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Allen C, Ghoora L, Murki R, Byworth C, Beale S, Mojadady A, Nagri J, Parmar C. Accuracy of Healthcare Professionals' Estimations of Health Literacy and Numeracy of Patients Visiting Metabolic Bariatric Surgery Clinic. Obes Surg 2024; 34:2799-2805. [PMID: 38965186 PMCID: PMC11289253 DOI: 10.1007/s11695-024-07379-y] [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] [Received: 04/14/2024] [Revised: 06/10/2024] [Accepted: 06/14/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION To effectively support patients through their weight loss journey, it is vital that healthcare professionals (HCPs) understand the health literacy skills of their patients and communicate in a way that meets these needs. This is the first study looking at the accuracy of HCPs' estimations of their patients' health literacy and numeracy attending a metabolic bariatric surgery (MBS) clinic. METHOD A cross-sectional study was completed at a tertiary-level MBS clinic in London. Patients completed a demographic questionnaire and a validated measure of health literacy and numeracy, the Medical Term Recognition Test (METER) and General Health Numeracy Test-Short Form (GHNT-6), respectively. HCPs provided estimations of their patient's health literacy and numeracy based on each questionnaire's scoring categories. RESULTS Data was collected for 31 patients. A 80.6% of patients had functional health literacy based on METER. HCPs estimated patients' health literacy correctly 61.1% of the time; inter-rater agreement was poor (ICC = 0.14; 95% CI = - 0.19, 0.443; p = 0.202). A total of 22.6% of patients scored 0 out of 6 on GHNT-6. HCPs estimated health numeracy correctly 13.9% of the time and were more likely to overestimate than underestimate health numeracy. Inter-rater agreement for health numeracy was poor (ICC = - 0.2; 95% CI = - 0.49, 0.14; p = 0.878). CONCLUSION There is poor agreement between HCPs' perception of their patients' health literacy and numeracy and their assessed ability. HCPs' understanding of their patient's health literacy and numeracy skills is vital in ensuring HCPs can support patients through the challenging bariatric surgical pathway, consenting process and post-operative course.
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Affiliation(s)
- Calisha Allen
- Institute of Health Informatics, University College London, London, NW1 2DA, UK.
- The Royal Free London NHS Foundation Trust, London, NW3 2QG, UK.
| | - Lubnaa Ghoora
- Department of Surgery, Whittington Hospital, London, N19 5NF, UK
| | - Rajashree Murki
- Department of Surgery, Whittington Hospital, London, N19 5NF, UK
| | - Chad Byworth
- The Royal Free London NHS Foundation Trust, London, NW3 2QG, UK
| | - Sarah Beale
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Akifah Mojadady
- Department of Surgery, Whittington Hospital, London, N19 5NF, UK
| | - Jameela Nagri
- Department of Surgery, Whittington Hospital, London, N19 5NF, UK
| | - Chetan Parmar
- Department of Surgery, Whittington Hospital, London, N19 5NF, UK
- Apollo Hospitals Educational and Research Foundation, New Delhi, India
- Department of Targeted Intervention, University College London, London, UK
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Ba DM, Kayembe C, Littlejohn J, Van Scoy LJ, VanDyke E, Williams J, Katoch A, Shook NC, Zhang Y, Livelsberger C, McDonald AC, Muscat JE. Navigation-Based Telehealth Informed Decision-Making for Prostate Cancer Screening in Black Men. Curr Oncol 2024; 31:3698-3712. [PMID: 39057145 PMCID: PMC11275421 DOI: 10.3390/curroncol31070273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
The rapid increase in telehealth has the potential to bring informed decision-making for prostate cancer screening (PCS) at the population level to high-risk individuals. We utilized a global technology platform of electronic health records data repositories (TriNetX) to determine its utility for Navigator-guided decision-making aid for PCS in Black men ages 45-79 years with no history of prostate cancer and PSA testing. Patients from Pennsylvania were invited to participate in a telehealth-delivered informed decision-making session for PCS. Focus groups, social learning theory, visual diagrams, and quantitative data on PCS risks and benefits were used to develop the content of the sessions, which included numerical discussions of risks vs. benefits in Black men. Participants completed several surveys, including baseline demographic and numeracy questionnaires, a one-on-one telehealth session with a trained Navigator, post-Navigation surveys, and an optional follow-up session with a urologist. Eighty-seven participants were consented and recruited. Although the mean numeracy score was only 1.9 out of 6, more than 90% rated as good or excellent that the sessions aided their PCS decision-making skills. This study indicates that Navigation by telehealth offers the ability to assist in informed decision-making for PCS at the population level.
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Affiliation(s)
- Djibril M. Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA; (D.M.B.); (C.K.); (L.J.V.S.); (A.K.); (Y.Z.); (C.L.); (A.C.M.)
| | - Chrispin Kayembe
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA; (D.M.B.); (C.K.); (L.J.V.S.); (A.K.); (Y.Z.); (C.L.); (A.C.M.)
| | - Joe Littlejohn
- Department of Urology, Penn State College of Medicine, Hershey, PA 17033, USA;
| | - Lauren J. Van Scoy
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA; (D.M.B.); (C.K.); (L.J.V.S.); (A.K.); (Y.Z.); (C.L.); (A.C.M.)
- Qualitative and Mixed Methods Core, Penn State College of Medicine, Hershey, PA 17033, USA;
| | - Erika VanDyke
- Qualitative and Mixed Methods Core, Penn State College of Medicine, Hershey, PA 17033, USA;
| | - James Williams
- Pennsylvania Prostate Cancer Coalition, Harrisburg, PA 17120, USA;
| | - Avnish Katoch
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA; (D.M.B.); (C.K.); (L.J.V.S.); (A.K.); (Y.Z.); (C.L.); (A.C.M.)
| | - Neil C. Shook
- Center for Survey Research, Penn State Harrisburg, Harrisburg, PA 17057, USA;
| | - Yue Zhang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA; (D.M.B.); (C.K.); (L.J.V.S.); (A.K.); (Y.Z.); (C.L.); (A.C.M.)
| | - Craig Livelsberger
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA; (D.M.B.); (C.K.); (L.J.V.S.); (A.K.); (Y.Z.); (C.L.); (A.C.M.)
| | - Alicia C. McDonald
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA; (D.M.B.); (C.K.); (L.J.V.S.); (A.K.); (Y.Z.); (C.L.); (A.C.M.)
| | - Joshua E. Muscat
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA; (D.M.B.); (C.K.); (L.J.V.S.); (A.K.); (Y.Z.); (C.L.); (A.C.M.)
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Shan Y, Ji M. Factors associated with COVID-19 misinformation rebuttal among college students: a descriptive study. Front Public Health 2023; 11:1233414. [PMID: 38045959 PMCID: PMC10690778 DOI: 10.3389/fpubh.2023.1233414] [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] [Received: 06/02/2023] [Accepted: 10/27/2023] [Indexed: 12/05/2023] Open
Abstract
Background The deluge of COVID-19 misinformation makes people confused, and acting on such misinformation can kill, leading to the tragic outcome of death. This makes it necessary to identify significant factors associated with college students' susceptibility. Objective This descriptive study sought to ascertain factors significantly associated with college students' susceptibility to online COVID-19 misinformation. Methods To assess college students' susceptibility to COVID-19 misinformation, we first chose as independent variables some demographic information, some well-developed, validated literacy tools, and the Patient Health Questionnaire-9 Items. Second, we selected as the dependent variable COVID-19 myths from some authoritative, official websites. Third, we integrated the independent and dependent variables into an online questionnaire. Fourth, we recruited students from Nantong University in China to participate in an online questionnaire survey. Finally, based on the data collected, we conducted quantitative and qualitative analyses to relate the independent variables to the dependent variable. Results Five hundred forty-six students participated in the survey voluntarily, and all questionnaires they answered were valid. The participants had an average of 2.32 (SD = 0.99) years of higher education. They have a mean age of 20.44 (SD = 1.52) years. 434 (79.5%) of the 546 participants were females. The frequency of their Internet use averaged 3.91 (SD = 0.41), indicating that they logged onto the Internet almost every day. Their self-reported Internet skill was rated 3.79 (SD = 1.07), indicating that the participants rated their Internet skills as basically "good." The mean scores of the sub-constructs in the AAHLS were 6.14 (SD = 1.37) for functional health literacy, 5.10 (SD = 1.65) for communicative health literacy, and 11.13 (SD = 2.65) for critical health literacy. These mean scores indicated that the participants needed help to read health-related materials "sometimes," the frequency that they knew how to communicate effectively with professional health providers was between "often" and "sometimes," and the frequency that they were critical about health information was between "often" and "sometimes," respectively. The sum of their scores for eHealth literacy averaged 28.29 (SD = 5.31), showing that they had a relatively high eHealth literacy level. The mean score for each question in the GHNT was determined at 1.31 (SD = 0.46), 1.36 (SD = 0.48), 1.41 (SD = 0.49), 1.77 (SD = 0.42), 1.51 (SD = 0.50), and 1.54 (SD = 0.50), respectively. These mean scores showed that a high percentage of the participants answered the 6 questions wrongly, especially Questions 4-6. Similarly, participants performed unsatisfactorily in answering the 3 questions in the CRT, with a mean score of 1.75 (SD = 0.43), 1.55 (SD = 0.50), and 1.59 (SD = 0.49) for each question, respectively. In the PHQ-9, the participants reported that they never felt depressed or felt depressed only for 1-3 days in the past week. The mean score for myths 1-6 and 9-10 ranged from 1.15 (SD = 0.36) to 1.29 (SD = 0.46). This meant that the participants rated these myths false. However, most of the participants rated myths 7-8 true (1.54, SD = 0.50; 1.49, SD = 0.50), showing that they were highly susceptible to these 2 pieces of misinformation. Through data analysis via Logistic Regression (forward stepwise), we found that (1) at an average threshold of 0.5, Internet use frequency, functional health literacy, general health numeracy, reflective thinking tendency, and depression severity were significant predictors of susceptibility to misinformation for both male and female students, (2) at a higher threshold of 0.8, aggregated general health numeracy scores and functional health literacy scores, as well as depression severity were predictors of susceptibility to misinformation for both male and female students, (3) functional health literacy, general health literacy, and depression predicted resistance to misinformation for female students, and (4) internet use frequency and self-reported digital health literacy predicted resistance to misinformation for male students. Conclusion We revealed the complexity, dynamics, and differences in age, gender, education, Internet exposure, communicative health literacy, and cognitive skills concerning college students' susceptibility to online COVID-19 misinformation. Hopefully, this study can provide valuable implications for counteracting COVID-19 misinformation among Chinese college students.
