the lifespan, which has practical application in guiding clinical practice, public health interventions and public policy for the advancement of global health.
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Affiliation(s)
- Janine Bröder
- Acknowledgement of supporting policy documents: Nutbeam (37); Sorensen (38); Kickbusch et al. (34)
| | - Peter Chang
- Acknowledgement of supporting policy documents: Nutbeam (37); Sorensen (38); Kickbusch et al. (34)
| | - Ilona Kickbusch
- Acknowledgement of supporting policy documents: Nutbeam (37); Sorensen (38); Kickbusch et al. (34)
| | - Diane Levin-Zamir
- Acknowledgement of supporting policy documents: Nutbeam (37); Sorensen (38); Kickbusch et al. (34)
| | - Evelyn McElhinney
- Acknowledgement of supporting policy documents: Nutbeam (37); Sorensen (38); Kickbusch et al. (34)
| | - Don Nutbeam
- Acknowledgement of supporting policy documents: Nutbeam (37); Sorensen (38); Kickbusch et al. (34)
| | - Orkan Okan
- Acknowledgement of supporting policy documents: Nutbeam (37); Sorensen (38); Kickbusch et al. (34)
| | - Richard Osborne
- Acknowledgement of supporting policy documents: Nutbeam (37); Sorensen (38); Kickbusch et al. (34)
| | - Jürgen Pelikan
- Acknowledgement of supporting policy documents: Nutbeam (37); Sorensen (38); Kickbusch et al. (34)
| | - Irving Rootman
- Acknowledgement of supporting policy documents: Nutbeam (37); Sorensen (38); Kickbusch et al. (34)
| | - Gillian Rowlands
- Acknowledgement of supporting policy documents: Nutbeam (37); Sorensen (38); Kickbusch et al. (34)
| | - Luis Nunes-Saboga
- Acknowledgement of supporting policy documents: Nutbeam (37); Sorensen (38); Kickbusch et al. (34)
| | - Robert Simmons
- Acknowledgement of supporting policy documents: Nutbeam (37); Sorensen (38); Kickbusch et al. (34)
| | - Kristine Sørensen
- Acknowledgement of supporting policy documents: Nutbeam (37); Sorensen (38); Kickbusch et al. (34)
| | - Stephan Van den Broucke
- Acknowledgement of supporting policy documents: Nutbeam (37); Sorensen (38); Kickbusch et al. (34)
| | - Stefania Velardo
- Acknowledgement of supporting policy documents: Nutbeam (37); Sorensen (38); Kickbusch et al. (34)
| | - Jane Wills
- Acknowledgement of supporting policy documents: Nutbeam (37); Sorensen (38); Kickbusch et al. (34)
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Heringa M, Floor-Schreudering A, Wouters H, De Smet PAGM, Bouvy ML. Preferences of Patients and Pharmacists with Regard to the Management of Drug-Drug Interactions: A Choice-Based Conjoint Analysis. Drug Saf 2018; 41:179-189. [PMID: 28965265 PMCID: PMC5808046 DOI: 10.1007/s40264-017-0601-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction The management of drug–drug interactions (DDIs) is a complex process in which risk–benefit assessments should be combined with the patient’s perspective. Objective The aim of this study was to determine patients’ and pharmacists’ preferences regarding DDI management. Methods We conducted a choice-based conjoint survey about a fictitious DDI concerning the combination of a cardiovascular drug and an antibiotic for pneumonia. Patients and pharmacists had to choose 12 times between two management options. The options were described by five attributes, including risk, benefit and practical consequences. Each attribute could have two different levels, which were varied over the choice tasks. Latent class analysis was used to identify potential classes of respondents with distinct patterns of similar preferences. Results In total, 298 patients and 178 pharmacists completed the questionnaire. The latent class model for both patients and pharmacists resulted in three classes. For patients, in one class the most importance was attached to avoiding switch of medication (class probability 20%), in a second class to fewer adverse events (41%), and in a third class to blood sampling (39%). For pharmacists, again one class attached the highest importance to avoiding switch of medication (31%). The other classes gave priority to curing pneumonia (31%) and avoiding blood sampling (38%). Conclusion The results showed diverging preferences regarding DDI management among both patients and pharmacists. Different groups attached different value to risk and benefit versus practical considerations. Awareness of existing variability in preferences among and between pharmacists and patients is a step towards shared decision making in DDI management. Electronic supplementary material The online version of this article (doi:10.1007/s40264-017-0601-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mette Heringa
- SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5B, 2331 JE, Leiden, The Netherlands. .,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands. .,Health Base Foundation, Houten, The Netherlands.
