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Chen C, Zheng J, Liu X, Liu J, You L. Role of health literacy profiles in fluid management of individuals receiving haemodialysis: A cross-sectional study. J Adv Nurs 2024; 80:2325-2339. [PMID: 38012855 DOI: 10.1111/jan.15973] [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: 04/05/2023] [Revised: 10/17/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
AIMS To identify health literacy profiles in individuals receiving haemodialysis and to explore how these profiles interact with individuals' self-efficacy, engagement with traditional dietary habits, self-reported fluid restriction and relative-interdialytic weight gain. DESIGN A cross-sectional study engaging nephrology departments from four hospitals in Guangdong Province, China. METHODS A sample of 433 individuals receiving haemodialysis participated between December 2018 and July 2019. We assessed health literacy, self-efficacy and self-reported fluid restriction using the Health Literacy Questionnaire, the Fluid Self-efficacy Scale and the Fluid Adherence Subscale, respectively. Traditional dietary habits, including daily tea drinking, soup drinking and preserved food consumption, were measured using three yes/no questions. Relative-interdialytic weight gain was calculated by dividing the mean interdialytic weight gain (from three recent intervals) by dry weight. Latent profile analysis and structural equation modelling were performed. RESULTS Three health literacy profiles were identified: low, moderate and high. Compared to those in the low health literacy profile, individuals in high and moderate health literacy profiles demonstrated an indirect association with reduced relative-interdialytic weight gain. This reduction can be attributed to their higher self-efficacy levels, decreased reliance on dietary habits and higher self-reported fluid restrictions. CONCLUSIONS Most participants exhibited either low or moderate levels of health literacy. Improving health literacy has the potential to promote self-efficacy and foster effective fluid restriction, ultimately leading to a reduction in relative-interdialytic weight gain in individuals receiving haemodialysis. IMPACT This study reveals heterogeneity in health literacy levels among individuals receiving haemodialysis and illuminates the connections between an individual's entire spectrum of health literacy and fluid management. These findings provide valuable insights for developing person-centred fluid management interventions, especially for individuals with diverse cultural dietary backgrounds within the haemodialysis population. REPORTING METHOD We adhered to the STROBE guideline. PATIENT OR PUBLIC CONTRIBUTION Patients were included only for collecting their data.
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Affiliation(s)
- Chen Chen
- Department of Nursing, Shenzhen Second People's Hospital (The First Affiliated Hospital of Shenzhen University), Shenzhen, China
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Shenzhen University Medical school, Shenzhen, China
| | - Jing Zheng
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Xu Liu
- Department of Infectious Disease, Guangdong Provincial Engineering Research Center of Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Jiali Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Nursing, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Liming You
- School of Nursing, Sun Yat-sen University, Guangzhou, China
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Wang D, Hu X, Jin H, Liu J, Chen X, Qin Y, Zhang Y, Xiang Q. Impaired kidney function and the risk of all-cause mortality and cardiovascular disease among Chinese hypertensive adults: Using three different equations to estimate the glomerular filtration rate. Prev Med 2024; 180:107869. [PMID: 38266581 DOI: 10.1016/j.ypmed.2024.107869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVES We aimed to seek accurate assessments of the glomerular filtration rate (GFR) in a Chinese hypertensive population to identify individuals at high risk for chronic kidney disease (CKD) progression. Then, the risk of cardiovascular disease (CVD) and all-cause death due to kidney injury were further investigated under appropriate GFR-estimation equations. METHODS In this prospective follow-up cohort study of 10,171 hypertensive patients, we compared the discrimination power of a trio of GFR-estimation equations using Harrell's C-index, measuring the model fit by calculating the Akaike information criterion. Univariate and multivariable logistic regression analyses were respectively used to calculate the hazard ratio (HR) and 95% confidence interval [CI] values for CKD progression. In addition, we also assessed the risk of CVD and all-cause death with impaired renal function using multivariable-adjusted Cox regression models. RESULTS The Modification of Diet in Renal Disease (MDRD) equation showed the highest C-index range for the predicted probability of CKD progression in the fully adjusted model. During MDRD analysis, a low eGFR (60-89 mL/min/1.73m2 or < 60 mL/min/1.73m2) was an independent risk factor for CVD, especially stroke (1.28 [95% CI, 1.05-1.55] and 1.89 [95% CI, 1.08-3.31]), as well as all-cause mortality (1.28 [95% CI, 1.09-1.50] and 1.68 [95% CI, 1.01-2.78]). CONCLUSIONS The MDRD equation seems to be more suitable for screening CKD progression in Chinese hypertensive populations, targeting potential risk factors for effective prevention to reduce renal impairment so as to further limit CVD morbidity and mortality.
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Affiliation(s)
- Dan Wang
- School of Public Health, Southeast University, Nanjing, China; Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiangju Hu
- Department of Chronic Non-communicable Disease Control and Prevention, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Hang Jin
- School of Public Health, Southeast University, Nanjing, China
| | - Jiali Liu
- School of Public Health, Southeast University, Nanjing, China
| | - Xin Chen
- School of Public Health, Southeast University, Nanjing, China
| | - Yu Qin
- Department of Chronic Non-communicable Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Yongqing Zhang
- Department of Chronic Non-communicable Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Quanyong Xiang
- School of Public Health, Southeast University, Nanjing, China; Department of Chronic Non-communicable Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.
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Saeed F, Dahl S, Horowitz RK, Duberstein PR, Epstein RM, Fiscella KA, Allen RJ. Development and Acceptability of a Kidney Therapy Decision Aid for Patients Aged 75 Years and Older: A Design-Based Research Involving Patients, Caregivers, and a Multidisciplinary Team. Kidney Med 2023; 5:100671. [PMID: 37492114 PMCID: PMC10363565 DOI: 10.1016/j.xkme.2023.100671] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
Rationale & Objective Many older adults prefer quality of life over longevity, and some prefer conservative kidney management (CKM) over dialysis. There is a lack of patient-decision aids for adults aged 75 years or older facing kidney therapy decisions, which not only include information on dialysis and CKM but also encourage end-of-life planning. We iteratively developed a paper-based patient-decision aid for older people with low literacy and conducted surveys to assess its acceptability. Study Design Design-based research. Setting and Participants Informed by design-based research principles and theory of behavioral activation, a multidisciplinary team of experts created a first version of the patient-decision aid containing 2 components: (1) educational material about kidney therapy options such as CKM, and (2) a question prompt list relevant to kidney therapy and end-of-life decision making. On the basis of the acceptability input of patients and caregivers, separate qualitative interviews of 35 people receiving maintenance dialysis, and with the independent feedback of educated layperson, we further modified the patient-decision aid to create a second version. Analytical Approach We used descriptive statistics to present the results of acceptability surveys and thematic content analyses for patients' qualitative interviews. Results The mean age of patients (n=21) who tested the patient-decision aid was 80 years and the mean age of caregivers (n=9) was 70 years. All respondents held positive views about the educational component and would recommend the educational component to others (100% patients and caregivers). Most of the patients reported that the question prompt list helped them put concerns into words (80% patients and 88% caregivers) and would recommend the question prompt list to others (95% patients and 100% caregivers). Limitations Single-center study. Conclusions Both components of the patient-decision aid received high acceptability ratings. We plan to launch a larger effectiveness study to test the outcomes of a decision-supporting intervention combining the patient-decision aid with palliative care-based decision coaching.
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Affiliation(s)
- Fahad Saeed
- Department of Medicine, Division of Nephrology, University of Rochester School of Medicine and Dentistry, Rochester, NY
- Department of Medicine, Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Spencer Dahl
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Robert K. Horowitz
- Department of Medicine, Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Paul R. Duberstein
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ
| | - Ronald M. Epstein
- Department of Medicine, Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, NY
- Department of Family Medicine and Center for Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Kevin A. Fiscella
- Department of Family Medicine and Center for Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Rebecca J. Allen
- Mount St. Joseph University, School of Behavioral and Natural Sciences, Cincinnati, OH
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Estrella ML, Allen-Meares P, Ricardo AC, Fischer MJ, Gordon EJ, Carmona-Powell E, Sondheimer J, Chen J, Horwitz E, Wang X, Hsu JY, Lash JP, Lora C. Prospective associations of health literacy with clinical outcomes in adults with CKD: findings from the CRIC study. Nephrol Dial Transplant 2023; 38:904-912. [PMID: 35746879 PMCID: PMC10064835 DOI: 10.1093/ndt/gfac201] [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: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Limited health literacy is associated with significant morbidity and mortality in the general population but the relation of health literacy with long-term clinical outcomes among adults with chronic kidney disease (CKD) is less clear. METHODS Prospective data from the Chronic Renal Insufficiency Cohort (CRIC) Study (n = 3715) were used. Health literacy was assessed with the Short Test of Functional Health Literacy in Adults (dichotomized as limited/adequate). Cox proportional hazards models were used to separately examine the relations of health literacy with CKD progression, cardiovascular event (any of the following: myocardial infarction, congestive heart failure, stroke or peripheral artery disease), and all-cause, cardiovascular and non-cardiovascular mortality. Poisson regression was used to assess the health literacy-hospitalization association. Models were sequentially adjusted: Model 1 adjusted for potential confounders (sociodemographic factors), while Model 2 additionally adjusted for potential mediators (clinical and lifestyle factors) of the associations of interest. RESULTS In confounder-adjusted models, participants with limited (vs adequate) health literacy [555 (15%)] had an increased risk of CKD progression [hazard ratio (HR) 1.34; 95% confidence interval (CI) 1.06-1.71], cardiovascular event (HR 1.67; 95% CI 1.39-2.00), hospitalization (rate ratio 1.33; 95% CI 1.26-1.40), and all-cause (HR 1.54; 95% CI 1.27-1.86), cardiovascular (HR 2.39; 95% CI 1.69-3.38) and non-cardiovascular (HR 1.27; 95% CI 1.01-1.60) mortality. Additional adjustments for potential mediators (Model 2) showed similar results except that the relations of health literacy with CKD progression and non-cardiovascular mortality were no longer statistically significant. CONCLUSIONS In the CRIC Study, adults with limited (vs adequate) health literacy had a higher risk for CKD progression, cardiovascular event, hospitalization and mortality-regardless of adjustment for potential confounders.
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Affiliation(s)
- Mayra L Estrella
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Brownsville, TX, USA
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Paula Allen-Meares
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
- Office of Health Literacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Ana C Ricardo
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Michael J Fischer
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
- Medicine/Nephrology, Jesse Brown VA Medical Center, Chicago, IL, USA
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, IL, USA
| | - Elisa J Gordon
- Division of Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Eunice Carmona-Powell
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - James Sondheimer
- Department of Medicine, Wayne State University, Detroit, MI, USA
| | - Jing Chen
- Department of Medicine, Tulane University, New Orleans, LA, USA
| | - Edward Horwitz
- Case Western Reserve University, School of Medicine, MetroHealth Medical Center, Cleveland, OH, USA
| | - Xue Wang
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jesse Y Hsu
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - James P Lash
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Claudia Lora
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Brownsville, TX, USA
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Khanal SP, Budhathoki CB, Okan O. Improving adolescent health literacy through school-based health literacy intervention: a mixed-method study protocol. BMC Public Health 2023; 23:407. [PMID: 36855125 PMCID: PMC9973246 DOI: 10.1186/s12889-023-15316-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/24/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Health-promoting actions might benefit from adolescent health literacy (AHL), however, there is scant research on it in Nepal. This study identifies adolescent students' health literacy (HL) needs and trials an intervention to improve their HL and intention to take health-promoting actions. METHODS This study employs a pre-and post-test mixed-method intervention involving three phases. First, we will conduct a formative and summative evaluation to identify participants' HL needs and design an intervention using quantitative and qualitative methods. Second, the intervention will be administered to the intervention group. Finally, formative and summative post-tests will be conducted to assess the effectiveness of the intervention. We will select four community schools from Birendranagar municipality based on random sampling. In quantitative research, data will be collected from adolescents selected through a census with standardized scales such as the HLS-Child-Q15, self-efficacy, social support, and health-promoting actions. A framework analysis was conducted to analyze qualitative data collected from focus group discussions with purposively chosen adolescents and key informant interviews with Health and Physical Education teachers and school nurses. The difference in difference approach will be used to analyze the intervention's outcome, i.e., the participants' improved HL, and health-promoting actions. DISCUSSION This is one of the first studies to explore HL in this group in Nepal. This study will provide the first insights into the overall level of AHL, potential AHL determinants, and the relationship between AHL and the intention to participate in health-promoting activities. The data can then be used to inform health promotion and health literacy initiatives.