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Affiliation(s)
- Yi Shan
- School of Foreign Studies, Nantong University, Nantong, China
| | - Meng Ji
- School of Languages and Cultures, University of Sydney, Sydney, NSW, Australia
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Klinger J, Berens EM, Schaeffer D. Health literacy and the role of social support in different age groups: results of a German cross-sectional survey. BMC Public Health 2023; 23:2259. [PMID: 37974154 PMCID: PMC10652531 DOI: 10.1186/s12889-023-17145-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Scholars demand more focus on context-related factors of health literacy as the management of health information is seen as a social practice. One prominent factor is social support that is expected to be particularly relevant for persons vulnerable for low health literacy. It was shown that health literacy can differ across the life span and especially older people have been demonstrated to be vulnerable for low health literacy. Therefore, health literacy and the relation of social support on health literacy in different age groups should be investigated. METHODS In a German nationwide survey 2,151 adults were interviewed face-to-face. General comprehensive health literacy was measured with the HLS19-Q47 which differentiates single steps of health information management - access, understand, appraise, and apply. Social support was measured with the Oslo 3 Social Support Scale. Bivariate and multivariate analyses were performed for all respondents and for five age groups. RESULTS Health literacy is relatively low in all age groups but particularly low among old-old people (76 + years). Also, the youngest adults (18-29 years) have slightly lower health literacy than middle-aged adults. On average, health literacy is higher among people with higher social support but this association varies between age groups. It tends to be quite strong among younger adults (18-45 years) and young-old persons (65-75 years) but is weak among older middle-aged (46-64 years) and old-old persons. The association also differs between steps of information management. It is stronger for accessing and applying information but there are differences in age groups as well. CONCLUSIONS Social support is a relevant aspect to improve individuals' health literacy and therefore should be addressed in interventions. However, it is necessary to differentiate between age groups. While both young adults and particularly old-old persons are challenged by health information management, young adults can strongly profit from social support whereas it can barely compensate the low health literacy of old-old persons. In addition, different challenges in information management steps in different age groups need to be considered when designing health literacy interventions. Thus, target group specific services and programs are needed.
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Affiliation(s)
- Julia Klinger
- Institute of Sociology and Social Psychology, University of Cologne, 50931, Cologne, Germany
| | - Eva-Maria Berens
- Ethics Committee, Bielefeld University, 33501, Bielefeld, Germany
| | - Doris Schaeffer
- School of Public Health, Bielefeld University, 33501, Bielefeld, Germany.
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Manzar S, El Koussaify J, Garcia VC, Ozdag Y, Akoon A, Dwyer CL, Klena JC, Grandizio LC. Statistical Literacy in Hand and Upper-Extremity Patients. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:793-798. [PMID: 38106924 PMCID: PMC10721529 DOI: 10.1016/j.jhsg.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/15/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose Statistical literacy is the ability of a patient to apply basic statistical concepts to their health care. Understanding statistics is a critical component of shared decision making. The purpose of this investigation was to define levels of statistical literacy in an upper-extremity (UE) patient population. We aimed to determine if patient demographics would be associated with statistical literacy. Methods An electronic survey was administered to a consecutive series of UE patients at a single institution. We recorded baseline demographics, Single Assessment Numeric Evaluation scores, the Berlin Numeracy Test (BNT), and General Health Numeracy Test. We also included a surgical risk question, which asked: "Approximately 3% of patients who get carpal tunnel surgery develop an infection. If 100 patients get this surgery, how many would you expect to develop an infection?" A covariate-controlled adjusted odds ratio reflecting the association between each statistical literacy outcome measure and patient characteristics was reported. Results A total 254 surveys were administered, 148 of which were completed and included. Fifty percent of respondents had a high-school education or less. For the BNT, 78% scored in the bottom quartile, and 52% incorrectly answered all questions. For the General Health Numeracy Test, 34% answered 0 or 1/6 questions correctly. For the surgical risk question, 24% of respondents answered incorrectly. Respondents who had a college or graduate degree had 2.62 times greater odds (95% confidence interval, 1.09-6.32) of achieving a BNT score in a higher quartile than patients who did not have a college or graduate degree. Conclusions Overall levels of statistical literacy are low for UE patients. Clinical relevance When engaging in management discussions and shared decision making, UE surgeons should assume low levels of statistical literacy. Consideration of alternative formats, such as frequencies, video-based materials, and pictographs, may be warranted when discussing outcomes and risks of surgical procedures.
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Affiliation(s)
- Shahid Manzar
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Jad El Koussaify
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Victoria C. Garcia
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Yagiz Ozdag
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Anil Akoon
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - C. Liam Dwyer
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Joel C. Klena
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Louis C. Grandizio
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
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Ichikowitz K, Bruce C, Meitanis V, Cheung K, Kim Y, Talbourdet E, Newton C. Which blueberries are better value? The development and validation of the functional numeracy assessment for adults with aphasia. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023. [PMID: 36912570 DOI: 10.1111/1460-6984.12867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND People with aphasia (PWA) can experience functional numeracy difficulties, that is, problems understanding or using numbers in everyday life, which can have numerous negative impacts on their daily lives. There is growing interest in designing functional numeracy interventions for PWA; however, there are limited suitable assessments available to monitor the impact of these interventions. Existing functional numeracy assessments lack breadth and are not designed to be accessible for PWA, potentially confounding their performance. Additionally, they do not include real-life demands, such as time pressure, which may affect their ecological validity. Thus, there is a crucial need for a new assessment to facilitate further research of PWA's functional numeracy. AIMS To develop, validate and pilot a wide-ranging, aphasia-friendly functional numeracy assessment to investigate how functional numeracy is impacted by aphasia severity and time pressure demands, and to explore predictors of PWA's functional numeracy. METHODS & PROCEDURES To develop the Functional Numeracy Assessment (FNA), 38 items inspired by the General Health Numeracy Test (GHNT) and Excellence Gateway were adapted for suitability for PWA and entered in a computerized psychometric-style test. The final 23 items (FNA23) were selected based on 213 neurotypical controls' performance, and controlled for difficulty, response modality and required numeracy skills. Aphasia-friendly adaptations of the GHNT and Subjective Numeracy Scale were used to examine the FNA23's concurrent validity. Internal consistency reliability and interrater reliability (for spoken responses) were also examined. A novel Time Pressure Task was created by slight adaptation of seven FNA23 questions to explore the effects of time pressure on functional numeracy performance. A total of 20 PWA and 102 controls completed all measures on an online testing platform. OUTCOMES & RESULTS The FNA23 demonstrated acceptable internal consistency reliability (KR-20 = 0.81) and perfect interrater reliability (for spoken responses). FNA23 and GHNT scores were positively associated, suggesting satisfactory concurrent validity. PWA demonstrated poorer functional numeracy than controls and took longer to complete assessments, indicating that aphasia impacts functional numeracy. Time pressure did not significantly impact performance. PWA demonstrated a wide range of functional numeracy abilities, with some performing similarly to controls. CONCLUSIONS & IMPLICATIONS The FNA23 is a wide-ranging, valid and reliable assessment which, with further development, will be a useful tool to identify and monitor PWA's functional numeracy difficulties in research and clinical practice. Considering PWA's widespread functional numeracy difficulties evidenced by this study, all PWA would likely benefit from routine evaluation for functional numeracy difficulties as part of their neurorehabilitation journeys. WHAT THIS PAPER ADDS What is already known on this subject Few studies have investigated functional numeracy difficulties in PWA. No published functional numeracy assessments exist that have been specifically designed to be accessible for PWA. What this paper adds to existing knowledge The newly developed FNA23 is a valid and reliable tool to extensively assess PWA's functional numeracy. This study confirmed previous findings of widespread functional numeracy difficulties in PWA that are related to their aphasia severity. What are the potential or actual clinical implications of this work? The FNA23 can be used to assess PWA's functional numeracy to inform areas of strengths and difficulties to target in intervention, and to monitor progress towards achieving intervention objectives. All PWA should be routinely evaluated for functional numeracy difficulties.
