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Azad CL, Beres LK, Wu AW, Fong A, Giladi AM. Developing a multimedia patient-reported outcomes measure for low literacy patients with a human-centered design approach. PLoS One 2024; 19:e0304351. [PMID: 38838037 DOI: 10.1371/journal.pone.0304351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 05/10/2024] [Indexed: 06/07/2024] Open
Abstract
INTRODUCTION Almost all patient-reported outcomes measures (PROMs) are text-based, which impedes accurate completion by low and limited literacy patients. Few PROMs are designed or validated to be self-administered, either in clinical or research settings, by patients of all literacy levels. We aimed to adapt the Patient Reported Outcomes Measurement Information System Upper Extremity Short Form (PROMIS-UE) to a multimedia version (mPROMIS-UE) that can be self-administered by hand and upper extremity patients of all literacy levels. METHODS Our study in which we applied the Multimedia Adaptation Protocol included seven phases completed in a serial, iterative fashion: planning with our community advisory board; direct observation; discovery interviews with patients, caregivers, and clinic staff; ideation; prototyping; member-checking interviews; and feedback. Direct observations were documented in memos that underwent rapid thematic analysis. Interviews were audio-recorded and documented using analytic memos; a rapid, framework-guided thematic analysis with both inductive and deductive themes was performed. Themes were distilled into design challenges to guide ideation and prototyping that involved our multidisciplinary research team. To assess completeness, credibility, and acceptability we completed additional interviews with member-checking of initial findings and consulted our community advisory board. RESULTS We conducted 12 hours of observations. We interviewed 17 adult English-speaking participants (12 patients, 3 caregivers, 2 staff) of mixed literacy. Our interviews revealed two distinct user personas and three distinct literacy personas; we developed the mPROMIS-UE with these personas in mind. Themes from interviews were distilled into four broad design challenges surrounding literacy, customizability, convenience, and shame. We identified features (audio, animations, icons, avatars, progress indicator, illustrated response scale) that addressed the design challenges. The last 6 interviews included member-checking; participants felt that the themes, design challenges, and corresponding features resonated with them. These features were synthesized into an mPROMIS-UE prototype that underwent rounds of iterative refinement, the last of which was guided by recommendations from our community advisory board. DISCUSSION We successfully adapted the PROMIS-UE to an mPROMIS-UE that addresses the challenges identified by a mixed literacy hand and upper extremity patient cohort. This demonstrates the feasibility of adapting PROMs to multimedia versions. Future research will include back adaptation, usability testing via qualitative evaluation, and psychometric validation of the mPROMIS-UE. A validated mPROMIS-UE will expand clinicians' and investigators' ability to capture patient-reported outcomes in mixed literacy populations.
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Affiliation(s)
- Chao Long Azad
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, Maryland, United States of America
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Medicine, Baltimore, Maryland, United States of America
| | - Laura K Beres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Albert W Wu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Allan Fong
- MedStar Health Research Institute, Hyattsville, Maryland, United States of America
| | - Aviram M Giladi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, Maryland, United States of America
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van der Boor CF, Taban D, Ismail K, Simon J, Roberts B, Fuhr D, Tol WA, Greco G. Measuring refugees' capabilities: translation, adaptation, and valuation of the OxCAP-MH into Juba Arabic for use among South Sudanese male refugees in Uganda. J Patient Rep Outcomes 2024; 8:40. [PMID: 38564035 PMCID: PMC10987405 DOI: 10.1186/s41687-024-00720-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/24/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Forcibly displaced populations are highly vulnerable to psychosocial distress and mental disorders, including alcohol misuse. In an ongoing trial that seeks to develop a transdiagnostic intervention addressing psychological distress and alcohol use disorders among conflict-affected populations, we will carry out a cost-effectiveness evaluation using a capability-based Oxford Capabilities Mental Health (OxCAP-MH) measure. The OxCAP-MH is a 16-item questionnaire developed from the Capability Approach, that covers multiple domains of functioning and welfare. The aim of the current paper is to present the results of the translation, cultural adaptation and valuation of the OxCAP-MH into Juba Arabic for South Sudanese refugees living in Uganda. We adhered to the official Translation and Linguistic Validation process of the OxCAP-MH. To carry out the translation, the Concept Elaboration document, official English version of the OxCAP-MH, and the Back-Translation Review Template were used. Four independent translators were used for forward and back translations. The reconciled translated version was then piloted in two focus group discussions (N = 16) in Rhino refugee settlement. A most important to least important valuation of the sixteen capability domains covered in the OxCAP-MH was also done. RESULTS The Juba Arabic version of the OxCAP-MH was finalized following a systematic iterative process. The content of the Juba Arabic version remained unchanged, but key concepts were adapted to ensure cultural acceptability, feasibility, and comprehension of the measure in the local context of Rhino refugee settlement. Most participants had low levels of literacy and required support with filling in the tool. Participants suggested an additional capability that is currently not reflected in the OxCAP-MH, namely access to food. Furthermore, discussions around the valuation exercise of the sixteen domains led to two separate importance scales, which showed relevant differences. CONCLUSIONS In this context, the OxCAP-MH was considered culturally acceptable. The valuation exercise proved cognitively demanding. Participants voiced confusion over how to answer the questions on the OxCAP-MH instrument due to low levels of literacy. These concerns invite consideration for future research to consider how measures such as the OxCAP-MH can be made more accessible to individuals with low literacy rates in resource poor settings.
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Affiliation(s)
- C F van der Boor
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - D Taban
- HealthRight International, Plot 855, Mawanda Road -Kamwokya, Kampala, Uganda
| | - K Ismail
- HealthRight International, Plot 855, Mawanda Road -Kamwokya, Kampala, Uganda
| | - J Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, Vienna, 1090, Austria
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - B Roberts
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - D Fuhr
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology, Achterstraße, 30D-28359, Bremen, Germany
- Health Sciences, University of Bremen, Bremen, Germany
| | - W A Tol
- Department of Public Health, University of Copenhagen, Bartholinsgade 4, bg. 9, 1356 København K, CSS, bg. 9, Building: 9.2.16, Copenhagen, Denmark
- Athena Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - G Greco
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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Hurstak E, Farina FR, Paasche-Orlow MK, Hahn EA, Henault LE, Moreno P, Weaver C, Marquez M, Serrano E, Thomas J, Griffith JW. COVID-19 Vaccine Confidence Mediates the Relationship between Health Literacy and Vaccination in a Diverse Sample of Urban Adults. Vaccines (Basel) 2023; 11:1848. [PMID: 38140251 PMCID: PMC10747333 DOI: 10.3390/vaccines11121848] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/01/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
We sought to analyze the relationship between health literacy, confidence in COVID-19 vaccines, and self-reported vaccination. We hypothesized that the relationship between health literacy and vaccination would be mediated by vaccine confidence. We recruited (N = 271) English- and Spanish-speaking adults in Boston and Chicago from September 2018 to September 2021. We performed a probit mediation analysis to determine if confidence in COVID-19 vaccines and health literacy predicted self-reported vaccination. We hypothesized that the relationship between health literacy and vaccination would be mediated by vaccine confidence. Participants were on average 50 years old, 65% female, 40% non-Hispanic Black, 25% Hispanic, and 30% non-Hispanic White; 231 (85%) reported at least one COVID-19 vaccination. A higher mean vaccine confidence score (t = -7.9, p < 0.001) and higher health literacy (t = -2.2, p = 0.03) were associated with vaccination, but only vaccine confidence predicted vaccination in a multivariate model. Vaccine confidence mediated the relationship between health literacy and COVID-19 vaccination (mediated effects: 0.04; 95% CI [0.02, 0.08]). We found that using a simple tool to measure vaccine confidence identified people who declined or delayed COVID-19 vaccination in a diverse sample of adults with varying levels of health literacy. Simple short survey tools can be useful to identify people who may benefit from vaccine promotion efforts and evidence-based communication strategies.
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Affiliation(s)
- Emily Hurstak
- Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02119, USA;
| | - Francesca R. Farina
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (F.R.F.); (E.A.H.); (C.W.); (M.M.); (E.S.); (J.T.); (J.W.G.)
| | - Michael K. Paasche-Orlow
- Department of Medicine, Tufts University School of Medicine, Tufts Medical Center, Boston, MA 02116, USA;
| | - Elizabeth A. Hahn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (F.R.F.); (E.A.H.); (C.W.); (M.M.); (E.S.); (J.T.); (J.W.G.)
| | - Lori E. Henault
- Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02119, USA;
| | - Patricia Moreno
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
| | - Claire Weaver
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (F.R.F.); (E.A.H.); (C.W.); (M.M.); (E.S.); (J.T.); (J.W.G.)
| | - Melissa Marquez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (F.R.F.); (E.A.H.); (C.W.); (M.M.); (E.S.); (J.T.); (J.W.G.)
| | - Eloisa Serrano
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (F.R.F.); (E.A.H.); (C.W.); (M.M.); (E.S.); (J.T.); (J.W.G.)
| | - Jessica Thomas
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (F.R.F.); (E.A.H.); (C.W.); (M.M.); (E.S.); (J.T.); (J.W.G.)
| | - James W. Griffith
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (F.R.F.); (E.A.H.); (C.W.); (M.M.); (E.S.); (J.T.); (J.W.G.)
