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Najmabadi S, Valentin V, Rolls J, Showstark M, Elrod L, Barry C, Broughton A, Bessette M, Honda T. Non-native English-speaking applicants and the likelihood of physician assistant program matriculation. MEDICAL EDUCATION ONLINE 2024; 29:2312713. [PMID: 38324669 PMCID: PMC10851801 DOI: 10.1080/10872981.2024.2312713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/26/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE Effective communication is critical in patient care. Multilingual medical providers, including Physician Assistants (PAs) can contribute to improved health care among patients with limited English proficiency; however, this is contingent upon matriculating multilingual providers. In this study, the association between prospective applicants' self-reported English as second language (ESL) status and their likelihood of matriculation into a PA program was investigated. METHODS Participants included applicants to five admission cycles of the Centralized Application Service for Physician Assistant from 2012 to 2020. Logistic regression was utilized to investigate association between applicant ESL status and odds of program matriculation in both bivariate and multivariable regression models. Models were adjusted for citizenship status, undergraduate grade point average, gender, age, race/ethnicity, number of programs applied to, and patient care hours. RESULTS In unadjusted and adjusted models, ESL status was associated with a significantly lower odds of matriculation to a PA program across all study years. In adjusted multivariable models, associations were strongest for 2014-2015 where ESL status was associated with a 35% lower odds of matriculation (odds ratio 0.65, 95% confidence interval 0.56, 0.76) when controlling for demographics, citizenship status, patient care experience, and academic achievement. In sensitivity analyses restricting to (a) those with TOEFL scores ≥ 100, and (b) restricting to those ESL applicants without TOEFL scores, we did not observe important changes in our results. CONCLUSIONS Results indicated that non-native English-speaking applicants have lower odds of PA program matriculation. Decrements in matriculation odds were large magnitude, minimally impacted by adjustment for confounders and persistent across the years. These findings suggest that PA program admission processes may disadvantage non-native English-speaking applicants. While there are potential explanations for the observed findings, they are cause for concern. Matriculating and training PAs who have language concordance with underserved populations are important means of improving patient outcomes.
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Affiliation(s)
- Shahpar Najmabadi
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Virginia Valentin
- Department of PA Studies, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Joanne Rolls
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Mary Showstark
- Affiliate Faculty Yale Institute of Global Health, School of Medicine, Physician Assistant Online Program, Yale University, New Haven, CT, USA
| | - Leigh Elrod
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Carey Barry
- Department of Medical Sciences, Physician Assistant Program, Northeastern University, Boston, MA, USA
| | - Adam Broughton
- Department of Medical Sciences, Physician Assistant Program, Northeastern University, Boston, MA, USA
| | - Michael Bessette
- Department of Medical Sciences, Physician Assistant Program, Northeastern University, Boston, MA, USA
| | - Trenton Honda
- School of Clinical and Rehabilitation Sciences, Northeastern University, Boston, MA, USA
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Hernandez J, Demiranda L, Perisetla P, Andrews L, Zhang K, Henderson R, Mittal A, Norton HF, Hagen MG. A systematic review and narrative synthesis of health literacy interventions among Spanish speaking populations in the United States. BMC Public Health 2024; 24:1713. [PMID: 38926697 PMCID: PMC11210103 DOI: 10.1186/s12889-024-19166-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND While many populations struggle with health literacy, those who speak Spanish preferentially or exclusively, including Hispanic, immigrant, or migrant populations, may face particular barriers, as they navigate a predominantly English-language healthcare system. This population also faces greater morbidity and mortality from treatable chronic diseases, such as hypertension and diabetes. The aim of this systematic review was to describe existing health literacy interventions for patients with a Spanish-language preference and present their effectiveness. METHODS We carried out a systematic review where Web of Science, EMBASE, and PubMed were queried using MeSH terms to identify relevant literature. Included articles described patients with a Spanish-language preference participating in interventions to improve health literacy levels in the United States. Screening and data abstraction were conducted independently and in pairs. Risk of bias assessments were conducted using validated appraisal tools. RESULTS A total of 2823 studies were identified, of which 62 met our eligibility criteria. The studies took place in a variety of community and clinical settings and used varied tools for measuring health literacy. Of the interventions, 28 consisted of in-person education and 27 implemented multimedia education, with 89% of studies in each category finding significant results. The remaining seven studies featured multimodal interventions, all of which achieved significant results. CONCLUSION Successful strategies included the addition of liaison roles, such as promotores (Hispanic community health workers), and the use of multimedia fotonovelas (photo comics) with linguistic and cultural adaptations. In some cases, the external validity of the results was limited. Improving low health literacy in patients with a Spanish-language preference, a population with existing barriers to high quality of care, may help them better navigate health infrastructure and make informed decisions regarding their health. REGISTRATION PROSPERO (available at https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021257655.t ).
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Affiliation(s)
- Joel Hernandez
- University of Central Florida College of Medicine, University of Central Florida, Orlando, USA
| | - Liliana Demiranda
- Equal Access Research, College of Medicine, University of Florida, 1549 Gale Lemerand Drive, 4 Floor, Suite 4592, Gainesville, FL, 32610-3008, USA
| | - Priyanka Perisetla
- Equal Access Research, College of Medicine, University of Florida, 1549 Gale Lemerand Drive, 4 Floor, Suite 4592, Gainesville, FL, 32610-3008, USA
| | - Lauren Andrews
- Equal Access Research, College of Medicine, University of Florida, 1549 Gale Lemerand Drive, 4 Floor, Suite 4592, Gainesville, FL, 32610-3008, USA
| | - Keer Zhang
- Equal Access Research, College of Medicine, University of Florida, 1549 Gale Lemerand Drive, 4 Floor, Suite 4592, Gainesville, FL, 32610-3008, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Rebecca Henderson
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Ajay Mittal
- Equal Access Research, College of Medicine, University of Florida, 1549 Gale Lemerand Drive, 4 Floor, Suite 4592, Gainesville, FL, 32610-3008, USA
| | - Hannah F Norton
- University of Florida Health Science Center Libraries, Gainesville, FL, USA
| | - Melanie G Hagen
- Equal Access Research, College of Medicine, University of Florida, 1549 Gale Lemerand Drive, 4 Floor, Suite 4592, Gainesville, FL, 32610-3008, USA.
- Department of Internal Medicine, College of Medicine, University of Florida, Gainesville, FL, USA.
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Romanova A, Rubinelli S, Diviani N. Improving health and scientific literacy in disadvantaged groups: A scoping review of interventions. PATIENT EDUCATION AND COUNSELING 2024; 122:108168. [PMID: 38301598 DOI: 10.1016/j.pec.2024.108168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/05/2023] [Accepted: 01/21/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To explore approaches for developing and implementing interventions aimed at improving health literacy and health-related scientific literacy in disadvantaged groups. METHODS A scoping review of literature published in 2012-2022 was conducted, followed by quality appraisal of eligible studies. RESULTS Interventions were conducted mainly in community settings, where the most popular venues were adult education facilities. The primary target groups were those with limited income or education, ethnic minorities, or immigrants. Programs were often held in-person using interactive and culturally appropriate methods. They were predominantly focused on functional and interactive health literacy dimensions rather than on critical and scientific ones. Evaluations measured knowledge, health literacy, behavioral and psychological outcomes using various quantitative and qualitative instruments. CONCLUSIONS The findings offer a comprehensive overview of the ways to design and evaluate health and scientific literacy interventions tailored to disadvantaged groups. PRACTICE IMPLICATIONS Future interventions should prioritize participatory designs, culturally appropriate materials, and shift focus to critical and scientific health literacy, as well as to program scalability in less controlled conditions.
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Affiliation(s)
- Anna Romanova
- Faculty of Health Sciences and Medicine, University of Lucerne, Alpenquai 4, 6005 Luzern, Switzerland; Swiss Paraplegic Research, Person-Centered Healthcare & Health Communication Group, Guido A, Zäch-Strasse 4, 6207 Nottwil, Switzerland
| | - Sara Rubinelli
- Faculty of Health Sciences and Medicine, University of Lucerne, Alpenquai 4, 6005 Luzern, Switzerland; Swiss Paraplegic Research, Person-Centered Healthcare & Health Communication Group, Guido A, Zäch-Strasse 4, 6207 Nottwil, Switzerland
| | - Nicola Diviani
- Faculty of Health Sciences and Medicine, University of Lucerne, Alpenquai 4, 6005 Luzern, Switzerland; Swiss Paraplegic Research, Person-Centered Healthcare & Health Communication Group, Guido A, Zäch-Strasse 4, 6207 Nottwil, Switzerland.