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Affiliation(s)
- Shanti Prasad Khanal
- Central Department of Education, Faculty of Education, Tribhuvan University, Kirtipur, Nepal.
| | | | - Orkan Okan
- TUM Department of Sport and Health Sciences, Technical University , Munich, Germany
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Kayler LK, Keller MM, Breckenridge B, Feeley TH, Suboh J, Tumiel-Berhalter L. Preliminary feasibility of animated video education designed to empower patients' referral to kidney transplantation. Clin Transplant 2023; 37:e14838. [PMID: 36377285 PMCID: PMC9841007 DOI: 10.1111/ctr.14838] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/04/2022] [Accepted: 10/12/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Referral for kidney transplantation is influenced by patient education; digital technologies can enhance broad information accessibility. This single-group study tested the feasibility and acceptability of patient-centered self-directed educational animated videos to improve mediators of kidney transplant referral. METHODS Community-based adults with chronic kidney disease stage ≥4 invited from a clinical registry or self-responding to flyers viewed eight sequential videos (19:36 min total duration) remotely on their own device. Change in kidney transplant knowledge, concerns, and confidence talking about kidney transplantation to doctors was assessed with self-report surveys before and immediately after viewing. Program feedback was assessed by survey and self-selected exit interview. RESULTS Viewers of the video set (n = 50) demonstrated increases in mean kidney transplantation knowledge by +22%, confidence discussing with their doctor by +6%, and reductions in concerns by -2%. Knowledge results were consistent across age, race, and literacy level. Over 90% indicated positive ratings on understanding, engaging, and helpfulness. In post-study interviews viewers indicated the videos promoted confidence in obtaining a kidney transplant and none reported that the 19-min duration of the home education was too long. CONCLUSION The animated video education is promising to improve diverse individuals' knowledge, concerns, and communication confidence about kidney transplantation and is highly acceptable.
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Affiliation(s)
- Liise K Kayler
- Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, New York, USA
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA
| | - Maria M Keller
- Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, New York, USA
- University at Buffalo, State University of New York, Department of Community Health and Behavior, Buffalo, New York, USA
| | | | - Thomas H Feeley
- University at Buffalo, State University of New York, Department of Communication, Buffalo, New York, USA
| | - Jamal Suboh
- Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, New York, USA
| | - Laurene Tumiel-Berhalter
- University at Buffalo, State University of New York, Department of Family Medicine, Buffalo, New York, USA
- University at Buffalo's Clinical and Translational Science Institute, Buffalo, New York, USA
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Shirazian S, Smaldone AM, Jacobson AM, Fazzari MJ, Weinger K. Improving quality of life and self-care for patients on hemodialysis using cognitive behavioral strategies: A randomized controlled pilot trial. PLoS One 2023; 18:e0285156. [PMID: 37141225 PMCID: PMC10159130 DOI: 10.1371/journal.pone.0285156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 04/16/2023] [Indexed: 05/05/2023] Open
Abstract
INTRODUCTION Behavioral-education interventions have the potential to improve quality of life and self-care for patients on hemodialysis (HD) but have not been incorporated into routine clinical practice. The purpose of this pilot study was to determine the feasibility of delivering a simple behavioral-education intervention using cognitive behavioral strategies in patients receiving HD with poor quality of life. METHODS In this mixed methods study, HD patients were randomly assigned to the study intervention (8 behavioral-education sessions delivered over 12 weeks) or a control group of dialysis education alone. Kidney disease quality of life (KDQOL)-36 scores, depressive symptoms and self-care behaviors were measured at weeks 0, 8, and 16. Following study completion, participants, social workers, and physicians provided their perspectives about the intervention via qualitative interviews. FINDINGS Forty-five participants were randomized. Due, in part, to social worker attrition from the intervention arm, 34 participants (76%) completed at least 1 study session and were included in the analysis. The intervention led to modest, but non-significant, increase in KDQOL-physical component summary scores (+3.1±1.2 points) from week 0 to week 16. There were small, non-significant decreases in interdialytic weight gain and pre-dialysis phosphorus levels in the intervention group. Participants felt that chair-side delivery was practical and efficient, and that content related to the impact of dialysis on daily life was unique and important. Suggestions for adapting the intervention included narrowing its content and its delivery by additional providers that are not necessarily therapy trained. DISCUSSION In this pilot study, we were able to deliver a simple behavioral-education intervention to improve both quality of life and self-care. Participants had a positive impression of the intervention, but we did not find significant improvements in quality of life or self-care. We will now adapt our intervention by narrowing its content and by using other providers that are focused solely on delivering the intervention.
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Affiliation(s)
- Shayan Shirazian
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Arlene M Smaldone
- Department of Nursing, Columbia University School of Nursing, New York, New York, United States of America
| | - Alan M Jacobson
- Research Institute, NYU Long Island School of Medicine, Mineola, New York, United States of America
| | - Melissa J Fazzari
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Katie Weinger
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, United States of America
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Cultural adaptation and validation of the Malay Chronic Kidney Disease Self-management instrument (MCKD-SM). BMC Nephrol 2022; 23:384. [PMID: 36457069 PMCID: PMC9716702 DOI: 10.1186/s12882-022-03016-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 11/24/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND There is growing evidence that self-management behaviour can improve outcomes for patients with chronic kidney disease (CKD). However, no measures are available in Malay to effectively assess the self-management of CKD. The aim of this study was to translate, culturally adapt and validate the Malay Chronic Kidney Disease Self-Management (MCKD-SM) instrument for Malay-speaking health professionals and patients. METHODS This study was carried out in two phases: the translation and cultural adaptation phase and the validation phase. The instrument was translated from English to Malay and then adapted and validated in a sample of 337 patients with CKD stages 3-4 attending a nephrology clinic in a tertiary hospital in Malaysia. Structural validity was evaluated by exploratory factor analysis. The instrument's reliability was assessed by internal consistency and test-retest reliability. The correlations between the MCKD-SM and kidney disease knowledge and the MCKD-SM and self-efficacy were hypothesised a priori and investigated. RESULTS The MCKD-SM instrument has 29 items grouped into three factors: 'Understanding and Managing My CKD', 'Seeking Support' and 'Adherence to Recommended Regimen'. The three factors accounted for 56.3% of the total variance. Each factor showed acceptable internal reliability, with Cronbach's α from 0.885 to 0.960. The two-week intra-rater test-retest reliability intraclass correlation coefficient values for all items ranged between 0.938 and 1.000. The MCKD-SM scores significantly correlated with kidney disease knowledge (r = 0.366, p < 0.01) and self-efficacy (r = 0.212, p < 0.01). CONCLUSION The MCKD-SM was found to be a valid and reliable patient-reported outcome measure of pre-dialysis CKD self-management behaviour in the Malay-speaking population.
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Candemir B, Yıldırım F, Yaşar E, Erten Y, Göker B. Relationship between Health Literacy and Frailty in Older Adults with Chronic Kidney Disease. Exp Aging Res 2022; 49:201-213. [PMID: 35467490 DOI: 10.1080/0361073x.2022.2068326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with an increased risk of frailty, morbidity, and mortality in older adults. Limited health literacy (HL) is a condition that can cause frailty in CKD. Frailty leads to a decreased resistance to stress situations caused by activities of daily living and increased morbidity and mortality. The aim of this study was to investigate the relationship between HL and frailty in older adults with stage 4-5 CKD. METHODS A total of 109 patients with stage 4-5CKD were included. All patients underwent a comprehensive geriatric assessment. Health literacy was assessed by the Turkish version of the European Health Literacy Questionnaire. Frailty status was measured using the Fried Frailty Index. RESULTS The median age was 72 (68-80) years and 72 patients (66.1%) had lowHL. Forty-six patients (42.2%) were frail, and frailty was more common in the low HL group. CONCLUSION The present study demonstrated that low HL level was common in geriatric patients with stage 4-5 CKD and was associated with frailty, as well as a decrease in daily and instrumental life activities, decrease in acceptance of illness scale, and compliance with medical treatment.
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Affiliation(s)
- Burcu Candemir
- Department of Geriatrics, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Funda Yıldırım
- Department of Geriatrics, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Emre Yaşar
- Department of Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Yasemin Erten
- Department of Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Berna Göker
- Department of Geriatrics, Gazi University Faculty of Medicine, Ankara, Turkey
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Wei CJ, Shih CL, Hsu YJ, Chen YC, Yeh JZ, Shih JH, Chiu CH. Development and application of a chronic kidney disease-specific health literacy, knowledge and disease awareness assessment tool for patients with chronic kidney disease in Taiwan. BMJ Open 2021; 11:e052597. [PMID: 34635527 PMCID: PMC8506855 DOI: 10.1136/bmjopen-2021-052597] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study aims to develop an assessment tool for health literacy and knowledge specific to chronic kidney disease (CKD) for use in examining the associations between health literacy, disease-specific knowledge and disease awareness among patients with CKD in Taiwan. DESIGN An assessment tool in Mandarin and Taiwanese was developed based on patient input, panel discussions with experts and a literature review, and checked for validity and reliability in a pilot test. Formal data were collected through population-based sampling with a set quota according to region and hospital accreditation level. Cross-sectional data were collected to confirm the reliability and validity of the assessment tool. Levels of health literacy, disease knowledge, and disease awareness were then reported and analysed. SETTING Sample hospitals included 10 medical centres, 18 regional hospitals and 15 local hospitals in Taiwan. Researchers were granted Internal Review Board approval and obtained agreement to collect data in all study settings. PARTICIPANTS Patients at least 20 years old who had been diagnosed with CKD of any stage were eligible to participate. The formal assessment collected 1155 valid questionnaires, yielding an 87.3% response rate. The mean age of participants was 67.48 years (SD=12.87, range 22-98), while 484 (41.95%) were female and 78% were aware they had CKD. RESULTS The self-devised instrument proved to have excellent reliability and validity. Use of the instrument in the main study showed that CKD-specific health literacy was significantly associated with age (β=-0.33, p<0.00), educational attainment and disease awareness (β=0.13, p<0.00). CKD-specific knowledge was also significantly associated with age (β=-0.18, p<0.00), educational attainment and disease awareness (β=0.19, p<0.00). CONCLUSIONS This CKD-specific health literacy and knowledge assessment tool developed for Mandarin and Taiwanese-speaking patients is reliable and well validated. Patients with CKD who are aware of and understand their disease performed better in the assessment.
