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Seo YH, Osborne RH, Kwak Y, Ahn JW. Validity testing of the Korean version of the Health Literacy Questionnaire (HLQ) and its application in people with chronic diseases. PLoS One 2024; 19:e0308086. [PMID: 39088442 PMCID: PMC11293725 DOI: 10.1371/journal.pone.0308086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 07/16/2024] [Indexed: 08/03/2024] Open
Abstract
Health literacy plays a crucial role in promoting and maintaining the health of patients with chronic illnesses. Therefore, adequate assessments and the application of interventions based on people's health literacy strengths, needs, and preferences are required to improve health outcomes. This study aimed to evaluate the psychometrical properties of the Health Literacy Questionnaire (HLQ) in Koreans with chronic diseases. Data were collected from 278 patients (57.04±15.22 years) diagnosed with chronic disease, including kidney disease, hypertension, and diabetes, who visited the outpatient clinic of a university hospital from June to December 2020. For validity assessment, construct, convergent, and discriminant validities were evaluated, along with the HLQ reliability using Cronbach's α. One-way analysis of variance was used to evaluate mean differences in the HLQ scale scores based on patients' characteristics. The confirmatory factor analysis (CFA) indicated that all items were loaded on their respective factors. The model fit of a full nine-factor CFA model showed satisfactory or better fit compared with nine one-factor CFA model; χ2WLSMV (866) = 576.596 (p < .001), comparative normed fit index of 1.000 (reference: >0.950), Tucker-Lewis index of 0.981 (reference: >0.950), root mean square error of approximation of 0.066 (reference: <0.080), and standardized root mean square residual of 0.055 (reference: <0.080). All scales demonstrated good to excellent internal consistency (Cronbach's α ≥.757). Sociodemographic characteristic variables with significant score differences in HLQ scores were reported across nine scales, with the level of education and income showing significant score differences in 8 and 6 scales, respectively. This study revealed that the Korean version of the HLQ has many strong measurement properties among patients with chronic diseases. The validation indicated the HLQ as a robust tool that is used cross-culturally and is recommended for use in the Korean population.
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Affiliation(s)
- Yon Hee Seo
- Department of Nursing Science, Andong National University, Andong-si, Gyeongsangbuk-do, Korea
| | - Richard H Osborne
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Yeunhee Kwak
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
| | - Jung-Won Ahn
- Department of Nursing, Gangneung-Wonju National University, Wonju-si, Gangwon-do, Korea
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Light SW, Sideman AB, Vela A, Wolf MS. Introducing a brain health literacy framework to promote health equity for Latinos: A discussion paper. PATIENT EDUCATION AND COUNSELING 2024; 124:108254. [PMID: 38493527 PMCID: PMC11070285 DOI: 10.1016/j.pec.2024.108254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Sophia W Light
- Center for Applied Health Research on Aging and the Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA; Global Brain Health Institute, University of California, San Francisco and Trinity College Dublin, San Francisco, CA, USA; Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Alyssa Vela
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael S Wolf
- Center for Applied Health Research on Aging and the Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Lane M, Dixon R, Donald KJ, Ware RS. Health literacy profiles of medical students in an Australian Doctor of Medicine programme: A cross-sectional study using the Health Literacy Questionnaire. Health Promot J Austr 2024; 35:617-627. [PMID: 37556927 DOI: 10.1002/hpja.790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023] Open
Abstract
ISSUE ADDRESSED With the emerging focus on designing health-literate organisations and health care systems, it is essential to understand the health literacy profiles of the medical workforce including medical students, as medical professionals play a key role in within these systems. Medical professionals contribute to good patient health outcomes through enabling access to appropriate health care, provision of quality health information and collaborative shared decision-making, which are fundamental health literacy competencies. The aim of this study is to identify health literacy strengths and weaknesses of medical students enrolled in an Australian Doctor of Medicine programme. METHODS Students from all 4 years of an Australian Doctor of Medicine programme were invited to complete an anonymous, online survey in January 2021. Health literacy profiles were identified using the 9-domain, 44-item multi-dimensional Health Literacy Questionnaire, a validated tool which comprehensively evaluates health literacy strengths and weaknesses from diverse perspectives. Demographic characteristics and social attributes were also recorded. The results were compared with Australian Bureau of Statistics data. RESULTS Eighty-six participants completed the survey. Most participants were female students (57%) who spoke English at home (88%) with tertiary-educated fathers (60%) and resided in locations associated with high socioeconomic status during adolescence (61%). Males scored significantly higher in three domains which explored health information access and appraisal, and ability to actively engage with health care providers. Students' scores were significantly lower than the Australian general population in Domain 6 (Ability to actively engage with health care providers) and Domain 7 (Navigating the health care system). CONCLUSIONS Medical students' health literacy profiles indicate areas of weakness in their ability to engage with health care providers and to navigate the health system. Medical educators will need to create opportunities to address these weaknesses within medical curricula. Gender differences identified in self-rated ability to access and appraise health information requires further exploration. SO WHAT?: Further understanding of health literacy profiles of medical students may influence design of medical school curricula.
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Affiliation(s)
- Margo Lane
- School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia
- UQ Medical School, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Robyn Dixon
- Faculty of Medical and Health Sciences, Nursing, University of Auckland, Auckland, New Zealand
| | - Ken J Donald
- School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Robert S Ware
- School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Bos P, Wouters E, Danhieux K, van Olmen J, Remmen R, Klipstein-Grobusch K, Boateng D, Buffel V. Unravelling the Belgian cascade of hypertension care and its determinants: insights from a cross-sectional analysis. BMC Public Health 2024; 24:1559. [PMID: 38872180 DOI: 10.1186/s12889-024-19010-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 05/30/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Hypertension is a major risk factor for cardiovascular disease and all-cause mortality worldwide. Despite the widespread availability of effective antihypertensives, blood pressure (BP) control rates remain suboptimal, even in high-income countries such as Belgium. In this study, we used a cascade of care approach to identify where most patients are lost along the continuum of hypertension care in Belgium, and to assess the main risk factors for attrition at various stages of hypertension management. METHODS Using cross-sectional data from the 2018 Belgian Health Interview Survey and the Belgian Health Examination Survey, we estimated hypertension prevalence among the Belgian population aged 40-79 years, and the proportion that was (1) screened, (2) diagnosed, (3) linked to care, (4) in treatment, (5) followed up and (6) well-controlled. Cox regression models were estimated to identify individual risk factors for being unlinked to hypertension care, untreated and not followed up appropriately. RESULTS The prevalence of hypertension based on self-reported and measured high BP was 43.3%. While 98% of the hypertensive population had their BP measured in the past 5 years, only 56.7% were diagnosed. Furthermore, 53.4% were linked to care, 49.8% were in treatment and 43.4% received adequate follow-up. Less than a quarter (23.5%) achieved BP control. Among those diagnosed with hypertension, males, those of younger age, without comorbidities, and smokers, were more likely to be unlinked to care. Once in care, younger age, lower BMI, financial hardship, and psychological distress were associated with a higher risk of being untreated. Finally, among those treated for hypertension, females, those of younger age, and without comorbidities were more likely to receive no adequate follow-up. CONCLUSION Our results show that undiagnosed hypertension is the most significant barrier to BP control in Belgium. Health interventions are thus needed to improve the accurate and timely diagnosis of hypertension. Once diagnosed, the Belgian health system retains patients fairly well along the continuum of hypertension care, yet targeted health interventions to improve hypertension management for high-risk groups remain necessary, especially with regard to improving treatment rates.
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Affiliation(s)
- Philippe Bos
- Department of Sociology, University of Antwerp, Antwerp, Belgium.
| | - Edwin Wouters
- Department of Sociology, University of Antwerp, Antwerp, Belgium
| | - Katrien Danhieux
- Department of Family Medicine and Population Health, University of Antwerp, Wilrijk, Belgium
| | - Josefien van Olmen
- Department of Family Medicine and Population Health, University of Antwerp, Wilrijk, Belgium
| | - Roy Remmen
- Department of Family Medicine and Population Health, University of Antwerp, Wilrijk, Belgium
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Department of Global Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Daniel Boateng
- Julius Global Health, Department of Global Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Veerle Buffel
- Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
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Haeri-Mehrizi A, Mohammadi S, Rafifar S, Sadighi J, Kermani RM, Rostami R, Hashemi A, Tavousi M, Montazeri A. Health literacy and mental health: a national cross-sectional inquiry. Sci Rep 2024; 14:13639. [PMID: 38871848 DOI: 10.1038/s41598-024-64656-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 06/11/2024] [Indexed: 06/15/2024] Open
Abstract
Health literacy and mental health are among the most important issues in the modern health and era of public health. This study aimed to investigate the association between health literacy and mental health status. This was a national cross-sectional study that was conducted in Iran. A sample of literate individuals aged 18-65 was entered into the study using multistage sampling. The data were collected by the Health Literacy Instrument for Adults (HELIA) and the 12-item General Health Questionnaire (GHQ-12). Logistic regression and path analysis were used for data analysis. A total of 20,571 individuals completed the questionnaires. The mean(± SD) age of participants was 34.9(± 11.8) years old, 51% were female, and 38.1% had higher education. The mean(± SD) health literacy score was 68.3(± 15.2), and 29.8% of the respondents reported some mental health problems. Logistic regression analysis showed that limited health literacy was associated with poor mental health status (OR 2.560, 95% CI 2.396-2.735, P = 0.001). The path analysis showed that an increase in health literacy could reduce psychological and social dysfunction (the effect of health literacy on reducing psychological distress is more profound). It is recommended to carry out interventions that strengthen adult's cognitive and communication skills to improve their ability to access and use health information to make healthy choices.
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Affiliation(s)
- Aliasghar Haeri-Mehrizi
- Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Samira Mohammadi
- Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
- Department of Medical Laboratory Science, College of Science, Knowledge University, Erbil, 44001, Iraq
| | - Shahram Rafifar
- Health Education and Promotion Office, Deputy of Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Jila Sadighi
- Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Ramin Mozaffari Kermani
- Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Rahele Rostami
- Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Akram Hashemi
- Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Mahmoud Tavousi
- Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran.
| | - Ali Montazeri
- Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran.
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van Leeuwen GL, Kooijman MA, Schuurmann RCL, van Leeuwen BL, van Munster BC, van der Wal-Huisman H, de Vries JPPM. Health Literacy and Disease Knowledge of Patients With Peripheral Arterial Disease or Abdominal Aortic Aneurysm: A Scoping Review. Eur J Vasc Endovasc Surg 2024; 67:935-947. [PMID: 38552837 DOI: 10.1016/j.ejvs.2024.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 03/01/2024] [Accepted: 03/25/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE This scoping review summarises health literacy and disease knowledge in patients with abdominal aortic aneurysm (AAA) or peripheral arterial disease (PAD) and the influencing factors. DATA SOURCES A systematic search was conducted in PubMed, Embase, PsychINFO, and CINAHL covering the period January 2012 to October 2022. REVIEW METHODS This scoping review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Inclusion criteria encompassed studies addressing health literacy, knowledge, perception, or awareness in patients with AAA or PAD. Two authors independently reviewed abstracts and full texts, resolving any discrepancies through discussion or by consulting a third author for consensus. All article types were included except letters, editorials, study protocols, reviews, and guidelines. No language restrictions were applied. Primary outcomes were health literacy and disease knowledge. Secondary outcomes were factors that could influence this. Quality assessment was done using the Mixed Methods Appraisal Tool (MMAT). RESULTS The review included 32 articles involving a total of 5 268 patients. Four articles reported health literacy and the rest disease knowledge. Ten studies (31%) met all quality criteria. Twenty studies were quantitative, eight were qualitative, and four were mixed methods studies. The review revealed inadequate health literacy in the majority of patients, and disease knowledge was relatively low among patients with AAA and PAD, with disparities in measures and assessment tools across studies. Factors influencing health literacy and disease knowledge included socioeconomic status, education, income, and employment. CONCLUSION This scoping review revealed low health literacy and low disease knowledge in patients with AAA and PAD. Standardised health literacy assessment may contribute to improve communication strategies and decision aids to enhance patients' understanding and engagement in healthcare decisions, however further research is needed to prove its merits.
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Affiliation(s)
- Goudje L van Leeuwen
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, Groningen, the Netherlands.
| | - Maria-Annette Kooijman
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Richte C L Schuurmann
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Barbara L van Leeuwen
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Barbara C van Munster
- Department of Geriatric Medicine, University Medical Centre Groningen, Groningen, the Netherlands
| | - Hanneke van der Wal-Huisman
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Jean-Paul P M de Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, Groningen, the Netherlands
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Landess L, Prieur MG, Brown AR, Dellon EP. Exploring perceptions of and decision-making about CFTR modulators. Pediatr Pulmonol 2024; 59:1614-1621. [PMID: 38456611 DOI: 10.1002/ppul.26953] [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] [Received: 10/06/2023] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Cystic fibrosis (CF) treatment has increasingly focused on highly effective modulators. Despite measurable benefits of modulators, there is little guidance for CF care team members on providing education and support to patients regarding initiation of these therapies. We aimed to explore patient, caregiver, and clinician perceptions of modulators and influences on decisions about starting cystic fibrosis transmembrane regulator (CFTR) modulators. METHODS We conducted semistructured interviews with CF clinicians, adults with CF, and caregivers of children with CF. We reviewed audio recordings and coded responses to identify central themes. RESULTS We interviewed 8 CF clinicians, 9 adults with CF, and 11 caregivers of children with CF. Themes centered on emotional responses to modulator availability, influences on decision-making, concerns about side effects, impact of modulators on planning for the future, the benefits of the multidisciplinary CF care team in supporting treatment decisions, and the unique needs of people with CF who are not eligible for modulators. Clinicians described changes in conversations about modulators since the approval of elexacaftor/tezacaftor/ivacaftor, specifically greater willingness to prescribe with less nuanced conversations with patients and/or caregivers regarding their use. CONCLUSION Based on perspectives and experiences of CF clinicians, adults with CF, and caregivers of children with CF, we suggest clinicians approach conversations about CFTR modulators thoughtfully and thoroughly, utilizing the multidisciplinary model of CF care in exploring patient and caregiver emotions while filling in knowledge gaps, asking about treatment goals beyond potential clinical benefit, and having compassionate conversations with those who are ineligible for modulators.