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Hurstak EE, Paasche-Orlow MK, Hahn EA, Henault LE, Taddeo MA, Moreno PI, Weaver C, Marquez M, Serrano E, Thomas J, Griffith JW. The mediating effect of health literacy on COVID-19 vaccine confidence among a diverse sample of urban adults in Boston and Chicago. Vaccine 2023; 41:2562-2571. [PMID: 36907736 PMCID: PMC9977617 DOI: 10.1016/j.vaccine.2023.02.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 02/03/2023] [Accepted: 02/19/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND A high rate of COVID-19 vaccination is critical to reduce morbidity and mortality related to infection and to control the COVID-19 pandemic. Understanding the factors that influence vaccine confidence can inform policies and programs aimed at vaccine promotion. We examined the impact of health literacy on COVID-19 vaccine confidence among a diverse sample of adults living in two major metropolitan areas. METHODS Questionnaire data from adults participating in an observational study conducted in Boston and Chicago from September 2018 through March 2021 were examined using path analyses to determine whether health literacy mediates the relationship between demographic variables and vaccine confidence, as measured by an adapted Vaccine Confidence Index (aVCI). RESULTS Participants (N = 273) were on average 49 years old, 63 % female, 4 % non-Hispanic Asian, 25 % Hispanic, 30 % non-Hispanic white, and 40 % non-Hispanic Black. Using non-Hispanic white and other race as the reference category, Black race and Hispanic ethnicity were associated with lower aVCI (-0.76, 95 % CI -1.00 to -0.50; -0.52, 95 % CI -0.80 to -0.27, total effects from a model excluding other covariates). Lower education was also associated with lower aVCI (using college or more as the reference, -0.73 for 12th grade or less, 95 % CI -0.93 to -0.47; -0.73 for some college/associate's/technical degree, 95 % CI -1.05 to -0.39). Health literacy partially mediated these effects for Black and Hispanic participants and those with lower education (indirect effects -0.19 and -0.19 for Black race and Hispanic ethnicity; 0.27 for 12th grade or less; -0.15 for some college/associate's/technical degree). CONCLUSIONS Lower levels of education, Black race, and Hispanic ethnicity were associated with lower scores on health literacy, which in turn were associated with lower vaccine confidence. Our findings suggest that efforts to improve health literacy may improve vaccine confidence, which in turn may improve vaccination rates and vaccine equity. CLINICAL TRIALS NUMBER NCT03584490.
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Affiliation(s)
- Emily E Hurstak
- Section of General Internal Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Boston, MA 02118, USA.
| | | | - Elizabeth A Hahn
- Department of Medical Social Sciences Northwestern Feinberg School of Medicine 625 N. Michigan Ave., Chicago, IL 60611, USA.
| | - Lori E Henault
- Section of General Internal Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Boston, MA 02118, USA.
| | - Michelle A Taddeo
- Department of Medical Social Sciences Northwestern Feinberg School of Medicine 625 N. Michigan Ave., Chicago, IL 60611, USA.
| | - Patricia I Moreno
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL 33136, USA.
| | - Claire Weaver
- Department of Medical Social Sciences Northwestern Feinberg School of Medicine 625 N. Michigan Ave., Chicago, IL 60611, USA.
| | - Melissa Marquez
- Department of Medical Social Sciences Northwestern Feinberg School of Medicine 625 N. Michigan Ave., Chicago, IL 60611, USA.
| | - Eloisa Serrano
- Department of Medical Social Sciences Northwestern Feinberg School of Medicine 625 N. Michigan Ave., Chicago, IL 60611, USA.
| | - Jessica Thomas
- Department of Medical Social Sciences Northwestern Feinberg School of Medicine 625 N. Michigan Ave., Chicago, IL 60611, USA.
| | - James W Griffith
- Department of Medical Social Sciences Northwestern Feinberg School of Medicine 625 N. Michigan Ave., Chicago, IL 60611, USA.
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Long C, Beres LK, Wu AW, Giladi AM. Developing a protocol for adapting multimedia patient-reported outcomes measures for low literacy patients. PLoS One 2021; 16:e0252684. [PMID: 34086774 PMCID: PMC8177453 DOI: 10.1371/journal.pone.0252684] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/19/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Self-administration of patient-reported outcomes measures (PROMs) by patients with low literacy is a methodologic and implementation challenge. There is an increasing emphasis on patient-centered care and wider adoption of PROMs to understand outcomes and measure healthcare quality. However, there is a risk that the use of PROMs could perpetuate health disparities unless they are implemented in an inclusive fashion. We present a protocol to adapt validated, text-based PROMs to a multimedia format (mPROMs) to optimize self-administration in populations with limited literacy. We describe the processes used to develop the protocol and the planned protocol implementation. METHODS/DESIGN Our study protocol development was guided by the International Quality of Life Assessment (IQOLA) protocol for translating and culturally adapting PROMs to different languages. We used the main components of IQOLA's protocol to generate a conceptual framework to guide development of a Multimedia Adaptation Protocol (MAP). The MAP, which incorporates human-centered design (HCD) and takes a community-engaged research approach, includes four stages: forward adaptation, backward adaptation, qualitative evaluation, and validation. The MAP employs qualitative and quantitative methods including observation, cognitive and discovery interviews, ideation workshops, prototyping, user testing, co-creation interviews, and psychometric testing. An iterative design is central to the MAP and consistent with both the IQOLA protocol and HCD processes. We will pilot test and execute the MAP to adapt the Patient Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Short Form for use in a mixed literacy hand and upper extremity patient population in Baltimore, Maryland. DISCUSSION The MAP provides an approach for adapting PROMs to a multimedia format. We encourage others to evaluate and test this approach with other questionnaires and patient populations. The development and use of mPROMs has the potential to expand our ability to accurately capture PROs in limited literacy populations and promote equity in PRO measurement.
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Affiliation(s)
- Chao Long
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, Maryland, United States of America
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Medicine, Baltimore, Maryland, United States of America
| | - Laura K. Beres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Albert W. Wu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Aviram M. Giladi
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, Maryland, United States of America
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Aida A, Svensson T, Svensson AK, Chung UI, Yamauchi T. eHealth Delivery of Educational Content Using Selected Visual Methods to Improve Health Literacy on Lifestyle-Related Diseases: Literature Review. JMIR Mhealth Uhealth 2020; 8:e18316. [PMID: 33295296 PMCID: PMC7758165 DOI: 10.2196/18316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 08/07/2020] [Accepted: 11/19/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Lifestyle-related diseases, such as stroke, heart disease, and diabetes, are examples of noncommunicable diseases. Noncommunicable diseases are now the leading cause of death in the world, and their major causes are lifestyle related. The number of eHealth interventions is increasing, which is expected to improve individuals' health literacy on lifestyle-related diseases. OBJECTIVE This literature review aims to identify existing literature published in the past decade on eHealth interventions aimed at improving health literacy on lifestyle-related diseases among the general population using selected visual methods, such as educational videos, films, and movies. METHODS A systematic literature search of the PubMed database was conducted in April 2019 for papers written in English and published from April 2, 2009, through April 2, 2019. A total of 538 papers were identified and screened in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram. Finally, 23 papers were included in this review. RESULTS The 23 papers were characterized according to study characteristics (author and year of publication, study design and region where the study was conducted, study objective, service platform, target disease and participant age, research period, outcomes, and research method); the playback time of the educational videos, films, and movies; and the evaluation of the study's impacts on health literacy. A total of 7 studies compared results using statistical methods. Of these, 5 studies reported significant positive effects of the intervention on health literacy and health-related measures (eg, physical activity, body weight). Although most of the studies included educational content aimed at improving health literacy, only 7 studies measured health literacy. In addition, only 5 studies assessed literacy using health literacy measurement tools. CONCLUSIONS This review found that the provision of educational content was satisfactory in most eHealth studies using selected visual methods, such as videos, films, and movies. These findings suggest that eHealth interventions influence people's health behaviors and that the need for this intervention is expected to increase. Despite the need to develop eHealth interventions, standardized measurement tools to evaluate health literacy are lacking. Further research is required to clarify acceptable health literacy measurements.