| | - Annemieke Floor-Schreudering
- SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5B, 2331 JE, Leiden, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Hans Wouters
- Department of Pharmacotherapy, -Epidemiology and -Economics, Groningen University, Groningen, The Netherlands
| | - Peter A G M De Smet
- Departments of Clinical Pharmacy and IQ Healthcare, University Medical Centre St Radboud, Nijmegen, The Netherlands
| | - Marcel L Bouvy
- SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5B, 2331 JE, Leiden, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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Melissant HC, Verdonck-de Leeuw IM, Lissenberg-Witte BI, Konings IR, Cuijpers P, Van Uden-Kraan CF. 'Oncokompas', a web-based self-management application to support patient activation and optimal supportive care: a feasibility study among breast cancer survivors. Acta Oncol 2018; 57:924-934. [PMID: 29451059 DOI: 10.1080/0284186x.2018.1438654] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Cancer survivors have to deal with symptoms related to cancer and its treatment. In Oncokompas, cancer survivors monitor their quality of life by completing patient reported outcome measures (PROMs), followed by personalized feedback, self-care advice, and supportive care options to stimulate patient activation. The aim of this study was to investigate feasibility and pretest-posttest differences of Oncokompas including a newly developed breast cancer (BC) module among BC survivors. MATERIAL AND METHODS A pretest-posttest design was used. Feasibility was investigated by means of adoption, usage, and satisfaction rates. Several socio-demographic and clinical factors, and health-related quality of life (HRQOL) were explored that might be associated with patient satisfaction. Barriers and facilitators of Oncokompas feasibility were investigated by evaluating nurse consultation reports. Differences in patient activation (Patient Activation Measure) and patient-physician interaction (Perceived Efficacy in Patient-Physician Interactions) before and after Oncokompas use were investigated. RESULTS In total, 101 BC survivors participated. Oncokompas had an adoption rate of 75%, a usage rate of 75-84%, a mean satisfaction score of 6.9 (range 0-10) and a Net Promoter Score (NPS) of -36 (range -100-100) (N = 68). The BC module had a mean satisfaction score of 7.6. BC survivors who received surgery including chemotherapy and/or radiotherapy were significantly more satisfied with Oncokompas than BC survivors with surgery alone (p = .013). Six facilitators and 10 barriers of Oncokompas feasibility were identified. After using Oncokompas, BC survivors scored significantly higher on patient activation (p = .007; r = .24), but not on patient-physician interaction (p = .75). CONCLUSION Oncokompas including a BC module is considered feasible, but needs further optimization to increase user satisfaction. This study shows the value of tailoring eHealth applications for cancer survivors to their specific tumor type. Oncokompas including the BC module seems to improve patient activation among BC survivors.
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Affiliation(s)
- Heleen C. Melissant
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), VU University Medical Center, Amsterdam, The Netherlands
| | - Irma M. Verdonck-de Leeuw
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), VU University Medical Center, Amsterdam, The Netherlands
- Department of Otolaryngology – Head and Neck Surgery, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Inge R. Konings
- Cancer Center Amsterdam (CCA), VU University Medical Center, Amsterdam, The Netherlands
- Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cornelia F. Van Uden-Kraan
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), VU University Medical Center, Amsterdam, The Netherlands
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Ousseine YM, Rouquette A, Bouhnik AD, Rigal L, Ringa V, Smith A'B, Mancini J. Validation of the French version of the Functional, Communicative and Critical Health Literacy scale (FCCHL). J Patient Rep Outcomes 2018; 2:3. [PMID: 29757319 PMCID: PMC5934921 DOI: 10.1186/s41687-018-0027-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 01/04/2018] [Indexed: 11/10/2022] Open
Abstract
Background Health literacy is a key asset, defined as the capacity to acquire, understand and use information in ways which promote and maintain good health. Objectives To assess the reliability and validity of the French translation of the Functional, Communicative and Critical Health Literacy (FCCHL) scale. Methods/participants A cross-sectional survey using an online questionnaire was proposed to all members of Seintinelles association. Exploratory and confirmatory factorial analyses were conducted. Results Data from 2342 respondents (45.8% had cancer history) were analysed. The FCCHL scale was well-accepted (missing value by item ≤0.7%). Factor analysis revealed an acceptable fit of three-factor model (comparative fit index = 0.922, root mean square error of approximation = 0.065 and standardized root mean square residual = 0.052). The FCCHL showed satisfactory reliability (α = 0.77) and scalar invariance was reached for education and deprivation, but not for age. Known group validity was verified as mean scale scores differed according to education, deprivation and age, as expected. Conclusion The French version of the FCCHL provides a brief reliable and valid measure to explore the dimensions of health literacy. It could be used by health professionals to screen for health literacy level in order to develop this skill and to tailor health communication. Electronic supplementary material The online version of this article (10.1186/s41687-018-0027-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Youssoufa M Ousseine
- 1Aix-Marseille Univ, INSERM, IRD, UMR912, SESSTIM, Institut Paoli-Calmettes, "Cancers, Biomedicine & Society" group, 232, Bd Ste Marguerite, BP 156, 13273 Marseille Cedex 9, France
| | - Alexandra Rouquette
