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Dinh TTH, Bonner A. Exploring the relationships between health literacy, social support, self-efficacy and self-management in adults with multiple chronic diseases. BMC Health Serv Res 2023; 23:923. [PMID: 37649013 PMCID: PMC10466814 DOI: 10.1186/s12913-023-09907-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/12/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Self-management in chronic diseases is essential to slowing disease progression and preventing complications. However, empirical research on the associations of critical factors, such as health literacy, social support, and self-efficacy with self-management in the context of multiple chronic diseases is scarce. This study aimed to investigate these associations and provides insights for healthcare providers to develop effective educational strategies for people with multiple chronic diseases. METHODS Using a cross-sectional survey design, adults (n = 600) diagnosed with at least two chronic diseases were conveniently recruited. To measure health literacy, social support, self-efficacy, and chronic disease self-management behaviours, the Health Literacy Questionnaire (HLQ), Medical Outcome Study - Social Support Survey, Self-efficacy in Managing Chronic Disease, and Self-management in Chronic Diseases instruments were utilized respectively. Comorbidity status was assessed using Age-adjusted Charlson Comorbidity Index (ACCI). A generalised linear regression model was used with a backward technique to identify variables associated with self-management. RESULTS Participants' mean age was 61 years (SD = 15.3), 46% were female, and most had up to 12 years of education (82.3%). Mean scores for HLQ domains 1-5 varied from 2.61 to 3.24 (possible score 1-4); domains 6-9 from 3.29 to 3.65 (possible score 1-5). The mean scores were 52.7 (SD = 10.4, possible score 0-95), 5.46 (SD = 1.9, possible score 0-10) and 82.1 (SD = 12.4, possible score 30-120) for social support, self-efficacy, and self-management, respectively. Mean ACCI was 6.7 (SD = 2.1). Eight factors (age > 65 years, being female, 4 health literacy domains, greater social support, and higher self-efficacy levels) were significantly associated with greater self-management behaviours while comorbidity status was not. The factors that showed the strongest associations with self-management were critical health literacy domains: appraisal of health information, social support for health, and healthcare provider support. CONCLUSIONS Developing critical health literacy abilities is a more effective way to enhance self-management behaviours than relying solely on self-confidence or social support, especially for people with multiple chronic diseases. By facilitating communication and patient education, healthcare providers can help patients improve their critical health literacy, which in turn can enhance their self-management behaviours.
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Affiliation(s)
- Thi Thuy Ha Dinh
- School of Nursing, University of Tasmania, Launceston, TAS, Australia.
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia.
| | - Ann Bonner
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia
- Kidney Health Service, Metro North Hospital and Health Service, Brisbane, QLD, Australia
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Koo LW, Baur C, Horowitz AM, Wang MQ. Parental Health Literacy, Empowerment, and Advocacy for Food Allergy Safety in Schools: A Cross-Sectional Study. Health Lit Res Pract 2023; 7:e165-e175. [PMID: 37698847 PMCID: PMC10495122 DOI: 10.3928/24748307-20230823-01] [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: 07/14/2022] [Accepted: 02/10/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Approximately 8% of elementary school-aged children in the United States have food allergies, a complicated health management situation that requires parents to use many types of health literacy, empowerment, and advocacy skills to work with school staff to protect their children. OBJECTIVE This cross-sectional study examined (a) whether the highest versus lowest levels of functional, communicative, and critical health literacy are associated with higher perceived effectiveness of parental advocacy behaviors for safe food allergy management in schools [parental advocacy]; and (b) whether communicative and critical health literacy are more strongly associated with parental advocacy than functional health literacy. METHODS A sample of parents of elementary school-aged children was recruited through 26 food allergy organizations and a research patient registry. Participants completed an anonymous online survey. Self-reported measurements of parental health literacy, empowerment, and advocacy were adapted and refined through pre-testing and pilot-testing. General linear model analyses were conducted to predict parental advocacy. KEY RESULTS Participants (N = 313) were predominantly White, college-educated mothers with moderately high levels of food allergy knowledge, health literacy, empowerment, and parental advocacy skills. Parents who scored at the highest levels in the three dimensions of health literacy reported they engaged in more effective advocacy behaviors than parents who scored at the lowest levels. Parental advocacy was predicted largely by parental empowerment and the quality of the relationship with the school (B = .41 and B = .40, respectively). Functional health literacy and the child's diagnosis of asthma were smaller predictors. While accounting for covariates, functional health literacy was significantly associated with parental advocacy whereas communicative and critical health literacy were not. CONCLUSIONS Interventions to impact parental empowerment and parent-school relationships, including a health-literate universal precautions approach of communicating food allergy school policies, may influence parental advocacy for food allergy safety in schools. Further research could use a performance-based multidimensional measure of health literacy. [HLRP: Health Literacy Research and Practice. 2023;7(3):e165-e175.].
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Affiliation(s)
- Laura W. Koo
- Address correspondence to Laura W. Koo, PhD, MS, FNP-BC, University of Maryland School of Nursing, 655 West Lombard Street, Suite 375D, Baltimore, MD 21201;
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Billany RE, Thopte A, Adenwalla SF, March DS, Burton JO, Graham-Brown MPM. Associations of health literacy with self-management behaviours and health outcomes in chronic kidney disease: a systematic review. J Nephrol 2023; 36:1267-1281. [PMID: 36645651 PMCID: PMC10333418 DOI: 10.1007/s40620-022-01537-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/21/2022] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Low health literacy is widely reported in people with chronic kidney disease (CKD) and has been associated with reduced disease self-management, poor health outcomes, increased mortality and poorer quality of life. However, these associations are still not well understood. METHODS Electronic-based systematic searches were performed to identify studies examining associations between health literacy and self-management behaviours and/or health outcomes in patients with CKD. A tabular and narrative synthesis of the data was performed. Meta-analysis was not appropriate due to the heterogeneity of study designs and methods. RESULTS Searches identified 48 studies that met the inclusion criteria. A total of 41 published articles, six conference abstracts, and one thesis were included. Of the 48 studies, 11 were cohort and 37 were cross-sectional. In total there were 25,671 patients; 16,952 from cohort studies. Median study sample size was 159 (IQR 92-275). Study quality was high (5), moderate (24) and poor (19). Thirteen measures of health literacy were used. Despite the limitations of the available evidence, there appear to be consistent relationships between higher health literacy and favourable self-management behaviours for patients with CKD. Definitive relationships between health literacy and patient outcomes are far less clear and remain incompletely understood. DISCUSSION Conclusive evidence describing a causal link between health literacy and patient outcomes remains limited, but for many outcomes, a consistent association is described. In addition to associations with mortality, hospitalisation and clinical events, there were consistent associations between health literacy and favourable self-management behaviours which could support the development of patient education aimed at improving health literacy.
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Affiliation(s)
- Roseanne E Billany
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK.
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - Ashnee Thopte
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Sherna F Adenwalla
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Daniel S March
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - James O Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Matthew P M Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
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Norris KC, Williams SF, Nee R. Flattening the Playing Field for Treatment of Diabetic Kidney Disease. Semin Nephrol 2023; 43:151428. [PMID: 37865981 DOI: 10.1016/j.semnephrol.2023.151428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Diabetic kidney disease (DKD) remains a major health care issue and is beset with significant racial and ethnic disparities in regard to its incidence, progression, and complication rate. An individual's health is influenced strongly by an array of societal-level factors commonly called the social determinants of health. Among these, DKD is influenced highly by structured resources and opportunities, as well as an individual's socioeconomic status, health insurance status, access to care, education, health literacy, nutrition, green space exposure, level of trust in the medical community, and more. Health equity is considered a state in which everyone has a fair and just opportunity to attain his or her highest level of health. Conversely, health inequities are a consequence of a structured discriminatory system of inequitable allocation of social determinants of health. When this discriminatory system is race-based it is referred to as structural racism, which eventually leads to racial and ethnic health disparities. The further downstream sequela of structural racism, consciously or unconsciously, impacts health systems, providers, and patients, and can lead to disparities in DKD development, progression, and complications. In this article, we explore potential interventions at the societal, health system, and provider levels that can help flatten the playing field and reduce racial and ethnic disparities in DKD.
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Affiliation(s)
- Keith C Norris
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA.
| | - Sandra F Williams
- Department of Integrated Medical Science, Florida Atlantic University, Boca Raton, FL
| | - Robert Nee
- Nephrology Service, Walter Reed National Military Medical Center, Department of Medicine, Uniformed Services University, Bethesda, MD
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Jafari A, Zadehahmad Z, Armanmehr V, Talebi M, Tehrani H. The evaluation of the role of diabetes health literacy and health locus of control on quality of life among type 2 diabetes using the Path analysis. Sci Rep 2023; 13:5447. [PMID: 37012271 PMCID: PMC10070490 DOI: 10.1038/s41598-023-32348-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/26/2023] [Indexed: 04/05/2023] Open
Abstract
Quality of life (QOL) in patients with diabetes is affected by multiple factors, and this study aimed to determine the effect of health locus of control points (HLOC) and diabetes health literacy (DHL) on QOL in Iranian patients with type 2 diabetes. This cross-sectional study was conducted between October 2021 and February 2022 among 564 people with type 2 diabetes. Patients were selected using proportional stratified sampling and simple random sampling methods. Data were collected using three questionnaires: (1) Multidimensional Health Locus of Control scale (form C), (2) World Health Organization Quality of Life Scale, and (3) Diabetes Health Literacy Scale. Data were analyzed by software's of SPSS V22 and AMOS V24. There was a positive and significant correlation between DHL and QOL. There was a positive and significant correlation between the subscales of internal HLOC, and doctors HLOC with QOL. According to the Path analysis results, all variables showed 58.93% of the direct effects and 41.07% of indirect effects of the final model. Numerate health literacy, informational health literacy, communicative health literacy, internal HLOC, other powerful people HLOC, chance HLOC, and doctors HLOC were able to predicted 49% variance of diabetes QOL (R2 = 0.49). The subscales of communicative health literacy, informational health literacy, internal HLOC, doctors HLOC, and chance HLOC had the greatest impact on QOL of people with diabetes. Based on the results of Path analysis, diabetes health literacy and HLOC play an effective role in QOL of diabetic. Therefore, there is a need to design and implement programs to improve the health literacy of patients as well as HLOC to improve QOL of patients.
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Affiliation(s)
- Alireza Jafari
- Department of Health Education and Health Promotion, School of Health, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Zohreh Zadehahmad
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Vajihe Armanmehr
- Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Mahdi Talebi
- Department of Community and Family Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hadi Tehrani
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
- Department of Health Education and Health Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
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Tavares VB, de Farias AL, da Silva ASA, Souza JDSE, da Silva HP, Bastos MDSCBDO, de Melo-Neto JS. Amazon Amandaba-Sociodemographic Factors, Health Literacy, Biochemical Parameters and Self-Care as Predictors in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3082. [PMID: 36833776 PMCID: PMC9966953 DOI: 10.3390/ijerph20043082] [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: 11/01/2022] [Revised: 12/30/2022] [Accepted: 12/30/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Health literacy (HL) and its domains (functional, critical, and communicative) appear to be related to self-care adherence in people with type 2 diabetes mellitus (DM2). This study aimed to verify if sociodemographic variables are predictors of HL, if HL and the sociodemographic factors affect biochemical parameters together, and if HL domains are predictors of self-care in DM2. METHODS We used the baseline assessment data from 199 participants ≥ 30 years in the project, "Amandaba na Amazônia: Culture Circles as a Strategy to Encourage Self-care for DM in Primary Health Care," which took place in November and December 2021. RESULTS In the HL predictor analysis, women (p = 0.024) and higher education (p = 0.005) were predictors of better functional HL. The predictors of biochemical parameters were: glycated hemoglobin control with low critical HL (p = 0.008); total cholesterol control with female sex (p = 0.004), and low critical HL (p = 0.024); low-density lipoprotein control with female sex (p = 0.027), and low critical HL (p = 0.007); high-density lipoprotein control with female sex (p = 0.001); triglyceride control with low Functional HL (p = 0.039); high levels of microalbuminuria with female sex (p = 0.014). A low critical HL was a predictor of a lower specific diet (p = 0.002) and a low total HL of low medication care (p = 0.027) in analyses of HL domains as predictors of self-care. CONCLUSION Sociodemographic factors can be used to predict HL, and HL can predict biochemical parameters and self-care.