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Affiliation(s)
- Lee Landess
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Mary G Prieur
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Ashley R Brown
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Elisabeth P Dellon
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Mohamed AA, Ali R, Johansen PM. Readability of Neurosurgical Patient Education Resources by the American Association of Neurological Surgeons. World Neurosurg 2024; 186:e734-e739. [PMID: 38636631 DOI: 10.1016/j.wneu.2024.04.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND The importance of patient education has become increasingly apparent in recent years. A prominent patient education tool in neurosurgery is the Neurosurgical Conditions and Treatments page provided by the American Association of Neurological Surgeons (AANS). This study aimed to investigate the readability of this resource page as many new articles have been incorporated in the past decade. METHODS Flesch-Kincaid Grade Level and Flesch-Kincaid Reading Ease scores were calculated for each article. One-way analysis of variance and Scheffé, Tukey-Kramer, Bonferroni, Fisher least significant difference, and Dunnett test post hoc analyses were conducted to determine differences between each category with respect to their mean grade level and reading ease scores. RESULTS Overall mean (SD) Flesch-Kincaid Reading Ease score was 40.2 (12.24), and overall mean (SD) Flesch-Kincaid Grade Level score was 7.48 (1.26). Significant differences were found between mean reading ease scores between each categorization by the AANS (P = 0.014). No significant differences were found between mean grade level score for each categorization (analysis of variance, P = 0.154). CONCLUSIONS As compared to a single previous investigation conducted 10 years ago, the readability of articles has changed modestly, and the reading grade level remains well above the recommendations by the American Medical Association and National Institutes of Health. The 6 new articles introduced in the past decade have demonstrated similar readability, presenting a persistent challenge in the realm of patient education in neurosurgery.
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Affiliation(s)
- Ali A Mohamed
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA; College of Engineering and Computer Science, Florida Atlantic University, Boca Raton, Florida, USA.
| | - Rifa Ali
- College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Phillip M Johansen
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA
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Engebretsen I, Bugge C, Støvring H, Husebye E, Sverre E, Dammen T, Halvorsen S, Munkhaugen J. Treatment patterns and adherence to lipid-lowering drugs during eight-year follow-up after a coronary heart disease event. Atherosclerosis 2024; 393:117550. [PMID: 38657552 DOI: 10.1016/j.atherosclerosis.2024.117550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND AIMS Proper prescription and high adherence to intensive lipid lowering drugs (LLD) in patients with coronary heart disease (CHD) are crucial and strongly recommended. The aim of this study is to investigate long-term treatment patterns and adherence to LLD following hospitalization for a CHD event. METHODS Patients admitted to two Norwegian hospitals with a CHD event from 2011 to 2014 (N = 1094) attended clinical examination and completed a questionnaire, median 16 months later. Clinical data were linked to pharmacy dispensing data from 2010 to 2020. The proportions using high-intensity statin therapy (atorvastatin 40/80 mg or rosuvastatin 20/40 mg) and non-statin LLD after the CHD event were assessed. Adherence was evaluated by proportion of days covered (PDC) and gaps in treatment. RESULTS Median age at hospitalization was 63 (IQR 12) years, 21 % were female. Altogether, 1054 patients (96 %) were discharged with a statin prescription, while treatment was dispensed in 85 % within the following 90 days. During median 8 (SD 2.5) years follow-up, the proportion using high-intensity statin therapy ranged 62-68 %, whereas the use of ezetimibe increased from 4 to 26 %. PDC <0.8 was found in 22 % of statin users and 26 % of ezetimibe users. The proportions with a treatment gap exceeding 180 days were 22 % for statins and 28 % for ezetimibe. Smoking at hospitalization and negative affectivity were significantly associated with reduced statin adherence, regardless of adherence measure. CONCLUSIONS In this long-term follow-up of patients with CHD, less than 70 % used high-intensity statin therapy with only small changes over time, and only 25 % used additional treatment with ezetimibe. We identified factors associated with reduced statin adherence that may be target for interventions.
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Affiliation(s)
- Ingrid Engebretsen
- Department of Behavioral Medicine, Faculty of Medicine, University of Oslo, Sognsvannsveien 9, 0372, Oslo, Norway; Oslo Economics, Klingenberggata 7A, 0161, Oslo, Norway; Department of Medicine, Drammen Hospital, Vestre Viken Trust, Dronninggata 28, 3004, Drammen, Norway.
| | | | - Henrik Støvring
- Oslo Economics, Klingenberggata 7A, 0161, Oslo, Norway; Steno Diabetes Center Aarhus, Paalle Juul-Jensens Blvd. 11, 8200, Aarhus, Denmark; Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, 8000, Aarhus, Denmark; Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
| | - Einar Husebye
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Dronninggata 28, 3004, Drammen, Norway
| | - Elise Sverre
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Dronninggata 28, 3004, Drammen, Norway; Department of Cardiology, Oslo University Hospital Ullevål, Kirkeveien 166, 0450, Oslo, Norway
| | - Toril Dammen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Kirkeveien 166, 0450, Oslo, Norway; Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Sognsvannsveien 21, 0372, Oslo, Norway
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ullevål, Kirkeveien 166, 0450, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Kirkeveien 166, 0450, Oslo, Norway
| | - John Munkhaugen
- Department of Behavioral Medicine, Faculty of Medicine, University of Oslo, Sognsvannsveien 9, 0372, Oslo, Norway; Department of Medicine, Drammen Hospital, Vestre Viken Trust, Dronninggata 28, 3004, Drammen, Norway
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Rivera E, Levoy K, Park C, Villalobos A, Martin P, Jung Kim M, Hirschman KB. Internal consistency reliability of the Revised Illness Perceptions Questionnaire: A systematic review and reliability generalization meta-analysis. J Health Psychol 2024; 29:734-746. [PMID: 38314719 DOI: 10.1177/13591053231221351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
The Revised Illness Perception Questionnaire (IPQ-R) assesses patients' perspectives of their illnesses. Original psychometric testing occurred in limited populations. The purpose of this reliability generalization meta-analysis was to: (1) estimate internal consistency reliability of each IPQ-R subscale, and (2) test moderators of these estimates. Web of Science was searched in July 2022 for articles citing the original IPQ-R paper that reported IPQ-R reliability data. Cronbach's alphas (⍺) were pooled for each IPQ-R subscale using inverse variance weighting and DerSimonian and Laird estimation. Sixty-six studies met criteria. Overall pooled ⍺ estimates were acceptable: 0.71-0.87. Treatment control reliability was reduced among cardiac (⍺ = 0.68), diabetes/kidney disease (⍺ = 0.63), and mixed/other (⍺ = 0.66) samples; cyclical reliability was reduced in cancer (⍺ = 0.65) samples. Age, gender, and race were also significant moderators. Subscale reliability varied based on sample characteristics. Adapting IPQ-R subscales to account for sample variation could improve measurement of illness perception constructs.
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Fleary SA, Joseph PL. Health literacy and health behaviors in parent-adolescent dyads: an actor-partner interdependence model approach. Psychol Health 2024; 39:803-822. [PMID: 36047615 PMCID: PMC10013691 DOI: 10.1080/08870446.2022.2117809] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 07/25/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Health literacy (HL), skills for accessing, appraising and using health information in health decision-making is implicated in adolescents' health behaviors. HL skills develop through scaffolding, modeling, practice and opportunity. Therefore, adolescents' HL skills are likely closely tied to parents' HL and health behaviors. Yet, no studies have examined the dyadic interdependence of the relationship between HL and health behaviors between parents and adolescents. The purpose of this study was to determine the interdependence of adolescents' and parents' HL and health behaviors. METHODS AND MEASURES Data were collected from 300 parent-adolescent dyads via Qualtrics Panel. Dyads completed identical measures of their HL, diet, physical activity, sedentary activity, cigarette-smoking, vaping, and alcohol binge-drinking behaviors. Data were analyzed using Pearson correlations and the Actor-Partner Interdependence Model. RESULTS Within-dyad correlations were significant for HL and all health behaviors assessed. After controlling for covariates and partner effects, adolescents' HL was related to their sugar-sweetened beverage intake, sedentary activity, and substance use. After controlling for covariates and actor effects, adolescents' HL was related to parents' sedentary activity, binge-drinking, and vaping while parents' HL was related to adolescents' sedentary activity. CONCLUSION Our results suggest that there is interdependence in these relationships especially for risk behaviors.
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Affiliation(s)
- Sasha A Fleary
- Department of Community Health and Social Sciences, City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Patrece L Joseph
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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Wu M, Card EB, Sussman JH, Villavisanis DF, Massenburg BB, Ng JJ, Romeo DJ, Swanson JW, Taylor JA, Low DW. Crowdsourcing the Impact of Illustration in Cleft Surgery Education. Cleft Palate Craniofac J 2024:10556656241257101. [PMID: 38778755 DOI: 10.1177/10556656241257101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE This study aimed to (1) assess layperson preferences for how surgical information is presented; (2) evaluate how the format of visual information relates to layperson comfort with undergoing surgery, perceptions of surgeon character traits, and beliefs about artistic skill impacting plastic surgery practice; and (3) identify sociodemographic characteristics associated with these outcomes. DESIGN A survey was developed in which one of five standardized sets of information depicting a unilateral cleft lip repair was presented as (1) text alone, (2) quick sketches, (3) simple drawings, (4) detailed illustrations, or (5) photographs. SETTING Online crowdsourcing platform. PARTICIPANTS Raters aged 18 years and older from the United States. INTERVENTIONS None. MAIN OUTCOME MEASURE(S) After viewing the surgical information, participants answered three sets of Likert scale questions. Ratings were averaged to produce three composite scores assessing (1) comfort with undergoing surgery (2) perceptions of surgeon character traits, and (3) beliefs about plastic surgery and artistry. RESULTS Four hundred seventy-nine participants were included. Surgeon character traits score was highest among participants who viewed detailed illustrations at 4.46 ± 0.59, followed by photographs at 4.43 ± 0.54, text alone at 4.28 ± 0.59, simple drawings at 4.17 ± 0.67, and quick sketches at 4.17 ± 0.71 (p = 0.0014). Participants who viewed detailed illustrations rated surgical comfort score and plastic surgery and artistry score highest, although differences did not achieve statistical significance. CONCLUSIONS Viewing detailed cleft lip repair illustrations was significantly associated with positive perceptions of surgeon character traits. Our data help to contextualize methods of communication and education valued by the public when seeking cleft care.
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Affiliation(s)
- Meagan Wu
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elizabeth B Card
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jonathan H Sussman
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dillan F Villavisanis
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Benjamin B Massenburg
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jinggang J Ng
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dominic J Romeo
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jordan W Swanson
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jesse A Taylor
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - David W Low
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Fiorini G, Pellegrini G, Franchi M, Rigamonti AE, Marazzi N, Sartorio A, Corrao G, Cella SG. Evaluation of adherence to pharmacological treatments by undocumented migrants with chronic diseases: a 10-year retrospective cohort study. BMJ Open 2024; 14:e078431. [PMID: 38724060 PMCID: PMC11086564 DOI: 10.1136/bmjopen-2023-078431] [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] [Received: 08/01/2023] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES To investigate the time course of medication adherence and some of the factors involved in this process in undocumented migrants with chronic diseases. DESIGN Retrospective cohort study. SETTING A big non-governmental organisation in Milano, Italy, giving medical assistance to undocumented migrants. PARTICIPANTS 1918 patients, 998 females and 920 males, with at least one chronic condition (diabetes, cardiovascular diseases (CVDs), mental health disorders) seen over a period of 10 years (2011-2020). Their mean age was 49.2±13 years. RESULTS Adherence to medications decreased over 1 year in all patients. This was more evident during the first 2 months of treatment. Patients on only one medication were less adherent than those on more than one medication; at 6 months the percentage of patients with high adherence was 33% vs 57% (p<0.0001) for diabetes, 15% vs 46% (p<0.0001) for mental disorders and 35% vs 59% (p<0.0001) for CVDs. Patients with mental disorders had the lowest adherence: 25% at 6 months and 3% at 1 year. Mental disorders, when present as comorbidities, greatly reduced the probability of being highly adherent: risk ratio (RR) 0.72 (95% CI 0.57 to 0.91; p=0.006) at 3 months, RR 0.77, (95% CI 0.59 to 1.01; p=0.06) at 6 months, RR 0.35 (95% CI 0.13 to 0.94; p=0.04) at 1 year. This was especially evident for patients with CVDs, whose percentage of high adherents decreased to 30% (p=0.0008) at 6 months and to 3% (p=0.01) at 1 year. We also noted that highly adherent patients usually were those most frequently seen by a doctor. CONCLUSIONS Interventions to increase medication adherence of undocumented migrants with chronic diseases are necessary, particularly in the first 2 months after beginning treatment. These should be aimed at people-centred care and include more outpatient consultations. Educational interventions should especially be taken into consideration for patients on monotherapy.
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Affiliation(s)
- Gianfrancesco Fiorini
- Istituti Clinici Zucchi Spa, Monza, Italy
- Università degli Studi di Milano, Milano, Italy
| | | | | | | | - Nicoletta Marazzi
- Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico, Milano, Italy
| | - Alessandro Sartorio
- Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico, Milano, Italy
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Han YY, Gutwein A, Apter A, Celedón JC. Health literacy and asthma: An update. J Allergy Clin Immunol 2024; 153:1241-1251. [PMID: 38135010 PMCID: PMC11070295 DOI: 10.1016/j.jaci.2023.12.007] [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: 10/10/2023] [Revised: 12/09/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Abstract
The US Department of Health and Human Services has defined health literacy (HL) as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Structural and social determinants of health lead to low HL in approximately 36% of adults in the United States, where this condition is most prevalent in racial and ethnic minorities, economically disadvantaged communities, and immigrants with limited English proficiency. In turn, low HL can worsen asthma outcomes through direct effects (eg, nonadherence to or incorrect use of medications) and indirect effects (eg, an unhealthy diet leading to obesity, a risk factor for asthma morbidity). The purpose of this update is to examine evidence from studies on low HL and health and asthma outcomes published in the last 12 years, identify approaches to improve HL and reduce health disparities in asthma, and discuss future directions for research in this area under the conceptual framework of a socioecological model that illustrates the multifactorial and interconnected complexity of this public health issue at different levels.
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Affiliation(s)
- Yueh-Ying Han
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
| | - Amanda Gutwein
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
| | - Andrea Apter
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pa
| | - Juan C Celedón
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa.
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Akakpo MG, Neuerer M. The relationship between health literacy and health-seeking behavior amongst university students in Ghana: A cross-sectional study. Health Sci Rep 2024; 7:e2153. [PMID: 38784248 PMCID: PMC11112626 DOI: 10.1002/hsr2.2153] [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: 10/20/2023] [Revised: 05/07/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
Background and Aims The crises of the last decades have provided more evidence of the need for health literacy as a measure of resilience and preparedness. In this study the relationship between health literacy and health-seeking behavior was investigated. Methods This study used a cross-sectional design with a questionnaire of five sections dedicated to health-seeking behavior, health literacy, family background, socioeconomic status and demographics. Health-seeking behavior was used in three dimensions namely preference for hospitals, self-medication, and herbal medicine. The questionnaire was completed by 262 students at the University of Ghana. Results A significant linear regression model (R = 0.39, R² = 0.15, Adjusted R² = 0.13, F = 8.89, p < 0.001) supported the relationship between health literacy and health-seeking in health facilities such as hospitals. A Pearson correlation further showed an association between self-medication and preference for herbal medication. Conclusion Findings support the crucial role of health literacy in timely hospital visits by patients. This implies the need to improve health literacy through education, policy, and research. This can promote prevention of diseases through timely health-seeking and improve preparedness against health crises. The study suggests health literacy should be integrated into educational curricula and regular health campaigns run by public health agencies.