- 2Public Health and Epidemiology Department, APHP, Bicêtre Hospital, Le Kremlin-Bicêtre, France.,Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Le Kremlin Bicêtre, France
| | - Anne-Déborah Bouhnik
- 1Aix-Marseille Univ, INSERM, IRD, UMR912, SESSTIM, Institut Paoli-Calmettes, "Cancers, Biomedicine & Society" group, 232, Bd Ste Marguerite, BP 156, 13273 Marseille Cedex 9, France
| | - Laurent Rigal
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Le Kremlin Bicêtre, France
| | - Virginie Ringa
- 2Public Health and Epidemiology Department, APHP, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Allan 'Ben' Smith
- 4Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW Australia.,5Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, Sydney, Australia
| | - Julien Mancini
- 1Aix-Marseille Univ, INSERM, IRD, UMR912, SESSTIM, Institut Paoli-Calmettes, "Cancers, Biomedicine & Society" group, 232, Bd Ste Marguerite, BP 156, 13273 Marseille Cedex 9, France.,6APHM, Timone Hospital, Public Health Department (BIOSTIC), Marseille, France
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The impact of vaccination and patient characteristics on influenza vaccination uptake of elderly people: A discrete choice experiment. Vaccine 2018; 36:1467-1476. [PMID: 29426662 DOI: 10.1016/j.vaccine.2018.01.054] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/17/2018] [Accepted: 01/19/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To improve information for patients and to facilitate a vaccination coverage that is in line with the EU and World Health Organization goals, we aimed to quantify how vaccination and patient characteristics impact on influenza vaccination uptake of elderly people. METHODS An online discrete choice experiment (DCE) was conducted among 1261 representatives of the Dutch general population aged 60 years or older. In the DCE, we used influenza vaccination scenarios based on five vaccination characteristics: effectiveness, risk of severe side effects, risk of mild side effects, protection duration, and absorption time. A heteroscedastic multinomial logit model was used, taking scale and preference heterogeneity (based on 19 patient characteristics) into account. RESULTS Vaccination and patient characteristics both contributed to explain influenza vaccination uptake. Assuming a base case respondent and a realistic vaccination scenario, the predicted uptake was 58%. One-way changes in vaccination characteristics and patient characteristics changed this uptake from 46% up to 61% and from 37% up to 95%, respectively. The strongest impact on vaccination uptake was whether the patient had been vaccinated last year, whether s/he had experienced vaccination side effects, and the patient's general attitude towards vaccination. CONCLUSIONS Although vaccination characteristics proved to influence influenza vaccination uptake, certain patient characteristics had an even higher impact on influenza vaccination uptake. Policy makers and general practitioners can use these insights to improve their communication plans and information regarding influenza vaccination for individuals aged 60 years or older. For instance, physicians should focus more on patients who had experienced side effects due to vaccination in the past, and policy makers should tailor the standard information folder to patients who had been vaccinated last year and to patient who had not.
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Koster ES, Philbert D, van Dijk L, Rademakers J, de Smet PAGM, Bouvy ML, Vervloet M. Recognizing pharmaceutical illiteracy in community pharmacy: Agreement between a practice-based interview guide and questionnaire based assessment. Res Social Adm Pharm 2018; 14:812-816. [PMID: 29398404 DOI: 10.1016/j.sapharm.2018.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/11/2018] [Accepted: 01/17/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with limited pharmaceutical literacy are at increased risk of drug-related problems. Recognizing these patients in daily practice is difficult. The Recognition and Addressing of Limited Pharmaceutical Literacy (RALPH) interview guide was developed as practical set of questions to recognize patients with limited pharmaceutical literacy in daily pharmacy practice. OBJECTIVE To compare agreement between pharmaceutical literacy measured with the RALPH guide and a validated general health literacy questionnaire. In addition, we provide insight into patients' pharmaceutical literacy using the RALPH interview guide. METHODS Structured face-to-face interviews with patients who visited a community pharmacy to fill a prescription for themselves were conducted. The interview included the RALPH guide as well as the Functional Communicative Critical Health Literacy (FCCHL) questionnaire to measure general health literacy. Functional, communicative and critical skills were measured and agreement between two methods was calculated. RESULTS Data were collected from 508 patients. Patients with limited pharmaceutical literacy, indicated by the RALPH questions, also had a lower general health literacy level according to FCCHL scores. Agreement between the RALPH guide and FCCHL questionnaire was moderate (∼60%) for the three health literacy domains. Most patients (>90%) had correct understanding of frequency and timing of medication use, but 25% did not understand warnings or precautions correctly. Finding understandable information (39%), assessing information applicability (50%) and reliability (64%) were mentioned as difficult by patients. CONCLUSION Patients experienced difficulties with more complex skills, e.g. interpretation of warnings or precautions when using a medicine, finding and analyzing medication information. Whereas the FCCHL questionnaire is useful to assess general health literacy, the RALPH interview guide provides insight in the level of skills needed for good medication use and is more suitable for use in a medication specific context such as community pharmacy. Context specific assessment of skills is important to provide tailored pharmaceutical care.