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Affiliation(s)
- Chung-Jen Wei
- Department of Public Health, Fu Jen Catholic University, Taipei, Taiwan
| | - Chung-Liang Shih
- Deputy Minister Office, Executive Yuan Republic of China Ministry of Health and Welfare, Taipei, Taiwan
| | - Yu-Juei Hsu
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yin-Cheng Chen
- Division of Nephrology, Department of Internal Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Jue-Zong Yeh
- Department of Pharmacy, Tri-Service General Hospital, Taipei, Taiwan
| | - Jia-Hui Shih
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Chiung-Hsuan Chiu
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
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ALTIPARMAK Ö, İZZETTİN F, OKUYAN B, ARIKAN İH, SANCAR M. Adaptation of Chronic Kidney Disease-Self Management Knowledge Tool (CKD-SMKT) into Turkish. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.778046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Boyer A, Begin Y, Dupont J, Rousseau-Gagnon M, Fernandez N, Demian M, Simonyan D, Agharazii M, Mac-Way F. Health literacy level in a various nephrology population from Québec: predialysis clinic, in-centre hemodialysis and home dialysis; a transversal monocentric observational study. BMC Nephrol 2021; 22:259. [PMID: 34243705 PMCID: PMC8272301 DOI: 10.1186/s12882-021-02464-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 06/04/2021] [Indexed: 03/06/2024] Open
Abstract
Background Health literacy refers to the ability of individuals to gain access to, use, and understand health information and services in order to maintain a good health. It is especially important in nephrology due to the complexity of chronic kidney disease (CKD). The present study sought to define health literacy levels in patients followed in predialysis clinic, in-center dialysis (ICHD), peritoneal dialysis (PD) and home hemodialysis (HHD). Methods This transversal monocentric observational study analysed 363 patients between October 2016 and April 2017. The Brief Health Literacy Screen (BHLS) and the Health Literacy Questionnaire (HLQ) were used to measure health literacy. Multivariate linear regressions were used to compare the mean scores on the BHLS and HLQ, across the four groups. Results Patients on PD had a significantly higher BHLS’score than patients on ICHD (p = 0.04). HLQ’s scores differed across the groups: patients on HHD (p = 0.01) and PD (p = 0.002) were more likely to feel understood by their healthcare providers. Compared to ICHD, patients on HHD were more likely to have sufficient information to manage their health (p = 0.02), and patients in the predialysis clinic were more likely to report high abilities for health information appraisal (p < 0.001). Conclusion In a monocentric study, there is a significant proportion of CKD patients, especially in predialysis clinic and in-centre hemodialysis, with limited health literacy. Patients on home dialysis (HHD and PD) had a higher level of health literacy compared to the other groups. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02464-1.
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Affiliation(s)
- Annabel Boyer
- CHU de Queébec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, QC, Canada. .,Division of Nephrology, Faculty of Medicine, Université Laval, Québec, QC, Canada. .,Centre Universitaire des Maladies Rénales, CHU de Caen, 14033, Caen Cedex 9, France.
| | - Yannick Begin
- CHU de Queébec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, QC, Canada.,Division of Nephrology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Julie Dupont
- Nurse practitioner, CHU de Québec-Université Laval Nursing Department, L'Hôtel-Dieu de Québec Hospital, Québec, QC, Canada
| | - Mathieu Rousseau-Gagnon
- CHU de Queébec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, QC, Canada.,Division of Nephrology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Nicolas Fernandez
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Québec, Canada
| | - Maryam Demian
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - David Simonyan
- Clinical and Evaluative Research Platform, CHU de Québec-Université Laval Research Center, Québec, Canada
| | - Mohsen Agharazii
- CHU de Queébec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, QC, Canada.,Division of Nephrology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Fabrice Mac-Way
- CHU de Queébec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, QC, Canada.,Division of Nephrology, Faculty of Medicine, Université Laval, Québec, QC, Canada
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13
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Chen C, Zheng J, Driessnack M, Liu X, Liu J, Liu K, Peng J, You L. Health literacy as predictors of fluid management in people receiving hemodialysis in China: A structural equation modeling analysis. PATIENT EDUCATION AND COUNSELING 2021; 104:1159-1167. [PMID: 33129627 DOI: 10.1016/j.pec.2020.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 10/05/2020] [Accepted: 10/08/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To explore the impact of health literacy (HL) on perceived benefits of fluid restriction (PBFR), self-reported fluid restriction (SRFR) and relative-interdialytic weight gain (R-IDWG) in people receiving hemodialysis (HD). METHODS We conducted a cross-sectional study in two nephrology departments from two hospitals in Guangzhou, China (n = 226). The HL questionnaire, PBFR Subscale of Health Belief Model Constructs and Fluid Adherence Subscale of the HD Patients Therapy Adherence Scale were used. R-IDWG was calculated by the mean IDWG (from 3 consecutive HD), divided by the dry weight. RESULTS In structural equation modeling, three domains of the HL questionnaire, namely Actively Managing My Health, Social Support and Actively Engaging with Healthcare Providers (HCPs), were directly and positively associated with PBFR. Higher Actively Managing My Health predicted higher SRFR both directly and indirectly. Sufficient Social Support and adequate Actively Engaging with HCPs predicted higher SRFR indirectly. All three HL domains predicted R-IDWG indirectly. CONCLUSION Improving patients' HL could increase their understanding of PBFR and be more apt to follow fluid restrictions and reduce R-IDWG. PRACTICE IMPLICATIONS A better understanding of the relationships among HL, PBFR, SRFR and R-IDWG will allow for tailored interventions to decrease R-IDWG in people receiving HD.
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Affiliation(s)
- Chen Chen
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Jing Zheng
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Martha Driessnack
- School of Nursing, Oregon Health & Science University, Portland, USA
| | - Xu Liu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jiali Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Nursing, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ke Liu
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Junsheng Peng
- School of Nursing, Sun Yat-sen University, Guangzhou, China; Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Liming You
- School of Nursing, Sun Yat-sen University, Guangzhou, China.
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14
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Liu C, Wang D, Liu C, Jiang J, Wang X, Chen H, Ju X, Zhang X. What is the meaning of health literacy? A systematic review and qualitative synthesis. Fam Med Community Health 2021; 8:fmch-2020-000351. [PMID: 32414834 PMCID: PMC7239702 DOI: 10.1136/fmch-2020-000351] [Citation(s) in RCA: 168] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The objective of this review was to clarify what health literacy represents. A systematic
review with qualitative syntheses was performed (CRD42017065149). Studies concerning
health literacy in all settings were included. Studies before 15 March 2017 were
identified from PubMed, Medline, Embase, Web of Science, Scopus, PsycARTICLES and the
Cochrane Library. The included literature either had defined the concept of health
literacy or made a detailed explanation of health literacy. A total of 34 original studies
met the inclusion criteria, including 13 involved in previous systematic reviews and 21
new studies. Health literacy was commonly conceptualised as a set of knowledge, a set of
skills or a hierarchy of functions (functional-interactive-critical). The construct of
health literacy covers three broad elements: (1) knowledge of health, healthcare and
health systems; (2) processing and using information in various formats in relation to
health and healthcare; and (3) ability to maintain health through self-management and
working in partnerships with health providers. Health literacy is defined as the ability
of an individual to obtain and translate knowledge and information in order to maintain
and improve health in a way that is appropriate to the individual and system contexts.
This definition highlights the diversity of needs from different individuals and the
importance of interactions between individual consumers, healthcare providers and
healthcare systems.
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Affiliation(s)
- Chenxi Liu
- School of Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan, China
| | - Dan Wang
- School of Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan, China
| | - Chaojie Liu
- Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Junnan Jiang
- School of Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan, China
| | - Xuemei Wang
- School of Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan, China
| | - Haihong Chen
- School of Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan, China
| | - Xin Ju
- School of Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan, China
| | - Xinping Zhang
- School of Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan, China
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15
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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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16
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Kita Y, Machida S, Shibagaki Y, Sakurada T. Fact-finding survey on health literacy among Japanese predialysis chronic kidney disease patients: a multi-institutional cross-sectional study. Clin Exp Nephrol 2020; 25:224-230. [PMID: 33063230 DOI: 10.1007/s10157-020-01982-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Low health literacy (HL) has been associated with poor chronic disease management and adverse outcomes. However, reports on HL in predialysis chronic kidney disease (CKD) patients are limited in Japan. METHODS From August 2019 to February 2020, the European Health Literacy Survey (Japanese version) and a patient background survey (highest level of education, income, social activities, and exercise habit) were conducted on adult predialysis CKD patients. We compared clinical parameters in two groups according to the average HL score of a healthy Japanese population. In addition, a median value of 42 items was used as a cutoff for extracting CKD patient background factors associated with HL since HLS-EU-Q47 included five items related to physical activity and exercise. RESULTS Valid responses were received from 200 patients. Median general HL index was 25.2 points. The high-HL group (≥ 25.3 points) showed a low proportion of male (56.7% vs. 70.9%, p = 0.038), high social activities (69.1% vs. 48.5%, p = 0.003), and high exercise habit (36.1% vs. 13.6%, p < 0.001). In the multivariate analysis, social activity [OR (95% CI); 2.12 (1.16-3.89), p = 0.015] and exercise habit [OR (95% CI); 2.39 (1.16-4.90), p = 0.018] were extracted as the only significant variable. CONCLUSIONS HL in Japanese predialysis CKD patients was associated with high social activity and exercise habit.
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Affiliation(s)
- Yohei Kita
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Shinji Machida
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Tsutomu Sakurada
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
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17
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Lim JH, Chinna K, Khosla P, Karupaiah T, Daud ZAM. Understanding How Nutrition Literacy Links to Dietary Adherence in Patients Undergoing Maintenance Hemodialysis: A Theoretical Exploration Using Partial Least Squares Structural Equation Modeling. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207479. [PMID: 33066603 PMCID: PMC7602379 DOI: 10.3390/ijerph17207479] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/29/2020] [Accepted: 10/09/2020] [Indexed: 11/16/2022]
Abstract
Dietary non-adherence is pervasive in the hemodialysis (HD) population. Health literacy is a plausible predictor of dietary adherence in HD patients, but its putative mechanism is scarcely studied. Thus, this study aimed to establish the causal model linking nutrition literacy to dietary adherence in the HD population. This was a multi-centre, cross-sectional study, involving 218 randomly selected multi-ethnic HD patients from nine dialysis centres in Klang Valley, Malaysia. Dietary adherence and self-management skills were assessed using validated End-Stage Renal Disease Adherence Questionnaire and Perceived Kidney/Dialysis Self-Management Scale, respectively. Validated self-developed scales were used to gauge nutrition literacy, dietary knowledge and Health Belief Model constructs. Relationships between variables were examined by multiple linear regressions and partial least squares structural equation modeling. Limited nutrition literacy was evident in 46.3% of the HD patients, associated with older age, lower education level, and shorter dialysis vintage. Dietary adherence rate was at 34.9%. Nutrition literacy (β = 0.390, p < 0.001) was an independent predictor of dietary adherence, mediated by self-efficacy (SIE = 0.186, BC 95% CI 0.110-0.280) and self-management skills (SIE = 0.192, BC 95% CI 0.103-0.304). Thus, nutrition literacy-enhancing strategies targeting self-efficacy and self-management skills should be considered to enhance dietary adherence in the HD population.