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Dee EC, Swami N, Kazzi B, Lapen K, Franco I, Jain B, Patel TA, Mahal BA, Rimner A, Wu A, Iyengar P, Li B, Florez N, Gomez DR. Disparities in Stage at Presentation Among Hispanic and Latinx Patients With Non-Small-Cell Lung Cancer in the United States. JCO Oncol Pract 2024; 20:525-537. [PMID: 38252900 DOI: 10.1200/op.23.00474] [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: 07/30/2023] [Revised: 10/12/2023] [Accepted: 11/02/2023] [Indexed: 01/24/2024] Open
Abstract
PURPOSE Hispanic and Latinx people in the United States are the fastest-growing ethnic group. However, previous studies in non-small-cell lung cancer (NSCLC) often analyze these diverse communities in aggregate. We aimed to identify differences in NSCLC stage at diagnosis in the US population, focusing on disaggregated Hispanic/Latinx individuals. METHODS Data from the National Cancer Database from 2004 to 2018 identified patients with primary NSCLC. Individuals were disaggregated by racial and ethnic subgroup and Hispanic country of origin. Ordinal logistic regression adjusting for age, facility type, income, educational attainment, comorbidity index, insurance, and year of diagnosis was used to create adjusted odds ratios (aORs), with higher odds representing diagnosis at later-stage NSCLC. RESULTS Of 1,565,159 patients with NSCLC, 46,616 were Hispanic/Latinx (3.0%). When analyzed in the setting of race and ethnicity, Hispanic patients were more likely to be diagnosed with metastatic disease compared with non-Hispanic White (NHW) patients: 47.0% for Hispanic Black, 46.0% Hispanic White, and 44.3% of Hispanic other patients versus 39.1% of non-Hispanic White patients (P < .001 for all). By country of origin, 51.4% of Mexican, 41.7% of Puerto Rican, 44.6% of Cuban, 50.8% of South or Central American, 48.4% of Dominican, and 45.6% of other Hispanic patients were diagnosed with metastatic disease, compared with 39.1% of NHWs. Conversely, 20.2% of Mexican, 26.9% of Puerto Rican, 24.2% of Cuban, 22.5% of South or Central American, 23.7% of Dominican, and 24.5% of other Hispanic patients were diagnosed with stage I disease, compared with 30.0% of NHWs. All Hispanic groups were more likely to present with later-stage NSCLC than NHW patients (greatest odds for Mexican patients, aOR, 1.44; P < .001). CONCLUSION Hispanic/Latinx patients with non-small-cell lung cancer were more likely to be diagnosed with advanced disease compared with NHWs. Disparities persisted upon disaggregation by both race and country of origin, with over half of Mexican patients with metastatic disease at diagnosis. Disparities among Hispanic/Latinx groups by race and by country of origin highlight the shortcomings of treating these groups as a monolith and underscore the need for disaggregated research and targeted interventions.
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Affiliation(s)
| | - Nishwant Swami
- University of Massachusetts Chan Medical School, Worcester, MA
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Bahaa Kazzi
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University, Decatur, GA
| | - Kaitlyn Lapen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Idalid Franco
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Bhav Jain
- Stanford School of Medicine, Palo Alto, CA
| | - Tej A Patel
- University of Pennsylvania, Philadelphia, PA
| | - Brandon A Mahal
- Department of Radiation Oncology, University of Miami/Sylvester Cancer Center, Miami, FL
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Abraham Wu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Puneeth Iyengar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Radiation Oncology, Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bob Li
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Narjust Florez
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Radiation Oncology, Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, NY
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Quigley DD, Qureshi N, Predmore Z, Diaz Y, Hays RD. Is Primary Care Patient Experience Associated with Provider-Patient Language Concordance and Use of Interpreters for Spanish-preferring Patients: A Systematic Literature Review. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01951-z. [PMID: 38441859 PMCID: PMC11374925 DOI: 10.1007/s40615-024-01951-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Healthcare provided by a bilingual provider or with the assistance of an interpreter improves care quality; however, their associations with patient experience are unknown. We reviewed associations of patient experience with provider-patient language concordance (LC) and use of interpreters for Spanish-preferring patients. METHOD We reviewed articles from academic databases 2005-2023 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Joanna Briggs Institute Checklists to rate study quality. We reviewed 217 (of 2193) articles, yielding 17 for inclusion. RESULTS Of the 17 included articles, most articles focused on primary (n = 6 studies) or pediatric care (n = 5). All were cross-sectional, collecting data by self-administered surveys (n = 7) or interviews (n = 4). Most assessed the relationship between LC or interpreter use and patient experience by cross-sectional associations (n = 13). Two compared subgroups, and two provided descriptive insights into the conversational content (provider-interpreter-patient). None evaluated interventions, so evidence on effective strategies is lacking. LC for Spanish-preferring patients was a mix of null findings (n = 4) and associations with better patient experience (n = 3) (e.g., receiving diet/exercise counseling and better provider communication). Evidence on interpreter use indicated better (n = 2), worse (n = 2), and no association (n = 2) with patient experience. Associations between Spanish-language preference and patient experience were not significant (n = 5) or indicated worse experience (n = 4) (e.g., long waits, problems getting appointments, and not understanding nurses). CONCLUSION LC is associated with better patient experience. Using interpreters is associated with better patient experience but only with high-quality interpreters. Strategies are needed to eliminate disparities and enhance communication for all Spanish-preferring primary care patients, whether with a bilingual provider or an interpreter.
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Affiliation(s)
- Denise D Quigley
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA.
| | - Nabeel Qureshi
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
| | | | - Yareliz Diaz
- RAND Corporation, 20 Park Plaza, Suite 910, Boston, MA, USA
| | - Ron D Hays
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
- David Geffen School of Medicine & Department of Medicine, UCLA, 1100 Glendon Avenue, Los Angeles, CA, 90024-1736, USA
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Birkelund L, Dieperink KB, Sodemann M, Lindell JF, Steffensen KD, Nielsen DS. Communicating without a Shared Language: A Qualitative Study of Language Barriers in Language-Discordant Cancer Communication. JOURNAL OF HEALTH COMMUNICATION 2024; 29:187-199. [PMID: 38294170 DOI: 10.1080/10810730.2024.2309357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
We use language to achieve understanding, and language barriers can have major health consequences for patients with serious illness. While ethnic minorities are more likely to experience social inequalities in health and health care, communicative processes in language-discordant cancer care remain unexplored. This study aimed to investigate communication between patients with cancer and limited Danish proficiency and oncology clinicians, with special emphasis on how linguistic barriers influenced patient involvement and decision-making. 18 participant observations of clinical encounters were conducted. Field notes and transcriptions of audio recordings were analyzed, and three themes were identified: Miscommunication and uncertainty as a basic linguistic condition; Impact of time on patient involvement; Unequally divided roles and (mis)communication responsibilities. The results showed that professional interpreting could not eradicate miscommunication but was crucial for achieving understanding. Organizational factors related to time and professional interpreting limited patient involvement. Without professional interpreting, patients' relatives were assigned massive communication responsibilities. When no Danish-speaking relatives partook, clinicians' ethical dilemmas further increased as did patient safety risks. Language barriers have consequences for everyone who engages in health communication, and the generated knowledge about how linguistic inequality manifests itself in clinical practice can be used to reduce social inequalities in health and health care.