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Affiliation(s)
- Azusa Aida
- Precision Health, Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo, Japan.,Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Thomas Svensson
- Precision Health, Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo, Japan.,Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.,School of Health Innovation, Kanagawa University of Human Services, Kawasaki-shi, Japan
| | - Akiko Kishi Svensson
- Precision Health, Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo, Japan.,Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Ung-Il Chung
- Precision Health, Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo, Japan.,School of Health Innovation, Kanagawa University of Human Services, Kawasaki-shi, Japan.,Clinical Biotechnology, Center for Disease Biology and Integrative Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Slesinger NC, Yost KJ, Choi SW, Hahn EA. Validation of a Short Form for Health Literacy Assessment Using Talking Touchscreen Technology. Health Lit Res Pract 2020; 4:e200-e207. [PMID: 33034662 PMCID: PMC7544526 DOI: 10.3928/24748307-20200909-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/04/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Health literacy is an area of growing research and clinical interest, necessitating short, accurate measures of this complex construct. Health Literacy Assessment Using Talking Touchscreen Technology (Health LiTT) measures prose, document, and quantitative literacy by self-administration on a touchscreen computer. OBJECTIVE The objective of this study was to assess the validity of a short form of Health LiTT and to identify a meaningful cutoff score for adequate health literacy. METHODS A subsample of 137 participants from the Literacy and Cognitive Function among Older Adults study completed a 10-item Health LiTT short form and three interviewer-administered health literacy measures: Test of Functional Health Literacy in Adults (TOFHLA), Rapid Estimate of Adult Literacy in Medicine (REALM), and Newest Vital Sign (NVS). Convergent validity was assessed by correlating scores for all measures, and known-groups validity was assessed by comparing mean Health LITT scores across TOFHLA levels (inadequate, marginal, adequate). Internal consistency reliability was estimated with Cronbach's alpha. A cutoff score for adequate health literacy was established using the TOFHLA cutoff for adequate versus inadequate/marginal health literacy. KEY RESULTS Spearman correlations between Health LiTT scores and total TOFHLA, REALM, and NVS scores were 0.65, 0.69, and 0.56, respectively (all p < .001). Mean Health LiTT scores were significantly and meaningfully different across inadequate (40.4), marginal (50.1), and adequate (57.1) TOFHLA categories (F = 60.6; p < .001). Cronbach's alpha for the Health LiTT short form was .73. A cutoff score of 55 on Health LiTT showed acceptable sensitivity and specificity to identify adequate health literacy. CONCLUSIONS This 10-item Health LiTT short form demonstrated excellent convergent and known-groups validity and acceptable internal consistency reliability in older adults. The established cutoff also showed excellent sensitivity and specificity. Validation of other custom Health LiTT short forms with varying items from the bank and computer adaptive test-generated Health LiTT scores is ongoing. [HLRP: Health Literacy Research and Practice. 2020;4(4):e200-e207.] PLAIN LANGUAGE SUMMARY: This article provides evidence of the need for and psychometric properties of a valid and reliable short form of the flexible, technologically advanced Health Literacy Assessment Using Talking Touchscreen Technology measure, as well as a cutoff score to note adequate versus marginal/inadequate health literacy.
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Affiliation(s)
- Noël C. Slesinger
- Address correspondence to Noël C. Slesinger, MS, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 2700, Chicago, IL 60611;
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Hahn EA, Boileau NR, Hanks RA, Sander AM, Miner JA, Carlozzi NE. Health literacy, health outcomes, and the caregiver role in traumatic brain injury. Rehabil Psychol 2020; 65:2020-37274-001. [PMID: 32463261 PMCID: PMC7704789 DOI: 10.1037/rep0000330] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose/Objective: The purpose of this study is to estimate the occurrence of low health literacy among caregivers of people with traumatic brain injury (TBI), and to evaluate associations of health literacy with caregiver health-related quality of life (HRQOL) and perceptions of the caregiving role. Research Method/Design: The TBI-CareQOL measurement system assesses important self-reported outcomes for caregivers of civilians or service members/veterans (SMVs) with TBI. The validation phase included the Health Literacy Assessment Using Talking Touchscreen Technology (Health LiTT) measure. Multivariable regression evaluated the impact of low health literacy on generic and TBI-specific HRQOL and appraisals of the caregiving role, adjusted for caregiver gender, race/ethnicity and education, and the functional status of the TBI care recipient. Results: Among 131 caregivers, 28 (21%) had low health literacy. Compared with the high health literacy group, the group with low health literacy had fewer women, more racial/ethnic minorities, and lower education (all p < .05). The low health literacy group reported more subjective caregiving burden, less satisfaction with their relationship with the TBI recipient, less caregiving mastery, and poorer physical health (all p < .05). There were no differences between health literacy groups in caregiving ideology, caregiver-specific HRQOL or general mental health. Conclusions/Implications: A better understanding of the links between health literacy and caregiver HRQOL and the caregiving role can help identify strategies to meet the needs of this underserved population. Tailored interventions for caregivers with low health literacy could improve outcomes for both the caregiver and the care recipient. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Elizabeth A Hahn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Nicholas R Boileau
- Center for Clinical Outcomes Development and Application (CODA), Department of Physical Medicine and Rehabilitation, University of Michigan
| | - Robin A Hanks
- Department of Physical Medicine and Rehabilitation, School of Medicine, Wayne State University
| | - Angelle M Sander
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine
| | - Jennifer A Miner
- Center for Clinical Outcomes Development and Application (CODA), Department of Physical Medicine and Rehabilitation, University of Michigan
| | - Noelle E Carlozzi
- Center for Clinical Outcomes Development and Application (CODA), Department of Physical Medicine and Rehabilitation, University of Michigan
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Welbie M, Wittink H, Bozkurt S, Coban T, Devillé WL. Usability of the Turkish Translation of the Dutch Talking Touch Screen Questionnaire for Physical Therapy Patients With a Turkish Background: Qualitative Study. JMIR Form Res 2020; 4:e14189. [PMID: 32053112 PMCID: PMC7055804 DOI: 10.2196/14189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 10/31/2019] [Accepted: 11/12/2019] [Indexed: 11/29/2022] Open
Abstract
Background The Turkish translation of the Dutch Talking Touch Screen Questionnaire (TTSQ) has been developed to help physical therapy patients with a Turkish background in the Netherlands to autonomously elucidate their health problems and impairments and set treatment goals, regardless of their level of health literacy. Objective The aim of this study was to evaluate the usability of the Turkish TTSQ for physical therapy patients with a Turkish background with diverse levels of health literacy and experience in using mobile technology. Methods The qualitative Three-Step Test-Interview method was carried out to gain insight into the usability of the Turkish TTSQ. A total of 10 physical therapy patients participated. The interview data were analyzed using a thematic content analysis approach aimed at determining the accuracy and completeness with which participants completed the questionnaire (effectiveness), the time it took participants to complete the questionnaire (efficiency), and the extent to which the participants were satisfied with the ease of use of the questionnaire (satisfaction). The problems encountered by the participants in this study were given a severity rating, which was used to provide a rough estimate of the need for additional usability improvements. Results No participant in this study was able to complete the questionnaire without encountering at least one usability problem. A total of 17 different kinds of problems were found. On the basis of their severity score, 3 problems that should be addressed during future development of the tool were “Not using the navigation function of the photo gallery in Question 4 causing the participant to not see all presented response items;” “Touching the text underneath a photo in Question 4 to select an activity instead of touching the photo itself, causing the activity not to be selected;” and “Pushing too hard or tapping too softly on the touch screen causing the touch screen to not respond.” The data on efficiency within this study were not valid and are, therefore, not reported in this study. No participant was completely satisfied or dissatisfied with the overall ease of use of the Turkish TTSQ. Two participants with no prior experience of using tablet computers felt that, regardless of what kinds of improvement might be made, it would just be too difficult for them to learn to work with the device. Conclusions As with the Dutch TTSQ, the Turkish TTSQ needs improvement before it can be released. The results of this study confirm the conclusion of the Dutch TTSQ study that participants with low levels of education and little experience in using mobile technology are less able to operate the TTSQ effectively. Using a Dutch speaking interviewer and Turkish interpreter has had a negative effect on data collection in this study.