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Affiliation(s)
- Ellen S Koster
- Utrecht Pharmacy Practice Network for Education and Research (UPPER), Utrecht University, The Netherlands.
| | - Daphne Philbert
- Utrecht Pharmacy Practice Network for Education and Research (UPPER), Utrecht University, The Netherlands
| | - Liset van Dijk
- NIVEL, Netherlands Institute for Health Services Research, The Netherlands
| | - Jany Rademakers
- NIVEL, Netherlands Institute for Health Services Research, The Netherlands; CAPHRI Care and Public Health Research Institute, Department of Family Medicine, Maastricht University, The Netherlands
| | - Peter A G M de Smet
- KNMP, Royal Dutch Pharmacists Association, The Netherlands; Radboud University Nijmegen, Radboud Institute for Health Sciences, Departments of Clinical Pharmacy and IQ Healthcare, Nijmegen, The Netherlands
| | - Marcel L Bouvy
- Utrecht Pharmacy Practice Network for Education and Research (UPPER), Utrecht University, The Netherlands
| | - Marcia Vervloet
- NIVEL, Netherlands Institute for Health Services Research, The Netherlands
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Lee EH, Lee YW. First-order vs. second-order structural validity of the Health Literacy Scale in patients with diabetes. Scand J Caring Sci 2017; 32:441-447. [PMID: 28771769 DOI: 10.1111/scs.12460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 02/20/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the structural validity of the Health Literacy Scale (HLS) in Korean patients with diabetes based on the previously reported first-order three-factor and two-factor models and a newly proposed second-order model, to identify which model best represents the structure of the Korean version of the HLS (HLS-K). METHODS The HLS was translated from Japanese into Korean using a translation and back-translation technique. A secondary data analysis was used to validate the structure of the HLS. Data were obtained from a cross-sectional survey involving 459 adults with diabetes recruited from outpatient clinics at two university hospitals in South Korea. The structural validity was examined using confirmatory factor analysis. Additionally, the known-groups validity by education level and internal consistency validity were assessed. RESULTS The second-order three-factor model of the HLS-K exhibited a good fit to the data, as indicated by χ2 /df = 3.891, SRMR = 0.042, GFI = 0.924, RMSEA = 0.079 (90% CI = 0.069-0.090), and CFI = 0.962. The second-order three-factor model empirically demonstrated that both communicative and critical factors explained the variance in the overall health literacy better than did the functional factor. The HLS-K mean score was significantly lower for patients with only elementary school education than for those with higher education levels, implying the presence of known-groups validity. Cronbach's alpha for the total scale was 0.90. CONCLUSIONS This study found that the second-order three-factor model of the HLS-K is better than that the original first-order three-factor and first-order two-factor models. Further validation studies are needed to generalise the underlying structure of the instrument in diabetes populations across various cultures.
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Affiliation(s)
- Eun-Hyun Lee
- Graduate School of Public Health, Ajou University, Suwon, Korea
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van der Hout A, van Uden-Kraan CF, Witte BI, Coupé VMH, Jansen F, Leemans CR, Cuijpers P, van de Poll-Franse LV, Verdonck-de Leeuw IM. Efficacy, cost-utility and reach of an eHealth self-management application 'Oncokompas' that helps cancer survivors to obtain optimal supportive care: study protocol for a randomised controlled trial. Trials 2017; 18:228. [PMID: 28532439 PMCID: PMC5440906 DOI: 10.1186/s13063-017-1952-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 04/11/2017] [Indexed: 12/18/2022] Open
Abstract
Background Cancer survivors have to deal with a wide range of physical symptoms, psychological, social and existential concerns, and lifestyle issues related to cancer and its treatment. Therefore, it is essential that they have access to optimal supportive care services. The eHealth self-management application Oncokompas was developed to support cancer survivors with where they need to turn to for advice and guidance, as well as to increase their knowledge on the availability of optimal support. A randomised controlled trial will be conducted to assess the efficacy, cost-utility and reach of Oncokompas as an eHealth self-management application compared with care as usual among cancer survivors. Methods/design Adult cancer survivors diagnosed with breast, colorectal or head and neck cancer or lymphoma who are at 3 months to 5 years since curative treatment will be included. In total, 544 cancer survivors will be randomly assigned to the intervention group or a wait-list control group. The primary outcome measure is patient activation. Secondary outcome measures include self-efficacy, personal control, perceived patient-physician interaction, need for supportive care, mental adjustment to cancer and health-related quality of life. Furthermore, cost-utility outcomes will be assessed. Reach is defined as the percentage of cancer survivors who get access to Oncokompas within the context of this trial. Questionnaires will be administered at baseline, post-intervention and at 3- and 6-month follow-up. Discussion In this study, we will evaluate the efficacy and cost-utility of Oncokompas among cancer survivors, as well as the reach of Oncokompas. These are essential first steps in the translation of research into practice and contribute to sustainable adoption, implementation and maintenance of an evidence-based Oncokompas. Trial registration Netherlands Trial Register identifier: NTR5774. Registered on 8 March 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1952-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anja van der Hout
