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Park S, Kim DD. Patient-Provider Communication and Access, Use, and Financial Burden of Care. Am J Prev Med 2024:S0749-3797(24)00230-7. [PMID: 39002888 DOI: 10.1016/j.amepre.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 07/15/2024]
Abstract
INTRODUCTION Effective patient-provider communication is a critical component of optimal patient care, but its potential impact on the delivery of healthcare services remains unclear. This study examines the association of patient-provider communication with access to care, healthcare utilization, and financial burden of care. METHODS Using the 2013-2021 Medical Expenditure Panel Survey longitudinal data, the level of patient-provider communication was measured across four domains (attentive listening, clear explanation, respectfulness, and time allocation) as a primary independent variable, categorized into low, moderate, and high. A lagged dependent model was employed to examine the associations of patient-provider communication at baseline with subsequent access to care, healthcare utilization, and financial burden of care, controlling for baseline sample characteristics and outcomes measured at the baseline. Analysis was conducted in February 2024. RESULTS Among 28,955 analytic samples (representing 709,547,678 U.S. adults), 5.3%, 50.2%, and 44.3% reported low, moderate, and high levels of patient-provider communication. Marginalized populations, including racial/ethnic minorities, those with low education and income, and those lacking insurance, were more likely to report low patient-provider communication. Compared with adults with high patient-provider communication, those with low patient-provider communication were more likely to encounter difficulties in accessing medical care (2.6 percentage points; 95% CI: 1.2-3.9), experience delays in obtaining necessary medical care (2.8 percentage points; 1.3-4.4), have emergency room visits (4.2 percentage points; 1.9-6.4), and face difficulties paying medical bills (4.0 percentage points; 2.2-5.8) in the subsequent year. CONCLUSIONS Encouraging effective patient-provider communication is essential for advancing patient-centered care and mitigating health inequities.
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Affiliation(s)
- Sungchul Park
- Department of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea; L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - David D Kim
- Department of Medicine and Public Health Sciences, Division of Biological Sciences, University of Chicago, Chicago, Illinois.
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Lough M, Whiston H, Saunders GH. The impact of using the Ida "My Hearing Explained" tool on audiologists' language and patient understanding of hearing test results: a comparison with standard audiogram explanations. Int J Audiol 2024:1-10. [PMID: 38824465 DOI: 10.1080/14992027.2024.2358432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 05/17/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVE Explore the impact of Ida's "My Hearing Explained" (MHE) tool on audiologists' language and patients' understanding/interpretation of hearing test results. DESIGN Audiologists were video-recorded in two sequential conditions: 1) giving standard audiogram explanations to 13 patients and, 2) following discretionary self-training, giving explanations using the MHE tool (nine patients). Outcomes of interest were audiologists' language complexity, use of jargon, and audiologist-patient interactivity. Semi-structured patient interviews, conducted 1-7 days after appointments, were analysed using inductive qualitative content analysis. Patient recall was verified. STUDY SAMPLE Four audiologists from one United Kingdom audiology service, and 22 patients (mean age 63.5 yrs) participated. RESULTS In comparison to standard audiogram explanations, audiologists' language was simpler and audiologist-patient interactivity greater with the MHE tool. Interview data analysis revealed differences between explanation types within the themes of "Understanding" and "Interpretation." 54% (standard audiogram) and 22% (MHE tool) of patients expressed a desire for takeaway information. 31% (standard audiogram) and 67% (MHE tool) of patients reported their explanation helped them relay their results to others. Four patients (one receiving the MHE tool) incorrectly recalled information, suggesting inadequate understanding in these cases. CONCLUSIONS The MHE tool has potential for improving the accessibility and comprehensibility of hearing test results.
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Affiliation(s)
- Melanie Lough
- Manchester Centre for Audiology and Deafness, School of Health Sciences, The University of Manchester, UK
| | - Helen Whiston
- Manchester Centre for Audiology and Deafness, School of Health Sciences, The University of Manchester, UK
| | - Gabrielle H Saunders
- Manchester Centre for Audiology and Deafness, School of Health Sciences, The University of Manchester, UK
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Jiang Y, Wu Y, Deng Q, Zhou R, Jin Q, Qian S, Jin S, Tung TH, Ji W, Zhang M. Using teach-back in patient education to improve patient satisfaction and the clarity of magnetic resonance imaging. PATIENT EDUCATION AND COUNSELING 2024; 123:108195. [PMID: 38340632 DOI: 10.1016/j.pec.2024.108195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/26/2023] [Accepted: 02/05/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE To explore the effects of using the teach-back method prior to contrast-enhanced magnetic resonance imaging (MRI) on patients' knowledge and satisfaction as well as the clarity of the resulting scans. METHODS A total of 254 patients who underwent contrast-enhanced MRI examination from July 4, 2022 to September 19, 2022 were enrolled and assigned to the intervention and control groups. Patients in the intervention group received education using the teach-back method, while those in the control group were given routine health education. A questionnaire that included patients' knowledge of contrast-enhanced MRI examination was answered before and after patient education. Data on patient satisfaction with nursing services were also collected. The clarity of the MRI images of all patients was assessed. RESULTS The scores of knowledge related to MRI after receiving education were significantly higher than those before receiving education (P < 0.001), and there were no significant differences between the intervention and control groups (11.27 ± 9.74 vs. 12.07 ± 8.71, P = 0.498). The score of satisfaction with nursing service in the teach-back group was significantly higher than that in the control group (39.82 ± 0.86 vs. 38.59 ± 3.73, P < 0.001), as was the image clarity score (96.4 ± 0.5 vs. 95.0 ± 0.4, P = 0.039). CONCLUSION Teach-back improves patient satisfaction and contrast-enhanced MRI clarity. PRACTICE IMPLICATIONS Including teach-back in patient education improves patient satisfaction and contrast-enhanced MRI clarity.
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Affiliation(s)
- Yingying Jiang
- Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang, China
| | - Yitian Wu
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang 312000, China
| | - Qilong Deng
- Department of Physiatry, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang, China
| | - Rongzhen Zhou
- Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang, China
| | - Qiaoqiao Jin
- Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang, China
| | - Shuangshuang Qian
- Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang, China
| | - Shengze Jin
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang 312000, China
| | - Tao-Hsin Tung
- Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang, China
| | - Wenbin Ji
- Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang, China; Key Laboratory of Evidence-based Radiology of Taizhou, Linhai 317000, Zhejiang, China.
| | - Meixian Zhang
- Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang, China; Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang, China; Key Laboratory of Evidence-based Radiology of Taizhou, Linhai 317000, Zhejiang, China.
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Yen RW, Hagedorn R, Durand MA, Leyenaar JK, O'Malley AJ, Saunders CH, Isaacs T, Elwyn G. Clinician-Spoken Plain Language in Health Care Encounters: A Qualitative Analysis to Assess Measurable Elements. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:663-672. [PMID: 38412476 DOI: 10.1097/acm.0000000000005666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
PURPOSE Good communication and use of plain language in health care encounters improve outcomes, including emotional health, symptom resolution, and functional status. Yet there is limited research on how to measure and report spoken plain language, which is the use of familiar, clear language. The authors aimed to describe key, measurable elements of spoken plain language that can be assessed and reported back to clinicians for self-reflection. METHOD The authors conducted secondary analysis of transcripts from recorded encounters between breast cancer surgeons and patients with early-stage breast cancer. Two coders used a hybrid qualitative analysis with a framework based on U.S. Federal Plain Language Guidelines. To develop major themes, they examined (1) alignment with the Guidelines and (2) code frequencies within and across transcripts. They also noted minor themes. RESULTS From 74 transcripts featuring 13 surgeons, the authors identified 2 major themes representing measurable elements of spoken plain language: (1) clinicians had a propensity to use both explained and unexplained medical terms, and (2) clinicians delivered information using either short turns (one unit of someone speaking) with 1 topic or long turns with multiple topics. There were 3 minor themes that were not indicative of whether or not clinicians used spoken plain language. First, clinicians regularly used absolute risk communication techniques. Second, question-asking techniques varied and included open-ended, close-ended, and comprehension checks. Third, some clinicians used imagery to describe complex topics. CONCLUSIONS Clinicians' propensity to use medical terms with and without explanation and parse encounters into shorter or longer turns are measurable elements of spoken plain language. These findings will support further research on the development of a tool that can be used in medical education and other settings. This tool could provide direct and specific feedback to improve the plain language practices of clinicians in training and beyond.
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Fenta ET, Kidie AA, Tiruneh MG, Anagaw TF, Bogale EK, Dessie AA, Worku NK, Amera MG, Tesfa H, Limenh LW, Delie AM, Ayal BG. Exploring barriers of health literacy on non-communicable disease prevention and care among patients in north wollo zone public hospitals; Northeast, Ethiopia, 2023: application of socio-ecological model. BMC Public Health 2024; 24:971. [PMID: 38581006 PMCID: PMC10998356 DOI: 10.1186/s12889-024-18524-8] [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: 11/04/2023] [Accepted: 04/04/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Health literacy is the important for the prevention of non-communicable disease to make informed health decisions, and practice healthy and protective behaviours. Therefore, application of socioecological model to this study aimed to identify multilevel factors on health literacy among patients and develop scientific health communication interventional strategies to improve health literacy on non-communicable disease prevention and care. OBJECTIVE To explore barriers of health literacy on non-communicable disease prevention and care among patients in north wollo zone public Hospitals, Northeast Ethiopia, 2023. METHOD In this study phenomenological study design was conducted from February 5 to 30/2023.We have used purposive sampling technique to select study participants from chronic follow up clinics. Data were collected using in-depth interview and focused group discussion in which audio was recorded, transcribed verbatim and translated to English. Thematic analysis was performed with atlas ti. 7 software. RESULT In this study four main themes with seven subthemes were developed. The main themes were factors at the organizational, community, interpersonal, and intra-personal factors. The poor knowledge, lack of enough money for transportation and medication at the hospital were identified as barrier to get early diagnosis and treatment. Some participants explored that they have no any support from family or others. The cultural norms like weeding and funeral ceremonies enforce patients to consume prohibited substances like alcohol and salty foods. CONCLUSION In this study different barriers of health literacy were explored. Lack of knowledge, economic problems, lack of social support, poor communication with health care providers, cultural influences, lack of regular health education, lack of access to health care services and poor infrastructure were main barriers of health literacy in patients with NCD. Therefore, we recommended all concerned bodies to work on social and behavioral change communication intervention focusing on awareness creation, supply of drugs and create supportive environment to get accessible and affordable health care service to decrease the impact of non-communicable disease at personal, community and national level.
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Affiliation(s)
- Eneyew Talie Fenta
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia.
| | - Atitegeb Abera Kidie
- Department of Public Health, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Misganaw Guadie Tiruneh
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadele Fentabel Anagaw
- Department of Health Promotion and Behavioral Science, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Eyob Ketema Bogale
- Department of Health Promotion and Behavioral Science, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Amanuel Addisu Dessie
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Nigus Kassie Worku
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Mastewal Giza Amera
- Department of Public Health, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Hiwot Tesfa
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | | | - Amare Mebrate Delie
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Birtukan Gizachew Ayal
- Department of Public Health, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
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Al-Bitar KM, Garcia JM, Han S, Guentsch A. Association between periodontal health status and quality of life: a cross-sectional study. FRONTIERS IN ORAL HEALTH 2024; 5:1346814. [PMID: 38333564 PMCID: PMC10850382 DOI: 10.3389/froh.2024.1346814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/03/2024] [Indexed: 02/10/2024] Open
Abstract
Introduction Attachment loss due to periodontal diseases is associated with functional limitations as well as physical pain and psychological discomfort, which may lead to a reduced quality of life. The purpose of this study is to determine if the oral health status, specifically the periodontal status, influences oral health-related quality of life. Materials and methods Survey data were collected in a US dental school clinical setting in a cross-sectional study. Quality of life related to oral health was assessed with the Oral Health Impact Profile-49 (OHIP-49). In addition, DMFT index, periodontal status, and health literacy scores (dental and medical health literacy) were recorded, and the data of n = 97 subjects were statistically analyzed. Results The DMFT index of the study population was 14.98 ± 6.21 (D: 4.72 ± 4.77; M: 3.19 ± 3.46; F: 7.12 ± 4.62). Of the subjects, 44% were identified as periodontitis cases. These periodontitis cases demonstrated significantly higher OHIP-49 scores (66.93 ± 30.72) than subjects without signs of periodontal diseases (NP) (32.40 ± 19.27, p < 0.05). There was also a significant difference between NP patients and patients with gingivitis (66.24 ± 46.12, p < 0.05). It was found that there was a statistically significant difference between Stage 3 (severe) periodontitis and periodontal health (p = 0.003). Pearson correlations were completed, and positive relationships were found with OHIP-49 and DMFT (0.206, p < 0.05), and periodontal risk self-assessment (0.237, p < 0.05). Age [odds ratio (OR) 4.46], smoking (OR 2.67), and the presence of mobile teeth (OR 2.96) are associated with periodontitis. Conclusions Periodontal diseases may negatively impact the oral health-related quality of life. Patients suffering from periodontitis also showed more missing teeth, which might influence function. Age and smoking are associated with a higher prevalence of periodontitis. A good general health literacy was no guarantee for having an adequate oral literacy.