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Affiliation(s)
- Kerri Ichikowitz
- Division of Psychology & Language Sciences, University College London, London, UK
| | - Carolyn Bruce
- Division of Psychology & Language Sciences, University College London, London, UK
| | - Vanessa Meitanis
- Division of Psychology & Language Sciences, University College London, London, UK
| | - Kelly Cheung
- Division of Psychology & Language Sciences, University College London, London, UK
| | - Yekyung Kim
- Division of Psychology & Language Sciences, University College London, London, UK
| | - Esther Talbourdet
- Division of Psychology & Language Sciences, University College London, London, UK
| | - Caroline Newton
- Division of Psychology & Language Sciences, University College London, London, UK
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Uncertainty in Conveying Uncertainty. J Orthop Trauma 2022; 36:427. [PMID: 35981226 DOI: 10.1097/bot.0000000000002375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Abstract
OBJECTIVE To evaluate the baseline level and demographic predictors of statistical literacy in orthopaedic patients who sustained traumatic injuries. DESIGN Prospective observational. SETTING Level 1 trauma center. PATIENTS One hundred ninety-eight patients presenting to the orthopaedic trauma clinic. INTERVENTION Berlin Numeracy Test (BNT) and General Health Numeracy Test-6 (GHNT-6). RESULTS When assessed using the BNT, 67% of patients had results that placed them into the lowest quartile of objective numeracy skills. Only 3.5% of patients had results that scored in the top quartile. Our multivariate ordinal regression model demonstrated lower education level ( P = 0.01), and older age ( P = 0.03) were significant predictors of poor performance on the BNT. The mean score on the GHNT-6 was 36% (SD 30%). CONCLUSIONS In a cohort of traumatically injured patients, poor statistical literacy was common, occurring in more than two-thirds of patient surveyed. Older age and lower levels of education were predictive of poor BNT performance and should be considered when discussing surgical options, associated risks, and likelihood of potential complications.
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Lau YK, Bhattarai H, Caverly TJ, Hung PY, Jimenez-Mendoza E, Patel MR, Coté ML, Arenberg DA, Meza R. Lung Cancer Screening Knowledge, Perceptions, and Decision Making Among African Americans in Detroit, Michigan. Am J Prev Med 2021; 60:e1-e8. [PMID: 33341184 DOI: 10.1016/j.amepre.2020.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Previously, a web-based, patient-facing decision aid for lung cancer screening, shouldiscreen.com, was developed and evaluated. An initial evaluation was completed before the Medicare coverage decision and recruited a nondiverse sample of mostly former smokers, limiting the understanding of the potential effectiveness of the tool among diverse populations. This study evaluates shouldiscreen.com among African Americans in Metro Detroit. METHODS Using insights obtained from participatory workshops in this population, content changes to shouldiscreen.com were implemented, and this modified version was evaluated with a before-after study. Measures included knowledge of lung cancer screening, decisional conflict, and concordance between individual preference and screening eligibility. Surveys occurred between April and July 2018. Participants were contacted 6 months after the survey to assess subsequent screening behaviors. Analysis took place in 2019. RESULTS Data were collected from 74 participants aged 45-77 years, who were current/former smokers with no history of lung cancer. The average knowledge score increased by 25% from 5.7 (SD=1.94) before to 7.1 (SD=2.30) after (out of 13 points). Decisional conflict was halved between before and after. Concordance between individual preference and eligibility for screening increased from 22% (SD=41) to 35% (SD=47). Half of the participants felt uncomfortable answering surveys electronically and requested paper versions. CONCLUSIONS The use of the tool led to small improvements in lung cancer screening knowledge and increased concordance with current recommendations. Additional design modifications and modes of information delivery of these decision aids should be considered to increase their efficacy in helping populations with lower educational attainment and computer literacy.
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Affiliation(s)
- Yan Kwan Lau
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Harihar Bhattarai
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Tanner J Caverly
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan; Division of General Internal Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Pei-Yao Hung
- School of Information, University of Michigan, Ann Arbor, Michigan
| | - Evelyn Jimenez-Mendoza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Minal R Patel
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Michele L Coté
- Department of Oncology, School of Medicine, Wayne State University, Detroit, Michigan; Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Douglas A Arenberg
- Division of Pulmonary and Critical Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan.
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Plaza-Zamora J, Legaz I, Osuna E, Pérez-Cárceles MD. Age and education as factors associated with medication literacy: a community pharmacy perspective. BMC Geriatr 2020; 20:501. [PMID: 33238894 PMCID: PMC7687724 DOI: 10.1186/s12877-020-01881-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 11/09/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Aging implies a higher prevalence of chronic pathologies and a corresponding increase in medication. The correct adherence and use of the medication are prerequisites for reducing risks of disease progression, comorbidity, and mortality. Medication literacy (ML) is the specific ability to safely access and understand the information available concerning medication, and to act accordingly. Currently, there are few specific instruments that ascertain the extent of ML in the general population. The aim of this work was to analyse ML in a large cohort of pharmacy customers. METHODS A total of 400 community pharmacy clients were analyzed to assess the level of ML (documental and numeracy) through the validated MedLitRxSE tool. RESULTS The results showed that out of a total of 400 community pharmacy clients only 136 (34%) had an adequate degree of ML, while the rest of the clients (n = 264; 66%) were adjudged not to have this ability. Statistically significant differences were found between the different age groups in terms of ML (P < 0.001; OR = 0.312; 95% CI: 0.195-0.499), the 51-65 and >65-year age groups having a lower frequency of adequate ML (23.5 and 7.1%, respectively) than the rest of the age groups. A statistically significant increase in adequate ML was observed as the academic level of the clients increased (P < 0.001; OR = 15.403; 95% CI: 8.109-29.257). Multivariate logistic regression confirmed the influence of both variables on ML. CONCLUSIONS An inadequate ML level was found in community pharmacy clients over the age of 51, and also in those with primary or non-formal studies. Our data add to our knowledge about ML, and should pharmacists and other health professionals to adopt new strategies to prevent, or at least reduce, errors in taking medicines, thus avoiding the undesirable effects of any misuse.
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Affiliation(s)
| | - Isabel Legaz
- Department of Legal and Forensic Medicine, Institute of Research into Aging. Biomedical Research Institute (IMIB), Regional Campus of International Excellence "Campus Mare Nostrum", Faculty of Medicine, University of Murcia, Murcia, Spain.
| | - Eduardo Osuna
- Department of Legal and Forensic Medicine, Institute of Research into Aging. Biomedical Research Institute (IMIB), Regional Campus of International Excellence "Campus Mare Nostrum", Faculty of Medicine, University of Murcia, Murcia, Spain
| | - María D Pérez-Cárceles
- Department of Legal and Forensic Medicine, Institute of Research into Aging. Biomedical Research Institute (IMIB), Regional Campus of International Excellence "Campus Mare Nostrum", Faculty of Medicine, University of Murcia, Murcia, Spain
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11
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Lee EH, Lee YW, Lee KW, Hong S, Kim SH. A New Objective Health Numeracy Test for Patients with Type 2 Diabetes: Development and Evaluation of Psychometric Properties. Asian Nurs Res (Korean Soc Nurs Sci) 2020; 14:66-72. [DOI: 10.1016/j.anr.2020.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/29/2020] [Accepted: 01/31/2020] [Indexed: 10/25/2022] Open
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Buljan I, Tokalić R, Marušić M, Marušić A. Health numeracy skills of medical students:cross-sectional and controlled before-and-after study. BMC MEDICAL EDUCATION 2019; 19:467. [PMID: 31864343 PMCID: PMC6925899 DOI: 10.1186/s12909-019-1902-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/08/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Although numeracy, defined as understanding and handling numbers, is an important skill for the medical profession, it is not clear whether it changes during graduate medical education and whether it can be improved by specific interventions. The objective of this study was to assess objective and subjective numeracy levels at different stages of medical education and explore whether a research methodology/statistics course improves numeracy levels in a longer period. METHODS We performed cross-sectional and controlled before-and-after studies. First-year sociology students and first- to sixth-year medical students from the in the cross sectional study and two groups of first-year medical students in a controlled before-and-after study. The intervention was a course on biostatistics and research methodology using blended approach. Numeracy was measured using Subjective Numeracy Scale (Cronbach α = 0.70) and Numeracy Understanding in Medicine instrument (Cronbach α = 0.75). RESULTS Whereas first-year medical students did not differ from first-year sociology students in objective numeracy, medicine students had higher results on subjective numeracy. Students from higher years of medical school had generally higher subjective and objective numeracy scores. In the controlled before-and-after study, the intervention group improved more in subjective numeracy (median difference on a 0-8 scale = 0.5, 95% CI 0.3 to 0.7 vs - 0.4, 95% CI - 0.4 to - 0.1, P < 0.001) but not in objective numeracy. CONCLUSIONS Although the numeracy levels at the beginning of the medical school are within the range of non-medical population, both objective and subjective numeracy improve during the higher years of medical school. Curriculum during medical school may help in numeracy increase, while research methodology training may help to increase subjective but not objective numeracy skills.