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Affiliation(s)
- Victória Brioso Tavares
- Postgraduate Program in Health, Environment and Society in the Amazon, Institute of Health Sciences, Federal University of Pará (UFPA), Belém 66050-160, Brazil
| | - Aline Lobato de Farias
- Postgraduate Program in Health, Environment and Society in the Amazon, Institute of Health Sciences, Federal University of Pará (UFPA), Belém 66050-160, Brazil
| | - Amanda Suzane Alves da Silva
- Faculty of Physiotherapy and Occupational Therapy (FFTO), Federal University of Pará (UFPA), Belém 66075-110, Brazil
| | - Josiel de Souza e Souza
- Faculty of Physiotherapy and Occupational Therapy (FFTO), Federal University of Pará (UFPA), Belém 66075-110, Brazil
| | - Hilton Pereira da Silva
- Postgraduate Program in Health, Environment and Society in the Amazon, Institute of Health Sciences, Federal University of Pará (UFPA), Belém 66050-160, Brazil
| | | | - João Simão de Melo-Neto
- Postgraduate Program in Health, Environment and Society in the Amazon, Institute of Health Sciences, Federal University of Pará (UFPA), Belém 66050-160, Brazil
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Taha A, Iman Y, Hingwala J, Askin N, Mysore P, Rigatto C, Bohm C, Komenda P, Tangri N, Collister D. Patient Navigators for CKD and Kidney Failure: A Systematic Review. Kidney Med 2022; 4:100540. [PMID: 36185707 PMCID: PMC9516458 DOI: 10.1016/j.xkme.2022.100540] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Rationale & Objective To what degree and how patient navigators improve clinical outcomes for patients with chronic kidney disease (CKD) and kidney failure is uncertain. We performed a systematic review to summarize patient navigator program design, evidence, and implementation in kidney disease. Study Design A search strategy was developed for randomized controlled trials and observational studies that evaluated the impact of navigators on outcomes in the setting of CKD and kidney failure. Articles were identified from various databases. Two reviewers independently screened the articles and identified those meeting the inclusion criteria. Setting & Participants Patients with CKD or kidney failure (in-center hemodialysis, peritoneal dialysis, home hemodialysis, or kidney transplantation). Selection Criteria for Studies Studies that compared patient navigators with a control, without limits on size, duration, setting, or language. Studies focusing solely on patient education were excluded. Data Extraction Data were abstracted from full texts and risk of bias was assessed. Analytical Approach No meta-analysis was performed. Results Of 3,371 citations, 17 articles met the inclusion criteria including 14 original studies. Navigators came from various healthcare backgrounds including nursing (n=6), social worker (n=2), medical interpreter (n=1), research (n=1), and also included kidney transplant recipients (n=2) and non-medical individuals (n=2). Navigators focused mostly on education (n=9) and support (n = 6). Navigators were used for patients with CKD (n=5), peritoneal dialysis (n=2), in-center hemodialysis (n=4), kidney transplantation (n=2), but not home hemodialysis. Navigators improved transplant workup and listing, peritoneal dialysis utilization, and patient knowledge. Limitations Many studies did not show benefits across other outcomes, were at a high risk of bias, and none reported cost-effectiveness or patient-reported experience measures. Conclusions Navigators improve some health outcomes for CKD but there was heterogeneity in their structure and function. High-quality randomized controlled trials are needed to evaluate navigator program efficacy and cost-effectiveness.
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Affiliation(s)
- Ali Taha
- Chronic Disease Innovation Center, Winnipeg, Manitoba, Canada
| | - Yasmin Iman
- Chronic Disease Innovation Center, Winnipeg, Manitoba, Canada
| | - Jay Hingwala
- Chronic Disease Innovation Center, Winnipeg, Manitoba, Canada
- Department of Medicine, Section of Nephrology, University of Manitoba, Manitoba, Canada
| | - Nicole Askin
- Libraries, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Priyanka Mysore
- Chronic Disease Innovation Center, Winnipeg, Manitoba, Canada
- Department of Medicine, Section of Nephrology, University of Manitoba, Manitoba, Canada
| | - Claudio Rigatto
- Chronic Disease Innovation Center, Winnipeg, Manitoba, Canada
- Department of Medicine, Section of Nephrology, University of Manitoba, Manitoba, Canada
| | - Clara Bohm
- Chronic Disease Innovation Center, Winnipeg, Manitoba, Canada
- Department of Medicine, Section of Nephrology, University of Manitoba, Manitoba, Canada
| | - Paul Komenda
- Chronic Disease Innovation Center, Winnipeg, Manitoba, Canada
- Department of Medicine, Section of Nephrology, University of Manitoba, Manitoba, Canada
| | - Navdeep Tangri
- Chronic Disease Innovation Center, Winnipeg, Manitoba, Canada
- Department of Medicine, Section of Nephrology, University of Manitoba, Manitoba, Canada
| | - David Collister
- Chronic Disease Innovation Center, Winnipeg, Manitoba, Canada
- Department of Medicine, Section of Nephrology, University of Manitoba, Manitoba, Canada
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Ziapour A, Ebadi Fard Azar F, Mahaki B, Mansourian M. Factors affecting the health literacy status of patients with type 2 diabetes through demographic variables: A cross-sectional study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:306. [PMID: 36438988 PMCID: PMC9683461 DOI: 10.4103/jehp.jehp_1759_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Health literacy (HL) is the ability of a person to acquire the process, understand the necessary health information, and make the health services needed for conscious health decisions. Besides, diabetes is the most common metabolic disorder that affects patients' quantity and quality of life. This study focused on determining the factors that affect the HL status of patients with type 2 diabetes (T2D) through the role of the demographic variables. MATERIALS AND METHODS This descriptive-analytical research survey recruited a sample based on 280 patients with T2D at the Diabetes Research Center of Ayatollah Taleghani Hospital in Kermanshah in 2020. This study selected patients with T2D using a simple random sampling technique. The study applied the demographic information questionnaire and the Functional, Communicative, and Critical HL Scale to collect data from patients with T2D. This study used the SPSS version 23 on the received data sets to perform statistical analysis, including t-test, analysis of the variance, and multiple regression, to predict the factors affecting HL among diabetes patients. RESULTS The study results showed that the mean age of the participating patients with T2D was 55.80 ± 13.04. The results indicated the mean score and standard deviation of total HL score in patients with T2D 2.70 ± 0.44. The findings specified a statistically significant relationship between HL, gender, education, occupation, income, and place of residence. Results indicated that β-coefficients of the multiple regression analysis and the income variable (β = 0.170), age (β = 0.176), and employment variable (β = 0.157). These are the most predictive of the HL of patients with T2D. CONCLUSION The results of this study specified that the HL rate of individuals with diabetes type 2 is average. The potential communicative and critical HL influence is essential for communication and education for diabetes patients in the primary health-care system settings. The findings indicate that communicative and critical HL related to patients' management and functional HL looks passable in this study.
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Affiliation(s)
- Arash Ziapour
- Department of Education and Health Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Farbod Ebadi Fard Azar
- Department of Education and Health Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Behzad Mahaki
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Morteza Mansourian
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran
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Boonstra MD, Reijneveld SA, Westerhuis R, Tullius JM, Vervoort JPM, Navis G, de Winter AF. A longitudinal qualitative study to explore and optimize self-management in mild to end stage chronic kidney disease patients with limited health literacy: Perspectives of patients and health care professionals. PATIENT EDUCATION AND COUNSELING 2022; 105:88-104. [PMID: 34024670 DOI: 10.1016/j.pec.2021.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/09/2021] [Accepted: 05/08/2021] [Indexed: 05/17/2023]
Abstract
OBJECTIVES Limited health literacy (LHL) is associated with faster kidney deterioration. Health care professionals (HCPs) promote self-management to maintain kidney function, which is difficult for patients with LHL. Evidence lacks on perceived barriers and best strategies to optimize their self-management. Our study aims to explore experiences with and barriers for self-management from the perspectives of LHL patients and HCPs to identify strategies to optimize self-management. METHODS We performed a longitudinal qualitative study with semi-structured in-depth interviews and focus group discussions among CKD patients and LHL (n = 24) and HCPs (n = 37) from general practices and hospitals. RESULTS Four themes arose among patients: (1) CKD elusiveness, (2) suboptimal intake of knowledge (3) not taking a front-seat role, and (4) maintaining change. Among HCPs, three themes emerged: (1) not recognizing HL problems, (2) lacking effective strategies, and (3) health care barriers. CONCLUSION We suggest three routes to optimize self-management: providing earlier information, applying person-centered strategies to maintain changes, and improving competencies of HCPs. PRACTICE IMPLICATIONS HCPs need to explain CKD self-management better to prevent kidney deterioration. New interventions, based on behavioral approaches, are needed to optimize self-management. HCPs need training to improve recognition and support of LHL patients.
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Affiliation(s)
- Marco D Boonstra
- University Medical Centre Groningen, Department of Health Sciences, Groningen, The Netherlands.
| | - Sijmen A Reijneveld
- University Medical Centre Groningen, Department of Health Sciences, Groningen, The Netherlands
| | - Ralf Westerhuis
- University Medical Centre Groningen, Department of Nephrology, Groningen, The Netherlands
| | - Janne M Tullius
- University Medical Centre Groningen, Department of Health Sciences, Groningen, The Netherlands
| | - Johanna P M Vervoort
- University Medical Centre Groningen, Department of Health Sciences, Groningen, The Netherlands
| | - Gerjan Navis
- University Medical Centre Groningen, Department of Nephrology, Groningen, The Netherlands
| | - Andrea F de Winter
- University Medical Centre Groningen, Department of Health Sciences, Groningen, The Netherlands
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Boonstra MD, Reijneveld SA, Navis G, Westerhuis R, de Winter AF. Co-Creation of a Multi-Component Health Literacy Intervention Targeting Both Patients with Mild to Severe Chronic Kidney Disease and Health Care Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413354. [PMID: 34948960 PMCID: PMC8704507 DOI: 10.3390/ijerph182413354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/30/2022]
Abstract
Limited health literacy (LHL) is common in chronic kidney disease (CKD) patients and frequently associated with worse self-management. Multi-component interventions targeted at patients and healthcare professionals (HCPs) are recommended, but evidence is limited. Therefore, this study aims to determine the objectives and strategies of such an intervention, and to develop, produce and evaluate it. For this purpose, we included CKD patients with LHL (n = 19), HCPs (n = 15), educators (n = 3) and students (n = 4) from general practices, nephrology clinics and universities in an Intervention Mapping (IM) process. The determined intervention objectives especially address the patients’ competences in maintaining self-management in the long term, and communication competences of patients and HCPs. Patients preferred visual strategies and strategies supporting discussion of needs and barriers during consultations to written and digital strategies. Moreover, they preferred an individual approach to group meetings. We produced a four-component intervention, consisting of a visually attractive website and topic-based brochures, consultation cards for patients, and training on LHL for HCPs. Evaluation revealed that the intervention was useful, comprehensible and fitting for patients’ needs. Healthcare organizations need to use visual strategies more in patient education, be careful with digitalization and group meetings, and train HCPs to improve care for patients with LHL. Large-scale research on the effectiveness of similar HL interventions is needed.
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Affiliation(s)
- Marco D. Boonstra
- Department of Health Sciences, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (S.A.R.); (A.F.d.W.)
- Correspondence: ; Tel.: +31653243985
| | - Sijmen A. Reijneveld
- Department of Health Sciences, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (S.A.R.); (A.F.d.W.)
| | - Gerjan Navis
- Department of Nephrology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (G.N.); (R.W.)
| | - Ralf Westerhuis
- Department of Nephrology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (G.N.); (R.W.)
| | - Andrea F. de Winter
- Department of Health Sciences, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (S.A.R.); (A.F.d.W.)