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Affiliation(s)
- Martin Gameli Akakpo
- Department of PsychologyRegent University College of Science and TechnologyAccraGhana
| | - Maresa Neuerer
- Heidelberg Institute of Global HealthUniversity Hospital, Heidelberg UniversityHeidelbergGermany
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Miskiewicz MJ, Leonardo C, Capotosto S, Ling K, Cohen D, Komatsu D, Wang ED. Can Generative Artificial Intelligence Enhance Health Literacy About Lateral Epicondylitis? Cureus 2024; 16:e61384. [PMID: 38947706 PMCID: PMC11214596 DOI: 10.7759/cureus.61384] [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] [Accepted: 05/30/2024] [Indexed: 07/02/2024] Open
Abstract
INTRODUCTION Health literacy is a critical determinant of a patient's overall health status, and studies have demonstrated a consistent link between poor health literacy and negative health outcomes. The Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) advise that patient educational materials (PEMs) should be written at an eighth-grade reading level or lower, matching the average reading level of adult Americans. The purpose of this study was to investigate the ability of generative artificial intelligence (AI) to edit PEMs from orthopaedic institutions to meet the CDC and NIH guidelines. METHODS PEMs about lateral epicondylitis (LE) from the top 25 ranked orthopaedic institutions from the 2022 U.S. News & World Report Best Hospitals Specialty Ranking were gathered. ChatGPT Plus (version 4.0) was then instructed to rewrite PEMs on LE from these institutions to comply with CDC and NIH-recommended guidelines. Readability scores were calculated for the original and rewritten PEMs, and paired t-tests were used to determine statistical significance. RESULTS Analysis of the original and edited PEMs about LE revealed significant reductions in reading grade level and word count of 3.70 ± 1.84 (p<0.001) and 346.72 ± 364.63 (p<0.001), respectively. CONCLUSION Our study demonstrated generative AI's ability to rewrite PEM about LE at a reading comprehension level that conforms to the CDC and NIH guidelines. Hospital administrators and orthopaedic surgeons should consider the findings of this study and the potential utility of artificial intelligence when crafting PEMs of their own.
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Affiliation(s)
| | - Christian Leonardo
- Department of Orthopaedic Surgery, Stony Brook University, Stony Brook, USA
| | | | - Kenny Ling
- Department of Orthopaedics, Stony Brook University Hospital, Stony Brook, USA
| | - Dorian Cohen
- Department of Orthopaedic Surgery, Stony Brook University, Stony Brook, USA
| | - David Komatsu
- Department of Orthopaedic Surgery, Stony Brook University, Stony Brook, USA
| | - Edward D Wang
- Department of Orthopaedic Surgery, Stony Brook University, Stony Brook, USA
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Venosa M, Cerciello S, Zoubi M, Petralia G, Vespasiani A, Angelozzi M, Romanini E, Logroscino G. Readability and Quality of Online Patient Education Materials Concerning Posterior Cruciate Ligament Reconstruction. Cureus 2024; 16:e58618. [PMID: 38770469 PMCID: PMC11103262 DOI: 10.7759/cureus.58618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
Objective This study aimed to assess the quality of online patient educational materials regarding posterior cruciate ligament (PCL) reconstruction. Methods We performed a search of the top-50 results on Google® (terms: "posterior cruciate ligament reconstruction," "PCL reconstruction," "posterior cruciate ligament surgery," and "PCL surgery") and subsequently filtered to rule out duplicated/inaccessible websites or those containing only videos (67 websites included). Readability was assessed using six formulas: Flesch-Kincaid Reading Ease (FRE), Flesch-Kincaid Grade Level (FKG), Gunning Fog Score (GF), Simple Measure of Gobbledygook (SMOG) Index, Coleman-Liau Index (CLI), Automated Readability Index (ARI); quality was assessed using the JAMA benchmark criteria and recording the presence of the HONcode seal. Results The mean FRE was 49.3 (SD 11.2) and the mean FKG level was 8.09. These results were confirmed by the other readability formulae (average: GF 8.9; SMOG Index 7.3; CLI 14.7; ARI 6.5). A HONcode seal was available for 7.4 % of websites. The average JAMA score was 1.3. Conclusion The reading level of online patient materials concerning PCL reconstruction is too high for the average reader, requiring high comprehension skills. Practice implications Online medical information has been shown to influence patient healthcare decision processes. Patient-oriented educational materials should be clear and easy to understand.
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Affiliation(s)
- Michele Venosa
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, ITA
- Department of Orthopaedics, RomaPro, Polo Sanitario San Feliciano, Rome, ITA
| | - Simone Cerciello
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, ITA
- Orthopaedic Department, Casa di Cura Villa Betania, Rome, ITA
| | - Mohammad Zoubi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, ITA
| | - Giuseppe Petralia
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, ITA
| | - Andrea Vespasiani
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, ITA
| | - Massimo Angelozzi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, ITA
| | - Emilio Romanini
- Department of Orthopaedics, RomaPro, Polo Sanitario San Feliciano, Rome, ITA
- Department of Orthopaedics, Italian Working Group on Evidence-Based Orthopaedics (GLOBE), Rome, ITA
| | - Giandomenico Logroscino
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, ITA
- Department of Minimally Invasive and Computer-Assisted Orthopaedic Surgery, San Salvatore Hospital, L'Aquila, ITA
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18
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Irshad S, Asif N, Ashraf U, Ashraf H. An Analysis of the Readability of Online Sarcoidosis Resources. Cureus 2024; 16:e58559. [PMID: 38770494 PMCID: PMC11102868 DOI: 10.7759/cureus.58559] [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] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Sarcoidosis is an inflammatory disease characterized by the formation of noncaseating granulomas in multiple organ systems. The presentation can vary widely; although some patients with sarcoidosis can be asymptomatic, sarcoidosis can also present in others with symptomatic multiorgan system involvement. Considering the potential severity of the disease, patients need to be well-informed about sarcoidosis to better manage their health. This study aims to assess the readability levels of online resources about sarcoidosis. Methods We conducted a retrospective cross-sectional study. The term "sarcoidosis" was searched online using both Google and Bing to find websites written in English. Each website was categorized by type: academic, commercial, government, nonprofit, and physician. The readability scores for each website were calculated using six different readability tests: the Flesch-Kincaid reading ease (FKRE), Flesch-Kincaid grade level (FKGL), Gunning fog score (GFS), Simple Measure of Gobbledygook (SMOG), automated readability index (ARI), and Coleman-Liau index (CLI). FKRE gives a score that corresponds to the difficulty of the text, while the remaining tests give a score that corresponds to a grade level in terms of reading ability. A one-sample t-test was used to compare all test scores with the national recommended standard of a sixth-grade reading level. Our null hypothesis was that the readability scores of the websites searched would not differ statistically significantly from the sixth-grade reading level and that there would be no significant differences across website categories. To evaluate the difference between the categories of websites, ANOVA testing was used. Results Thirty-four websites were analyzed. Each of the six readability tests for the websites had an average score, which corresponded to being significantly harder to read than the nationally recommended sixth-grade reading level (p<0.001). None of the mean readability scores showed a statistically significant difference across the five different website categories. Conclusions This is the first study, to our knowledge, to examine the readability of online English resources on sarcoidosis and calculate standardized readability scores for them. It implies that the online English material for sarcoidosis is above the health literacy recommended reading levels for patients. There is a need to simplify the material to be easier to read for patients.
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Affiliation(s)
- Shahmeen Irshad
- Internal Medicine, Richmond University Medical Center, New York, USA
| | - Nasir Asif
- Medicine, Rutgers University, Newark, USA
| | - Usman Ashraf
- Medicine, Rutgers University, New Brunswick, USA
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Bailly S, Foote A, Mendelson M, Rakotovao A, Borel JC, Pepin JL, Tamisier R, Revil H. Sociological determinants of adherence to continuous positive airway pressure in the management of sleep apnoea syndrome: protocol for a transdisciplinary, prospective observational study. BMJ Open 2024; 14:e079765. [PMID: 38448064 PMCID: PMC10916145 DOI: 10.1136/bmjopen-2023-079765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/07/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Obstructive sleep apnoea syndrome (OSAS) is a chronic multiorgan pathology that has a negative impact on quality of life. Continuous positive airway pressure (CPAP) is the first-line treatment for OSAS. However, CPAP termination rates remain very high, and adherence to therapy is a major issue. To date, studies targeting predictive factors of CPAP adherence by OSAS patients mainly include clinical data. The social, socioeconomic, psychological, and home environment aspects have been far less studied and largely underestimated. This study aims to obtain solid quantitative results examining the relationship between the determinants of refusal, non-adherence, or termination of CPAP treatment, and in particular the pivotal role played by health literacy. METHODS AND ANALYSIS This is a prospective, multicentre, observational study recruiting patients attending the sleep clinic of the Grenoble Alpes University Hospital, France. Consecutive adults (>18 years) recently diagnosed with OSAS and prescribed CPAP treatment with telemonitoring will be enrolled in the present study. They will benefit from home visits by a CPAP technician or nurse at CPAP initiation. Patients will then be followed up for 6 months through the telemonitoring platform of a home-care provider. The primary objective is to evaluate the impact of health literacy (health literacy, measured by the European Health Literacy Survey questionnaire (HLS-EU-16) on the refusal, non-adherence or termination of CPAP treatment in newly diagnosed OSAS patients, during the first 6 months after diagnosis. The target sample size is 250 participants. ETHICS AND DISSEMINATION The study protocol, patient information, and the non-opposition form were approved by the French national ethics committee (CPP 2021-92, January 2022). All patients are required to have signed a written informed consent form permitting their anonymised personal and medical data to be used for clinical research purposes. We will publish the results in a peer-reviewed medical journal and on our institutional websites. TRIAL REGISTRATION NUMBER NCT05385302.
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Affiliation(s)
- Sebastien Bailly
- HP2 Laboratory, INSERM U1300, Grenoble Alpes University, Grenoble Alpes University Hospital, Grenoble, France
| | - Alison Foote
- Research Department, Grenoble Alpes University Hospital Northern Site, Grenoble, France
| | - Monique Mendelson
- HP2 Laboratory, INSERM U1300, Grenoble Alpes University, Grenoble Alpes University Hospital, Grenoble, France
| | - Andry Rakotovao
- HP2 Laboratory, INSERM U1300, Grenoble Alpes University, Grenoble Alpes University Hospital, Grenoble, France
| | | | - Jean Louis Pepin
- HP2 Laboratory, INSERM U1300, Grenoble Alpes University, Grenoble Alpes University Hospital, Grenoble, France
| | - Renaud Tamisier
- HP2 Laboratory, INSERM U1300, Grenoble Alpes University, Grenoble Alpes University Hospital, Grenoble, France
- EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Helena Revil
- PACTE Laboratory, CNRS, UMR, Grenoble Alpes University, Grenoble, France
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Eshiet UI, Igwe CN, Ogbeche AO. Comparative assessment of medication knowledge among ambulatory patients: A cross-sectional study in Nigeria. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 13:100388. [PMID: 38188471 PMCID: PMC10770546 DOI: 10.1016/j.rcsop.2023.100388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024] Open
Abstract
Background Patient knowledge on medication is considered a critical aspect of medication self-management by the patient. Medication education and counseling is an important component of pharmaceutical care services. Objective This study was aimed at evaluating the impact of medication education and counseling services offered to ambulatory patients receiving care in a typical Nigerian healthcare setting on the patients' knowledge of their medication. Methods A cross sectional prospective study conducted at the outpatient pharmacy unit of University of Uyo Teaching Hospital, Nigeria. The patient population was divided into two arms: those who were yet to receive medication education/counseling - Arm 1, and those who had received medication education/counseling from the clinical pharmacist - Arm 2. A patient medication knowledge assessment questionnaire was used to assess patients' knowledge of their prescribed medication. Data obtained were analyzed using the IBM SPSS computer package version 25.0. Results Three hundred and ninety-one outpatients (196 in Arm-1 and 195 in Arm-2) participated in the study. There was a statistically significant difference in the mean medication knowledge score between patients in Arm-1 and those in Arm-2. Patients in Arm-2 had a statistically significant higher mean medication knowledge score than those in Arm-1 (5.228 versus 3.191; t = 10.152; P = 0.000). Conclusion Outpatients who received medication education and counseling from clinical pharmacists had better knowledge of their prescribed medications than those who were yet to receive this pharmaceutical intervention.
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Affiliation(s)
| | - Chioma Nneoma Igwe
- Department of Clinical Pharmacy and Biopharmacy, University of Uyo, Nigeria
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Pappadis MR, Sander AM, Juengst SB, Leon-Novelo L, Ngan E, Bell KR, Corrigan JD, Driver S, Dreer LE, Lequerica AH. The Relationship of Health Literacy to Health Outcomes Among Individuals With Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study. J Head Trauma Rehabil 2024; 39:103-114. [PMID: 37862139 PMCID: PMC10965390 DOI: 10.1097/htr.0000000000000912] [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] [Indexed: 10/22/2023]
Abstract
OBJECTIVE To examine the associations between health literacy and health outcomes among individuals with traumatic brain injury (TBI) at least a year post-injury. SETTING Community following discharge from inpatient rehabilitation. PARTICIPANTS A total of 205 individuals with complicated mild to severe TBI who completed a TBI Model Systems National Database follow-up interview and a web-based health literacy measure. DESIGN A multicenter, cross-sectional, observational study. MAIN MEASURES The Health Literacy Assessment Using Talking Touchscreen Technology (Health LiTT), number of comorbid conditions (Medical and Mental Health Comorbidities Interview [MMHCI]), perceived physical and mental health (PROMIS Global Physical and Mental Health subscales), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). RESULTS After controlling for sociodemographic, injury, cognition, and time post-injury, adequate health literacy was associated with higher odds of greater perceived physical health compared with participants with marginal/inadequate health literacy (odds ratio = 4.10; CI = 1.52-11.70]. Participants with inadequate/marginal health literacy had 3.50 times greater odds of depression (PHQ-9 ≥ 10) compared with those with adequate health literacy. Participants 45 years and older reported a greater number of MMHCI physical health conditions, but fewer MMHCI mental health conditions and GAD-7 anxiety symptoms compared with those who were younger. Non-Hispanic White participants and those with mild/moderate TBI were more likely to report a greater number of MMHCI mental health conditions compared with non-Hispanic Black participants or those with severe TBI. Greater time post-injury was associated with greater number of chronic physical and mental health conditions, and less odds of good-to-excellent perceived global mental health. CONCLUSIONS Inadequate health literacy is associated with worse perceived physical health and greater depressive symptoms among adults with TBI. Greater efforts are needed to explore the mechanisms by which health literacy influences chronic disease management and mental health after TBI to improve postinjury health status and outcomes, particularly among those with limited health literacy skills.
