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Murugesu L, Fransen MP, Timmermans DR, Pieterse AH, Smets EM, Damman OC. Co-creation of a health literate-sensitive training and conversation aid to support shared decision-making in maternity care. PEC INNOVATION 2024; 4:100278. [PMID: 38596600 PMCID: PMC11002297 DOI: 10.1016/j.pecinn.2024.100278] [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: 08/27/2023] [Revised: 11/17/2023] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
Background Maternity care increasingly aims to achieve Shared Decision-making (SDM), yet seemingly not to the benefit of clients with low health literacy (HL). We developed an SDM training for healthcare professionals (HCPs) and a conversation aid to support HL-sensitive SDM in maternity care. Methods The training and conversation aid were based on previous needs assessments and expert consultation, and were developed in co-creation with clients (n = 15) and HCPs (n = 7). Usability, acceptability and comprehension of the conversation aid were tested among new clients (n = 14) and HCPs (n = 6). Acceptability of the training was tested among midwifery students (n = 5). Results In the co-creation sessions, clients reported to expect that their midwife becomes acquainted with their general values, priorities and daily context. Clients also emphasized wanting to be supported in their preferred decisional role. User test interviews showed that clients and HCPs were positive towards using the conversation aid, but also apprehensive about the time it required. The user test of the training showed that more attention was needed for recognizing and adapting information provision to clients' HL level. Conclusion and innovation The newly developed conversation aid and training have potential to support HCPs and clients in HL-sensitive SDM.
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Affiliation(s)
- Laxsini Murugesu
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Mirjam P. Fransen
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Danielle R.M. Timmermans
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- Amsterdam UMC Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
| | - Arwen H. Pieterse
- Leiden University Medical Center, Biomedical Data Sciences, Leiden, the Netherlands
| | - Ellen M.A. Smets
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- Amsterdam UMC Location University of Amsterdam, Medical Psychology, Amsterdam, the Netherlands
| | - Olga C. Damman
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- Amsterdam UMC Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
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Westendorp J, van Vliet LM, Meeuwis SH, Olde Hartman TC, Sanders ARJ, Jutten E, Dirven M, Peerdeman KJ, Evers AWM. Optimizing placebo and minimizing nocebo effects through communication: e-learning and virtual reality training development. BMC MEDICAL EDUCATION 2024; 24:707. [PMID: 38951784 PMCID: PMC11218054 DOI: 10.1186/s12909-024-05671-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 06/18/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND The effects of many treatments in healthcare are determined by factors other than the treatment itself. Patients' expectations and the relationship with their healthcare provider can significantly affect treatment outcomes and thereby play a major role in eliciting placebo and nocebo effects. We aim to develop and evaluate an innovative communication training, consisting of an e-learning and virtual reality (VR) training, for healthcare providers across all disciplines, to optimize placebo and minimize nocebo effects through healthcare provider-patient communication. The current paper describes the development, mid-term evaluation, optimization, and final evaluation of the communication training, conducted in The Netherlands. METHODS The development of both the e-learning and the VR training consisted of four phases: 1) content and technical development, 2) mid-term evaluation by healthcare providers and placebo/communication researchers, 3) optimization of the training, and 4) final evaluation by healthcare providers. To ensure the success, applicability, authenticity, and user-friendliness of the communication training, there was ongoing structural collaboration with healthcare providers as future end users, experts in the field of placebo/communication research, and educational experts in all phases. RESULTS Placebo/communication researchers and healthcare providers evaluated the e-learning positively (overall 7.9 on 0-10 scale) and the content was perceived as useful, accessible, and interesting. The VR training was assessed with an overall 6.9 (0-10 scale) and was evaluated as user-friendly and a safe method for practicing communication skills. Although there were some concerns regarding the authenticity of the VR training (i.e. to what extent the virtual patient reacts like a real patient), placebo and communication researchers, as well as healthcare providers, recognized the significant potential of the VR training for the future. CONCLUSIONS We have developed an innovative and user-friendly communication training, consisting of an e-learning and VR training (2D and 3D), that can be used to teach healthcare providers how to optimize placebo effects and minimize nocebo effects through healthcare provider-patient communication. Future studies can work on improved authenticity, translate the training into other languages and cultures, expand with additional VR cases, and measure the expected effects on providers communication skills and subsequently patient outcomes.
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Affiliation(s)
- Janine Westendorp
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands.
- Center for Interdisciplinary Placebo Studies (IPS) Leiden, Leiden, The Netherlands.
| | - Liesbeth M van Vliet
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
- Center for Interdisciplinary Placebo Studies (IPS) Leiden, Leiden, The Netherlands
| | - Stefanie H Meeuwis
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
- Center for Interdisciplinary Placebo Studies (IPS) Leiden, Leiden, The Netherlands
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ariëtte R J Sanders
- General Medical Practice Van Lennep Huisartsenpraktijk, Driebergen, The Netherlands
| | - Eric Jutten
- The Simulation Crew (TSC), Nijmegen, The Netherlands
| | - Monique Dirven
- Dutch Institute for Rational Use of Medicine (IVM), Utrecht, The Netherlands
| | - Kaya J Peerdeman
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
- Center for Interdisciplinary Placebo Studies (IPS) Leiden, Leiden, The Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
- Center for Interdisciplinary Placebo Studies (IPS) Leiden, Leiden, The Netherlands
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Jolidon V, Eicher M, Peytremann-Bridevaux I, Arditi C. Inequalities in patients' experiences with cancer care: the role of economic and health literacy determinants. BMC Health Serv Res 2024; 24:733. [PMID: 38877526 PMCID: PMC11179203 DOI: 10.1186/s12913-024-11174-x] [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: 10/25/2023] [Accepted: 06/05/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Patients with fewer socioeconomic and health literacy resources are disadvantaged in their access and use of healthcare, which may give rise to worse experiences with care and thus inequalities in patient experiences. However, only a limited number of studies have examined how socioeconomic and health literacy factors shape inequalities in patients' experiences with cancer care. OBJECTIVE To examine whether patients' experiences with cancer care differ according to their economic status and health literacy. METHODS Secondary analysis of data on 2789 adult patients diagnosed with cancer from the Swiss Cancer Patient Experiences-2 (SCAPE-2) study, a cross-sectional survey conducted in eight hospitals across Switzerland from September 2021 to February 2022. Regression analysis was applied to examine the independent effect of patients' economic status and health literacy on various outcomes of experiences with cancer care, covering eight different dimensions of patient-centred care, controlling for confounding factors. RESULTS Adjusted regression analysis showed that patients with lower economic status reported significantly worse experiences with cancer care in 12 out of 29 specific care experiences, especially in the dimensions of 'respect for patients' preferences' and 'physical comfort' where all items of experiences were associated with economic status. Additionally, lower health literacy was associated with worse patient experiences in 23 specific care experiences. All items in the dimensions of 'respect for patients' preferences', 'physical comfort' and 'emotional support' were associated with health literacy. DISCUSSION This study revealed significant inequalities in experiences with cancer care shaped by the economic status and health literacy of patients across different dimensions of patient-centred care. It is essential to address the needs of more disadvantaged patients who face obstacles in their access and use of the healthcare system, not only to mitigate inequalities in cancer care but also to avoid inequalities in health outcomes.
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Affiliation(s)
- Vladimir Jolidon
- Unisanté, University Center for Primary Care and Public Health, Department of Epidemiology and Health Systems, University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Manuela Eicher
- Institute of Higher Education and Research in Healthcare (IUFRS), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Unisanté, University Center for Primary Care and Public Health, Department of Epidemiology and Health Systems, University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Chantal Arditi
- Unisanté, University Center for Primary Care and Public Health, Department of Epidemiology and Health Systems, University of Lausanne, CH-1011 Lausanne, Switzerland.
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Udemgba C, Burbank AJ, Gleeson P, Davis CM, Matsui EC, Mosnaim G. Factors Affecting Adherence in Allergic Disorders and Strategies for Improvement. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00632-9. [PMID: 38878860 DOI: 10.1016/j.jaip.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/29/2024] [Accepted: 06/04/2024] [Indexed: 07/25/2024]
Abstract
Addressing patient adherence is a key element in ensuring positive health outcomes and improving health-related quality of life for patients with atopic and immunologic disorders. Understanding the complex etiologies of patient nonadherence and identifying real-world solutions is important for clinicians, patients, and systems to design and effect change. This review serves as an important resource for defining key issues related to patient nonadherence and outlines solutions, resources, knowledge gaps, and advocacy areas across five domains: health care access, financial considerations, socioenvironmental factors, health literacy, and psychosocial factors. To allow for more easily digestible and usable content, we describe solutions based on three macrolevels of focus: patient, clinician, and system. This review and interactive tool kit serve as an educational resource and call to action to improve equitable distribution of resources, institutional policies, patient-centered care, and practice guidelines for improving health outcomes for all patients with atopic and immunologic disorders.
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Affiliation(s)
- Chioma Udemgba
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md; University Medicine Associates, University Health, San Antonio, Tex.
| | - Allison J Burbank
- Division of Pediatric Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Patrick Gleeson
- Section of Allergy and Immunology, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa
| | - Carla M Davis
- Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Elizabeth C Matsui
- Center for Health & Environment: Education & Research, University of Texas at Austin Dell Medical School, Austin, Texas
| | - Giselle Mosnaim
- Division of Allergy and Immunology, Department of Medicine, Endeavor Health, Glenview, Ill
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Efthymiou A, Kalaitzaki A, Kondilis B, Rovithis M. Health literacy continuing education courses and tools for healthcare professionals: A scoping review. GERONTOLOGY & GERIATRICS EDUCATION 2024; 45:212-247. [PMID: 36545846 DOI: 10.1080/02701960.2022.2156865] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Strengthening the health literacy (HL) skills of the healthcare users is a multicomponent process involving the users, the healthcare professionals, the stakeholders, and the environment. Health organizations, universities, private initiatives, and funded projects focused on developing and implementing continuing education courses target at increasing healthcare professionals' HL. This scoping review aimed at reporting the HL continuing education courses for healthcare professionals to enhance their knowledge and skills in identifying and supporting healthcare users with limited HL, and particularly, older people. This review followed the five stages by Arksey and O'Malley framework and the guidelines by Joanna Briggs Institute for scoping reviews. Peer-reviewed papers and gray literature published between years 2000 to 2020 were included in this bibliometric search utilizing four electronic databases (PUBMED, MEDLINE, CINAHL, PSYCHINFO, and Opengrey). Twenty-seven (27) papers met the criteria, including twenty-one (21) full-texts and six (6) other records (website contents, eLearning, and funded projects). There is a lack of HL tools that address the training needs of healthcare professionals working with older adults. Tailored HL tools could benefit healthcare professionals' clinical work by improving their communication with older adults.