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Affiliation(s)
- Marlies Welbie
- Research Group Lifestyle and Health, Research Center Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, Netherlands
| | - Harriet Wittink
- Research Group Lifestyle and Health, Research Center Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, Netherlands
| | - Sahin Bozkurt
- Research Group Lifestyle and Health, Research Center Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, Netherlands
| | - Tugba Coban
- Research Group Lifestyle and Health, Research Center Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, Netherlands
| | - Walter Ljm Devillé
- Julius Centre for health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands.,Faculty of Social and Behavioral Sciences, University of Amsterdam, Amsterdam, Netherlands.,Dutch Centre of Expertise on Health Disparities (Pharos), Utrecht, Netherlands
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10
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Welbie M, Wittink H, Westerman MJ, Topper I, Snoei J, Devillé WLJM. A Mobile Patient-Reported Outcome Measure App With Talking Touchscreen: Usability Assessment. JMIR Form Res 2019; 3:e11617. [PMID: 31573909 PMCID: PMC6789421 DOI: 10.2196/11617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 03/01/2019] [Accepted: 03/24/2019] [Indexed: 12/24/2022] Open
Abstract
Background In the past years, a mobile health (mHealth) app called the Dutch Talking Touch Screen Questionnaire (DTTSQ) was developed in The Netherlands. The aim of development was to enable Dutch physical therapy patients to autonomously complete a health-related questionnaire regardless of their level of literacy and digital skills. Objective The aim of this study was to evaluate the usability (defined as the effectiveness, efficiency, and satisfaction) of the prototype of the DTTSQ for Dutch physical therapy patients with diverse levels of experience in using mobile technology. Methods The qualitative Three-Step Test-Interview method, including both think-aloud and retrospective probing techniques, was used to gain insight into the usability of the DTTSQ. A total of 24 physical therapy patients were included. The interview data were analyzed using a thematic content analysis approach aimed at analyzing the accuracy and completeness with which participants completed the questionnaire (effectiveness), the time it took the participants to complete the questionnaire (efficiency), and the extent to which the participants were satisfied with the ease of use of the questionnaire (satisfaction). The problems encountered by the participants in this study were given a severity rating that was used to provide a rough estimate of the need for additional usability efforts. Results All participants within this study were very satisfied with the ease of use of the DTTSQ. Overall, 9 participants stated that the usability of the app exceeded their expectations. The group of 4 average-/high-experienced participants encountered only 1 problem in total, whereas the 11 little-experienced participants encountered an average of 2 problems per person and the 9 inexperienced participants an average of 3 problems per person. A total of 13 different kind of problems were found during this study. Of these problems, 4 need to be addressed before the DTTSQ will be released because they have the potential to negatively influence future usage of the tool. The other 9 problems were less likely to influence future usage of the tool substantially. Conclusions The usability of the DTTSQ needs to be improved before it can be released. No problems were found with satisfaction or efficiency during the usability test. The effectiveness needs to be improved by (1) making it easier to navigate through screens without the possibility of accidentally skipping one, (2) enabling the possibility to insert an answer by tapping on the text underneath a photograph instead of just touching the photograph itself, and (3) making it easier to correct wrong answers. This study shows the importance of including less skilled participants in a usability study when striving for inclusive design and the importance of measuring not just satisfaction but also efficiency and effectiveness during such studies.
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Affiliation(s)
- Marlies Welbie
- Research Group Lifestyle and Health, Research Center Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, Netherlands
| | - Harriet Wittink
- Research Group Lifestyle and Health, Research Center Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, Netherlands
| | - Marjan J Westerman
- Institute of Health Sciences, Amsterdam Public Health Research Institute, Department of Methodology and Statistics, VU University, Amsterdam, Netherlands
| | - Ilse Topper
- Research Group Lifestyle and Health, Research Center Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, Netherlands
| | - Josca Snoei
- Research Group Lifestyle and Health, Research Center Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, Netherlands
| | - Walter L J M Devillé
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands.,Faculty of Social and Behavioral Sciences, University of Amsterdam, Amsterdam, Netherlands.,Dutch Centre of Expertise on Health Disparities (Pharos), Utrecht, Netherlands
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11
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Hahn EA, Ianni PA, Hanks RA, Miner JA, Freedman J, Carlozzi NE. Survey response burden in caregivers of civilians and service members/veterans with traumatic brain injury. Patient Relat Outcome Meas 2019; 10:59-66. [PMID: 30881163 PMCID: PMC6398416 DOI: 10.2147/prom.s171712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Caregivers have expressed interest in survey research, yet there is limited information available about survey response burden, ie, the time, effort, and other demands needed to complete the survey. This may be particularly important for caregivers due to excessive time demands and/or stress associated with caregiving. METHOD Survey response burden indicators were collected as part of a study to develop and validate a patient-reported outcome (PRO) measurement system for caregivers of civilians or service members/veterans (SMVs) with traumatic brain injury (TBI). RESULTS Compared to the group caring for civilians (n=335), the group caring for SMVs (n=123) was comprised of all women, was younger, had fewer racial/ethnic minorities, had more education, and nearly all were the spouse of a person with TBI. All PRO outcomes were poorer for the group caring for SMVs. Although the caregivers of SMVs had poorer PRO outcomes compared to caregivers of civilians, they were more likely to report that they would recommend the study to others. Caregivers with less education and those from racial/ethnic minority groups had more favorable ratings of their study participation experience, even though they needed more help using the computer or answering the questions. CONCLUSION The results of this study provide useful information about the acceptability of computer-based survey administration for caregiver PROs. PROs are widely gathered in clinical and health services research and could be particularly useful in TBI care programs. More data are needed to determine the best assessment strategies for individuals with lower education who are likely to require some assistance completing PRO surveys. Studies evaluating PROs administered by multimedia platforms could help researchers and clinicians plan the best strategies for assessing health-related quality of life in TBI caregivers.
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Affiliation(s)
- Elizabeth A Hahn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,
- Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,
| | - Phillip A Ianni
- Center for Clinical Outcomes Development and Application (CODA), Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Robin A Hanks
- Department of Physical Medicine and Rehabilitation, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Jennifer A Miner
- Center for Clinical Outcomes Development and Application (CODA), Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Jenna Freedman
- Center for Clinical Outcomes Development and Application (CODA), Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Noelle E Carlozzi
- Center for Clinical Outcomes Development and Application (CODA), Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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12
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Hahn EA, Downing NR, Stout JC, Paulsen JS, Ready B, Goodnight S, Lai JS, Miner JA, Carlozzi NE. Understanding the need for assistance with survey completion in people with Huntington disease. Qual Life Res 2018; 27:801-810. [PMID: 29214414 PMCID: PMC5845783 DOI: 10.1007/s11136-017-1747-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE In Huntington disease (HD), motor, cognitive, and psychiatric changes can have a detrimental impact on health-related quality of life (HRQOL). The purpose of this paper is to describe the extent and type of assistance needed to complete online HRQOL surveys, and the impact of assistance on HRQOL scores. METHODS A patient-reported outcome measurement system was developed for HD-specific HRQOL. Individuals across the prodromal and diagnosed disease severity spectrum (n = 532) completed surveys by computer, and reported the amount and type of assistance they received. RESULTS Some participants (n = 56; 10.5%) did not complete all surveys; this group had larger proportions with late stage disease, racial/ethnic minority status, low education and single marital status, and poorer motor, independence and cognitive function compared to those who completed all surveys (n = 476). Overall, 72% of individuals did not receive assistance, 11% received computer assistance only, and 17% received assistance answering the survey questions. The majority of late stage individuals (78%) received some assistance compared to early stage (29%) and prodromal individuals (< 1%). Those who received assistance had higher proportions with late stage disease, were older, had less education, and had poorer functional and cognitive skills. Before and after adjustment for sociodemographic and clinical characteristics, those who received assistance had poorer scores on some HRQOL outcomes than those who did not receive assistance. CONCLUSIONS Computer-based assessments are feasible for many persons with HD, although other methods may also be needed. Clinicians and researchers should develop strategies to assist people with HD to complete HRQOL surveys.
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Affiliation(s)
- Elizabeth A Hahn
- Department of Medical Social Sciences and Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, 633 N. St. Clair St., Suite 1900, Chicago, IL, 60611, USA.
| | - Nancy R Downing
- College of Nursing, Texas A&M University Health Science Center, Bryan, TX, USA
| | - Julie C Stout
- School of Psychological Sciences, Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, VIC, Australia
| | - Jane S Paulsen
- Departments of Neurology, Psychiatry, and Psychological and Brain Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Becky Ready
- Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, USA
| | - Siera Goodnight
- Department of Physical Medicine and Rehabilitation, Center for Clinical Outcomes Development and Application (CODA), University of Michigan, Ann Arbor, MI, USA
| | - Jin-Shei Lai
- Department of Medical Social Sciences and Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, 633 N. St. Clair St., Suite 1900, Chicago, IL, 60611, USA
| | - Jennifer A Miner
- Department of Physical Medicine and Rehabilitation, Center for Clinical Outcomes Development and Application (CODA), University of Michigan, Ann Arbor, MI, USA
| | - Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, Center for Clinical Outcomes Development and Application (CODA), University of Michigan, Ann Arbor, MI, USA
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13
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Merker VL, McDannold S, Riklin E, Talaei-Khoei M, Sheridan MR, Jordan JT, Plotkin SR, Vranceanu AM. Health literacy assessment in adults with neurofibromatosis: electronic and short-form measurement using FCCHL and Health LiTT. J Neurooncol 2017; 136:335-342. [PMID: 29119424 DOI: 10.1007/s11060-017-2657-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 10/27/2017] [Indexed: 11/24/2022]
Abstract
Determining health literacy level is an important prerequisite for effective patient education. We assessed multiple dimensions of health literacy and sociodemographic predictors of health literacy in patients with neurofibromatosis. In 86 individuals with a confirmed diagnosis of neurofibromatosis 1 (NF1), neurofibromatosis 2 (NF2), or schwannomatosis, we assessed health literacy status using two HL tools-the adapted functional, communicative, and critical health literacy scale (adapted FCCHL) and health literacy assessment using talking touchscreen technology (Health LiTT). Factor analyses of the adapted FCCHL in NF patients showed factor structure and psychometric properties similar to pilot work in other patient populations. As a group, patients with NF had moderate scores on the Health LiTT and moderate to high scores on the adapted FCCHL, with the highest score on the functional health literacy subscale. Patients with NF1, those with lower education and those with learning disabilities had lower scores on Health LiTT; in multivariate analysis, learning disability and education remained significant predictors of HealthLiTT scores. Only lower education was associated with lower adapted FCCHL scores. Results suggest utilizing health literacy tools in NF patients is feasible and could provide physicians with valuable information to tailor health communication to subpopulations with lower health literacy levels.