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Affiliation(s)
- Monique R Pappadis
- Author Affiliations: Department of Population Health and Health Disparities School of Public and Population Health, The University of Texas Medical Branch (UTMB) and Sealy Center on Aging, UTMB, Galveston (Dr Pappadis); Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas (Drs Sander, Pappadis, and Juengst); H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine and Harris Health System, Houston, Texas (Dr Sander); Department of Physical Medicine and Rehabilitation, UTHealth, Houston, Texas (Dr Juengst); School of Public Health, Biostatistics and Data Science Department, University of Texas Health Sciences Center at Houston, Houston (Dr Leon-Novelo); Department of Radiology, Baylor College of Medicine, Houston, Texas (Dr Ngan); Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas (Dr Bell); Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus (Dr Corrigan); Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas (Dr Driver); Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham (Dr Dreer); and Kessler Foundation, East Hanover, New Jersey, and Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark (Dr Lequerica)
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Pimentel SM, de Avila MAG, de Medeiros VDA, Prata RA, Nunes HRDC, da Silva JB. Factors related to health literacy among Brazilian adolescents: cross-sectional study. Rev Esc Enferm USP 2024; 58:e20230310. [PMID: 38407465 PMCID: PMC10896200 DOI: 10.1590/1980-220x-reeusp-2023-0310en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/05/2024] [Indexed: 02/27/2024] Open
Abstract
OBJECTIVE To analyze the relationship between sociodemographic and clinical factors with health literacy in Brazilian adolescents. METHOD This is a cross-sectional study with 526 adolescents aged 14 to 19. Data were collected virtually between July and September 2021 using a sociodemographic characterization questionnaire, clinical profile and the Health Literacy Assessment Tool - Portuguese version. The variables were evaluated by multiple linear regression with normal response, with significance p < 0.05. RESULTS The average age was 16.9 years (±1.6), the average health literacy score was 25.3 (±5.4). Female gender (p = 0.014), university educational level (p = 0.002) and use of medication (p = 0.020) were related to higher levels of health literacy. Adolescents with chronic illnesses had a higher total literacy score, on average 1.51 points, compared to those without chronic illnesses. CONCLUSION Male adolescents and those with less education performed worse in health literacy and, therefore, deserve special attention in health promotion actions.
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Affiliation(s)
| | | | | | - Rafaela Aparecida Prata
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil
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Kirchberger I, Fischer S, Raake P, Linseisen J, Meisinger C, Schmitz T. Depression mediates the association between health literacy and health-related quality of life after myocardial infarction. Front Psychiatry 2024; 15:1341392. [PMID: 38419900 PMCID: PMC10899501 DOI: 10.3389/fpsyt.2024.1341392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction So far, health literacy (HL) and its related factors in patients with acute myocardial infarction received little attention. Thus, the objective of this study was to investigate the associations between the different dimensions of HL and disease-specific health-related quality of life (HRQOL), and factors that may affect these relations in patients after acute myocardial infarction (AMI). Methods All survivors of AMI between June 2020 and September 2021, from the Myocardial Infarction Registry Augsburg (n=882) received a postal questionnaire on HL [Health Literacy Questionnaire (HLQ)], HRQOL (MacNew Heart Disease HRQOL questionnaire) and depression (Patient Health Questionnaire). From the 592 respondents, 546 could be included in the analysis. Multivariable linear regression models were performed to investigate the associations between the nine subscales of the HLQ and the total score and three subscales of the MacNew questionnaire. A mediation analysis was performed to estimate direct and indirect effects of HL on HRQOL taking into account the mediating effect of depression. Results In the sample of 546 patients (72.5% male, mean age 68.5 ± 12.2 years), patients with poor education showed significantly lower HLQ scores. Significant associations between the subscales of the HLQ and the MacNew were found, which remained significant after adjustment for sociodemographic variables with few exceptions. More than 50% of the association between HL and HRQOL was mediated by depression in seven HLQ subscales and a complete mediating effect was found for the HLQ subscales 'Actively managing my health' and 'Appraisal of health information'. Discussion Depression mediates the associations between HL and disease-specific HRQOL in patients with myocardial infarction.
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Affiliation(s)
- Inge Kirchberger
- Epidemiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Simone Fischer
- Epidemiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Philip Raake
- Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Augsburg, Germany
| | - Jakob Linseisen
- Epidemiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians Universität Munich, Munich, Germany
| | - Christine Meisinger
- Epidemiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Timo Schmitz
- Epidemiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
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Habib GMM, Uzzaman N, Rabinovich R, Akhter S, Ali M, Sultana M, Pinnock H. Exploring the perceptions of patients with chronic respiratory diseases and their insights into pulmonary rehabilitation in Bangladesh. J Glob Health 2024; 14:04036. [PMID: 38299780 PMCID: PMC10832548 DOI: 10.7189/jogh.14.04036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
Background Chronic respiratory diseases (CRDs) require holistic management which considers patients' preferences, appropriate pharmacotherapy, pulmonary rehabilitation, and integrated care. We aimed to understand the perceptions of people with CRDs about their condition and pulmonary rehabilitation in Bangladesh. Methods We conducted semi-structured interviews with a maximum variation sample of people with CRDs who had participated in a feasibility study of pulmonary rehabilitation in 2021/2022. A multidisciplinary team transcribed the interviews verbatim and analysed them in Bengali using a grounded theory approach. Results We interviewed 15 participants with chronic obstructive pulmonary disease, asthma, or post-tuberculosis. The analysis revealed three themes. The first encompassed understanding CRDs: Patients characterised their condition by the symptoms (e.g. 'Hapani' meaning 'breathlessness') rather than describing a disease entity. Some believed occupation, previous infection, or family history to be a cause. The second theme included perceptions of pulmonary rehabilitation: Exercise was counterintuitive, as it exacerbated the breathlessness symptom that defined their disease. Views varied, though many acknowledged the benefits after a few sessions. Even with home-based programmes, participants described practical barriers to finding time for the sessions and adopted strategies to overcome the challenges. The third theme focused on implementation: Participants highlighted the need for raising awareness of CRDs and the potential of pulmonary rehabilitation in the community, adapting to the local context, and establishing an accessible resourced service. Conclusions Understanding how patients and their communities perceive their condition and the barriers (both conceptual and logistical) to acceptance is the first step to embedding this highly effective intervention into routine health care services in Bangladesh with potential benefits for the increasing number of people living with CRDs in low- and middle-income countries.
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Affiliation(s)
- GM Monsur Habib
- Community Respiratory Centre, Khulna, Bangladesh Primary Care Respiratory Society (BPCRS), Bangladesh
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Nazim Uzzaman
- Community Respiratory Centre, Khulna, Bangladesh Primary Care Respiratory Society (BPCRS), Bangladesh
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Roberto Rabinovich
- ELEGI/Colt laboratory, Centre for Inflammation Research, Queen's Medical Research Institute (QMRI), University of Edinburgh, Edinburgh, UK
| | - Sumaiya Akhter
- Community Respiratory Centre, Khulna, Bangladesh Primary Care Respiratory Society (BPCRS), Bangladesh
| | - Mohsin Ali
- Community Respiratory Centre, Khulna, Bangladesh Primary Care Respiratory Society (BPCRS), Bangladesh
| | - Mustarin Sultana
- Community Respiratory Centre, Khulna, Bangladesh Primary Care Respiratory Society (BPCRS), Bangladesh
| | - Hilary Pinnock
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
| | - RESPIRE Collaboration
- Community Respiratory Centre, Khulna, Bangladesh Primary Care Respiratory Society (BPCRS), Bangladesh
- ELEGI/Colt laboratory, Centre for Inflammation Research, Queen's Medical Research Institute (QMRI), University of Edinburgh, Edinburgh, UK
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
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Kianian R, Sun D, Crowell EL, Tsui E. The Use of Large Language Models to Generate Education Materials about Uveitis. Ophthalmol Retina 2024; 8:195-201. [PMID: 37716431 DOI: 10.1016/j.oret.2023.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/08/2023] [Accepted: 09/08/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVE To assess large language models in generating readable uveitis information and in improving the readability of online health information. DESIGN Evaluation of technology. SUBJECTS Not applicable. METHODS ChatGPT and Bard were asked the following prompts: (prompt A) "considering that the average American reads at a 6th grade level, using the Flesch-Kincaid Grade Level (FKGL) formula, can you write patient-targeted health information on uveitis of around 6th grade level?" and (prompt B) "can you write patient-targeted health information on uveitis that is easy to understand by an average American?" Additionally, ChatGPT and Bard were asked the following prompt from the first-page results of Google when the term "uveitis" was searched: "Considering that the average American reads at a 6th grade level, using the FKGL formula, can you rewrite the following text to 6th grade level: [insert text]." The readability of each response was analyzed and compared using several metrics described below. MAIN OUTCOME MEASURES The FKGL is a highly validated readability assessment tool that assigns a grade level to a given text, the total number of words, sentences, syllables, and complex words. Complex words were defined as those with > 2 syllables. RESULTS ChatGPT and Bard generated responses with lower FKGL scores (i.e., easier to understand) in response to prompt A compared with prompt B. This was only significant for ChatGPT (P < 0.0001). The mean FKGL of responses to ChatGPT (6.3 ± 1.2) was significantly lower (P < 0.0001) than Bard 10.5 ± 0.8. ChatGPT responses also contained less complex words than Bard (P < 0.0001). Online health information on uveitis had a mean grade level of 11.0 ± 1.4. ChatGPT lowered the FKGL to 8.0 ± 1.0 (P < 0.0001) when asked to rewrite the content. Bard was not able to do so (mean FKGL of 11.1 ± 1.6). CONCLUSIONS ChatGPT can aid clinicians in producing easier-to-understand health information on uveitis for patients compared with already-existing content. It can also help with reducing the difficulty of the language used for uveitis health information targeted for patients. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Reza Kianian
- Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Deyu Sun
- Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Eric L Crowell
- Mitchel and Shannon Wong Eye Institute, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - Edmund Tsui
- Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
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Seger M, Ryan CD, Januszewski AS, Kilov G, MacIsaac RJ, Ludvigsson J, O'Neal DN, Jenkins AJ. Is it time to screen health literacy in diabetes clinical practice? Diabetes Res Clin Pract 2024; 208:111117. [PMID: 38280468 DOI: 10.1016/j.diabres.2024.111117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 01/29/2024]
Affiliation(s)
- Moa Seger
- Dept. of Endocrinology and Diabetes, St. Vincent's Hospital, Fitzroy, Melbourne, VIC, Australia; University of Melbourne, Faculty of Medicine, St. Vincent's Clinical School, Fitzroy, Melbourne, VIC, Australia; Crown Princess Victoria Childreńs Hospital and Div of Pediatrics, Dept of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Chris D Ryan
- University of Melbourne, Faculty of Medicine, St. Vincent's Clinical School, Fitzroy, Melbourne, VIC, Australia; Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Andrzej S Januszewski
- University of Melbourne, Department of Medicine, St. Vincent's, Fitzroy, Melbourne, VIC, Australia; NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, Sydney, NSW, Australia; Sydney Pharmacy School, The University of Sydney, Camperdown, Sydney, NSW, Australia
| | - Gary Kilov
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; Sydney Pharmacy School, The University of Sydney, Camperdown, Sydney, NSW, Australia; University of Melbourne, Department of General Practice, Parkville, Melbourne, VIC, Australia; Launceston Diabetes Clinic, Launceston, TAS, Australia
| | - Richard J MacIsaac
- Dept. of Endocrinology and Diabetes, St. Vincent's Hospital, Fitzroy, Melbourne, VIC, Australia; University of Melbourne, Department of Medicine, St. Vincent's, Fitzroy, Melbourne, VIC, Australia; Australian Centre for Accelerating Diabetes Innovations, School of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Johnny Ludvigsson
- Crown Princess Victoria Childreńs Hospital and Div of Pediatrics, Dept of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - David N O'Neal
- Dept. of Endocrinology and Diabetes, St. Vincent's Hospital, Fitzroy, Melbourne, VIC, Australia; University of Melbourne, Department of Medicine, St. Vincent's, Fitzroy, Melbourne, VIC, Australia; Australian Centre for Accelerating Diabetes Innovations, School of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Alicia J Jenkins
- Dept. of Endocrinology and Diabetes, St. Vincent's Hospital, Fitzroy, Melbourne, VIC, Australia; University of Melbourne, Faculty of Medicine, St. Vincent's Clinical School, Fitzroy, Melbourne, VIC, Australia; Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; University of Melbourne, Department of Medicine, St. Vincent's, Fitzroy, Melbourne, VIC, Australia; Australian Centre for Accelerating Diabetes Innovations, School of Medicine, University of Melbourne, Parkville, VIC, Australia; Monash University, Faculty of Medicine, Melbourne, VIC, Australia.
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Chan JKY, Vartanian LR. Psychological predictors of adherence to lifestyle changes after bariatric surgery: A systematic review. Obes Sci Pract 2024; 10:e741. [PMID: 38404933 PMCID: PMC10893879 DOI: 10.1002/osp4.741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/08/2024] [Accepted: 02/04/2024] [Indexed: 02/27/2024] Open
Abstract
Objective Adherence to lifestyle changes after bariatric surgery is associated with better health outcomes; however, research suggests that patients struggle to follow post-operative recommendations. This systematic review aimed to examine psychological factors associated with adherence after bariatric surgery. Methods PubMed, PsycInfo, and Embase were searched (from earliest searchable to August 2022) to identify studies that reported on clinically modifiable psychological factors related to adherence after bariatric surgery. Retrieved abstracts (n = 891) were screened and coded by two raters. Results A total of 32 studies met the inclusion criteria and were included in the narrative synthesis. Appointment attendance and dietary recommendations were the most frequently studied post-operative instructions. Higher self-efficacy was consistently predictive of better post-operative adherence to diet and physical activity, while pre-operative depressive symptoms were commonly associated with poorer adherence to appointments, diet, and physical activity. Findings were less inconsistent for anxiety and other psychiatric conditions. Conclusions This systematic review identified that psychological factors such as mood disorders and patients' beliefs/attitudes are associated with adherence to lifestyle changes after bariatric surgery. These factors can be addressed with psychological interventions; therefore, they are important to consider in patient care after bariatric surgery. Future research should further examine psychological predictors of adherence with the aim of informing interventions to support recommended lifestyle changes.