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Affiliation(s)
- Areti Efthymiou
- Department of Social Work, School of Health Sciences, Hellenic Mediterranean University (HMU), Heraklion, Crete, Greece
- Laboratory of Interdisciplinary Approaches to the Enhancement of Quality of Life (Quality of Life Lab), HMUb
| | - Argyroula Kalaitzaki
- Department of Social Work, School of Health Sciences, Hellenic Mediterranean University (HMU), Heraklion, Crete, Greece
- Laboratory of Interdisciplinary Approaches to the Enhancement of Quality of Life (Quality of Life Lab), HMUb
- University Centre of Research and Innovation 'Institute of AgriFood and Life Sciences, HMU
| | - Barbara Kondilis
- Department of Art & Sciences, Hellenic American University, Nashua, Greece
| | - Michael Rovithis
- Laboratory of Interdisciplinary Approaches to the Enhancement of Quality of Life (Quality of Life Lab), HMUb
- Department of Business Administration and Tourism, Hellenic Mediterranean University, Heraklion, Crete
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Chang MC, Yu JH, Hsieh JG, Wei MH, Wang YW. Effectiveness of the refined health literacy course on improving the health literacy competencies of undergraduate nursing students: quantitative and qualitative perspectives. MEDICAL EDUCATION ONLINE 2023; 28:2173042. [PMID: 36718508 PMCID: PMC9891155 DOI: 10.1080/10872981.2023.2173042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/05/2023] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
People with limited health literacy comprise a high-risk group for adverse health outcomes. Nurses must be made aware of the importance of health literacy and communicate with patients in plain language, which will solve the obstacles for patients using health care services. Providing health literacy education for nurses is an important strategy for health literacy practices. This study aimed to develop a refined health literacy course for nursing students and evaluate its effectiveness. The study used a single-group pre- and post-test quasi-experimental design and conducted focus group interviews. The intervention was an eight-hour course and applied team-based learning combined with various teaching methods. The study enrolled second-year nursing students of a university in eastern Taiwan via convenient sampling. A self-reported structured questionnaire was used to compare the participants' familiarity with health literacy, attitude, confidence in oral communication, and ability in written communication before and after the course. To discuss the learning experience of the course, the study held two focus groups with 12 participants. A total of 81 participants completed the pre- and post-test questionnaires. The results showed that familiarity with health literacy (t=9.12, t<.001), attitude (t=4.89, t<.001), confidence in oral communication (t=4.12, t<.001), and ability in written communication (t=8.83, t<.001) showed improvement after the course. Data analysis of focus group interviews yielded two categories and seven themes for the learning experience, most of which showed participants' positive learning experiences in the health literacy course. The course effectively enhanced the nursing students' knowledge and attitude toward health literacy and the ability to communicate with patients using health literacy principles. The results can provide a reference for integrating health literacy education into the undergraduate nursing curriculum.
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Affiliation(s)
- Mei-Chuan Chang
- Department of Nursing, College of Medicine, Tzu Chi University, Hualien City, Taiwan
| | - Jui-Hung Yu
- Department of Public Health, Tzu Chi University, Hualien City, Taiwan
| | - Jyh-Gang Hsieh
- Department of Family Medicine, Hualien Tzu Chi Hospital, Hualien City, Taiwan
- Department of Medical Humanities, School of Medicine, Tzu Chi University, Hualien City, Taiwan
| | - Mi-Hsiu Wei
- Department of Communication Studies, Tzu Chi University, Hualien City, Taiwan
| | - Ying-Wei Wang
- Department of Family Medicine, Hualien Tzu Chi Hospital, Hualien City, Taiwan
- Department of Medical Humanities, School of Medicine, Tzu Chi University, Hualien City, Taiwan
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Papa R, Sixsmith J, Giammarchi C, Lippke S, McKenna V, Di Furia L, Ceravolo MG, De Winter A. Health literacy education at the time of COVID-19: development and piloting of an educational programme for university health professional students in 4 European countries. BMC MEDICAL EDUCATION 2023; 23:650. [PMID: 37684654 PMCID: PMC10492329 DOI: 10.1186/s12909-023-04608-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/23/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Health literacy has a strong influence on individual health outcomes and the sustainability of healthcare systems. Healthcare professionals often overestimate patients' health literacy levels and lack adequate competencies to address limited health literacy effectively. Therefore, promoting understanding through effective health communication between professionals and citizens is becoming increasingly important. Although health literacy has recently gained more attention, health literacy educational programmes targeting future healthcare professionals are still scarce, especially in Europe. This study describes the piloting process of a pan-European health literacy educational programme and shows how the educational material is being used during time of crisis such as the COVID-19 pandemic. METHODS The educational programme was developed through the definition of an educational philosophy and iterative co-creation processes consisting of stakeholders' consultations, material development and pilots with students. The evaluation was carried out in Italy through four pilot tests involving 107 students of health-related degrees. An evaluation questionnaire and a pre-post test were developed and used to collect students' and educators' feedback (quantitative and qualitative) and assess changes in health literacy awareness, respectively. Three additional pilots were organized in Italy and Germany mostly during the COVID-19 pandemic to evaluate the feasibility of the educational programme through online and hybrid learning, respectively. RESULTS The pilots received positive feedback from both students and educators. Students were highly satisfied with the courses, reported their relevance for their future profession and appreciated the interactive teaching methods. The pre-post test showed a significant improvement in health literacy awareness after the training. Educators reported the adequacy and flexibility of the training material, the ease of transferability of the content of the lessons into practice, and the validity of the tested options to integrate the educational programme into the curricula. CONCLUSIONS Our comprehensive, evidence-based educational programme contributes to addressing the existing challenges in Europe, and its flexibility allows for easy integration in the curricula, through different options, hence supporting a widespread uptake in the European Union and maybe beyond. Health literacy education is a useful tool to improve citizens' access to healthcare information and services, achieve better health outcomes and support healthcare systems' sustainability.
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Affiliation(s)
- Roberta Papa
- Regional Health Agency Marche Region, Palazzo Rossini - via Gentile da Fabriano n.3, Ancona, 60125, Italy.
- IRCCS INRCA, Ancona, Italy.
| | - Jane Sixsmith
- Health Promotion Research Centre, Discipline of Health Promotion, National University of Ireland Galway, Galway, Ireland
| | | | | | - Verna McKenna
- Health Promotion Research Centre, Discipline of Health Promotion, National University of Ireland Galway, Galway, Ireland
| | - Lucia Di Furia
- Regional Health Agency Marche Region, Palazzo Rossini - via Gentile da Fabriano n.3, Ancona, 60125, Italy
| | - Maria Gabriella Ceravolo
- Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Andrea De Winter
- Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Murugesu L, Damman OC, Timmermans DRM, de Wit S, Nieuwenhuijze M, Smets EMA, Fransen MP. Health literate-sensitive shared decision-making in maternity care: needs for support among maternity care professionals in the Netherlands. BMC Pregnancy Childbirth 2023; 23:594. [PMID: 37605153 PMCID: PMC10440871 DOI: 10.1186/s12884-023-05915-9] [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] [Accepted: 08/11/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) in maternity care is challenging when clients have insufficient health literacy (HL) skills. This study gained insight in how professionals apply HL-sensitive SDM in Dutch maternity care and their needs for support therein. METHODS Maternity care professionals (n = 30) completed a survey on SDM and the role of HL. Midwives (n = 13) were observed during simulated conversations discussing pain relief options and interviewed afterwards. The client-actors were instructed to portrait specific inadequate HL skills. Observation items focused on adapting communication to HL, and SDM (OPTION-5). RESULTS In the survey, professionals indicated experiencing most challenges when estimating clients' information comprehension. Observations showed that most midwives created choice awareness and informed clients about options, whereas exploring preferences and actual decision-making together with clients were observed less frequently. Their perceived HL-related obstacles and needs for support related to clients' information comprehension. In the interviews, midwives reported putting much effort into explaining available options in maternity care, but also that decisions about pain relief are often postponed until the moment of labour. CONCLUSION Professionals' self-reported needs focus on clients' information comprehension. However, observations indicate that it is not the stage of informing, but rather value clarification and actual decision-making that need improvement in HL-sensitive SDM.
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Affiliation(s)
- Laxsini Murugesu
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands.
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands.
| | - Olga C Damman
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
| | - Danielle R M Timmermans
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
| | - Sanne de Wit
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
| | - Marianne Nieuwenhuijze
- Research Centre for Midwifery Science, Zuyd University, Universiteitssingel 60, Maastricht, 6229 ER, the Netherlands
- CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Ellen M A Smets
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- Amsterdam UMC Location University of Amsterdam, Medical Psychology, Amsterdam, the Netherlands
| | - Mirjam P Fransen
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
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Tong Y, Wu Y, Han Z, Xue Z, Wei Y, Lai S, Chen Z, Wang M, Chen S. Development and validation of the health literacy environment scale for Chinese hospitals from patients' perspective. Front Public Health 2023; 11:1130628. [PMID: 37333562 PMCID: PMC10273272 DOI: 10.3389/fpubh.2023.1130628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/12/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction While the research on improving individual health literacy by promoting individual skills and abilities is increasing, less attention has been paid to the complexities of the healthcare environment that may influence patients' ability to access, understand, and apply health information and health services to make health decisions. This study aimed to develop and validate a Health Literacy Environment Scale (HLES) that is suitable for Chinese culture. Methods This study was conducted in two phases. First, using the Person-Centered Care (PCC) framework as a theoretical framework, initial items were developed by using the existing health literacy environment (HLE) related measurement tools, literature review, qualitative interviews, and the researcher's clinical experience. Second, scale development was based on two rounds of Delphi expert consultation and a pre-test conducted with 20 hospitalized patients. Using 697 hospitalized patients from three sample hospitals, the initial scale was developed after item screening and its reliability and validity were evaluated. Results The HLES comprised 30 items classified into three dimensions as follows: interpersonal (11 items), clinical (9 items), and structural (10 items) dimensions. The Cronbach's α coefficient of the HLES was 0.960 and the intra-class correlation coefficient was 0.844. The confirmatory factor analysis verified the three-factor model after allowing for the correlation of five pairs of error terms. The goodness-of-fit indices signified a good fit for the model (χ2/df = 2.766, RMSEA = 0.069, RMR = 0.053, CFI = 0.902, IFI = 0.903, TLI = 0.893, GFI = 0.826, PNFI = 0.781, PCFI = 0.823, PGFI = 0.705). The item-content validity index ranged from 0.91 to 1.00, and the scale-content validity index was 0.90. Conclusion The HLES had good reliability and validity and provides a patient perspective tool for evaluating HLE and a new perspective for improving health literacy in China. That is, healthcare organizations make it easier for patients to access, understand, and use health information and service. Further studies about the validity and reliability of HLE should include other districts and different tiers or types of healthcare organizations.