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Affiliation(s)
- Kinan M. Al-Bitar
- Private Practitioner, Waukesha, WI, United States
- Department of Surgical and Diagnostic Sciences, Marquette University School of Dentistry, Milwaukee, WI, United States
| | | | - Shengtong Han
- Department of General Dental Sciences, Marquette University School of Dentistry, Milwaukee, WI, United States
| | - Arndt Guentsch
- Department of Surgical and Diagnostic Sciences, Marquette University School of Dentistry, Milwaukee, WI, United States
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Pham TV, Doorley J, Kenney M, Joo JH, Shallcross AJ, Kincade M, Jackson J, Vranceanu AM. Addressing chronic pain disparities between Black and White people: a narrative review of socio-ecological determinants. Pain Manag 2023; 13:473-496. [PMID: 37650756 PMCID: PMC10621777 DOI: 10.2217/pmt-2023-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/10/2023] [Indexed: 09/01/2023] Open
Abstract
A 2019 review article modified the socio-ecological model to contextualize pain disparities among different ethnoracial groups; however, the broad scope of this 2019 review necessitates deeper socio-ecological inspection of pain within each ethnoracial group. In this narrative review, we expanded upon this 2019 article by adopting inclusion criteria that would capture a more nuanced spectrum of socio-ecological findings on chronic pain within the Black community. Our search yielded a large, rich body of literature composed of 174 articles that shed further socio-ecological light on how chronic pain within the Black community is influenced by implicit bias among providers, psychological and physical comorbidities, experiences of societal and institutional racism and biomedical distrust, and the interplay among these factors. Moving forward, research and public-policy development must carefully take into account these socio-ecological factors before scaling up pre-existing solutions with questionable benefit for the chronic pain needs of Black individuals.
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Affiliation(s)
- Tony V Pham
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - James Doorley
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Martha Kenney
- Department of Anesthesiology, Duke University Medical Centre, Durham, NC 27710, USA
| | - Jin Hui Joo
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Amanda J Shallcross
- Wellness & Preventative Medicine, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Michael Kincade
- Center for Alzheimer's Research & Treatment, Massachusetts Alzheimer's Disease Research Centre, Boston, MA 02129, USA
| | - Jonathan Jackson
- Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
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Zhang X, Buttery SC, Sterniczuk K, Brownrigg A, Kennington E, Quint JK. Patient Experiences of Communication with Healthcare Professionals on Their Healthcare Management around Chronic Respiratory Diseases. Healthcare (Basel) 2023; 11:2171. [PMID: 37570411 PMCID: PMC10418967 DOI: 10.3390/healthcare11152171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Communication is an important clinical tool for the prevention and control of diseases, to advise and inform patients and the public, providing them with essential knowledge regarding healthcare and disease management. This study explored the experience of communication between healthcare professionals (HCPs) and people with long-term lung conditions, from the patient perspective. METHODS This qualitative study analyzed the experience of people with chronic lung disease, recruited via Asthma & Lung UK (A&LUK) and COPD research databases. A&LUK invited people who had expressed a desire to be involved in research associated with their condition via their Expert Patient Panel and associated patients' groups. Two focus group interviews (12 participants) and one individual interview (1 participant) were conducted. Thematic analysis was used for data analysis. RESULTS Two main themes were identified and we named them 'involving communication' and 'communication needs to be improved. 'They included seven subthemes: community-led support increased the patients' social interaction with peers; allied-HCP-led support increased patients' satisfaction; disliking being repeatedly asked the same basic information; feeling communication was unengaging, lacking personal specifics and the use of medical terminology and jargon. CONCLUSIONS The study has identified what most matters in the process of communication with HCPs in people with long-term respiratory diseases of their healthcare management. The findings of the study can be used to improve the patient-healthcare professional relationship and facilitate a better communication flow in long-term healthcare management.
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Affiliation(s)
- Xiubin Zhang
- National Heart and Lung Institute, Imperial College London, London SW7 2BX, UK; (X.Z.); (S.C.B.)
| | - Sara C. Buttery
- National Heart and Lung Institute, Imperial College London, London SW7 2BX, UK; (X.Z.); (S.C.B.)
| | | | | | | | - Jennifer K. Quint
- National Heart and Lung Institute, Imperial College London, London SW7 2BX, UK; (X.Z.); (S.C.B.)
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Connell L, Finn Y, Sixsmith J. Health literacy education programmes developed for qualified health professionals: a scoping review. BMJ Open 2023; 13:e070734. [PMID: 36997248 PMCID: PMC10069593 DOI: 10.1136/bmjopen-2022-070734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES Both literature and policy have identified the need for health literacy education for qualified health professionals. This study aimed to identify and map health literacy competencies and health literacy related communication skills educational interventions for qualified health professionals. The research questions included: Of the qualified health professional education interventions identified, which are focused on diabetes care? What health literacy competencies and health literacy related communication skills are integrated into each programme? What are the characteristics of each education programme? What were the barriers and facilitators to implementation? What methods are used to evaluate intervention effectiveness, if any? DESIGN Scoping review, informed by the Joanna Briggs Institute guidelines. DATA SOURCES The following databases: OVID; CINAHL; Cochrane; EMBASE; ERIC: PsycInfo; RIAN; Pro-Quest; UpToDate were searched. ELIGIBILITY CRITERIA Articles were included if the education programme focused on qualified health professionals, in all clinical settings, treating adult patient populations, of all study types. DATA EXTRACTION AND SYNTHESIS Two authors independently screened titles, abstracts and full text articles that met the inclusion criteria. The third author mediated any discrepancies. The data were extracted and charted in table format. RESULTS In total, 53 articles were identified. One article referred to diabetes care. Twenty-six addressed health literacy education, and 27 addressed health literacy related communication. Thirty-five reported using didactic and experiential methods. The majority of studies did not report barriers (N=45) or facilitators (N=52) to implementation of knowledge and skills into practice. Forty-nine studies evaluated the reported education programmes using outcome measures. CONCLUSIONS This review mapped existing education programmes regarding health literacy and health literacy related communication skills, where programme characteristics were identified to inform future intervention development. An evident gap was identified regarding qualified health professional education in health literacy, specifically in diabetes care.
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Affiliation(s)
- Lauren Connell
- Health Promotion Research Centre (HPRC), University of Galway, Galway, Ireland
- Alliance for Research and Innvoation in Wounds (ARIW), University of Galway, Galway, Ireland
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, University of Galway, Galway, Ireland
| | - Yvonne Finn
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, University of Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Jane Sixsmith
- Health Promotion Research Centre (HPRC), University of Galway, Galway, Ireland
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, University of Galway, Galway, Ireland
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Montenegro JLZ, da Costa CA, da Rosa Righi R, Farias ER, Matté LB. Development and Validation of Conversational Agent to Pregnancy Safe-education. J Med Syst 2023; 47:7. [PMID: 36626106 DOI: 10.1007/s10916-022-01903-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/14/2022] [Indexed: 01/11/2023]
Abstract
Pregnant women constantly need some information to support nutritional decisions during pregnancy, and many do not receive such assistance at all. This study aims to present a conversational agent to provide reliable information to pregnant women, focusing on nutritional education and evaluating the perception of pregnant women and health professionals about the agent. As a scientific contribution, this article developed and implemented a conversational agent in a real environment capable of generating reliable responses on the basis of a set of health documents. We proposed an intervention study with 25 women and 10 healthcare providers through a survey to measure the perceptions of these groups towards conversational agents. The results show that the intended design could ensure positive support for pregnant women, clarify certain issues for the public, and remove some knowledge barriers. The results showed no significant difference between the groups (p-value = 0.713). Depending on the perception of the pregnant group, the conversational agent model can teach new knowledge during the prenatal period (Mean = 4.56). The model presented for health professionals could already be indicated as a support tool for pregnant women (Mean = 4.7).
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Affiliation(s)
- João Luis Zeni Montenegro
- Software Innovation Laboratory - SOFTWARELAB, Programa de Pós-Graduação em Computação Aplicada, Universidade do Vale do Rio dos Sinos - Unisinos, Av. Unisinos 950, São Leopoldo, RS, 93022-000, Brazil
| | - Cristiano André da Costa
- Software Innovation Laboratory - SOFTWARELAB, Programa de Pós-Graduação em Computação Aplicada, Universidade do Vale do Rio dos Sinos - Unisinos, Av. Unisinos 950, São Leopoldo, RS, 93022-000, Brazil.
| | - Rodrigo da Rosa Righi
- Software Innovation Laboratory - SOFTWARELAB, Programa de Pós-Graduação em Computação Aplicada, Universidade do Vale do Rio dos Sinos - Unisinos, Av. Unisinos 950, São Leopoldo, RS, 93022-000, Brazil
| | - Elson Romeu Farias
- School of Public Health of the State Health Secretariat of RS, Universidade Luterana do Brasil - Ulbra, Canoas, Brazil
| | - Lara Balen Matté
- Software Innovation Laboratory - SOFTWARELAB, Programa de Pós-Graduação em Computação Aplicada, Universidade do Vale do Rio dos Sinos - Unisinos, Av. Unisinos 950, São Leopoldo, RS, 93022-000, Brazil
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Zubiri-Esnaola H, Racionero-Plaza S, Fernández-Villardón A, Carbonell S. "It was Very Liberating". Dialogic Literary Gatherings Supporting Mental Health Literacy. Community Ment Health J 2022; 59:869-880. [PMID: 36572742 DOI: 10.1007/s10597-022-01071-0] [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: 09/27/2022] [Accepted: 12/08/2022] [Indexed: 12/28/2022]
Abstract
Mental health is being reframed as a fundamental right for all people, and mental health literacy is a tool that can enable patients to gain the knowledge, personal skills, and confidence to take action to improve their mental health, and their lives overall. This exploratory study analysed the power of dialogic literary gatherings (DLGs) to foster it in a group of patients with mental health disorders who gathered for 1 h once a week to share their readings of literature masterpieces. During the year-long study, a total of 140 patients participated in the DLGs in groups of 12 to 15 people. Results suggest that DLGs promoted the development of the participants' mental health literacy and produced gains in emotional and social wellbeing by strengthening reading, speaking, and listening skills, fostering supportive relations, contributing to overcoming stigma, and enhancing agency. The transferability of DLGs to mental health care is discussed.
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Affiliation(s)
- Harkaitz Zubiri-Esnaola
- Department of Language and Literature Didactics, University of the Basque Country UPV/EHU, San Sebastian, Spain
| | | | | | - Sara Carbonell
- Faculty of Education, University of Girona, Girona, Spain
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Thominet L, Hamel LM, Baidoun F, Moore TF, Barton E, Heath EI, Carducci M, Lansey D, Eggly S. Physicians' use of plain language during discussions of prostate cancer clinical trials with patients. PATIENT EDUCATION AND COUNSELING 2022; 105:3453-3458. [PMID: 36085183 PMCID: PMC9675686 DOI: 10.1016/j.pec.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/25/2022] [Accepted: 09/01/2022] [Indexed: 05/10/2023]
Abstract
OBJECTIVE This study described physicians' use of plain language during patient-physician cancer clinical trial discussions. METHODS Video-recorded clinical interactions and accompanying transcripts were taken from a larger study of communication and clinical trials (PACCT). Interactions (n = 25) were selected if they included invitations to participate in a clinical trial. We used descriptive, qualitative discourse analysis, a method that identifies language patterns at or above the sentence level. We first excerpted discussions of clinical trials, then identified instances of plain language within those discussions. Finally, we inductively coded those instances to describe physicians' plain language practices. RESULTS The analysis identified four plain language practices. Lexical simplification replaced medical terminology with simpler words. Patient-centered definition named, categorized, and explained complex medical terminology. Metaphor explained medical terminology by comparing it with known concepts. Finally, experience-focused description replaced medical terminology with descriptions of patients' potential physical experiences. CONCLUSION These plain language practices hold promise as part of effective information exchange in discussions of cancer clinical trials. Testing is needed to identify patient preferences and the extent to which these practices address patient health literacy needs. PRACTICE IMPLICATIONS Pending further testing, these plain language practices may be integrated into physician clinical trial and other communication training.