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Affiliation(s)
- Jade K. Y. Chan
- School of PsychologyUNSW SydneySydneyNew South WalesAustralia
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Lee HY, Yoon YJ, Choi YJ, Ham YH. Factors Associated with Korean American Women's Health-Related Internet Use: Findings from Andersen's Behavioral Model. J Immigr Minor Health 2024; 26:124-132. [PMID: 37747617 DOI: 10.1007/s10903-023-01540-y] [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] [Accepted: 08/19/2023] [Indexed: 09/26/2023]
Abstract
Literature suggests that access to health information improves health outcomes in various medical domains. This study investigated health-related Internet use levels and examined which factors influence health-related Internet use in Korean American women, grounded by Andersen's Behavioral Model. Participants included 243 Korean American women aged 19-85 years old residing in a Southeastern metropolitan area. Health-related Internet use was assessed by 11 items taken from HINTS 4 Cycle 2. Multiple regression analysis was conducted to reveal factors significantly associated with health-related Internet use of Korean American women. Predisposing factors of being aged 60 or older (β = - 0.329, SE = 0.694, p = 0.004) and employment status (β = 0.179, SE = 0.404, p = 0.037), as well as an enabling factor of having a primary care physician (β = 0.217, SE = 0.423, p = 0.013), were significantly associated with health-related Internet use. The differences in health-related Internet use may exacerbate disparities in access to healthcare services. The primary care physician's role is important in enhancing health-related Internet use. Research, policy, and programmatic attention are necessary to enhance physicians' encouragement and education for patients to use existing digital technology to improve their health and wellness.
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Affiliation(s)
- Hee Yun Lee
- School of Social Work, University of Alabama, 1022 Little Hall, Tuscaloosa, AL, 35487, USA.
| | - Young Ji Yoon
- Department of Social Work, Colorado State University-Pueblo, 2200 Bonforte Blvd, Pueblo, CO, 81001, USA
| | - Y Joon Choi
- School of Social Work, Georgia State University, 55 Park Place NE, Atlanta, GA, 30302, USA
| | - Young-Hoon Ham
- Korean Service Center, 2417 Larpenteur Ave W, Saint Paul, MN, 55113, USA
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Gil G, Tosin MHS, Ferraz HB. The impact of the socioeconomic factor on Parkinson's disease medication adherence: a scoping review. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-8. [PMID: 38395420 PMCID: PMC10890916 DOI: 10.1055/s-0044-1779608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/31/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND Therapeutic adherence is a decisive issue on chronic disease management in patients requiring long-term pharmacotherapy, such as Parkinson's disease (PD). Although it is well known that socioeconomic factor is a barrier to medication adherence in many chronic diseases, its impacts on PD still need to be investigated. OBJECTIVE Explore what and how socioeconomic factors impact medication adherence in people with PD. METHODS We carried out a scoping review across three databases to identify studies exploring what and how socioeconomic factors impact medication adherence in people with PD considering eight attributes: 1. educational level, 2. disease-related knowledge, 3. income, 4. cost of medication, 5. drug subsidy (meaning presence of subsidies in the cost of medication), 6. employability, and 7. ethnicity (black, indigenous, immigrants). RESULTS Of the 399 identified studies (Embase = 294, Medline = 88, LILACS = 17), eight met inclusion criteria. We identified factors covering the eight attributes of socioeconomic impact, and all of them negatively impacted the medication adherence of people with PD. The most prevalent factor in the studies was low patient educational level (four studies), followed by costs of medications (three studies), income (three studies), and disease-related knowledge (three studies). Distinctly from most of the studies selected, one of them evidenced suboptimal adherence in individuals receiving the medication free of charge, and another one could not find correlation between suboptimal adherence and educational level. CONCLUSION Socioeconomic factors negatively impact medication adherence in PD patients. This review provides basis for developing patient and population-based interventions to improve adherence to treatment in PD.
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Affiliation(s)
- Gustavo Gil
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.
| | - Michelle H. S. Tosin
- Rush University Medical Center, Department of Neurological Sciences, Chicago, Illinois, United States.
| | - Henrique Ballalai Ferraz
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.
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León-Herrera S, Oliván-Blázquez B, Samper-Pardo M, Aguilar-Latorre A, Sánchez Arizcuren R. Motivational Interviewing as a Tool to Increase Motivation and Adherence to a Long COVID Telerehabilitation Intervention: Secondary Data Analysis from a Randomized Clinical Trial. Psychol Res Behav Manag 2024; 17:157-169. [PMID: 38234406 PMCID: PMC10793119 DOI: 10.2147/prbm.s433950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/26/2023] [Indexed: 01/19/2024] Open
Abstract
Background Although motivational interviewing was originally developed to address abuse disorders, scientific evidence confirms that it is an increasingly used and effective approach in a wide range of therapeutic interventions. To date, however, no studies have analyzed the use of this tool in patients with persistent symptoms following coronavirus disease 2019, a condition known as Long COVID. Purpose To analyze the effectiveness of motivational interviewing with regard to the adherence to telerehabilitation for Long COVID using a mobile application. As a secondary objective, factors related to greater motivation before and after the motivational interviewing techniques were analyzed. Patients and Methods This longitudinal design substudy used a sample of 52 adult patients with Long COVID participating in the intervention group of a randomized clinical trial. This trial examined the effectiveness of a telerehabilitation program for this population using a mobile application. This program included three motivational interviews to achieve maximum treatment adherence. In this study, the main variables were motivation and adherence to application use. Sociodemographic and clinical data, personal constructs, and affective state were also collected. Subsequently, a descriptive, correlational, and regression statistical analysis was performed using the SPSS Statistics program. Results The median motivation prior to the first motivational interview was 8 (IQR 2), the median at the end of the last motivational interview was 8.5 (IQR 2.75), and the change in motivation levels after the three motivational interviews was 0.5 (IQR 1). Affective state and final motivation scores were predictors of greater adherence to telerehabilitation treatment. Conclusion A high level of motivation after participating in motivational interviewing appears to be related to higher levels of adherence to telerehabilitation in patients with Long COVID. This suggests that motivational interviewing may be an effective tool in the treatment of this disease.
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Affiliation(s)
- Sandra León-Herrera
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Bárbara Oliván-Blázquez
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | | | - Alejandra Aguilar-Latorre
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
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Abstract
This JAMA Insights summarizes strategies for effective medical communication, with considerations for the message delivered, the messenger source, and the social context.
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Affiliation(s)
- Anne R Cappola
- Penn Medical Communication Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Associate Editor, JAMA
| | - Karthika S Cohen
- Penn Medical Communication Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Gao B, Skalitzky MK, Rund J, Shamrock AG, Gulbrandsen TR, Buckwalter J. Carpal Tunnel Surgery: Can Patients Read, Understand, and Act on Online Educational Resources? THE IOWA ORTHOPAEDIC JOURNAL 2024; 44:47-58. [PMID: 38919356 PMCID: PMC11195886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Background Patients often access online resources to educate themselves prior to undergoing elective surgery such as carpal tunnel release (CTR). The purpose of this study was to evaluate available online resources regarding CTR on objective measures of readability (syntax reading grade-level), understandability (ability to convey key messages in a comprehensible manner), and actionability (providing actions the reader may take). Methods The study conducted two independent Google searches for "Carpal Tunnel Surgery" and among the top 50 results, analyzed articles aimed at educating patients about CTR. Readability was assessed using six different indices: Flesch-Kincaid Grade Level Index, Flesch Reading Ease, Gunning Fog Index, Simple Measure of Gobbledygook (SMOG) Index, Coleman Liau Index, Automated Readability Index. The Patient Education Materials Assessment Tool evaluated understandability and actionability on a 0-100% scale. Spearman's correlation assessed relationships between these metrics and Google search ranks, with p<0.05 indicating statistical significance. Results Of the 39 websites meeting the inclusion criteria, the mean readability grade level exceeded 9, with the lowest being 9.4 ± 1.5 (SMOG index). Readability did not correlate with Google search ranking (lowest p=0.25). Mean understandability and actionability were 59% ± 15 and 26% ± 24, respectively. Only 28% of the articles used visual aids, and few provided concise summaries or clear, actionable steps. Notably, lower grade reading levels were linked to higher actionability scores (p ≤ 0.02 in several indices), but no readability metrics significantly correlated with understandability. Google search rankings showed no significant association with either understandability or actionability scores. Conclusion Online educational materials for CTR score poorly in readability, understandability, and actionability. Quality metrics do not appear to affect Google search rankings. The poor quality metric scores found in our study highlight a need for hand specialists to improve online patient resources, especially in an era emphasizing shared decision-making in healthcare. Level of Evidence: IV.
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Affiliation(s)
- Burke Gao
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Mary Kate Skalitzky
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Joseph Rund
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Alan G. Shamrock
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Trevor R. Gulbrandsen
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Joseph Buckwalter
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Louizou E, Panagiotou N, Dafli E, Smyrnakis E, Bamidis PD. Medical Doctors Approaches and Understanding of Health Literacy: A Systematic Literature Review. Cureus 2024; 16:e51448. [PMID: 38298293 PMCID: PMC10829061 DOI: 10.7759/cureus.51448] [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] [Accepted: 12/30/2023] [Indexed: 02/02/2024] Open
Abstract
A physician's role is critical in fostering patient health literacy (HL) and influencing various aspects, including patient-physician communication and treatment effectiveness. The purpose of this systematic literature review is to analyze physicians' perspectives, comprehension, and management of HL. The focus of this review is on physicians' views, opinions, experiences, and strategies related to HL. We conducted comprehensive searches across seven databases, including PubMed, Scopus, ProQuest, Science Direct, Web of Science, The Cochrane Library, and Google Scholar. Original research articles published between January 1, 2009, and July 31, 2020, were considered for inclusion. This literature review incorporates qualitative studies and mixed-methods studies, with a focus on extracting qualitative data. Among the 22 articles included in our review, we employed the method of inductive thematic analysis for data analysis. A detailed description of the review methodology can be found in a previously published protocol available through PROSPERO (CRD42020212599). The themes that emerged from the thematic analysis include: (a) physicians' perception and management of HL; and (b) barriers. The results of the systematic review reveal that healthcare professionals exhibit varying perceptions of patients' HL levels and ascribe different meanings to it. However, none of them employ a specific measuring tool. While there appears to be no uniform approach to managing patients with low HL, some prioritize certain communication strategies, such as repetition, simplified language, and providing written instructions, among others. Most physicians cited multiple barriers that impede the development of patients' HL, including dysfunctions within the healthcare system, staff shortages, managing a large number of patients, limited time, work-related stress, cultural and socio-economic barriers, medical jargon, and language barriers. Considering the pivotal role of physicians in fostering patient HL, it is crucial to enhance medical education in addressing and managing HL, both within academic curricula and through continuing education seminars. Furthermore, there is a pressing need to improve healthcare professionals' working conditions, ensuring that each physician can allocate the necessary time to each patient based on their individual needs, without being hindered by stress-inducing work environments.
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Affiliation(s)
- Eleni Louizou
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Nikolaos Panagiotou
- School of Journalism & Mass Communications, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Eleni Dafli
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Emmanouil Smyrnakis
- Primary Health Care, General Practice and Health Services Research, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Panagiotis D Bamidis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
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Lima ACP, Maximiano-Barreto MA, Martins TCR, Luchesi BM. Factors associated with poor health literacy in older adults: A systematic review. Geriatr Nurs 2024; 55:242-254. [PMID: 38070263 DOI: 10.1016/j.gerinurse.2023.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 02/06/2024]
Abstract
OBJECTIVES To identify factors associated with poor health literacy in older adults. METHODS A systematic literature review was conducted, employing the descriptors "Aged" and "Health Literacy". PROSPERO - CRD 42022350140. RESULTS Out of 23,500 articles screened, 176 were selected. Several factors associated with poor health literacy in older adults were identified, such as sociodemographic (e.g., advanced age, low educational level, non-white population, and others), social (e.g., poor family/social support, loneliness, social isolation, few social activities, and others), economic (e.g., lower income and/or lower socioeconomic status) and health aspects (e.g., poor health, chronic conditions, mental health challenges, hospitalizations, frailty, physical inactivity, cognitive impairment, and others). CONCLUSIONS The factors associated with poor health literacy in older adults identified in this review could contribute to future research, support interventions to improve health literacy, and assist professionals in planning educational activities and public policies.
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Affiliation(s)
- Ana Caroline Pinto Lima
- Campus de Três Lagoas, Programa de Pós-Graduação em Enfermagem, Federal University of Mato Grosso do Sul, Três Lagoas, MS, Brazil
| | | | - Tatiana Carvalho Reis Martins
- Campus de Três Lagoas, Programa de Pós-Graduação em Enfermagem, Federal University of Mato Grosso do Sul, Três Lagoas, MS, Brazil; Instituto Integrado de Saúde, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Bruna Moretti Luchesi
- Campus de Três Lagoas, Programa de Pós-Graduação em Enfermagem, Federal University of Mato Grosso do Sul, Três Lagoas, MS, Brazil; Research Group on Mental Health, Cognition and Aging, Federal University of São Carlos, São Carlos, SP, Brazil.
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Aby ES, Vogel AS, Winters AC. Intersection of Coronavirus Disease 2019 and Alcohol-associated Liver Disease: A Review of Emerging Trends and Implications. Clin Ther 2023; 45:1164-1170. [PMID: 37758533 DOI: 10.1016/j.clinthera.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/04/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE This review will provide an overview of alcohol use and alcohol associated liver disease (ALD) prior to the coronavirus disease 2019 (COVID-19) pandemic and the impact of the pandemic on alcohol use and ALD. Furthermore, this review will explore strategies to mitigate the growing disease burden of AUD and ALD. METHODS A search using PubMed was performed for articles on topics related to alcohol use, ALD, and COVID-19. The literature was reviewed and pertinent sources were used for this narrative review. FINDINGS In the United States (US), excessive alcohol use is the third leading cause of preventable death. Prior to the COVID-19 pandemic, the increasing prevalence of alcohol use disorder (AUD) and ALD in the US had already constituted a public health crisis given the association between alcohol misuse, AUD, and ALD with significant medical, economic, and societal burdens. The COVID-19 pandemic led to increased alcohol consumption and downstream consequences, including increased prevalence of AUD, ALD, ALD-related hospitalization and death, and liver transplantation for ALD. IMPLICATIONS There is a critical need for additional, multi-pronged interventions to mitigate the mortality and morbidity linked to ALD.
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Affiliation(s)
- Elizabeth S Aby
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota.
| | - Alexander S Vogel
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Adam C Winters
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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Brlecic PE, Hogan KJ, Treffalls JA, Sylvester CB, Coselli JS, Moon MR, Rosengart TK, Chatterjee S, Ghanta RK. Socioeconomic disparities in procedural choice and outcomes after aortic valve replacement. JTCVS OPEN 2023; 16:139-157. [PMID: 38204692 PMCID: PMC10775113 DOI: 10.1016/j.xjon.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/07/2023] [Accepted: 10/04/2023] [Indexed: 01/12/2024]
Abstract
Objective To identify potential socioeconomic disparities in the procedural choice of patients undergoing surgical aortic valve replacement (SAVR) versus transcatheter aortic valve replacement (TAVR) and in readmission outcomes after SAVR or TAVR. Methods The Nationwide Readmissions Database was queried to identify a total of 243,691 patients who underwent isolated SAVR and TAVR between January 2016 and December 2018. Patients were stratified according to a tiered socioeconomic status (SES) metric comprising patient factors including education, literacy, housing, employment, insurance status, and neighborhood median income. Multivariable analyses were used to assess the effect of SES on procedural choice and risk-adjusted readmission outcomes. Results SAVR (41.4%; 100,833 of 243,619) was performed less frequently than TAVR (58.6%; 142,786 of 243,619). Lower SES was more frequent among patients undergoing SAVR (20.2% [20,379 of 100,833] vs 19.4% [27,791 of 142,786]; P < .001). Along with such variables as small hospital size, drug abuse, arrhythmia, and obesity, lower SES was independently associated with SAVR relative to TAVR (adjusted odds ratio [aOR], 1.17; 95% confidence interval [CI], 1.11 to 1.24). After SAVR, but not after TAVR, lower SES was independently associated with increased readmission at 30 days (aOR, 1.19; 95% CI, 1.07-1.32), 90 days (aOR, 1.27; 95% CI, 1.15-1.41), and 1 year (adjusted hazard ratio, 1.19; 95% CI, 1.11 to 1.28; P < .05 for all). Conclusions Our study findings indicate that socioeconomic disparities exist in the procedural choice for patients undergoing AVR. Patients with lower SES had increased odds of undergoing SAVR, as well as increased odds of readmission after SAVR, but not after TAVR, supporting that health inequities exist in the surgical care of socioeconomically disadvantaged patients.