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Affiliation(s)
- Lisbeth Birkelund
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Karin B Dieperink
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Family focused healthcare research Center, University of Southern Denmark, Odense, Denmark
| | - Morten Sodemann
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Infectious Diseases, Migrant Health Clinic, Odense University Hospital, Odense, Denmark
| | - Johanna F Lindell
- Department of Nordic Studies and Linguistics, University of Copenhagen, Copenhagen, Denmark
| | - Karina D Steffensen
- Centre for Shared Decision Making, Lillebaelt University Hospital of Southern Denmark, Vejle, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Dorthe S Nielsen
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Singh H, Samkange-Zeeb F, Kolschen J, Herrmann R, Hübner W, Barnils NP, Brand T, Zeeb H, Schüz B. Interventions to promote health literacy among working-age populations experiencing socioeconomic disadvantage: systematic review. Front Public Health 2024; 12:1332720. [PMID: 38439762 PMCID: PMC10909862 DOI: 10.3389/fpubh.2024.1332720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/05/2024] [Indexed: 03/06/2024] Open
Abstract
Background Experiencing financial insecurity and being underserved is often associated with low health literacy, i.e., the ability to identify, obtain, interpret and act upon health information, which may result in poor health outcomes. Little is known about effective interventions for promoting health literacy among underserved populations. The objective of this systematic review is to summarize the literature on such interventions and identify characteristics that differentiate more effective interventions. Methods Following PRISMA guidelines we searched the databases SCOPUS, Pubmed, Web of Science core collection and CINAHL. We included primary studies with a quantitative study design and control groups testing interventions to increase health literacy or health knowledge in underserved populations between 18 and 65 years. Where possible, we converted effect sizes into Cohen's d and compared mean differences of intervention and control groups. Albatross plots were created to summarize the results according to different health literacy and health knowledge outcomes. Results We screened 3,696 titles and abstracts and 206 full texts. In total, 86 articles were analyzed, of which 55 were summarized in seven albatross plots. The majority of the studies (n = 55) were conducted in the United States and had a randomized controlled study design (n = 44). More effective intervention approaches assessed needs of participants through focus group discussions prior to conducting the intervention, used bilingual educational materials, and included professionals fluent in the first languages of the study population as intervention deliverers. Additionally, the use of educational materials in video and text form, fotonovelas and interactive group education sessions with role playing exercises were observed to be effective. Discussion Although the outcomes addressed in the included studies were heterogeneous, effective intervention approaches were often culturally sensitive and developed tailored educational materials. Interventions aiming to promote health literacy in underserved populations should hence consider applying similar approaches.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=323801, PROSPERO registration ID: CRD42022323801.
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Affiliation(s)
- Himal Singh
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Florence Samkange-Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Jonathan Kolschen
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Ruben Herrmann
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Wiebke Hübner
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Núria Pedrós Barnils
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Tilman Brand
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Benjamin Schüz
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
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Sagong H, Tsai PF, Jang AR, Yoon JY. Impact of English Proficiency on Health Literacy in Older Korean Immigrants: Mediating Effects of Social Support and Acculturation. J Immigr Minor Health 2024; 26:81-90. [PMID: 37550523 DOI: 10.1007/s10903-023-01530-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/09/2023]
Abstract
Limited English proficiency (LEP) is one of the most influencing factors of personal health literacy (PHL) in the older immigrant population. Over the years, the proportion of older Korean immigrants with LEP has not improved and it is still noted as a major barrier to PHL. Therefore, organizational approaches are needed to enhance the PHL of older immigrants with LEP. This study aims to find the mediating effect of social support and acculturation between LEP and PHL by conceptualizing social support and acculturation as an organizational health literacy strategy. Data from 244 older Korean immigrants living in the states of Alabama and Georgia, USA, were used to conduct the study. Korean version of the Multidimensional Scale of Perceived Social Support (MSPSS), East Asian Acculturation Measure (EAAM), and Health Literacy Survey-12 Questionnaires (HLS-Q12) were used to measure the variables. The path analysis was conducted to find the serial mediation effects of social support and acculturation. The results showed that 77.5% of the participants reported not having fluent English proficiency. English proficiency (β =- 0.21, p = 0.007), social support (β = 0.17, p = 0.004), and acculturation (β = 0.18, p = 0.011) significantly predicted the PHL, and social support (β = 0.04, p = 0.028) and acculturation (β = 0.14, p < 0.001) mediated the relationship between LEP and PHL. Discussion: Health-related organizations and communities are encouraged to provide external social support and acculturation opportunities to enhance PHL in older Korean immigrants with LEP.
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Affiliation(s)
- Hae Sagong
- College of Nursing, Auburn University, 710 South Donahue Drive Auburn, Auburn, AL, USA.
| | - Pao-Feng Tsai
- College of Nursing, Auburn University, 710 South Donahue Drive Auburn, Auburn, AL, USA
| | - Ah Ram Jang
- Department of Nursing, Yeoju Institute of Technology, Yeoju, Republic of Korea
| | - Ju Young Yoon
- College of Nursing and Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
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Baumeister A, Aldin A, Chakraverty D, Hübner C, Adams A, Monsef I, Skoetz N, Kalbe E, Woopen C. Interventions for improving health literacy in migrants. Cochrane Database Syst Rev 2023; 11:CD013303. [PMID: 37963101 PMCID: PMC10645402 DOI: 10.1002/14651858.cd013303.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND Health literacy (HL) is a determinant of health and important for autonomous decision-making. Migrants are at high risk for limited HL. Improving HL is important for equitable promotion of migrants' health. OBJECTIVES To assess the effectiveness of interventions for improving HL in migrants. To assess whether female or male migrants respond differently to the identified interventions. SEARCH METHODS We ran electronic searches to 2 February 2022 in CENTRAL, MEDLINE, Embase, PsycInfo and CINAHL. We also searched trial registries. We used a study filter for randomised controlled trials (RCTs) (RCT classifier). SELECTION CRITERIA We included RCTs and cluster-RCTs addressing HL either as a concept or its components (access, understand, appraise, apply health information). DATA COLLECTION AND ANALYSIS We used the methodological procedures recommended by Cochrane and followed the PRISMA-E guidelines. Outcome categories were: a) HL, b) quality of life (QoL), c) knowledge, d) health outcomes, e) health behaviour, f) self-efficacy, g) health service use and h) adverse events. We conducted meta-analysis where possible, and reported the remaining results as a narrative synthesis. MAIN RESULTS We included 28 RCTs and six cluster-RCTs (8249 participants), all conducted in high-income countries. Participants were migrants with a wide range of conditions. All interventions were adapted to culture, language and literacy. We did not find evidence that HL interventions cause harm, but only two studies assessed adverse events (e.g. anxiety). Many studies reported results for short-term assessments (less than six weeks after total programme completion), reported here. For several comparisons, there were also findings at later time points, which are presented in the review text. Compared with no HL intervention (standard care/no intervention) or an unrelated HL intervention (similar intervention but different information topic) Self-management programmes (SMP) probably improve self-efficacy slightly (standardised mean difference (SMD) 0.28, 95% confidence interval (CI) 0.06 to 0.50; 2 studies, 333 participants; moderate certainty). SMP may improve HIV-related HL (understanding (mean difference (MD) 4.25, 95% CI 1.32 to 7.18); recognition of HIV terms (MD 3.32, 95% CI 1.28 to 5.36)) (1 study, 69 participants). SMP may slightly improve health behaviours (3 studies, 514 participants), but may have little or no effect on knowledge (2 studies, 321 participants) or subjective health status (MD 0.38, 95% CI -0.13 to 0.89; 1 study, 69 participants) (low certainty). We are uncertain of the effects of SMP on QoL, health service use or adverse events due to a lack of evidence. HL skills building courses (HLSBC) may improve knowledge (MD 10.87, 95% CI 5.69 to 16.06; 2 studies, 111 participants) and any generic HL (SMD 0.48, 95% CI 0.20 to 0.75; 2 studies, 229 participants), but may have little or no effect on depression literacy (MD 0.17, 95% CI -1.28 to 1.62) or any health behaviour (2 studies, 229 participants) (low certainty). We are uncertain if HLSBC improve QoL, health outcomes, health service use, self-efficacy or adverse events, due to very low-certainty or a lack of evidence. Audio-/visual education without personal feedback (AVE) probably improves depression literacy (MD 8.62, 95% CI 7.51 to 9.73; 1 study, 202 participants) and health service use (MD -0.59, 95% CI -1.11 to -0.07; 1 study, 157 participants), but probably has little or no effect on health behaviour (risk ratio (RR) 1.07, 95% CI 0.91 to 1.25; 1 study, 135 participants) (moderate certainty). AVE may improve self-efficacy (MD 3.51, 95% CI 2.53 to 4.49; 1 study, 133 participants) and may slightly improve knowledge (MD 8.44, 95% CI -2.56 to 19.44; 2 studies, 293 participants) and intention to seek depression treatment (MD 1.8, 95% CI 0.43 to 3.17), with little or no effect on depression (SMD -0.15, 95% CI -0.40 to 0.10) (low certainty). No evidence was found for QoL and adverse events. Adapted medical instruction may improve understanding of health information (3 studies, 478 participants), with little or no effect on medication adherence (MD 0.5, 95% CI -0.1 to 1.1; 1 study, 200 participants) (low certainty). No evidence was found for QoL, health outcomes, knowledge, health service use, self-efficacy or adverse events. Compared with written information on the same topic SMP probably improves health numeracy slightly (MD 0.7, 95% CI 0.15 to 1.25) and probably improves print literacy (MD 9, 95% CI 2.9 to 15.1; 1 study, 209 participants) and self-efficacy (SMD 0.47, 95% CI 0.3 to 0.64; 4 studies, 552 participants) (moderate certainty). SMP may improve any disease-specific HL (SMD 0.67, 95% CI 0.27 to 1.07; 4 studies, 955 participants), knowledge (MD 11.45, 95% CI 4.75 to 18.15; 6 studies, 1101 participants) and some health behaviours (4 studies, 797 participants), with little or no effect on health information appraisal (MD 1.15, 95% CI -0.23 to 2.53; 1 study, 329 participants) (low certainty). We are uncertain whether SMP improves QoL, health outcomes, health service use or adverse events, due to a lack of evidence or low/very low-certainty evidence. AVE probably has little or no effect on diabetes HL (MD 2, 95% CI -0.15 to 4.15; 1 study, 240 participants), but probably improves information appraisal (MD -9.88, 95% CI -12.87 to -6.89) and application (RR 1.51, 95% CI 1.29 to 1.77) (1 study, 608 participants; moderate certainty). AVE may slightly improve knowledge (MD 8.35, 95% CI -0.32 to 17.02; low certainty). No short-term evidence was found for QoL, depression, health behaviour, self-efficacy, health service use or adverse events. AVE compared with another AVE We are uncertain whether narrative videos are superior to factual knowledge videos as the evidence is of very low certainty. Gender differences Female migrants' diabetes HL may improve slightly more than that of males, when receiving AVE (MD 5.00, 95% CI 0.62 to 9.38; 1 study, 118 participants), but we do not know whether female or male migrants benefit differently from other interventions due to very low-certainty or a lack of evidence. AUTHORS' CONCLUSIONS Adequately powered studies measuring long-term effects (more than six months) of HL interventions in female and male migrants are needed, using well-validated tools and representing various healthcare systems.