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Affiliation(s)
- Yingge Tong
- School of Nursing, Hangzhou Normal University, Hangzhou, China
| | - Yixue Wu
- School of Nursing, Hangzhou Normal University, Hangzhou, China
| | - Zhiqing Han
- School of Nursing, Hangzhou Normal University, Hangzhou, China
| | - Zihao Xue
- Department of Operating Room, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yeling Wei
- School of Nursing, Hangzhou Normal University, Hangzhou, China
| | - Shanyuan Lai
- School of Nursing, Hangzhou Normal University, Hangzhou, China
| | - Ziyi Chen
- School of Nursing, Hangzhou Normal University, Hangzhou, China
| | - Miaoling Wang
- School of Nursing, Hangzhou Normal University, Hangzhou, China
| | - Siyi Chen
- School of Nursing, Hangzhou Normal University, Hangzhou, China
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Connell L, Finn Y, Sixsmith J. Health literacy education programmes developed for qualified health professionals: a scoping review. BMJ Open 2023; 13:e070734. [PMID: 36997248 PMCID: PMC10069593 DOI: 10.1136/bmjopen-2022-070734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES Both literature and policy have identified the need for health literacy education for qualified health professionals. This study aimed to identify and map health literacy competencies and health literacy related communication skills educational interventions for qualified health professionals. The research questions included: Of the qualified health professional education interventions identified, which are focused on diabetes care? What health literacy competencies and health literacy related communication skills are integrated into each programme? What are the characteristics of each education programme? What were the barriers and facilitators to implementation? What methods are used to evaluate intervention effectiveness, if any? DESIGN Scoping review, informed by the Joanna Briggs Institute guidelines. DATA SOURCES The following databases: OVID; CINAHL; Cochrane; EMBASE; ERIC: PsycInfo; RIAN; Pro-Quest; UpToDate were searched. ELIGIBILITY CRITERIA Articles were included if the education programme focused on qualified health professionals, in all clinical settings, treating adult patient populations, of all study types. DATA EXTRACTION AND SYNTHESIS Two authors independently screened titles, abstracts and full text articles that met the inclusion criteria. The third author mediated any discrepancies. The data were extracted and charted in table format. RESULTS In total, 53 articles were identified. One article referred to diabetes care. Twenty-six addressed health literacy education, and 27 addressed health literacy related communication. Thirty-five reported using didactic and experiential methods. The majority of studies did not report barriers (N=45) or facilitators (N=52) to implementation of knowledge and skills into practice. Forty-nine studies evaluated the reported education programmes using outcome measures. CONCLUSIONS This review mapped existing education programmes regarding health literacy and health literacy related communication skills, where programme characteristics were identified to inform future intervention development. An evident gap was identified regarding qualified health professional education in health literacy, specifically in diabetes care.
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Affiliation(s)
- Lauren Connell
- Health Promotion Research Centre (HPRC), University of Galway, Galway, Ireland
- Alliance for Research and Innvoation in Wounds (ARIW), University of Galway, Galway, Ireland
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, University of Galway, Galway, Ireland
| | - Yvonne Finn
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, University of Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Jane Sixsmith
- Health Promotion Research Centre (HPRC), University of Galway, Galway, Ireland
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, University of Galway, Galway, Ireland
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11
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Naperola-Johnson J, Gutierrez J, Doyle K, Thompson J, Hendrix C. Implementation of health literacy training for clinicians in a federally qualified health center. PEC INNOVATION 2022; 1:100083. [PMID: 37213779 PMCID: PMC10194109 DOI: 10.1016/j.pecinn.2022.100083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 08/30/2022] [Accepted: 09/13/2022] [Indexed: 05/23/2023]
Abstract
Objective The objective of this quality improvement project was to evaluate the effectiveness of a succinct health literacy training for providers at a demanding federally qualified health center. Methods One group, pretest-posttest design was used to measure for a change in knowledge regarding the effects of limited health literacy, a change in self-reported measure of routine screening for limited health literacy and a change in self-reported utilization of patient-centered communication techniques. Results The average percentage of correct responses on the Health Literacy Knowledge Check showed significant improvement from 23.6% (SD = 18.1%) to 63.9% (SD = 25.3%), p < .001. There were no significant changes in median responses at pre- and post-intervention for self-reported use of screening and communication techniques (all p > .05). Conclusion This brief training was effective at improving participants' knowledge of health literacy but did not improve use of recommended communication techniques or screening for health literacy. The results suggest that emphasizing a universal precautions approach to health literacy may be more effective with participants who work in high-volume clinics. Practice implications For high-volume clinics, a brief training may improve participants' knowledge but does not increase use of actual communication techniques based on self-report.
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Affiliation(s)
- Jacqueline Naperola-Johnson
- School of Nursing, Duke University school of nursing, Durham, United States
- Corresponding author at: 511 Constitution Dr, Durham, NC 27705, United States.
| | - Jose Gutierrez
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, United States
| | - Kathryn Doyle
- School of Nursing, Duke University school of nursing, Durham, United States
| | - Julie Thompson
- School of Nursing, Duke University school of nursing, Durham, United States
| | - Cristina Hendrix
- School of Nursing, Duke University school of nursing, Durham, United States
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12
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Hsieh JG, Yu JH, Wang YW, Wei MH, Chang MC, Wu CC, Chia SL. Health literacy training program for community healthcare providers using hybrid online team-based learning in Taiwan. BMC MEDICAL EDUCATION 2022; 22:576. [PMID: 35897091 PMCID: PMC9327261 DOI: 10.1186/s12909-022-03646-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Health literacy (HL) has proven to be a determining factor influencing the health of individuals. Community health providers (CHPs) work on the front line of improving public HL. Increasing their understanding of HL and their ability to incorporate HL into healthcare can reduce obstacles in healthcare services. This study evaluated the effectiveness of an HL training program for CHP by using the hybrid online team-based learning (TBL) model. METHODS A quasi-experimental study and focused group interviews were conducted. We developed a six weeks HL online course for CHPs. The program included teaching videos for pre-class preparation, a 90-min online TBL model, and a case discussion in the last two weeks. Team application activities were designed for each class to enhance knowledge application. A total of 81 CHPs from 20 public health centers took the course and provided complete data for analysis. Learning effectiveness was evaluated based on the familiarity, attitude, and confidence in implementing HL practices, course satisfaction, and participants' learning experiences. RESULTS The comparison showed that the participants' familiarity with HL (4.29 ± 1.76 vs 6.92 ± 1.52, p < .001), attitude (7.39 ± 1.88 vs 8.10 ± 1.44, p = .004), and confidence in implementing HL practices (6.22 ± 1.48 vs 7.61 ± 1.34, p < .001) increased after the course. The average satisfaction with the teaching strategies was 4.06 ± .53 points, the average helpfulness to practice was 4.13 ± .55 points, and the overall feedback on satisfaction with learning was 4.06 ± .58 points (the full score was 5 points). According to the learning experience of the 20 participants in the focus group discussion, the experiences of teaching strategies and the learning experiences of the HL course were summed up into two categories, seven themes, and 13 subthemes. The results showed a positive experience with the hybrid online TBL program. CONCLUSION The use of hybrid online TBL model is a feasible and valid approach for the HL training of CHPs. The result can serve as a reference for the on-the-job training of various healthcare workers.
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Affiliation(s)
- Jyh-Gang Hsieh
- Department of Family Medicine, Hualien Tzu Chi Hospital, Hualien City, Taiwan
- Department of Medical Humanities, School of Medicine, Tzu Chi University, Hualien City, Taiwan
| | - Jui-Hung Yu
- Department of Public Health, Tzu Chi University, Hualien City, Taiwan
| | - Ying-Wei Wang
- Department of Family Medicine, Hualien Tzu Chi Hospital, Hualien City, Taiwan
- Department of Medical Humanities, School of Medicine, Tzu Chi University, Hualien City, Taiwan
| | - Mi-Hsiu Wei
- Department of Communication Studies, Tzu Chi University, Hualien City, Taiwan
| | - Mei-Chuan Chang
- Department of Nursing, College of Medicine, Tzu Chi University, Hualien City, Taiwan
| | - Chao-Chun Wu
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Shu-Li Chia
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
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Barriers and Supports in eHealth Implementation among People with Chronic Cardiovascular Ailments: Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148296. [PMID: 35886149 PMCID: PMC9318125 DOI: 10.3390/ijerph19148296] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 02/01/2023]
Abstract
eHealth interventions use information technology to provide attention to patients with chronic cardiovascular conditions, thereby supporting their self-management abilities. OBJECTIVE Identify barriers and aids to the implementation of eHealth interventions in people with chronic cardiovascular conditions from the perspectives of users, health professionals and institutions. METHOD An integrative database review of WoS, Scopus, PubMed and Scielo of publications between 2016 and 2020 reporting eHealth interventions in people with chronic cardiovascular diseases. Keywords used were eHealth and chronic disease. Following inclusion and exclusion criteria application, 14 articles were identified. RESULTS Barriers and aids were identified from the viewpoints of users, health professionals and health institutions. Some notable barriers include users' age and low technological literacy, perceived depersonalization in attention, limitations in technology access and usability, and associated costs. Aids included digital education and support from significant others. CONCLUSIONS eHealth interventions are an alternative with wide potentiality for chronic disease management; however, their implementation must be actively managed.