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Goh ZZS, Chia JMX, Seow TYY, Choo JCJ, Foo M, Seow PS, Griva K. Treatment-related decisional conflict in pre-dialysis chronic kidney disease patients in Singapore: Prevalence and determinants. Br J Health Psychol 2021; 27:844-860. [PMID: 34865298 DOI: 10.1111/bjhp.12577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 10/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In advanced chronic kidney disease (CKD), patients face complex decisions related to renal replacement modality that can cause decisional conflict and delay. This study aimed to evaluate the prevalence of severe decisional conflict across decision types and to identify the psychosocial and clinical factors associated with decisional conflict in this population. DESIGN Observational cross-sectional study. METHODS Patients with CKD in renal care were recruited. The Decisional Conflict Scale (DCS), Functional, Communicative, and Critical Health Literacy (FCCHL), Health Literacy Questionnaire (HLQ), Hospital Anxiety and Depression Scale (HADS), Brief Illness Perception Questionnaire (BIPQ), and the Kidney-disease Quality of Life (KDQOL) questionnaires were used. Clinical data were obtained from medical records. Bivariate and multivariable logistic regression models were used to identify predictors of severe decisional conflict (DCS score ≥ 37.5). RESULTS Participants (N = 190; response rate = 56.7%; mean age = 62.8 ± 10.8) reported moderate levels of decisional conflict (29.7 ± 14.5). The overall prevalence of severe decisional conflict was 27.5% (n = 46) with no significant differences across decision types (dialysis, modality, access). Ethnicity (Chinese), marital status (married), BIPQ treatment control, coherence, KDQOL staff encouragement, and all health literacy domains, except functional health literacy, were significant predictors of decisional conflict in the unadjusted models. In the multivariable model, only the health literacy domains of FCCHL Communicative, and HLQ Active Engagement remained significant. CONCLUSION Even after pre-dialysis education, many CKD patients in this study still report severe decisional conflict, with rates remaining substantial across decision junctures. The associations of decisional conflict and health literacy skills related to communication and engagement with healthcare providers indicate that more collaborative and patient-centric pre-dialysis programs may support patient activation and resolve decisional conflict.
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Affiliation(s)
- Zack Zhong Sheng Goh
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Jace Ming Xuan Chia
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | | | | | | | | | - Konstadina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
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Wei CJ, Shih CL, Hsu YJ, Chen YC, Yeh JZ, Shih JH, Chiu CH. Development and application of a chronic kidney disease-specific health literacy, knowledge and disease awareness assessment tool for patients with chronic kidney disease in Taiwan. BMJ Open 2021; 11:e052597. [PMID: 34635527 PMCID: PMC8506855 DOI: 10.1136/bmjopen-2021-052597] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study aims to develop an assessment tool for health literacy and knowledge specific to chronic kidney disease (CKD) for use in examining the associations between health literacy, disease-specific knowledge and disease awareness among patients with CKD in Taiwan. DESIGN An assessment tool in Mandarin and Taiwanese was developed based on patient input, panel discussions with experts and a literature review, and checked for validity and reliability in a pilot test. Formal data were collected through population-based sampling with a set quota according to region and hospital accreditation level. Cross-sectional data were collected to confirm the reliability and validity of the assessment tool. Levels of health literacy, disease knowledge, and disease awareness were then reported and analysed. SETTING Sample hospitals included 10 medical centres, 18 regional hospitals and 15 local hospitals in Taiwan. Researchers were granted Internal Review Board approval and obtained agreement to collect data in all study settings. PARTICIPANTS Patients at least 20 years old who had been diagnosed with CKD of any stage were eligible to participate. The formal assessment collected 1155 valid questionnaires, yielding an 87.3% response rate. The mean age of participants was 67.48 years (SD=12.87, range 22-98), while 484 (41.95%) were female and 78% were aware they had CKD. RESULTS The self-devised instrument proved to have excellent reliability and validity. Use of the instrument in the main study showed that CKD-specific health literacy was significantly associated with age (β=-0.33, p<0.00), educational attainment and disease awareness (β=0.13, p<0.00). CKD-specific knowledge was also significantly associated with age (β=-0.18, p<0.00), educational attainment and disease awareness (β=0.19, p<0.00). CONCLUSIONS This CKD-specific health literacy and knowledge assessment tool developed for Mandarin and Taiwanese-speaking patients is reliable and well validated. Patients with CKD who are aware of and understand their disease performed better in the assessment.
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Affiliation(s)
- Chung-Jen Wei
- Department of Public Health, Fu Jen Catholic University, Taipei, Taiwan
| | - Chung-Liang Shih
- Deputy Minister Office, Executive Yuan Republic of China Ministry of Health and Welfare, Taipei, Taiwan
| | - Yu-Juei Hsu
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yin-Cheng Chen
- Division of Nephrology, Department of Internal Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Jue-Zong Yeh
- Department of Pharmacy, Tri-Service General Hospital, Taipei, Taiwan
| | - Jia-Hui Shih
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Chiung-Hsuan Chiu
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
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Gurgel do Amaral MS, Reijneveld SA, Geboers B, Navis GJ, Winter AFD. Low Health Literacy is Associated with the Onset of CKD during the Life Course. J Am Soc Nephrol 2021; 32:1436-1443. [PMID: 33766810 PMCID: PMC8259635 DOI: 10.1681/asn.2020081155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/30/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Health literacy, the ability to deal with information related to one's health, is a predictor of health outcomes in CKD. However, research has not explored whether low health literacy predicts the onset of CKD. METHODS We used data from participants of Lifelines, a prospective population-based cohort study of individuals living in The Netherlands, to assess the share of individuals with low health literacy by eGFR category, whether low health literacy is associated with CKD onset in the general population and in the subgroup of older adults, and whether established CKD risk factors mediate this association. RESULTS In the total sample of 93,885 adults (mean follow-up 3.9 years), low health literacy was more likely among individuals in worse eGFR categories, increasing from 26.4% in eGFR category 1 to 50.0% in category 5 (P=0.02). Low health literacy, compared with adequate health literacy, was associated with the onset of CKD in the total sample (3.0% versus 2.1%) and in the subgroup of older adults (13.4% versus 11.3%), with odds ratios (ORs) of 1.44 (95% confidence interval (95% CI), 1.31 to 1.59) and 1.21 (95% CI, 1.04 to 1.41), respectively. After adjustment for sex, age, education, and income, health literacy was associated with CKD onset only in older adults (OR, 1.25; 95% CI, 1.04 to 1.50). This association was mediated by hypertension and high body mass index (BMI) in the crude model, but only by BMI after adjustment (with BMI explaining 18.8% of the association). CONCLUSIONS Low health literacy is a risk factor for CKD onset among older adults, which suggests that CKD prevention might benefit from strategies to address low health literacy.
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Affiliation(s)
- Matheus S Gurgel do Amaral
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Bas Geboers
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Gerjan J Navis
- Department of Nephrology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Andrea F de Winter
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, The Netherlands
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Gurgel do Amaral M, Reijneveld SA, Almansa J, Navis G, de Winter AF. Do Uncontrolled Hypertension, Diabetes, Dyslipidemia, and Obesity Mediate the Relationship Between Health Literacy and Chronic Kidney Disease Complications? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105235. [PMID: 34069095 PMCID: PMC8157126 DOI: 10.3390/ijerph18105235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 12/30/2022]
Abstract
Health literacy is the ability to deal with information related to one’s health. Patients with low health literacy and chronic diseases, such as chronic kidney disease (CKD), have poor disease-management skills, which could lead to complications. We used logistic regressions and structural equational modeling to assess whether low health literacy is associated with the development of cardiovascular disease and mortality in patients with CKD, and whether this association is mediated by the presence of uncontrolled hypertension, diabetes, dyslipidemia, obesity, or albuminuria. Data from 2742 adult participants with CKD from the Lifelines study were analyzed at baseline and after approximately four years. Low health literacy was associated with cardiovascular disease and mortality in the crude models, with OR and 95%CI of 1.93 (1.46 to 2.55) and 1.59 (1.08 to 2.36), respectively. After adjustment for age and sex, low health literacy was only associated with cardiovascular disease (OR 1.76 (1.31 to 2.23)). This association was mediated by uncontrolled diabetes (27.1%) and obesity (8.0%). Low health literacy is associated with the development of cardiovascular disease after adjustment for age and sex, and this association is mediated by uncontrolled diabetes and obesity.
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Affiliation(s)
- Matheus Gurgel do Amaral
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, Hanzeplein 1, 9700RB Groningen, The Netherlands; (S.A.R.); (J.A.); (A.F.d.W.)
- Correspondence:
| | - Sijmen A. Reijneveld
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, Hanzeplein 1, 9700RB Groningen, The Netherlands; (S.A.R.); (J.A.); (A.F.d.W.)
| | - Josue Almansa
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, Hanzeplein 1, 9700RB Groningen, The Netherlands; (S.A.R.); (J.A.); (A.F.d.W.)
| | - Gerjan Navis
- Department of Nephrology, University Medical Center Groningen, Hanzeplein 1, 9700RB Groningen, The Netherlands;
| | - Andrea F. de Winter
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, Hanzeplein 1, 9700RB Groningen, The Netherlands; (S.A.R.); (J.A.); (A.F.d.W.)
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15
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Wang X, Lin L, Xu J, Wang W, Zhou X. Expectant parents' vaccine decisions influenced by the 2018 Chinese vaccine crisis: A cross-sectional study. Prev Med 2021; 145:106423. [PMID: 33440190 DOI: 10.1016/j.ypmed.2021.106423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
Immunization programs have been challenged by vaccine crises. Between 2013 and 2018, China has experienced three major vaccine scandals and crises, which has partly impaired Chinese public trust in domestically produced vaccines. This study aims to explore the associations between parental trust toward CDC-released crisis communication information, parents' critical understanding of crisis information, parental confidence in vaccine efficacy, and parental vaccine decisions. A cross-sectional survey was conducted among 1065 expectant parents two weeks after the 2018 vaccine crisis was revealed. The proportion of parental hesitancy toward domestically produced vaccines and overall vaccination increased from 30.6% to 82.7% and 8.3% to 52.1%, respectively, after the crisis. Parents with higher levels of trust toward crisis communication information were less likely to report vaccine hesitancy toward both domestically produced vaccines and vaccines overall after the crisis. Parents with better critical understanding of crisis information were less likely to report a vaccine hesitancy toward overall vaccine and more likely to maintain a vaccine intention. Additionally, parents with lower levels of confidence in vaccine efficacy were more likely to became vaccine hesitant but were also more likely to maintain their vaccine intentions after the crisis. It is crucial to guarantee the safety of vaccines, maintain parental confidence in vaccine efficacy, and eliminate the potential risks that result in parental vaccine hesitancy. Future crisis communication strategies are encouraged to ensure timely responses to sustain public confidence.
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Affiliation(s)
- Xiaomin Wang
- Institute of Social Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China.
| | - Leesa Lin
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7TH, UK.
| | - Jiayao Xu
- Institute of Social Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China.
| | - Weiyi Wang
- Institute of Social Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China.
| | - Xudong Zhou
- Institute of Social Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China.
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Abstract
PROBLEM IDENTIFICATION Patients with cancer face high expectations for performing health literacy activities necessary for self-management and decision making, but only 12% of adults in the United States are proficient in health literacy. This review explores evidence regarding what is known about functional, interactive, and critical health literacy in adult oncology populations. LITERATURE SEARCH The review was conducted by searching extensively in the CINAHL® Plus database. DATA EVALUATION Of 614 articles retrieved from the literature search, 22 were included in the final sample. Most were cross-sectional, descriptive, correlational studies. SYNTHESIS Health literacy research in the United States focuses primarily on functional health literacy, but studies that include interactive and/or critical health literacy indicate their applicability in adult oncology populations. IMPLICATIONS FOR RESEARCH Additional research is needed to clarify the role of health literacy in cancer care to develop effective interventions that facilitate self-management and decision making.