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Affiliation(s)
- Annika Baumeister
- Center for Life Ethics/Hertz Chair TRA 4, University of Bonn, Bonn, Germany
| | - Angela Aldin
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Digo Chakraverty
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Constanze Hübner
- Center for Life Ethics/Hertz Chair TRA 4, University of Bonn, Bonn, Germany
| | - Anne Adams
- Institute of Medical Statistics and Computational Biology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Ina Monsef
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nicole Skoetz
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christiane Woopen
- Center for Life Ethics/Hertz Chair TRA 4, University of Bonn, Bonn, Germany
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Hughes-Barton D, Chapman J, Flight I, Wilson C. Utilizing RE-AIM to scope potential for feasible immigrant cancer literacy education. Prev Med Rep 2023; 33:102224. [PMID: 37223576 PMCID: PMC10201872 DOI: 10.1016/j.pmedr.2023.102224] [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: 11/10/2022] [Revised: 03/26/2023] [Accepted: 04/27/2023] [Indexed: 05/25/2023] Open
Abstract
Disparities in cancer incidence and mortality exist between settled and newly-arrived immigrant communities in immigrant-nations, such as Australia, Canada and USA. This may be due to differences in the uptake of cancer prevention behaviours and services for early detection, and cultural, language or literacy barriers impacting understanding of mainstream health messages. Blending cancer-literacy with immigrant English language education presents a promising means to reach new immigrants attending language programs. Guided by the RE-AIM framework for translational research, this study explored the feasibility and translation potential of this approach within the Australian context. Focus groups and interviews (N = 22) were held with English-as-a-Second-Language (ESL) teachers and immigrant resource-centre personnel. Thematic Framework Analysis, driven by RE-AIM, identified potential barriers to Reach for immigrants, Adoption by teachers, Implementation into immigrant-language programs and long-term curriculum Maintenance. Responses further highlighted that an Efficacious ESL cancer-literacy resource could be facilitated by developing flexible, culturally-sensitive content to cater for multiple cultures. Interviewees also raised the importance of developing the resource according to national curricula-frameworks, different language levels, and incorporating varied communicative activities and media. This study therefore offers insight into potential barriers and facilitators to developing a resource feasible for inclusion in existing immigrant-language programs, and achieving reach to multiple communities.
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Affiliation(s)
- Donna Hughes-Barton
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University of South Australia, GPO Box 2100, Adelaide, SA 5001, Australia
| | - Janine Chapman
- Appleton Institute for Behavioural Science, Central Queensland University, 44 Greenhill Road, Wayville, SA 5034, Australia
| | - Ingrid Flight
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University of South Australia, GPO Box 2100, Adelaide, SA 5001, Australia
| | - Carlene Wilson
- Olivia Newton John Cancer Wellness and Research Centre, 145 Studley Road, Heidelberg, VIC 3084, Australia
- La Trobe University, Plenty Road, Bundoora, VIC 3083, Australia
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Sommer TE, Tighe LA, Sabol TJ, Chor E, Chase-Lansdale PL, Yoshikawa H, Brooks-Gunn J, Morris AS, King CT. The effects of a two-generation English as a second language (ESL) intervention on immigrant parents and children in Head Start. APPLIED DEVELOPMENTAL SCIENCE 2023. [DOI: 10.1080/10888691.2023.2174118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
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12
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Wood H, Benino D, Brand G, Clifford R, Lee K, Seubert L. 'You have to have a level of trust': Consumer-described health literacy barriers and enablers to engaging with health care professionals. Health Promot J Austr 2023; 34:173-184. [PMID: 36073007 PMCID: PMC10086825 DOI: 10.1002/hpja.659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 08/17/2022] [Accepted: 09/05/2022] [Indexed: 01/27/2023] Open
Abstract
ISSUE ADDRESSED Health literacy - the degree to which people can access, understand and use health information - is essential for shared decision-making and improved health outcomes. Health consumers' ability to engage with health care professionals (HCPs) is influenced by their health literacy capabilities. This research sought to understand health literacy-related barriers and enablers to engage with non-physician HCPs as experienced by consumers. METHODS A qualitative descriptive approach was undertaken. A semi-structured interview guide was used, incorporating five health literacy domains described in the Health Literacy Questionnaire that related to consumers' engagement with health professionals. Audio- or digitally-recorded interviews were conducted with Australian health consumers, and transcribed and themed using the Patient-centred Access to Care framework as a template. RESULTS Interviewing 30 consumers revealed that HCPs' clinical skills often enabled consumers to seek engagement; however, during active engagement their interpersonal skills became a key enabler. Conversely, a lack of developed interpersonal skills in HCPs was frequently seen as a barrier to consumer engagement. Barriers to engagement were also created when HCPs' information did not match what consumers discovered from other sources. However, consumers self-reported that they were unable to appraise health information at least some of the time. CONCLUSION Barriers and enablers to consumers' engagement with HCPs were identified across each of the five relevant health literacy domains. SO WHAT?: HCPs should be aware of the importance of interpersonal skills and clear health information suitable for consumers with lower health literacy. Additionally, time dedicated to educating consumers on information appraisal could act as a further enabler to effective engagement.
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Affiliation(s)
- Helen Wood
- School of Allied HealthThe University of Western AustraliaPerthAustralia
| | - Diana Benino
- School of Allied HealthThe University of Western AustraliaPerthAustralia
| | - Gabrielle Brand
- School of Allied HealthThe University of Western AustraliaPerthAustralia
- School of Nursing & MidwiferyMonash UniversityMelbourneAustralia
| | - Rhonda Clifford
- School of Allied HealthThe University of Western AustraliaPerthAustralia
| | - Kenneth Lee
- School of Allied HealthThe University of Western AustraliaPerthAustralia
| | - Liza Seubert
- School of Allied HealthThe University of Western AustraliaPerthAustralia
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Li B, Huang Y, Ling C, Jiao F, Fu H, Deng R. The effect of community-based health education programs on health literacy in severely impoverished counties in Southwestern China: Results from a quasi-experimental design. Front Public Health 2023; 10:1088934. [PMID: 36703836 PMCID: PMC9871388 DOI: 10.3389/fpubh.2022.1088934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
Background A national health education program in impoverished counties to promote health literacy among rural populations was released by the Chinese government in 2018. Under this nationwide campaign, an integrated health education program was implemented in Yunnan province, which included additional culturally sensitive educational components for the severely impoverished prefectures. Objective This study examined the differential effects of the health education program models on health literacy outcomes among residents in poverty-stricken areas. Methods A quasi-experimental design was applied with two arms that included surveys at baseline (in October 2019) and endline (in June 2021) to collect a range of individual-level health information, including the Chinese Resident Health Literacy Scale. The intervention group received the national health education program with the additional Yunnan specific program; the control group received only the national program. Respondents were recruited via a multi-stage stratified sampling, including 641 participants at baseline (261 from the intervention sites and 380 from the control sites) and 693 participants at endline (288 from the intervention sites and 405 from the control sites). Chi-square and logistic regression analyses were performed to examine the association between program intervention and health literacy outcomes. Results The overall health literacy levels were low (1.87%) at baseline, and there was no statistically significant difference between two groups (1.92 vs. 1.84%, P = 1.000). A significant increase (from 1.87 to 11.11%, P < 0.001) in the health literacy level was observed at endline in both groups. The magnitude of increase was significantly greater in the intervention group relative to the control group (17.71 vs. 6.42%, P < 0.001). Adjusting for the confounding factors of individual and household characteristics, results from multivariate logistic regression revealed that the odds of having adequate health literacy among participants who received both the National Program and the Yunnan Program were 3.92 times higher than those who only received the National Program (95% CI: 2.10-7.33). Conclusion The findings highlighted the importance of incorporating non-verbal visual aids and culturally-sensitive media tools in health literacy education to address healthy lifestyle and the living contexts of the populations in poverty-stricken areas.