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14
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Cesar FCR, Moraes KL, Brasil VV, Alves AG, Barbosa MA, Oliveira LMDAC. Professional Responsiveness to Health Literacy: A Scoping Review. Health Lit Res Pract 2022; 6:e96-e103. [PMID: 35522856 PMCID: PMC9126054 DOI: 10.3928/24748307-20220418-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Flaviane Cristina Rocha Cesar
- Address correspondence to Flaviane Cristina Rocha Cesar, MSc, PhD, Avenida Elizabeth Marques, 45 - St. Maysa, Trindade, Goiás, Brazil, 75380-307;
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Yang HF, Chang CC, Tseng PL, Lai HR, Tasi JS, Huang WH, Fan YH, Weng CX, Tung CY. Effectiveness of innovative instructional module for professional competence in health literacy in medical students. BMC MEDICAL EDUCATION 2022; 22:210. [PMID: 35351115 PMCID: PMC8960696 DOI: 10.1186/s12909-022-03252-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 03/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Physicians should be equipped with professional competence in health literacy to communicate more effectively with patients with limited health literacy. However, the health literacy curriculum has not yet been refined globally, and is scarce in Taiwan's medical education. We implemented an innovative instructional module to attain professional competence in health literacy among medical students and investigated its effects. METHODS We adopted a quasi-experimental design and recruited 204 fifth-year Taiwanese medical students between December 2019 and May 2020. Participants who worked as clerks at the Department of Family Medicine of three medical schools in northern Taiwan were assigned to the experimental group through convenience sampling. A total of 98 students received a three-hour innovative instruction, including medical simulation videos, role-playing, and board games. Both the experimental and control groups completed the online pre-test and mail-in post-test. A generalized estimating equation was applied to measure the effects of the intervention. RESULTS There was a significant difference between the experimental and control groups in terms of professional competence in health literacy in all three aspects. In terms of knowledge, the experimental group improved 12% more than the control group (𝛽=0.12, 95% CI: 0.05 ~ 0.19, p = 0.001). In terms of attitude, the experimental group improved by an average of 0.27 more points per question than the control group (𝛽=0.27, 95% CI: 0.08 ~ 0.46, p = 0.007). As for skill, the experimental group improved by an average of 0.35 more points per question than the control group (𝛽=0.35, 95% CI: 0.14 ~ 0.55, p = 0.001). CONCLUSION The proposed innovative instructional module significantly improved fifth-year medical students' professional competence in health literacy, which is expected to benefit their future medical practices.
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Affiliation(s)
- Hui-Fang Yang
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, 162, Section 1, Heping E. Rd, Taipei City, 106, Taiwan
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Chen Chang
- Department of Senior Citizen Service Business, College of Human Ecology and Design, St. John's University, New Taipei, Taiwan
| | - Pei-Ling Tseng
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, 162, Section 1, Heping E. Rd, Taipei City, 106, Taiwan
| | - Hsiang-Ru Lai
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, 162, Section 1, Heping E. Rd, Taipei City, 106, Taiwan
| | - Jaw-Shiun Tasi
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Hsin Huang
- Community Health Center, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yu-Hao Fan
- Department of General Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ci-Xiang Weng
- Department of General Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chen-Yin Tung
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, 162, Section 1, Heping E. Rd, Taipei City, 106, Taiwan.
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16
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Connell L, Finn Y, Dunne R, Sixsmith J. Health literacy education programmes developed for qualified health professionals: a scoping review protocol. HRB Open Res 2022; 4:97. [PMID: 35280849 PMCID: PMC8881692 DOI: 10.12688/hrbopenres.13386.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: Health literacy education, for health professionals, has been identified as having the potential to improve patient outcomes and has been recognized as such in policy developments. Health literacy, as a relational concept, encompasses individuals’ skills and how health information is processed in relation to the demands and complexities of the surrounding environment. Focus has been predominantly on the dimension of functional health literacy (reading, writing and numeracy), although increasing emphasis has been placed on interactive and critical domains. Such dimensions often guide the development of health professional education programmes, where the aim is to enhance the patient-practitioner relationship, and ultimately reduce the health literacy burden experienced by patients navigating health services. Currently little is known about qualified health professionals’ education in health literacy and communication skills, and development, implementation or evaluation of such interventions. Aim: To identify and map current educational interventions to improve health literacy competencies and communication skills of qualified health professionals. Methods: A scoping review will be conducted drawing on methods and guidance from the Joanna Briggs Institute, and will be reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. This study will retrieve literature on health professional education for health literacy and communication skills through a comprehensive search strategy in the following databases: CINAHL; Medline (Ovid); the Cochrane Library; EMBASE; ERIC; UpToDate; PsycINFO. Grey literature will be searched within the references of identified articles; Lenus; ProQuest E-Thesis Portal; RIAN and OpenGrey. A data charting form will be developed with categories including: article details, demographics, intervention details, implementation and evaluation methods. Conclusion: Little is known about the extent and nature of the current evidence base therefore a scoping review will be conducted, in order to identify programme characteristics in relation to health literacy competencies and communication skills.
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Affiliation(s)
- Lauren Connell
- Discipline of Health Promotion, National University of Ireland, Galway, Galway, Ireland
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, National University of Ireland, Galway, Galway, Ireland
- Alliance for Research and Innovation in Wounds (ARIW), National University of Ireland, Galway, Galway, Ireland
| | - Yvonne Finn
- Discipline of Health Promotion, National University of Ireland, Galway, Galway, Ireland
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, National University of Ireland, Galway, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Galway, Ireland
| | - Rosie Dunne
- James Hardiman Library, National University of Ireland, Galway, Galway, Ireland
| | - Jane Sixsmith
- Discipline of Health Promotion, National University of Ireland, Galway, Galway, Ireland
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, National University of Ireland, Galway, Galway, Ireland
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Boonstra MD, Reijneveld SA, Navis G, Westerhuis R, de Winter AF. Co-Creation of a Multi-Component Health Literacy Intervention Targeting Both Patients with Mild to Severe Chronic Kidney Disease and Health Care Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413354. [PMID: 34948960 PMCID: PMC8704507 DOI: 10.3390/ijerph182413354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/30/2022]
Abstract
Limited health literacy (LHL) is common in chronic kidney disease (CKD) patients and frequently associated with worse self-management. Multi-component interventions targeted at patients and healthcare professionals (HCPs) are recommended, but evidence is limited. Therefore, this study aims to determine the objectives and strategies of such an intervention, and to develop, produce and evaluate it. For this purpose, we included CKD patients with LHL (n = 19), HCPs (n = 15), educators (n = 3) and students (n = 4) from general practices, nephrology clinics and universities in an Intervention Mapping (IM) process. The determined intervention objectives especially address the patients’ competences in maintaining self-management in the long term, and communication competences of patients and HCPs. Patients preferred visual strategies and strategies supporting discussion of needs and barriers during consultations to written and digital strategies. Moreover, they preferred an individual approach to group meetings. We produced a four-component intervention, consisting of a visually attractive website and topic-based brochures, consultation cards for patients, and training on LHL for HCPs. Evaluation revealed that the intervention was useful, comprehensible and fitting for patients’ needs. Healthcare organizations need to use visual strategies more in patient education, be careful with digitalization and group meetings, and train HCPs to improve care for patients with LHL. Large-scale research on the effectiveness of similar HL interventions is needed.
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Affiliation(s)
- Marco D. Boonstra
- Department of Health Sciences, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (S.A.R.); (A.F.d.W.)
- Correspondence: ; Tel.: +31653243985
| | - Sijmen A. Reijneveld
- Department of Health Sciences, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (S.A.R.); (A.F.d.W.)
| | - Gerjan Navis
- Department of Nephrology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (G.N.); (R.W.)
| | - Ralf Westerhuis
- Department of Nephrology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (G.N.); (R.W.)
| | - Andrea F. de Winter
- Department of Health Sciences, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (S.A.R.); (A.F.d.W.)
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Curbach J, Lander J, Dierks ML, Grepmeier EM, von Sommoggy J. How do health professionals translate evidence on early childhood allergy prevention into health literacy-responsive practice? A protocol for a mixed-method study on the views of German health professionals. BMJ Open 2021; 11:e047733. [PMID: 34785543 PMCID: PMC8596052 DOI: 10.1136/bmjopen-2020-047733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 10/13/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Paediatricians, general practitioners (GPs) and midwives in primary care are important sources of information for parents on early childhood allergy prevention (ECAP). Research has shown that preventive counselling by health professionals can be effective in improving patients' health literacy (HL) and health behaviour. Providing effective advice relies on two factors. First, health professionals need be up-to-date with research evidence on ECAP, to consider popular misconceptions and fears and to translate this knowledge into clear recommendations for parents (knowledge translation). Second, they need to know and apply counselling techniques and create a practice setting which accommodates parental HL needs (health literacy-responsive care). The objective of this study is to explore and assess how German health professionals take up and translate ECAP evidence into appropriate recommendations for parents, how they consider HL in counselling and practice organisation and what barriers and enablers they find in their performance of HL-responsive ECAP. METHODS AND ANALYSIS The study has a sequential mixed-method design, in two phases. In the first phase, qualitative semi-structured expert interviews will be conducted with health professionals (paediatricians, GPs and midwives) at primary care level and professional policy level. Data collection is ongoing until January 2022. In the second phase, based on the qualitative results, a standardised questionnaire will be developed, and pilot-tested in a wider population of German health professionals. The findings of both phases will be integrated. ETHICS AND DISSEMINATION The study has received ethical approval from the Ethics Committee of the University of Regensburg (18-1205-101). The results will be published in international peer-reviewed open access journals and via presentations at scientific conferences. The results will also be shared with German health professionals, decision-makers and potential funders of interventions.