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Affiliation(s)
- Luke Thominet
- Department of English, Floria International University, Miami, FL, USA.
| | - Lauren M Hamel
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, USA.
| | - Fatmeh Baidoun
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, USA.
| | - Tanina F Moore
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, USA.
| | - Ellen Barton
- Linguistics Program, Department of English, Wayne State University, Detroit, USA.
| | - Elisabeth I Heath
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, USA.
| | - Michael Carducci
- Johns Hopkins Medicine/Sidney Kimmel Comprehensive Cancer Center, Baltimore, USA.
| | - Dina Lansey
- Johns Hopkins Medicine/Sidney Kimmel Comprehensive Cancer Center, Baltimore, USA.
| | - Susan Eggly
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, USA.
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13
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Naperola-Johnson J, Gutierrez J, Doyle K, Thompson J, Hendrix C. Implementation of health literacy training for clinicians in a federally qualified health center. PEC INNOVATION 2022; 1:100083. [PMID: 37213779 PMCID: PMC10194109 DOI: 10.1016/j.pecinn.2022.100083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 08/30/2022] [Accepted: 09/13/2022] [Indexed: 05/23/2023]
Abstract
Objective The objective of this quality improvement project was to evaluate the effectiveness of a succinct health literacy training for providers at a demanding federally qualified health center. Methods One group, pretest-posttest design was used to measure for a change in knowledge regarding the effects of limited health literacy, a change in self-reported measure of routine screening for limited health literacy and a change in self-reported utilization of patient-centered communication techniques. Results The average percentage of correct responses on the Health Literacy Knowledge Check showed significant improvement from 23.6% (SD = 18.1%) to 63.9% (SD = 25.3%), p < .001. There were no significant changes in median responses at pre- and post-intervention for self-reported use of screening and communication techniques (all p > .05). Conclusion This brief training was effective at improving participants' knowledge of health literacy but did not improve use of recommended communication techniques or screening for health literacy. The results suggest that emphasizing a universal precautions approach to health literacy may be more effective with participants who work in high-volume clinics. Practice implications For high-volume clinics, a brief training may improve participants' knowledge but does not increase use of actual communication techniques based on self-report.
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Affiliation(s)
- Jacqueline Naperola-Johnson
- School of Nursing, Duke University school of nursing, Durham, United States
- Corresponding author at: 511 Constitution Dr, Durham, NC 27705, United States.
| | - Jose Gutierrez
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, United States
| | - Kathryn Doyle
- School of Nursing, Duke University school of nursing, Durham, United States
| | - Julie Thompson
- School of Nursing, Duke University school of nursing, Durham, United States
| | - Cristina Hendrix
- School of Nursing, Duke University school of nursing, Durham, United States
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14
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Finbråten HS, Nowak P, Griebler R, Bíró É, Vrdelja M, Charafeddine R, Griese L, Bøggild H, Schaeffer D, Link T, Kucera Z, Mancini J, Pelikan JM. The HLS 19-COM-P, a New Instrument for Measuring Communicative Health Literacy in Interaction with Physicians: Development and Validation in Nine European Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11592. [PMID: 36141865 PMCID: PMC9517091 DOI: 10.3390/ijerph191811592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Sufficient communicative health literacy (COM-HL) is important for patients actively participating in dialogue with physicians, expressing their needs and desires for treatment, and asking clarifying questions. There is a lack of instruments combining communication and HL proficiency. Hence, the aim was to establish an instrument with sufficient psychometric properties for measuring COM-HL. METHODS The HLS19-COM-P instrument was developed based on a conceptual framework integrating HL with central communicative tasks. Data were collected using different data collection modes in nine countries from December 2019 to January 2021 (n = 18,674). Psychometric properties were assessed using Rasch analysis and confirmatory factor analysis. Cronbach's alpha and Person separation index were considered for reliability. RESULTS The 11-item version (HLS19-COM-P-Q11) and its short version of six items (HLS19-COM-P-Q6) fit sufficiently the unidimensional partial credit Rasch model, obtained acceptable goodness-of-fit indices and high reliability. Two items tend to under-discriminate. Few items displayed differential item functioning (DIF) across person factors, and there was no consistent pattern in DIF across countries. All items had ordered response categories. CONCLUSIONS The HLS19-COM-P instrument was well accepted in nine countries, in different data collection modes, and could be used to measure COM-HL.
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Affiliation(s)
- Hanne Søberg Finbråten
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, P.O. Box 400, 2418 Elverum, Norway
| | - Peter Nowak
- Competence Centre for Health Promotion and Health System, Austrian National Public Health Institute, A-1010 Vienna, Austria
| | - Robert Griebler
- Competence Centre for Health Promotion and Health System, Austrian National Public Health Institute, A-1010 Vienna, Austria
| | - Éva Bíró
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4028 Debrecen, Hungary
| | - Mitja Vrdelja
- Communication Unit, National Institute of Public Health, Trubarjeva 2, 1000 Ljubljana, Slovenia
| | - Rana Charafeddine
- Department of Public Health and Epidemiology, Sciensano, 1050 Brussels, Belgium
| | - Lennert Griese
- Interdisciplinary Centre for Health Literacy Research [ICHL], School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
| | - Henrik Bøggild
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
| | - Doris Schaeffer
- Interdisciplinary Centre for Health Literacy Research [ICHL], School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
| | - Thomas Link
- Department of Quality Measurement and Patient Survey, Austrian National Public Health Institute, A-1010 Vienna, Austria
| | - Zdenek Kucera
- Czech Health Literacy Institute, Sokolská 490/31, 120 00 Prague, Czech Republic
| | - Julien Mancini
- Aix Marseille University, APHM INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society Group, Ligue 2019 Accredited Team, F-13009 Marseille, France
| | - Jürgen M. Pelikan
- WHO-CC Health Promotion in Hospitals and Health Care, Austrian National Public Health Institute, A-1010 Vienna, Austria
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15
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Miller AN, Bharathan A, Duvuuri VNS, Navas V, Luceno L, Zraick R, Atmakuri S, Schmidt-Owens M, Deichen M, Ayers T, Thrash K. Use of seven types of medical jargon by male and female primary care providers at a university health center. PATIENT EDUCATION AND COUNSELING 2022; 105:1261-1267. [PMID: 34489148 DOI: 10.1016/j.pec.2021.08.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/10/2021] [Accepted: 08/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The purposes of this study were to investigate extent and type of jargon use among primary care providers at a university health center, to evaluate the association of jargon use with patient outcomes, and to identify differences in jargon use between male and female providers. METHOD The study employed a causal comparative design. Audio recordings of 87 primary care interviews were transcribed and coded using Pitt and Hendrickson's seven-category medical jargon classification framework. RESULTS Nearly 80% of appointments included at least one instance of unexplained jargon, with an average of more than four uses of jargon per visit. The most frequently used types of jargon were technical terminology and medical vernacular. Acronyms and abbreviations, medicalized English, and unnecessary synonyms were also regularly used. Just under half of distinct jargon terms were explained. Male providers used nearly 50% more jargon per minute than female providers, and they used more technical jargon than did their female colleagues. However, they explained that jargon just as frequently as female providers. CONCLUSIONS Whereas previous studies have frequently limited the operational definition of jargon to two or three types, the comprehensive typology proposed by Pitt and Hendrickson provides a useful tool for identifying a wide range of jargon usage. Future research should examine the outcomes of this range of jargon types in more varied, less educated patient populations, and across different types of healthcare providers. PRACTICE IMPLICATIONS With jargon used on average more than once every four minutes in our sample, and only half of jargon terms explained, medical jargon may be more of a problem even in primary care contexts than providers themselves realize. Male providers especially may want to make efforts to become more conscious of their jargon use and take care to explain terms, in an effort to facilitate more effective patient-provider communication and improved patient outcomes.
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Affiliation(s)
- Ann Neville Miller
- University of Central Florida, 12405 Aquarius Agora Drive, Orlando, FL 32816, United States.
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16
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The HoPE Model Architecture: a Novel Approach to Pregnancy Information Retrieval Based on Conversational Agents. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2022; 6:253-294. [PMID: 35411331 PMCID: PMC8985747 DOI: 10.1007/s41666-022-00115-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 01/26/2022] [Accepted: 02/16/2022] [Indexed: 10/28/2022]
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17
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Blake Gornall A, Hutchinson AM, Redley B. Clinician perspectives of pregnant women's participation in antiemetic decision-making: A qualitative study. Nurs Health Sci 2022; 24:54-64. [PMID: 35174947 DOI: 10.1111/nhs.12930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/30/2022] [Accepted: 02/07/2022] [Indexed: 11/30/2022]
Abstract
This study explored clinician perceptions of women's participation in decision-making about antiemetic treatments during pregnancy, and the suitability of the five Choosing Wisely questions to increase women's involvement. The qualitative interpretive descriptive design used semi-structured interviews to capture data. Participants were six obstetricians and six midwives experienced in providing care for pregnant women seeking support for nausea and vomiting at a single private, obstetrician-led maternity health service in Australia. Thematic analysis revealed four themes that captured clinician perspectives about women's participation in decision-making about antiemetic treatments: (i) information gathering; (ii) developing an understanding; (iii) using knowledge; and (iv) making decisions. Clinician attitudes and perspectives, as well as their self-reported styles of communication and negotiation, influenced how they engaged with women during decision-making. While unfamiliar with the five Choosing Wisely questions, almost all participants considered them potentially useful, but for other clinicians. Strategies to actively involve women in decision-making about antiemetics were inconsistently used. The five Choosing Wisely questions may provide a useful tool for clinicians, but further research is needed to better understand women's perspectives and clinician-related barriers to shared decision-making.
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Affiliation(s)
| | - Alison M Hutchinson
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia.,Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia.,Monash Health, Clayton, Victoria, Australia
| | - Bernice Redley
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia.,Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia.,Monash Health, Clayton, Victoria, Australia
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18
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Lenhart PD, Lambert SR. Current management of infantile cataracts. Surv Ophthalmol 2022; 67:1476-1505. [DOI: 10.1016/j.survophthal.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
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19
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Aysola J, Clapp JT, Sullivan P, Brennan PJ, Higginbotham EJ, Kearney MD, Xu C, Thomas R, Griggs S, Abdirisak M, Hilton A, Omole T, Foster S, Mamtani M. Understanding Contributors to Racial/Ethnic Disparities in Emergency Department Throughput Times: a Sequential Mixed Methods Analysis. J Gen Intern Med 2022; 37:341-350. [PMID: 34341916 PMCID: PMC8811086 DOI: 10.1007/s11606-021-07028-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 07/08/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ensuring equitable care remains a critical issue for healthcare systems. Nationwide evidence highlights the persistence of healthcare disparities and the need for research-informed approaches for reducing them at the local level. OBJECTIVE To characterize key contributors in racial/ethnic disparities in emergency department (ED) throughput times. DESIGN We conducted a sequential mixed methods analysis to understand variations in ED care throughput times for patients eventually admitted to an emergency department at a single academic medical center from November 2017 to May 2018 (n=3152). We detailed patient progression from ED arrival to decision to admit and compared racial/ethnic differences in time intervals from electronic medical record time-stamp data. We then estimated the relationships between race/ethnicity and ED throughput times, adjusting for several patient-level variables and ED-level covariates. These quantitative analyses informed our qualitative study design, which included observations and semi-structured interviews with patients and physicians. KEY RESULTS Non-Hispanic Black as compared to non-Hispanic White patients waited significantly longer during the time interval from arrival to the physician's decision to admit, even after adjustment for several ED-level and patient demographic, clinical, and socioeconomic variables (Beta (average minutes) (SE): 16.35 (5.8); p value=.005). Qualitative findings suggest that the manner in which providers communicate, advocate, and prioritize patients may contribute to such disparities. When the race/ethnicity of provider and patient differed, providers were more likely to interrupt patients, ignore their requests, and make less eye contact. Conversely, if the race/ethnicity of provider and patient were similar, providers exhibited a greater level of advocacy, such as tracking down patient labs or consultants. Physicians with no significant ED throughput disparities articulated objective criteria such as triage scores for prioritizing patients. CONCLUSIONS Our findings suggest the importance of (1) understanding how our communication style and care may differ by race/ethnicity; and (2) taking advantage of structured processes designed to equalize care.