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Affiliation(s)
- Benyan Li
- School of Public Health, Kunming Medical University, Kunming, China,Department of Health Insurance, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yuan Huang
- School of Public Health, Kunming Medical University, Kunming, China
| | - Caitlyn Ling
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Feng Jiao
- School of Public Health, Kunming Medical University, Kunming, China
| | - Hongyun Fu
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, United States,Hongyun Fu ✉
| | - Rui Deng
- School of Public Health, Kunming Medical University, Kunming, China,*Correspondence: Rui Deng ✉
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An Acceptance and Commitment Training (ACT) Framework for Teaching Cultural Humility: A Guide for Translating ACT from a Therapeutic Context into a Medical Education Curriculum. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09909-1. [PMID: 36053403 PMCID: PMC9437399 DOI: 10.1007/s10880-022-09909-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 11/25/2022]
Abstract
The objective of this project was to train future physicians to work effectively and thoughtfully with diverse populations by teaching them to employ Acceptance and Commitment Training (ACT) skills to increase cultural humility, with the goal of improving attitudes, knowledge, and beliefs about working with diverse patients. We developed ACT for cultural humility online interactive modules as part of an elective course to teach Medical Spanish to 4th-year medical students. Pre- and post-pilot data pertaining to the cultural humility training modules on the Work-Related Acceptance and Action questionnaire, Multidimensional Cultural Humility Scale, knowledge, attitudes, and beliefs were analyzed using paired samples t-tests and Wilcoxon signed-rank tests. We also included descriptive data pertaining to overall satisfaction with the cultural humility modules and intent to apply the material learned to patient care. Our data showed a significant increase in the cultural humility of our participants as well as an increase in psychological flexibility, a higher favorability rating toward various ethnicities, improvements in attitude, and positive changes in beliefs and knowledge following completion of the modules. The modules were well received by the medical students, with high social validity ratings. The ACT for cultural humility curriculum has great potential to enhance medical education in diversity, equity, and inclusion by increasing both the understanding and the cultural humility of medical students and future professionals to work with diverse populations. The current paper provides a framework that can be used by other programs to shape the education of the future medical workforce to help promote culturally humble care.
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Sawyers L, Anderson C, Aslani P, Duncan G, Janjua SS, Toh LS. Community health literacy outcome measurement practices: A scoping review of recent interventions. Health Sci Rep 2022; 5:e810. [PMID: 36101717 PMCID: PMC9455946 DOI: 10.1002/hsr2.810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/12/2022] [Accepted: 08/14/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Evidence suggests that, while a preference for functional Health Literacy (HL) outcome measurement exists, researchers are converging towards more all-encompassing instruments. While this claim is present in the HL field, minimal research has comprehensively explored the state of community HL measurement practices at the direct and proxy level. The almost exclusive focus on direct, as opposed to proxy, community HL measurement indicates a review of progress is needed. Objective To identify HL outcome measurement practices for community HL interventions at the direct and proxy level of measurement. Search Strategy Medline, PsycINFO, Web of Science, ERIC, Embase, Scopus, CINAHL, ProQuest Dissertations and Theses, Google Scholar and targeted websites were searched. Inclusion Criteria Studies were sampled from the general population, included HL as an outcome of interest, involved an intervention aiming to improve HL, were English-text publications and were published ≥2010. Data Extraction and Synthesis Study author(s) and publication years, sample characteristics, intervention profiles and direct and proxy instrument and outcome measurement information were extracted. Full-text review retrieved 25 eligible studies. Main Results In total, 21 unique direct and 38 unique proxy instruments were extracted. The majority of interventions assessed functional compared to communicative, critical, and other HL domains, with objective instruments more frequently used than subjective or combined objective-subjective types, though more unique subjective HL instruments were extracted overall. The Test of Functional HL in Adults was the most popular instrument, and perceived health, knowledge, behaviors and health intentions were the most frequent proxy outcome measures, with only the Healthy Lifestyle Behavior Scale-II and Patient Activation Measure used across multiple interventions. Discussion and Conclusions Direct HL outcome practices endured a unidimensional profile, despite previous suggestions of a convergence towards holistic instruments. This review provides the first overview of proxy HL measurement across community HL interventions, identifying substantial variation in proxy outcome practices. Patient or Public Contribution A University-based senior librarian contributed to the development of the search strategy, and reviewed iterations of the strategy until refinement was complete. No further public or patient contribution was made given the review-based nature of the research.
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Affiliation(s)
- Luke Sawyers
- Division of Pharmacy Practice and Policy, School of PharmacyUniversity of NottinghamNottinghamUK
| | - Claire Anderson
- Division of Pharmacy Practice and Policy, School of PharmacyUniversity of NottinghamNottinghamUK
| | - Parisa Aslani
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of SydneySydneyAustralia
| | - Gregory Duncan
- Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneAustralia
| | - Sobia S. Janjua
- Division of Pharmacy Practice and Policy, School of PharmacyUniversity of NottinghamNottinghamUK
| | - Li Shean Toh
- Division of Pharmacy Practice and Policy, School of PharmacyUniversity of NottinghamNottinghamUK
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Chakraverty D, Baumeister A, Aldin A, Seven ÜS, Monsef I, Skoetz N, Woopen C, Kalbe E. Gender differences of health literacy in persons with a migration background: a systematic review and meta-analysis. BMJ Open 2022; 12:e056090. [PMID: 37667874 PMCID: PMC9301804 DOI: 10.1136/bmjopen-2021-056090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 07/03/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate gender differences of health literacy in individuals with a migration background. DESIGN Systematic review and meta-analysis. OVID/MEDLINE, PsycINFO and CINAHL were searched in March 2018 and July 2020. SETTING Studies had to provide health literacy data for adult women and men with a migration background, collected with a standardised instrument, or report results that demonstrated the collection of such data. Health literacy data were extracted from eligible studies or requested from the respective authors. Using a random-effects model, a meta-analysis was conducted to assess standardised mean differences (SMDs) of health literacy in men and women. Two researchers independently assessed risk of bias for each included study using the Appraisal Tool for Cross-Sectional Studies. RESULTS Twenty-four studies were included in this systematic review. Thereof, 22 studies (8012 female and 5380 male participants) were included in the meta-analyses. In six studies, gender-specific health literacy scores were reported. The authors of additional 15 studies provided their data upon request and for one further study data were available online. Women achieved higher health literacy scores than men: SMD=0.08, 95% CI 0.002 to 0.159, p=0.04, I2=65%. Another 27 studies reported data on female participants only and could not be included due to a lack of comparable studies with male participants only. Authors of 56 other eligible studies were asked for data, but without success. CONCLUSION Men with a migration background-while being much less frequently examined-may have lower health literacy than women. As heterogeneity between studies was high and the difference became statistically insignificant when excluding studies with a high risk of bias, this result must be interpreted with caution. There is a paucity of research on the social and relational aspects of gender in relation to health literacy among people with a migration background, especially for men. PROSPERO REGISTRATION NUMBER CRD42018085555.