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17
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Shah JM, Ramsbotham J, Seib C, Muir R, Bonner A. A scoping review of the role of health literacy in chronic kidney disease self-management. J Ren Care 2021; 47:221-233. [PMID: 33533199 DOI: 10.1111/jorc.12364] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/02/2020] [Accepted: 12/29/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic kidney disease is a serious health condition and is increasing globally. Effective self-management could slow disease progression and improve health outcomes, although the contribution of health literacy and knowledge for self-management is not well known. AIM To investigate the recent evidence of health literacy and the relationship between health literacy, knowledge and self-management of chronic kidney disease. METHODS Arksey and O'Malley's framework informed this scoping review. Eligible studies involving adults with any grade of chronic kidney disease, measuring all dimensions of health literacy (i.e., functional, communicative, and critical), disease-specific knowledge and self-management, published in English between January 2005 and March 2020, were included. RESULTS The scoping review found 12 eligible studies, with 11 assessing all dimensions of health literacy. No study examined health literacy, knowledge and self-management. When individuals had greater health literacy, this was associated with greater knowledge about the disease. Communicative health literacy was a significant predictor of medication, diet and fluid adherence, and overall self-management behaviours. CONCLUSION This scoping review shows that disease-specific knowledge is important for health literacy and that health literacy is essential for effective self-management of chronic kidney disease. The implications of these relationships can inform strategies for the development of evidence-based patient education to support increased self-management. There is also a need for further research to explore these associations.
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Affiliation(s)
- Jennifer M Shah
- School of Nursing and Midwifery, Health Groups, Griffith University, Brisbane, Queensland, Australia
| | - Joanne Ramsbotham
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Charrlotte Seib
- School of Nursing and Midwifery, Health Groups, Griffith University, Brisbane, Queensland, Australia
| | - Rachel Muir
- School of Nursing and Midwifery, Health Groups, Griffith University, Brisbane, Queensland, Australia
| | - Ann Bonner
- School of Nursing and Midwifery, Health Groups, Griffith University, Brisbane, Queensland, Australia.,Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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18
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Boonstra MD, Reijneveld SA, Foitzik EM, Westerhuis R, Navis G, de Winter AF. How to tackle health literacy problems in chronic kidney disease patients? A systematic review to identify promising intervention targets and strategies. Nephrol Dial Transplant 2020; 36:gfaa273. [PMID: 33351936 PMCID: PMC8237988 DOI: 10.1093/ndt/gfaa273] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Limited health literacy (LHL) is associated with multiple adverse health outcomes in chronic kidney disease (CKD). Interventions are needed to improve this situation, but evidence on intervention targets and strategies is lacking. This systematic review aims to identify potential targets and strategies by summarizing the evidence on: (i) patient- and system-level factors potentially mediating the relation between LHL and health outcomes; and (ii) the effectiveness of health literacy interventions customized to CKD patients. METHODS We performed a systematic review of peer-reviewed research articles in Medline, Embase and Web of Science, 2009-19. We assessed the quality of the studies and conducted a best-evidence synthesis. RESULTS We identified 860 publications and included 48 studies. Most studies were of low quality (n = 26) and focused on dialysis and transplantation (n = 38). We found strong evidence for an association of LHL with smoking and having a suboptimal transplantation process. Evidence was weak for associations between LHL and a variety of factors related to self-care management (n = 25), utilization of care (n = 23), patient-provider interaction (n = 8) and social context (n = 5). Six interventions were aimed at improving knowledge, decision-making and health behaviours, but evidence for their effectiveness was weak. CONCLUSIONS Study heterogeneity, low quality and focus on kidney failure largely impede the identification of intervention targets and strategies for LHL. More and higher quality studies in earlier CKD stages are needed to unravel how LHL leads to worse health outcomes, and to identify targets and strategies to prevent disease deterioration. Healthcare organizations need to develop and evaluate efforts to support LHL patients.
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Affiliation(s)
- Marco D Boonstra
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Elisabeth M Foitzik
- Institute for Applied Health Sciences, Coburg University of Applied Sciences and Arts, Coburg, Germany
| | - Ralf Westerhuis
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerjan Navis
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Andrea F de Winter
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Guo XM, Zhai X, Hou BR. Adequacy of health literacy and its effect on diabetes self-management: a meta-analysis. Aust J Prim Health 2020; 26:458-465. [PMID: 33296622 DOI: 10.1071/py20079] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/28/2020] [Indexed: 11/23/2022]
Abstract
This study evaluated the role of health literacy (HL) in the self-management of diabetes. A literature search was conducted in electronic databases and studies were selected using precise eligibility criteria. A meta-analysis was conducted to estimate the HL adequacy rate, factors affecting the adequacy of HL and correlations between HL and diabetes self-management variables. Thirty-three studies were included in the analysis. The HL adequacy rate was 67% (95% confidence interval (CI) 57, 76). Compared with patients with inadequate HL, patients with adequate HL were younger (mean difference -5.2 years; 95% CI -7.2, -3.2; P<0.00001), more likely to have a high school or higher level of education (odds ratio (OR) 8.39; 95% CI 5.03, 13.99]; P<0.00001) and were less likely to belong to a low-income group (OR 0.36; 95% CI 0.23, 0.56; P<0.00001). HL was positively correlated with self-monitoring (r=0.19; 95% CI 0.11, 0.27; P<0.00001), dietary and physical care (r=0.12; 95% CI 0.07, 0.18; P=0.009), diabetes knowledge (r=0.29; 95% CI 0.09, 0.45; P<0.001), self-efficacy (r=0.28; 95% CI 0.15, 0.41; P<0.00001), self-care (0.24; 95% CI 0.16, 0.31; P<0.00001), formal education (r=0.35; 95% CI 0.18, 0.53; P<0.00001) and social support (r=0.2; 95% CI 0.07, 0.33; P<0.00001). Patient age (r=-0.28; 95% CI -0.39, -0.17; P<0.00001) was inversely correlated with HL. In conclusion, 67% of diabetes patients had adequate HL, with a higher rate among better educated and higher income groups. HL had a statistically significant but weak positive correlation with diabetes self-management variables.
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Affiliation(s)
- Xiu-Mei Guo
- Department of Outpatient, Lanzhou University Second Hospital, Lanzhou, No. 82, Cuiyingmen, Chengguan District, Gansu 730030, China
| | - Xia Zhai
- Department of Outpatient, Lanzhou University Second Hospital, Lanzhou, No. 82, Cuiyingmen, Chengguan District, Gansu 730030, China
| | - Bo-Ru Hou
- Department of Neurosurgery, Lanzhou University Second Hospital, No. 82, Cuiyingmen, Chengguan District, Lanzhou, Gansu 730030, China; and Corresponding author.
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21
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McKenna VB, Sixsmith J, Barry M. Facilitators and Barriers to the Development of Health Literacy Capacities Over Time for Self-Management. Health Lit Res Pract 2020; 4:e104-e118. [PMID: 32392349 PMCID: PMC7213021 DOI: 10.3928/24748307-20200221-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/17/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Health literacy is a dynamic construct that is content and context specific. An understanding of the facilitators and barriers involved in the development of health literacy over time can provide important insights for the health care providers (HCP) in supporting patients with chronic illness. OBJECTIVE The study was conducted to expand an understanding of how health literacy development can be supported through exploration of the main facilitators and barriers in the process. METHODS This study used a longitudinal qualitative study design involving repeat interviews at three separate time points over a 12-month period. A purposive sample of 26 participants attending a structured cardiovascular disease risk-reduction program participated in the study, 17 of whom completed all three interviews. The European Health Literacy Survey measure was used to determine health literacy levels at the beginning and end of the 12-month period. Employing qualitative thematic analysis and a longitudinal-specific question framework, a trajectory approach was applied to explore individual cases longitudinally. KEY RESULTS Facilitators and barriers to health literacy capacity development were identified. Participants demonstrated increased perceptions of having control and being empowered over time. However, this was also found to be affected by external life events. Study participants were also found to be embedding health knowledge, motivation, and behaviors over time within the everyday contexts of their lives. The relationship with the HCP permeated all aspects of health literacy capacity development, including aspects of treatment decision-making. Participants identified the need for psychological supports and the increased importance of looking after their mental health. CONCLUSIONS Positive developments in health literacy capacities are important for the self-management of illness. Longitudinal findings underscore the importance of the HCP in supporting the development of health literacy capacities over time. These findings lend support to the need to integrate health literacy into medical and other HCP curricula to raise awareness of the concept of health literacy. [HLRP: Health Literacy Research and Practice. 2020;4(2):e104-e118.] PLAIN LANGUAGE SUMMARY: Using a longitudinal qualitative study design, this study proposes that health literacy capacities develop over time and that the health care provider (HCP) plays a central role in this process. Findings from this study support the need to embed health literacy training into medical and other applied HCP curricula to raise awareness of the concept of health literacy.
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Affiliation(s)
- Verna B. McKenna
- Address correspondence to Verna B. McKenna, BA, MA, Health Promotion Research Centre, Discipline of Health Promotion, National University of Ireland, Galway, University Road, Galway, Ireland H91 TK33;
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RobatSarpooshi D, Mahdizadeh M, Alizadeh Siuki H, Haddadi M, Robatsarpooshi H, Peyman N. The Relationship Between Health Literacy Level and Self-Care Behaviors in Patients with Diabetes. PATIENT-RELATED OUTCOME MEASURES 2020; 11:129-135. [PMID: 32440244 PMCID: PMC7211311 DOI: 10.2147/prom.s243678] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 03/26/2020] [Indexed: 11/23/2022]
Abstract
Background The most important factor in controlling diabetes is self-care behaviors; improving self-care behaviors is the first step in helping patients to better control and manage their diseases and health literacy is recognized as a vital and important indicator of outcomes and costs in healthcare. Therefore, the effectiveness of health-care systems requires that people have the desirable health literacy level. Therefore, this research intended to study the relationship between health literacy levels in patients with diabetes and their self-care behaviors. Patients and Methods This analytical cross-sectional study was conducted during two months on 400 patients with diabetes selected using the census method in diabetes clinics in Mashhad County. Information was collected through a demographic survey questionnaire, the Health Literacy Questionnaire and a self-care behavior questionnaire. Data analysis was performed using SPSS 21 and Spearman correlation coefficient, the independent t-test, and ANOVA. Results The total mean score for self-care was 33.52 (SD±13.27). There was a significant relationship between self-care and health literacy in this study (P <0.05) so that people with higher levels of self-care literacy had better self-care behaviors. There was also a significant relationship between education level and monthly income and self-care behaviors and health literacy (P <0.001). Conclusion Patients received an average score for self-care behaviors. Given the impact of health literacy on patients' self-care behaviors, and considering its inclusion in educational, therapeutic, and caregiver programs, it is possible to reduce complications in patients, and improve their quality of life, by improving their self-care behaviors. Special attention should also be paid to health literacy levels of the audience when designing the related educational programs.