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Affiliation(s)
- Jaya Aysola
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA. .,Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA. .,Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA. .,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA.
| | - Justin T Clapp
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA.,Department of Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Patricia Sullivan
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Patrick J Brennan
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Eve J Higginbotham
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA.,Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Matthew D Kearney
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Chang Xu
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA.,Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Rosemary Thomas
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Sarah Griggs
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Mohamed Abdirisak
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA.,Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Alec Hilton
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA.,Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Toluwa Omole
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA.,Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Sean Foster
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mira Mamtani
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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20
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Connell L, Finn Y, Dunne R, Sixsmith J. Health literacy education programmes developed for qualified health professionals: a scoping review protocol. HRB Open Res 2022; 4:97. [PMID: 35280849 PMCID: PMC8881692 DOI: 10.12688/hrbopenres.13386.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: Health literacy education, for health professionals, has been identified as having the potential to improve patient outcomes and has been recognized as such in policy developments. Health literacy, as a relational concept, encompasses individuals’ skills and how health information is processed in relation to the demands and complexities of the surrounding environment. Focus has been predominantly on the dimension of functional health literacy (reading, writing and numeracy), although increasing emphasis has been placed on interactive and critical domains. Such dimensions often guide the development of health professional education programmes, where the aim is to enhance the patient-practitioner relationship, and ultimately reduce the health literacy burden experienced by patients navigating health services. Currently little is known about qualified health professionals’ education in health literacy and communication skills, and development, implementation or evaluation of such interventions. Aim: To identify and map current educational interventions to improve health literacy competencies and communication skills of qualified health professionals. Methods: A scoping review will be conducted drawing on methods and guidance from the Joanna Briggs Institute, and will be reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. This study will retrieve literature on health professional education for health literacy and communication skills through a comprehensive search strategy in the following databases: CINAHL; Medline (Ovid); the Cochrane Library; EMBASE; ERIC; UpToDate; PsycINFO. Grey literature will be searched within the references of identified articles; Lenus; ProQuest E-Thesis Portal; RIAN and OpenGrey. A data charting form will be developed with categories including: article details, demographics, intervention details, implementation and evaluation methods. Conclusion: Little is known about the extent and nature of the current evidence base therefore a scoping review will be conducted, in order to identify programme characteristics in relation to health literacy competencies and communication skills.
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Affiliation(s)
- Lauren Connell
- Discipline of Health Promotion, National University of Ireland, Galway, Galway, Ireland
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, National University of Ireland, Galway, Galway, Ireland
- Alliance for Research and Innovation in Wounds (ARIW), National University of Ireland, Galway, Galway, Ireland
| | - Yvonne Finn
- Discipline of Health Promotion, National University of Ireland, Galway, Galway, Ireland
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, National University of Ireland, Galway, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Galway, Ireland
| | - Rosie Dunne
- James Hardiman Library, National University of Ireland, Galway, Galway, Ireland
| | - Jane Sixsmith
- Discipline of Health Promotion, National University of Ireland, Galway, Galway, Ireland
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, National University of Ireland, Galway, Galway, Ireland
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21
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Schillinger D, Duran ND, McNamara DS, Crossley SA, Balyan R, Karter AJ. Precision communication: Physicians' linguistic adaptation to patients' health literacy. SCIENCE ADVANCES 2021; 7:eabj2836. [PMID: 34919437 PMCID: PMC8682984 DOI: 10.1126/sciadv.abj2836] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 10/29/2021] [Indexed: 05/27/2023]
Abstract
Little quantitative research has explored which clinician skills and behaviors facilitate communication. Mutual understanding is especially challenging when patients have limited health literacy (HL). Two strategies hypothesized to improve communication include matching the complexity of language to patients’ HL (“universal tailoring”); or always using simple language (“universal precautions”). Through computational linguistic analysis of 237,126 email exchanges between dyads of 1094 physicians and 4331 English-speaking patients, we assessed matching (concordance/discordance) between physicians’ linguistic complexity and patients’ HL, and classified physicians’ communication strategies. Among low HL patients, discordance was associated with poor understanding (P = 0.046). Physicians’ “universal tailoring” strategy was associated with better understanding for all patients (P = 0.01), while “universal precautions” was not. There was an interaction between concordance and communication strategy (P = 0.021): The combination of dyadic concordance and “universal tailoring” eliminated HL-related disparities. Physicians’ ability to adapt communication to match their patients’ HL promotes shared understanding and equity. The ‘Precision Medicine’ construct should be expanded to include the domain of ‘Precision Communication.’
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Affiliation(s)
- Dean Schillinger
- UCSF Division of General Internal Medicine and Heath Communications Research Program at the Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Nicholas D. Duran
- School of Social and Behavioral Sciences, Arizona State University, Glendale, AZ, USA
| | | | - Scott A. Crossley
- Department of Applied Linguistics/ESL, College of Arts and Sciences, Georgia State University, Atlanta, GA, USA
| | - Renu Balyan
- Department of Mathematics, Computer and Information Science, State University of New York, Old Westbury, NY, USA
| | - Andrew J. Karter
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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22
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Connell L, Finn Y, Dunne R, Sixsmith J. Health literacy education programmes developed for qualified health professionals: a scoping review protocol. HRB Open Res 2021; 4:97. [DOI: 10.12688/hrbopenres.13386.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: Health professional education for health literacy has been identified as having the potential to improve patient outcomes and has been recognized as such in policy developments. Health literacy is an emerging concept encompassing individuals’ skills and how health information is processed in relation to the demands and complexities of the surrounding environment. Focus has been predominantly on the dimension of functional health literacy (reading, writing and numeracy), although increasing emphasis has been placed on interactive and critical domains. Such dimensions can guide the development of health professional education programmes and bridge the gap in the interaction between health professionals and their patients. Currently little is known about qualified health professional’s education for health literacy, its development, implementation or evaluation. Aim: To identify and map current educational interventions to improve health literacy competencies and communication skills of qualified health professionals. Methods: A scoping review will be conducted drawing on methods and guidance from the Joanna Briggs Institute, and will be reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. This study will retrieve literature on health professional education for health literacy through a comprehensive search strategy in the following databases: CINAHL; Medline (Ovid); the Cochrane Library; EMBASE; ERIC; UpToDate; PsycINFO and Central Register of Controlled Trials (CENTRAL). Grey literature will be searched within the references of identified articles: Lenus; ProQuest E-Thesis Portal; the HSE health research repository and RIAN. A data charting form will be developed with categories agreed by the research team, including: article details, demographics, intervention details, implementation and evaluation methods. Conclusion: Little is known about the extent and nature of the current evidence base therefore in order to identify programmes and consolidate their demographics and characteristics within health literacy competencies and communication skills, a scoping review is warranted.
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23
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Boateng MA, Agyei-Baffour E, Angel S, Asare O, Prempeh B, Enemark U. Co-creation and prototyping of an intervention focusing on health literacy in management of malaria at community-level in Ghana. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:55. [PMID: 34353378 PMCID: PMC8340491 DOI: 10.1186/s40900-021-00302-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 07/22/2021] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Collaborating with end-users to develop interventions tailored to fit unique circumstances is proposed as a way to improve relevance and effectiveness of an intervention. This study used a local needs driven approach to develop a health literacy intervention for caregivers in Ghana concerning management of malaria in children under 5 years. METHOD For the period, November 2017-February 2019, we carried out the study using a three-phase framework including: 1) Needs assessment based on data from questionnaires, focus groups, individual interviews and observations, 2) Co-creation of a board game and brochures for health education at Child Welfare Clinics to address needs in health literacy concerning malaria and 3) Development of a prototype of the game, brochures as well as determining feasibility. In addition to the research team, health administrators, community health workers, designers and caregivers contributed to the development of the intervention. FINDINGS The needs assessment contributed to the development of interactive and useful materials including a board game and brochures, to help bridge the gaps in health literacy among caregivers. Co-creation of the materials and prototyping yielded a varying sense of ownership among stakeholders. End-users' engagement and participation in developing the intervention resulted in a high interest and adherence to interventions. However, high attrition rates of health workers and caregivers' inconsistent use of the Child Welfare Clinics challenged sustainability of this intervention. CONCLUSION Co-creation led to an interactive intervention. The interactive nature of the board game and brochures resulted in a better caregiver-health provider relationship and a sense of recognition of a more participatory approach to health delivery. We recommend co-creation as an approach to develop needs-driven interventions in a context like Ghana. Still, a stronger buy-in at the top-level of health management would improve sustainability and reach a larger audience.
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Affiliation(s)
| | - Eter Agyei-Baffour
- Department of Health Policy, Management and Economics, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sanne Angel
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Ofeibea Asare
- Career Development Centre, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Benjamin Prempeh
- Department of Communication Design, College of Art and Built Environment, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ulrika Enemark
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
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Baumeister A, Chakraverty D, Aldin A, Seven ÜS, Skoetz N, Kalbe E, Woopen C. "The system has to be health literate, too" - perspectives among healthcare professionals on health literacy in transcultural treatment settings. BMC Health Serv Res 2021; 21:716. [PMID: 34289853 PMCID: PMC8293586 DOI: 10.1186/s12913-021-06614-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 06/08/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Effective communication is a central aspect of organizational health literacy. Healthcare professionals are expected to ensure an effective and satisfactory flow of information and to support their patients in accessing, understanding, appraising, and applying health information. This qualitative study aimed to examine the health literacy-related challenges, needs, and applied solutions of healthcare professionals when engaging with persons with a migrant background. Based on the integrated model of health literacy (Sørensen et al., BMC Public Health 12:80, 2012), we focused on environmental, personal, and situational factors that shape health literacy in transcultural treatment settings. METHODS We conducted five focus group discussions with healthcare professionals (N = 31) who are in regular contact with persons with a migrant background. Discussions were transcribed verbatim and analyzed using qualitative content analysis by applying a deductive-inductive categorization procedure. Deductive categories were derived from the integrated model of health literacy. RESULTS Challenges included a mismatch in the provision and use of health services. Participants regarded easily accessible services and outreach counselling as helpful solutions. Further challenges were the migrant patients' distrust in healthcare professionals and the German healthcare system, the participants' uncertainty in dealing with patients' expectations and needs, and the patients' non-compliance with appointments. Environmental factors included systemic lack of time and economic pressure. Both were reported as impeding the flow of information in all treatment settings. Participants with a migrant background themselves (n = 16) regarded this personal factor as an opportunity that increased patients' trust in them. They also reported challenges such as high levels of responsibility felt when ad hoc interpreting for colleagues. CONCLUSIONS Known issues observed in the delivery of healthcare for the majority population (i.e., systemic lack of time, economic pressure) appear to be intensified in the context of migration. An increasingly diverse patient clientele indicates a growing need for culture-sensitive, health-literate healthcare organizations. A corresponding diversity of the health workforce is desirable and should be strengthened by national finance and educational programs. Healthcare professionals who interpret for colleagues should be given the necessary time. Further studies are needed to develop appropriate interventions for improving health literacy at individual and organizational levels. Funding for interpreting services should be expanded.
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Affiliation(s)
- Annika Baumeister
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (CERES), University of Cologne and Research Unit Ethics, Faculty of Medicine and University Hospital Cologne, 50931, Cologne, Germany.
| | - Digo Chakraverty
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937, Cologne, Germany
| | - Angela Aldin
- Evidence-Based Internal Medicine, Department I of Internal Medicine and Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935, Cologne, Germany
| | - Ümran Sema Seven
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937, Cologne, Germany
| | - Nicole Skoetz
- Evidence-Based Internal Medicine, Department I of Internal Medicine and Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935, Cologne, Germany
| | - Elke Kalbe
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937, Cologne, Germany
| | - Christiane Woopen
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (CERES), University of Cologne and Research Unit Ethics, Faculty of Medicine and University Hospital Cologne, 50931, Cologne, Germany
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Taylor DJ, Jones L, Edwards L, Crabb DP. Patient-reported outcome measures in ophthalmology: too difficult to read? BMJ Open Ophthalmol 2021; 6:e000693. [PMID: 34212114 PMCID: PMC8208024 DOI: 10.1136/bmjophth-2020-000693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/30/2021] [Indexed: 12/14/2022] Open
Abstract
Objective Patient-reported outcome measures (PROMs) are commonly used in clinical trials and research. Yet, in order to be effective, a PROM needs to be understandable to respondents. The aim of this cross-sectional analysis was to assess reading level of PROMs validated for use in common eye conditions. Methods and analysis Readability measures determine the level of education a person is expected to have attained to be able to read a passage of text; this was calculated using the Flesch-Kincaid Grade Level, FORCAST and Gunning-Fog tests within readability calculations software package Oleander Readability Studio 2012.1. Forty PROMs, previously validated for use in at least one of age-related macular degeneration, glaucoma and/or diabetic retinopathy, were identified for inclusion via a systematic literature search. The American Medical Association (AMA) and National Institutes of Health (NIH) recommend patient materials should not exceed a sixth-grade reading level. Number of PROMs exceeding this level was calculated. Results Median (IQR) readability scores were 7.9 (5.4-10.5), 9.9 (8.9-10.7) and 8.4 (6.9-11.1) for Flesch-Kincaid Grade Level, FORCAST and Gunning-Fog test, respectively. Depending on metric used, this meant 61% (95% CI 45% to 76%), 100% (95% CI 91% to 100%) and 80% (95% CI 65% to 91%) exceeded the recommended threshold. Conclusion Most PROMs commonly used in ophthalmology require a higher reading level than that recommended by the AMA and NIH and likely contain questions that are too difficult for many patients to read. Greater care is needed in designing PROMs appropriate for the literacy level of a population.