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Affiliation(s)
- Ivan Buljan
- Department of Research in Biomedicine in Health, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia.
| | - Ružica Tokalić
- Department of Research in Biomedicine in Health, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia
| | - Matko Marušić
- Department of Research in Biomedicine in Health, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia
| | - Ana Marušić
- Department of Research in Biomedicine in Health, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia
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13
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Rodgers J, Kakarmath S, Denis V, Encinas-Martin M, Subramanian SV. Association between numeracy and self-rated poor health in 33 high- and upper middle- income countries. Prev Med 2019; 129:105872. [PMID: 31644897 DOI: 10.1016/j.ypmed.2019.105872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
The association between numeracy proficiency and health outcomes has been the subject of several studies. However, it is not known if this association is independent of educational attainment and literacy proficiency. In this study, we used logistic regression to model numeracy proficiency as a predictor of self-rated poor health after accounting for educational attainment and literacy proficiency. The prevalence of self-rated poor health among 166,863 adults aged 16-65 years from 33 high- and upper middle-income countries was 24%. Compared to those with the highest numeracy proficiency (level 4), the odds ratio of self-rated poor health for those with the lowest numeracy proficiency (level 1) was 2.2 (95% CI 1.9-2.7) and attenuated to 1.8 (95% CI 1.5-2.1) and 1.5 (95% CI 1.1, 2.0), respectively, after sequential addition of self-education and literacy proficiency. For those who were assessed to have low levels of both numeracy and literacy proficiency, the odds ratio of self-rated poor health was 1.4 (95% CI 1.3 to 1.5), relative to those who had high levels of both numeracy and literacy proficiencies. Numeracy and literacy proficiencies show both independent and interdependent correlations with poor self-rated health. Further, these associations varied by sociodemographic characteristics and across countries. Policies aimed at improving numeracy and literacy may be beneficial in preventing adverse health outcomes.
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Affiliation(s)
- Justin Rodgers
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA 02138, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Sujay Kakarmath
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Vanessa Denis
- Directorate for Education and Skills, Organisation for Economic Co-operation and Development, 2 Rue André Pascal, 75116 Paris, France
| | - Marta Encinas-Martin
- Directorate for Education and Skills, Organisation for Economic Co-operation and Development, 2 Rue André Pascal, 75116 Paris, France
| | - S V Subramanian
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA 02138, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
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14
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Gutierrez KM, Cohn LD. Medication Competence, Numeracy, and Health Literacy. Health Lit Res Pract 2019; 3:e181-e186. [PMID: 31428735 PMCID: PMC6690220 DOI: 10.3928/24748307-20190625-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 11/30/2018] [Indexed: 11/20/2022] Open
Abstract
Two studies investigated the association between medication literacy and numeracy. Study 1 revealed an association between both variables in a sample of adults. Study 2 replicated the finding in a sample of parents of young children, even after controlling for level of parental health literacy. Both studies employed the Medication Literacy in Spanish and English (MedLitRxSE) assessment tool. Objective and subjective numeracy scores were significantly correlated with MedLitRxSE scores in both studies, suggesting that interventions for reducing medication errors might benefit by simplifying the numerical information presented in medication instructions. [HLRP: Health Literacy Research and Practice. 2019;3(3):e181–e186.]
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Affiliation(s)
| | - Lawrence D. Cohn
- Address correspondence to Lawrence D. Cohn, PhD, University of Texas at El Paso, Psychology Building, Room 118, 500 W. University, El Paso, TX 79902;
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15
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Dorst MT, Anders SH, Chennupati S, Chen Q, Purcell Jackson G. Health Information Technologies in the Support Systems of Pregnant Women and Their Caregivers: Mixed-Methods Study. J Med Internet Res 2019; 21:e10865. [PMID: 31094327 PMCID: PMC6532338 DOI: 10.2196/10865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 01/31/2019] [Accepted: 03/30/2019] [Indexed: 11/14/2022] Open
Abstract
Background The quality and quantity of families’ support systems during pregnancy can affect maternal and fetal outcomes. The support systems of expecting families can include many elements, such as family members, friends, and work or community groups. Emerging health information technologies (eg, social media, internet websites, and mobile apps) provide new resources for pregnant families to augment their support systems and to fill information gaps. Objective This study sought to determine the number and nature of the components of the support systems of pregnant women and their caregivers (eg, family members) and the role of health information technologies in these support systems. We examined the differences between pregnant women’s support systems and those of their caregivers and the associations between support system composition and stress levels. Methods We enrolled pregnant women and caregivers from advanced maternal-fetal and group prenatal care clinics. Participants completed surveys assessing sociodemographic characteristics, health literacy, numeracy, and stress levels and were asked to draw a picture of their support system. Support system elements were extracted from drawings, categorized by type (ie, individual persons, groups, technologies, and other) and summarized for pregnant women and caregivers. Participant characteristics and support system elements were compared using the Pearson chi-square test for categorical variables and Wilcoxon ranked sum test for continuous variables. Associations between support system characteristics and stress levels were measured with Spearman correlation coefficient. Results The study enrolled 100 participants: 71 pregnant women and 29 caregivers. The support systems of pregnant women were significantly larger than those of caregivers—an average of 7.4 components for pregnant women and 5.4 components for caregivers (P=.003). For all participants, the most commonly reported support system elements were individual persons (408/680, 60.0%), followed by people groups (132/680, 19.4%), technologies (112/680, 16.5%), and other resources (28/680, 4.1%). Pregnant women’s and caregivers’ technology preferences within their support systems differed—pregnant women more often identified informational websites, apps, and social media as parts of their support systems, whereas caregivers more frequently reported general internet search engines. The size and components of these support systems were not associated with levels of stress. Conclusions This study is one of the first demonstrating that technologies comprise a substantial portion of the support systems of pregnant women and their caregivers. Pregnant women more frequently reported specific medical information websites as part of their support system, whereas caregivers more often reported general internet search engines. Although social support is important for maternal and fetal health outcomes, no associations among stress, support system size, and support system components were found in this study. As health information technologies continue to evolve and their adoption increases, their role in patient and caregiver support systems and their effects should be further explored.
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Affiliation(s)
| | - Shilo H Anders
- Vanderbilt University Medical Center, Nashville, TN, United States
| | | | - Qingxia Chen
- Vanderbilt University Medical Center, Nashville, TN, United States
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16
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Reid M, Nel M, Janse van Rensburg-Bonthuyzen E. Development of a Sesotho health literacy test in a South African context. Afr J Prim Health Care Fam Med 2019; 11:e1-e13. [PMID: 31038342 PMCID: PMC6495000 DOI: 10.4102/phcfm.v11i1.1853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/19/2018] [Accepted: 11/19/2018] [Indexed: 11/05/2022] Open
Abstract
Background Research shows that poor health literacy (HL) can be a threat to health and health care. Health literacy is under-researched and poorly understood in developing countries, including South Africa, because of the absence of language and context-specific HL tests. Aim The researchers aimed to develop an appropriate HL test for use among South African public health service users with Sesotho as their first language. Setting The test was developed in the Free State Province of South Africa, for use among Sesotho speakers. Methods Mixed methods were employed to develop the Sesotho Health Literacy Test (SHLT). The process of developing the test was carried out in distinctive methodological steps. Results The stepwise process set out by identifying abstracts (n = 206) referring to HL tests. Sourcing of HL tests followed a tapered process resulting in the use of 17 HL tests. Elements within a conceptual framework guided HL test item selection (n = 47). Two Delphi sessions assisted in reaching consensus regarding final HL test items (n = 40). The readability testing of the SHLT tested 4.19 on the Coleman–Liau Index score. A context-suitable and comprehensive SHLT ensued from this work. Conclusion The SHLT assessment instrument development creates a platform for HL testing among Sesotho first language speakers in South Africa. The context-sensitive methodology is entrenched in a theoretical framework, distributing HL test items between identified competencies and related skill dimensions and domains. The methodology can be applied to the development of HL tests for other languages and population groups in developing countries. Keywords health literacy assessment; primary health care; South Africa; developing countries; public health service; context-sensitive assessment.
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Affiliation(s)
- Marianne Reid
- School of Nursing, Faculty of Health Sciences, University of the Free State, Bloemfontein.
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A New Measure of Health Numeracy: Brief Medical Numbers Test (BMNT). PSYCHOSOMATICS 2018; 60:271-277. [PMID: 30093241 DOI: 10.1016/j.psym.2018.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 07/07/2018] [Accepted: 07/09/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Approximately half of Americans have inadequate health literacy, which leads to poorer health outcomes. Health numeracy is an important component of literacy, which reflects one's ability to understand and manipulate numbers. This is especially important for transplant candidates, as adherence to medical recommendations is essential for posttransplant care. Although validated measures of numeracy exist, they can be inconvenient and time consuming to administer. OBJECTIVE The Brief Medical Numbers Test (BMNT) was created in 2011 to quickly assess the health numeracy of a patient during presurgical psychiatric transplant evaluations. The purpose of this study was to evaluate the reliability and validity of the BMNT for this use via retrospective chart review. METHODS There were 293 patients referred over a 2-year period for a presurgical psychiatric evaluation. The evaluation consisted of a semistructured interview and completion of several measures, including the BMNT, a measure of health literacy, and a brief test of cognitive functioning. RESULTS The BMNT had acceptable internal consistency (α = .71), convergent validity with health literacy and cognitive functioning, and predictive validity with surgical outcomes. CONCLUSIONS Preliminary data suggests the BMNT is a reliable and valid measure of health numeracy in patients being evaluated for transplant.