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Affiliation(s)
- Vanessa L Merker
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Sarah McDannold
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA.,Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, USA
| | - Eric Riklin
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - Mojtaba Talaei-Khoei
- Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Monica R Sheridan
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Justin T Jordan
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott R Plotkin
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Behavioral Medicine Service, Massachusetts General Hospital, Harvard Medical School, One Bowdoin Square, 7th floor, Suite 758, Boston, MA, 02114, USA.
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14
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Johnson NX, Marquine MJ, Flores I, Umlauf A, Baum CM, Wong AWK, Young AC, Manly JJ, Heinemann AW, Magasi S, Heaton RK. Racial Differences in Neurocognitive Outcomes Post-Stroke: The Impact of Healthcare Variables. J Int Neuropsychol Soc 2017; 23:640-652. [PMID: 28660849 PMCID: PMC5703208 DOI: 10.1017/s1355617717000480] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The present study examined differences in neurocognitive outcomes among non-Hispanic Black and White stroke survivors using the NIH Toolbox-Cognition Battery (NIHTB-CB), and investigated the roles of healthcare variables in explaining racial differences in neurocognitive outcomes post-stroke. METHODS One-hundred seventy adults (91 Black; 79 White), who participated in a multisite study were included (age: M=56.4; SD=12.6; education: M=13.7; SD=2.5; 50% male; years post-stroke: 1-18; stroke type: 72% ischemic, 28% hemorrhagic). Neurocognitive function was assessed with the NIHTB-CB, using demographically corrected norms. Participants completed measures of socio-demographic characteristics, health literacy, and healthcare use and access. Stroke severity was assessed with the Modified Rankin Scale. RESULTS An independent samples t test indicated Blacks showed more neurocognitive impairment (NIHTB-CB Fluid Composite T-score: M=37.63; SD=11.67) than Whites (Fluid T-score: M=42.59, SD=11.54; p=.006). This difference remained significant after adjusting for reading level (NIHTB-CB Oral Reading), and when stratified by stroke severity. Blacks also scored lower on health literacy, reported differences in insurance type, and reported decreased confidence in the doctors treating them. Multivariable models adjusting for reading level and injury severity showed that health literacy and insurance type were statistically significant predictors of the Fluid cognitive composite (p<.001 and p=.02, respectively) and significantly mediated racial differences on neurocognitive impairment. CONCLUSIONS We replicated prior work showing that Blacks are at increased risk for poorer neurocognitive outcomes post-stroke than Whites. Health literacy and insurance type might be important modifiable factors influencing these differences. (JINS, 2017, 23, 640-652).
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Affiliation(s)
- Neco X Johnson
- 1San Diego State University,Department of Psychology,San Diego,California
| | - Maria J Marquine
- 2University of California,San Diego,Department of Psychiatry,San Diego,California
| | - Ilse Flores
- 1San Diego State University,Department of Psychology,San Diego,California
| | - Anya Umlauf
- 2University of California,San Diego,Department of Psychiatry,San Diego,California
| | - Carolyn M Baum
- 3Washington University in St. Louis,Program in Occupational Therapy,St. Louis,Missouri
| | - Alex W K Wong
- 3Washington University in St. Louis,Program in Occupational Therapy,St. Louis,Missouri
| | - Alexis C Young
- 3Washington University in St. Louis,Program in Occupational Therapy,St. Louis,Missouri
| | | | - Allen W Heinemann
- 5Northwestern University,Feinberg School of Medicine,Department of Physical Medicine & Rehabilitation and Rehabilitation Institute of Chicago,Chicago,Illinois
| | - Susan Magasi
- 6University of Illinois at Chicago,Department of Occupational Therapy,Chicago,Illinois
| | - Robert K Heaton
- 2University of California,San Diego,Department of Psychiatry,San Diego,California
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15
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Kim H, Xie B. Health literacy in the eHealth era: A systematic review of the literature. PATIENT EDUCATION AND COUNSELING 2017; 100:1073-1082. [PMID: 28174067 DOI: 10.1016/j.pec.2017.01.015] [Citation(s) in RCA: 182] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 11/29/2016] [Accepted: 01/24/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVES This study aimed to identify studies on online health service use by people with limited health literacy, as the findings could provide insights into how health literacy has been, and should be, addressed in the eHealth era. METHODS To identify the relevant literature published since 2010, we performed four rounds of selection-database selection, keyword search, screening of the titles and abstracts, and screening of full texts. This process produced a final of 74 publications. RESULTS The themes addressed in the 74 publications fell into five categories: evaluation of health-related content, development and evaluation of eHealth services, development and evaluation of health literacy measurement tools, interventions to improve health literacy, and online health information seeking behavior. CONCLUSION Barriers to access to and use of online health information can result from the readability of content and poor usability of eHealth services. We need new health literacy screening tools to identify skills for adequate use of eHealth services. Mobile apps hold great potential for eHealth and mHealth services tailored to people with low health literacy. PRACTICE IMPLICATIONS Efforts should be made to make eHealth services easily accessible to low-literacy individuals and to enhance individual health literacy through educational programs.
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Affiliation(s)
- Henna Kim
- School of Information, The University of Texas at Austin, 1616 Guadalupe Suite #5.518, Austin, TX, 78701, USA.
| | - Bo Xie
- School of Nursing & School of Information, The University of Texas at Austin, Austin, USA.
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Hahn EA, Magasi SR, Carlozzi NE, Tulsky DS, Wong A, Garcia SF, Lai JS, Hammel J, Miskovic A, Jerousek S, Goldsmith A, Nitsch K, Heinemann AW. Health and Functional Literacy in Physical Rehabilitation Patients. Health Lit Res Pract 2017; 1:e71-e85. [PMID: 31294252 PMCID: PMC6607848 DOI: 10.3928/24748307-20170427-02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/05/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND People with disabilities, who face multiple barriers to care, experience health disparities, yet few studies have measured health literacy in this population. OBJECTIVE This study evaluated functional literacy, health literacy, fluid cognitive function, and self-reported health in people who live in community dwellings with spinal cord injury, stroke, or traumatic brain injury. METHODS Participants with a traumatic spinal cord injury, stroke, or traumatic brain injury, one-year postinjury, and age 18 to 85 years, completed a battery of instruments at three medical centers in the Midwestern U.S.: functional literacy (word recognition, vocabulary knowledge), health literacy (comprehension of prose, document, and quantitative health information), fluid cognitive function (memory, executive function, and processing speed), and patient-reported outcomes (mobility, fatigue, sadness, anxiety, social function, and overall health). KEY RESULTS There were strong correlations between functional literacy, health literacy, and fluid cognitive function. After adjustment for sociodemographic and clinical characteristics, higher health literacy was associated with better mobility, less anxiety, and better overall health; higher functional literacy was associated with less anxiety and better overall health; and higher fluid cognitive function was associated with better mobility, less sadness, better social function, and better overall health. CONCLUSIONS To effectively address limited health literacy among people with spinal cord injury, stroke, and traumatic brain injury, and ensure that they are able to be informed partners in their health care, intervention is required at the level of patients, providers, and health care delivery systems. A special consideration is to ensure that health information is both well-targeted to people's health literacy levels and accessible for people with a range of physical, cognitive, and sensory limitations. The multimedia self-administered health literacy measure used in this study could be useful to rehabilitation providers and designers of health information and interfaces. [Health Literacy Research and Practice. 2017;1(2):e71-e85.]. PLAIN LANGUAGE SUMMARY Health literacy represents people's abilities to obtain, understand, and use health information to make informed decisions about their health and health care. People with disabilities face physical, attitudinal, economic, and structural barriers to care. Consideration of health literacy in rehabilitation practice can enhance the effectiveness of the patient-clinician relationship and help address the needs of this population.