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Affiliation(s)
- Digo Chakraverty
- Medical Psychology | Neuropsychology and Gender Studies and Centre for Neuropsychological Diagnostics and Intervention (CeNDI), University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Annika Baumeister
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (CERES),University of Cologne and Research Unit Ethics, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Angela Aldin
- Evidence-Based Oncology, Department I of Internal Medicine, University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Ümran Sema Seven
- Medical Psychology | Neuropsychology and Gender Studies and Centre for Neuropsychological Diagnostics and Intervention (CeNDI), University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Ina Monsef
- Evidence-Based Oncology, Department I of Internal Medicine, University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Nicole Skoetz
- Evidence-Based Oncology, Department I of Internal Medicine, University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Christiane Woopen
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (CERES),University of Cologne and Research Unit Ethics, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Elke Kalbe
- Medical Psychology | Neuropsychology and Gender Studies and Centre for Neuropsychological Diagnostics and Intervention (CeNDI), University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
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Noblin A, Gabriel MH, Cortelyou-Ward K, Holmes K. Health literacy among visiting college students in the U.S.: A pilot study. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:589-597. [PMID: 32432972 DOI: 10.1080/07448481.2020.1758114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 03/06/2020] [Accepted: 04/13/2020] [Indexed: 06/11/2023]
Abstract
Objective This study examined the health literacy of international college students from Colombia visiting the United States. Participants: Thirty (30) students from a Colombian university completed the survey in October 2017. Methods: This pilot study surveyed international college students using the eHEALS and Newest Vital Signs (NVS) health literacy tools to determine the health literacy of this group. Although these students spoke English, a translator was provided. Results: The results show 63% of participants agreed they were confident with filling out health forms alone. In terms of finding helpful health resources on the Internet, 87% of participants felt they knew how to find health information, while 80% felt they knew where to find the resources. Conclusion: There was no association between the health literacy and the confidence of completing forms alone or the perception of using the Internet to answer health questions and knowing where to find helpful resources on the Internet.
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Affiliation(s)
- Alice Noblin
- Department of Health Management and Informatics, University of Central Florida, Orlando, Florida, USA
| | - Meghan Hufstader Gabriel
- Department of Health Management and Informatics, University of Central Florida, Orlando, Florida, USA
| | - Kendall Cortelyou-Ward
- Department of Health Management and Informatics, University of Central Florida, Orlando, Florida, USA
| | - Khristen Holmes
- Department of Health Management and Informatics, University of Central Florida, Orlando, Florida, USA
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Nzomo P, McKenzie P, Ajiferuke I, Vaughan L. Towards a Definition of Multilingual Information Literacy (MLIL): An Essential Skill for the 21st Century. JOURNAL OF LIBRARY ADMINISTRATION 2021. [DOI: 10.1080/01930826.2021.1972737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Peggy Nzomo
- Global Education Librarian, Kent State University, Kent, OH, USA
| | | | - Isola Ajiferuke
- Associate Professor, Western University, London, Ontario, Canada
| | - Liwen Vaughan
- Professor Emeritus, Western University, London, Ontario, Canada
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Abstract
BACKGROUND Cultural background, language, and literacy are factors that may affect access, healthcare utilization, and cancer screening behaviors. OBJECTIVE This study aimed to characterize health literacy among Spanish-preferring Hispanic/Latino individuals ages 50-75 and examine associations between sociodemographic characteristics, health beliefs, and health literacy. METHODS Participants self-identified as Hispanic/Latino, preferring health information in Spanish, were ages 50-75 years old, at average risk for colorectal cancer (CRC), not up to date with CRC screening, and enrolled in a CRC screening education intervention trial. Sociodemographic characteristics, health beliefs, and health literacy (i.e., difficulty understanding written health information and confidence completing health forms) were assessed at baseline. Descriptive and logistic regression analyses were performed. RESULTS Fifty-three percent of participants reported either sometimes having difficulty or always having difficulty with written health information, and 25% reported always asking for help or being not so confident in completing health forms. Univariate predictors of adequate health literacy for written health information were lower cancer worry and lower religious beliefs. Higher educational attainment predicted confidence in completing health forms. CONCLUSIONS Findings highlight the need for interventions that address health beliefs and health literacy among Hispanic/Latino patients who have low confidence in completing written forms and difficulty understanding written information and reinforce the use of plain language and salient design features when developing patient education materials.
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Pitts MH, Smith NJ, Bates JA, Stevenson R, Fohner AM, Moser HM, Pahl B, Chen AMH. Development and perceptions of an academic success tool for pharmacy students. Res Social Adm Pharm 2021; 18:3131-3136. [PMID: 34483081 DOI: 10.1016/j.sapharm.2021.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Some students may face challenges with graduate-level reading and writing, particularly in certain active learning pedagogies, such as team-based learning or peer instruction, which require extensive pre-reading. The objective of this study is to determine the perceived utility of an academic literacy (reading/writing) test for first professional year student pharmacists (P1s). METHODS In a collaboration between pharmacy and linguistics faculty, an academic literacy assessment tool was developed using fall P1 course materials. After pilot testing and adjustments, the revised test was administered to all P1 students by trained facilitators, then scored. Students needing literacy support were identified, met with individually to debrief on the assessment, and offered a year-long, one-on-one tutoring program. P1 faculty participated in an end-of-semester focus group session to determine whether the assessment correctly identified students who benefited from literacy support, and to decide on the impact of subsequent support. Thematic analysis was performed on the data. RESULTS A total of 13 students were identified as at-risk through the assessment. Since tutoring was optional, eight students met at least once, and two students met weekly during the ensuing semester. Faculty from the end-of-semester focus group 1) stated that the assessment accurately pre-identified students who struggled with literacy components of P1 coursework, and 2) expressed a wish for earlier identification of students with required instead of optional tutoring. CONCLUSIONS Faculty perceived that the tool accurately identified students, but the timing and the volunteer nature of the follow-up tutoring limited the success of the assessment effort.
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Affiliation(s)
- Merideth Hoagland Pitts
- Pharmacy Practice, Cedarville University School of Pharmacy, 251 N. Main St., Cedarville, OH, 45314, USA.
| | - Nathanael J Smith
- Pharmacy Practice, Cedarville University School of Pharmacy, 251 N. Main St., Cedarville, OH, 45314, USA.
| | - Jeffrey A Bates
- Pharmacy Practice, Cedarville University School of Pharmacy, 251 N. Main St., Cedarville, OH, 45314, USA.
| | - Rachel Stevenson
- Pharmacy Practice, Cedarville University School of Pharmacy, 251 N. Main St., Cedarville, OH, 45314, USA.
| | - Amy M Fohner
- Pharmacy Practice, Cedarville University School of Pharmacy, 251 N. Main St., Cedarville, OH, 45314, USA.
| | - Haylee M Moser
- Pharmacy Practice, Cedarville University School of Pharmacy, 251 N. Main St., Cedarville, OH, 45314, USA.
| | - Brenda Pahl
- Pharmacy Practice, Cedarville University School of Pharmacy, 251 N. Main St., Cedarville, OH, 45314, USA.
| | - Aleda M H Chen
- Pharmacy Practice, Cedarville University School of Pharmacy, 251 N. Main St., Cedarville, OH, 45314, USA.
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21
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Walters R, Leslie SJ, Polson R, Cusack T, Gorely T. Establishing the efficacy of interventions to improve health literacy and health behaviours: a systematic review. BMC Public Health 2020; 20:1040. [PMID: 32605608 PMCID: PMC7329558 DOI: 10.1186/s12889-020-08991-0] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/27/2020] [Indexed: 12/29/2022] Open
Abstract
Background The primary aim of this review was to establish whether health literacy interventions, in adults, are effective for improving health literacy. Two secondary aims assessed the impact of health literacy interventions on health behaviours and whether health literacy interventions have been conducted in cardiovascular patients. Methods A systematic review (Prospero registration: CRD42018110772) with no start date running through until April 2020. Eligible studies were conducted in adults and included a pre/post measure of health literacy. Medline, Embase, Eric, PsychINFO, CINAHL, Psychology and Behavioural Science, HMIC, Web of Science, Scopus, Social Care Online, NHS Scotland Journals, Social Policy and Practice, and Global Health were searched. Two thousand one hundred twenty-seven papers were assessed, and 57 full text papers screened to give 22 unique datasets from 23 papers. Risk of bias was assessed regarding randomisation, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting and other biases. Intervention reporting quality was assessed using the TIDieR checklist. Results Twenty-two studies were included reporting on 10,997 participants in nine countries. The majority of studies (14/22) were published in 2018 or later. Eight studies (n = 1268 participants) also reported on behavioural outcomes. Health literacy interventions resulted in improvements in at least some aspect of health literacy in 15/22 studies (n = 10,180 participants) and improved behavioural outcomes in 7/8 studies (n = 1209 participants). Only two studies were conducted with cardiovascular patients. All studies were at risk of bias with 18 judged as high risk. In addition, there was poor reporting of intervention content with little explication of the theoretical basis for the interventions. Conclusions Health literacy interventions can improve health literacy and can also lead to changes in health behaviours. Health literacy interventions offer a way to improve outcomes for populations most at risk of health inequalities. Health literacy is a developing field with very few interventions using clear theoretical frameworks. Closer links between health literacy and behaviour change theories and frameworks could result in higher quality and more effective interventions. Prospero registration Prospero registration: CRD42018110772
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Affiliation(s)
- Ronie Walters
- Centre for Health Science, University of the Highlands and Islands, Old Perth Road, Inverness, IV2 3JH, UK.