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Affiliation(s)
- Jun-Hao Lim
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang 43400, Malaysia;
| | - Karuthan Chinna
- School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya 47500, Malaysia;
| | - Pramod Khosla
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202-0340, USA;
| | - Tilakavati Karupaiah
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya 47500, Malaysia;
| | - Zulfitri Azuan Mat Daud
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang 43400, Malaysia;
- Research Center of Excellent (RCoE) Nutrition and Non-communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia
- Correspondence: ; Tel.: +60-397-692-431
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18
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Wembenyui C, Douglas C, Bonner A. Validation of the Australian version of the Chronic Kidney Disease Self-Management instrument. Int J Nurs Pract 2020; 27:e12857. [PMID: 32614488 DOI: 10.1111/ijn.12857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 04/13/2020] [Accepted: 04/28/2020] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study is to evaluate the validity and reliability of the modified Chronic Kidney Disease Self-Management instrument in an English-speaking population. BACKGROUND There is growing evidence that self-management behaviours can improve outcomes for people with chronic kidney disease. However, there are few suitable instruments available. DESIGN The study was cross sectional, with a test-retest protocol. METHOD Adults with chronic kidney disease attending a primary health care between June and December 2015 completed the Chronic Kidney Disease Self-Management instrument. Construct validity was determined using exploratory factor analysis, internal consistency and test-retest reliability using Cronbach's α and intraclass correlation. For convergent validity, the relationships between knowledge, self-efficacy and self-management were investigated. RESULTS The Australian version of the Chronic Kidney Disease Self-Management instrument has 17 items grouped into four factors: self-integration, seeking social support, adherence to lifestyle modification and problem solving. The instrument demonstrated good reliability. Self-efficacy was positively correlated with self-management scores, although there was no correlation between chronic kidney disease knowledge and self-management. CONCLUSIONS The Australian version of the Chronic Kidney Disease Self-Management instrument was found to be a valid and reliable patient-reported outcome measure. It can be used in clinical practice to support self-management, as well as future research.
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Affiliation(s)
- Colette Wembenyui
- Kidney Health Service, Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,QUT School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Clint Douglas
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,NHMRC Chronic Kidney Disease Centre of Research Excellence, University of Queensland, Brisbane, Queensland, Australia
| | - Ann Bonner
- Kidney Health Service, Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,QUT School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.,Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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19
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Schrauben SJ, Cavanaugh KL, Fagerlin A, Ikizler TA, Ricardo AC, Eneanya ND, Nunes JW. The Relationship of Disease-Specific Knowledge and Health Literacy With the Uptake of Self-Care Behaviors in CKD. Kidney Int Rep 2020; 5:48-57. [PMID: 31922060 PMCID: PMC6943760 DOI: 10.1016/j.ekir.2019.10.004] [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: 09/18/2019] [Accepted: 10/07/2019] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Individuals with chronic kidney disease (CKD) generally have poor participation in self-care. We hypothesized that greater kidney disease knowledge and health literacy would associate with better self-care. METHODS We enrolled 401 participants with non-dialysis-dependent CKD from one academic center in this cross-sectional study. Validated surveys were used to assess health literacy level (inadequate vs. adequate; Rapid Estimate of Adult Literacy in Medicine), perceived kidney disease knowledge (Perceived Kidney Disease Knowledge Survey [PiKS]), objective kidney disease knowledge (Kidney Disease Knowledge Survey [KiKS]), and a CKD self-care measure was constructed as the sum of self-reported self-care behaviors using the adapted Summary of Diabetes Self-Care Activities Assessment. The association between health literacy level, PiKS scores, KiKS scores, and the CKD self-care measure was assessed with multivariable adjusted linear regression models. RESULTS Participants had a mean age of 57 years and 17.7% had inadequate health literacy. PiKS scores were positively associated with the CKD self-care measure (β = 1.05, 95% confidence interval [CI] 0.50-1.63), and a positive trend was observed for KiKS scores and the CKD self-care measure (β = 0.30, 95% CI: -0.12 to 0.72). Health literacy was not associated with CKD self-care measure. CONCLUSION Objective kidney disease knowledge is likely necessary, but not sufficient for self-care and may depend on the level of health literacy. Perceived kidney knowledge may offer a novel target to assess patients at risk for poor self-care, and be used in targeted educational interventions.
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Affiliation(s)
- Sarah J. Schrauben
- Division of Nephrology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kerri L. Cavanaugh
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
- US Department of Veteran's Affairs, Salt Lake City VA Center for Informatics Decision Enhancement and Surveillance (IDEAS), Salt Lake City, Utah, USA
| | - T. Alp Ikizler
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ana C. Ricardo
- Division of Nephrology, University of Illinois, Chicago, Illinois, USA
| | - Nwamaka D. Eneanya
- Division of Nephrology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julie Wright Nunes
- Division of Nephrology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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20
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Purnell TS, Luo X, Crews DC, Bae S, Ruck JM, Cooper LA, Grams ME, Henderson ML, Waldram MM, Johnson M, Segev DL. Neighborhood Poverty and Sex Differences in Live Donor Kidney Transplant Outcomes in the United States. Transplantation 2019; 103:2183-2189. [PMID: 30768570 DOI: 10.1097/tp.0000000000002654] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neighborhood poverty has been associated with worse outcomes after live donor kidney transplantation (LDKT), and prior work suggests that women with kidney disease may be more susceptible to the negative influence of poverty than men. As such, our goal was to examine whether poverty differentially affects women in influencing LDKT outcomes. METHODS Using data from the Scientific Registry of Transplant Recipients and US Census, we performed multivariable Cox regression to compare outcomes among 18 955 women and 30 887 men who received a first LDKT in 2005-2014 with follow-up through December 31, 2016. RESULTS Women living in poor (adjusted hazard ratio [aHR], 1.30; 95% confidence interval [CI], 1.13-1.50) and middle-income (aHR, 1.26; 95% CI, 1.14-1.40) neighborhoods had higher risk of graft loss than men, but there were no differences in wealthy areas (aHR, 1.07; 95% CI, 0.88-1.29). Women living in wealthy (aHR, 0.71; 95% CI, 0.59-0.87) and middle-income (aHR, 0.82; 95% CI, 0.74-0.92) neighborhoods incurred a survival advantage over men, but there were no statistically significant differences in mortality in poor areas (aHR, 0.85; 95% CI, 0.72-1.01). CONCLUSIONS Given our findings that poverty is more strongly associated with graft loss in women, targeted efforts are needed to specifically address mechanisms driving these disparities in LDKT outcomes.
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Affiliation(s)
- Tanjala S Purnell
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD
| | - Xun Luo
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Deidra C Crews
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Sunjae Bae
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jessica M Ruck
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Lisa A Cooper
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Morgan E Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Macey L Henderson
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD
| | - Madeleine M Waldram
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD
| | - Morgan Johnson
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD
| | - Dorry L Segev
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD
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21
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Tuot DS, Wong KK, Velasquez A, Crews DC, Zonderman AB, Evans MK, Powe NR. CKD Awareness in the General Population: Performance of CKD-Specific Questions. Kidney Med 2019; 1:43-50. [PMID: 32734184 PMCID: PMC7380399 DOI: 10.1016/j.xkme.2019.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Rationale & Objective Data from patients in one delivery system have suggested that the prevalence of chronic kidney disease (CKD) awareness differs by how the question is asked. We examined the sensitivity and specificity of different CKD awareness questions among diverse community-dwelling adults who were not necessarily engaged in primary care to determine the generalizability of prior results. Study Design Cross-sectional study. Setting & Participants Participants in the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) Study. Predictor CKD awareness, ascertained using 5 different questions. Outcome Sensitivity and specificity of each awareness question, using laboratory results as the gold standard. Analytic Approach Logistic regression was used to compare sensitivities of different awareness questions. Results Among 2,046 participants, mean (SD) age was 56.5 (9.1) years, 41.5% were men, and 61.3% were African American. More than 40% were poor, 35% reported not having health insurance, and 16.9% had low health literacy. More than 20% (n = 424) had CKD. Sensitivities of single CKD awareness questions ranged from 2.2% for “kidney damage” to 5.2% for “kidney problem.” Sensitivity of the compound question asking about “weak kidneys, failing kidneys, or kidney disease” was 19.5%. Sensitivity of this compound CKD awareness question was higher among study participants with more advanced CKD and low health literacy, and those who lived below the poverty level. Limitations Single measures of estimated glomerular filtration rate and albuminuria; study participants may have been more engaged in their health care than the average US adult, potentially limiting the generalizability of results. Conclusions CKD awareness is low among community-dwelling adults with kidney disease, though data using a sensitive compound question ascertaining awareness suggest that we have met the Healthy People 2020 goal related to CKD awareness of 13.4%. Understanding the phrases about kidney disease that are most understandable to patients with and at risk for CKD is important to further increase CKD awareness.
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Affiliation(s)
- Delphine S. Tuot
- Division of Nephrology, University of California, San Francisco
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
- Address for Correspondence: Delphine S. Tuot, MDCM, MAS, Division of Nephrology, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, 1001 Potrero Ave, Bldg 100, Rm 342, San Francisco, CA 94110.
| | - Karen K. Wong
- Touro University California College of Osteopathic Medicine, Vallejo, CA
| | - Alexandra Velasquez
- Division of Nephrology, University of California, San Francisco
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
| | - Deidra C. Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine
| | - Alan B. Zonderman
- National Institute on Aging, National Institutes of Health, Baltimore, MD
| | - Michele K. Evans
- National Institute on Aging, National Institutes of Health, Baltimore, MD
| | - Neil R. Powe
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
- Department of Medicine, University of California, San Francisco, San Francisco, CA
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Notaras S, Conti J. A qualitative analysis of eating behaviour change for patients with diabetes and non-dialysis dependent chronic kidney disease stages 4-5. J Ren Care 2018; 44:219-228. [PMID: 30353696 DOI: 10.1111/jorc.12258] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dietary changes recommended for chronic kidney disease (CKD) stages 4-5 and concurrent diabetes are difficult to follow given the multitude of food and fluid restrictions aimed at reducing the rate of CKD progression. Reduced adherence is commonplace and there is limited literature on patients' experiences with dietary changes and potential strategies to overcome this. OBJECTIVES Examine patients' experiences when adopting dietary changes recommended for CKD Stages 4-5 (pre-dialysis) and diabetes, and their perceptions of dietetic services and how they can be improved to assist them with dietary change. METHODS An exploratory qualitative study was undertaken using a purposive sampling method from a dietetic pre-dialysis clinic. Participants were interviewed using a semi-structured interview style. Data were analysed using an inductive thematic analysis from a constructivist perspective. RESULTS Three themes were identified: (1) Negative motivation to change eating behaviour to avoid dialysis; (2) sustaining motivation for change is challenging due to a sense of loss and confusion to incorporate the dietary changes recommended and (3) support is needed for eating behaviour change. CONCLUSION These findings have implications for dietitians to enhance their understanding of the patient experience and improve their skills in motivational counselling. Development of dietitian-specific communication and nutrition counselling programmes are recommended to equip dietitians with skills to better support patients. CKD Stage 3 nutrition education programmes could be beneficial to promote earlier access to dietetic services and dietary recommendations.
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Affiliation(s)
- Stephanie Notaras
- Department of Dietetics, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Janet Conti
- Western Sydney University, School of Social Sciences and Psychology, New South Wales, Australia
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Parental health literacy and progression of chronic kidney disease in children. Pediatr Nephrol 2018; 33:1759-1764. [PMID: 29948310 PMCID: PMC6129202 DOI: 10.1007/s00467-018-3962-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/19/2018] [Accepted: 04/04/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Limited health literacy has been associated with adverse outcomes in children. We evaluated this association in the setting of chronic kidney disease (CKD). METHODS We assessed the parental health literacy of 367 children enrolled in the Chronic Kidney Disease in Children (CKiD) Study, using the Short Test of Functional Health Literacy (STOFHLA). We evaluated the association between parental health literacy and CKD progression, defined as time to the composite event of renal replacement therapy (RRT, dialysis, or kidney transplant) or 50% decline in estimated glomerular filtration rate (eGFR). RESULTS Median CKiD participant age was 9.5 years, 63% were male, and 59% non-Hispanic white. Median eGFR at baseline was 63 ml/min/1.73 m2, and median urine protein-to-creatinine ratio was 0.22. The median STOFHLA score was 98. Over a median follow-up of 3.7 years, the overall CKD progression rate was 2.8 per 100 person-years. After adjustment for demographic and clinical factors, the relative time to CKD progression was 28% longer per 1 SD increase in STOFHLA score (relative time, 95% CI, 1.28, 1.06-1.53). CONCLUSIONS In this cohort of children with CKD, higher parental health literacy was associated with a nearly 30% longer time to the composite CKD progression outcome.