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18
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Buljan I, Malički M, Wager E, Puljak L, Hren D, Kellie F, West H, Alfirević Ž, Marušić A. No difference in knowledge obtained from infographic or plain language summary of a Cochrane systematic review: three randomized controlled trials. J Clin Epidemiol 2018; 97:86-94. [PMID: 29269021 DOI: 10.1016/j.jclinepi.2017.12.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 11/14/2017] [Accepted: 12/11/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to test the usefulness of an infographic in the translation of knowledge about health information from a Cochrane systematic review to lay and professional populations in comparison to a plain language summary (PLS) and scientific abstract (SA). STUDY DESIGN AND SETTING We conducted three parallel randomized trials with university students (n = 171), consumers (n = 99), and doctors (n = 64), to examine the effect of different summary formats of a Cochrane systematic review on the knowledge about health information presented in the review, reading experience, and perceived user-friendliness. In the trials involving students and doctors, an infographic was compared to a PLS and a SA, while in those with consumers, an infographic was compared to a PLS. RESULTS We found no difference in knowledge between the infographic and the text-based PLS in any of the trials or in the whole participant sample. All three participant groups preferred the infographic and gave it higher ratings for reading experience (d = 0.48 in the overall sample) and user-friendliness (d = 0.46 in the overall sample). CONCLUSION Although the infographic format was perceived as more enjoyable for reading, it was not better than a traditional, text-based PLS in the translation of knowledge about findings from a Cochrane systematic review.
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Affiliation(s)
- Ivan Buljan
- Cochrane Croatia, Department of Research in Biomedicine and Health, University of Split School of Medicine, Šoltanska 2 21000, Split, Croatia.
| | - Mario Malički
- Cochrane Croatia, Department of Research in Biomedicine and Health, University of Split School of Medicine, Šoltanska 2 21000, Split, Croatia
| | - Elizabeth Wager
- Sideview, Princes Risborough, UK; University of Split School of Medicine, Split, Croatia
| | - Livia Puljak
- Cochrane Croatia, University of Split School of Medicine, Split, Croatia
| | - Darko Hren
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Split, Split Croatia
| | - Frances Kellie
- Cochrane Pregnancy and Childbirth, Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Helen West
- Cochrane Pregnancy and Childbirth, Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Žarko Alfirević
- Cochrane Pregnancy and Childbirth, Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Ana Marušić
- Cochrane Croatia, Department of Research in Biomedicine and Health, University of Split School of Medicine, Šoltanska 2 21000, Split, Croatia
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Abstract
Objectives Health literacy—the ability to obtain, process, and understand basic health information—is a major determinant of an individual’s overall health and health care utilization. In this project, the authors examined predictors of health literacy levels, including numeracy and graphic literacy, among an adult population in the Upper Midwest. Methods The research was conducted at the Minnesota State Fair. Three previously validated scales were used to assess health literacy: Newest Vital Sign, the General Health Numeracy Test, and questions from Galesic and Garcia-Retamero’s Graph Literacy Scale. Demographic information—such as age, educational attainment, zip code, and other potential predictors and modifiers—was collected. Multivariate linear regression was conducted to examine the independent effects of educational attainment, race, ethnicity, gender, and rural or urban location on overall health literacy and scores on each of the individual instruments. Results A total of 353 Upper Midwest residents completed the survey, with the majority being white, college-educated, and from an urban area. Having a graduate or professional degree or being under the age of 21 were associated with increased health literacy scores, while having a high school diploma or some high school education, being Asian American, or being American Indian/Alaska Native were associated with lower health literacy scores. Conclusion Advanced health literacy skills, including the ability to calculate and compare information, were problematic even in well-educated populations. Understanding numerical and graphical information was found to be particularly difficult, and more research is needed to understand these deficits and how best to address them.
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Chakkalakal RJ, Venkatraman S, White RO, Kripalani S, Rothman R, Wallston K. Validating Health Literacy and Numeracy Measures in Minority Groups. Health Lit Res Pract 2017; 1:e23-e30. [PMID: 29888342 PMCID: PMC5991606 DOI: 10.3928/24748307-20170329-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Validation studies of existing health literacy or numeracy tools among racial/ethnic minorities are limited. Objective: This study assessed the validity of the Subjective Numeracy Scale (SNS), the Diabetes Numeracy Test (DNT-5), the Brief Health Literacy Screen (BHLS), and the Short Test of Functional Health Literacy in Adults (S-TOFHLA) by trait (health literacy or numeracy) and by method (subjective or objective) among non-Hispanic white (NHW), non-Hispanic black (NHB), and Hispanic patients with type 2 diabetes mellitus (T2DM). Methods: We conducted a secondary analysis of baseline data from the Partnering to Improve Diabetes Education (PRIDE) study, a clustered randomized controlled trial testing the efficacy of a health communication intervention on T2DM outcomes at state Department of Health clinics in middle Tennessee. PRIDE participants with race/ethnicity data available (n = 398) were included in this study. Most patients identified as NHW (59%), 18% identified as NHB, and 23% identified as Hispanic. Pearson correlations among the 4 measures were compared for each racial/ethnic group by trait and method. The convergent validity of each measure with education was also assessed using Pearson correlation analyses. Key Results: Significant correlations were observed across all 3 subgroups for the numeracy measures (SNS and DNT-5) and the objective measures (DNT-5 and S-TOFHLA). Nonsignificant correlations were observed among Hispanic participants for the health literacy measures (BHLS and S-TOFHLA, correlation coefficient = 0.13) and among NHB and Hispanic participants for the subjective measures (SNS and BHLS, correlations coefficients = 0.15 and 0.09, respectively). A significant positive correlation was noted between education and each measure across all 3 subgroups. Conclusions: Subjective and health literacy measures demonstrate weaker correlations than objective and numeracy measures, respectively, among minority patients in this study. Our findings highlight the need to further evaluate the appropriateness of these tools for use with minority populations, particularly the BHLS for Hispanic patients. [Health Literacy Research and Practice. 2017;1(2):e23–e30.] Plain Language Summary: Few studies have tested the validity of health literacy and numeracy measures in minority groups. This study highlights racial/ethnic differences in the results of validity testing of the Subjective Numeracy Scale, the Diabetes Numeracy Test, the Brief Health Literacy Screen, and the Short Test of Functional Health Literacy in Adults among adults with type 2 diabetes.
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Affiliation(s)
- Rosette J Chakkalakal
- Division of General Internal Medicine and Public Health, Department of Internal Medicine, Vanderbilt University Medical Center
| | | | - Richard O White
- Division of Community Internal Medicine and Family Medicine, Mayo Clinic Florida
| | - Sunil Kripalani
- Division of General Internal Medicine and Public Health, Center for Health Services Research, Vanderbilt University Medical Center
| | - Russell Rothman
- Division of General Internal Medicine and Public Health, Center for Health Services Research, Vanderbilt University Medical Center
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Schapira MM, Mozal C, Shofer FS, Gonzalez R, Apter AJ. Alignment of Patient Health Numeracy with Asthma Care Instructions in the Patient Portal. Health Lit Res Pract 2017; 1:e1-e10. [PMID: 31294245 PMCID: PMC6607833 DOI: 10.3928/24748307-20170307-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 01/23/2017] [Indexed: 11/20/2022] Open
Abstract
Background After Visit Summary (AVS) instructions provided through the patient portal of the electronic medical record can support asthma self-management if patients have the skills to interpret and apply the health information provided. Print literacy demands of patient materials are often higher than the reading ability of patients. However, less is known regarding the numeric demand of patient education materials and how well it aligns with patient health numeracy. Objectives This study (1) developed measures of numeric demand for use in the AVS, (2) described the health numeracy demand of AVS instructions for asthma care, and (3) evaluated the association between numeracy demand of materials and patient health numeracy. Methods We reviewed personalized AVS instructions for an index visit from 74 adults with moderate or severe asthma recruited from clinics serving low-income urban communities. Using measures of numeric complexity and density developed for this study, numeracy demand of the AVS was compared to the numeracy skills of patients using the validated Asthma Numeracy Questionnaire. Key Results The numeric complexity and density scales demonstrated content and face validity. The median (range) of the numeric complexity score for AVS instructions was 2.5 (0-46), and density of numeric information was 8% (0%-33%). The median (range) of the Asthma Numeracy Questionnaire was 2 (0-4). There was no association between patient asthma-related health numeracy and the complexity (p = .29) or density (p = .81) of numeric information. Conclusions Patient instructions regarding medications and self-management often include numeric information. Lack of alignment of the numeracy demand of materials with health numeracy skill may be a barrier to communication, particularly among patients of lower health numeracy. [Health Literacy Research and Practice. 2017;1(1):e1-e10.]. Plain Language Summary This study developed a way to measure the frequency and complexity of numeric information in instructions given to patients with asthma. No association was found between the difficulty of numeric information provided and the numeracy level of patients. This poses a potential barrier to communication, especially for patients with low health numeracy.