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Affiliation(s)
- Davood RobatSarpooshi
- Department of Health Education and Health Promotion, Student Research Committee, Social Determinants of Health Research Center, Faculty of Health, Mashhad University of Medical Sciences, Masshad, Iran
| | - Mehrsadat Mahdizadeh
- Department of Health Education and Health Promotion, Social Determinants of Health Research Center, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hadi Alizadeh Siuki
- Department of Public Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Mohammad Haddadi
- Department of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | | | - Nooshin Peyman
- Department of Health Education and Health Promotion, Social Determinants of Health Research Center, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
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Griva K, Yoong RKL, Nandakumar M, Rajeswari M, Khoo EYH, Lee VYW, Kang AWC, Osborne RH, Brini S, Newman SP. Associations between health literacy and health care utilization and mortality in patients with coexisting diabetes and end‐stage renal disease: A prospective cohort study. Br J Health Psychol 2020; 25:405-427. [DOI: 10.1111/bjhp.12413] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/09/2020] [Indexed: 01/20/2023]
Affiliation(s)
- Konstadina Griva
- Centre for Population Health Sciences Lee Kong Chian School of Medicine Imperial College and Nanyang Technological University Singapore City Singapore
| | | | | | | | - Eric Y. H. Khoo
- Department of Medicine Yong Loo Lin School of Medicine National University Singapore Singapore
- Division of Endocrinology University Medicine Cluster National University Health System Singapore City Singapore
| | | | | | - Richard H. Osborne
- Centre for Global Health and Equity Faculty of Health, Arts and Design Swinburne University of Technology Melbourne Australia
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The influence of expert patients on the increase of medication adherence among tuberculosis patients. ENFERMERIA CLINICA 2020. [DOI: 10.1016/j.enfcli.2019.07.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Finbråten HS, Guttersrud Ø, Nordström G, Pettersen KS, Trollvik A, Wilde-Larsson B. Explaining variance in health literacy among people with type 2 diabetes: the association between health literacy and health behaviour and empowerment. BMC Public Health 2020; 20:161. [PMID: 32013897 PMCID: PMC6998369 DOI: 10.1186/s12889-020-8274-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/24/2020] [Indexed: 11/17/2022] Open
Abstract
Background To reflect the health literacy (HL) skills needed for managing type 2 diabetes (T2DM) in everyday life, HL in people with T2DM should be measured from a broader perspective than basic skills, such as proficiency in reading and writing. The HLS-Q12, based on the European Health Literacy Survey Questionnaire (HLS-EU-Q47), assesses four cognitive domains across three health domains. International studies on people with T2DM show inconsistent results regarding the association between HL and general health and the association between HL and glycaemic control. Moreover, knowledge is needed related to the link between HL and empowerment for those with T2DM. The aims of this study were to examine the association between i) HL and general health and diabetes outcomes, ii) HL and health behaviours and iii) HL and empowerment in people with T2DM. Methods During March and April 2015, 388 adults with T2DM responded to a paper-and-pencil self-administered questionnaire. A sequential multiple regression analysis was applied to explore the association between HL, as measured by the HLS-Q12, and health conditions, HbA1c, health behaviours and empowerment. Results For people with T2DM, higher levels of HL were associated with higher levels of education, better overall health conditions and higher self-perceived empowerment. No empirical evidence strengthening either the link between HL and glycaemic control or the link between HL and health behaviours was found. Conclusions The independent variables education level, overall health condition and empowerment explained about one-third of the total observed variance in HL.
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Affiliation(s)
- Hanne Søberg Finbråten
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, PO Box 400, N-2418, Elverum, Norway. .,Department of Health Sciences, Faculty of Health, Science and Technology, Nursing science, Karlstad University, SE-65188, Karlstad, Sweden.
| | - Øystein Guttersrud
- Norwegian Centre for Science Education, Faculty of Mathematics and Natural Sciences, University of Oslo, PO Box 1106, Blindern, N-0317, Oslo, Norway
| | - Gun Nordström
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, PO Box 400, N-2418, Elverum, Norway
| | - Kjell Sverre Pettersen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, PO Box 4, St Olavs plass, N-0130, Oslo, Norway
| | - Anne Trollvik
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, PO Box 400, N-2418, Elverum, Norway
| | - Bodil Wilde-Larsson
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, PO Box 400, N-2418, Elverum, Norway.,Department of Health Sciences, Faculty of Health, Science and Technology, Nursing science, Karlstad University, SE-65188, Karlstad, Sweden
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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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The association of diabetes literacy with self-management among older people with type 2 diabetes mellitus: a cross-sectional study. BMC Nurs 2019; 18:34. [PMID: 31427896 PMCID: PMC6696697 DOI: 10.1186/s12912-019-0354-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Diabetes has become one of public health problem up until now. As the disease progressed, it might lead to increasing complication as well as death related to them. Diabetes as chronic disease in older people can lead to more vulnerable conditions if they fail to carry out a proper diabetes self-management. Diabetes literacy is an internal factor affecting how the older people go about their diabetes management routines. This study aimed to describe diabetes literacy of the older people and identify the relation of diabetes literacy to diabetes self-management of the older people with T2DM in selected areas of Depok City, West Java, Indonesia. Method A cross-sectional observational study was utilized and used 106 samples of older people individuals with T2DM, all of whom were chosen via cluster sampling. This research took place in five selected areas under the supervision of three public health center in Depok City. The data were analyzed using a bivariate t-independent test, the Pearson product-moment correlation, and logistic regression for multivariate analysis to determine the relationship of independent and dependent variable. Result This research shows a significant correlation between diabetes literacy and diabetes self-management (p = 0,011). Conclusion Diabetes self management is associated with diabetes literacy in older people with type 2 diabetes mellitus. Diabetes literacy should be considered when assessing and addressing diabetes-specific health education needs.
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Wang RH, Hsu HC, Chen SY, Hsieh CH, Lee YJ. Modeling patient empowerment and health literacy to glycemic control in insulin-treated patients: A prospective study. PATIENT EDUCATION AND COUNSELING 2019; 102:1336-1341. [PMID: 30773291 DOI: 10.1016/j.pec.2019.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 01/28/2019] [Accepted: 02/05/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To model the pathways of patient empowerment (PE) and health literacy (HL) to glycemic control specific to insulin-treated patients by prospective design. METHODS Insulin-treated patients with type 2 diabetes (T2DM) (N = 185) were recruited by convenience sampling. Data of personal characteristics, PE, and HL were collected by questionnaires at baseline and 9 months later. The 9-month glycosylated hemoglobin (HbA1c) levels of each participant were collected from medical records. Structural equation modeling was used to test a hypothesized model. RESULTS Baseline and 9-month communicative HL and critical HL significantly and negatively correlated with 9-month HbA1c levels. Structural equation modeling supported that baseline and 9-month PE significantly affected HL at corresponding time points. Baseline PE indirectly affected 9-month HL through 9-month PE. The 9-month HL directly affected 9-month HbA1c. Baseline HL indirectly affected 9-month HbA1c through 9-month HL. CONCLUSION Communicative HL and critical HL rather than functional HL were crucial in improving glycemic control. PE is essential to improve HL in insulin-treated patients. PRACTICE IMPLICATIONS Healthcare providers could apply the empowerment approach to educate insulin-treated patients. Through reciprocal dynamic process of PE, insulin-treated patients with T2DM might improve their communicative and critical HL; and finally, glycemic control could be improved.
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Affiliation(s)
- Ruey-Hsia Wang
- College of Nursing, Kaohsiung Medical University, Department of Medical Research, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1st Road, Kaohsiung City, 807, Taiwan, ROC.
| | - Hui-Chun Hsu
- Lee's Endocrinology Clinic, No. 396, Guangdong Road, Pingtung City, 900, Taiwan, ROC.
| | - Shi-Yu Chen
- Tri-Service General Hospital, No. 325, Sec. 2, Chenggong Road, Taipei City, 114, Taiwan, ROC.
| | - Chang-Hsun Hsieh
- Tri-Service General Hospital, No. 325, Sec. 2, Chenggong Road, Taipei City, 114, Taiwan, ROC.
| | - Yau-Jiunn Lee
- Lee's Endocrinology Clinic, No. 396, Guangdong Road, Pingtung City, 900, Taiwan, ROC.
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Yarmohammadi S, Momenyan S, Ghaffari M, Ali R, Azizpour M. Impact of functional, communicative and critical health literacy on glycemic control among patients with type 2 diabetes, and the mediating role of self-care. Psychol Res Behav Manag 2019; 12:427-435. [PMID: 31417324 PMCID: PMC6592064 DOI: 10.2147/prbm.s207466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/07/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Health literacy (HL) could influence self-care behaviors and further affect HbA1c values. Understanding the mechanism relationships between HL, self-care behaviors and HbA1c could provide the valuable knowledge for developing evidence-based interventions in diabetic patients. In this study, we hypothesized that HL and its subscales would be related to self-care behaviors and that HL would be indirectly related to glycemic control (HbA1c) via relations with self-care behaviors among diabetes patients. Methods: This cross-sectional study was performed on 300 patients with type 2 diabetes referred to five educational hospitals affiliated to Shahid Beheshti University of Medical Sciences in 2018. The Persian version of Functional, Communicative, and Critical Health Literacy (FCCHL) questionnaire and the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire were used. Also, recent HbA1c values were extracted from patients’ medical records. Structural equation modeling (SEM) was also used to investigate the relationships between the variables. Results: The SEM results showed the direct standardized path of the total HL score, functional HL, communicative HL and critical HL on HbA1c were nonsignificant in the model with mediator. While the indirect effect of the total HL score (β = −0.24, P=0.042), functional HL (β = −0.15, P=0.01), communicative HL (β = −0.16, P=0.01) and critical HL (β = −0.22, P=0.03) on HbA1c through the mediation of self-care behaviors were significant. Conclusion: The results of this study indicated that HL and particularly critical HL are significant factors in reducing HbA1c in patients with type 2 diabetes through the mediation of self-care behaviors.
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Affiliation(s)
- Soudabeh Yarmohammadi
- Research Center for Environmental Determinants of Health (RCEDH), Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Somayeh Momenyan
- Department of Biostatistics, Faculty of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohtasham Ghaffari
- Health Education & Health Promotion, Environmental and Occupational Hazards Control Research Center, School of Public Health & Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramezankhani Ali
- Department of Public Health, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohyeddin Azizpour
- School of Public Health & Safety, Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Marciano L, Camerini AL, Schulz PJ. The Role of Health Literacy in Diabetes Knowledge, Self-Care, and Glycemic Control: a Meta-analysis. J Gen Intern Med 2019; 34:1007-1017. [PMID: 30877457 PMCID: PMC6544696 DOI: 10.1007/s11606-019-04832-y] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/25/2018] [Accepted: 01/08/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Empirical evidence on how health literacy affects diabetes outcomes is inconsistent. The purpose of this meta-analysis was to quantitatively summarize the findings on the associations between health literacy and diabetes knowledge, self-care activities, and glycemic control as disease-related outcomes, with specific focus on the type of health literacy assessment. DATA SOURCES Nine databases (MEDLINE, CINAHL, Communication and Mass Media Complete, PsychInfo, PsychArticles, Psychology and Behavioral Sciences Collection, ERIC, Sociology, Embase) were searched for peer-reviewed original research articles published until 31 March 2018. METHODS Studies with type 1 and/or type 2 diabetes patients aged 18 or older, providing a calculable baseline effect size for functional health literacy and diabetes knowledge, self-care activities, or HbA1C were included. RESULTS The meta-analysis includes 61 studies with a total of 18,905 patients. The majority were conducted in the USA, on type 2 diabetes patients, and used the S-TOFHLA as a performance-based or the BHLS as a perception-based measure of functional health literacy. Meta-analytic results show that all three outcomes are related to health literacy. Diabetes knowledge was best predicted by performance-based health literacy measures, self-care by self-report measures, and glycemic control equally by both types of health literacy assessment. DISCUSSION Health literacy plays a substantial role in diabetes knowledge. Findings for the role of health literacy in self-care and glycemic control remain heterogeneous, partly due to the type of health literacy assessment (performance- vs. perception-based). This has implications for the use of health literacy measures in clinical settings and original research. This meta-analysis was limited to functional health literacy and, due to the paucity of studies, did not investigate the role of other dimensions including communicative and critical health literacy.
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Affiliation(s)
- Laura Marciano
- Faculty of Communication Sciences, Institute of Communication and Health, Università della Svizzera italiana, Via Giuseppe Buffi 13, 6904, Lugano, Switzerland.
| | - Anne-Linda Camerini
- Faculty of Communication Sciences, Institute of Communication and Health, Università della Svizzera italiana, Via Giuseppe Buffi 13, 6904, Lugano, Switzerland
| | - Peter J Schulz
- Faculty of Communication Sciences, Institute of Communication and Health, Università della Svizzera italiana, Via Giuseppe Buffi 13, 6904, Lugano, Switzerland
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Ko D, Myung E, Moon TJ, Shah DV. Physical activity in persons with diabetes: its relationship with media use for health information, socioeconomic status and age. HEALTH EDUCATION RESEARCH 2019; 34:257-267. [PMID: 30759200 DOI: 10.1093/her/cyz003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/23/2019] [Indexed: 06/09/2023]
Abstract
Although low socio-economic status (SES) persons with diabetes show low levels of physical activity (PA), there is limited knowledge regarding which media is effective in improving their PA. This study aimed to determine the appropriate media for providing PA-related information to persons with diabetes in low SES compared with those in high SES. The data of 770 persons with diabetes in low or high SES were extracted from Multimedia Audience Research Systems 2013, a nationwide cross-sectional study. The relationships among media use for health information (i.e. magazine, television and Internet use), PA, and high and low SES were examined using regression analysis. Additional analysis was conducted to examine whether the above relationships differ by age, which influences the use of media. The relationships of media use for health information with PA levels varied by SES; while television use was associated with increased PA levels, Internet use was associated with decreased PA levels in older, low SES persons with diabetes. The findings indicated that television can be a useful resource to provide PA-related information to low SES persons with diabetes and suggest the significance of choosing appropriate media to provide PA-related information for them.