- Department of Clinical Psychology, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,EMGO+ Institute for Health and Care Research, Vrije Universiteit and VU University Medical Centre, Amsterdam, The Netherlands.,Cancer Centre Amsterdam (CCA), VU University Medical Centre, Amsterdam, The Netherlands
| | - Cornelia F van Uden-Kraan
- Department of Clinical Psychology, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,EMGO+ Institute for Health and Care Research, Vrije Universiteit and VU University Medical Centre, Amsterdam, The Netherlands.,Cancer Centre Amsterdam (CCA), VU University Medical Centre, Amsterdam, The Netherlands
| | - Birgit I Witte
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
| | - Veerle M H Coupé
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
| | - Femke Jansen
- Cancer Centre Amsterdam (CCA), VU University Medical Centre, Amsterdam, The Netherlands.,Department of Otolaryngology-Head and Neck Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - C René Leemans
- Cancer Centre Amsterdam (CCA), VU University Medical Centre, Amsterdam, The Netherlands.,Department of Otolaryngology-Head and Neck Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical Psychology, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,EMGO+ Institute for Health and Care Research, Vrije Universiteit and VU University Medical Centre, Amsterdam, The Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Research, Netherlands Comprehensive Cancer Organisation, Eindhoven, The Netherlands.,Department of Medical Psychology, Tilburg University, Tilburg, The Netherlands.,Division of Psychosocial Research & Epidemiology, Department of Psychosocial Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Clinical Psychology, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. .,EMGO+ Institute for Health and Care Research, Vrije Universiteit and VU University Medical Centre, Amsterdam, The Netherlands. .,Cancer Centre Amsterdam (CCA), VU University Medical Centre, Amsterdam, The Netherlands. .,Department of Otolaryngology-Head and Neck Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
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Visser LNC, Tollenaar MS, Bosch JA, van Doornen LJP, de Haes HCJM, Smets EMA. Are psychophysiological arousal and self-reported emotional stress during an oncological consultation related to memory of medical information? An experimental study. Stress 2017; 20:86-94. [PMID: 28235396 DOI: 10.1080/10253890.2017.1286323] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Patients forget 20-80% of information provided during medical consultations. The emotional stress often experienced by patients during consultations could be one of the mechanisms that lead to limited recall. The current experimental study therefore investigated the associations between (analog) patients' psychophysiological arousal, self-reported emotional stress and their (long term) memory of information provided by the physician. One hundred and eighty one cancer-naïve individuals acted as so-called analog patients (APs), i.e. they were instructed to watch a scripted video-recoding of an oncological bad news consultation while imagining themselves being in the patient's situation. Electrodermal and cardiovascular activity (e.g. skin conductance level and heart rate) were recorded during watching. Self-reported emotional stress was assessed before and after watching, using the STAI-State and seven Visual Analog Scales. Memory, both free recall and recognition, was assessed after 24-28 h. Watching the consultation evoked significant psychophysiological and self-reported stress responses. However, investigating the associations between 24 psychophysiological arousal measures, eight self-reported stress measures and free recall and recognition of information resulted in one significant, small (partial) correlation (r = 0.19). Considering multiple testing, this significant result was probably due to chance. Alternative analytical methods yielded identical results, strengthening our conclusion that no evidence was found for relationships between variables of interest. These null-findings are highly relevant, as they may be considered to refute the long-standing, but yet untested assumption that a relationship between stress and memory exists within this context. Moreover, these findings suggest that lowering patients' stress levels during the consultation would probably not be sufficient to raise memory of information to an optimal level. Alternative explanations for these findings are discussed.