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Affiliation(s)
- Paige E. Brlecic
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Katie J. Hogan
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Medical Scientist Training Program, Baylor College of Medicine, Houston, Tex
| | - John A. Treffalls
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, Tex
| | - Christopher B. Sylvester
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Medical Scientist Training Program, Baylor College of Medicine, Houston, Tex
| | - Joseph S. Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, Tex
| | - Marc R. Moon
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, Tex
| | - Todd K. Rosengart
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, Tex
| | - Subhasis Chatterjee
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, Tex
| | - Ravi K. Ghanta
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, Tex
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Simkins J, Breakwell R, Kumar K. Physiotherapists' views and experiences of health literacy in clinical practice. Musculoskeletal Care 2023; 21:1204-1212. [PMID: 37548540 DOI: 10.1002/msc.1800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/16/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Using a qualitative design, this study aimed to explore the experience of physiotherapists' supporting patient health literacy in clinical practice, gain an understanding of their conceptualisation of health literacy, and make recommendations for improving health literacy support in clinical practice. METHODS Convenience sampling via social media was used to recruit eight participants who were all physiotherapists practicing in the United Kingdom. Semi-structured interviews took place on Zoom during the second Covid-19 lockdown. Interviews were audio-recorded, transcribed, coded, and thematically analysed to uncover physiotherapists' views on health literacy, experiences of supporting patients with health literacy and opinions and recommendations for practice. RESULTS Of the eight participants, five were female and the mean years of clinical experience as a qualified physiotherapist was 5.8. Four main themes were identified: physiotherapists' conceptualisation of health literacy, identification of health literacy and skills required to support patients, training and barriers to providing health literacy-sensitive care and recommendations for improvement. CONCLUSION The findings highlighted that physiotherapists identified a patient's health literacy abilities by picking up tacit clues throughout their consultations and they pre-dominantly viewed health literacy as the ability to read, write and communicate effectively. They reported having a limited exposure to health literacy training and recommended raising awareness and education as key to improve practice.
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Affiliation(s)
- Joanna Simkins
- College of Medical and Dental Sciences, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Richard Breakwell
- School of Nursing and Midwifery, College of Medical and Dental Sciences, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Kanta Kumar
- School of Nursing and Midwifery, College of Medical and Dental Sciences, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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Nam HJ, Lee S, Park HN, Kim B, Yoon JY. A mixed-method systematic literature review of health literacy interventions for people with disabilities. J Adv Nurs 2023; 79:4542-4559. [PMID: 37503718 DOI: 10.1111/jan.15805] [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: 02/27/2023] [Revised: 06/29/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023]
Abstract
AIMS To identify the components and characteristics of health literacy interventions for people with disabilities and to explore the outcomes in terms of health literacy competencies. DESIGN A mixed-method systematic literature review. REVIEW METHODS The search results were reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. The quality appraisal was guided by the Mixed Methods Appraisal Tool. The contents of each intervention were mapped to the health literacy intervention model and the outcomes were annotated using the integrated model of health literacy. DATA SOURCES The literature search was conducted using several electronic databases, including PubMed, EMBASE, CINAHL, Cochrane library and PsycINFO in December 2022. RESULTS Ten studies were selected for this systematic literature review. Seven studies were quantitative, two were qualitative and one was a mixed-methods study. The four components of the health literacy interventions included empowering individuals with low-health literacy (n = 10), strengthening individuals' social support system (n = 3), improving communication with health professionals (n = 1) and reducing barriers to access health systems (n = 3). No intervention addressed improving health professionals' health literacy competencies. Health literacy competencies identified as outcomes in the studies included access (n = 1), understand (n = 7), appraise (n = 1) and apply (n = 9) the health information. CONCLUSIONS The significant findings of this systematic literature review provide baseline data and evidence for developing health literacy interventions for people with disabilities. However, this review demonstrates that only a handful of intervention studies have addressed the low-health literacy of people with disabilities. Further and more rigorous interventions addressing health literacy for people with diverse disabilities are warranted. IMPACT This review provides insights into how health literacy interventions can be tailored to the type of disability. Further, efforts should be expanded to comprehensively promote all the four core competencies of health literacy to reduce health disparities for individuals living with disabilities. NO PATIENT OR PUBLIC CONTRIBUTION Systematic literature review.
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Affiliation(s)
- Hye Jin Nam
- College of Nursing, Seoul National University, Seoul, South Korea
| | - Sujin Lee
- College of Nursing, Seoul National University, Seoul, South Korea
| | - Han Nah Park
- College of Nursing, Seoul National University, Seoul, South Korea
| | - Bohye Kim
- College of Nursing, Seoul National University, Seoul, South Korea
| | - Ju Young Yoon
- College of Nursing, Seoul National University, Seoul, South Korea
- Research Institute of Nursing Science, Seoul National University, Seoul, South Korea
- Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) Four Project, College of Nursing, Seoul National University, Seoul, South Korea
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Tang KWK, Millar BC, Moore JE. Improving health literacy of antibiotic use in people with cystic fibrosis (CF)-comparison of the readability of patient information leaflets (PILs) from the EU, USA and UK of 23 CF-related antibiotics used in the treatment of CF respiratory infections. JAC Antimicrob Resist 2023; 5:dlad129. [PMID: 38046567 PMCID: PMC10691746 DOI: 10.1093/jacamr/dlad129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023] Open
Abstract
Background Antibiotic adherence is poor amongst people with cystic fibrosis (CF). Low-quality patient information leaflets (PILs), which accompany prescription antibiotics, with poor readability may contribute to poor antibiotic adherence, with the potential for antimicrobial resistance (AMR) development. The aim of this study was to examine the readability of antibiotic PILs used to treat CF lung infections. Methods CF-related antibiotics (n = 23; seven classes: aminoglycosides, β-lactams, fluoroquinolones, macrolides/lincosamides, oxazolidinones, tetracyclines, trimethoprim/sulfamethoxazole) were investigated. Readability of PILs (n = 141; 23 antibiotics) from the EU (n = 40), USA (n = 42) and UK (n = 59) was calculated. Results Mean [± standard error of mean (SEM)] values for the Flesch Reading Ease (FRE) for EU, USA and UK were 50.0 ± 1.1, 56.2 ± 1.3 and 51.7 ± 1.1, respectively (FRE target ≥60). Mean (± SEM) values for the Flesch Kinkaid Grade Level (FKGL) for the EU, USA and UK were 9.0 ± 0.2, 7.5 ± 0.2 and 9.6 ± 0.2, respectively (FKGL target ≤8). US PILs were significantly shorter (P < 0.0001) in words (mean ± SEM = 1365 ± 52), than either UK or EU PILs, with fewer sentences (P < 0.0001), fewer words per sentence (P < 0.0001) and fewer syllables per word. The mean ( ± SEM) reading time of UK PILs (n = 59) was 12.7 ± 0.55 mins . Conclusions Readability of antibiotic PILs is poor. Improving PIL readability may lead to improved health literacy, which may translate to increased antibiotic adherence and AMR avoidance. Authors preparing written materials for the lay/patient CF community are encouraged to employ readability calculators, so that final materials are within recommended readability reference parameters, to support the health (antibiotic) literacy of their readers.
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Affiliation(s)
- Ka Wah Kelly Tang
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine BT52 1SA Northern Ireland, UK
| | - Beverley C Millar
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine BT52 1SA Northern Ireland, UK
- Laboratory for Disinfection and Pathogen Elimination Studies, Northern Ireland Public Health Laboratory, Belfast City Hospital, Lisburn Road, Belfast BT9 7AD Northern Ireland, UK
- Northern Ireland Regional Adult Cystic Fibrosis Centre, Level 8, Belfast City Hospital, Lisburn Road, Belfast BT9 7AB, Northern Ireland, UK
| | - John E Moore
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine BT52 1SA Northern Ireland, UK
- Laboratory for Disinfection and Pathogen Elimination Studies, Northern Ireland Public Health Laboratory, Belfast City Hospital, Lisburn Road, Belfast BT9 7AD Northern Ireland, UK
- Northern Ireland Regional Adult Cystic Fibrosis Centre, Level 8, Belfast City Hospital, Lisburn Road, Belfast BT9 7AB, Northern Ireland, UK
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Weidmann AE, Sonnleitner-Heglmeier A, Dartsch DC. Effect of patient education videos on modifying medication-related health behaviours: A systematic review using the behaviour intervention functions. PATIENT EDUCATION AND COUNSELING 2023; 117:107992. [PMID: 37788537 DOI: 10.1016/j.pec.2023.107992] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/13/2023] [Accepted: 09/25/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE This systematic review appraises, synthesises, and presents the published evidence on the effect of patient education videos in modifying medication-related health behaviours. METHODS A systematic literature review was conducted across 12 databases. Title, abstract and full-text screening was done independently using PICOS. Data extraction results were mapped directly to the Behaviour Change Intervention Functions. Results are reported in accordance with PRISMA 2020. RESULTS Out of 583 studies 12 articles from 4 countries were included. Interventions focus on improving patient's knowledge. Modelling, Enablement, Persuasion, and Training are used in video education development. PASS analysis showed very few well designed studies that allow the reliable determination of behaviour changes. CONCLUSIONS A reliable or sustained effect of patient education videos in modifying medication-related health behaviours could not be reported due to a lack of robust study design. Modelling, Enablement, Persuasion, and Training are all intervention designs used to target behaviour change often resulting either in a narrative (real people acting) or practice (demonstrating) presentation format. PRACTICE IMPLICATIONS With the increased use of health education technology, robust, theoretically underpinned studies are urgently needed to evaluate the effectiveness of these interventions in the context of their impact on patient medication-related behaviour change.
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Kelley CJ, Niznik JD, Ferreri SP, Schlusser C, Armistead LT, Hughes TD, Henage CB, Busby-Whitehead J, Roberts E. Patient Perceptions of Opioids and Benzodiazepines and Attitudes Toward Deprescribing. Drugs Aging 2023; 40:1113-1122. [PMID: 37792262 PMCID: PMC10768261 DOI: 10.1007/s40266-023-01071-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Opioids and benzodiazepines (BZDs) pose a public health problem. Older adults are especially susceptible to adverse events from opioids and BZDs owing to an increased usage of opioids and BZDs, multiple comorbidities, and polypharmacy. Deprescribing is a possible, yet challenging, solution to reducing opioid and BZD use. OBJECTIVE We aimed to explore older adult patients' knowledge of opioids and BZDs, perceived facilitators and barriers to deprescribing opioids and BZDs, and attitudes toward alternative treatments for opioids and BZDs. METHODS We conducted 11 semi-structured interviews with patients aged 65+ years with long-term opioid and/or BZD prescriptions. The interview guide was developed by an interprofessional team and focused on patients' knowledge of opioids and BZDs, perceived ability to reduce opioid or BZD use, and attitudes towards alternative treatments. RESULTS Three patients had taken opioids, either currently or in the past, three had taken BZDs, and five had taken both opioids and BZDs. Generally, knowledge of opioids and BZDs was variable among patients; yet facilitators and barriers to deprescribing both opioids and BZDs were consistent. Facilitators of deprescribing included patient-provider trust and slow tapering of medications, while barriers included concerns about re-emergence of symptoms and a lack of motivation, particularly if medications and symptoms were stable. Patients were generally unenthusiastic about pursuing alternative pharmacologic and non-pharmacologic alternatives to opioids and BZDs for symptom management. CONCLUSIONS Our findings indicate that patients are open to deprescribing opioids and BZDs under certain circumstances, but overall remain hesitant with a lack of enthusiasm for alternative treatments. Future studies should focus on supportive approaches to alleviate older adults' deprescribing concerns.
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Affiliation(s)
- Casey J Kelley
- Division of Geriatric Medicine and Center for Aging and Health, School of Medicine, University of North Carolina at Chapel Hill, 5003 Old Clinic, CB# 7550, Chapel Hill, NC, 27599, USA
| | - Joshua D Niznik
- Division of Geriatric Medicine and Center for Aging and Health, School of Medicine, University of North Carolina at Chapel Hill, 5003 Old Clinic, CB# 7550, Chapel Hill, NC, 27599, USA.
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, NC, USA.
- Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, PA, USA.
| | - Stefanie P Ferreri
- Division of Practice Advancement and Clinical Education, University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Courtney Schlusser
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lori T Armistead
- Division of Practice Advancement and Clinical Education, University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Tamera D Hughes
- Division of Practice Advancement and Clinical Education, University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Cristine B Henage
- Division of Geriatric Medicine and Center for Aging and Health, School of Medicine, University of North Carolina at Chapel Hill, 5003 Old Clinic, CB# 7550, Chapel Hill, NC, 27599, USA
| | - Jan Busby-Whitehead
- Division of Geriatric Medicine and Center for Aging and Health, School of Medicine, University of North Carolina at Chapel Hill, 5003 Old Clinic, CB# 7550, Chapel Hill, NC, 27599, USA
| | - Ellen Roberts
- Division of Geriatric Medicine and Center for Aging and Health, School of Medicine, University of North Carolina at Chapel Hill, 5003 Old Clinic, CB# 7550, Chapel Hill, NC, 27599, USA
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Bou Malhab S, Haddad C, Sacre H, Hajj A, Zeenny RM, Akel M, Salameh P. Adherence to treatment and harmful effects of medication shortages in the context of severe crises: scale validation and correlates. J Pharm Policy Pract 2023; 16:163. [PMID: 38031177 PMCID: PMC10685472 DOI: 10.1186/s40545-023-00667-5] [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: 07/21/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Medication shortage is a public health problem, affecting patients' outcomes mainly through the difficulty in maintaining adherence, particularly in the context of a severe economic crisis. There is a need for a new scale that assesses the effect of medication shortage on adherence. AIM To develop and validate a scale to evaluate the harmful impact of medication shortage among the general Lebanese population and assess its correlates and association with medication adherence. METHODS A questionnaire was used to assess medication shortage harmful effects and patients' adherence, allowing to generate the Harmful Impact of Medication Shortage scale (HIMS). The factor analysis, convergent validity and reliability of the generated scale were assessed, followed by multivariable regressions to evaluate its correlates. RESULTS The developed HIMS scale is a 9-item tool, used to assess how difficult it was for people to deal with medication shortages and their harmful effects on treatment. It was significantly and inversely linked to treatment adherence and affected by the patients' socioeconomic status and the type of chronic disease. CONCLUSION The Harmful Impact of Medication Shortage scale could be an efficient tool to measure the detrimental effects of medication shortages among the Lebanese adult population with chronic diseases, particularly affecting treatment adherence. Future studies and evidence are still needed to confirm our findings and help build global mitigation policies addressing medication shortages.