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Affiliation(s)
- Dami Ko
- School of Nursing, University of Wisconsin-Madison, 701 Highland Avenue, Madison, WI, USA
| | - Eunyoung Myung
- School of Journalism and Mass Communication, University of Wisconsin-Madison, 821 University Avenue, Madison, WI, USA
| | - Tae-Joon Moon
- School of Journalism and Mass Communication, University of Wisconsin-Madison, 821 University Avenue, Madison, WI, USA
| | - Dhavan V Shah
- School of Journalism and Mass Communication, University of Wisconsin-Madison, 821 University Avenue, Madison, WI, USA
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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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Lael-Monfared E, Tehrani H, Moghaddam ZE, Ferns GA, Tatari M, Jafari A. Health literacy, knowledge and self-care behaviors to take care of diabetic foot in low-income individuals: Application of extended parallel process model. Diabetes Metab Syndr 2019; 13:1535-1541. [PMID: 31336518 DOI: 10.1016/j.dsx.2019.03.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 03/05/2019] [Indexed: 02/03/2023]
Abstract
AIM This study has been conducted with the aim of determining the relationship between health literacy, knowledge and self-care behaviors to take care of the diabetic foot in low-income individuals, based on the extended parallel process model (EPPM). METHODS This cross-sectional study was conducted on 400 patients with type II diabetes referred to the Diabetes Clinic, using a random sampling method and using standard questionnaires. In this study, the constructs of knowledge, EPPM (perceived sensitivity, perceived severity, response efficacy, self-efficacy), and health literacy were significantly related to self-care behaviors (p < 0.05). RESULTS Based on the linear regression results, the constructs of knowledge, health literacy, and constructs of EPPM were able to account for 43% of the variance to perform diabetic foot self-care behaviors. The maximum impact was related to the constructs of health literacy and self-efficacy (p < 0.001). CONCLUSION Based on these results, levels of knowledge and health literacy of patients were very poor overall, and the self-care behaviors were not appropriate. On the other hand, considering the great impact of health literacy in performing self-care behaviors, it is suggested that educational courses be held in this regard and proper strategies are employed to enhance the health literacy of diabetic patients.
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Affiliation(s)
- Elaheh Lael-Monfared
- Ph.D Student in Health Education and Health Promotion, Student Research Committee, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hadi Tehrani
- Health Education & Health Promotion, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Zahra Esmati Moghaddam
- Student Research Committee, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
| | - Gordon A Ferns
- Department of Medical Education Brighton and Sussex Medical School, Division of Medical Education, University of Brighton Falmer Campus, Brighton BN1 9PH, UK.
| | - Maryam Tatari
- School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
| | - Alireza Jafari
- Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran; Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Mahjubian A, Bahraminejad N, Kamali K. The Effects of Group Discussion Based Education on the Promotion of Self-Management Behaviors in Hemodialysis Patients. J Caring Sci 2019; 7:225-232. [PMID: 30607364 PMCID: PMC6311626 DOI: 10.15171/jcs.2018.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 04/21/2018] [Indexed: 12/12/2022] Open
Abstract
Introduction: Improving self-management of the patients
undergoing hemodialysis is an effective way to reduce complications and to improve the
quality of life of them. The current study aims to assess the effects of group discussion
on the promotion of self-management behaviors in hemodialysis patients. Methods: In this quasi -experimental clinical trial study
(with experimental and control groups) 60 patients were arranged in two experimental and
control groups through using convenience sampling with random allocation. Self-management
interventions were conducted on the experimental group during 3 to 4 sessions of group
discussion. The control group received routine interventions. The data were collected
through Li and colleagues' self-management standard questionnaire before and 3 months
after the intervention. The data were analyzed via SPSS software version 13 and
chi-square, t-test, Mann-Whitney, and Wilcoxon test. Results: The results showed that the mean scores of four
dimension of self-management including participation with the medical team, problem
solving, self-care and emotional management after the implementation of group were
significantly different between the experimental and control groups. Conclusion: Based on the findings, group discussion was an
effective educational method to promote self-management of chronic hemodialysis patients.
Therefore, holding group discussion to reinforce the self- management behaviors in
patients undergoing hemodialysis is recommended.
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Affiliation(s)
- Azam Mahjubian
- Department of Midwifery, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Koorosh Kamali
- Department of Histology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Griva K, Rajeswari M, Nandakumar M, Khoo EYH, Lee VYW, Chua CG, Goh ZS, Choong YTD, Newman SP. The combined diabetes and renal control trial (C-DIRECT) - a feasibility randomised controlled trial to evaluate outcomes in multi-morbid patients with diabetes and on dialysis using a mixed methods approach. BMC Nephrol 2019; 20:2. [PMID: 30606135 PMCID: PMC6318946 DOI: 10.1186/s12882-018-1183-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 12/11/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND This cluster randomised controlled trial set out to investigate the feasibility and acceptability of the "Combined Diabetes and Renal Control Trial" (C-DIRECT) intervention, a nurse-led intervention based on motivational interviewing and self-management in patients with coexisting end stage renal diseases and diabetes mellitus (DM ESRD). Its efficacy to improve glycaemic control, as well as psychosocial and self-care outcomes were also evaluated as secondary outcomes. METHODS An assessor-blinded, clustered randomised-controlled trial was conducted with 44 haemodialysis patients with DM ESRD and ≥ 8% glycated haemoglobin (HbA1c), in dialysis centres across Singapore. Patients were randomised according to dialysis shifts. 20 patients were assigned to intervention and 24 were in usual care. The C-DIRECT intervention consisted of three weekly chair-side sessions delivered by diabetes specialist nurses. Data on recruitment, randomisation, and retention, and secondary outcomes such as clinical endpoints, emotional distress, adherence, and self-management skills measures were obtained at baseline and at 12 weeks follow-up. A qualitative evaluation using interviews was conducted at the end of the trial. RESULTS Of the 44 recruited at baseline, 42 patients were evaluated at follow-up. One patient died, and one discontinued the study due to deteriorating health. Recruitment, retention, and acceptability rates of C-DIRECT were generally satisfactory HbA1c levels decreased in both groups, but C-DIRECT had more participants with HbA1c < 8% at follow up compared to usual care. Significant improvements in role limitations due to physical health were noted for C-DIRECT whereas levels remained stable in usual care. No statistically significant differences between groups were observed for other clinical markers and other patient-reported outcomes. There were no adverse effects. CONCLUSIONS The trial demonstrated satisfactory feasibility. A brief intervention delivered on bedside as part of routine dialysis care showed some benefits in glycaemic control and on QOL domain compared with usual care, although no effect was observed in other secondary outcomes. Further research is needed to design and assess interventions to promote diabetes self-management in socially vulnerable patients. TRIAL REGISTRATION NUMBER Trial registered with the International Standard Randomised Controlled Trial (ISRCTN10546597). Registered 12 September 2016 (Retrospectively registered).
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Affiliation(s)
- K. Griva
- Centre for Population Health Sciences, Clinical Sciences Building, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232 Singapore
- Department of Psychology, National University of Singapore, 9 Arts Link AS4, Singapore, 117570 Singapore
| | - M. Rajeswari
- National Kidney Foundation, 81 Kim Keat Road, Singapore, 328836 Singapore
| | - M. Nandakumar
- National Kidney Foundation, 81 Kim Keat Road, Singapore, 328836 Singapore
| | - E. Y. H. Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Division of Endocrinology, University Medicine Cluster, National University Health System, Singapore, Singapore
| | - V. Y. W. Lee
- Department of Psychology, National University of Singapore, 9 Arts Link AS4, Singapore, 117570 Singapore
| | - C. G. Chua
- National Kidney Foundation, 81 Kim Keat Road, Singapore, 328836 Singapore
| | - Z. S. Goh
- Centre for Population Health Sciences, Clinical Sciences Building, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232 Singapore
| | - Y. T. D. Choong
- Department of Psychology, National University of Singapore, 9 Arts Link AS4, Singapore, 117570 Singapore
| | - S. P. Newman
- School of Health Sciences, City University of London, Northampton Square, London, UK
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Lima MDFG, Vasconcelos EMRD, Borba AKDOT. Instruments used to evaluate functional health literacy in elderly persons with chronic kidney disease: Integrative review. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2019. [DOI: 10.1590/1981-22562019022.180198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: To identify the instruments used to evaluate the functional health literacy of elderly persons with chronic kidney disease, and to assess whether they are suitable for this population. Method: An integrative review of the Lilacs, PubMed, Ibecs, Scopus and Cochrane databases was carried out in July and August 2018, seeking original articles dealing with functional health literacy and chronic kidney disease in the elderly. Results: A total of 15 articles were evaluated and seven different instruments used in the research were identified, with the Rapid Estimate of Adult Literacy in Medicine (REALM) and Test of Functional Health Literacy in Adults (TOFHLA) the most prevalent. Conclusion: The instruments identified are applicable for the elderly, but are not specific for this population. The construction and/or adaptation of new instruments is suggested considering the specific characteristics of this age group.
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Neter E, Brainin E. Association Between Health Literacy, eHealth Literacy, and Health Outcomes Among Patients With Long-Term Conditions. EUROPEAN PSYCHOLOGIST 2019. [DOI: 10.1027/1016-9040/a000350] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abstract. The objective of this paper is to synthesize and update findings from systematic review on health literacy and health outcomes among patients with long-term conditions, and extend the review to the digital domain. Health outcomes include clinical outcomes, processes of care, and health service use. Data sources are the following: (1) studies which appeared in two previous systematic reviews in 2004 and 2011 whose participants were people with long-term conditions or elderly ( n = 54); (2) articles on health literacy and health outcomes identified in an updated 2011–2016 search ( n = 26); (3) articles on eHealth literacy and its association with health outcomes ( n = 8). Strength of evidence was determined by a qualitative assessment of risk of bias, consistency, and directness. There was a lack of consistent evidence on the relationship between health literacy and clinical outcomes despite the consistent evidence on the association with mortality. There was low to insufficient evidence on the association between health literacy and self-rated health/function and emotional states of anxiety and depression, alongside high evidence on lack of association with quality of life. There was insufficient to low evidence on the association between health literacy and behavioral outcomes (medication adherence, other health behaviors) and finally also low to moderate evidence on the association between health literacy and use of health services such as hospitalization and emergency department. In the eHealth literacy domain, there were few studies reporting association with health behaviors and self-rated health with inconsistent results. In conclusion, it is advocated to examine performed heath literacy and eHealth literacy in large longitudinal studies.
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Affiliation(s)
- Efrat Neter
- Department of Behavioral Sciences, Ruppin Academic Center, Emeq Hefer, Israel
| | - Esther Brainin
- Department of Behavioral Sciences, Ruppin Academic Center, Emeq Hefer, Israel
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Matsuda N, Murata S, Ono R. [Association between life space and health literacy in community-dwelling older adults]. Nihon Ronen Igakkai Zasshi 2018; 55:650-656. [PMID: 30542031 DOI: 10.3143/geriatrics.55.650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To examine the association between health literacy (HL) and life space in community-dwelling older adults. METHODS In this cross-sectional study, we analyzed 210 community-dwelling older adults (mean age: 74.6 years, women: 63.8%). Health literacy was measured using the 14-item Health Literacy Scale (HLS-14). The 14 items consist of 5 items for functional HL (FHL), 5 items for interactive HL (CHL), and 4 items for critical HL (IHL). We calculated the total score, FHL score, CHL score, and IHL score. Life space was measured using the life-space assessment (LSA). A linear regression model was used to analyze the association between the HLS-14 score and LSA score. We adjusted for variables associated with the LSA score. RESULTS The FHL score was significantly associated with the LSA score (crude model: β = 1.40, p < 0.01, adjusted model: β = 1.11, p = 0.01). However, the total score, IHL, and CHL were not significantly associated with the LSA score. CONCLUSIONS A higher FHL is significantly associated with a greater larger life space in community-dwelling older adults. This finding may help elderly people maintain a greater life space which will help them to improve their HL while also making it possible for them to obtain easy-to-understand information.