| | - Stephen J Leslie
- Centre for Health Science, University of the Highlands and Islands, Old Perth Road, Inverness, IV2 3JH, UK.,NHS Highlands, Cardiology Department, Raigmore Hospital, Old Perth Road, Inverness, IV2 3JH, UK
| | - Rob Polson
- Centre for Health Science, University of the Highlands and Islands, Old Perth Road, Inverness, IV2 3JH, UK
| | - Tara Cusack
- University College Dublin, Health Sciences Building, Bellfield, Dublin, Ireland
| | - Trish Gorely
- Centre for Health Science, University of the Highlands and Islands, Old Perth Road, Inverness, IV2 3JH, UK
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22
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Development and pilot testing of a health education program to improve immigrants' access to Canadian health services. BMC Health Serv Res 2020; 20:321. [PMID: 32303224 PMCID: PMC7164356 DOI: 10.1186/s12913-020-05180-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/01/2020] [Indexed: 11/14/2022] Open
Abstract
Background In Canada’s increasing immigrant population, a phenomenon called the “healthy immigrant effect” has arisen in which health declines after four years of settling. Access to healthcare is an important consideration. There is strong evidence that immigrants lack confidence and knowledge for navigating health services. The aim of this study was to develop and pilot test the Accessing Canadian Healthcare for Immigrants: Empowerment, Voice & Enablement (ACHIEVE) program. Method The study employed an exploratory sequential mixed methods design. A qualitative study was completed. Program content was developed based on a scoping review and refined in a formative evaluation. Then, a pilot test of the program measured participants’ perceived efficacy in improving confidence in healthcare navigation, program satisfaction, and learning in individual sessions. Results Researchers found significantly higher rates of health navigation and an increase in knowledge about the Canadian health system post-program. Conclusions Results provide promising evidence that ACHIEVE may improve confidence in healthcare access among immigrants, demonstrating potential for dispersion on a larger scale.
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23
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Hoffman S, Rueda HA, Beasley L. Health-Related Quality of Life and Health Literacy among Mexican American and Black American Youth in a Southern Border State. SOCIAL WORK IN PUBLIC HEALTH 2020; 35:114-124. [PMID: 32248757 DOI: 10.1080/19371918.2020.1747584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Among adults, health literacy and health-related quality of life are highly correlated constructs that are associated with tangible health outcomes. While the connection between these concepts and health outcomes among youth is still unclear, studying these factors among at-risk adolescent populations can provide researchers, policy-creators, and educators a quantifiable summary of the challenge they face in their efforts to reduce health disparities. The purpose of this study was to better understand the health of minority youth living in a Southern state near the US-Mexico border. Specifically, we sought to describe their health literacy and health-related quality of life, and identify how those concepts may be interrelated. Results indicated that our sample of primarily Mexican American and Black American youth living along the US-Mexico border may be struggling more than other known high-risk groups in terms of health literacy and health-related quality of life. Practical implications for families, schools, and border communities are discussed.
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Affiliation(s)
- Steven Hoffman
- School of Social Work, Brigham Young University, Provo, Utah, USA
| | - Heidi Adams Rueda
- Department of Social Work, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Lauren Beasley
- Knoxville Department of Kinesiology, Recreation and Sport Studies, University of Tennessee, Knoxville, Tennessee, USA
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24
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McCaffery KJ, Morony S, Muscat DM, Hayen A, Shepherd HL, Dhillon HM, Smith SK, Cvejic E, Meshreky W, Luxford K, Nutbeam D. Evaluation of an Australian Health Literacy Program Delivered in Adult Education Settings. Health Lit Res Pract 2019; 3:S42-S57. [PMID: 31687657 PMCID: PMC6826892 DOI: 10.3928/24748307-20190402-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/05/2019] [Indexed: 01/07/2023] Open
Abstract
Background: Adult education targeting health literacy (HL) may bring added value in the form of improved health. Objective: This study evaluated the effects of a HL program as part of an adult education curriculum for adults with low literacy and numeracy. Methods: This was a partial-cluster randomized controlled trial among 308 adults enrolled in basic education programs in Australia. Of the 308 participants, 141 (46%) were randomized to either the standard program (language, literacy, and numeracy [LLN]), or the HL intervention (LLN with embedded health content); the remainder (n = 167) were allocated to standard intervention programs by the education provider at the class level. The main outcomes were functional HL, self-reported confidence, patient activation, generic HL (ie, HLQ, health knowledge, and self-reported health behavior). Data were collected at baseline, immediately after, and at 6 months post-intervention. Key Results: Of the 308 participants, 71% had limited literacy and 60% spoke a language other than English at home. Both interventions benefited participants, with improvements from baseline to immediate follow up on individual-level functional HL (e.g., reading a thermometer; HL group 18.4% vs. standard group 7.2%; p = .001), confidence (HL group 0.34 vs. standard group 0.06; p = .014) and health literacy questionnaire (HLQ) subscales. At 6 months, improvements in confidence (p < .001) and some HLQ measures were retained. A consistent pattern of increased improvement in the HL program was observed compared to the standard program, although only some measures reached statistical significance: reading a food label (HL group 6.03/10 correct vs. standard group 5.49/10 correct; p = .022); confidence (p = .008); ability to actively manage health (HLQ) (p = .017), and health knowledge at 6 months (HL group 68% vs. standard group 60% correct, p = .052). HL participants reported being more likely to share course information and rated the program more useful to understand their health. Conclusions: Improving language, literacy, and numeracy generally has potential public health benefits that are retained at 6 months. Integrating health content adds further value to adult basic learning, is feasible, and potentially scalable. [HLRP: Health Literacy Research and Practice. 2019;3(Suppl.):S42–S57.] Plain Language Summary: We compared the effect of an adult education-based health literacy (HL) program versus a standard language, literacy, and numeracy program on students' HL skills and psychosocial outcomes. Although students in both trial arms improved their skills, students in the HL program had better outcomes with higher HL, greater confidence, and higher health knowledge scores at 6 months.
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Affiliation(s)
- Kirsten J. McCaffery
- Address correspondence to Kirsten J. McCaffery, PhD, Sydney School of Public Health, Room 128B Edward Ford Building, The University of Sydney, NSW 2006, Australia;
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25
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Hughes DL, Flight I, Chapman J, Wilson C. Can we address cancer disparities in immigrants by improving cancer literacy through English as a second language instruction? Transl Behav Med 2019; 9:357-367. [PMID: 29596625 DOI: 10.1093/tbm/iby030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
In many Western countries, immigrants exhibit disparities in cancer incidence and mortality, and variable uptake of cancer prevention services. New immigrants may not be aware of cancer risks pertinent to their new country, or prevention resources. Traditional cancer prevention health messaging may not be accessible for cultural, language, or literacy reasons. New methods are needed. In North America, health message delivery via English classes for immigrants is showing potential as an efficacious and a feasible way to reach immigrants at the same time improving language skills. Interventions published to date are promising but limited in their ability to generalize or be adapted to a variety of populations and settings. This concept paper aims to synthesize previous findings and identify ways to improve and advance the translation potential of this approach. We propose that this could be achieved by (i) using a translation framework to guide intervention planning, development, implementation, and evaluation; (ii) encouraging and evaluating health message spread throughout language learners' social networks; and (iii) incorporating cultural sensitivity into the curriculum. A pilot project following these recommendations is planned for Australia and will be discussed. These recommendations could serve as a framework to fit the requirements of immigrant language programs in other countries and other health topics.