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Affiliation(s)
- Sandrella Bou Malhab
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique Et de Toxicologie-Liban), Beirut, Lebanon
- Department of Natural Sciences, School of Arts and Science, Lebanese American University, Beirut, Lebanon
| | - Chadia Haddad
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique Et de Toxicologie-Liban), Beirut, Lebanon.
- School of Medicine, Lebanese American University, Beirut, Lebanon.
- Research Department, Psychiatric Hospital of the Cross, P.O. Box 60096, Jall-Eddib, Lebanon.
| | - Hala Sacre
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique Et de Toxicologie-Liban), Beirut, Lebanon
- Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon
| | - Aline Hajj
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique Et de Toxicologie-Liban), Beirut, Lebanon
- Faculté de Pharmacie, Université Laval, Québec, Canada
- Oncology Division, CHU de Québec Université Laval Research Center, Québec, Canada
| | - Rony M Zeenny
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique Et de Toxicologie-Liban), Beirut, Lebanon
- Department of Pharmacy, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan Akel
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique Et de Toxicologie-Liban), Beirut, Lebanon
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Pascale Salameh
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique Et de Toxicologie-Liban), Beirut, Lebanon
- School of Medicine, Lebanese American University, Beirut, Lebanon
- Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
- Department of Primary Care and Population Health, University of Nicosia Medical School, 2417, Nicosia, Cyprus
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Briceland LL, Dudla C, Watson A, Denvir P. Exploring the Impact of a Vicarious Learning Approach on Student Pharmacists' Professional Identity Formation Using a Simulated Pharmacist-Patient Encounter. PHARMACY 2023; 11:177. [PMID: 37987387 PMCID: PMC10661241 DOI: 10.3390/pharmacy11060177] [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: 09/19/2023] [Revised: 10/25/2023] [Accepted: 11/12/2023] [Indexed: 11/22/2023] Open
Abstract
Purposefully developed professional identity formation (PIF) learning activities within the didactic curriculum provide crucial groundwork to complement PIF within authentic settings. The aim of this didactic exercise was to explore the impact upon student pharmacists' PIF after viewing, analyzing, and reflecting upon a simulated pharmacist-patient encounter (PPE). A 12 min role-play video was created, featuring a pharmacist counseling a standardized patient on a new medication regimen; foundational principles of medication safety, health literacy, social determinants of health, empathic communication, and motivational interviewing were included in the counseling, with some aspects intentionally performed well, others in need of improvement. Also included were the patient's varied reactions to the counseling. Students assumed the observer role and learned vicariously through viewing the PPE. Postactivity debriefs included justifying a foundational principle performed well by the pharmacist, and another in need of improvement, and a self-reflection essay expressing the impact of viewing the PPE on their PIF, from which extracts were thematically analyzed for impact. The main themes of the impact included increased awareness of counseling techniques, patient-friendly medical jargon, patient perspectives/empathy, positive and negative pharmacist role-modeling, and the value of the observer role. This PPE exercise enhanced PIF in terms of students thinking, acting, and feeling like a pharmacist, based on students' self-reflections, which most often referenced effective pharmacist-patient communication and enacting optimal patient care.
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Affiliation(s)
- Laurie L. Briceland
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY 12208, USA;
| | | | - Alexandra Watson
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY 12208, USA;
- Community Care Physicians, Latham, NY 12110, USA;
| | - Paul Denvir
- Department of Allied Health Sciences, Albany College of Pharmacy and Health Sciences, Albany, NY 12208, USA;
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Barksdale S, Stark Taylor S, Criss S, Kemper K, Friedman DB, Thompson W, Donelle L, MacGilvray P, Natafgi N. Improving Patient Health Literacy During Telehealth Visits Through Remote Teach-Back Methods Training for Family Medicine Residents: Pilot 2-Arm Cluster, Nonrandomized Controlled Trial. JMIR Form Res 2023; 7:e51541. [PMID: 37971799 PMCID: PMC10690523 DOI: 10.2196/51541] [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: 08/03/2023] [Revised: 09/29/2023] [Accepted: 10/14/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND As telemedicine plays an increasing role in health care delivery, providers are expected to receive adequate training to effectively communicate with patients during telemedicine encounters. Teach-back is an approach that verifies patients' understanding of the health care information provided by health care professionals. Including patients in the design and development of teach-back training content for providers can result in more relevant training content. However, only a limited number of studies embrace patient engagement in this capacity, and none for remote care settings. OBJECTIVE We aimed to design and evaluate the feasibility of patient-centered, telehealth-focused teach-back training for family medicine residents to promote the use of teach-back during remote visits. METHODS We codeveloped the POTENTIAL (Platform to Enhance Teach-Back Methods in Virtual Care Visits) curriculum for medical residents to promote teach-back during remote visits. A patient participated in the development of the workshop's videos and in a patient-provider panel about teach-back. We conducted a pilot, 2-arm cluster, nonrandomized controlled trial. Family medicine residents at the intervention site (n=12) received didactic and simulation-based training in addition to weekly cues-to-action. Assessment included pre- and postsurveys, observations of residents, and interviews with patients and providers. To assess differences between pre- and postintervention scores among the intervention group, chi-square and 1-tailed t tests were used. A total of 4 difference-in-difference models were constructed to evaluate prepost differences between intervention and control groups for each of the following outcomes: familiarity with teach-back, importance of teach-back, confidence in teach-back ability, and ease of use of teach-back. RESULTS Medical residents highly rated their experience of the teach-back training sessions (mean 8.6/10). Most residents (9/12, 75%) used plain language during training simulations, and over half asked the role-playing patient to use their own words to explain what they were told during the encounter. Postintervention, there was an increase in residents' confidence in their ability to use teach-back (mean 7.33 vs 7.83; P=.04), but there was no statistically significant difference in familiarity with, perception of importance, or ease of use of teach-back. None of the difference-in-difference models were statistically significant. The main barrier to practicing teach-back was time constraints. CONCLUSIONS This study highlights ways to effectively integrate best-practice training in telehealth teach-back skills into a medical residency program. At the same time, this pilot study points to important opportunities for improvement for similar interventions in future larger-scale implementation efforts, as well as ways to mitigate providers' concerns or barriers to incorporating teach-back in their practice. Teach-back can impact remote practice by increasing providers' ability to actively engage and empower patients by using the features (whiteboards, chat rooms, and mini-views) of their remote platform.
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Affiliation(s)
- Shanikque Barksdale
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Shannon Stark Taylor
- School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
- Family Medicine Residency Greenville, Prisma Health, Greenville, SC, United States
| | - Shaniece Criss
- Department of Health Sciences, Furman University, Greenville, SC, United States
| | - Karen Kemper
- Department of Public Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, United States
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Wanda Thompson
- Patient Engagement Studio, University of South Carolina, Greenville, SC, United States
| | - Lorie Donelle
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Phyllis MacGilvray
- School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
- Family Medicine, Prisma Health, Greenville, SC, United States
| | - Nabil Natafgi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Patient Engagement Studio, University of South Carolina, Greenville, SC, United States
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Baumeister A, Aldin A, Chakraverty D, Hübner C, Adams A, Monsef I, Skoetz N, Kalbe E, Woopen C. Interventions for improving health literacy in migrants. Cochrane Database Syst Rev 2023; 11:CD013303. [PMID: 37963101 PMCID: PMC10645402 DOI: 10.1002/14651858.cd013303.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND Health literacy (HL) is a determinant of health and important for autonomous decision-making. Migrants are at high risk for limited HL. Improving HL is important for equitable promotion of migrants' health. OBJECTIVES To assess the effectiveness of interventions for improving HL in migrants. To assess whether female or male migrants respond differently to the identified interventions. SEARCH METHODS We ran electronic searches to 2 February 2022 in CENTRAL, MEDLINE, Embase, PsycInfo and CINAHL. We also searched trial registries. We used a study filter for randomised controlled trials (RCTs) (RCT classifier). SELECTION CRITERIA We included RCTs and cluster-RCTs addressing HL either as a concept or its components (access, understand, appraise, apply health information). DATA COLLECTION AND ANALYSIS We used the methodological procedures recommended by Cochrane and followed the PRISMA-E guidelines. Outcome categories were: a) HL, b) quality of life (QoL), c) knowledge, d) health outcomes, e) health behaviour, f) self-efficacy, g) health service use and h) adverse events. We conducted meta-analysis where possible, and reported the remaining results as a narrative synthesis. MAIN RESULTS We included 28 RCTs and six cluster-RCTs (8249 participants), all conducted in high-income countries. Participants were migrants with a wide range of conditions. All interventions were adapted to culture, language and literacy. We did not find evidence that HL interventions cause harm, but only two studies assessed adverse events (e.g. anxiety). Many studies reported results for short-term assessments (less than six weeks after total programme completion), reported here. For several comparisons, there were also findings at later time points, which are presented in the review text. Compared with no HL intervention (standard care/no intervention) or an unrelated HL intervention (similar intervention but different information topic) Self-management programmes (SMP) probably improve self-efficacy slightly (standardised mean difference (SMD) 0.28, 95% confidence interval (CI) 0.06 to 0.50; 2 studies, 333 participants; moderate certainty). SMP may improve HIV-related HL (understanding (mean difference (MD) 4.25, 95% CI 1.32 to 7.18); recognition of HIV terms (MD 3.32, 95% CI 1.28 to 5.36)) (1 study, 69 participants). SMP may slightly improve health behaviours (3 studies, 514 participants), but may have little or no effect on knowledge (2 studies, 321 participants) or subjective health status (MD 0.38, 95% CI -0.13 to 0.89; 1 study, 69 participants) (low certainty). We are uncertain of the effects of SMP on QoL, health service use or adverse events due to a lack of evidence. HL skills building courses (HLSBC) may improve knowledge (MD 10.87, 95% CI 5.69 to 16.06; 2 studies, 111 participants) and any generic HL (SMD 0.48, 95% CI 0.20 to 0.75; 2 studies, 229 participants), but may have little or no effect on depression literacy (MD 0.17, 95% CI -1.28 to 1.62) or any health behaviour (2 studies, 229 participants) (low certainty). We are uncertain if HLSBC improve QoL, health outcomes, health service use, self-efficacy or adverse events, due to very low-certainty or a lack of evidence. Audio-/visual education without personal feedback (AVE) probably improves depression literacy (MD 8.62, 95% CI 7.51 to 9.73; 1 study, 202 participants) and health service use (MD -0.59, 95% CI -1.11 to -0.07; 1 study, 157 participants), but probably has little or no effect on health behaviour (risk ratio (RR) 1.07, 95% CI 0.91 to 1.25; 1 study, 135 participants) (moderate certainty). AVE may improve self-efficacy (MD 3.51, 95% CI 2.53 to 4.49; 1 study, 133 participants) and may slightly improve knowledge (MD 8.44, 95% CI -2.56 to 19.44; 2 studies, 293 participants) and intention to seek depression treatment (MD 1.8, 95% CI 0.43 to 3.17), with little or no effect on depression (SMD -0.15, 95% CI -0.40 to 0.10) (low certainty). No evidence was found for QoL and adverse events. Adapted medical instruction may improve understanding of health information (3 studies, 478 participants), with little or no effect on medication adherence (MD 0.5, 95% CI -0.1 to 1.1; 1 study, 200 participants) (low certainty). No evidence was found for QoL, health outcomes, knowledge, health service use, self-efficacy or adverse events. Compared with written information on the same topic SMP probably improves health numeracy slightly (MD 0.7, 95% CI 0.15 to 1.25) and probably improves print literacy (MD 9, 95% CI 2.9 to 15.1; 1 study, 209 participants) and self-efficacy (SMD 0.47, 95% CI 0.3 to 0.64; 4 studies, 552 participants) (moderate certainty). SMP may improve any disease-specific HL (SMD 0.67, 95% CI 0.27 to 1.07; 4 studies, 955 participants), knowledge (MD 11.45, 95% CI 4.75 to 18.15; 6 studies, 1101 participants) and some health behaviours (4 studies, 797 participants), with little or no effect on health information appraisal (MD 1.15, 95% CI -0.23 to 2.53; 1 study, 329 participants) (low certainty). We are uncertain whether SMP improves QoL, health outcomes, health service use or adverse events, due to a lack of evidence or low/very low-certainty evidence. AVE probably has little or no effect on diabetes HL (MD 2, 95% CI -0.15 to 4.15; 1 study, 240 participants), but probably improves information appraisal (MD -9.88, 95% CI -12.87 to -6.89) and application (RR 1.51, 95% CI 1.29 to 1.77) (1 study, 608 participants; moderate certainty). AVE may slightly improve knowledge (MD 8.35, 95% CI -0.32 to 17.02; low certainty). No short-term evidence was found for QoL, depression, health behaviour, self-efficacy, health service use or adverse events. AVE compared with another AVE We are uncertain whether narrative videos are superior to factual knowledge videos as the evidence is of very low certainty. Gender differences Female migrants' diabetes HL may improve slightly more than that of males, when receiving AVE (MD 5.00, 95% CI 0.62 to 9.38; 1 study, 118 participants), but we do not know whether female or male migrants benefit differently from other interventions due to very low-certainty or a lack of evidence. AUTHORS' CONCLUSIONS Adequately powered studies measuring long-term effects (more than six months) of HL interventions in female and male migrants are needed, using well-validated tools and representing various healthcare systems.