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Affiliation(s)
- Janina Curbach
- Department of Epidemiology and Preventive Medicine/Medical Sociology, University of Regensburg Faculty of Medicine, Regensburg, Germany
- Faculty of Businesss Studies, Ostbayerische Technische Hochschule (OTH) Regensburg, Regensburg, Germany
| | - Jonas Lander
- Department of Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Marie Luise Dierks
- Department of Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Eva-Maria Grepmeier
- Department of Epidemiology and Preventive Medicine/Medical Sociology, University of Regensburg Faculty of Medicine, Regensburg, Germany
| | - Julia von Sommoggy
- Department of Epidemiology and Preventive Medicine/Medical Sociology, University of Regensburg Faculty of Medicine, Regensburg, Germany
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eHealth Literacy: From Theory to Clinical Application for Digital Health Improvement. Results from the ACCESS Training Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211800. [PMID: 34831555 PMCID: PMC8618977 DOI: 10.3390/ijerph182211800] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 12/29/2022]
Abstract
Skills, knowledge, and awareness of digital and technological tools are essential to improve the state of well-being and health of older adults and also to mitigate the condition of social isolation in the aging process. For this reason, it is necessary to implement a social learning of electronic/digital tools for health of older people to support the achievement of eHealth and digital competences. The paper reports the results of an Italian innovative eHealth training for the European project ACCESS. The training has been based on blended didactical and interactive educational techniques, aimed at collecting as many points of view as possible from older adults. A total of 58 older adults were recruited to attend a four-week training program, which included five modules. The results showed a statistical significant difference between the eHealth Literacy Scale (eHEALS) mean value before and after the course. A significant negative correlation was found between eHEALS and positive/total Survey of Technology Use (SOTU), suggesting an inverse relationship between positive/total SOTU and eHEALS. There is a strong positive and statistically significant relationship between satisfaction with the training and eHEALS. The results indicate that the intervention increased the digital competences of participants connected to health.
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20
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Skoumalova I, Madarasova Geckova A, Rosenberger J, Majernikova M, Kolarcik P, Klein D, de Winter AF, van Dijk JP, Reijneveld SA. Health-Related Quality of Life Profiles in Dialyzed Patients With Varying Health Literacy. A Cross-Sectional Study on Slovak Haemodialyzed Population. Int J Public Health 2021; 66:585801. [PMID: 34744558 PMCID: PMC8565259 DOI: 10.3389/ijph.2021.585801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/05/2021] [Indexed: 12/12/2022] Open
Abstract
Objectives: Chronic kidney disease (CKD) strongly affects patients’ health-related quality of life (HRQoL), mostly in the advanced stages of CKD. Health literacy (HL) may affect this association, in particular for some aspects of HRQoL. The aim of this study is to compare the profiles of HRQoL in dialyzed patients with varying HL. Methods: We obtained data on HL using the Health Literacy Questionnaire (HLQ) and on HRQoL using the Kidney Disease Quality of Life – Short Form (KDQoL-SF 1.3) in a multicentre cross-sectional study in 20 dialysis clinics in Slovakia (n = 542; mean age = 63.6 years; males: 60.7%). We compared HRQoL for three HL groups using ANOVA and the Kruskal-Wallis test. Results: Patients with low HL reported worse HRQoL than patients with moderate and high HL. The greatest differences between HL groups were found in the scales Effect of kidney disease, Cognitive function, Quality of social interaction, Social support, Dialysis staff encouragement, Patient satisfaction, Physical functioning, Pain, Emotional well-being and Social function. p-values in all cases were <0.001. Conclusion: Patients with low HL have a worse HRQoL in several domains than patients with a higher HL. Increasing HL capacities and better supporting patients with low HL should thus be given priority to support their HRQoL and at least maintain its level.
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Affiliation(s)
- Ivana Skoumalova
- Department of Community and Occupational Medicine, University Medical Center Groningen, Groningen, Netherlands.,Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia.,Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
| | - Andrea Madarasova Geckova
- Department of Community and Occupational Medicine, University Medical Center Groningen, Groningen, Netherlands.,Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia.,Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia.,Olomouc University Social Health Institute, Palacky University, Olomouc, Czech Republic
| | - Jaroslav Rosenberger
- Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia.,Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia.,Olomouc University Social Health Institute, Palacky University, Olomouc, Czech Republic.,FMC-Dialysis Services Slovakia, Kosice, Slovakia
| | | | - Peter Kolarcik
- Department of Community and Occupational Medicine, University Medical Center Groningen, Groningen, Netherlands.,Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia.,Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia.,Olomouc University Social Health Institute, Palacky University, Olomouc, Czech Republic
| | - Daniel Klein
- Institute of Mathematics, Faculty of Science, Pavol Jozef Safarik University, Kosice, Slovakia
| | - Andrea F de Winter
- Department of Community and Occupational Medicine, University Medical Center Groningen, Groningen, Netherlands
| | - Jitse P van Dijk
- Department of Community and Occupational Medicine, University Medical Center Groningen, Groningen, Netherlands
| | - Sijmen A Reijneveld
- Department of Community and Occupational Medicine, University Medical Center Groningen, Groningen, Netherlands
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21
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Nutbeam D, Lloyd JE. Understanding and Responding to Health Literacy as a Social Determinant of Health. Annu Rev Public Health 2021; 42:159-173. [PMID: 33035427 DOI: 10.1146/annurev-publhealth-090419-102529] [Citation(s) in RCA: 269] [Impact Index Per Article: 89.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Evidence of a social gradient in health literacy has been found in all reported national population surveys. Health literacy is a midstream determinant of health but not a panacea for addressing health inequities created by the maldistribution of opportunity and resources. It is possible to optimize the contribution health literacy makes in mediating the causes and effects of established social determinants of health. Existing interventions demonstrate the feasibility of improving health literacy among higher-risk populations, but research remains underdeveloped and effects on health inequity are largely untested. Future health literacy intervention research should focus on (a) improving the quality of health communication that reaches a diversity of populations, especially by improving frontline professional skills and support; (b) enabling people to develop transferable skills in accessing, understanding, analyzing, and applying health information; and (c) ensuring that priority is proportionate to need by reaching and engaging the population groups who are disproportionately affected by low health literacy.
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Affiliation(s)
- Don Nutbeam
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales 2006, Australia;
| | - Jane E Lloyd
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales 2052, Australia;
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22
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Connell L, Finn Y, Dunne R, Sixsmith J. Health literacy education programmes developed for qualified health professionals: a scoping review protocol. HRB Open Res 2021; 4:97. [DOI: 10.12688/hrbopenres.13386.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: Health professional education for health literacy has been identified as having the potential to improve patient outcomes and has been recognized as such in policy developments. Health literacy is an emerging concept encompassing individuals’ skills and how health information is processed in relation to the demands and complexities of the surrounding environment. Focus has been predominantly on the dimension of functional health literacy (reading, writing and numeracy), although increasing emphasis has been placed on interactive and critical domains. Such dimensions can guide the development of health professional education programmes and bridge the gap in the interaction between health professionals and their patients. Currently little is known about qualified health professional’s education for health literacy, its development, implementation or evaluation. Aim: To identify and map current educational interventions to improve health literacy competencies and communication skills of qualified health professionals. Methods: A scoping review will be conducted drawing on methods and guidance from the Joanna Briggs Institute, and will be reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. This study will retrieve literature on health professional education for health literacy through a comprehensive search strategy in the following databases: CINAHL; Medline (Ovid); the Cochrane Library; EMBASE; ERIC; UpToDate; PsycINFO and Central Register of Controlled Trials (CENTRAL). Grey literature will be searched within the references of identified articles: Lenus; ProQuest E-Thesis Portal; the HSE health research repository and RIAN. A data charting form will be developed with categories agreed by the research team, including: article details, demographics, intervention details, implementation and evaluation methods. Conclusion: Little is known about the extent and nature of the current evidence base therefore in order to identify programmes and consolidate their demographics and characteristics within health literacy competencies and communication skills, a scoping review is warranted.
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Lubasch JS, Voigt-Barbarowicz M, Lippke S, De Wilde RL, Griesinger F, Lazovic D, Ocampo Villegas PC, Roeper J, Salzmann D, Seeber GH, Torres-de-la-Roche LA, Weyhe D, Ansmann L, Brütt AL. Improving professional health literacy in hospitals: study protocol of a participatory codesign and implementation study. BMJ Open 2021; 11:e045835. [PMID: 34400444 PMCID: PMC8370497 DOI: 10.1136/bmjopen-2020-045835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION In connection with a hospital stay, patients have to make important health-related decisions. They need to find, understand, assess and apply health-related information, and therefore, require health literacy. Adequately responding to the needs of patients requires promoting the communication skills of healthcare professionals within healthcare organisations. Health-literate healthcare organisations can provide an environment strengthening professionals' and patients' health literacy. When developing health-literate healthcare organisations, it has to be considered that implementing organisational change is typically challenging. In this study, a communication concept based on previously evaluated communication training is codesigned, implemented and evaluated in four clinical departments of a university hospital. METHOD AND ANALYSIS In a codesign phase, focus group interviews among employees and patients as well as a workshop series with employees and hospital management are used to tailor the communication concept to the clinical departments and to patients' needs. Also, representatives responsible for the topic of health literacy are established among employees. The communication concept is implemented over a 12-month period; outcomes studied are health literacy on the organisational and patient levels. Longitudinal survey data acquired from a control cohort prior to the implementation phase are compared with data of an intervention cohort after the implementation phase. Moreover, survey data from healthcare professionals before and after the implementation are compared. For formative evaluation, healthcare professionals are interviewed in focus groups. ETHICS AND DISSEMINATION The study protocol was approved by the Ethics Committee of the Medical Faculty of the University of Oldenburg and is in accordance with the Declaration of Helsinki. Study participants are asked to provide written informed consent. The results are disseminated via direct communication within the hospital, publications and conference presentations. If the intervention turns out to be successful, the intervention and implementation strategies will be made available to other hospitals. TRIAL REGISTRATION NUMBER DRKS00019830.