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Affiliation(s)
- Deanna J Taylor
- Optometry and Visual Sciences, City University of London, London, UK
| | - Lee Jones
- Optometry and Visual Sciences, City University of London, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Laura Edwards
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - David P Crabb
- Optometry and Visual Sciences, City University of London, London, UK
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Bennett G, Richmond J, Thompson AJ. Producing health information in consultation with health workers and the hepatitis B-affected communities is worthwhile. Aust J Prim Health 2021; 27:116-121. [PMID: 33583486 DOI: 10.1071/py20188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/13/2020] [Indexed: 11/23/2022]
Abstract
Globally, approximately 257 million people are living with chronic hepatitis B. Many people are undiagnosed, have low health literacy and experience barriers to engaging in care. In Australia, there is a lack of culturally and linguistically appropriate resources to support people living with the infection to increase their understanding and build their capacity. This innovative practice paper describes the process of developing a culturally and linguistically appropriate resource using the principles of participatory action research. The hepatitis B story was designed to facilitate discussion between healthcare workers and consumers, and to increase the knowledge and understanding of both. Consultation with consumers and a broad range of health services contributed to the quality of and demand for the resource. A case study tells the story of 'Thuy'. This case study demonstrates the practical application of the resource and describes the positive affect its use had on Thuy and her family. Increasing our understandings of how people experience chronic hepatitis B is crucial to improving health information, testing and engagement in care. Producing health information with consumers is a worthwhile process to increase consumers' health literacy and improve service delivery.
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Affiliation(s)
- Gabrielle Bennett
- Department of Gastroenterology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Vic. 3065, Australia; and Corresponding author. Emails: ,
| | - Jacqueline Richmond
- The Burnet Institute, Disease Elimination, Commercial Road, Melbourne, Vic. 3000, Australia; and La Trobe University, The Australian Research Centre in Sex, Health and Society, Bundoora, Vic. 3083, Australia; and Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic. 3000, Australia
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital and Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Vic. 3000, Australia
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Chen AT, Swaminathan A. Factors in the Building of Effective Patient-Provider Relationships in the Context of Fibromyalgia. PAIN MEDICINE 2021; 21:138-149. [PMID: 30980668 PMCID: PMC6953340 DOI: 10.1093/pm/pnz054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective Fibromyalgia patients face particular challenges in building relationships with health care providers. In this study, we examine, from patients’ perspectives, factors that influence the formation of effective patient–provider relationships. Design This research employed a qualitative approach to analyze data collected from a study that employed semistructured interviews. Methods Multiple methods were used to recruit 23 fibromyalgia patients for interviews. Semistructured interviews were conducted to explore how participants’ information behaviors, including their communication with and relationships to providers, changed over time. The interview data were analyzed using a qualitative analytic method based on interpretative phenomenological analysis and constructivist grounded theory. Results We identified three important factors that influenced the building of effective relationships: patients and providers’ interactions involving information, identifying health care providers that fit patients’ needs, and realizing shared responsibilities. With regard to information, we described three important themes: information gaps, providers as educators/facilitators, and collaborative information behavior. Conclusions Understanding of the key elements of relationship development between patients and providers can be utilized in various ways to improve clinical care. First, the knowledge gained in this study can inform the design of patient education materials that assist patients to identify providers that fit their needs, prepare for consultations, and develop realistic expectations for providers. The findings of this study can also inform the design of resources and tools to enable clinicians to communicate and relate better with their patients.
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Affiliation(s)
- Annie T Chen
- Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, Washington, USA
| | - Aarti Swaminathan
- Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, Washington, USA
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Watach AJ, Hwang D, Sawyer AM. Personalized and Patient-Centered Strategies to Improve Positive Airway Pressure Adherence in Patients with Obstructive Sleep Apnea. Patient Prefer Adherence 2021; 15:1557-1570. [PMID: 34285474 PMCID: PMC8286071 DOI: 10.2147/ppa.s264927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/23/2021] [Indexed: 12/12/2022] Open
Abstract
Obstructive sleep apnea (OSA), a common sleep disorder characterized by repeated pauses in breathing during sleep, is effectively treated with positive airway pressure (PAP) therapy. The magnitude of improvements in daily functioning and reduced negative health risks are dependent on maintaining PAP adherence, which is a significant challenge. Evidence-based interventions to improve PAP use are not easily translated to clinical practice because they are labor-intensive and require specialty expertise. Further, to date, individualized care, inclusive of personalized medicine and patient- and person-centered care have been marginally incorporated in the field's understanding of OSA and PAP adherence. This integrative review describes current PAP adherence assessment processes, interventions to improve adherence, and outlines future opportunities to advance the field, particularly as it relates to individualizing care and the use of implementation science to apply evidence to practice.
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Affiliation(s)
- Alexa J Watach
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Correspondence: Alexa J Watach University of Pennsylvania, School of Nursing, Claire Fagin Hall, Rm 349, 418 Curie Blvd, Philadelphia, PA, 19104, USATel +1-717-599-9908 Email
| | - Dennis Hwang
- Kaiser Permanente Southern California, Sleep Medicine and Department of Research and Evaluation, Fontana, CA, USA
| | - Amy M Sawyer
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
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Hickman RL, Clochesy JM, Alaamri M. Effects of an eHealth Intervention on Patient-Provider Interaction and Functional Health Literacy in Adults With Hypertension. SAGE Open Nurs 2021; 7:23779608211005863. [PMID: 33997280 PMCID: PMC8083006 DOI: 10.1177/23779608211005863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/17/2021] [Accepted: 03/09/2021] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Hypertension is a life-limiting, chronic condition affecting millions of Americans. Modifiable factors, quality of the patient-provider interaction and functional health literacy, have been linked to effective hypertension self-management. However, there has been limited interventional research targeting these modifiable factors. Electronic hypertension self-management interventions, in particular those incorporating virtual simulation, may positively influence the quality of the patient-provider interaction and functional health literacy status of adults with hypertension. Yet there is a dearth of evidence examining the efficacy of eHealth interventions targeting these modifiable factors of hypertension self-management. OBJECTIVE Evaluate the effects of two electronic hypertension self-management interventions on the quality of the patient-provider interaction and functional health literacy in adults with hypertension. METHODS A convenience sample of community-dwelling adults (>18 years) with hypertension were recruited and randomized to an avatar-based simulation (eSMART-HTN) or a video presentation on hypertension self-management (attention control). Participants were administered questionnaires to capture demographic characteristics, the quality of the patient-provider interaction, and functional health literacy. Questionnaire data were collected at baseline, and then monthly across three months. Two separate repeated measures analysis of covariance models were conducted to assess the effects of the interventions across the time points. RESULTS The sample included 109 participants who were predominately middle-aged and older, nonwhite, and female. Scores for the quality of the patient-provider interaction demonstrated significant within-group changes across time. However, there were no significant differences in the quality of the patient-provider interaction or functional health literacy scores between experimental conditions while adjusting for covariates. CONCLUSION An avatar-based simulation (eSMART-HTN) intervention proved to have a positive effect on patient-provider interaction compared to an attention control condition. Although the results are promising, future research is needed to optimize the effectiveness of eSMART-HTN and enhance its efficacy and scalability in a larger cohort of adults with hypertension.
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Affiliation(s)
- Ronald L. Hickman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, United States
| | - John M. Clochesy
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, United States
| | - Marym Alaamri
- School of Nursing, King AbdulAziz University, Jeddah, Saudi Arabia
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Forner D, Ungar G, Meier J, Hong P. Oral literacy in pediatric otolaryngology surgical consultations amongst parents with high levels of decisional conflict. Int J Pediatr Otorhinolaryngol 2020; 138:110269. [PMID: 32741748 DOI: 10.1016/j.ijporl.2020.110269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/18/2020] [Accepted: 07/19/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Oral literacy is an important aspect of physician and patient/family communication. Adequate communication is essential in the shared decision-making process and is inherently important in pediatric surgical consultations where parents must make decisions for their children. The aim of this study was to describe oral literacy in pediatric otolaryngology consultations and how it may relate to shared decision-making in a cohort of parents experiencing significant decisional conflict. METHODS Thirty-six parent/patient-physician interactions from two pediatric otolaryngology clinics were recorded. Parents completed the Decision Conflict Scale (DCS), and both parents and physicians completed the Shared Decision-making (SDM-Q-9/SDM-Q-Doc) questionnaires. Language complexity was assessed by the Flesch Reading Ease Scale (FRES), the Simple Measure of Gobbledygook (SMOG) Readability Formula, and a series of grammar statistics. The Pearson product-moment was used to examine the correlation between measures. RESULTS The mean age of parents was 32.3 (mother) and 34.8 (father) years, with the majority having a college education or greater (77.8%). The mean DCS score was 85.8 (range 56-100), and all parents reported clinically significant conflict scores (DCS score > 25). Physicians spoke at a higher-grade level (mean difference SMOG 1.2 (95% CI: 0.8-1.6)), with more words per sentence (mean difference 3.7 (95% CI: 2.4-4.9)), and longer words (mean difference 0.1 (95% CI: 0.03-0.16)). Parents who had higher language complexity experienced less decisional conflict (SMOG vs DCS, r = -0.471, p = 0.004; words per sentence, r = -0.414, p = 0.012; word length, r = -0.419, p = 0.011), but there was no correlation between physician language complexity and DCS or SDM-Q-9 scores. CONCLUSION Physicians demonstrated higher language complexity than that of parents in this study. Differences in language complexity between physicians and parents do not appear to play a substantial role in decisional conflict or the perception of shared decision-making in general. However, parents who use a more complex vocabulary may experience less conflict.
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Affiliation(s)
- David Forner
- IWK Health Centre, Halifax, Nova Scotia, Canada; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Gilanders Ungar
- IWK Health Centre, Halifax, Nova Scotia, Canada; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeremy Meier
- Primary Children's Hospital, Salt Lake City, UT, USA; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Paul Hong
- IWK Health Centre, Halifax, Nova Scotia, Canada; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Radiation therapist health literacy training: Does learning alternate communication methods translate into improved confidence in patient interactions? Radiography (Lond) 2020; 26:220-226. [DOI: 10.1016/j.radi.2019.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/17/2019] [Accepted: 12/02/2019] [Indexed: 11/17/2022]
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van den Muijsenbergh M, Gingnagel D, Duijnhoven T, Dees M. “Ik weet niet wat lock-down betekent”. HUISARTS EN WETENSCHAP 2020; 63:46-48. [PMID: 32836342 PMCID: PMC7334625 DOI: 10.1007/s12445-020-0783-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Meer dan 2 miljoen Nederlanders hebben moeite met lezen en schrijven. Zij hebben stress omdat ze informatie niet altijd begrijpen. Zeker nu, in corona-tijd. Huisartsen vinden het moeilijk om begrijpelijke uitleg te geven. Daarom hebben we dit artikel geschreven. Zodat huisartsen zien hoe ze over corona kunnen praten met makkelijke woorden. Huisartsen kunnen de terugvraag-methode gebruiken. Zo weten ze of de patiënt de informatie begrepen heeft. Het artikel zelf schreven we in makkelijke taal. Met korte zinnen, zonder moeilijke woorden en met koppel-tekens. Als voorbeeld dat het goed kan om makkelijke woorden te gebruiken.