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Affiliation(s)
- Leonie N C Visser
- a Department of Medical Psychology , Academic Medical Centre/University of Amsterdam , Amsterdam , The Netherlands
| | - Marieke S Tollenaar
- b Department of Clinical Psychology , Leiden University , Leiden , The Netherlands
| | - Jos A Bosch
- c Department of Clinical Psychology , University of Amsterdam , Amsterdam , The Netherlands
| | - Lorenz J P van Doornen
- d Department of Clinical and Health Psychology , Utrecht University , Utrecht , The Netherlands
| | - Hanneke C J M de Haes
- a Department of Medical Psychology , Academic Medical Centre/University of Amsterdam , Amsterdam , The Netherlands
| | - Ellen M A Smets
- a Department of Medical Psychology , Academic Medical Centre/University of Amsterdam , Amsterdam , The Netherlands
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Koster ES, Schmidt A, Philbert D, van de Garde EMW, Bouvy ML. Health literacy of patients admitted for elective surgery. JOURNAL OF PUBLIC HEALTH-HEIDELBERG 2016; 25:181-186. [PMID: 28357196 PMCID: PMC5350210 DOI: 10.1007/s10389-016-0774-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 11/17/2016] [Indexed: 11/30/2022]
Abstract
Aim Patients with limited health literacy have poorer surgical outcomes. However, current studies assessing the prevalence of limited health literacy in patients expecting surgery are small scale. We aimed to provide insight into the health literacy level of patients undergoing planned surgery. Subject and Methods Patients aged ≥18 years visiting the preoperative screening department were approached in the waiting area and invited to participate in a brief interview including the Functional Communicative Critical Health Literacy (FCCHL). Results In total, 225 patients (84.9% response) were studied. Based on the FCCHL, 37.3% of the patients were classified as having limited health literacy. The mean score in the critical domain (2.7 ± 0.9) was lower than scores in the functional (3.3 ± 0.6) and communicative (3.3 ± 0.6) domains. Conclusion More than one third of the patients admitted to the hospital for surgery had limited health literacy. Healthcare professionals should be aware of the different health literacy levels and tailor their information provision strategies accordingly.
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Affiliation(s)
- E S Koster
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, PO Box 80082 3508 TB, Utrecht, The Netherlands
| | - A Schmidt
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, PO Box 80082 3508 TB, Utrecht, The Netherlands
| | - D Philbert
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, PO Box 80082 3508 TB, Utrecht, The Netherlands
| | - E M W van de Garde
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, PO Box 80082 3508 TB, Utrecht, The Netherlands.,Department of Clinical Pharmacy, St. Antonius Hospital Nieuwegein, Utrecht, The Netherlands
| | - M L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, PO Box 80082 3508 TB, Utrecht, The Netherlands
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Cnossen IC, van Uden-Kraan CF, Eerenstein SEJ, Jansen F, Witte BI, Lacko M, Hardillo JA, Honings J, Halmos GB, Goedhart-Schwandt NLQ, de Bree R, Leemans CR, Verdonck-de Leeuw IM. An online self-care education program to support patients after total laryngectomy: feasibility and satisfaction. Support Care Cancer 2015; 24:1261-8. [PMID: 26306518 PMCID: PMC4729815 DOI: 10.1007/s00520-015-2896-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 08/09/2015] [Indexed: 12/23/2022]
Abstract
Purpose The purpose of this study was to investigate the feasibility of an online self-care education program supporting early rehabilitation of patients after total laryngectomy (TLPs) and factors associated with satisfaction. Methods Health care professionals (HCPs) were invited to participate and to recruit TLPs. TLPs were informed on the self-care education program “In Tune without Cords” (ITwC) after which they gained access. A study specific survey was used (at baseline T0 and postintervention T1) on TLPs’ uptake. Usage, satisfaction (general impression, willingness to use, user-friendliness, satisfaction with self-care advice and strategies, Net Promoter Score (NPS)), sociodemographic, and clinical factors were analyzed. Results HCPs of 6 out of 9 centers (67 % uptake rate) agreed to participate and recruited TLPs. In total, 55 of 75 TLPs returned informed consent and the baseline T0 survey and were provided access to ITwC (73 % uptake rate). Thirty-eight of these 55 TLPs used ITwC and completed the T1 survey (69 % usage rate). Most (66 %) TLPs were satisfied (i.e., score ≥7 (scale 1–10) on 4 survey items) with the self-care education program (mean score 7.2, SD 1.1). NPS was positive (+5). Satisfaction with the self-care education program was significantly associated with (higher) educational level and health literacy skills (P = .004, P = .038, respectively). No significant association was found with gender, age, marital status, employment status, Internet use, Internet literacy, treatment modality, time since total laryngectomy, and quality of life. Conclusion The online self-care education program ITwC supporting early rehabilitation was feasible in clinical practice. In general, TLPs were satisfied with the program.