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Wong KK, Velasquez A, Powe NR, Tuot DS. Association between health literacy and self-care behaviors among patients with chronic kidney disease. BMC Nephrol 2018; 19:196. [PMID: 30081951 PMCID: PMC6091174 DOI: 10.1186/s12882-018-0988-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We explored the association between health literacy and self-care behaviors among low-income patients with chronic kidney disease (CKD). METHODS We used baseline data from the Kidney Awareness Registry and Education trial (n = 137 patients with CKD) and multivariable logistic regressions to cross-sectionally examine the association between health literacy, defined by a validated questionnaire, and healthy behaviors. RESULTS Study participants had a mean age of 55 years, were racially diverse (6% White, 36% Hispanic, 43% Black, 15% Asian) and 26% had low health literacy. Over one-third (38%) had hypertension, 51% had diabetes, and 67% had CKD stage 3 or 4. Compared to individuals with adequate health literacy, those with low health literacy had non-statistically significant higher tobacco use (adjusted odds ratio [aOR] = 2.33; 95% CI 0.90-6.06) and lower consumption of sugary beverages (aOR = 0.50; 0.20-1.23) and statistically significant decreased fast food intake (aOR = 0.38; 0.16-0.93). Health literacy was not associated with differences in medication adherence (0.84; 0.38-1.89) or physical activity (aOR = 2.39; 0.54-10.53). CONCLUSIONS Health literacy was not uniformly associated with all self-care behaviors important for CKD management. A more nuanced understanding of the association of health literacy and self-care may be necessary to promote participation in behaviors known to slow CKD progression.
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Affiliation(s)
- Karen K Wong
- Touro University California College of Osteopathic Medicine, Vallejo, USA
| | | | - Neil R Powe
- Department of Medicine, University of California, San Francisco, USA.,Center for Vulnerable Populations, University of California, San Francisco, USA.,Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center, University of California, 1001 Potrero Ave, Bldg. 100, Room 342, San Francisco, CA, 94110, USA
| | - Delphine S Tuot
- Division of Nephrology, University of California, San Francisco, USA. .,Center for Vulnerable Populations, University of California, San Francisco, USA. .,Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center, University of California, 1001 Potrero Ave, Bldg. 100, Room 342, San Francisco, CA, 94110, USA.
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25
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Dehghani A, Keshavarzi A. Development and validation of a multidimensional health literacy questionnaire for multiple sclerosis patients. Mult Scler Relat Disord 2018; 25:156-162. [PMID: 30081315 DOI: 10.1016/j.msard.2018.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/18/2018] [Accepted: 07/10/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Assessment of health literacy among patients with multiple sclerosis can be used in education planning, disease management, compliance, and quality of life. In addition, health literacy can be assessed using a standard questionnaire based on the social and cultural context more accurately. This study aimed to develop and validate a questionnaire for the assessment of health literacy in patients with multiple sclerosis. METHODS This is an exploratory sequential mixed method research which was conducted in three sections. In the first section, the concept of health literacy among patients with MS was analyzed using the hybrid concept analysis in the theoretical work, field work, and final analysis stages in order to extract features of the concept. In the second section, an initial pool of items of the questionnaire was designed based on the extracted features from the concept, reviewed texts, and related questionnaires. In the third section, psychometric properties of the questionnaire were evaluated including validity (face, content and construct) and reliability (internal consistency and stability). RESULTS Totally, 68 items were included in the initial pool, which shrank to 22 items in the final questionnaire after reviewing the psychometric features. Factor analyses led to the extraction of four factors including appraisal of health information, ability to search health information, knowledge of caring for the disease, and successful practices in health conditions. Internal consistency of the questionnaire was also confirmed by Cronbach's alpha coefficient of 0.94, and its stability was calculated and confirmed by the inter-class coefficient of correlation of 0.96. CONCLUSION The developed 22-item-questionnaire is valid and reliable for assessment of levels of health literacy in Iranian patients with MS.
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Affiliation(s)
- Ali Dehghani
- Department of Nursing, School of Nursing and Paramedical, Jahrom University of Medical Sciences, Jahrom, Iran.
| | - Abdolkhalegh Keshavarzi
- Department of General Surgery, School of Medicine, Member of Shiraz burn research center, Shiraz University of Medical Sciences, Shiraz, Iran
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Shin KS, Lee E. Relationships of health literacy to self‐care behaviors in people with diabetes aged 60 and above: Empowerment as a mediator. J Adv Nurs 2018; 74:2363-2372. [DOI: 10.1111/jan.13738] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/16/2018] [Accepted: 06/06/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Kyung Suk Shin
- Graduate School of Public Health Ajou University Suwon Korea
| | - Eun‐Hyun Lee
- Graduate School of Public Health Ajou University Suwon Korea
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Moving towards a Comprehensive Approach for Health Literacy Interventions: The Development of a Health Literacy Intervention Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061268. [PMID: 29914065 PMCID: PMC6025600 DOI: 10.3390/ijerph15061268] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/06/2018] [Accepted: 06/12/2018] [Indexed: 11/16/2022]
Abstract
Low health literacy (HL) is associated with many negative health outcomes, and is a major challenge in public health and healthcare. Interventions to improve outcomes associated with HL are needed. In this paper, we aim to develop a comprehensive HL intervention model. We used a multimethod approach, consisting of (1) a literature review of articles listed in MEDLINE, presenting HL intervention models, (2) online consultation of international HL experts, and (3) two consensus meetings with members (n = 36 and 27) of a consortium studying HL among older adults (50+) in Europe. In our literature review, we identified twenty-two HL models, only a few of which focused explicitly on interventions. Sixty-eight health literacy experts took part in the online survey. The results from all three methods came together in a comprehensive HL intervention model. This model conceptualized interventions as potentially targeting five factors affecting HL outcomes: (1) individuals’ personal characteristics, (2) individuals’ social context, (3) communication between individuals and health professionals, (4) health professionals’ HL capacities, and (5) health systems. Our model is the first comprehensive HL model focused specifically on interventions. The model can support the further development of HL interventions to improve the health outcomes of people with low HL.
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Chen YC, Chang LC, Liu CY, Ho YF, Weng SC, Tsai TI. The Roles of Social Support and Health Literacy in Self-Management Among Patients With Chronic Kidney Disease. J Nurs Scholarsh 2018; 50:265-275. [DOI: 10.1111/jnu.12377] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Yu-Chi Chen
- Lambda Beta-at-Large , Associate Professor, Institute of Clinical Nursing, School of Nursing; National Yang-Ming University; Taipei Taiwan ROC
| | - Li-Chun Chang
- Lambda Beta-at-Large , Associate Professor, School of Nursing; Chang Gung University of Science and Technology; Tao-Yuan Taiwan ROC
| | - Chieh-Yu Liu
- Associate Professor, Department of Midwifery and Women Health Care; National Taipei University of Nursing and Health Sciences; Taipei City Taiwan ROC
| | - Ya-Fang Ho
- Lambda Beta-at-Large , PhD Candidate, Department of Nursing, School of Nursing; National Yang-Ming University; Taiwan ROC
| | - Shuo-Chun Weng
- PhD Candidate, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, and Attending Physician, Center for Geriatrics and Gerontology, Division of Nephrology, Department of Internal Medicine; Taichung Veterans General Hospital; Taichung Taiwan ROC
| | - Tzu-I Tsai
- Professor, Department of Nursing, School of Nursing; National Yang-Ming University; Taiwan ROC
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Morony S, Webster AC, Buchbinder R, Kirkendall S, McCaffery KJ, Clerehan R. A Linguistic Analysis of Health Literacy Demands of Chronic Kidney Disease Patient Education Materials. Health Lit Res Pract 2018; 2:e1-e14. [PMID: 31294272 PMCID: PMC6608909 DOI: 10.3928/24748307-20171227-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 12/13/2017] [Indexed: 12/01/2022] Open
Abstract
Background: Instruments to assess the quality and comprehensibility of printed patient education materials may lack proper consideration of how readers derive meaning from text. The Evaluative Linguistic Framework (ELF) considers how factors that influence readers' expectations about health care texts also affect their ability to understand them. The ELF has demonstrated value in improving the quality of patient materials about medication, consent, and self-reported questionnaires, but has not yet been used to evaluate a corpus of patient education materials about chronic disease self-management. Objective: This study sought to apply the ELF to examine specific elements of printed self-management patient education materials for chronic kidney disease (CKD) not captured by other tools. Methods: From a previously published systematic review, we identified 14 patient education materials (eight self-management, six diet and nutrition) for people with CKD. We used the ELF to identify the different ways the text could be structured, its intended purpose, the relationship established between reader and writer, presence of signposting, its complexity and technicality of language, and factual content. Key Results: Our analysis identified nine possible structural units, of which “introducing the problem” and “instructing the reader to self-manage” were common to all materials. However, there was no consistency or common sequence to these units of text. The intended readership and aims of the author(s) were not always clear; many materials made assumptions about what the reader knew, the language was often complex and dense, and the meta-discourse was sometimes distracting. Conclusions: Our analysis suggests CKD document developers can benefit from a theoretically grounded linguistic tool that focuses on the intended audience and their specific needs. The ELF identified structural units of text, aligned with rhetorical elements that can be uniformly applied for developing self-management education materials for CKD, and provided checks for language complexity. Further work can determine its usefulness for other (e.g., electronic) formats and other chronic diseases. [HLRP: Health Literacy Research and Practice. 2018;2(1):e1–e14.] Plain Language Summary: Helping patients make meaning from information about their condition is a key goal of health care organizations. We analyzed chronic kidney disease patient education materials on self-management using the Evaluative Linguistic Framework. The purpose and intended audience were frequently unclear. We identified nine structural units of text that may assist information providers to plan and structure content.
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Affiliation(s)
- Suzanne Morony
- Address correspondence to Suzanne Morony, PhD, MPsych(Org), Sydney School of Public Health, 126a, Edward Ford Building A27, The University of Sydney, NSW 2006, Australia;
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St Clair Russell J, Boulware LE. End-stage renal disease treatment options education: What matters most to patients and families. Semin Dial 2018; 31:122-128. [PMID: 29315798 DOI: 10.1111/sdi.12665] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Treatment modality education can offer many important benefits to patients and their families. Evidence suggests such education can increase use of home dialysis, reduce catheter use, decrease 90-day mortality, and increase transplantation. While these benefits are encouraging, not all patients are offered options education and when they are, it may not be presented in a way that is immediately applicable to them and their lives. Furthermore, little is known regarding specific characteristics (e.g. format such as group or individual or in-person or online, duration, teaching methods, location, content) of educational programs that are most successful. No single approach has emerged as a best practice. In the absence of such evidence, adult learning principles, such as involving patients and families in the development programs and materials, can serve as a guide for educational development. Adult learning principles can enhance options education, evolving them from information delivery to a person-centered, values-based endeavor that helps match treatment to values and lifestyle.
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Affiliation(s)
| | - L Ebony Boulware
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
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Devraj R, Borrego ME, Vilay AM, Pailden J, Horowitz B. Awareness, self-management behaviors, health literacy and kidney function relationships in specialty practice. World J Nephrol 2018; 7:41-50. [PMID: 29359119 PMCID: PMC5760511 DOI: 10.5527/wjn.v7.i1.41] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/20/2017] [Accepted: 12/04/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To determine the relationship between chronic kidney disease (CKD) awareness (CKD-A), self-management behaviors (CKD-SMB) knowledge, performance of CKD-SMBs, health literacy (HL) and kidney function.