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Affiliation(s)
- Naoka Matsuda
- Department of Community Health Sciences, Kobe University, Graduate School of Health Sciences
| | - Shunsuke Murata
- Department of Community Health Sciences, Kobe University, Graduate School of Health Sciences.,Research Fellowship for Young Scientists, Japan Society for the Promotion of Science
| | - Rei Ono
- Department of Community Health Sciences, Kobe University, Graduate School of Health Sciences
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Abbasi YF, See OG, Ping NY, Balasubramanian GP, Hoon YC, Paruchuri S. Diabetes knowledge, attitude, and practice among type 2 diabetes mellitus patients in Kuala Muda District, Malaysia - A cross-sectional study. Diabetes Metab Syndr 2018; 12:1057-1063. [PMID: 30017505 DOI: 10.1016/j.dsx.2018.06.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 06/29/2018] [Indexed: 11/26/2022]
Abstract
Diabetes is among leading public health concerns in Malaysia due to premature and preventable mortality involving macro and microvascular complications. Diabetes knowledge, attitude, and practice (KAP) are vital in diabetes management. The present study assessed the level of diabetes KAP among type 2 diabetes patients with associated and correlated factors through a self-administered questionnaire-based study on a convenience sample of 386 type 2 diabetes mellitus patients in Kuala Muda District, Kedah, Malaysia. Majority of the respondents possessed levels above the cut-off points for poor levels in knowledge (63.21%), attitude (62.69%), and practices (58.03%). Age, academic qualification, occupation, monthly income, current therapy type, comorbid diseases, and therapy preference were associated with KAP whereas the associations of disease duration, the best source of information about diabetes, and health status satisfaction were witnessed for attitude and practice. Academic qualification had strongest correlation for knowledge (r = 0.785), attitude (r = 0.725), and practice (r = 0.709). Knowledge level was significantly correlated with attitude level (r = 0.735), practice level (r = 0.786), income (r = 0.556), occupation (r = 0.358), age (r = 0.173), current therapy type (r = 0.133), and diabetes education exposure (r = 0.113). Attitude level had significant correlations with practice level (r = 0.679), income (r = 0.357), occupation (r = 0.348), health status satisfaction (r = 0.147), age (r = 0.145), and gender (r = 0.109). Practice level correlated significantly with income (r = 0.448), occupation (r = 0.317), age (r = 0.173), health status satisfaction (r = 0.167), and current therapy type (r = 0.118). All associations and correlations were significant at P < 0.005. Although overall having good levels of diabetes KAP, educational interventions are required to further improve diabetes KAP.
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Affiliation(s)
- Yasir Faraz Abbasi
- Master of Clinical Pharmacy candidate, Faculty of Pharmacy, AIMST University, Kedah, Malaysia
| | - Ooi Guat See
- Clinical Pharmacy Unit, Faculty of Pharmacy, AIMST University, Kedah, Malaysia
| | - Ng Yen Ping
- Clinical Pharmacy Unit, Faculty of Pharmacy, AIMST University, Kedah, Malaysia
| | | | | | - Sireesha Paruchuri
- Clinical Pharmacy Unit, Faculty of Pharmacy, AIMST University, Kedah, Malaysia
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Chen PY, Elmer S, Callisaya M, Wills K, Greenaway TM, Winzenberg TM. Associations of health literacy with diabetic foot outcomes: a systematic review and meta-analysis. Diabet Med 2018; 35:1470-1479. [PMID: 29802639 DOI: 10.1111/dme.13694] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND People with diabetes have low health literacy, but the role of the latter in diabetic foot disease is unclear. AIM To determine, through a systematic review and meta-analysis, if health literacy is associated with diabetic foot disease, its risk factors, or foot care. METHODS We searched PubMed, EMBASE, CINAHL, Web of Science, Scopus and Science Direct. All studies were screened and data extracted by two independent reviewers. Studies in English with valid and reliable measures of health literacy and published tests of association were included. Data were extracted on the associations between the outcomes and health literacy. Meta-analyses were performed using random effects models. RESULTS Sixteen articles were included in the systematic review, with 11 in the meta-analysis. In people with inadequate health literacy, the odds of having diabetic foot disease were twice those in people with adequate health literacy, but this was not statistically significant [odds ratio 1.99 (95% CI 0.83, 4.78); two studies in 1278 participants]. There was no statistically significant difference in health literacy levels between people with and without peripheral neuropathy [standardized mean difference -0.14 (95% CI -0.47, 0.18); two studies in 399 participants]. There was no association between health literacy and foot care [correlation coefficient 0.01 (95% CI -0.07, 0.10); seven studies in 1033 participants]. CONCLUSIONS There were insufficient data to exclude associations between health literacy and diabetic foot disease and its risk factors, but health literacy appears unlikely to have a role in foot care. The contribution of low health literacy to diabetic foot disease requires definitive assessment through robust longitudinal studies.
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Affiliation(s)
- P Y Chen
- Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - S Elmer
- Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - M Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - K Wills
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - T M Greenaway
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - T M Winzenberg
- Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
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Diamantidis CJ, Bosworth HB, Oakes MM, Davenport CA, Pendergast JF, Patel S, Moaddeb J, Barnhart HX, Merrill PD, Baloch K, Crowley MJ, Patel UD. Simultaneous Risk Factor Control Using Telehealth to slOw Progression of Diabetic Kidney Disease (STOP-DKD) study: Protocol and baseline characteristics of a randomized controlled trial. Contemp Clin Trials 2018; 69:28-39. [PMID: 29649631 PMCID: PMC5986182 DOI: 10.1016/j.cct.2018.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 04/02/2018] [Accepted: 04/08/2018] [Indexed: 01/03/2023]
Abstract
Diabetic kidney disease (DKD) is the leading cause of end-stage kidney disease (ESKD) in the United States. Multiple risk factors contribute to DKD development, yet few interventions target more than a single DKD risk factor at a time. This manuscript describes the study protocol, recruitment, and baseline participant characteristics for the Simultaneous Risk Factor Control Using Telehealth to slOw Progression of Diabetic Kidney Disease (STOP-DKD) study. The STOP-DKD study is a randomized controlled trial designed to evaluate the effectiveness of a multifactorial behavioral and medication management intervention to mitigate kidney function decline at 3 years compared to usual care. The intervention consists of up to 36 monthly educational modules delivered via telephone by a study pharmacist, home blood pressure monitoring, and medication management recommendations delivered electronically to primary care physicians. Patients seen at seven primary care clinics in North Carolina, with diabetes and [1] uncontrolled hypertension and [2] evidence of kidney dysfunction (albuminuria or reduced estimated glomerular filtration rate [eGFR]) were eligible to participate. Study recruitment completed in December 2014. Of the 281 participants randomized, mean age at baseline was 61.9; 52% were male, 56% were Black, and most were high school graduates (89%). Baseline co-morbidity was high- mean blood pressure was 134/76 mmHg, mean body mass index was 35.7 kg/m2, mean eGFR was 80.7 ml/min/1.73 m2, and mean glycated hemoglobin was 8.0%. Experiences of recruiting and implementing a comprehensive DKD program to individuals at high risk seen in the primary care setting are provided. TRIAL REGISTRATION NCT01829256.
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Affiliation(s)
- Clarissa J Diamantidis
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, United States; Division of Nephrology, Duke University School of Medicine, Durham, NC, United States.
| | - Hayden B Bosworth
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, United States; Center for Health Services Research in Primary Medicine, Durham VAMC, United States; Department of Population Health Science, Duke University School of Medicine, Durham, NC, United States
| | - Megan M Oakes
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, United States; Department of Population Health Science, Duke University School of Medicine, Durham, NC, United States
| | - Clemontina A Davenport
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, United States
| | - Jane F Pendergast
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, United States; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, United States
| | - Sejal Patel
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Jivan Moaddeb
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, United States; Duke Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Huiman X Barnhart
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, United States; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
| | - Peter D Merrill
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
| | - Khaula Baloch
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
| | - Matthew J Crowley
- Division of Endocrinology, Duke University School of Medicine, Durham, NC, United States
| | - Uptal D Patel
- Division of Nephrology, Duke University School of Medicine, Durham, NC, United States; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States; Gilead Sciences, Inc, Foster City, CA, United States
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Walker RL, Hong JH, Talavera DC, Verduzco M, Woods SP. Health literacy and current CD4 cell count in a multiethnic U.S. sample of adults living with HIV infection. Int J STD AIDS 2018; 29:498-504. [PMID: 29065780 PMCID: PMC5708154 DOI: 10.1177/0956462417738679] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hispanic and Black adults are disproportionately affected by HIV and experience poorer HIV-related health outcomes relative to non-Hispanic White adults. The current study adopted Sørensen's integrated model to test the hypothesis that lower functional and critical health literacy competencies contribute to poorer HIV-related health and CD4 cell count for Hispanic and Black individuals. Eighty-one non-Hispanic White, Hispanic, and Black HIV seropositive individuals from a large, Southwestern metropolitan area were administered measures of health literacy, including the Expanded Numeracy Scale, Newest Vital Sign, Rapid Estimate of Adult Literacy in Medicine, Test of Functional Health Literacy (TOHFLA)-numeracy, and TOHFLA-reading. Hispanic and Black individuals demonstrated less HIV knowledge than non-Hispanic White individuals. Black participants demonstrated fewer health literacy appraisal skills. Importantly, lower levels of health literacy were linked to poorer CD4 cell count (an index of immune functioning) for Hispanic and Black individuals and not for non-Hispanic White individuals. These findings suggest race group differences for health literacy on current CD4 cell count such as very specific dimensions of low health literacy (e.g. poorer judgment of health-related information), but not other presumed deficits (e.g. motivation, access), play an important role in clinical health outcomes in HIV.
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Affiliation(s)
- Rheeda L Walker
- 1 Department of Psychology, University of Houston, Houston, TX, USA
| | - Judy H Hong
- 1 Department of Psychology, University of Houston, Houston, TX, USA
| | - David C Talavera
- 1 Department of Psychology, University of Houston, Houston, TX, USA
| | - Marizela Verduzco
- 2 University of California, San Diego, HIV Neurobehavioral Research Program (HNRP), San Diego, CA, USA
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Chen YC, Chang LC, Liu CY, Ho YF, Weng SC, Tsai TI. The Roles of Social Support and Health Literacy in Self-Management Among Patients With Chronic Kidney Disease. J Nurs Scholarsh 2018; 50:265-275. [DOI: 10.1111/jnu.12377] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Yu-Chi Chen
- Lambda Beta-at-Large , Associate Professor, Institute of Clinical Nursing, School of Nursing; National Yang-Ming University; Taipei Taiwan ROC
| | - Li-Chun Chang
- Lambda Beta-at-Large , Associate Professor, School of Nursing; Chang Gung University of Science and Technology; Tao-Yuan Taiwan ROC
| | - Chieh-Yu Liu
- Associate Professor, Department of Midwifery and Women Health Care; National Taipei University of Nursing and Health Sciences; Taipei City Taiwan ROC
| | - Ya-Fang Ho
- Lambda Beta-at-Large , PhD Candidate, Department of Nursing, School of Nursing; National Yang-Ming University; Taiwan ROC
| | - Shuo-Chun Weng
- PhD Candidate, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, and Attending Physician, Center for Geriatrics and Gerontology, Division of Nephrology, Department of Internal Medicine; Taichung Veterans General Hospital; Taichung Taiwan ROC
| | - Tzu-I Tsai
- Professor, Department of Nursing, School of Nursing; National Yang-Ming University; Taiwan ROC
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Carrara A, Schulz PJ. The role of health literacy in predicting adherence to nutritional recommendations: A systematic review. PATIENT EDUCATION AND COUNSELING 2018; 101:16-24. [PMID: 28739178 DOI: 10.1016/j.pec.2017.07.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/04/2017] [Accepted: 07/06/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Synthesize quantitative empirical evidence on the role of health literacy in predicting adherence to dietary recommendations. METHODS A systematic search of 13 online databases resulted in 1498 articles eligible for screening. Of those, 20 met the predefined inclusion criteria and, together with 6 studies retrieved from their reference lists, were included for review. Screening of full-texts, data extraction and quality appraisal were independently performed by two reviewers. Inconsistencies regarding eligibility were resolved through discussion. RESULTS Of the 26 reviewed articles, 17 involved patients and 9 the general population. Overall, 35 associations between health literacy and various nutrition behaviours were observed. A significant direct positive association was reported in 5 cases, all of them concerning the general population. An insignificant association was reported in 20 cases, 15 of which were related to patients. The remaining associations were negative (n=2), partially mediated (n=1) or entirely mediated (n = 7). CONCLUSION Health literacy was scarcely determinant of dietary adherence and other nutrition behaviours, especially among patients. PRACTICE IMPLICATION Patients' dietary adherence is likely to be unaffected by interventions based on health literacy. Empowering approaches are expected to be more beneficial.