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Affiliation(s)
- Marilyn M. Schapira
- Address correspondence to Marilyn M. Schapira, MD, MPH, 1110 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104;
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Tique JA, Howard LM, Gaveta S, Sidat M, Rothman RL, Vermund SH, Ciampa PJ. Measuring Health Literacy Among Adults with HIV Infection in Mozambique: Development and Validation of the HIV Literacy Test. AIDS Behav 2017; 21:822-832. [PMID: 26961538 PMCID: PMC5306223 DOI: 10.1007/s10461-016-1348-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The role of health literacy on HIV outcomes has not been evaluated widely in Africa, in part because few appropriate literacy measures exist. We developed a 16-item scale, the HIV Literacy Test (HIV-LT) to assess literacy-related tasks needed to participate in HIV care. Items were scored as correct or incorrect; higher scores indicated higher literacy skill (range 0-100 %). We tested internal reliability (Kuder-Richardson coefficient) of the HIV-LT in a convenience sample of 319 Portuguese-speaking, HIV infected adults on antiretroviral treatment in Maputo, Mozambique. Construct validity was assessed by a hypothetical model developed a priori. The HIV-LT was reliable and valid to measure participants' literacy skills. The mean HIV-LT score was 42 %; literacy skills applicable to HIV care were challenging for many participants. The HIV-LT could be used to assess the relationship of literacy and HIV-related outcomes in diverse settings, and evaluate interventions to improve health communication for those in HIV care.
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Affiliation(s)
- José A Tique
- National STI's and HIV Program, Ministry of Health, Avenida Eduardo Mondlane/Salvador Allende, Maputo, Mozambique.
| | - Leigh M Howard
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, USA
| | - Sandra Gaveta
- Community Health Department, Eduardo Mondlane University, Maputo, Mozambique
| | - Mohsin Sidat
- Community Health Department, Eduardo Mondlane University, Maputo, Mozambique
| | - Russell L Rothman
- Departments of Pediatrics and Medicine, Vanderbilt University School of Medicine, Nashville, USA
| | - Sten H Vermund
- Departments of Pediatrics and Medicine, Vanderbilt University School of Medicine, Nashville, USA
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Schapira MM, Swartz S, Ganschow PS, Jacobs EA, Neuner JM, Walker CM, Fletcher KE. Tailoring Educational and Behavioral Interventions to Level of Health Literacy: A Systematic Review. MDM Policy Pract 2017; 2:2381468317714474. [PMID: 30288424 PMCID: PMC6124923 DOI: 10.1177/2381468317714474] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 05/13/2017] [Indexed: 11/15/2022] Open
Abstract
Background: The relative value of universal compared to contingent approaches to communication and behavioral interventions for persons of low health literacy remains unknown. Objective: To examine the effectiveness of interventions that are tailored to individual health literacy level compared to nontailored interventions on health-related outcomes. Design: Systematic review. Data Sources: PubMed and Embase databases. Eligibility Criteria: Studies were eligible if they were in English, used an experimental or observational design, included an intervention that was tailored based on the individual's level of education, health literacy or health numeracy, and had a comparator group in which the intervention was not tailored to individual characteristics. Review Methods: Databases were searched from inception to January 2016, and the retrieved reference lists hand searched. Abstracts that met PICOS criteria underwent dual review for data extraction to assess study details and study quality. A qualitative synthesis was conducted. Results: Of 2,323 unique citations, 458 underwent full review, and 9 met criteria for the systematic review. Five studies were positive and rated as good quality, 3 were negative with 2 of those of good quality, and 1 had mixed results (fair quality). Positive studies were conducted in the clinical domains of hypertension, diabetes, and depression with interventions including educational materials, disease management sessions, literacy training, and physician notification of limited health literacy among patients. Negative studies were conducted in the clinical domains of heart disease, glaucoma, and nutrition with interventions including medication reconciliation and educational materials. Conclusions: Tailoring communication and behavioral interventions to the individual level of health literacy may be an effective strategy to improve knowledge and indicators of disease control in selected clinical settings.
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Affiliation(s)
- Marilyn M. Schapira
- Marilyn M. Schapira, University of
Pennsylvania, 1110 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104,
USA; telephone: 215-898-2022; e-mail:
| | - Sheila Swartz
- University of Pennsylvania, Philadelphia,
Pennsylvania (MMS)
- Crescenz VA Medical Center, Philadelphia,
Pennsylvania (MMS)
- Medical College of Wisconsin, Milwaukee, Wisconsin
(SS, JMN, KEF)
- Rush University Medical Center, Chicago, Illinois
(PSG)
- University of Wisconsin, Madison, Wisconsin
(EAJ)
- Duquensne University, Pittsburgh, Pennsylvania
(CMW)
- Milwaukee VA Medical Center, Milwaukee, Wisconsin
(KEF)
| | - Pamela S. Ganschow
- University of Pennsylvania, Philadelphia,
Pennsylvania (MMS)
- Crescenz VA Medical Center, Philadelphia,
Pennsylvania (MMS)
- Medical College of Wisconsin, Milwaukee, Wisconsin
(SS, JMN, KEF)
- Rush University Medical Center, Chicago, Illinois
(PSG)
- University of Wisconsin, Madison, Wisconsin
(EAJ)
- Duquensne University, Pittsburgh, Pennsylvania
(CMW)
- Milwaukee VA Medical Center, Milwaukee, Wisconsin
(KEF)
| | - Elizabeth A. Jacobs
- University of Pennsylvania, Philadelphia,
Pennsylvania (MMS)
- Crescenz VA Medical Center, Philadelphia,
Pennsylvania (MMS)
- Medical College of Wisconsin, Milwaukee, Wisconsin
(SS, JMN, KEF)
- Rush University Medical Center, Chicago, Illinois
(PSG)
- University of Wisconsin, Madison, Wisconsin
(EAJ)
- Duquensne University, Pittsburgh, Pennsylvania
(CMW)
- Milwaukee VA Medical Center, Milwaukee, Wisconsin
(KEF)
| | - Joan M. Neuner
- University of Pennsylvania, Philadelphia,
Pennsylvania (MMS)
- Crescenz VA Medical Center, Philadelphia,
Pennsylvania (MMS)
- Medical College of Wisconsin, Milwaukee, Wisconsin
(SS, JMN, KEF)
- Rush University Medical Center, Chicago, Illinois
(PSG)
- University of Wisconsin, Madison, Wisconsin
(EAJ)
- Duquensne University, Pittsburgh, Pennsylvania
(CMW)
- Milwaukee VA Medical Center, Milwaukee, Wisconsin
(KEF)
| | - Cindy M. Walker
- University of Pennsylvania, Philadelphia,
Pennsylvania (MMS)
- Crescenz VA Medical Center, Philadelphia,
Pennsylvania (MMS)
- Medical College of Wisconsin, Milwaukee, Wisconsin
(SS, JMN, KEF)
- Rush University Medical Center, Chicago, Illinois
(PSG)
- University of Wisconsin, Madison, Wisconsin
(EAJ)
- Duquensne University, Pittsburgh, Pennsylvania
(CMW)
- Milwaukee VA Medical Center, Milwaukee, Wisconsin
(KEF)
| | - Kathlyn E. Fletcher
- University of Pennsylvania, Philadelphia,
Pennsylvania (MMS)
- Crescenz VA Medical Center, Philadelphia,
Pennsylvania (MMS)
- Medical College of Wisconsin, Milwaukee, Wisconsin
(SS, JMN, KEF)
- Rush University Medical Center, Chicago, Illinois
(PSG)
- University of Wisconsin, Madison, Wisconsin
(EAJ)
- Duquensne University, Pittsburgh, Pennsylvania
(CMW)
- Milwaukee VA Medical Center, Milwaukee, Wisconsin
(KEF)
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Dolan JG, Cherkasky OA, Li Q, Chin N, Veazie PJ. Should Health Numeracy Be Assessed Objectively or Subjectively? Med Decis Making 2016; 36:868-75. [PMID: 25948493 PMCID: PMC4636483 DOI: 10.1177/0272989x15584332] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 04/06/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Because current evidence suggests that numeracy affects how people make decisions, it is an important factor to account for in studies assessing the effectiveness of medical decision support interventions. Subjective and objective numeracy assessment methods are available that vary in theoretical background, skills assessed, known relationship with decision making skills, and ease of implementation. The best way to use these tools to assess numeracy when conducting medical decision-making research is currently unknown. METHODS We conducted Internet surveys comparing numeracy assessments obtained using the subjective numeracy scale (SNS) and 5 objective numeracy scales. Each study participant completed the SNS and 1 objective numeracy measure. Following each assessment, participants indicated willingness to repeat the assessment and rated its user acceptability. RESULTS The overall response rate was 78%, resulting in a total sample size of 673. Spearman correlations between the SNS and the objective numeracy measures ranged from 0.19 to 0.44. Acceptability assessments for the short form of the Numeracy Understanding in Medicine Instrument and the SNS did not differ significantly. The other objective scales all had lower acceptability ratings than the SNS. CONCLUSIONS These findings are consistent with prior research suggesting that objective and subjective numeracy scales measure related but distinct constructs. Due to current uncertainty regarding which construct is more likely to influence the effectiveness of decision support interventions, these findings warrant further investigation to determine the proper use of objective versus subjective numeracy assessments in medical decision-making research. Pending additional information, a reasonable approach is to measure both objective and subjective numeracy so that the full range of actual and perceived numeracy skills can be taken into account.