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Affiliation(s)
- Elizabeth A. Hahn
- Address correspondence to Elizabeth A. Hahn, MA, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N. Saint Clair Street, Suite 1900, Chicago, IL 60611;
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Paiva CE, Siquelli FAF, Zaia GR, de Andrade DAP, Borges MA, Jácome AA, Giroldo GASN, Santos HA, Hahn EA, Uemura G, Paiva BSR. Development of a new multimedia instrument to measure cancer-specific quality of life in Portuguese-speaking patients with varying literacy skills. SPRINGERPLUS 2016; 5:972. [PMID: 27429882 PMCID: PMC4932016 DOI: 10.1186/s40064-016-2675-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 06/26/2016] [Indexed: 12/21/2022]
Abstract
Purpose To develop and validate a new multimedia instrument to measure health-related quality of life (HRQOL) in Portuguese-speaking patients with cancer. Methods A mixed-methods study conducted in a large Brazilian Cancer Hospital. The instrument was developed along the following sequential phases: identification of HRQOL issues through qualitative content analysis of individual interviews, evaluation of the most important items according to the patients, review of the literature, evaluation by an expert committee, and pretesting. In sequence, an exploratory factor analysis was conducted (pilot testing, n = 149) to reduce the number of items and to define domains and scores. The psychometric properties of the IQualiV-OG-21 were measured in a large multicentre Brazilian study (n = 323). A software containing multimedia resources were developed to facilitate self-administration of IQualiV-OG-21; its feasibility and patients’ preferences (“paper and pencil” vs. software) were further tested (n = 54). Results An exploratory factor analysis reduced the 30-item instrument to 21 items. The IQualiV-OG-21 was divided into 6 domains: emotional, physical, existential, interpersonal relationships, functional and financial. The multicentre study confirmed that it was valid and reliable. The electronic multimedia instrument was easy to complete and acceptable to patients. Regarding preferences, 61.1 % of them preferred the electronic format in comparison with the paper and pencil format. Conclusions The IQualiV-OG-21 is a new valid and reliable multimedia HRQOL instrument that is well-understood, even by patients with low literacy skills, and can be answered quickly. It is a useful new tool that can be translated and tested in other cultures and languages. Electronic supplementary material The online version of this article (doi:10.1186/s40064-016-2675-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carlos Eduardo Paiva
- Divisão de Mama e Ginecologia, Departamento de Oncologia Clínica, Barretos Cancer Hospital, Rua Antenor Duarte Vilella, 1331, Bairro Dr Paulo Prata, Barretos, São Paulo CEP: 14784-400 Brazil ; Health-Related Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil ; Center for Research Support - NAP, Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil
| | - Felipe Augusto Ferreira Siquelli
- Health-Related Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil ; Barretos School of Health Sciences, Dr. Paulo Prata - FACISB, Barretos, São Paulo 14785-002 Brazil
| | - Gabriela Rossi Zaia
- Health-Related Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil ; Barretos School of Health Sciences, Dr. Paulo Prata - FACISB, Barretos, São Paulo 14785-002 Brazil
| | | | | | - Alexandre A Jácome
- Department of Clinical Oncology, Mater Dei Hospital, Belo Horizonte, Minas Gerais 30140-093 Brazil
| | | | - Henrique Amorim Santos
- Health-Related Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil ; Barretos School of Health Sciences, Dr. Paulo Prata - FACISB, Barretos, São Paulo 14785-002 Brazil
| | - Elizabeth A Hahn
- Department of Medical Social Sciences and Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL 60611 USA
| | - Gilberto Uemura
- Botucatu Medical School, Universidade Estadual Paulista -UNESP, Botucatu, São Paulo 18618-970 Brazil
| | - Bianca Sakamoto Ribeiro Paiva
- Health-Related Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil ; Center for Research Support - NAP, Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil
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Hughson JA, Woodward-Kron R, Parker A, Hajek J, Bresin A, Knoch U, Phan T, Story D. A review of approaches to improve participation of culturally and linguistically diverse populations in clinical trials. Trials 2016; 17:263. [PMID: 27229153 PMCID: PMC4880985 DOI: 10.1186/s13063-016-1384-3] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 05/07/2016] [Indexed: 01/08/2023] Open
Abstract
The under-representation of culturally and linguistically diverse participants in clinical trials is an ongoing concern for medical researchers and the community. The aim of this review is to examine the complex issue of recruiting culturally and linguistically diverse (CALD) older people to medical research and to examine responses to these issues. The review focuses on (1) trends in the existing literature on barriers to and strategies for recruiting CALD and older people to clinical research, (2) issues with informed consent for CALD populations, and (3) the efficacy of innovative approaches, including approaches incorporating multimedia in research and consent processes. The literature indicates that predominant barriers to greater involvement of CALD patients in clinical trials are communication, including literacy and health literacy considerations; English language competence; and cultural factors in the research setting such as mistrust of consent processes, as well as considerable practical and logistical barriers, including mobility considerations. Some evidence exists that incorporating multimedia resources into the informed consent process can improve patient understanding and is preferred by patients, yet these findings are inconclusive. A multi-methodological approach, including the use of culturally and linguistically sensitive multimedia tools, may help address the issue of low inclusion of CALD groups in clinical research. Researcher education needs to be taken into account to address preconceptions about CALD resistance to research participation and to raise awareness of cultural concerns in regard to research participation.
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Affiliation(s)
- Jo-Anne Hughson
- School of Languages and Linguistics, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Robyn Woodward-Kron
- Department of Medical Education, Melbourne Medical School, University of Melbourne, Parkville VIC, 3010, Australia.
| | - Anna Parker
- Anaesthesia, Perioperative and Pain Medicine Unit, Melbourne Medical School, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - John Hajek
- School of Languages and Linguistics, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Agnese Bresin
- School of Languages and Linguistics, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Ute Knoch
- School of Languages and Linguistics, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Tuong Phan
- Anaesthesia, Perioperative and Pain Medicine Unit, Melbourne Medical School, The University of Melbourne, Parkville, VIC, 3010, Australia.,Department of Anaesthesia, St Vincent's Hospital, Fitzroy, VIC, 3065, Australia
| | - David Story
- Anaesthesia, Perioperative and Pain Medicine Unit, Melbourne Medical School, The University of Melbourne, Parkville, VIC, 3010, Australia
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Hughson JA, Woodward-Kron R, Parker A, Hajek J, Bresin A, Knoch U, Phan T, Story D. A review of approaches to improve participation of culturally and linguistically diverse populations in clinical trials. Trials 2016. [PMID: 27229153 DOI: 10.1186/s13063-016-1384-3.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The under-representation of culturally and linguistically diverse participants in clinical trials is an ongoing concern for medical researchers and the community. The aim of this review is to examine the complex issue of recruiting culturally and linguistically diverse (CALD) older people to medical research and to examine responses to these issues. The review focuses on (1) trends in the existing literature on barriers to and strategies for recruiting CALD and older people to clinical research, (2) issues with informed consent for CALD populations, and (3) the efficacy of innovative approaches, including approaches incorporating multimedia in research and consent processes. The literature indicates that predominant barriers to greater involvement of CALD patients in clinical trials are communication, including literacy and health literacy considerations; English language competence; and cultural factors in the research setting such as mistrust of consent processes, as well as considerable practical and logistical barriers, including mobility considerations. Some evidence exists that incorporating multimedia resources into the informed consent process can improve patient understanding and is preferred by patients, yet these findings are inconclusive. A multi-methodological approach, including the use of culturally and linguistically sensitive multimedia tools, may help address the issue of low inclusion of CALD groups in clinical research. Researcher education needs to be taken into account to address preconceptions about CALD resistance to research participation and to raise awareness of cultural concerns in regard to research participation.
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Affiliation(s)
- Jo-Anne Hughson
- School of Languages and Linguistics, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Robyn Woodward-Kron
- Department of Medical Education, Melbourne Medical School, University of Melbourne, Parkville VIC, 3010, Australia.
| | - Anna Parker
- Anaesthesia, Perioperative and Pain Medicine Unit, Melbourne Medical School, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - John Hajek
- School of Languages and Linguistics, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Agnese Bresin
- School of Languages and Linguistics, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Ute Knoch
- School of Languages and Linguistics, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Tuong Phan
- Anaesthesia, Perioperative and Pain Medicine Unit, Melbourne Medical School, The University of Melbourne, Parkville, VIC, 3010, Australia.,Department of Anaesthesia, St Vincent's Hospital, Fitzroy, VIC, 3065, Australia
| | - David Story
- Anaesthesia, Perioperative and Pain Medicine Unit, Melbourne Medical School, The University of Melbourne, Parkville, VIC, 3010, Australia
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Reprint of: Health literacy in Canada and the ophthalmology patient. Can J Ophthalmol 2015; 50 Suppl 1:S40-6. [PMID: 26049890 DOI: 10.1016/j.jcjo.2015.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 09/05/2011] [Accepted: 10/04/2011] [Indexed: 01/04/2023]
Abstract
Health literacy represents the cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand, and use information in ways that promote and maintain good health.(1) According to the 2003 International Adult Literacy and Life Skills Survey (IALSS), over 12 million (60%) adult Canadians lack the capacity to obtain, understand, and act on health information and services, as well as make appropriate health decisions on their own.(2,3) Of these 12 million Canadians, the elderly are the most health illiterate age group in Canada. What this suggests for Canadian physicians is that to improve the CanMEDS roles of communicator and health advocate,(4) physicians need to recognize health literacy as a modifiable contributor of poor health outcomes and work to remove literacy-related barriers.(5) This is particularly important for ophthalmologists who manage chronic illnesses in elderly patients.(2,6,7) The objective of this review is 2-fold. The first objective is to describe health literacy in Canada and provide a summary on the current state of health literacy research, both generally in medicine and specifically to Ophthalmology. The second objective is to propose a 3-step approach of evidence based techniques for managing low health literate patients in clinic.