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Affiliation(s)
- Johanna Sophie Lubasch
- Division for Organizational Health Services Research, Department of Health Services Research, University of Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Mona Voigt-Barbarowicz
- Junior Research Group for Rehabilitation Sciences, Department of Health Services Research, University of Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Sonia Lippke
- Department of Psychology & Methods, Jacobs University Bremen gGmbH, Bremen, Germany
| | - Rudy Leon De Wilde
- University Hospital for Gynaecology, Pius-Hospital Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Frank Griesinger
- University Hospital for Haematology and Oncology, Pius-Hospital Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Djordje Lazovic
- University Hospital of Orthopedics and Trauma Surgery Pius-Hospital, Medical Campus University Oldenburg, Oldenburg, Lower Saxony, Germany
| | | | - Julia Roeper
- University Hospital for Haematology and Oncology, Pius-Hospital Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Daniela Salzmann
- University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Gesine H Seeber
- University Hospital of Orthopedics and Trauma Surgery Pius-Hospital, Medical Campus University Oldenburg, Oldenburg, Lower Saxony, Germany
| | | | - Dirk Weyhe
- University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Lena Ansmann
- Division for Organizational Health Services Research, Department of Health Services Research, University of Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Anna Levke Brütt
- Junior Research Group for Rehabilitation Sciences, Department of Health Services Research, University of Oldenburg, Oldenburg, Lower Saxony, Germany
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Halm MA. When Stakes Are High and Stress Soars: Addressing Health Literacy in the Critical Care Environment. Am J Crit Care 2021; 30:326-330. [PMID: 34195777 DOI: 10.4037/ajcc2021933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Margo A. Halm
- Margo A. Halm is associate chief nurse executive, nursing research and evidence-based practice, VA Portland HealthCare System, Portland, Oregon
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Wirner C, Pott C, Kirschneck M, Coenen M. Das Konstrukt Gesundheitskompetenz in Ausbildung und Studium der Physiotherapie in Deutschland – Ergebnisse einer Dokumentenanalyse. PHYSIOSCIENCE 2021. [DOI: 10.1055/a-1218-5340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Zusammenfassung
Hintergrund Physiotherapeutinnen und -therapeuten stellen eine Schlüsselrolle in der Förderung der Gesundheitskompetenz von Patientinnen und Patienten dar. Der Wunsch von Physiotherapeutinnen und -therapeuten nach Informationen zum Thema Gesundheitskompetenz ist groß. Die Ausbildung wird u. a. als wichtiger Informationsweg für dieses Thema eingeschätzt.
Ziel Explorative Studie zur Beantwortung der Fragestellung: Welche Rolle spielt das Thema Gesundheitskompetenz und Förderung der Gesundheitskompetenz von Patientinnen und Patienten in der beruflichen Ausbildung bzw. im Studium der Physiotherapie in Deutschland?
Methode Dokumentenanalyse von relevanten Unterlagen zu Ausbildung und Studium (z. B. Ausbildungslehrpläne, Modulbeschreibungen) in der Physiotherapie. Im Rahmen vorbereitender Arbeiten wurde mittels Workshops mit Expertinnen die Grundlage des in den Analysen verwendeten Kodierleitfadens erarbeitet. Qualitative Auswertung der Daten anhand der strukturierenden Inhaltsanalyse nach Mayring.
Ergebnisse In 27 analysierten relevanten Unterlagen zu Ausbildung und Studium wurde der Begriff Gesundheitskompetenz nur in einem Dokument explizit erwähnt. Allerdings werden zukünftigen Physiotherapeutinnen und -therapeuten in der Ausbildung und im Studium wichtige Fähigkeiten und Fertigkeiten, z. B. Kommunikationskompetenz, vermittelt, die für die Förderung der Gesundheitskompetenz der Patientenschaft grundlegend sind.
Schlussfolgerung Das Thema Gesundheitskompetenz ist in der Ausbildung und im Studium der Physiotherapie nicht explizit verankert. Durch die Aufnahme in die Curricula kann das explizite Wissen der Physiotherapeutinnen und -therapeuten vertieft werden und durch ihre Sensibilisierung für das Thema ihre Schlüsselrolle in der Förderung der Gesundheitskompetenz von Patientinnen und Patienten weiter ausgebaut werden.
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Affiliation(s)
- Corinna Wirner
- Friedrich-Baur-Institut, Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Deutschland
| | | | - Michaela Kirschneck
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie – IBE, Lehrstuhl für Public Health und Versorgungsforschung, Ludwig-Maximilians-Universität München, Deutschland
- Pettenkofer School of Public Health München, Deutschland
| | - Michaela Coenen
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie – IBE, Lehrstuhl für Public Health und Versorgungsforschung, Ludwig-Maximilians-Universität München, Deutschland
- Pettenkofer School of Public Health München, Deutschland
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Muscat DM, Shepherd HL, Nutbeam D, Trevena L, McCaffery KJ. Health Literacy and Shared Decision-making: Exploring the Relationship to Enable Meaningful Patient Engagement in Healthcare. J Gen Intern Med 2021; 36:521-524. [PMID: 32472490 PMCID: PMC7878628 DOI: 10.1007/s11606-020-05912-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/04/2020] [Indexed: 02/06/2023]
Abstract
Research into health literacy and shared decision-making has largely developed along parallel, but distinct lines over the past two decades. There is little evidence that the concepts and related practice have intersected except in the most functional way, for example, to simplify shared decision-making tools by improving readability scores of decision aids. This paper presents an integrated model to strengthen and sustain patient engagement in health care by drawing on the strengths of both concepts. This includes addressing patients' skills and capacities, alongside modifications to written and verbal information. We propose an expanded model of shared decision-making which incorporates health literacy concepts and promotes two-tiered intervention methods to improve the targeting and personalization of communication and support the development of transferable health literacy skills among patients.
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Affiliation(s)
- Danielle M Muscat
- Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, The University of Sydney , Sydney, NSW, Australia.
| | - Heather L Shepherd
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Don Nutbeam
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Lyndal Trevena
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Kirsten J McCaffery
- Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, The University of Sydney , Sydney, NSW, Australia.,Faculty of Medicine and Health, School of Public Health, Wiser Healthcare, The University of Sydney, Sydney, NSW, Australia
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Boonstra MD, Reijneveld SA, Foitzik EM, Westerhuis R, Navis G, de Winter AF. How to tackle health literacy problems in chronic kidney disease patients? A systematic review to identify promising intervention targets and strategies. Nephrol Dial Transplant 2020; 36:gfaa273. [PMID: 33351936 PMCID: PMC8237988 DOI: 10.1093/ndt/gfaa273] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Limited health literacy (LHL) is associated with multiple adverse health outcomes in chronic kidney disease (CKD). Interventions are needed to improve this situation, but evidence on intervention targets and strategies is lacking. This systematic review aims to identify potential targets and strategies by summarizing the evidence on: (i) patient- and system-level factors potentially mediating the relation between LHL and health outcomes; and (ii) the effectiveness of health literacy interventions customized to CKD patients. METHODS We performed a systematic review of peer-reviewed research articles in Medline, Embase and Web of Science, 2009-19. We assessed the quality of the studies and conducted a best-evidence synthesis. RESULTS We identified 860 publications and included 48 studies. Most studies were of low quality (n = 26) and focused on dialysis and transplantation (n = 38). We found strong evidence for an association of LHL with smoking and having a suboptimal transplantation process. Evidence was weak for associations between LHL and a variety of factors related to self-care management (n = 25), utilization of care (n = 23), patient-provider interaction (n = 8) and social context (n = 5). Six interventions were aimed at improving knowledge, decision-making and health behaviours, but evidence for their effectiveness was weak. CONCLUSIONS Study heterogeneity, low quality and focus on kidney failure largely impede the identification of intervention targets and strategies for LHL. More and higher quality studies in earlier CKD stages are needed to unravel how LHL leads to worse health outcomes, and to identify targets and strategies to prevent disease deterioration. Healthcare organizations need to develop and evaluate efforts to support LHL patients.
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Affiliation(s)
- Marco D Boonstra
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Elisabeth M Foitzik
- Institute for Applied Health Sciences, Coburg University of Applied Sciences and Arts, Coburg, Germany
| | - Ralf Westerhuis
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerjan Navis
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Andrea F de Winter
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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28
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Bird ML, Elmer S, Osborne RH, Flittner A, O'Brien J. Training physiotherapists to be responsive to their clients' health literacy needs. Physiother Theory Pract 2020; 38:1398-1406. [PMID: 33225778 DOI: 10.1080/09593985.2020.1850956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: To evaluate health literacy learning modules designed specifically for physiotherapists in private practice.Methods: Mixed-method design was used, evaluating pre-post physiotherapist health literacy knowledge and competencies using questionnaires and semi-structured interviews. One rural and one metropolitan private physiotherapy practice were recruited.Participants: Clients, physiotherapists, and other clinic staff. The OPHELIA (Optimizing Health Literacy and Access) process was applied to identify the health literacy needs of clients; co-design interventions; and implement and evaluate the interventions. The health literacy learning modules were co-designed with the physiotherapists and included one 3-h face-to-face workshop, followed by two 1-h videoconference workshops. Health literacy knowledge (rated 1-5 for 10 items, max score 50) and skills (rated 1-5 for 5 items, max score 25) were assessed before and after the workshops. Data were analyzed by paired t-test. Interviews were recorded, transcribed, and thematically analyzed.Results: Health literacy knowledge of 19 health professionals improved after the workshop by 63% (pre 26.0 (7.5), post 41.0 (2.7), p < .001). Health literacy skills improved by 65% (pre 4.2 (3.3), post 21.8 (2.3), p < .001). We identified three themes from interview data: 1) 'the multi-faceted nature of health literacy requires multiple strategies'; 2) 'changing practice to promote understanding'; and 3) 'reflection on roles of multidisciplinary private practice.'Practice Implications: Improvements in health literacy knowledge and skills are possible through post-graduate professional development.Conclusion: Workshops changed physiotherapists' understanding of their role in promoting health literacy.