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Affiliation(s)
- James G Dolan
- Department of Public Health Sciences, University of Rochester, Rochester, NY (JGD, OAC, NC, PJV)
| | - Olena A Cherkasky
- Department of Public Health Sciences, University of Rochester, Rochester, NY (JGD, OAC, NC, PJV)
| | | | - Nancy Chin
- Department of Public Health Sciences, University of Rochester, Rochester, NY (JGD, OAC, NC, PJV)
| | - Peter J Veazie
- Department of Public Health Sciences, University of Rochester, Rochester, NY (JGD, OAC, NC, PJV)
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25
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Wolff K, Chambers L, Bumol S, White RO, Gregory BP, Davis D, Rothman RL. The PRIDE (Partnership to Improve Diabetes Education) Toolkit: Development and Evaluation of Novel Literacy and Culturally Sensitive Diabetes Education Materials. DIABETES EDUCATOR 2015; 42:23-33. [PMID: 26647414 DOI: 10.1177/0145721715620019] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Patients with low literacy, low numeracy, and/or linguistic needs can experience challenges understanding diabetes information and applying concepts to their self-management. The authors designed a toolkit of education materials that are sensitive to patients' literacy and numeracy levels, language preferences, and cultural norms and that encourage shared goal setting to improve diabetes self-management and health outcomes. The Partnership to Improve Diabetes Education (PRIDE) toolkit was developed to facilitate diabetes self-management education and support. METHODS The PRIDE toolkit includes a comprehensive set of 30 interactive education modules in English and Spanish to support diabetes self-management activities. The toolkit builds upon the authors' previously validated Diabetes Literacy and Numeracy Education Toolkit (DLNET) by adding a focus on shared goal setting, addressing the needs of Spanish-speaking patients, and including a broader range of diabetes management topics. Each PRIDE module was evaluated using the Suitability Assessment of Materials (SAM) instrument to determine the material's cultural appropriateness and its sensitivity to the needs of patients with low literacy and low numeracy. Reading grade level was also assessed using the Automated Readability Index (ARI), Coleman-Liau, Flesch-Kincaid, Fry, and SMOG formulas. CONCLUSIONS The average reading grade level of the materials was 5.3 (SD 1.0), with a mean SAM of 91.2 (SD 5.4). All of the 30 modules received a "superior" score (SAM >70%) when evaluated by 2 independent raters. The PRIDE toolkit modules can be used by all members of a multidisciplinary team to assist patients with low literacy and low numeracy in managing their diabetes.
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Affiliation(s)
- Kathleen Wolff
- School of Nursing, Vanderbilt University, Nashville, TN (Ms Wolff)
| | - Laura Chambers
- Department of Epidemiology, University of Washington, Seattle, WA (Ms Chambers)
| | - Stefan Bumol
- Department of Psychology, University of Illinois, Chicago, IL (Dr Bumol)
| | - Richard O White
- Division of Community Internal Medicine, Mayo Clinic, Jacksonville, FL (Dr White)
| | | | - Dianne Davis
- Vanderbilt Diabetes Center, Nashville, TN (Ms Davis)
| | - Russell L Rothman
- Departments of Medicine and Pediatrics, Vanderbilt University, Nashville, TN (Dr Rothman)
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26
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Duell P, Wright D, Renzaho AMN, Bhattacharya D. Optimal health literacy measurement for the clinical setting: A systematic review. PATIENT EDUCATION AND COUNSELING 2015; 98:1295-1307. [PMID: 26162954 DOI: 10.1016/j.pec.2015.04.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 12/05/2014] [Accepted: 04/04/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To identify the optimal measurement instrument for assessing health literacy in a clinical setting. METHODS Seven databases were searched for studies evaluating health literacy instruments used with patients. Standardised systematic review methods were used by two reviewers independently assessing eligibility, extracting data and evaluating study quality. A narrative summary was produced. RESULTS The searches identified 626 articles of which 64 were eligible. Forty-three different health literacy instruments were identified. The quality of these instruments, based on their psychometric properties, varied considerably. The majority of health literacy instruments were found to only assess communicative health literacy of which the numeracy element was often not represented. The NVS instrument was found to be the most practical health literacy instrument to use. CONCLUSION There is an urgent need to develop and psychometrically test a more encompassing health literacy instrument applicable in clinical settings as well as health promotion in general. PRACTICE IMPLICATIONS In the absence of a more comprehensive health literacy instrument, the NVS is a practical instrument to quickly assess for health literacy in a clinical setting.
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Affiliation(s)
- Paul Duell
- University of East Anglia, School of Pharmacy, Norwich Research Park, Norwich, UK.
| | - David Wright
- University of East Anglia, School of Pharmacy, Norwich Research Park, Norwich, UK
| | - Andre M N Renzaho
- School of Social Sciences and Psychology, University of Western Sydney, Sydney, Australia
| | - Debi Bhattacharya
- University of East Anglia, School of Pharmacy, Norwich Research Park, Norwich, UK
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27
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Nguyen TH, Park H, Han HR, Chan KS, Paasche-Orlow MK, Haun J, Kim MT. State of the science of health literacy measures: Validity implications for minority populations. PATIENT EDUCATION AND COUNSELING 2015; 98:S0738-3991(15)30021-5. [PMID: 26275841 PMCID: PMC4732928 DOI: 10.1016/j.pec.2015.07.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 07/07/2015] [Accepted: 07/15/2015] [Indexed: 05/12/2023]
Abstract
OBJECTIVES To review the evidence supporting the validity of health literacy (HL) measures for ethnic minority populations. METHODS PubMed, CINAHL, and PsycINFO databases were searched for HL measures between 1965 and 2013. RESULTS A total of 109HL measures were identified; 37 were non-English HL measures and 72 were English language measures. Of the 72 English language measures, 17 did not specify the racial/ethnic characteristic of their sample. Of the remaining 55 measures, 10 (18%) did not include blacks, 30 (55%) did not include Hispanics, and 35 (64%) did not include Asians in their validation sample. When Hispanic and Asian Americans were included, they accounted for small percentages in the overall sample. Between 2005-2013, a growing number of REALM and TOFHLA translations were identified, and new HL measures for specific cultural/linguistic groups within and outside the United States were developed. CONCLUSIONS While there are a growing number of new and translated HL measures for minority populations, many existing HL measures have not been properly validated for minority groups. PRACTICE IMPLICATIONS HL measures that have not been properly validated for a given population should be piloted before wider use. In addition, improving HL instrument development/validation methods are imperative to increase the validity of these measures for minority populations.
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Affiliation(s)
- Tam H Nguyen
- School of Nursing, Boston College, Chestnut Hill, USA.
| | | | - Hae-Ra Han
- School of Nursing, Johns Hopkins University, Baltimore, USA
| | - Kitty S Chan
- School of Public Health, Johns Hopkins University, Baltimore, USA
| | | | - Jolie Haun
- Center of Innovation on Disability and Rehabilitation Research, James A. Haley VA Hospital, Tampa, USA; Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, USA
| | - Miyong T Kim
- School of Nursing, University of Texas at Austin, Austin, USA
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28
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McNaughton CD, Cavanaugh KL, Kripalani S, Rothman RL, Wallston KA. Validation of a Short, 3-Item Version of the Subjective Numeracy Scale. Med Decis Making 2015; 35:932-6. [PMID: 25878195 DOI: 10.1177/0272989x15581800] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 03/07/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE Efficiency in scale design reduces respondent burden. A brief but reliable measure of numeracy may provide a useful research tool eligible for integration into large epidemiological studies or clinical trials. Our goal was to validate a 3-item version of the Subjective Numeracy Scale (SNS-3). DESIGN AND SETTING We examined 7 separate cross-sectional data sets: patients in the emergency department (n = 208), clinic (n = 205), and hospital (n = 460; n = 2053) and patients with chronic kidney disease (n = 147), with diabetes (n = 318), and on hemodialysis (n = 143). MEASUREMENTS Internal reliability of the SNS-3 was assessed with Cronbach's α. Criterion validity was determined by nonparametric correlations of the SNS-3 with SNS-8 and other measures of numeracy; construct validity was determined by correlations with measures of health literacy and education. RESULTS The SNS-3 had good internal reliability (median Cronbach's α = 0.78) and correlated highly with the full SNS (median ρ = 0.91). The SNS-3 was significantly correlated with other measures of numeracy (e.g., median ρ = 0.57 with the Wide Range Achievement Test 4), health literacy (e.g., median ρ = 0.35 with the Shortened Test of Functional Health Literacy in Adults), and education (median ρ = 0.41), providing good evidence of criterion and construct validity. CONCLUSION The SNS-3 is sufficiently reliable and valid to be used as a measure of subjective numeracy.
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Affiliation(s)
- Candace D McNaughton
- Department of Emergency Medicine (CDM), Vanderbilt University, Nashville, TN, USA
| | - Kerri L Cavanaugh
- Department of Internal Medicine (KLC, SK, RLR), Vanderbilt University, Nashville, TN, USA,Vanderbilt Center for Kidney Disease (KLC), Vanderbilt University, Nashville, TN, USA
| | - Sunil Kripalani
- Department of Internal Medicine (KLC, SK, RLR), Vanderbilt University, Nashville, TN, USA
| | - Russell L Rothman
- Department of Internal Medicine (KLC, SK, RLR), Vanderbilt University, Nashville, TN, USA
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29
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Kripalani S, Goggins K, Nwosu S, Schildcrout J, Mixon AS, McNaughton C, McDougald Scott AM, Wallston KA. Medication Nonadherence Before Hospitalization for Acute Cardiac Events. JOURNAL OF HEALTH COMMUNICATION 2015; 20 Suppl 2:34-42. [PMID: 26513029 PMCID: PMC4705844 DOI: 10.1080/10810730.2015.1080331] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Medication nonadherence increases the risk of hospitalization and poor outcomes, particularly among patients with cardiovascular disease. The purpose of this study was to examine characteristics associated with medication nonadherence among adults hospitalized for cardiovascular disease. Patients in the Vanderbilt Inpatient Cohort Study who were admitted for acute coronary syndrome or heart failure completed validated assessments of self-reported medication adherence (the Adherence to Refills and Medications Scale), demographic characteristics, health literacy, numeracy, social support, depressive symptoms, and health competence. We modeled the independent predictors of nonadherence before hospitalization, standardizing estimated effects by each predictor's interquartile range. Among 1,967 patients studied, 70.7% indicated at least some degree of medication nonadherence leading up to their hospitalization. Adherence was significantly lower among patients with lower health literacy (0.18-point change in adherence score per interquartile range change in health literacy), lower numeracy (0.28), lower health competence (0.30), and more depressive symptoms (0.52) and those of younger age, of non-White race, of male gender, or with less social support. Medication nonadherence in the period before hospitalization is more prevalent among patients with lower health literacy, numeracy, or other intervenable psychosocial factors. Addressing these factors in a coordinated care model may reduce hospitalization rates.