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Affiliation(s)
- Ingrid C Cnossen
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Cornelia F van Uden-Kraan
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands
- Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081, BT, Amsterdam, The Netherlands
| | - Simone E J Eerenstein
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Femke Jansen
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Birgit I Witte
- Department of Epidemiology and Biostatistics, VU University Medical Center, PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Martin Lacko
- Department of Otorhinolaryngology-Head and Neck Surgery, Maastricht University Medical Center (MUMC), PO Box 5800, 6202, AZ, Maastricht, The Netherlands
| | - José A Hardillo
- Department of Otorhinolaryngology-Head and Neck Surgery, Erasmus University Medical Center (Erasmus MC), PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Medical Center (Radboud UMC), PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Gyorgy B Halmos
- Department of Otolaryngology-Head and Neck Surgery, University of Groningen, University Medical Center Groningen (UMCG), PO Box 30001, 9700, RD, Groningen, The Netherlands
| | - Noortje L Q Goedhart-Schwandt
- Department of Otolaryngology-Head and Neck Surgery, Medical Center Leeuwarden (MCL), PO Box 888, 8901, BR, Leeuwarden, The Netherlands
| | - Remco de Bree
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center (UMCU), PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands.
- Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081, BT, Amsterdam, The Netherlands.
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van der Heide I, Heijmans M, Schuit AJ, Uiters E, Rademakers J. Functional, interactive and critical health literacy: Varying relationships with control over care and number of GP visits. PATIENT EDUCATION AND COUNSELING 2015; 98:998-1004. [PMID: 25956070 DOI: 10.1016/j.pec.2015.04.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 04/08/2015] [Accepted: 04/12/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The aim of this study is to examine the extent to which functional, interactive and critical health literacy are associated with patients' perceived control over care and frequency of GP visits. METHODS Data from the Dutch 'National Panel of People with Chronic Illness or Disability' was used (N=2508). Health literacy was assessed by the Functional, Communicative and Critical Health Literacy measure. Perceived control over care was indicated by perceived ability to organize care, interact with providers and to perform self-care. By multivariate linear and logistic regression analyses, associations between health literacy and perceived control over care and subsequently frequency of GP visits were studied. RESULTS Mainly interactive health literacy was associated with patients' perceived ability to organize care, interact with healthcare providers and perform self-care, whereas only functional health literacy was associated with number of GP visits. CONCLUSION The results imply that some patients' may be less able to exert control over their care because of lower health literacy. Functional, interactive and critical health literacy vary in their relevance for patients' ability to exert control. PRACTICE IMPLICATIONS Initiatives for strengthening patients' role in healthcare may be improved by paying attention to patients' health literacy, specifically functional and interactive health literacy.
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Affiliation(s)
- Iris van der Heide
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, Netherlands.
| | - Monique Heijmans
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - A Jantine Schuit
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands; Department of Health Sciences and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, Netherlands
| | - Ellen Uiters
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Jany Rademakers
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, Netherlands
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Heijmans M, Waverijn G, Rademakers J, van der Vaart R, Rijken M. Functional, communicative and critical health literacy of chronic disease patients and their importance for self-management. PATIENT EDUCATION AND COUNSELING 2015; 98:41-48. [PMID: 25455794 DOI: 10.1016/j.pec.2014.10.006] [Citation(s) in RCA: 189] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 07/21/2014] [Accepted: 10/04/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To provide insight into the level of health literacy among chronic disease patients in the Netherlands, to identify subgroups with low literacy and to examine the associations between health literacy and self-management. METHODS Self-report questionnaires were sent to a nationwide sample of 1.341 chronic disease patients. The Dutch Functional Communicative and Critical Health Literacy scale (FCCHL), the Partners in Health scale (PIH) and Perceived Efficacy in Patient-Doctor Interactions (PEPPI-5) were used to assess health literacy and aspects of self-management. RESULTS In general, health literacy skills were good. A higher age, lower education, lower income, multi-morbidity and/or functional limitations were associated with lower levels of health literacy. Communicative and critical health literacy were related to some aspects of self-management but not to all. Functional health literacy was less important. CONCLUSION Communicative and critical health literacy play a role in successful self-management of chronic disease but the impact differs by context. Health literacy levels vary according to socio-demographic and disease characteristics of patients. PRACTICE IMPLICATIONS Health care professionals should tailor their information and support to the health literacy skills and personal context of their patients.