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Affiliation(s)
- Marie-Louise Bird
- College of Health and Medicine, University of Tasmania, Launceston, Australia
| | - Shandell Elmer
- Faculty of Health, Arts and Design, Swinburne University, Melbourne, Australia
| | - Richard H Osborne
- Faculty of Health, Arts and Design, Swinburne University, Melbourne, Australia
| | - Anna Flittner
- College of Health and Medicine, University of Tasmania, Launceston, Australia
| | - Jane O'Brien
- College of Health and Medicine, University of Tasmania, Launceston, Australia
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Wirner C, Pott C, Kirschneck M, Coenen M. [Nationwide Inventory of the Health Literacy Construct from the Perspective of the Profession Physiotherapy]. DAS GESUNDHEITSWESEN 2020; 84:60-63. [PMID: 32413910 DOI: 10.1055/a-1144-2948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In a nationwide online survey of professional physiotherapists PT, the role of health literacy in the professional self-image of physiotherapists was investigated. The construct of health literacy was considered by PT to be important in working with patients. A lack of time resources was mentioned by the majority as an inhibiting factor with regard to dealing with the topic and its integration into everyday clinical practice. Specialist articles and further training courses on the subject of health literacy are necessary in addition to being anchored in training and studies in order to improve knowledge of health literacy and its relevance in the care of patients by PT.
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Affiliation(s)
- Corinna Wirner
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie - IBE, Lehrstuhl für Public Health und Versorgungsforschung, Ludwig-Maximilians-Universität München.,Pettenkofer School of Public Health München
| | | | - Michaela Kirschneck
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie - IBE, Lehrstuhl für Public Health und Versorgungsforschung, Ludwig-Maximilians-Universität München.,Pettenkofer School of Public Health München
| | - Michaela Coenen
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie - IBE, Lehrstuhl für Public Health und Versorgungsforschung, Ludwig-Maximilians-Universität München.,Pettenkofer School of Public Health München
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McKenna VB, Sixsmith J, Barry M. Facilitators and Barriers to the Development of Health Literacy Capacities Over Time for Self-Management. Health Lit Res Pract 2020; 4:e104-e118. [PMID: 32392349 PMCID: PMC7213021 DOI: 10.3928/24748307-20200221-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/17/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Health literacy is a dynamic construct that is content and context specific. An understanding of the facilitators and barriers involved in the development of health literacy over time can provide important insights for the health care providers (HCP) in supporting patients with chronic illness. OBJECTIVE The study was conducted to expand an understanding of how health literacy development can be supported through exploration of the main facilitators and barriers in the process. METHODS This study used a longitudinal qualitative study design involving repeat interviews at three separate time points over a 12-month period. A purposive sample of 26 participants attending a structured cardiovascular disease risk-reduction program participated in the study, 17 of whom completed all three interviews. The European Health Literacy Survey measure was used to determine health literacy levels at the beginning and end of the 12-month period. Employing qualitative thematic analysis and a longitudinal-specific question framework, a trajectory approach was applied to explore individual cases longitudinally. KEY RESULTS Facilitators and barriers to health literacy capacity development were identified. Participants demonstrated increased perceptions of having control and being empowered over time. However, this was also found to be affected by external life events. Study participants were also found to be embedding health knowledge, motivation, and behaviors over time within the everyday contexts of their lives. The relationship with the HCP permeated all aspects of health literacy capacity development, including aspects of treatment decision-making. Participants identified the need for psychological supports and the increased importance of looking after their mental health. CONCLUSIONS Positive developments in health literacy capacities are important for the self-management of illness. Longitudinal findings underscore the importance of the HCP in supporting the development of health literacy capacities over time. These findings lend support to the need to integrate health literacy into medical and other HCP curricula to raise awareness of the concept of health literacy. [HLRP: Health Literacy Research and Practice. 2020;4(2):e104-e118.] PLAIN LANGUAGE SUMMARY: Using a longitudinal qualitative study design, this study proposes that health literacy capacities develop over time and that the health care provider (HCP) plays a central role in this process. Findings from this study support the need to embed health literacy training into medical and other applied HCP curricula to raise awareness of the concept of health literacy.
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Affiliation(s)
- Verna B. McKenna
- Address correspondence to Verna B. McKenna, BA, MA, Health Promotion Research Centre, Discipline of Health Promotion, National University of Ireland, Galway, University Road, Galway, Ireland H91 TK33;
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Nantsupawat A, Wichaikhum O, Abhicharttibutra K, Kunaviktikul W, Nurumal MSB, Poghosyan L. Nurses' knowledge of health literacy, communication techniques, and barriers to the implementation of health literacy programs: A cross‐sectional study. Nurs Health Sci 2020; 22:577-585. [DOI: 10.1111/nhs.12698] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 02/06/2020] [Accepted: 02/20/2020] [Indexed: 01/14/2023]
Affiliation(s)
| | | | | | - Wipada Kunaviktikul
- Nursing Division, Faculty of Nursing Chiang Mai University Chiang Mai Thailand
| | - Mohd Said Bin Nurumal
- Kulliyyah of Nursing International Islamic University Malaysia Bandar Indera Mahkota, Kuantan, Pahang Malaysia
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Coates D, Clerke T. Training Interventions to Equip Health Care Professionals With Shared Decision-Making Skills: A Systematic Scoping Review. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2020; 40:100-119. [PMID: 32433322 DOI: 10.1097/ceh.0000000000000289] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION To support the development, implementation, and evaluation of shared decision-making (SDM) training programs, this article maps the relevant evidence in terms of training program design and content as well as evaluation outcomes. METHOD A systematic scoping review methodology was used. To identify studies, the databases PubMed, Medline, and CINAHL were searched from 2009 to 2019, and reference lists of included studies were examined. After removal of duplicates, 1367 articles were screened for inclusion. To be included, studies were to be published in peer-reviewed journals, and should not merely be descriptive but report on evaluation outcomes. Articles were reviewed for inclusion by both authors, and data were extracted using a purposely designed data charting form implemented using REDCap. RESULTS The review identified 49 studies evaluating 36 unique SDM training programs. There was considerable variation in terms of program design and duration. Most programs included an overview of SDM theories and key competencies, as well as SDM skill development through role plays. Few programs provided training in reflective practice, in identifying and working with patients' individually preferred decision-making style, or in relation to SDM in a context of medical uncertainty or ambiguity. Most programs were evaluated descriptively, mostly using mixed methods, and there were 18 randomized controlled trials, showing that training was feasible, well received, and improved participants' knowledge and skills, but was limited in its impact on patients. DISCUSSION Although there is limited capacity to comment on which types of training programs are most effective, overall training was feasible, well received, and improved participants' knowledge and skills.
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Affiliation(s)
- Dominiek Coates
- Dr. Coates: Senior Research Fellow, University of Technology Sydney, Faculty of Health, Sydney, Australia.Clerke: Project Officer, Maridulu Budyari Gumal, the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE) Maridulu Budyari Gumal, the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Sydney, Australia
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Kaper MS, Reijneveld SA, van Es FD, de Zeeuw J, Almansa J, Koot JA, de Winter AF. Effectiveness of a Comprehensive Health Literacy Consultation Skills Training for Undergraduate Medical Students: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010081. [PMID: 31861918 PMCID: PMC6982343 DOI: 10.3390/ijerph17010081] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/12/2019] [Accepted: 12/15/2019] [Indexed: 11/16/2022]
Abstract
Comprehensible communication by itself is not sufficient to overcome health literacy related problems. Future doctors need a larger scope of capacities in order to strengthen a patient’s autonomy, participation, and self-management abilities. To date, such comprehensive training-interventions are rarely embedded in curricula, nor systematically evaluated. We assessed whether comprehensive training increased these health literacy competencies, in a randomized controlled trial (RCT), with a waiting list condition. Participants were international undergraduate medical students of a Dutch medical faculty (intervention: 39; control: 40). The 11-h-training-intervention encompassed a health literacy lecture and five interactive small-group sessions to practise gathering information and providing comprehensible information, shared decision-making, and enabling of self-management using role-play and videotaped conversations. We assessed self-reported competencies (knowledge and awareness of health literacy, attitude, self-efficacy, and ability to use patient-centred communication techniques) at baseline, after a five and ten-week follow-up. We compared students’ competencies using multi-level analysis, adjusted for baseline. As validation, we evaluated demonstrated skills in videotaped consultations for a subsample. The group of students who received the training intervention reported significantly greater health literacy competencies, which persisted up to five weeks afterwards. Increase was greatest for providing comprehensible information (B: 1.50; 95% confidence interval, CI 1.15 to 1.84), shared decision-making (B: 1.08; 95% CI 0.60 to 1.55), and self-management (B: 1.21; 95% CI 0.61 to 1.80). Effects regarding demonstrated skills confirmed self-rated competency improvement. This training enhanced a larger scope of health literacy competences and was well received by medical students. Implementation and further evaluation of this training in education and clinical practice can support sustainable health literacy capacity building of future doctors and contribute to better patient empowerment and outcomes of consultations.
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Affiliation(s)
- Marise S. Kaper
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, FA10, 9700 RB Groningen, The Netherlands; (S.A.R.); (J.A.); (A.F.d.W.)
- Correspondence:
| | - Sijmen A. Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, FA10, 9700 RB Groningen, The Netherlands; (S.A.R.); (J.A.); (A.F.d.W.)
| | - Frank D. van Es
- Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, FA10, 9700 RB Groningen, The Netherlands; (F.D.v.E.); (J.d.Z.)
| | - Janine de Zeeuw
- Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, FA10, 9700 RB Groningen, The Netherlands; (F.D.v.E.); (J.d.Z.)
| | - Josué Almansa
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, FA10, 9700 RB Groningen, The Netherlands; (S.A.R.); (J.A.); (A.F.d.W.)
| | - Jaap A.R. Koot
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, FA10, 9700 RB Groningen, The Netherlands; (S.A.R.); (J.A.); (A.F.d.W.)
| | - Andrea F. de Winter
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, FA10, 9700 RB Groningen, The Netherlands; (S.A.R.); (J.A.); (A.F.d.W.)