METHODS Participants were eligible patients attending an outpatient nephrology clinic. Participants were administered: Newest Vital Sign to measure HL, CKD self-management knowledge tool (CKD-SMKT) to assess knowledge, past performance of CKD-SMB, CKD-A. Estimated GFR (eGFR) was determined using the MDRD-4 equation. Duration of clinic participation and CKD cause were extracted from medical charts.
RESULTS One-hundred-fifty patients participated in the study. eGFRs ranged from 17-152 mL/min per 1.73 m2. Majority (83%) of respondents had stage 3 or 4 CKD, low HL (63%), and were CKD aware (88%). Approximately 40% (10/25) of patients in stages 1 and 2 and 6.4% (8/125) in stages 3 and 4 were unaware of their CKD. CKD-A differed with stage (P < 0.001) but not by HL level, duration of clinic participation, or CKD cause. Majority of respondents (≥ 90%) correctly answered one or more CKD-SMKT items. Knowledge of one behavior, “controlling blood pressure” differed significantly by CKD-A. CKD-A was associated with past performance of two CKD-SMBs, “controlling blood pressure” (P = 0.02), and “keeping healthy body weight” (P = 0.01). Adjusted multivariate analyses between CKD-A and: (1) HL; and (2) CKD-SMB knowledge were non-significant. However, there was a significant relationship between CKD-A and kidney function after controlling for demographics, HL, and CKD-SMB (P < 0.05).
CONCLUSION CKD-A is not associated with HL, or better CKD-SMBs. CKD-A is significantly associated with kidney function and substantially lower eGFR, suggesting the need for focused patient education in CKD stages 1.
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Affiliation(s)
- Radhika Devraj
- School of Pharmacy, Southern Illinois University Edwardsville, Edwardsville, IL 62026, United States
| | - Matthew E Borrego
- College of Pharmacy, University of New Mexico, Albuquerque, NM 87131, United States
| | - A Mary Vilay
- College of Pharmacy, University of New Mexico, Albuquerque, NM 87131, United States
| | - Junvie Pailden
- College of Arts and Sciences, Southern Illinois University Edwardsville, Edwardsville, IL 62026, United States
| | - Bruce Horowitz
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, UT 84112, United States
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Lambert K, Mullan J, Mansfield K. An integrative review of the methodology and findings regarding dietary adherence in end stage kidney disease. BMC Nephrol 2017; 18:318. [PMID: 29061163 PMCID: PMC5653982 DOI: 10.1186/s12882-017-0734-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 09/27/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Dietary modification is an important component of the management of end stage kidney disease (ESKD). The diet for ESKD involves modifying energy and protein intake, and altering sodium, phosphate, potassium and fluid intake. There have been no comprehensive reviews to date on this topic. The aims of this integrative review were to (i) describe the methods used to measure dietary adherence (ii) determine the rate of dietary adherence and (iii) describe factors associated with dietary adherence in ESKD. METHODS The Web of Science and Scopus databases were searched using the search terms 'adherence' and 'end stage kidney disease'. Of the 787 potentially eligible papers retrieved, 60 papers of 24,743 patients were included in this review. Of these papers, 44 reported the rate of dietary adherence and 44 papers described factors associated with adherence. RESULTS Most of the evidence regarding dietary adherence is derived from studies of hemodialysis patients (72% of patients). The most common method of measuring dietary adherence in ESKD was subjective techniques (e.g. food diaries or adherence questionnaires). This was followed by indirect methods (e.g. serum potassium, phosphate or interdialytic weight gain). The weighted mean adherence rate to ESKD dietary recommendations was 31.5% and 68.5% for fluid recommendations. Adherence to protein, sodium, phosphate, and potassium recommendations were highly variable due to differences in measurement methods used, and were often derived from a limited evidence base. Socioeconomic status, age, social support and self-efficacy were associated with dietary adherence. However, factors such as taste, the impact of the diet on social eating occasions; and dietetic staffing also appear to play a role in dietary adherence. CONCLUSION Dietary adherence rates in people with ESKD are suboptimal. Further research is required on dietary adherence in patients with ESKD from different social, educational, economic and ethnic groups. This research may identify other factors which may impact upon adherence, and could be used to inform the design of future strategies to improve dietary adherence. Future research that reports not just the rate of adherence to individual components of the nutrient prescription but also the overall quality of the diet would be useful.
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Affiliation(s)
- Kelly Lambert
- Department of Clinical Nutrition, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Level 5, Block C, Crown Street, Wollongong, NSW 2500 Australia
| | - Judy Mullan
- Centre for Health Research Illawarra Shoalhaven Population (CHRISP), Australian Health Services Research Institute, University of Wollongong, iC Enterprise 1, Innovation Campus, Wollongong, New South Wales 2522 Australia
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Ave, Wollongong, New South Wales 2522 Australia
| | - Kylie Mansfield
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Ave, Wollongong, New South Wales 2522 Australia
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Gonzalez K, Ulloa JG, Moreno G, Echeverría O, Norris K, Talamantes E. Intensive procedure preferences at the end of life (EOL) in older Latino adults with end stage renal disease (ESRD) on dialysis. BMC Nephrol 2017; 18:319. [PMID: 29061178 PMCID: PMC5654039 DOI: 10.1186/s12882-017-0739-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 10/02/2017] [Indexed: 12/03/2022] Open
Abstract
Background Latinos in the U.S. are almost twice as likely to progress to End Stage Renal disease (ESRD) compared to non-Latino whites. Patients with ESRD on dialysis experience high morbidity, pre-mature mortality and receive intensive procedures at the end of life (EOL). This study explores intensive procedure preferences at the EOL in older Latino adults. Methods Seventy-three community-dwelling Spanish- and English-Speaking Latinos over the age of 60 with and without ESRD participated in this study. Those without ESRD (n = 47) participated in one of five focus group sessions, and those with ESRD on dialysis (n = 26) participated in one-on-one semi-structured interviews. Focus group and individual participants answered questions regarding intensive procedures at the EOL. Recurring themes were identified using standard qualitative content-analysis methods. Participants also completed a brief survey that included demographics, language preference, health insurance coverage, co-morbidities, Emergency Department visits and functional limitations. Results The majority of participants were of Mexican origin with mean age of 70, and there were more female participants in the non-ESRD group, compared to the ESRD dialysis dependent group. The dialysis group reported a higher number of co-morbidities and functional limitations. Nearly 69% of those in the dialysis group reported one or more emergency department visits in the past year, compared to 38% in the non-ESRD group. Primary themes centered on 1) The acceptability of a “natural” versus “invasive” procedure 2) Cultural traditions and family involvement 3) Level of trust in physicians and autonomy in decision-making. Conclusion Our results highlight the need for improved patient- and family-centered approaches to better understand intensive procedure preferences at the EOL in this underserved population of older adults.
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Affiliation(s)
- Karla Gonzalez
- Department of Family Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA. .,UCLA Family Health Center, 1920 Colorado Avenue, Santa Monica, CA, 90404, USA.
| | - Jesus G Ulloa
- Department of Surgery, University of California San Francisco, 513 Parnassus Ave, S-321, San Francisco, CA, 94143, USA.,Robert Wood Johnson Foundation, Clinical Scholars Program, University of California, Los Angeles, Los Angeles, CA, USA.,Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Gerardo Moreno
- Department of Family Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA.,UCLA Family Health Center, 1920 Colorado Avenue, Santa Monica, CA, 90404, USA
| | - Oscar Echeverría
- UCLA David Geffen School of Medicine at University of California, 10833 Le Conte Ave # 12138, Los Angeles, CA, 90095, USA
| | - Keith Norris
- Robert Wood Johnson Foundation, Clinical Scholars Program, University of California, Los Angeles, Los Angeles, CA, USA.,Division of General Internal Medicine and Health Services Research University of California, 911 Broxton Avenue, Los Angeles, CA, 90095, USA
| | - Efrain Talamantes
- Division of General Internal Medicine, University of California, Davis School of Medicine, 4150 V Street, Suite 2400, Sacramento, CA, 95817, USA
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Costa-Requena G, Moreso F, Cantarell MC, Serón D. Health literacy and chronic kidney disease. Nefrologia 2016; 37:115-117. [PMID: 27837925 DOI: 10.1016/j.nefro.2016.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/29/2016] [Accepted: 10/02/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
- Gema Costa-Requena
- Unidad de Psiquiatría, Hospital Universitari Vall d'Hebron, Barcelona, España.
| | - Francesc Moreso
- Unidad de Psiquiatría, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Carmen Cantarell
- Unidad de Psiquiatría, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - Daniel Serón
- Unidad de Psiquiatría, Hospital Universitari Vall d'Hebron, Barcelona, España
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Tuot DS, Zhu Y, Velasquez A, Espinoza J, Mendez CD, Banerjee T, Hsu CY, Powe NR. Variation in Patients' Awareness of CKD according to How They Are Asked. Clin J Am Soc Nephrol 2016; 11:1566-1573. [PMID: 27340288 PMCID: PMC5012470 DOI: 10.2215/cjn.00490116] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/06/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Awareness of CKD is necessary for patient engagement and adherence to medical regimens. Having an accurate tool to assess awareness is important. Use of the National Health and Nutrition Examination Survey (NHANES) CKD awareness question "Have you ever been told by a doctor or other health professional that you had weak or failing kidneys (excluding kidney stones, bladder infections, or incontinence)?" produces surprisingly low measures of CKD awareness. We sought to compare the sensitivity and specificity of different questions ascertaining awareness of CKD and other health conditions. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Between August of 2011 and August of 2014, an in-person questionnaire was administered to 220 adults with CKD, diabetes, hypertension, or hyperlipidemia who received primary care in a public health care delivery system to ascertain awareness of each condition. CKD awareness was measured using the NHANES question, and other questions, asking if patients knew about their "kidney disease", "protein in the urine", "kidney problem", or "kidney damage." Demographic data were self-reported; health literacy was measured. The sensitivity and specificity of each question was calculated using the medical record as the gold standard. RESULTS In this diverse population (9.6% white, 40.6% black, 36.5% Hispanic, 12.3% Asian), the mean age was 58 years, 30% had a non-English language preference, and 45% had low health literacy. Eighty percent of participants had CKD, with a mean eGFR of 47.2 ml/min per 1.73 m(2). The sensitivities of each CKD awareness question were: 26.4% for "kidney damage", 27.7% for "kidney disease", 33.2% for "weak or failing kidneys", 39.8% for "protein in the urine", and 40.1% for "kidney problem." Specificities ranged from 82.2% to 97.6%. The best two-question combination yielded a sensitivity of 53.1% and a specificity of 83.3%. This was lower than awareness of hypertension (90.1%) or diabetes (91.8%). CONCLUSIONS CKD awareness is low compared with other chronic diseases regardless of how it is ascertained. Nevertheless, more sensitive questions to ascertain CKD awareness suggest current under-ascertainment.