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Hahn EA, Burns JL, Jacobs EA, Ganschow PS, Garcia SF, Rutsohn JP, Baker DW. Health Literacy and Patient-Reported Outcomes: A Cross-Sectional Study of Underserved English- and Spanish-Speaking Patients With Type 2 Diabetes. JOURNAL OF HEALTH COMMUNICATION 2015; 20 Suppl 2:4-15. [PMID: 26513026 DOI: 10.1080/10810730.2015.1061071] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study examined associations between patient characteristics, health behaviors, and health outcomes and explored the role of health literacy as a potential mediator of outcomes. English- and Spanish-speaking adults with Type 2 diabetes used a bilingual multimedia touchscreen to complete questionnaires. The behavioral model for vulnerable populations guided multivariable regression and mediation testing. Dependent variables were diabetes self-care, health status, and satisfaction with communication. Independent variables included sociodemographic and clinical characteristics, health literacy, health beliefs, and self-efficacy. Spanish speakers had lower health literacy and poorer physical, mental, and overall health compared to English speakers. Higher health literacy was associated with less social support for diet, fewer diet and medication barriers, younger age, higher diabetes knowledge, and talking with health care professionals to get diabetes information. In contrast to expectations, health literacy was not associated with diabetes self-care, health status, or satisfaction with communication, and it did not mediate the effects of other factors on these outcomes. Diabetes self-efficacy was significantly associated with health behaviors and outcomes. The association between Spanish language preference and poorer health was not mediated by this group's lower health literacy. Increasing health-related self-efficacy might be an important clinical strategy for improving outcomes in underserved patients with Type 2 diabetes.
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Affiliation(s)
- Elizabeth A Hahn
- a Department of Medical Social Sciences , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
- b Center for Patient-Centered Outcomes , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - James L Burns
- a Department of Medical Social Sciences , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Elizabeth A Jacobs
- c Department of Medicine and Health Innovation Program , University of Wisconsin School of Medicine and Public Health , Madison , Wisconsin , USA
| | - Pamela S Ganschow
- d Department of Medicine , Stroger Hospital, and Rush University Medical Center , Chicago , Illinois , USA
| | - Sofia F Garcia
- a Department of Medical Social Sciences , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
- b Center for Patient-Centered Outcomes , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Joshua P Rutsohn
- a Department of Medical Social Sciences , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - David W Baker
- e Healthcare Quality Evaluation , The Joint Commission , Oakbrook Terrace , Illinois , USA
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O′Neill B, Gonçalves D, Ricci-Cabello I, Ziebland S, Valderas J. An overview of self-administered health literacy instruments. PLoS One 2014; 9:e109110. [PMID: 25478813 PMCID: PMC4257499 DOI: 10.1371/journal.pone.0109110] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 08/28/2014] [Indexed: 11/18/2022] Open
Abstract
With the increasing recognition of health literacy as a worldwide research priority, the development and refinement of indices to measure the construct is an important area of inquiry. Furthermore, the proliferation of online resources and research means that there is a growing need for self-administered instruments. We undertook a systematic overview to identify all published self-administered health literacy assessment indices to report their content and considerations associated with their administration. A primary aim of this study was to assist those seeking to employ a self-reported health literacy index to select one that has been developed and validated for an appropriate context, as well as with desired administration characteristics. Systematic searches were carried out in four electronic databases, and studies were included if they reported the development and/or validation of a novel health literacy assessment measure. Data were systematically extracted on key characteristics of the instruments: breadth of construct (“generic” vs. “content- or context- specific” health literacy), whether it was an original instrument or a derivative, country of origin, administration characteristics, age of target population (adult vs. pediatric), and evidence for validity. 35 articles met the inclusion criteria. There were 27 original instruments (27/35; 77.1%) and 8 derivative instruments (8/35; 22.9%). 22 indices measured “general” health literacy (22/35; 62.9%) while the remainder measured condition- or context- specific health literacy (13/35; 37.1%). Most health literacy measures were developed in the United States (22/35; 62.9%), and about half had adequate face, content, and construct validity (16/35; 45.7%). Given the number of measures available for many specific conditions and contexts, and that several have acceptable validity, our findings suggest that the research agenda should shift towards the investigation and elaboration of health literacy as a construct itself, in order for research in health literacy measurement to progress.
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Affiliation(s)
- Braden O′Neill
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Daniela Gonçalves
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Ignacio Ricci-Cabello
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Jose Valderas
- Medical School, University of Exeter, Exeter, United Kingdom
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Hahn EA, Kallen MA, Jacobs EA, Ganschow PS, Garcia SF, Burns JL. English-Spanish equivalence of the Health Literacy Assessment Using Talking Touchscreen Technology (Health LiTT). JOURNAL OF HEALTH COMMUNICATION 2014; 19 Suppl 2:285-301. [PMID: 25315599 DOI: 10.1080/10810730.2014.936567] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Unbiased measurement instruments are needed to reliably estimate health literacy in diverse populations. The study aimed (a) to evaluate measurement equivalence of Health Literacy Assessment Using Talking Touchscreen Technology (Health LiTT) and (b) to compare Health LiTT scores between English- and Spanish-speaking individuals. Health LiTT and several patient-reported outcome instruments were completed by adult patients receiving care for type 2 diabetes at a safety net clinic. English-Spanish measurement equivalence was evaluated with an item response theory approach to differential item functioning (DIF) detection and impact. Health LiTT scores were compared by language using multivariable linear regression. Approximately equal numbers of English-speaking patients (n=146) and Spanish-speaking patients (n=149) with type 2 diabetes were enrolled. English participants were primarily non-Hispanic Black (65%); all Spanish participants were Hispanic. Six Health LiTT items were flagged for DIF. The Pearson correlation between unadjusted and DIF adjusted scores was 0.995; the mean difference of individual difference scores was 0.0005 (SD=0.0888). After adjusting for predisposing characteristics, enabling resources and need for care, Health LiTT scores were comparable for Spanish-speaking individuals versus English-speaking individuals. The effect of DIF items on Health LiTT scores appeared to be trivial. English-Spanish equivalence of Health LiTT will permit researchers to determine the independent effects of limited English proficiency and limited literacy.
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Affiliation(s)
- Elizabeth A Hahn
- a Department of Medical Social Sciences and Center for Patient-Centered Outcomes , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
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Yost KJ, DeWalt DA, Lindquist LA, Hahn EA. The association between health literacy and indicators of cognitive impairment in a diverse sample of primary care patients. PATIENT EDUCATION AND COUNSELING 2013; 93:319-26. [PMID: 23932515 PMCID: PMC3802526 DOI: 10.1016/j.pec.2013.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 07/01/2013] [Accepted: 07/08/2013] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To confirm the association of health literacy scores as measured by Health Literacy Assessment Using Talking Touchscreen Technology (Health LiTT) with cognitive ability and education. To determine whether this association differs by cognitive task. METHODS Cognitive impairment was measured using the Mini-Cog, which combines a delayed word recall task (WRT) and a clock drawing task (CDT) to yield an overall classification of normal versus cognitively impaired. Participants were recruited from primary care clinics that provide care to underserved patients. RESULTS Participants (n=574) were predominantly non-Hispanic black (67%) with a mean age of 46 years, 50% did not have health insurance, 56% had a high school education or less and 21% screened positive for cognitive impairment. Overall cognitive ability and education were significantly associated with health literacy after adjusting for other variables, including race/ethnicity and physical health. We observed a stronger association between the CDT and health literacy than between the WRT and health literacy. CONCLUSION By confirming hypothesized associations, this study provides additional support of the validity of Health LiTT. PRACTICE IMPLICATIONS Health LiTT is a reliable and valid tool that researchers and clinicians can use to identify individuals who might have difficulty understanding health information.
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Affiliation(s)
- Kathleen J Yost
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA.