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Affiliation(s)
- Annika Baumeister
- Center for Life Ethics/Hertz Chair TRA 4, University of Bonn, Bonn, Germany
| | - Angela Aldin
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Digo Chakraverty
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Constanze Hübner
- Center for Life Ethics/Hertz Chair TRA 4, University of Bonn, Bonn, Germany
| | - Anne Adams
- Institute of Medical Statistics and Computational Biology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Ina Monsef
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nicole Skoetz
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christiane Woopen
- Center for Life Ethics/Hertz Chair TRA 4, University of Bonn, Bonn, Germany
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Tsai PC, Liu YC, Li TS, Hsu FT, Lee YH, Chiang IT, Chang Y, Lee CH. Clinical Effect of Moisturized Skin Care on Radiation Dermatitis of Head and Neck Cancer. In Vivo 2023; 37:2776-2785. [PMID: 37905662 PMCID: PMC10621431 DOI: 10.21873/invivo.13389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND/AIM Radiation therapy (RT) for head and neck cancer may cause severe radiation dermatitis (RD) resulting in RT interruption and affecting disease control. A few studies address skin moisture changes during RT for head and neck cancer. The purpose of this study was to explore the effect of moisturized skin care (MSC) on severity of RD. PATIENTS AND METHODS The study includes newly diagnosed head and neck cancer patients undergoing RT. Participants were divided into MSC group and routine skin care (RSC) group based on patient's preferred decision. Skin moisture in the four quadrants of the neck was measured weekly before and after RT. RD was assessed with the Radiation Induced Skin Reaction Assessment Scale (RISRAS) and the Radiation Therapy Oncology Group (RTOG) acute skin toxicity grading criteria. RESULTS A total of 54 patients were enrolled, of which 49 patients were suitable for the statistical analysis. There was a statistically significant difference in the RISRAS total score since the 5th week after RT between the groups. The severity of RD was less (B=0.814, p=0.021) and the onset was later (B=-0.384, p=0.006) in the MSC group when compared to the RSC group. Skin moisture decreased with cumulative radiation dose. In the upper neck, the MSC group had a slower rate of skin moisture decrease compared to the RSC group (right upper neck: B=0.935, p=0.007; left upper neck: B=0.93, p=0.018). CONCLUSION MSC can effectively reduce the severity and delay the onset of RD, while slows down skin moisture decrease during RT.
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Affiliation(s)
- Pei-Chuan Tsai
- Center of Hyperbaric Oxygen Center and Wound Care, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan, R.O.C
- Department of Nursing Chung Shan Medical University, Taichung, Taiwan, R.O.C
| | - Yu-Chang Liu
- Department of Radiation Oncology, Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan, R.O.C
- Department of Radiation Oncology, Show Chwan Memorial Hospital, Changhua, Taiwan, R.O.C
- Department of Medical Imaging and Radiologic Sciences, Central Taiwan University of Science and Technology, Taichung, Taiwan, R.O.C
| | - Tzong Shiun Li
- Department of Plastic Surgery, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan, R.O.C
- Innovation Research Center, Show Chwan Health Care System, Changhua, Taiwan, R.O.C
| | - Fei-Ting Hsu
- Department of Biological Science and Technology, China Medical University, Taichung, Taiwan, R.O.C
| | - Yuan-Hao Lee
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan, R.O.C
| | - I-Tsang Chiang
- Department of Radiation Oncology, Chang Bing Show Chwan Memorial Hospital, Lukang, Taiwan, R.O.C
- Department of Radiation Oncology, Show Chwan Memorial Hospital, Changhua, Taiwan, R.O.C
- Department of Medical Imaging and Radiologic Sciences, Central Taiwan University of Science and Technology, Taichung, Taiwan, R.O.C
- Medical Administrative Center, Show Chwan Memorial Hospital, Changhua, Taiwan, R.O.C
| | - Yuan Chang
- Department of Radiology, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan, R.O.C
| | - Chiu-Hsiang Lee
- Department of Nursing Chung Shan Medical University, Taichung, Taiwan, R.O.C.;
- Department of Nursing Chung Shan Medical University Hospital, Taichung, Taiwan, R.O.C
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Ramay BM, Sierra AGE, Enríquez AL, Espel C, Zelaya C, Gonzalez ALA, Lou-Meda R. A multimedia program for caregivers of pediatric patients with chronic kidney disease in Guatemala. J Pediatr Nurs 2023; 73:67-71. [PMID: 37647790 DOI: 10.1016/j.pedn.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES A multimedia medication training program for parents and legal guardians of children with chronic kidney disease (CKD) aimed to improve comprehension CKD and general information about medications used in pediatric patients attending The Foundation for Children with Kidney Disease (FUNDANIER, Guatemala City). METHODS A quasi-experimental study was carried out to measure the impact of the educational intervention on medication knowledge, at FUNDANIER from September to October 2019. Means and standard deviations was used to described test results. A Wilcoxon test was performed, to compare scores of pre and post-tests. Odds Ratio (OR) was used to determine if there was an improvement in the knowledge score before and after the intervention. Results There was significant improvement in knowledge scores knowledge before and after the intervention(27/35 versus 33/35, P < 0.005). Mestizo participants had higher odds of improvement before and after the intervention (OR 7, CI: 0.6-78). Parent-guardians with prior education, and who spoke Spanish had higher odds of improved knowledge scores (OR 3.2, CI:0.3-35; OR 1.1 CI: 0.1-14 respectively). CONCLUSION Caregivers who participated in the educational workshop improved and retained information related to CKD comprehension and medications used. This study provides a model for educational modules that can be used, tested, and applied in other chronic disease settings in low to middle income countries. PRACTICE IMPLICATIONS A culturally relevant multimedia CKD educational platform was effective in improving medication knowledge among parent/guardians of children with CKD in a low literacy setting.
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Affiliation(s)
- Brooke M Ramay
- Department of Pharmaceutical Chemistry, Universidad del Valle de Guatemala, 18 Avenida 11-95, Guatemala City, Guatemala 01015, Guatemala; Center for Health Studies, Universidad del Valle de Guatemala, 18 Avenida 11-95, Guatemala City, Guatemala 01015, Guatemala; Paul G. Allen School for Global Health, Washington State University, 1155 NE College Ave, Pullman, WA 99164, United States.
| | - Ana Gabriela Espinoza Sierra
- Department of Pharmaceutical Chemistry, Universidad del Valle de Guatemala, 18 Avenida 11-95, Guatemala City, Guatemala 01015, Guatemala
| | - Ana Lucía Enríquez
- Department of Pharmaceutical Chemistry, Universidad del Valle de Guatemala, 18 Avenida 11-95, Guatemala City, Guatemala 01015, Guatemala
| | - Celeste Espel
- Fundación para el Niño Enfermo Renal-FUNDANIER, 5ta. Avenida 6-22 z.11, Emergencia de Pediatría, Hospital Roosevelt, Guatemala City, Guatemala
| | - Cristina Zelaya
- Fundación para el Niño Enfermo Renal-FUNDANIER, 5ta. Avenida 6-22 z.11, Emergencia de Pediatría, Hospital Roosevelt, Guatemala City, Guatemala
| | - Angie Lizet Aguilar Gonzalez
- Fundación para el Niño Enfermo Renal-FUNDANIER, 5ta. Avenida 6-22 z.11, Emergencia de Pediatría, Hospital Roosevelt, Guatemala City, Guatemala.
| | - Randall Lou-Meda
- Fundación para el Niño Enfermo Renal-FUNDANIER, 5ta. Avenida 6-22 z.11, Emergencia de Pediatría, Hospital Roosevelt, Guatemala City, Guatemala
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Signorelli J, Tran T, Sirek ME, Díaz-Rohena Y, Taraba JL, Muluneh B, Basu N, Lilly J, Darling J. Development of oral oncolytic nonadherence estimator (ORACLE): A pretreatment nonadherence risk assessment for oral oncolytics. J Oncol Pharm Pract 2023:10781552231208442. [PMID: 37899586 DOI: 10.1177/10781552231208442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
INTRODUCTION To date, there is no adherence estimator to identify risk of nonadherence prior to initiating oral oncolytics. METHODS A workgroup was assembled through the National Community Oncology Dispensing Association and tasked with creating a tool to meet this need. Tool constructs were defined after a review of the literature identifying top barriers to adherence. A second literature search was conducted to identify questions targeting specific barriers from validated adherence questionnaires. Once a finalized draft was complete, the risk assessment tool was built into an electronic survey where a risk category can be automatically calculated for the patient. RESULTS The six most impactful factors affecting compliance to oral oncolytics were identified as patient's confidence, health literacy, perception of treatment, quality of life, social support, and complexity of chemotherapy regimen. A six-item questionnaire was created with five patient-directed questions and one clinician-directed question. Examples and descriptions were provided for clinicians to consider when categorizing complexity of a regimen. The tool was designed for responses to each question to be indexed into categories through a 10-point system. Results will be stratified into low, moderate, or high risk for nonadherence. CONCLUSION The creation of a tool to predict nonadherence prior to starting therapy is an unmet need for patients initiating oral oncolytics. The aim of this tool is to meet those needs and better guide clinicians to provide patients with strategies to better manage nonadherence. Next steps include tool validation and piloting in clinical practice.
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Affiliation(s)
| | - Thuy Tran
- Specialty Pharmacy Services, Atrium Health, Charlotte, NC, USA
| | | | - Yarelis Díaz-Rohena
- NCODA University, National Community Oncology Dispensing Association, Cazenovia, NY, USA
| | - Jodi L Taraba
- Department of Pharmacy, Mayo Clinic, Rochester, MN, USA
| | - Benyam Muluneh
- Division of Pharmacotherapy and Experimental Therapeutics, University of Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
- Cancer Prevention and Control Program, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Nayanika Basu
- Department of Pharmacy, University of Virginia Breast Care Center, Charlottesville VA, USA
| | - Jennifer Lilly
- Department of Pharmacy, Fort Wayne Medical Oncology and Hematology, Fort Wayne, IN, USA
| | - Julianne Darling
- NCODA University, National Community Oncology Dispensing Association, Birmingham, AL, USA
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Dweib M, El Sharif N. Diabetes-Related Microvascular Complications in Primary Health Care Settings in the West Bank, Palestine. J Clin Med 2023; 12:6719. [PMID: 37959185 PMCID: PMC10649955 DOI: 10.3390/jcm12216719] [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: 09/28/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Worldwide, retinopathy, nephropathy, and neuropathy are the major diabetes-related microvascular complications. In Palestine, a low-middle-income country, diabetes is the fourth reason for death. However, a few studies examined diabetes microvascular consequences and its management. Therefore, we carried out a national study that aims to investigate the factors associated with diabetes-related microvascular complications among individuals seeking care in primary healthcare settings of the West Bank of Palestine. METHOD Using a cluster systematic sampling technique, 882 participants with diabetes patients were chosen for a cross-sectional study from primary healthcare facilities operated by the Ministry of Health (PMoH), the United Nations Relief and Works Agency (UNRWA), and the Palestinian Medical Relief Society (PMRS). Data about patients related to diabetes-related complications, medication use, and other diseases were extracted from patients' medical records. In addition, an interview face-to-face questionnaire was used to collect information about patients' sociodemographic variables, medical history, smoking habits, duration of the disease, presence of concurrent conditions previous referrals, and hospital admissions, as well as their level of knowledge regarding diabetes, complications, and treatments. RESULTS Approximately 34.4% of persons with diabetes patients in Palestine encounter at least one microvascular complication associated with diabetes. The most prevalent diabetes-related microvascular complication was retinopathy (17.3%), 23.4% of participants had more than one microvascular complication, and 29% of male patients had erectile dysfunction. A higher probability of having any microvascular complications was associated with older age (over 60 years). Participants with diabetes patients with fundoscopy or ophthalmology reports, according to diabetes follow-up guidelines, were less likely to develop retinopathy. Also, those who performed regular kidney function testing were less likely to have nephropathy, and those who performed a regular foot exam were less likely to develop diabetic foot. CONCLUSIONS Diabetes-related microvascular complications were associated with patient age, low education level, residency location, and adherence to diabetes follow-up guidelines of diabetes management; i.e., having been tested for HbA1c, consulting with specialists, regular kidney function, and foot examination. These factors can be utilized in setting up proper management protocols to prevent or delay microvascular complications in many patients.
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Affiliation(s)
- Mohammad Dweib
- College of Pharmacy and Medical Sciences, Hebron University, P.O. Box 40, Hebron P720, Palestine;
- School of Public Health, Al-Quds University, Abu Dis, P.O. Box 51000, Jerusalem 20002, Palestine
| | - Nuha El Sharif
- School of Public Health, Al-Quds University, Abu Dis, P.O. Box 51000, Jerusalem 20002, Palestine
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Tolley A, Grewal K, Weiler A, Papameletiou AM, Hassan R, Basu S. Factors influencing adherence to non-communicable disease medication in India: secondary analysis of cross-sectional data from WHO - SAGE2. Front Pharmacol 2023; 14:1183818. [PMID: 37900158 PMCID: PMC10603298 DOI: 10.3389/fphar.2023.1183818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Background: Non-communicable diseases (NCDs) are a leading cause of death globally and disproportionately affect those in low- and middle-income countries lower-middle-income countries. Poor medication adherence among patients with NCDs is prevalent in India due to lack of initiation, missed dosing or cessation of treatment, and represents a growing healthcare and financial burden. Objective: This study aimed to identify factors influencing medication adherence in adults with NCDs in India. Methods: We performed a cross-sectional study, conducting secondary data analysis on the second wave of the World Health Organisation's 'Study on global AGEing and adult health (SAGE)', a survey that collected data from predominantly older adults across India. Bivariate analysis and multivariate logistic regression modelling were conducted to specifically interrogate the reasons for lack of initiation and cessation of treatment. Reporting of this study was informed by the STROBE guidelines. Results: The average medication adherence rate was 51% across 2,840 patients with one or more NCDs, reflecting non-initiation and lack of persistence of treatment. The strongest factor significantly predicting non-adherence to medication across these components was multimorbidity (odds ratio 0.47, 95% CI 0.40-0.56). Tobacco use (OR = 0.76, CI 0.59-0.98) and never having attended school (OR = 0.75, CI 0.62-0.92) were significantly associated with poor medication adherence (p < 0.05) while rural living (OR = 0.70, CI 0.48-1.02), feelings of anxiety (OR = 0.84, CI 0.66-1.08) and feelings of depression (OR = 0.90, CI 0.70-1.16) were factors lacking statistically significant association with medication adherence on multivariate analysis. Older age (OR = 2.02, CI 1.51-2.71) was significantly associated with improved medication adherence whilst there was a weak association between increased wealth and improved medication use. Limitations: The SAGE2 survey did not capture whether patients were taking their medication doses according to prescribed instructions-as a result our findings may under-estimate the true prevalence of medication non-adherence. Conclusion: Our analysis provides evidence that poor medication adherence in India is multifactorial, with distinct socioeconomic and health-system factors interacting to influence patient decision making. Future large-scale surveys interrogating adherence should assess all components of adherence specifically, whilst public health interventions to improve medication adherence should focus on barriers that may exist due to multimorbidity, comorbid depression and anxiety, and low educational status.
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Affiliation(s)
- Abraham Tolley
- School of Clinical Medicine, University of Cambridge, Cambridge, England
| | - Kirpal Grewal
- Faculty of Natural Science, University of Cambridge, Cambridge, England
| | - Alessa Weiler
- Faculty of Natural Science, University of Cambridge, Cambridge, England
| | | | - Refaat Hassan
- School of Clinical Medicine, University of Cambridge, Cambridge, England
| | - Saurav Basu
- Indian Institute of Public Health, Public Health Foundation of India, New Delhi, India
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