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Jager M, de Zeeuw J, Tullius J, Papa R, Giammarchi C, Whittal A, de Winter AF. Patient Perspectives to Inform a Health Literacy Educational Program: A Systematic Review and Thematic Synthesis of Qualitative Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4300. [PMID: 31694299 PMCID: PMC6862529 DOI: 10.3390/ijerph16214300] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 01/22/2023]
Abstract
Patient-centred care is tailored to the needs of patients and is necessary for better health outcomes, especially for individuals with limited health literacy (LHL). However, its implementation remains challenging. The key to effectively address patient-centred care is to include perspectives of patients with LHL within the curricula of (future) healthcare providers (HCP). This systematic review aimed to explore and synthesize evidence on the needs, experiences and preferences of patients with LHL and to inform an existing educational framework. We searched three databases: PsychInfo, Medline and Cinahl, and extracted 798 articles. One-hundred and three articles met the inclusion criteria. After data extraction and thematic synthesis, key themes were identified. Patients with LHL and chronic diseases encounter multiple problems in the care process, which are often related to a lack of person-centeredness. Patient perspectives were categorized into four key themes: (1) Support system; (2) Patient self-management; (3) Capacities of HCPs; (4) Barriers in healthcare systems. "Cultural sensitivity" and "eHealth" were identified as recurring themes. A set of learning outcomes for (future) HCPs was developed based on our findings. The perspectives of patients with LHL provided valuable input for a comprehensive and person-centred educational framework that can enhance the relevance and quality of education for (future) HCPs, and contribute to better person-centred care for patients with LHL.
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Affiliation(s)
- Margot Jager
- Department of Health Sciences, University Medical Center Groningen and University of Groningen, 9700 AD Groningen, The Netherlands; (J.T.); (A.F.d.W.)
| | - Janine de Zeeuw
- Department of Health Sciences, University Medical Center Groningen and University of Groningen, 9700 AD Groningen, The Netherlands; (J.T.); (A.F.d.W.)
- Department of Medical Sciences, Educational Institute, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Janne Tullius
- Department of Health Sciences, University Medical Center Groningen and University of Groningen, 9700 AD Groningen, The Netherlands; (J.T.); (A.F.d.W.)
| | - Roberta Papa
- Regional Health Agency Marche Region, 60125 Ancona, Italy; (R.P.); (C.G.)
- IRCCS INRCA, 60124 Ancona, Italy
| | - Cinzia Giammarchi
- Regional Health Agency Marche Region, 60125 Ancona, Italy; (R.P.); (C.G.)
- IRCCS INRCA, 60124 Ancona, Italy
| | - Amanda Whittal
- Department of Psychology & Methods, Jacobs University, 28759 Bremen, Germany;
| | - Andrea F. de Winter
- Department of Health Sciences, University Medical Center Groningen and University of Groningen, 9700 AD Groningen, The Netherlands; (J.T.); (A.F.d.W.)
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Kaper MS, Winter AFD, Bevilacqua R, Giammarchi C, McCusker A, Sixsmith J, Koot JAR, Reijneveld SA. Positive Outcomes of a Comprehensive Health Literacy Communication Training for Health Professionals in Three European Countries: A Multi-centre Pre-post Intervention Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203923. [PMID: 31619010 PMCID: PMC6843857 DOI: 10.3390/ijerph16203923] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 11/16/2022]
Abstract
Many professionals have limited knowledge of how to address health literacy; they need a wider range of health literacy competencies to enhance empowerment and person-centred prevention. We evaluated whether: (1) a comprehensive health literacy training increased self-rated competencies of health professionals to address health literacy related problems and support the development of people's autonomy and self-management abilities after training and 6-12 weeks later, (2) professionals were satisfied with the training, (3) outcomes differed for the three participating European countries. Health professionals (N = 106) participated in a multicentre pre-post intervention study in Italy, the Netherlands and Northern Ireland. The 8-hour training-intervention involved health literacy knowledge, the practice of comprehensible communication skills, shared decision-making, and enhancing self-management. Self-rated health literacy competencies and training satisfaction were assessed at baseline, immediately after training and 6-12 weeks later, and analysed by multi-level analysis. Professionals' self-rated health literacy competencies significantly improved following training in all three countries; this increase persisted at 6-12 weeks follow-up. The strongest increase regarded professional's skills to enhance shared-decision making and enabling self-management after training and follow-up respectively. Professionals perceived the training as relevant for practice. Competency increases seemed to be consistent across countries. In three countries, professionals' self-rated health literacy competencies increased following this comprehensive training. These promising findings should be confirmed in a further full effect study. Implementation of this training in European education and health care may improve person-centred communication by professionals and might help to tackle health literacy related problems and to strengthen people's abilities in achieving better health outcomes.
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Affiliation(s)
- Marise S Kaper
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, 9700 RB Groningen, The Netherlands.
| | - Andrea F de Winter
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, 9700 RB Groningen, The Netherlands
| | - Roberta Bevilacqua
- IRCCS INRCA (the National Institute of Health and Science on Aging), 60124 Ancona, Italy
| | - Cinzia Giammarchi
- IRCCS INRCA (the National Institute of Health and Science on Aging), 60124 Ancona, Italy
- The Regional Agency for Health (ARS of the Marche region), 60125 Ancona, Italy
| | | | - Jane Sixsmith
- Health Promotion Research Centre, National University of Ireland Galway, Galway H91 TK33, Ireland
| | - Jaap A R Koot
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, 9700 RB Groningen, The Netherlands
| | - Sijmen A Reijneveld
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, 9700 RB Groningen, The Netherlands
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Paiva D, Abreu L, Azevedo A, Silva S. Patient-centered communication in type 2 diabetes: The facilitating and constraining factors in clinical encounters. Health Serv Res 2019; 54:623-635. [PMID: 30815858 PMCID: PMC6505418 DOI: 10.1111/1475-6773.13126] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To explore the perceptions of the constraining and facilitating factors to patient-centered communication in clinical encounters of patients with type 2 diabetes and the providers involved in their care. DATA SOURCES/STUDY SETTING Patients (n = 12) and providers (n = 33) involved in diabetes care in northern Portugal. STUDY DESIGN Seven focus groups. DATA COLLECTION/EXTRACTION METHODS Grounded theory, using open, axial, and selective coding. PRINCIPAL FINDINGS Patients focused on the patient-provider relationship, while providers emphasized the constraining factors when exchanging information and the facilitating factors regarding disease and treatment-related behavior. Patients and providers both agreed on some constraints (power imbalance, avoidance of criticism, disease minimization, use of jargon, and insufficient competencies and consistency among providers) and facilitators (seeing patients as persons, providing tailored information in plain language, and recognizing the "wake-up call"). Patients perceived an aggressive attitude as a barrier to communication, but providers perceived it as a facilitator. Patients included issues related to trust, respect, and psychosocial support as important factors to them. Only providers mentioned the influence of macro-level interventions and patients' socioeconomic position as essential factors. CONCLUSIONS Improvements in patient-centered communication depend on fostering the patient-provider relationship, patients' participation and involvement, and training providers' communication skills.
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Affiliation(s)
- Dagmara Paiva
- EPIUnit – Instituto de Saúde PúblicaUniversidade do PortoPortoPortugal
- USF Monte MuradoACES Espinho‐GaiaARS NorteVila Nova de GaiaPortugal
| | - Liliana Abreu
- EPIUnit – Instituto de Saúde PúblicaUniversidade do PortoPortoPortugal
| | - Ana Azevedo
- EPIUnit – Instituto de Saúde PúblicaUniversidade do PortoPortoPortugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação MédicaFaculdade de Medicina da Universidade do PortoPortoPortugal
- Centro de Epidemiologia HospitalarCentro Hospitalar São JoãoPortoPortugal
| | - Susana Silva
- EPIUnit – Instituto de Saúde PúblicaUniversidade do PortoPortoPortugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação MédicaFaculdade de Medicina da Universidade do PortoPortoPortugal
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McKenna VB, Sixsmith J, Barry MM. A Qualitative Study of the Development of Health Literacy Capacities of Participants Attending a Community-Based Cardiovascular Health Programme. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1157. [PMID: 29865222 PMCID: PMC6025538 DOI: 10.3390/ijerph15061157] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/17/2018] [Accepted: 05/30/2018] [Indexed: 12/13/2022]
Abstract
Health literacy is a critical determinant of health, which can empower individuals and lead to engagement in collective health promotion action and is also a crucial component in the self-management of illness. The current study moves beyond a focus on functional health literacy and presents findings from a longitudinal qualitative (LQ) study consisting of three phases. This paper presents findings from the second phase of the study, which assessed the development of health literacy capacities of individuals attending a structured cardiovascular risk reduction programme in Ireland. The study objectives were to: explore perceptions of changes in interactions and information exchange within health consultations; identify the facilitators associated with changes in health literacy capacities; assess developments in engagement with broader contexts for health literacy capacities. A LQ study design was undertaken, which employed repeat interview methodology with 19 participants (aged 36⁻76 years) 12 weeks after beginning a structured cardiovascular risk reduction programme. Health literacy levels were assessed using the HLS-EU 47 item instrument in phase 1 (68% limited health literacy (HL), 32% adequate health literacy). A semi-structured interview guide, (informed by Sørensen's conceptual model of health literacy), was used to explore the development of health literacy and to identify changes in knowledge, attitudes and experiences over time. Thematic analysis was used, informed by aspects of Saldaña's framework for longitudinal qualitative data analysis. All participants reported having acquired increased understanding of issues relevant to their health and self-care. Participants described health literacy capacities that incorporate aspects of all levels of health literacy (functional, interactive and critical). Core themes were identified corresponding to changes in these levels: re-engagement with health information and increased understanding of risk and protective factors (changes in functional health literacy); changes in interactions with healthcare providers (HCP) (changes in interactive health literacy); enhanced psychological insights and understanding the broader determinants of health (changes in critical health literacy). Findings support the development of health literacy capacities across the functional, interactive and critical health literacy domains. Participants are capable of locating responsibility for health beyond the individual level and are making sense of knowledge within their own social contexts. Individuals, regardless of their initial health literacy levels, are capable of engaging with broader issues that can impact on their health and can be supported to develop these critical health literacy capacities.
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Affiliation(s)
- Verna B McKenna
- Health Promotion Research Centre, Discipline of Health Promotion, National University of Ireland Galway, H91 CF50 Galway, Ireland.
| | - Jane Sixsmith
- Health Promotion Research Centre, Discipline of Health Promotion, National University of Ireland Galway, H91 CF50 Galway, Ireland.
| | - Margaret M Barry
- Health Promotion Research Centre, Discipline of Health Promotion, National University of Ireland Galway, H91 CF50 Galway, Ireland.
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