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Affiliation(s)
- Sunil Kripalani
- a Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- b Center for Clinical Quality and Implementation Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- c Center for Health Services Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Kathryn Goggins
- b Center for Clinical Quality and Implementation Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- c Center for Health Services Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Sam Nwosu
- d Department of Biostatistics , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Jonathan Schildcrout
- d Department of Biostatistics , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Amanda S Mixon
- a Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- b Center for Clinical Quality and Implementation Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- c Center for Health Services Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- e Department of Veterans Affairs , Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center , Nashville , Tennessee , USA
| | - Candace McNaughton
- f Department of Emergency Medicine , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Amanda M McDougald Scott
- c Center for Health Services Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- f Department of Emergency Medicine , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- g Department of Biomedical Informatics , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Kenneth A Wallston
- h School of Nursing , Vanderbilt University Medical Center , Nashville , Tennessee , USA
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30
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Fransen MP, Rowlands G, Leenaars KEF, Essink-Bot ML. Self-rated literacy level does not explain educational differences in health and disease. Arch Public Health 2014; 72:14. [PMID: 24872884 PMCID: PMC4036107 DOI: 10.1186/2049-3258-72-14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 02/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although literacy is increasingly considered to play a role in socioeconomic inequalities in health, its contribution to the explanation of educational differences in health has remained unexplored. The aim of this study was to investigate the contribution of self-rated literacy to educational differences in health. METHODS Data was collected from the Healthy Foundation and Lifestyle Segmentation Dataset (n = 4257). Self-rated literacy was estimated by individuals' self-reported confidence in reading written English. We used logistic regression analyses to assess the association between educational level and health (long term conditions and self-rated health). Self-rated literacy and other potential explanatory variables were separately added to each model. For each added variable we calculated the percentage change in odds ratio to assess the contribution to the explanation of educational differences in health. RESULTS People with lower educational attainment level were more likely to report a long term condition (OR 2.04, CI 1.80-2.32). These educational differences could mostly be explained by age (OR decreased by 27%) and could only minimally be explained by self-rated literacy, as measured by self-rated reading skills (OR decreased by 1%). Literacy could not explain differences in cardiovascular condition or diabetes, and only minimally contributed to mental health problems and depression (OR decreased by 5%). The odds of rating ones own health more negatively was higher for people with a low educational level compared to those with a higher educational level (OR 1.83, CI 1.59-2.010), self-rated literacy decreased the OR by 7%. CONCLUSION Measuring self-rated reading skills does not contribute significantly to the explanation of educational differences in health and disease. Further research should aim for the development of objective generic and specific instruments to measure health literacy skills in the context of health care, disease prevention and health promotion. Such instruments are not only important in the explanation of educational differences in health and disease, but can also be used to identify a group at risk of poorer health through low basic skills, enabling health services and health information to be targeted at those with greater need.
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Affiliation(s)
- Mirjam P Fransen
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Gillian Rowlands
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
- Institut for Folkesundhed, Aarhus Universitet, Aarhus, Denmark
| | - Karlijn EF Leenaars
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Marie-Louise Essink-Bot
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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31
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Zhang NJ, Terry A, McHorney CA. Impact of health literacy on medication adherence: a systematic review and meta-analysis. Ann Pharmacother 2014; 48:741-51. [PMID: 24619949 DOI: 10.1177/1060028014526562] [Citation(s) in RCA: 207] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To systematically review the literature and estimate the effect size of the relationship between health literacy and medication adherence through meta-analysis. DATA SOURCES Databases searched included Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982-2013), International Pharmaceutical Abstracts (IPA; 1970-2013), MEDLINE OVID (1966-2013), PubMed (1966-2013), PsycInfo (1966-2013), and Web of Science (1966-2013). STUDY SELECTION AND DATA EXTRACTION Inclusion criteria were as follows: English language; published through May 1, 2013; medication adherence as the outcome variable; use of validated measures of health literacy and medication adherence; availability of a direct (not mediating) relationship between health literacy and medication adherence; and identifiable effect size and statistical significance of the relationship. Exclusion criteria were as follows: duplicated results, irrelevant results, conference abstracts, proceeding papers, books, dissertations, reviews, editorial letters, continuing education units, or book reviews. Data included author, publication year, disease area, sample size, sampling method, location, study design, effect size of the relationship between health literacy and medication adherence, and measures of health literacy and medication adherence. DATA SYNTHESIS There is a small statistically significant and positive association between health literacy and medication adherence. In the conservative results, the unweighted and weighted correlation coefficients were 0.081 and 0.056 with P values <0.001. In the less conservative results, the unweighted and weighted correlation coefficients were 0.088 and 0.072. CONCLUSIONS The relationship between health literacy and medication adherence is statistically significant but weak. It is plausible that health literacy has a mediator relationship with other adherence determinants. Future research should explore such relationships.
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Affiliation(s)
- Ning Jackie Zhang
- College of Health and Public Affairs, University of Central Florida, Orlando, FL, USA
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32
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Schapira MM, Walker CM, Miller T, Fletcher KE, Ganschow PS, Jacobs EA, Imbert D, O'Connell M, Neuner JM. Development and validation of the numeracy understanding in Medicine Instrument short form. JOURNAL OF HEALTH COMMUNICATION 2014; 19 Suppl 2:240-253. [PMID: 25315596 PMCID: PMC4201377 DOI: 10.1080/10810730.2014.933916] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Health numeracy can be defined as the ability to understand and use numeric information and quantitative concepts in the context of health. The authors previously reported the development of the Numeracy Understanding in Medicine Instrument (NUMi), a 20-item test developed using item response theory. The authors now report the development and validation of a short form of the NUMi. Item statistics were used to identify a subset of 8 items representing a range of difficulty and content areas. Internal reliability was evaluated with Cronbach's alpha. Divergent and convergent validity was assessed by comparing scores of the S-NUMI with existing measures of education, print and numeric health literacy, mathematic achievement, cognitive reasoning, and the original NUMi. The 8-item scale had adequate reliability (α=.72) and was strongly correlated to the 20-item NUMi (α=.92). S-NUMi scores were strongly correlated with the Lipkus Expanded Health Numeracy Scale (α=.62), the Wide Range of Achievement Test-Mathematics (α=.72), and the Wonderlic Cognitive Ability Test (α=.76). Moderate correlation was found with education level (α=.58) and print literacy as measured by the Test of Functional Health Literacy in Adults (α=.49). Results show that the short form of the NUMi is a reliable and valid measure of health numeracy feasible for use in clinical and research settings.
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Affiliation(s)
- Marilyn M Schapira
- a Department of Medicine, Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania , USA
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33
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Haun JN, Valerio MA, McCormack LA, Sørensen K, Paasche-Orlow MK. Health literacy measurement: an inventory and descriptive summary of 51 instruments. JOURNAL OF HEALTH COMMUNICATION 2014; 19 Suppl 2:302-333. [PMID: 25315600 DOI: 10.1080/10810730.2014.936571] [Citation(s) in RCA: 245] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This article aimed to provide a descriptive review of the psychometric properties and conceptual dimensions of published health literacy measurement tools. PsycINFO and PubMed search from 1999 through 2013, review of the grey literature, and an environmental scan was conducted to identify health literacy measurement tools. For each tool, we evaluated the conceptual dimensions assessed, test parameters, and psychometric properties. Of the 51 tools identified, 26 measured general health literacy, and 15 were disease or content specific, and 10 aimed at specific populations. Most tools are performance based, require in-person administration, and are exclusively available in a pencil and paper testing mode. The tools assess 0 (proxy measure) to 9 of the 11 defined dimensions of health literacy. Reported administration times vary, from less than 1 to 60 minutes. Validation procedures for most of the tools are limited by inadequate power to ensure reliability across subgroups (i.e., race, age, ethnicity, and gender). The health literacy measurement tools currently available generally represent a narrow set of conceptual dimensions with limited modes of administration. Most of the tools lack information on key psychometric properties. Significant work is needed to establish important aspects of the construct, convergent, and predictive validity for many tools. As researchers develop new measures, inclusion of a full range of conceptual dimensions of health literacy, more representative sampling for testing, and additional modes of administration will allow a more refined and flexible approach to research in this field.
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Affiliation(s)
- Jolie N Haun
- a Veterans Health Administration, HSR&D Center of Innovation for Disability and Rehabilitation Research , James A. Haley VA Hospital
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