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Affiliation(s)
- Maria van den Muijsenbergh
- Huisarts, hoogleraar Gezondheidsverschillen en persoonsgerichte integrale eerstelijnszorg, Radboudumc, afdeling Eerstelijnsgeneeskunde, Nijmegen, Nederland
| | | | - Thea Duijnhoven
- Senior adviseur en projectleider participatie en eigen regie, Pharos, expertisecentrum gezondheidsverschillen, Utrecht, Nederland
| | - Marianne Dees
- Huisarts, wetenschappelijk onderzoeker, Radboudumc, afdeling Eerstelijnsgeneeskunde, Nijmegen, Nederland
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Harnagea H, Couturier Y, Lamothe L, Emami E. [Integrating oral health care services into primary care in Quebec]. SANTE PUBLIQUE 2020; 31:809-816. [PMID: 32550663 DOI: 10.3917/spub.196.0809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Although integrated care is drawing considerable attention from health care policy makers, little is known about integration of oral health care services into primary care in Quebec. Therefore, the objective of this study was to compile information and compare the aspects of primary oral health care in two public health care organizations. METHOD An environmental scan was carried out in one rural and one urban primary health care organizations in Quebec. Data were collected from organizations' websites, operational documents, observational notes on facility visits, primary care meeting minutes, online pages of professional orders and face to face interviews (N = 74) and focus groups (N = 5), between November 2016 and October 2018. Thematic and Prior's documentation analyses were used to analyse the data. RESULTS Three themes were identified: normative aspects of integrated care delivery, integration trajectories, and integration initiatives. In both organizations, the integration of oral health into primary care rooted in public health sectors and dental teams were the key players. While urban center showed informal linkages between dental and non-dental primary care providers, the rural organization succeeded in coordination processes, even though these were also informal. CONCLUSION The majority of primary oral health care services are delivered in the public health sectors and the sustainability of integration initiatives in other primary health care sectors remains to be demonstrated. A better management of resources, as well as partnerships between public health care organizations and universities, could contribute to this integration.
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Wong HM, Bridges SM, Ma KW, Yiu CKY, McGrath CP, Zayts OA. Advanced informatics understanding of clinician-patient communication: A mixed-method approach to oral health literacy talk in interpreter-mediated pediatric dentistry. PLoS One 2020; 15:e0230575. [PMID: 32196519 PMCID: PMC7083275 DOI: 10.1371/journal.pone.0230575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 03/03/2020] [Indexed: 12/30/2022] Open
Abstract
Background In the clinical dental consultation, multi-party configurations predominate with the presence of parents/ primary caregivers in pediatric dentistry adding another layer of complexity. In managing child oral healthcare, parents/ primary caregivers are critical, especially in dental caries prevention. This study aimed (1) to identify the structure of oral health literacy (OHL) talk in interpreter-mediated pediatric dentistry and (2) to analyze interpreter contributions to the communication strategies: patient-centered direct interpreting (PC-DI), patient-centered mediated interpreting (PC-MI), clinician-centered direct interpreting (CC-DI), and clinician-centered mediated interpreting (CC-MI). Methods Visual text analysis (VTA) of video recorded pediatric clinical consultations in Hong Kong utilized Discursis™ software to illustrate temporal and topical structures and their distribution across turns-at-talk. Conversation analysis (CA) was applied to analyze turn-taking of the identified OHL talk qualitatively. The mixed-method approach of combining VTA and CA was applied to analyze the patterns and features of the recorded OHL talk. Results The conceptual recurrences of the 77 transcribed video recordings were plotted visually. CC- and PC-OHL talk were identified by the recurrence patterns of monochromatic and multi-colored triangular clusters formed by off-diagonal boxes, respectively. CA of interpreter-mediated turns supported earlier findings regarding patterns of MI in multilingual adult dental consultations; however, the role of the interpreter in parent/ primary caregiver education and patient management was more distinctive in the pediatric dentistry. Conclusions The mixed-method approach assisted in unpacking the complexities of the multi-party interactions, supported identification of effective communication strategies, and illustrated the roles of the dental professionals in initiating CC- and PC-OHL talk in pediatric dentistry. The intervention showed the implication of the professional education of evidence-based practices for clinicians in balancing agenda management and the communicative dimension of OHL with the help of VTA and CA in multilingual consultations.
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Affiliation(s)
- Hai Ming Wong
- Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
- * E-mail:
| | - Susan Margaret Bridges
- Faculty of Education/Centre for the Enhancement of Teaching and Learning, The University of Hong Kong, Hong Kong SAR, China
| | - Kuen Wai Ma
- Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Cynthia Kar Yung Yiu
- Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | | | - Olga A. Zayts
- School of English, Faculty of Arts, The University of Hong Kong, Hong Kong SAR, China
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Rudd RE. Health Literacy Considerations for a New Cancer Prevention Initiative. THE GERONTOLOGIST 2020; 59:S7-S16. [PMID: 31100142 PMCID: PMC6524755 DOI: 10.1093/geront/gnz032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Indexed: 11/17/2022] Open
Abstract
Cancer prevention efforts are newly focused on the older adult population. Adult literacy and health literacy findings and suggestions can help shape more efficacious health communication strategies and thereby increase the “accessibility” of important health information and the potential for healthful action. National and international surveys of adult literacy skills have consistently offered problematic findings that older adults have more limited proficiencies than do younger working adults and face difficulties using commonly available materials to accomplish everyday tasks. Clinical as well as population-based studies of health literacy similarly find limited health literacy among a majority of U.S. adults and even poorer health literacy among older adults. This is of concern because health literacy studies have established clear links between limited literacy and poor health outcomes as well as diminished participation in activities related to disease prevention. Literacy experts note difficulties associated with abstract concepts and with sophisticated numeracy tasks, both associated with disease prevention. Health literacy findings and insights are important considerations in the development of health messages and materials to promote cancer prevention among older adults.
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Affiliation(s)
- Rima E Rudd
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Kamimura A, Higham R, Rathi N, Panahi S, Lee E, Ashby J. Patient-Provider Relationships Among Vulnerable Patients: The Association With Health Literacy, Continuity of Care, and Self-Rated Health. J Patient Exp 2020; 7:1450-1457. [PMID: 33457601 PMCID: PMC7786733 DOI: 10.1177/2374373519895680] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
While the patient–provider relationship is one factor that can improve access to primary care for underserved populations, vulnerable patients often experience challenges to have a good relationship with providers. The purpose of this study is to examine factors that affect patient–provider relationship among vulnerable patients; in particular, among uninsured primary care patients. This study focused on health literacy, continuity of care, and self-rated health as predictors of patient–provider relationship. A self-administered survey was collected from uninsured primary care patients utilizing a free clinic in the metropolitan area in the Rocky Mountain Region in the United States from May to July in 2018. Higher levels of health literacy and continuity of care are associated with a better patient–provider relationship. Better self-rated health is associated with better patient–provider relationship. Health literacy may improve by the communication and connection with a specific provider because patients better understand the care and/or medications that are being prescribed. Seeing the same provider helps patients develop a better relationship and make clinical decisions in a way that they prefer. Improving the patient–provider relationship can potentially change health outcomes positively for vulnerable patients. Informing patients that they can request a specific medical provider may allow them to increase continuity of care, and improve communication, partnering, connection, and patient centeredness, leading to an increase in health literacy and better self-rated health.
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Affiliation(s)
| | | | | | | | - Edward Lee
- University of Utah, Salt Lake City, UT, USA
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Fahmi B, Fitrina K, Supriyati S. Who are the actual beneficiaries of health promotion? An evaluation of health promotion scope in Yogyakarta. BIO WEB OF CONFERENCES 2020. [DOI: 10.1051/bioconf/20202805005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Healthy lifestyle media campaign is one of health promotion method that offers a challenge in evaluation. Healthy lifestyle media campaign doesn’t usually result in behaviour change because the changing needs times and provision of other interventions. This study was trying to evaluate a healthy lifestyle media campaign developed by District Health Office of Yogyakarta using the RE-AIM framework. The mixed method study consists of a quantitative approach to describe the reach of media campaigns and the qualitative approach to describe public perception of media campaign effectiveness. This study’s total sample is 288 respondents (32+ 11 y.o; 57.56 % women) consists of community, cadres, and students. The data were collected through survey, in-depth interviews and focus group discussions. Healthy lifestyle media have not been able to reach all respondents. Nine from 11 produced media were not known by more than 60 % respondents. Respondents describe media distribution, media placement, media competition and channel suitability as the factors that affect their familiarity with healthy lifestyle media campaign. Not all media could reach enough target in the community. Health promoter should take notice on the media’s ability to reach specific targets when developing the media campaign.
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Mitchell KM, Holtz BE, McCarroll A. Patient-Centered Methods for Designing and Developing Health Information Communication Technologies: A Systematic Review. Telemed J E Health 2019; 25:1012-1021. [PMID: 30576258 DOI: 10.1089/tmj.2018.0236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background: Chronic disease management and maintaining healthy behaviors to prevent disease are important lifelong considerations. Adherence to prescribed management and behaviors often falls short of physician recommendations, which can result in negative health outcomes. Information communication technologies (ICTs) offer an approach to combat this issue. However, uptake and sustainability of ICTs have mixed results. One reason could be that technologies are often created without an understanding of the complexities of patient needs. Therefore, the intent of this study is to explore the current landscape of patient-centered design and development of health ICTs through a systematic review. Materials and Methods: Systematic literature searches were conducted in the databases EBSCO, PubMed, and Web of Science between October 2016 and February 2017. Each paper was critically evaluated for each data extraction classification, and was categorized based on the chronic disease or health focus, method of patient-centered design, resulting themes, and use of theory. Results: The study search resulted in 3,748 articles total. After duplicates and articles not meeting criteria were removed, 57 articles were selected for assessment. Four main themes emerged: participant experience, technological requirements, behavioral and knowledge components, and social components. Conclusions: Adhering to chronic disease management and healthy behaviors are both crucial to attain positive health outcomes. ICTs can play an interesting role in aiding disease management and healthy behavior promotion, but involving end-users and applying a theoretical foundation in the design and development of these technologies should be considered.
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Affiliation(s)
- Katharine M Mitchell
- Department of Advertising and Public Relations, Michigan State University, East Lansing, Michigan
| | - Bree E Holtz
- Department of Advertising and Public Relations, Michigan State University, East Lansing, Michigan
| | - Alexis McCarroll
- Department of Media and Information, Michigan State University, East Lansing, Michigan
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Tran S, Bennett G, Richmond J, Nguyen T, Ryan M, Hong T, Howell J, Demediuk B, Desmond P, Bell S, Thompson A. 'Teach-back' is a simple communication tool that improves disease knowledge in people with chronic hepatitis B - a pilot randomized controlled study. BMC Public Health 2019; 19:1355. [PMID: 31647001 PMCID: PMC6813056 DOI: 10.1186/s12889-019-7658-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 09/20/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The low diagnosis rate and poor access to clinical care among people with CHB is a major barrier to reducing HBV-related morbidity and mortality in Australia. One explanation for this is a lack of disease-specific knowledge among people living with CHB. Health literacy has been shown to be important for maximising engagement with medical care and adherence to recommended management. The 'teach-back' communication strategy has been shown to improve patient understanding in other clinical areas. This study aims to assess disease-specific knowledge; and evaluate the efficacy of the teach-back strategy for improving HBV knowledge, compared to a standard medical consultation. METHOD A randomized pilot study was conducted between February and June 2017. Participants were recruited from the liver clinic at an inner-city tertiary hospital. English-speaking patients aged ≥18 years and diagnosed with CHB were eligible for the study. Participants were randomised to a control group (medical specialist appointment) and intervention group (teach-back). Knowledge was assessed at baseline, immediately post-intervention and at one month using a validated questionnaire. Participants in the intervention group received a one-on-one teach-back session about CHB. The main outcome measure was a combined knowledge score of the domains assessed - transmission, natural history, epidemiology and prevention and clinical management. RESULTS Seventy participants were recruited (control n = 32, teach-back n = 38). Mean baseline knowledge score was 19.1 out of 23 with 55 (79%) participants scoring ≥17.3 (defined as high knowledge) (7). Sub-analysis of CHB knowledge domains identified focal deficits concerning transmission and whether HBV is curable. Knowledge scores were found to be positively associated with English proficiency and antiviral treatment experience (p < 0.05). Teach-back was associated with a significant increase in CHB knowledge at early recall (22.5 vs 18.7, p < 0.001) and at 1-month follow-up (21.9 vs 18.7, p < 0.001); there was no improvement in CHB knowledge associated with standard clinical consultant (early recall: 19.6 vs 19.4, p = 0.49, one-month follow-up: 19.5 vs 19.4, p = 0.94). CONCLUSION In a tertiary hospital liver clinic population, baseline knowledge about CHB was good, but there were focal deficits concerning transmission and potential for cure. Teach-back was associated with improvement in CHB knowledge and it is a simple communication tool suitable for incorporation into a standard medical consultation.