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Affiliation(s)
| | - Yunnuo Zhu
- Center for Vulnerable Populations, and
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | | | | | | | - Tanushree Banerjee
- Center for Vulnerable Populations, and
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | | | - Neil R. Powe
- Center for Vulnerable Populations, and
- Department of Medicine, University of California, San Francisco, San Francisco, California
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Stanifer JW, Turner EL, Egger JR, Thielman N, Karia F, Maro V, Kilonzo K, Patel UD, Yeates K. Knowledge, Attitudes, and Practices Associated with Chronic Kidney Disease in Northern Tanzania: A Community-Based Study. PLoS One 2016; 11:e0156336. [PMID: 27280584 PMCID: PMC4900616 DOI: 10.1371/journal.pone.0156336] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/12/2016] [Indexed: 11/18/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are a leading cause of death among adults in sub-Saharan Africa, and chronic kidney disease (CKD) is a growing public health threat. Understanding knowledge, attitudes, and practices associated with NCDs is vital to informing optimal policy and public health responses in the region, but few community-based assessments have been performed for CKD. To address this gap, we conducted a cross-sectional survey of adults in northern Tanzania using a validated instrument. Methods Between January and June 2014, we administered a structured survey to a random sample of adults from urban and rural communities. The validated instrument consisted of 25 items designed to measure knowledge, attitudes, and practices associated with kidney disease. Participants were also screened for CKD, diabetes, hypertension, and human immunodeficiency virus. Results We enrolled 606 participants from 431 urban and rural households. Knowledge of the etiologies, symptoms, and treatments for kidney disease was low (mean score 3.28 out of 10; 95% CI 2.94, 3.63). There were no significant differences by CKD status. Living in an urban setting and level of education had the strongest independent associations with knowledge score. Attitudes were characterized by frequent concern about the health (27.3%; 20.2, 36.0%), economic (73.1%; 68.2, 77.5%), and social impact (25.4%; 18.6, 33.6%) of kidney disease. Practices included the use of traditional healers (15.2%; 9.1, 24.5%) and traditional medicines (33.8%; 25.0, 43.9%) for treatment of kidney disease as well as a willingness to engage with mobile-phone technology in CKD care (94.3%; 90.1, 96.8%). Conclusions Community-based adults in northern Tanzania have limited knowledge of kidney disease. However, there is a modest knowledge base upon which to build public health programs to expand awareness and understanding of CKD, but these programs must also consider the variety of means by which adults in this population meet their healthcare needs. Finally, our assessment of local attitudes suggested that such public health efforts would be well-received.
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Affiliation(s)
- John W. Stanifer
- Department of Medicine, Duke University, DUMC Box 3182, Durham, NC, 27710, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, 27710, United States of America
- Duke Clinical Research Institute, Duke University, DUMC Box 3646, Durham, NC, 27710, United States of America
- * E-mail:
| | - Elizabeth L. Turner
- Duke Global Health Institute, Duke University, Durham, NC, 27710, United States of America
- Department of Biostatistics and Bioinformatics, Duke University, DUMC Box 2721, Durham, NC, 27710, United States of America
| | - Joseph R. Egger
- Duke Global Health Institute, Duke University, Durham, NC, 27710, United States of America
| | - Nathan Thielman
- Department of Medicine, Duke University, DUMC Box 3182, Durham, NC, 27710, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, 27710, United States of America
| | - Francis Karia
- Kilimanjaro Christian Medical College, Sokoine Road, Moshi, Tanzania
| | - Venance Maro
- Kilimanjaro Christian Medical College, Sokoine Road, Moshi, Tanzania
| | - Kajiru Kilonzo
- Kilimanjaro Christian Medical College, Sokoine Road, Moshi, Tanzania
| | - Uptal D. Patel
- Department of Medicine, Duke University, DUMC Box 3182, Durham, NC, 27710, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, 27710, United States of America
- Duke Clinical Research Institute, Duke University, DUMC Box 3646, Durham, NC, 27710, United States of America
| | - Karen Yeates
- Department of Medicine, Queen’s University, 76 Stuart Street, Kingston, Ontario, Canada K7L 2VL
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Jain D, Green JA. Health literacy in kidney disease: Review of the literature and implications for clinical practice. World J Nephrol 2016; 5:147-151. [PMID: 26981438 PMCID: PMC4777785 DOI: 10.5527/wjn.v5.i2.147] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/18/2015] [Accepted: 01/29/2016] [Indexed: 02/06/2023] Open
Abstract
Health literacy is the capacity of an individual to understand information related to a disease in order to make an informed decision. In patients with kidney diseases, studies have reported increasing impact of limited health literacy on health outcomes. Our paper discusses current literature on health literacy in kidney diseases.
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Devraj R, Borrego M, Vilay AM, Gordon EJ, Pailden J, Horowitz B. Relationship between Health Literacy and Kidney Function. Nephrology (Carlton) 2016; 20:360-7. [PMID: 25661456 DOI: 10.1111/nep.12425] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2015] [Indexed: 12/29/2022]
Abstract
AIM Low health literacy (HL) may contribute to poor self-management of chronic kidney disease (CKD) and poor kidney function. This study aimed to assess the relationship between HL and estimated glomerular filtration rate (eGFR). METHODS A cross-sectional observational study was conducted among consecutive eligible adult patients with CKD stages 1-4 attending an outpatient nephrology clinic. HL was assessed using Newest Vital Sign (NVS). eGFR was estimated using the Modification of Diet in Renal Disease equation. CKD self-management behaviour knowledge was assessed using a study instrument (CKD self-management knowledge (SMKT)). RESULTS One hundred fifty patients participated in the study (83% participation rate). The prevalence of high likelihood of limited HL was 32.7%. Participants' eGFRs ranged from 17 to 152 mL/min / 1.73 m(2) , with over 80% of the eGFRs below 60 mL/min / 1.73 m(2) . HL was associated with eGFR after controlling for all demographics except age, race and gender (which are included in eGFR equation) (P = 0.05). Every unit increase in NVS score was associated with a 1.9% increase (95% confidence interval = 0 to 3.86%) in eGFR (model R square = 0.23, P = 0.002), which remained significant after controlling for CKD-SMKT (P = 0.05; model R square = 0.28, P < 0.001). The relationship was non-significant after controlling for age, although it remained significant after controlling for other demographics including gender and race. CONCLUSIONS There is a small but significant association between HL and eGFR. Providers should use HL-tailored communication strategies in CKD patients. Larger multicentre studies are needed to substantiate this relationship.
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Affiliation(s)
- Radhika Devraj
- School of Pharmacy, Southern Illinois University Edwardsville, Edwardsville, Illinois, USA
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Johns TS, Yee J, Smith-Jules T, Campbell RC, Bauer C. Interdisciplinary care clinics in chronic kidney disease. BMC Nephrol 2015; 16:161. [PMID: 26458811 PMCID: PMC4603306 DOI: 10.1186/s12882-015-0158-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 10/04/2015] [Indexed: 12/13/2022] Open
Abstract
The burden of chronic kidney disease (CKD) is substantial, and is associated with high hospitalization rates, premature deaths, and considerable health care costs. These factors provide strong rationale for quality improvement initiatives in CKD care. The interdisciplinary care clinic (IDC) has emerged as one solution to improving CKD care. The IDC team may include other physicians, advanced practice providers, nurses, dietitians, pharmacists, and social workers—all working together to provide effective care to patients with chronic kidney disease. Studies suggest that IDCs may improve patient education and preparedness prior to kidney failure, both of which have been associated with improved health outcomes. Interdisciplinary care may also delay the progression to end-stage renal disease and reduce mortality. While most studies suggest that IDC services are likely cost-effective, financing IDCs is challenging and many insurance providers do not pay for all of the services. There are also no robust long-term studies demonstrating the cost-effectiveness of IDCs. This review discusses IDC models and its potential impact on CKD care as well as some of the challenges that may be associated with implementing these clinics.
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Affiliation(s)
- Tanya S Johns
- Department of Medicine, Division of Nephrology, Albert Einstein School of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA.
| | - Jerry Yee
- Department of Internal Medicine, Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI, USA.
| | | | - Ruth C Campbell
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA.
| | - Carolyn Bauer
- Department of Medicine, Division of Nephrology, Albert Einstein School of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA.
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Berns JS. Improving Care of Patients With CKD: The 2015 National Kidney Foundation Presidential Address. Am J Kidney Dis 2015; 66:547-51. [PMID: 26243584 DOI: 10.1053/j.ajkd.2015.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 07/15/2015] [Indexed: 01/06/2023]
Affiliation(s)
- Jeffrey S Berns
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
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Cavanaugh KL, Osborn CY, Tentori F, Rothman RL, Ikizler TA, Wallston KA. Performance of a brief survey to assess health literacy in patients receiving hemodialysis. Clin Kidney J 2015; 8:462-8. [PMID: 26251719 PMCID: PMC4515892 DOI: 10.1093/ckj/sfv037] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 04/28/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Health literacy is associated with important outcomes among patients with kidney disease, but widely used measures of health literacy can be burdensome. In an effort to make a practical assessment available, we compared the performance of the three-item brief health literacy screen (BHLS) to other widely used measures of health literacy among patients with end-stage renal disease (ESRD). METHODS Adult hemodialysis patients (n = 150) from four urban dialysis facilities participated in a cross-sectional study from 2009 to 2012. Three health literacy measures were administered including (i) the rapid estimate of adult literacy in medicine (REALM), (ii) the short test of functional health literacy in adults (S-TOFHLA) and (iii) the three-item BHLS. The mini-mental state exam assessed cognitive status, and the chronic hemodialysis knowledge survey (CHeKS) and perceived kidney disease knowledge survey (PiKS) assessed kidney knowledge. Spearman's ρs and area under the receiver-operating curves examined relationships between the aforementioned variables. RESULTS Participants had received dialysis for a mean of 4.6 years. They were 49% female, 73% African American and averaged 52 years of age. Less education and less cognitive capacity were each associated (P < 0.05) with lower health literacy for all three health literacy measures. Performance on the BHLS was significantly associated with the REALM [0.35 (95% confidence interval (95% CI): 0.20-0.49); P < 0.001] and S-TOFHLA [0.49 (95% CI: 0.35-0.69); P < 0.001], the CHeKS [0.43 (95% CI: 0.28-0.55); P < 0.001] and PiKS [0.41 (95% CI: 0.27-0.54); P < 0.001]. CONCLUSIONS The BHLS demonstrates evidence of construct validity among ESRD patients. Furthermore, health literacy was associated with kidney knowledge, supporting it as a potential intervention target to improve outcomes among patients with lower health literacy.
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Affiliation(s)
- Kerri L. Cavanaugh
- Division of Nephrology, Department of Medicine, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Center for Kidney Disease, Nashville, TN, USA
| | - Chandra Y. Osborn
- Department of Medicine & Biomedical Informatics, Vanderbilt University, Nashville, TN, USA
| | | | - Russell L. Rothman
- Department of Medicine & Pediatrics, Vanderbilt University, Nashville, TN, USA
| | - Talat Alp Ikizler
- Division of Nephrology, Department of Medicine, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Center for Kidney Disease, Nashville, TN, USA
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Carrillo Algarra AJ, Mesa Melgarejo L, Moreno Rubio F. El cuidado en un programa de trasplante renal: un acompañamiento de vida. AQUICHAN 2015. [DOI: 10.5294/aqui.2015.15.2.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivo: comprender las experiencias de cuidado de enfermeras integrantes de grupos de trasplante de la ciudad de Bogotá. Materiales y métodos: investigación cualitativa, utilizó la estrategia de grupos focales; la organización y el análisis de datos siguieron la propuesta de codificación de Janice M. Morse; participaron, previo consentimiento informado, 10 de 20 enfermeras de unidades de trasplante. Se realizó triangulación entre las integrantes del equipo investigador y la literatura relevante. Resultados: emergieron 6 categorías: 1) los múltiples significados del trasplante: cambio, pasión, satisfacción, esperanza, libertad, mayor cercanía, responsabilidad, compromiso, complejidad; 2) las redes de apoyo: familia, asociación de enfermeras, grupo de trabajo interdisciplinario, empresas promotoras de salud, industria farmacéutica; 3) implicaciones del día a día: relación cercana con el paciente y la familia, fortalecimiento de la autoestima profesional, estatus dentro del grupo de trasplante, manejo de las cargas; 4) trayectorias del cuidado profesional: acompañamiento de la enfermera a través del ciclo vital del paciente y posibilidad de identificar necesidades por la estrecha relación con él; 5) el perfil de la enfermera: carácter, conocimiento, compromiso, disponibilidad permanente y capacidad de gestión; 6) contradicciones del trasplante: rechazo al injerto, sufrimiento, desesperanza, sistema de salud; para enfermería, las agotadoras jornadas de trabajo.