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Affiliation(s)
- Monique Heijmans
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
| | - Geeke Waverijn
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Jany Rademakers
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Rosalie van der Vaart
- Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | - Mieke Rijken
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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Londoño AMM, Schulz PJ. Impact of patients' judgment skills on asthma self-management: a pilot study. J Public Health Res 2014; 3:307. [PMID: 25553312 PMCID: PMC4274496 DOI: 10.4081/jphr.2014.307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 11/06/2014] [Indexed: 12/02/2022] Open
Abstract
Background The majority of current health literacy tools assess functional skills including reading, writing, and numeracy. Although these tools have been able to underline the impact of such skills on individuals’ health behaviour, there is a need for comprehensive measures to examine more advanced skills. The individual’s ability to use health-related information considering his/her own health context, and judging positive and negative consequences of their decisions has been conceptualized as judgment skills. The present study used a newly developed judgment skills tool to explore asthma self-management practices. Design and methods Eighty asthma patients were recruited from medical offices during the year 2013. The questionnaire was self-administered and contained health literacy questions, the judgment skill tool, the Asthma Control Test, and several self-management questions. Results Sixty-nine percent of participants had adequate health literacy, while 24% and 5% had marginal and inadequate levels, respectively. The high-judgment group referred more to their doctor when experiencing asthma problems t(76)=–2.18, P<0.032; complied more with the use of their control medicine t(77)=–3.24, P<0.002 and went more regularly to the doctor t(78)=–1.80, P<0.038 (one-tailed) than the low-judgment group. Conclusions The judgment skills tool can help identify asthma patients’ health information use and reveal how this use may affect some self-management practices. Significance for public health Patients’ health literacy has a great impact on their health behaviours and their health outcomes. Therefore, it has become more and more common to measure health literacy within the healthcare setting to determine the most effective approach to target patients. The measurement of asthma judgment skills contribute to a deeper understanding of patients’ asthma self-management in crucial topics for asthma control, and have the advantage of assessing the specific abilities needed for this particular condition, which in turn benefits the translation of the findings from the use of this tool into strategies that directly tackle the needs of asthma patients.
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Affiliation(s)
| | - Peter J Schulz
- Institute of Communication and Health, University of Lugano , Switzerland
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Pleasant A. Advancing health literacy measurement: a pathway to better health and health system performance. JOURNAL OF HEALTH COMMUNICATION 2014; 19:1481-1496. [PMID: 25491583 PMCID: PMC4292229 DOI: 10.1080/10810730.2014.954083] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The concept of health literacy initially emerged and continues to gain strength as an approach to improving health status and the performance of health systems. Numerous studies clearly link low levels of education, literacy, and health literacy with poor health, poor health care utilization, increased barriers to care, and early death. However, theoretical understandings and methods of measuring the complex social construct of health literacy have experienced a continual evolution that remains incomplete. As a result, the seemingly most-cited definition of health literacy proposed in the now-decade-old Institute of Medicine report on health literacy is long overdue for updating. Such an effort should engage a broad and diverse set of health literacy researchers, practitioners, and members of the public in creating a definition that can earn broad consensus through validation testing in a rigorous scientific approach. That effort also could produce the basis for a new universally applicable measure of health literacy. Funders, health systems, and policymakers should reconsider their timid approach to health literacy. Although the field and corresponding evidence base are not perfect, health literacy-especially when combined with a focus on prevention and integrative health-is one of the most promising approaches to advancing public health.
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Altin SV, Finke I, Kautz-Freimuth S, Stock S. The evolution of health literacy assessment tools: a systematic review. BMC Public Health 2014; 14:1207. [PMID: 25418011 PMCID: PMC4289240 DOI: 10.1186/1471-2458-14-1207] [Citation(s) in RCA: 183] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 11/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health literacy (HL) is seen as an increasingly relevant issue for global public health and requires a reliable and comprehensive operationalization. By now, there is limited evidence on how the development of tools measuring HL proceeded in recent years and if scholars considered existing methodological guidance when developing an instrument. METHODS We performed a systematic review of generic measurement tools developed to assess HL by searching PubMed, ERIC, CINAHL and Web of Knowledge (2009 forward). Two reviewers independently reviewed abstracts/ full text articles for inclusion according to predefined criteria. Additionally we conducted a reporting quality appraisal according to the survey reporting guideline SURGE. RESULTS We identified 17 articles reporting on the development and validation of 17 instruments measuring health literacy. More than two thirds of all instruments are based on a multidimensional construct of health literacy. Moreover, there is a trend towards a mixed measurement (self-report and direct test) of health literacy with 41% of instruments applying it, though results strongly indicate a weakness of coherence between the underlying constructs measured. Overall, almost every third instrument is based on assessment formats modeled on already existing functional literacy screeners such as the REALM or the TOFHLA and 30% of the included articles do not report on significant reporting features specified in the SURGE guideline. CONCLUSIONS Scholars recently developing instruments that measure health literacy mainly comply with recommendations of the academic circle by applying multidimensional constructs and mixing up measurement approaches to capture health literacy comprehensively. Nonetheless, there is still a dependence on assessment formats, rooted in functional literacy measurement contradicting the widespread call for new instruments. All things considered, there is no clear "consensus" on HL measurement but a convergence to more comprehensive tools. Giving attention to this finding can help to offer direction towards the development of comparable and reliable health literacy assessment tools that effectively respond to the informational needs of populations.
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Affiliation(s)
- Sibel Vildan Altin
- Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne, Gleuelerstr 176-178 50935, Cologne.
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