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Affiliation(s)
- Sophie Tran
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Level 4 Daly Wing, 35 Victoria Parade, Fitzroy, Victoria 3065 Australia
- The University of Melbourne, Grattan Street, Parkville, Victoria 3010 Australia
| | - Gabrielle Bennett
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Level 4 Daly Wing, 35 Victoria Parade, Fitzroy, Victoria 3065 Australia
- The University of Melbourne, Grattan Street, Parkville, Victoria 3010 Australia
| | - Jacqui Richmond
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Level 4 Daly Wing, 35 Victoria Parade, Fitzroy, Victoria 3065 Australia
- The University of Melbourne, Grattan Street, Parkville, Victoria 3010 Australia
- The Burnet Institute, Disease Elimination, 85 Commercial Road, Prahran, Melbourne, 3004 Australia
| | - Tin Nguyen
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Level 4 Daly Wing, 35 Victoria Parade, Fitzroy, Victoria 3065 Australia
- The University of Melbourne, Grattan Street, Parkville, Victoria 3010 Australia
| | - Marno Ryan
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Level 4 Daly Wing, 35 Victoria Parade, Fitzroy, Victoria 3065 Australia
- The University of Melbourne, Grattan Street, Parkville, Victoria 3010 Australia
| | - Thai Hong
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Level 4 Daly Wing, 35 Victoria Parade, Fitzroy, Victoria 3065 Australia
- The University of Melbourne, Grattan Street, Parkville, Victoria 3010 Australia
| | - Jessica Howell
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Level 4 Daly Wing, 35 Victoria Parade, Fitzroy, Victoria 3065 Australia
- The University of Melbourne, Grattan Street, Parkville, Victoria 3010 Australia
| | - Barbara Demediuk
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Level 4 Daly Wing, 35 Victoria Parade, Fitzroy, Victoria 3065 Australia
- The University of Melbourne, Grattan Street, Parkville, Victoria 3010 Australia
| | - Paul Desmond
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Level 4 Daly Wing, 35 Victoria Parade, Fitzroy, Victoria 3065 Australia
- The University of Melbourne, Grattan Street, Parkville, Victoria 3010 Australia
| | - Sally Bell
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Level 4 Daly Wing, 35 Victoria Parade, Fitzroy, Victoria 3065 Australia
- The University of Melbourne, Grattan Street, Parkville, Victoria 3010 Australia
| | - Alexander Thompson
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Level 4 Daly Wing, 35 Victoria Parade, Fitzroy, Victoria 3065 Australia
- The University of Melbourne, Grattan Street, Parkville, Victoria 3010 Australia
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Ståhl C, Karlsson EA, Sandqvist J, Hensing G, Brouwer S, Friberg E, MacEachen E. Social insurance literacy: a scoping review on how to define and measure it. Disabil Rehabil 2019; 43:1776-1785. [PMID: 31589073 DOI: 10.1080/09638288.2019.1672111] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Sickness insurance and workers' compensation systems decide on peoples' eligibility for benefits, and are commonly based on medical certificates and assessments of work ability. Systems differ in the extent to which they preserve clients' dignity and right to fair assessments. In this article, we define a new concept for studying interactions between individuals and systems: social insurance literacy, which concerns how well people understand the different procedures and regulations in social insurance systems, and how well systems communicate with clients in order to help them understand the system. METHODS The concept was defined through a scoping literature review of related concepts, a conceptual re-analysis in relation to the social insurance field, and a following workshop. RESULTS Five related concepts were reviewed for definitions and operationalizations: health literacy, financial/economic literacy, legal capability/ability, social security literacy, and insurance literacy. CONCLUSIONS Social insurance literacy is defined as the extent to which individuals can obtain, understand and act on information in a social insurance system, related to the comprehensibility of the information provided by the system. This definition is rooted in theories from sociology, social medicine and public health. In the next step, a measure for the concept will be developed based on this review.Implications for rehabilitationSocial insurance literacy is a new concept that is based on theories in sociology, social medicine and public health.It provides conceptual orientation for analyzing factors that may influence different outcomes of peoples' contacts with social insurance systems.The concept is of relevance for rehabilitation professionals since it focuses on how interactions between individuals and systems can influence the rehabilitation process.The study will in the next step develop a measure of social insurance literacy which will have practical applications for rehabilitation professionals.
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Affiliation(s)
- Christian Ståhl
- Department of Behaviour Sciences and Learning, Linköping University, Linköping, Sweden.,HELIX Competence Centre, Linköping University, Linköping, Sweden
| | - Elin A Karlsson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jan Sandqvist
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Gunnel Hensing
- Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sandra Brouwer
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Emilie Friberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Ellen MacEachen
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
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Abstract
Health literacy is a concept discussed in the literature of many disciplines, but the definitions used are varied. Using the Walker and Avant method of concept analysis, the authors explore health literacy in relation to health outcomes-the defining attributes, antecedents, consequences, and empirical referents. In addition, cases are provided that illustrate health literacy in relation to health outcomes. This concept analysis allows for colleagues in nursing to have a better understanding of this concept and facilitates further development of tools to assess and improve health literacy and ultimately improve health outcomes overall.
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Affiliation(s)
- Melanie Sierra
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Rosina Cianelli
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
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Washburn L, Hadden KB, Prince LY, McNeill C, Moon Z. Development and Implementation of the How to Talk to Your Doctor HANDbook Health Literacy Program in Rural Counties. Health Lit Res Pract 2019; 3:e205-e215. [PMID: 31511846 PMCID: PMC6733308 DOI: 10.3928/24748307-20190731-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 02/13/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Improvements in health literacy are unlikely without intervention in community settings. However, interventions appropriate for delivery in these settings are lacking, limiting reach to rural adults who are disproportionately affected by low health literacy and poor health outcomes. The How to Talk to Your Doctor (HTTTYD) HANDbook Program was developed through a research-practice partnership to educate rural residents to effectively advocate and participate in their own health care. Brief Description of Activity: We describe development of the HTTTYD HANDbook Program delivered through the Cooperative Extension Service to educate adults who are eligible for Medicaid and have low health literacy. HTTTYD HANDbook implementation is described using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework (and specifically the reach, adoption, implementation, and maintenance dimensions). Implementation: The HTTTYD HANDbook was developed using health literacy best practices with user-centered design, and it was field tested with community members with varying levels of health literacy. Reach, adoption, implementation, and maintenance of the HTTTYD HANDbook were assessed by tracking distribution of HTTTYD HANDbook Program materials, return submission of evaluation and tracking instruments, adherence to program and data collection/submission protocols, and program continuation. Results: Overall reach into the population was 6 per 10,000; about 25% were Medicaid recipients and 28.2% had low health literacy. Most participants were age 65 years or older. Of the 72 counties with program access, 52.7% requested HTTTYD HANDbook Program materials; 31% adopted the program, but only 30% of these counties adhered to program implementation and data collection protocols. Reach and adoption were higher among rural counties, and rural counties were more likely than nonrural counties to maintain the HTTTYD HANDbook Program. Lessons Learned: The HTTTYD HANDbook Program addresses barriers to engagement in patient-provider communication for rural, low-income community members. Programs can be implemented in community settings through established local organizations, such as county extension offices, to increase access for rural adults. Implementation barriers included staff turnover and transportation of program materials. Online facilitator training availability had little impact on adherence to program protocols. Organizational context and established procedures for program delivery and evaluation should be considered in adoption decisions and integrated into implementation protocols. [HLRP: Health Literacy Research and Practice. 2019;3(3):e205–e215.] Plain Language Summary: The How to Talk to Your Doctor HANDbook Program was created with people from the community to help patients prepare for doctor visits. The How to Talk to Your Doctor HANDbook Program helps patients to overcome barriers to talking to their doctor so that they can better understand how to get healthy and stay healthy.
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Affiliation(s)
- Lisa Washburn
- Address correspondence to Lisa Washburn, DrPH, University of Tennessee Extension, Family & Consumer Sciences, 2621 Morgan Circle, 119 Morgan Hall, Knoxville, TN 37996-4501;
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Nouri SS, Barnes DE, Volow AM, McMahan RD, Kushel M, Jin C, Boscardin J, Sudore RL. Health Literacy Matters More Than Experience for Advance Care Planning Knowledge Among Older Adults. J Am Geriatr Soc 2019; 67:2151-2156. [PMID: 31424575 DOI: 10.1111/jgs.16129] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/02/2019] [Accepted: 07/13/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Advance care planning (ACP) engagement is low among vulnerable populations, including those with limited health literacy (LHL). Limited knowledge about ACP may be a modifiable mediator of the relationship between LHL and ACP. Our goal was to determine whether health literacy is associated with ACP knowledge. DESIGN Cross-sectional design. SETTING A public health delivery system and Veterans Affairs Medical Center in San Francisco, CA. PARTICIPANTS English- and Spanish-speaking patients (N = 1400). MEASUREMENTS ACP knowledge was assessed with seven validated multiple-choice questions. Health literacy was measured using a validated scale. Sociodemographic measures included age, sex, language, education, race, health status, and social support. Prior ACP experience was defined as having documented legal forms and/or goals-of-care discussions in the medical record. We used Kruskal-Wallis tests and linear regression to examine associations of ACP knowledge with LHL, prior ACP experience, and sociodemographic factors. RESULTS Mean age of participants was 65 (±10) years, 48% were women, 34% had LHL, 32% were Spanish speaking, 47% had high school education or less, and 70% were nonwhite. Mean 7-point knowledge scores were lower for those with limited vs adequate health literacy (3.8 [SD = 1.9 vs 5.5 (SD = 1.7); P < .001). In multivariable analysis, ACP knowledge scores were 1.0 point lower among those with LHL; 0.6 points lower among Spanish speakers and those with high school education or less; and 0.5 points lower among individuals of nonwhite race (P < .001 for all). Knowledge scores were 0.02 points lower per year of older age (P = .007) and 0.01 points higher per point of greater social support (P = .005). Prior ACP experience was not associated with knowledge after adjustment (P = .7). CONCLUSIONS Health literacy and sociodemographics are stronger predictors than prior ACP experience of ACP knowledge. This study suggests that providing easy-to-understand ACP materials is paramount and should be offered even if patients have previous experience with the ACP process. J Am Geriatr Soc 67:2151-2156, 2019.
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Affiliation(s)
- Sarah S Nouri
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Deborah E Barnes
- Department of Psychiatry, University of California, San Francisco, San Francisco, California.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.,Division of Geriatrics, Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California.,Innovation and Implementation Center in Aging and Palliative Care Research), University of California, San Francisco, San Francisco, California
| | - Aiesha M Volow
- Division of Geriatrics, Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California.,Innovation and Implementation Center in Aging and Palliative Care Research), University of California, San Francisco, San Francisco, California.,Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Ryan D McMahan
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Margot Kushel
- Division of General Internal Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, California.,Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, California
| | - Chengshi Jin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - John Boscardin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.,Innovation and Implementation Center in Aging and Palliative Care Research), University of California, San Francisco, San Francisco, California
| | - Rebecca L Sudore
- Division of Geriatrics, Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California.,Innovation and Implementation Center in Aging and Palliative Care Research), University of California, San Francisco, San Francisco, California.,Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California.,Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, California
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Gray SA, Zraick RI, Atcherson SR. Readability of Individuals With Disabilities Education Act Part B Procedural Safeguards: An Update. Lang Speech Hear Serv Sch 2019; 50:373-384. [DOI: 10.1044/2018_lshss-18-0057] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose
The purpose of this study was to analyze the readability of Individuals with Disabilities Education Act (IDEA) Part B procedural safeguard documents, as distributed by each of the 50 U.S. states. Results were compared to the 5th- to 6th-grade readability guideline for documents recommended by experts in health literacy and health communication.
Method
A commercially available readability software, Readability Studio (
Oleander Software, 2009
), was used to assess document readability. Text-based files of each IDEA Part B procedural safeguard document were analyzed using four readability formulas: Flesch-Kincaid (
Flesch, 1965
), Gunning fog index (
Gunning, 1952
), Flesch Reading Ease (
Flesch, 1948
), and Simple Measure of Gobbledygook (
McLaughlin, 1969
).
Results
No procedural safeguard document scored below an 11th-grade reading level. Seventy-four percent of these documents were found to be written at a graduate reading level—meaning these documents are written for a reader who is currently enrolled in a master's degree or higher education program.
Conclusion
In an effort to decrease barriers to parent participation in the Individualized Education Planning process, those who administer IDEA Part B procedural safeguards should be sensitive to the potential mismatch between the literacy skills of the parent/guardian and the literacy skills needed to comprehend these documents. Developers of IDEA Part B procedural safeguards should account for estimated literacy skills of the general public as ongoing revisions to these safeguards are made.