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Mudano AS, Gary LC, Oliveira AL, Melton M, Wright NC, Curtis JR, Delzell E, Harrington TM, Kilgore ML, Lewis CE, Singh JA, Warriner AH, Pace WD, Saag KG. Using tablet computers compared to interactive voice response to improve subject recruitment in osteoporosis pragmatic clinical trials: feasibility, satisfaction, and sample size. Patient Prefer Adherence 2013; 7:517-23. [PMID: 23807841 PMCID: PMC3685447 DOI: 10.2147/ppa.s44551] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Pragmatic clinical trials (PCTs) provide large sample sizes and enhanced generalizability to assess therapeutic effectiveness, but efficient patient enrollment procedures are a challenge, especially for community physicians. Advances in technology may improve methods of patient recruitment and screening in PCTs. Our study looked at a tablet computer versus an integrated voice response system (IVRS) for patient recruitment and screening for an osteoporosis PCT in community physician offices. MATERIALS AND METHODS We recruited women ≥ 65 years of age from community physician offices to answer screening questions for a hypothetical osteoporosis active comparator PCT using a tablet computer or IVRS. We assessed the feasibility of these technologies for patient recruitment as well as for patient, physician, and office staff satisfaction with the process. We also evaluated the implications of these novel recruitment processes in determining the number of primary care practices and screened patients needed to conduct the proposed trial. RESULTS A total of 160 women (80% of those approached) agreed to complete the osteoporosis screening questions in ten family physicians' offices. Women using the tablet computer were able to complete all screening questions consistently and showed a nonsignificant trend towards greater ease of use and willingness to spend more time in their physician's office compared to those using IVRS. Using the proportion of women found to be eligible in this study (almost 20%) and other eligibility scenarios, we determined that between 240 and 670 community physician offices would be needed to recruit ample patients for our hypothetical study. CONCLUSION We found good satisfaction and feasibility with a tablet computer interface for the recruitment and screening of patients for a hypothetical osteoporosis PCT in community office settings. In addition, we used this experience to estimate the number of research sites needed for such a study.
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Affiliation(s)
- Amy S Mudano
- Center for Education and Research on Therapeutics (CERTs)
- Center for Outcomes Effectiveness Research and Education (COERE), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Center for Clinical and Translational Sciences (CCTS), (University of Alabama at Birmingham, Birmingham, AL, USA)
| | - Lisa C Gary
- Center for Education and Research on Therapeutics (CERTs)
- Center for Outcomes Effectiveness Research and Education (COERE), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Center for Clinical and Translational Sciences (CCTS), (University of Alabama at Birmingham, Birmingham, AL, USA)
| | - Ana L Oliveira
- Center for Education and Research on Therapeutics (CERTs)
- Center for Outcomes Effectiveness Research and Education (COERE), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Center for Clinical and Translational Sciences (CCTS), (University of Alabama at Birmingham, Birmingham, AL, USA)
| | - Mary Melton
- Center for Education and Research on Therapeutics (CERTs)
- Center for Outcomes Effectiveness Research and Education (COERE), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Center for Clinical and Translational Sciences (CCTS), (University of Alabama at Birmingham, Birmingham, AL, USA)
| | - Nicole C Wright
- Center for Education and Research on Therapeutics (CERTs)
- Center for Outcomes Effectiveness Research and Education (COERE), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Center for Clinical and Translational Sciences (CCTS), (University of Alabama at Birmingham, Birmingham, AL, USA)
| | - Jeffrey R Curtis
- Center for Education and Research on Therapeutics (CERTs)
- Center for Outcomes Effectiveness Research and Education (COERE), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Center for Clinical and Translational Sciences (CCTS), (University of Alabama at Birmingham, Birmingham, AL, USA)
| | - Elizabeth Delzell
- Center for Education and Research on Therapeutics (CERTs)
- Center for Outcomes Effectiveness Research and Education (COERE), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Center for Clinical and Translational Sciences (CCTS), (University of Alabama at Birmingham, Birmingham, AL, USA)
| | - T Michael Harrington
- Center for Education and Research on Therapeutics (CERTs)
- Center for Outcomes Effectiveness Research and Education (COERE), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Center for Clinical and Translational Sciences (CCTS), (University of Alabama at Birmingham, Birmingham, AL, USA)
| | - Meredith L Kilgore
- Center for Education and Research on Therapeutics (CERTs)
- Center for Outcomes Effectiveness Research and Education (COERE), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Center for Clinical and Translational Sciences (CCTS), (University of Alabama at Birmingham, Birmingham, AL, USA)
| | - Cora Elizabeth Lewis
- Center for Education and Research on Therapeutics (CERTs)
- Center for Outcomes Effectiveness Research and Education (COERE), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Center for Clinical and Translational Sciences (CCTS), (University of Alabama at Birmingham, Birmingham, AL, USA)
| | - Jasvinder A Singh
- Center for Education and Research on Therapeutics (CERTs)
- Center for Outcomes Effectiveness Research and Education (COERE), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Center for Clinical and Translational Sciences (CCTS), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Amy H Warriner
- Center for Education and Research on Therapeutics (CERTs)
- Center for Outcomes Effectiveness Research and Education (COERE), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Center for Clinical and Translational Sciences (CCTS), (University of Alabama at Birmingham, Birmingham, AL, USA)
| | - Wilson D Pace
- Distributed Ambulatory Research in Therapeutics Network (DARTNet), American Academy of Family Physicians (AAFP), University of Colorado, Denver, CO, USA
| | - Kenneth G Saag
- Center for Education and Research on Therapeutics (CERTs)
- Center for Outcomes Effectiveness Research and Education (COERE), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Center for Clinical and Translational Sciences (CCTS), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Correspondence: Kenneth G Saag, The University of Alabama at Birmingham, 820 Faculty Office Tower, 510 20th Street South, Birmingham, AL, USA 35294, Tel +1 205 996 9784, Fax +1 205 975 6859, Email
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Visscher KL, Hutnik CM. Health literacy in Canada and the ophthalmology patient. Can J Ophthalmol 2012; 47:72-8. [DOI: 10.1016/j.jcjo.2011.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 09/05/2011] [Accepted: 10/04/2011] [Indexed: 11/29/2022]
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Fransen MP, Van Schaik TM, Twickler TB, Essink-Bot ML. Applicability of internationally available health literacy measures in the Netherlands. JOURNAL OF HEALTH COMMUNICATION 2011; 16 Suppl 3:134-149. [PMID: 21951248 DOI: 10.1080/10810730.2011.604383] [Citation(s) in RCA: 148] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Health literacy measures for use in clinical-epidemiological research have all been developed outside Europe. In the absence of validated Dutch measures, we evaluated the cross-cultural applicability of the Rapid Estimate of Adult Literacy in Medicine (REALM), the Newest Vital Sign (NVS), the Set of Brief Screening Questions (SBSQ), and the measure of Functional Communicative and Critical Health Literacy (FCCHL). Each measure was translated into Dutch following standardized procedures. We assessed feasibility, internal consistency, and construct validity among patients with coronary artery disease (n = 201) and patients with diabetes type 2 (n = 88). Patients expressed most problems in responding to the NVS-D. They were not familiar with the type of food label and had difficulties calculating in portions instead of grams. The FCCHL-D items seemed too theoretical for many patients. Cronbach's alpha was acceptable for all measures. Correlation patterns between the measures were moderately coherent with a priori hypotheses. All translated measures were able to distinguish between high- and low-educated groups of patients, with the NVS-D performing best. Despite reasonable psychometric properties as demonstrated so far, these measures need to be further developed in order to increase applicability for assessing health literacy in clinical-epidemiological research in the Netherlands.
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Affiliation(s)
- M P Fransen
- Department of Public Health, Amsterdam Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Hahn EA, Choi SW, Griffith JW, Yost KJ, Baker DW. Health literacy assessment using talking touchscreen technology (Health LiTT): a new item response theory-based measure of health literacy. JOURNAL OF HEALTH COMMUNICATION 2011; 16 Suppl 3:150-62. [PMID: 21951249 PMCID: PMC3269120 DOI: 10.1080/10810730.2011.605434] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The importance of health literacy has grown considerably among researchers, clinicians, patients, and policymakers. Better instruments and measurement strategies are needed. Our objective was to develop a new health literacy instrument using novel health information technology and modern psychometrics. We designed Health LiTT as a self-administered multimedia touchscreen test based on item response theory (IRT) principles. We enrolled a diverse group of 619 English-speaking, primary care patients in clinics for underserved patients. We tested three item types (prose, document, quantitative) that worked well together to reliably measure a single dimension of health literacy. The Health LiTT score meets psychometric standards (reliability of 0.90 or higher) for measurement of individual respondents in the low to middle range. Mean Health LiTT scores were associated with age, race/ethnicity, education, income, and prior computer use (p < .05). We created an IRT-calibrated item bank of 82 items. Standard setting needs to be performed to classify and map items onto the construct and to identify measurement gaps. We are incorporating Health LiTT into an existing online research management tool. This will enable administration of Health LiTT on the same touchscreen used for other patient-reported outcomes, as well as real-time scoring and reporting of health literacy scores.
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Affiliation(s)
- Elizabeth A Hahn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA
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Paasche-Orlow MK, Wilson EAH, McCormack L. The evolving field of health literacy research. JOURNAL OF HEALTH COMMUNICATION 2010; 15 Suppl 2:5-8. [PMID: 20845188 DOI: 10.1080/10810730.2010.499995] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Michael K Paasche-Orlow
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.
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