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Dageforde LA, Cavanaugh KL, Moore DE, Harms K, Wright A, Pinson CW, Feurer ID. Validation of the Written Administration of the Short Literacy Survey. JOURNAL OF HEALTH COMMUNICATION 2015; 20:835-842. [PMID: 26073801 PMCID: PMC4698961 DOI: 10.1080/10810730.2015.1018572] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Most health literacy assessments are time consuming and administered verbally. Written self-administration of measures may facilitate more widespread assessment of health literacy. This study aimed to determine the intermethod reliability and concurrent validity of the written administration of the 3 subjective health literacy questions of the Short Literacy Survey (SLS). The Rapid Estimate of Adult Literacy in Medicine (REALM) and the shortened test of Functional Health Literacy in Adults (S-TOFHLA) were the reference measures of health literacy. Two hundred ninety-nine participants completed the written and verbal administrations of the SLS from June to December 2012. Intermethod reliability was demonstrated when (a) the written and verbal SLS score did not differ and (b) written and verbal scores were highly correlated. The written items were internally consistent (Cronbach's α = .733). The written total score successfully identified persons with sixth-grade equivalency or less for literacy on the REALM (AUROC = 0.753) and inadequate literacy on the S-TOFHLA (AUROC = 0. 869). The written administration of the SLS is reliable, valid, and is effective in identifying persons with limited health literacy.
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Affiliation(s)
- Leigh Anne Dageforde
- Vanderbilt Transplant Center, Vanderbilt University Medical Center; Nashville, Tennessee; USA
- Department of Surgery, Vanderbilt University Medical Center; Nashville, Tennessee; USA
| | - Kerri L. Cavanaugh
- Department of Medicine, Division of Nephrology, Vanderbilt University Medical Center; Nashville, Tennessee; USA
| | - Derek E. Moore
- Vanderbilt Transplant Center, Vanderbilt University Medical Center; Nashville, Tennessee; USA
- Department of Surgery, Vanderbilt University Medical Center; Nashville, Tennessee; USA
| | - Kelly Harms
- Vanderbilt Transplant Center, Vanderbilt University Medical Center; Nashville, Tennessee; USA
| | - Andrew Wright
- Vanderbilt Transplant Center, Vanderbilt University Medical Center; Nashville, Tennessee; USA
| | - C. Wright Pinson
- Vanderbilt Transplant Center, Vanderbilt University Medical Center; Nashville, Tennessee; USA
- Department of Surgery, Vanderbilt University Medical Center; Nashville, Tennessee; USA
| | - Irene D. Feurer
- Vanderbilt Transplant Center, Vanderbilt University Medical Center; Nashville, Tennessee; USA
- Department of Surgery, Vanderbilt University Medical Center; Nashville, Tennessee; USA
- Department of Biostatistics, Vanderbilt University Medical Center; Nashville, Tennessee; USA
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Tuot DS, Cavanaugh KL. Evaluating the Merits of CKD Patient Educational Materials: Readability Is Necessary But Not Sufficient. Am J Kidney Dis 2015; 65:814-6. [PMID: 26003608 DOI: 10.1053/j.ajkd.2015.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 03/12/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Delphine S Tuot
- University of California San Francisco, San Francisco, California.
| | - Kerri L Cavanaugh
- Vanderbilt University School of Medicine and Vanderbilt University Medical Center, Nashville, Tennessee
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Health Literacy and Medical Adherence in Hemodialysis Patients: The Mediating Role of Disease-Specific Knowledge. ACTA ACUST UNITED AC 2015. [DOI: 10.5812/thrita.26195] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Morony S, Flynn M, McCaffery KJ, Jansen J, Webster AC. Readability of Written Materials for CKD Patients: A Systematic Review. Am J Kidney Dis 2015; 65:842-50. [PMID: 25661679 DOI: 10.1053/j.ajkd.2014.11.025] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 11/23/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND The "average" patient has a literacy level of US grade 8 (age 13-14 years), but this may be lower for people with chronic kidney disease (CKD). Current guidelines suggest that patient education materials should be pitched at a literacy level of around 5th grade (age 10-11 years). This study aims to evaluate the readability of written materials targeted at patients with CKD. STUDY DESIGN Systematic review. SETTING & POPULATION Patient information materials aimed at adults with CKD and written in English. SEARCH STRATEGY & SOURCES Patient education materials designed to be printed and read, sourced from practices in Australia and online at all known websites run by relevant international CKD organizations during March 2014. ANALYTICAL APPROACH Quantitative analysis of readability using Lexile Analyzer and Flesch-Kincaid tools. RESULTS We analyzed 80 materials. Both Lexile Analyzer and Flesch-Kincaid analyses suggested that most materials required a minimum of grade 9 (age 14-15 years) schooling to read them. Only 5% of materials were pitched at the recommended level (grade 5). LIMITATIONS Readability formulas have inherent limitations and do not account for visual information. We did not consider other media through which patients with CKD may access information. Although the study covered materials from the United States, United Kingdom, and Australia, all non-Internet materials were sourced locally, and it is possible that some international paper-based materials were missed. Generalizability may be limited due to exclusion of non-English materials. CONCLUSIONS These findings suggest that patient information materials aimed at patients with CKD are pitched above the average patient's literacy level. This issue is compounded by cognitive decline in patients with CKD, who may have lower literacy than the average patient. It suggests that information providers need to consider their audience more carefully when preparing patient information materials, including user testing with a low-literacy patient population.
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Affiliation(s)
- Suzanne Morony
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney, Australia; Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), The University of Sydney, Sydney, Australia
| | - Michaela Flynn
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Kirsten J McCaffery
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney, Australia; Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), The University of Sydney, Sydney, Australia
| | - Jesse Jansen
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney, Australia; Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), The University of Sydney, Sydney, Australia
| | - Angela C Webster
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia.
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Green JA, Cavanaugh KL. Understanding the influence of educational attainment on kidney health and opportunities for improved care. Adv Chronic Kidney Dis 2015; 22:24-30. [PMID: 25573509 DOI: 10.1053/j.ackd.2014.07.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 07/02/2014] [Accepted: 07/16/2014] [Indexed: 12/31/2022]
Abstract
Educational attainment is an important but often overlooked contributor to health outcomes in patients with kidney disease. Those with lower levels of education have an increased risk of ESRD, complications of peritoneal dialysis, worse transplant outcomes, and mortality. Mediators of these associations are poorly understood but involve a complex interplay between health knowledge, behaviors, and socioeconomic and psychosocial factors. Interventions targeting these aspects of care have the potential to reduce disparities related to educational attainment; however, few programs have been described that specifically address this issue. Future research efforts should not only systematically assess level of educational attainment but also report the differential impact of interventions across educational strata. In addition, routine measurement of health literacy may be useful to identify high-risk patients independent of years of schooling. A better understanding of the influence of educational attainment on kidney health provides an opportunity to improve the care and outcomes of vulnerable patients with kidney disease.
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Lambert K, Mullan J, Mansfield K, Lonergan M. A Cross-Sectional Comparison of Health Literacy Deficits Among Patients With Chronic Kidney Disease. JOURNAL OF HEALTH COMMUNICATION 2015; 20 Suppl 2:16-23. [PMID: 26513027 DOI: 10.1080/10810730.2015.1080329] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Inadequate health literacy in people with chronic kidney disease (CKD) is associated with poorer disease management and greater complications. There are limited data on the health literacy deficits of people with CKD. The aim of this study was to investigate the types and extent of health literacy deficits in patients with CKD using the multidimensional Health Literacy Management Scale (HeLMS) and to identify associations between patient characteristics and the domains of health literacy measured by the HeLMS. Invitations to participate were sent to patients with CKD attending the renal unit of a regional Australian hospital. These patients included predialysis, dialysis (peritoneal and hemodialysis), and kidney transplant patients. This study identified that inadequate health literacy--especially in the domains relating to attending to one's health needs, understanding health information, social support, and socioeconomic factors--was common. Male gender and education level were significantly associated with inadequate health literacy. The type and extent of health literacy deficits varied among CKD groups, and transplant patients had more deficits than other CKD patient groups. This study provides useful information for health professionals treating patients with CKD, especially with regard to the design of self-management interventions and health information.
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Affiliation(s)
- Kelly Lambert
- a School of Medicine , University of Wollongong , Wollongong , New South Wales , Australia
- b Department of Clinical Nutrition , Illawarra Shoalhaven Local Health District , Wollongong , New South Wales , Australia
| | - Judy Mullan
- c Graduate School of Medicine , University of Wollongong , Wollongong , New South Wales , Australia
| | - Kylie Mansfield
- c Graduate School of Medicine , University of Wollongong , Wollongong , New South Wales , Australia
| | - Maureen Lonergan
- d Renal Medicine , Illawarra Shoalhaven Local Health District , Wollongong , New South Wales , Australia
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Tuot DS, Grubbs V. Chronic kidney disease care in the US safety net. Adv Chronic Kidney Dis 2015; 22:66-73. [PMID: 25573515 DOI: 10.1053/j.ackd.2014.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 05/20/2014] [Accepted: 05/22/2014] [Indexed: 11/11/2022]
Abstract
The US Health Care System provides a patchwork of services, known as the safety net, for the uninsured, underinsured, and indigent populations who would otherwise have little access to health care services. Individuals who rely on safety-net facilities are from racial/ethnic minority groups, have low socioeconomic status, and often have low health literacy and/or limited English proficiency. They shoulder a disproportionate burden of CKD in the United States and experience excess CKD-associated morbidity and mortality. Suboptimal delivery of CKD care may be contributing and is an area of active translational research. Several initiatives that show promise in improving safety-net CKD care delivery include those that enhance diagnostic and management skills of primary care providers, rely on comprehensive care management programs led by nonphysicians, and leverage technology to enhance patient access to virtual nephrology expertise. Uncovering better ways to translate scientific evidence into practice for vulnerable patients with CKD is a formidable challenge that will require national surveillance of CKD quality measures across diverse ambulatory health systems, including safety nets. Only then will the nephrology community be to identify and share best practices to enhance health and mitigate disparities of care among patients with CKD.
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Abstract
BACKGROUND Health literacy (HL) may be a mediator for known socioeconomic and racial disparities in living kidney donation. METHODS We evaluated the associations of patient and demographic characteristics with HL in living kidney donors (LD), living donor kidney transplant recipients (LDR), and deceased donor recipients (DDR) in a single-center retrospective review of patients undergoing kidney donation or transplantation from September 2010 to July 2012. HL and demographic data were collected. HL was assessed via the Short Literacy Survey (SLS) comprising three self-reported screening questions scored using the five-point Likert scale (low, moderate, high). Chi-square and logistic regression were used to test factors associated with lower HL. RESULTS The sample included 360 adults (105 LD, 103 LDR, and 152 DDR; 46±14 years; 70% white; 56% male; 14±3 years of education). HL scores were skewed (49% high, 41% moderate, and 10% low). The distribution of HL categories differed significantly among groups (P=0.019). After controlling for age, race, sex, education, and a race-education interaction term, DDR was more likely to have moderate or low HL than LDR (OR, 1.911; 95% CI, 1.096-3.332; P=0.022). CONCLUSION Overall, living donors had high HL. The distribution of low, moderate, and high HL differed significantly between LD, DDR, and LDR. DDR had a higher likelihood of having low HL than LDR. Screening kidney transplant candidates and donors for lower HL may identify barriers to living donation. Future interventions addressing HL may be important to increase living donation and reduce disparities.
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