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Affiliation(s)
- Sara A. Gray
- School of Communication Sciences and Disorders, University of Central Florida, Orlando
| | - Richard I. Zraick
- School of Communication Sciences and Disorders, University of Central Florida, Orlando
| | - Samuel R. Atcherson
- Department of Audiology and Speech Pathology, University of Arkansas at Little Rock
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Paiva D, Silva S, Severo M, Moura-Ferreira P, Lunet N, Azevedo A. Validation of the Short Assessment of Health Literacy in Portuguese-speaking Adults in Portugal. GACETA SANITARIA 2019; 34:435-441. [PMID: 31155446 DOI: 10.1016/j.gaceta.2019.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 03/07/2019] [Accepted: 03/12/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To validate the Brazilian version of the Short Assessment of Health Literacy in Portuguese-speaking Adults (SAHLPA), a 50-item test proposed as a particularly helpful instrument to assess health literacy in people with limited skills, in the Portuguese population. METHODS We used the standard procedure for cultural adaptation and administered the instrument to 249 participants. We examined construct validity using groups with expectedly increasing levels of health literacy (laypersons from the general population, engineering researchers, health researchers, and physicians), and through association with age and educational attainment, dichotomizing scores at the median of the layperson's group. RESULTS Exploratory factor analysis revealed the instrument was one-dimensional and justified reduction to 33 items. SAHLPA-33 displayed adequate reliability (Cronbach's α = 0.73). The frequency of limited health literacy was highest among laypersons and lowest among physicians (p <0.001; p for trend <0.001). The proportion of participants with limited health literacy decreased with increasing education attainment (age- and sex-adjusted p for trend <0.001). Limited health literacy also tended to decrease with age, although the association was non-significant (sex- and education-adjusted p for trend = 0.067). CONCLUSION We culturally adapted a brief and simple instrument for health literacy assessment, and showed it was valid and fairly reliable. In Portuguese low-literate adults, SAHLPA-33 fills the gap in health literacy assessment instruments, and may be used to guide communication strategies with vulnerable patients and communities.
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Affiliation(s)
- Dagmara Paiva
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; USF Monte Murado, ACeS Espinho-Gaia, ARS Norte, Vila Nova de Gaia, Portugal.
| | - Susana Silva
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Milton Severo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | | | - Nuno Lunet
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Ana Azevedo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Centro de Epidemiologia Hospitalar, Centro Hospitalar São João, Porto, Portugal
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Meints SM, Cortes A, Morais CA, Edwards RR. Racial and ethnic differences in the experience and treatment of noncancer pain. Pain Manag 2019; 9:317-334. [PMID: 31140916 PMCID: PMC6587104 DOI: 10.2217/pmt-2018-0030] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 12/12/2018] [Indexed: 12/11/2022] Open
Abstract
The burden of pain is unequal across racial and ethnic groups. In addition to racial and ethnic differences in the experience of pain, there are racial and ethnic disparities in the assessment and treatment of pain. In this article, we provide a nonexhaustive review of the biopsychosocial mechanistic factors contributing to racial and ethnic differences in both the experience and treatment of pain. Using a modified version of the Socioecological Model, we focus on patient-, provider- and system-level factors including coping, perceived bias and discrimination, patient preferences, expectations, patient/provider communication, treatment outcomes and healthcare access. In conclusion, we provide psychosocial factors influencing racial and ethnic differences in pain and highlight future research targets and possible solutions to reduce these disparities.
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Affiliation(s)
- Samantha M Meints
- Department of Anesthesiology, Pain Management Center, Brigham & Women’s Hospital, Harvard Medical School, Chestnut Hill, MA 02467, USA
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Alejandro Cortes
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Calia A Morais
- Department of Psychology, The University of Alabama, Tuscaloosa, AL 35487, USA
| | - Robert R Edwards
- Department of Anesthesiology, Pain Management Center, Brigham & Women’s Hospital, Harvard Medical School, Chestnut Hill, MA 02467, USA
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Heuser C, Diekmann A, Kowalski C, Enders A, Conrad R, Pfaff H, Ansmann L, Ernstmann N. Health literacy and patient participation in multidisciplinary tumor conferences in breast cancer care: a multilevel modeling approach. BMC Cancer 2019; 19:330. [PMID: 30961598 PMCID: PMC6454712 DOI: 10.1186/s12885-019-5546-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 03/28/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Decisions made in multidisciplinary tumor conferences (MTC) that consider patient preferences result in better patient outcomes. Furthermore, it has been shown that in some breast cancer centers in Germany, patients participate in MTCs and that participation is associated with sociodemographic and breast cancer center-related factors. Health literacy (HL) has been shown to be predictive for individual health behavior and is an important prerequisite for patient participation in healthcare. However, so far nothing is known about the association between HL and MTC patient participation. To close this gap in research, we analyzed which patient characteristics affect participation in MTCs and whether participation varies between breast cancer centers. METHODS In a prospective, multicenter cohort study, newly diagnosed breast cancer patients were surveyed directly after surgery (T1) as well as 10 weeks (T2) and 40 weeks (T3) after surgery. After descriptive analysis, t-tests were conducted, correlations for independent variables were run, and logistic multilevel regression analysis was applied to estimate the association between patient participation in MTCs at T1 and HL (HLS-EU-Q16 [1]), sociodemographic and disease-related characteristics (n = 863 patients) and the variation between breast cancer centers (n = 43 centers). RESULTS Descriptive results show that 6.8% of breast cancer patients took part in a MTC. The logistic multilevel regression model revealed that patients with an inadequately HL are less likely to participate in MTCs (OR = 0.31, 95%-CI = 0.1-0.9, Pseudo-R2 = 0.06), and participation is dependent on the breast cancer center (ICC = 0.161). CONCLUSIONS These findings are the first to show significant differences in HL and patient participation in MTCs in a large sample of breast cancer patients. In future research on patient participation in MTCs and HL, questions concerning the organization, communication and decision-making in MTCs with and without patient participation have to be addressed, and patient and provider perspectives must be equally considered. TRIAL REGISTRATION Database Health Services Research, VfD_PIAT_12_001630 , registered prospectively on 01.03.2012.
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Affiliation(s)
- Christian Heuser
- Center for Health Communication and Health Services Research (CHSR), Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
- Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Annika Diekmann
- Center for Health Communication and Health Services Research (CHSR), Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
- Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Christoph Kowalski
- German Cancer Society e.V. (DKG), Department for Certification, Kuno-Fischer-Straße 8, 14057 Berlin, Germany
| | - Anna Enders
- Department for Research and Quality Management, The Federal Centre for Health Education (BZgA), Maarweg 149-161, 50825 Cologne, Germany
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Eupener Str. 129, 50933 Cologne, Germany
| | - Lena Ansmann
- Organizational Health Services Research, Department for Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerlaender Heerstraße 140, 26129 Oldenburg, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
- Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
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Penry Williams C, Elliott K, Gall J, Woodward-Kron R. Patient and clinician engagement with health information in the primary care waiting room: A mixed methods case study. J Public Health Res 2019; 8:1476. [PMID: 30997358 PMCID: PMC6444378 DOI: 10.4081/jphr.2019.1476] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 02/22/2019] [Indexed: 12/25/2022] Open
Abstract
Background. Primary care waiting rooms can be sites of health promotion
and health literacy development through the provision of readily accessible health
information. To date, few studies have considered patient engagement with televised health
messages in the waiting room, nor have studies investigated whether patients ask their
clinicians about this information. The aim of this study was therefore to examine patient
(or accompanying person) and clinician engagement with waiting room health information,
including televised health messages. Design and methods. The mixed methods case study was undertaken in a
regional general practice in Victoria, Australia, utilising patient questionnaires,
waiting room observations, and clinician logbooks and interviews. The qualitative data
were analysed by content analysis; the questionnaire data were analysed using descriptive
statistics. Results. Patients engaged with a range of health information in the
waiting room and reportedly received health messages from this information. 44% of the
questionnaire respondents (33 of 74) reported watching the television health program, and
half of these reported receiving a take home health message from this source. Only one of
the clinicians (N=9) recalled a patient asking about the televised health
program. Conclusions. The general practice waiting room remains a site where
people engage with the available health information, with a televised health
‘infotainment’ program receiving most attention from patients. Our study
showed that consumption of health information was primarily passive and tended not to
activate patient discussions with clinicians. Future studies could investigate any link
between the health infotainment program and behaviour change. Significance for public health Primary care waiting rooms are traditionally sites of health promotion, with leaflets
and posters providing opportunities for patient education about disease prevention and
treatment information for common illnesses. This case study in regional Australia
investigated how and to what extent patients, accompanying persons and primary care
providers engaged with the health information in their waiting rooms. Despite the
ubiquity of personalised digital communication tools, the findings showed that
patients engage with and continue to value health information in the general practice
waiting room. By knowing more about patient behaviours and preferences for the mode of
health messages (e.g. via screen), medical practices can better
target their audience. The study also investigated the connection between the health
messages in the waiting room and whether this activated patients to ask their doctor
about these messages. To optimise the benefits of patient education materials in the
waiting room, practices should seek opportunities to keep clinicians up to date with
the resources on offer and refer patients to these resources when relevant as did the
practice nurses in this study. We also suggest that clinician familiarity with the
resources can be fostered by a dedicated person in the practice. For example, at the
conclusion of this case study, the clinic involved decided to add patient health
information resources to the weekly meeting agenda, for which one of the registrars
volunteered to take responsibility.
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Morony S, Weir KR, Bell KJL, Biggs J, Duncan G, Nutbeam D, McCaffery KJ. A stepped wedge cluster randomised trial of nurse-delivered Teach-Back in a consumer telehealth service. PLoS One 2018; 13:e0206473. [PMID: 30379942 PMCID: PMC6209310 DOI: 10.1371/journal.pone.0206473] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/12/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the impact of Teach-Back on communication quality in a national telephone-based telehealth service, for callers varying in health literacy. DESIGN Cross-sectional stepped wedge cluster randomised trial with continuous recruitment, short (fixed) exposure and blinded outcome assessors. Nurses were stratified by hours worked and randomised into training groups using a computer generated sequence. SETTING An Australian national pregnancy and parenting telephone helpline. INTERVENTION Complex intervention involving a single 2-hour group Teach-Back training session, combined with ongoing nurse self-reflection on their communication following each call and each shift. PARTICIPANTS Participants were 637 callers to the telephone helpline aged 18-75 (87% female), of whom 127 (13%) had inadequate health literacy (measured with the Single Item Literacy Screener); and 15 maternal and child health nurses with 15 years' experience on average. MEASURES Primary outcome was a modified subscale of the Health Literacy Questionnaire, 'having sufficient information to manage health'. Secondary caller outcomes included caller confidence, perceived actionability of information and nurse effort to listen and understand. Nurse outcomes were perceptions of their communication effectiveness. RESULTS Over a 7 week period, 376 surveyed callers received usual care and 261 Teach-Back. Ratings on the primary outcome increased over time (OR 1.17, CI 1.01 to 1.32, p = 0.03) but no independent Teach-Back effect was observed. A consistent pattern suggests that, compared with usual care, Teach-Back helps callers with inadequate health literacy feel listened to (OR 2.3, CI 0.98 to 5.42, p = 0.06), confident to act (OR 2.44, CI 1.00 to 5.98, p = 0.06), and know what steps to take (OR 2.68, CI 1.00 to 7.17, p = 0.06). Nurse perceptions of both their own communication effectiveness (OR = 2.31; CI 1.38 to 3.86, p<0.0001), and caller understanding (OR = 2.56; CI 1.52 to 4.30, p<0.001) both increased with Teach-Back. No harms were reported. CONCLUSIONS Teach-Back appears to benefit telephone health service users with inadequate health literacy, but the extent of this is unclear due to smaller numbers of lower literacy participants. Improving caller ratings over time are likely due to increasing nurse communication competence.
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Affiliation(s)
- Suzanne Morony
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Kristie R. Weir
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Health Literacy Lab, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Katy J. L. Bell
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | | | - Gregory Duncan
- Eastern Health Clinical School, Monash University, Box Hill, Australia
| | - Don Nutbeam
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Health Literacy Lab, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Kirsten J. McCaffery
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Health Literacy Lab, Sydney School of Public Health, The University of Sydney, Sydney, Australia
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Williams R, Moeller L, Willis S. Barriers and enablers to improved access to health information for patients with low health literacy in the radiotherapy department. Radiography (Lond) 2018; 24 Suppl 1:S11-S15. [DOI: 10.1016/j.radi.2018.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 06/24/2018] [Accepted: 06/28/2018] [Indexed: 11/26/2022]
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