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Affiliation(s)
- Anna Carrara
- Institute of Communication and Health, Università della Svizzera italiana, Lugano, Switzerland.
| | - Peter J Schulz
- Institute of Communication and Health, Università della Svizzera italiana, Lugano, Switzerland
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Shen Q, Zhu H, Jiang G, Liu X. Nurse-Led Self-Management Educational Intervention Improves Symptoms of Patients With Functional Constipation. West J Nurs Res 2017; 40:874-888. [PMID: 28395593 DOI: 10.1177/0193945917701128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This study aimed to evaluate the effects of self-management educational intervention on the symptoms of patients with functional constipation. From January 2014 to April 2015, 66 patients with functional constipation were randomly assigned into intervention group receiving intensive educational interventions and control group receiving routine nursing care. The constipation score of all clinical symptoms (Bristol stool form scale, defecation interval, incomplete evacuation, evacuatory difficulty) at 1 month postdischarge were all significantly lower in the intervention group than in the control group (all, p < .05). At 1 month postdischarge, the intervention group had a significantly higher proportion of patients with good health habits (reasonable diet, regular exercise, good defecation habits, proper use of laxatives) as compared with the control group (all, p < .05). These data suggest educational intervention can effectively improve constipation symptoms and compliance with treatment of patients, and lead to the development of good health habits.
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Affiliation(s)
- Qiong Shen
- Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Hongqin Zhu
- Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Guixiang Jiang
- Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Xueqin Liu
- Zhujiang Hospital of Southern Medical University, Guangzhou, China
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Norton JM, Moxey-Mims MM, Eggers PW, Narva AS, Star RA, Kimmel PL, Rodgers GP. Social Determinants of Racial Disparities in CKD. J Am Soc Nephrol 2016; 27:2576-95. [PMID: 27178804 PMCID: PMC5004663 DOI: 10.1681/asn.2016010027] [Citation(s) in RCA: 194] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Significant disparities in CKD rates and outcomes exist between black and white Americans. Health disparities are defined as health differences that adversely affect disadvantaged populations, on the basis of one or more health outcomes. CKD is the complex result of genetic and environmental factors, reflecting the balance of nature and nurture. Social determinants of health have an important role as environmental components, especially for black populations, who are disproportionately disadvantaged. Understanding the social determinants of health and appreciating the underlying differences associated with meaningful clinical outcomes may help nephrologists treat all their patients with CKD in an optimal manner. Altering the social determinants of health, although difficult, may embody important policy and research efforts, with the ultimate goal of improving outcomes for patients with kidney diseases, and minimizing the disparities between groups.
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Affiliation(s)
- Jenna M Norton
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Marva M Moxey-Mims
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Paul W Eggers
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Andrew S Narva
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Robert A Star
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Paul L Kimmel
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Griffin P Rodgers
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland Office of the Director and
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Waverijn G, Heijmans M, Spreeuwenberg P, Groenewegen PP. Associations Between Neighborhood Social Capital, Health Literacy, and Self-Rated Health Among People With Chronic Illness. JOURNAL OF HEALTH COMMUNICATION 2016; 21:36-44. [PMID: 27548376 DOI: 10.1080/10810730.2016.1179369] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Health literacy skills are important for health and self-management for people with chronic illness. Neighborhood social capital can provide resources, such as access to information and informal social control over unhealthy behavior. The benefit of these resources, and the access people have to these resources, might depend on levels of health literacy. We investigated whether neighborhood social capital is differentially related to the health of people with chronic illness according to health literacy skills. This study focused on health literacy skills in 4 domains related to the ability to access and understand health information and to the ability to perform self-management. We found a significant positive interaction between social capital and health literacy skills for accessing and understanding health information. This suggests that health literacy enhances people's ability to gain access to and use neighborhood resources to benefit health. There was no interaction effect between social capital and health literacy skills in the other 2 domains. More research is needed to investigate how people with chronic illness can benefit from knowledge, support, and other social resources for health and self-management also whether they have limited health literacy skills.
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Affiliation(s)
- Geeke Waverijn
- a Netherlands Institute for Health Services Research , Utrecht , The Netherlands
| | - Monique Heijmans
- a Netherlands Institute for Health Services Research , Utrecht , The Netherlands
| | - Peter Spreeuwenberg
- a Netherlands Institute for Health Services Research , Utrecht , The Netherlands
| | - Peter P Groenewegen
- a Netherlands Institute for Health Services Research , Utrecht , The Netherlands
- b Department of Sociology and Department of Human Geography , Utrecht University , Utrecht , The Netherlands
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Shirooka H, Nishiguchi S, Fukutani N, Adachi D, Tashiro Y, Hotta T, Morino S, Nozaki Y, Hirata H, Yamaguchi M, Aoyama T. Association between comprehensive health literacy and frailty level in community-dwelling older adults: A cross-sectional study in Japan. Geriatr Gerontol Int 2016; 17:804-809. [PMID: 27381868 DOI: 10.1111/ggi.12793] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 02/15/2016] [Accepted: 02/26/2016] [Indexed: 01/16/2023]
Abstract
AIM The present study explored the association between comprehensive health literacy and frailty level in community-dwelling older adults in Japan. METHODS This was a cross-sectional study. We enrolled 517 community-dwelling older adults (mean age 73.2 ± 6.3 years; 410 women). We divided the cohort into two groups, non-frail and any-frail, based on Fried Frailty Index scores. We assessed comprehensive health literacy using a 14-item health literacy scale, and classified the participants as having high or low health literacy. We carried out multivariate logistic regression analysis in which the dependent variable was the presence of non-frailty and the independent variable was the presence of high health literacy. The analysis was adjusted for age, sex, body mass index, educational history and cognitive function. RESULTS There were 132 (25.5%) and 385 (74.5%) participants in the non-frail and any-frail groups, respectively. The analysis showed that high health literacy was independently associated with the non-frail group (odds ratio 1.64, 95% confidence interval 1.03-2.61). CONCLUSIONS The results showed that high health literacy was associated with non-frailty. This result implies that comprehensive health literacy might play a salient role in maintaining good health status in community-dwelling older adults in Japan. Geriatr Gerontol Int 2017; 17: 804-809.
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Affiliation(s)
- Hidehiko Shirooka
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto
| | - Shu Nishiguchi
- Department of Physical Therapy, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Naoto Fukutani
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto
| | - Daiki Adachi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto
| | - Yuto Tashiro
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto
| | - Takayuki Hotta
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto
| | - Saori Morino
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto
| | - Yuma Nozaki
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto
| | - Hinako Hirata
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto
| | - Moe Yamaguchi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto
| | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto
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Bergjan M, Schaepe C. Educational strategies and challenges in peritoneal dialysis: a qualitative study of renal nurses' experiences. J Clin Nurs 2016; 25:1729-39. [PMID: 27074958 DOI: 10.1111/jocn.13191] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2015] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES The aim of the study was to explore renal nurses' experiences, strategies and challenges with regard to the patient education process in peritoneal dialysis. BACKGROUND Patient education in peritoneal dialysis is essential to developing a successful home-based peritoneal dialysis program. In this area research is scarce and there is a particular lack of focus on the perspective of the renal nurse. DESIGN Qualitative design formed by thematic qualitative text analysis. METHODS Five group interviews (n = 20) were used to explore the challenges peritoneal dialysis nurses face and the training strategies they use. The interviews were analyzed with thematic qualitative content analysis using deductive and inductive subcategory application. RESULTS The findings revealed the education barriers perceived by nurses that patients may face. They also showed that using assessment tools is important in peritoneal dialysis patient education, as is developing strategies to promote patient self-management. There is a need for a deeper understanding of affective learning objectives, and existing teaching activities and materials should be revised to incorporate the patient's perspective. Patients usually begin having questions about peritoneal dialysis when they return home and are described as feeling overwhelmed. Adapting existing conditions is considered a major challenge for patients and nurses. CONCLUSIONS The results provided useful insights into the best approaches to educating peritoneal dialysis patients and served to raise awareness of challenges experienced by renal nurses. Findings underline the need for nosogogy - an approach of teaching adults (andragogy) with a chronic disease. Flexibility and cooperation are competencies that renal nurses must possess. RELEVANCE TO CLINICAL PRACTICE Still psychomotor skills dominate peritoneal dialysis patient training, there is a need of both a deeper understanding of affective learning objectives and the accurate use of (self-)assessment tools, particularly for health literacy.
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Affiliation(s)
- Manuela Bergjan
- Institute of Health and Nursing Science, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Christiane Schaepe
- Institute of Health and Nursing Science, Charité - Universitaetsmedizin Berlin, Berlin, Germany
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Reisi M, Mostafavi F, Javadzade H, Mahaki B, Tavassoli E, Sharifirad G. Impact of Health Literacy, Self-efficacy, and Outcome Expectations on Adherence to Self-care Behaviors in Iranians with Type 2 Diabetes. Oman Med J 2016; 31:52-9. [PMID: 26813680 PMCID: PMC4720937 DOI: 10.5001/omj.2016.10] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 09/09/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Diabetic patients with higher health literacy (HL) may feel more confident in their ability to perform self-care behaviors and may have strong beliefs that diabetes-related behaviors will lead to specific outcomes. Our study aimed to document the relationships between HL, self-efficacy, outcome expectations, and diabetes self-care of patients with type 2 diabetes mellitus (T2DM) in Iran. METHODS We conducted a cross-sectional observational study of 187 patients with T2DM. Participants completed the Functional Communicative and Critical Health Literacy scale, the Summary of Diabetes Self-Care Activities, the Diabetes Management Self-Efficacy Scale, Outcome Expectations Questionnaire, and a demographic questionnaire. RESULTS Participants who received diabetes education (t = 5.79, p<0.001) and were married (F = 3.04, p<0.050) had better diabetes self-care behavior. There was a significant positive correlation between self-care behaviors and communicative HL (r = 0.455, p<0.010), critical HL (r = 0.297, p<0.010), self-efficacy (r = 0.512, p<0.010) and outcome expectations (r = 0.387, p<0.010). Diabetes education and marital status accounted for 16.9% of the variance in diabetes self-care. Self-efficacy, outcome expectations, communicative, and critical HL explained 28.0%, 1.5%, 3.7%, and 1.4% of the variance, respectively. CONCLUSIONS This study revealed that the potential impact of self-efficacy, outcome expectations, communicative, and critical HL should be considered in the education program for patients with diabetes. We found self-efficacy to be the most important predictor of diabetes self-care. Therefore, the use of self-efficacy theory when designing patient education interventions could enhance diabetes self-care. It is essential that health care providers assess patient's HL levels to tailor health-related information specific to a domain of HL. This would fully inform patients and promote empowerment rather than simple compliance.
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Affiliation(s)
- Mahnoush Reisi
- Department of Health Education and Health Promotion, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Firoozeh Mostafavi
- Department of Health Education and Health Promotion, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Homamodin Javadzade
- Department of Health Education and Health Promotion, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Behzad Mahaki
- Department of Biostatistics and Epidemiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elahe Tavassoli
- The Student’s Research Committee Department of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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