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Affiliation(s)
- Donna L Hughes
- Flinders Centre for Innovation in Cancer, School of Medicine, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Ingrid Flight
- Flinders Centre for Innovation in Cancer, School of Medicine, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Janine Chapman
- Flinders Centre for Innovation in Cancer, School of Medicine, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Carlene Wilson
- Flinders Centre for Innovation in Cancer, School of Medicine, Flinders University of South Australia, Adelaide, South Australia, Australia.,La Trobe University, School of Psychology and Public Health, Plenty Rd & Kingsbury Dr, Bundoora VIC 3083 & the Olivia Newton-John Cancer and Wellness Centre, Heidelberg VIC
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26
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Champlin S, Hoover DS, Mackert M. Health Literacy in Adult Education Centers: Exploring Educator and Staff Needs. Health Promot Pract 2018; 21:198-208. [PMID: 30070148 DOI: 10.1177/1524839918789690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective. Incorporating health content into adult education courses is promising for increasing health literacy skills among "hard-to-reach" populations. The purpose of this study was to gain previously untapped knowledge of adult education personnel (i.e., educators, staff) about the strategies and programs that would be beneficial for helping students learn about health. Method. Personnel (N = 53) from three literacy coalitions completed an online survey that assessed interest and preferences for developing a health literacy curriculum. Results. Personnel indicated general concepts such as health services and insurance as those of greatest priority. Additionally, tools designed for general use (completion of forms) were favored. Personnel preferred programs that focused on general skills over those designed to address specific health topics, χ2(1) = 11.52, p = .001. Conclusions. Adult education personnel find greatest value in health literacy programs aimed at increasing general skills rather than disease-/topic-specific content. There were several mismatches in topics noted as a "priority" and those for which personnel felt comfortable teaching. A focus on fostering general health skills will help all students-not just those with specific health concerns such as diabetes and asthma. Teaching health literacy through general skill development could make health programs exciting, engaging, and accessible for students.
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27
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Soto Mas F, Jacobson HE. Advancing Health Literacy Among Hispanic Immigrants: The Intersection Between Education and Health. Health Promot Pract 2018; 20:251-257. [PMID: 29564920 DOI: 10.1177/1524839918761865] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Health literacy is a priority issue in both medicine and public health, as it refers to the capacity to obtain and understand basic health information and services and to make appropriate health decisions. Health literacy has been associated with a variety of health care and health outcomes such as hospital admissions, use of preventive services, management of chronic conditions, and mortality. There is also evidence of the connection between low health literacy and health disparities. Despite federal and private efforts, improving health literacy has proven to be an enormous challenge. The negative health consequences of low health literacy are being experienced by most minority groups; however, health literacy is particularly relevant to Spanish speakers. Although disparities in health literacy among language minorities have been sufficiently identified and reported, there continue to exist fundamental research gaps. This article discusses health literacy research and practice gaps affecting Spanish speakers and recommends educational opportunities as an effective strategy for improving the health literacy level of Hispanic immigrants.
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28
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Soto Mas F, Schmitt CL, Jacobson HE, Myers OB. A Cardiovascular Health Intervention for Spanish Speakers: The Health Literacy and ESL Curriculum. J Community Health 2018; 43:717-724. [PMID: 29428986 DOI: 10.1007/s10900-018-0475-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Spanish speakers in the United States are in need of effective interventions that address both cardiovascular disease (CVD) and health literacy. However, the literature lacks interventions that have used and evaluated a strategies that focus on both, particularly at the community level. The aim of this study was to explore the effect of a health literacy curriculum on cardiovascular health behavior among Spanish speaking adults. It used a randomized controlled pre-posttest design. Participants included Hispanic adults with a low-to-intermediate level of English proficiency. The intervention group received the health literacy and English as a second language (ESL) Curriculum with CVD specific content, while the control group received a conventional ESL curriculum. Tools included the Spanish Cardiovascular Health Questionnaire (CSC), the test of functional health literacy in adults (TOFHLA), and the Combined English Language Skills Assessment. Analysis of change scores included independent sample t test and multiple linear regression. A total of 155 participants completed the study. There was a significant greater improvement for the intervention group in change of CSC score from pretest to posttest (P = 0.049) compared to controls. The study also found significantly improved TOFHLA (P = 0.011), however it did not find a relationship between changes in CVD behavior and health literacy or English proficiency. The Health Literacy and ESL Curriculum constitutes a valuable resource for addressing the cardiovascular health, literacy, and language needs of Spanish-speaking adults. Interventions that take a multilevel education and health approach may be more effective in addressing the needs of immigrants. Research should further explore the interactions between CVD behavior, health literacy, and English proficiency.
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Affiliation(s)
- Francisco Soto Mas
- College of Population Health MSC09 5070, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA.
| | - Cheryl L Schmitt
- School of Medicine, Family & Community Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Holly E Jacobson
- Department of Linguistics, University of New Mexico, Albuquerque, NM, USA
| | - Orrin B Myers
- School of Medicine, Family & Community Medicine, University of New Mexico, Albuquerque, NM, USA
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29
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Muscat DM, Shepherd HL, Nutbeam D, Morony S, Smith SK, Dhillon HM, Trevenal L, Hayen A, Luxford K, McCaffery K. Developing Verbal Health Literacy with Adult Learners Through Training in Shared Decision-Making. Health Lit Res Pract 2017; 1:e257-e268. [PMID: 31294271 PMCID: PMC6607778 DOI: 10.3928/24748307-20171208-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 10/27/2017] [Indexed: 11/20/2022] Open
Abstract
Background Health literacy skills are often assessed in relation to written health materials; however, many important communications are in other formats, especially verbal communication with health care providers. Objective This qualitative study sought to examine adult learners' experiences of developing verbal health literacy skills within an Australian adult basic education program, and to explore verbal communication and shared decision-making as a constituent domain of health literacy. Methods We conducted a semi-structured qualitative interview study between September and November 2014 with adult learners who had participated in a single-semester health literacy program that included an integrated shared decision-making component. We analyzed interviews using the Framework method; a matrix-based approach to thematic analysis. A hybrid process of inductive and deductive coding was used to interpret raw data. Key Results Interviewees were 22 students from six health literacy classes and ranged in age from 18 to 74 years (mean, 48.3). The majority were women (n = 15) and born outside Australia (n = 13). Health literacy was generally limited according to the Newest Vital Sign screening tool (n = 17). The health literacy program appeared to serve two key functions. First, it stimulated awareness that patients have the right to participate in decision-making concerning their treatment and care. Second, it facilitated verbal skill development across the domains of functional (e.g., communicating symptoms), communicative (e.g., asking questions to extract information about treatment options), and critical (e.g., integrating new knowledge with preferences) health literacy. Conclusions Our findings support the conceptualization of health literacy as a modifiable health asset that is subject to change and improvement as a result of deliberate intervention. Results reinforce verbal health literacy as an important component of health literacy, and draw attention to the hierarchy of verbal skills needed for consumers to become more actively involved in decisions about their health. We present a revised model of health literacy based on our findings. [Health Literacy Research and Practice. 2017;1(4):e257-e268.]. Plain Language Summary We developed a health literacy program for adults with lower literacy to help learners develop skills to talk to health care providers and share health decisions. The program was taught in Australian adult education settings. The article explores the range of health literacy skills needed for communication and decision-making in this study, and presents a model in which verbal skills are an important part of health literacy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Kirsten McCaffery
- Address correspondence to Kirsten McCaffery, PhD, Room 128B, Edward Ford Building (A27), The University of Sydney, NSW, 2006, Australia;
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30
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Morony S, Lamph E, Muscat D, Nutbeam D, Dhillon HM, Shepherd H, Smith S, Khan A, Osborne J, Meshreky W, Luxford K, Hayen A, McCaffery KJ. Improving health literacy through adult basic education in Australia. Health Promot Int 2017; 33:867-877. [DOI: 10.1093/heapro/dax028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Suzanne Morony
- Sydney School of Public Health, The University of Sydney, NSW, Australia
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, NSW, Australia
| | - Emma Lamph
- School of Psychology, The University of Sydney, NSW, Australia
| | - Danielle Muscat
- Sydney School of Public Health, The University of Sydney, NSW, Australia
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, NSW, Australia
| | - Don Nutbeam
- Sydney School of Public Health, The University of Sydney, NSW, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, NSW, Australia
- School of Psychology, The University of Sydney, NSW, Australia
| | - Heather Shepherd
- Sydney School of Public Health, The University of Sydney, NSW, Australia
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, NSW, Australia
- Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, NSW, Australia
| | - Sian Smith
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Aisha Khan
- College of Global Public Health, New York University, NY, USA
| | - Julie Osborne
- Health and Social Policy Branch, NSW Ministry of Health, NSW, Australia
| | | | - Karen Luxford
- Executive Director, Clinical Excellence Commission, NSW, Australia
| | - Andrew Hayen
- Faculty of Health, University of Technology Sydney, NSW, Australia
| | - Kirsten J McCaffery
- Sydney School of Public Health, The University of Sydney, NSW, Australia
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, NSW, Australia
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31
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Fernández-Gutiérrez M, Bas-Sarmiento P, Albar-Marín MJ, Paloma-Castro O, Romero-Sánchez JM. Health literacy interventions for immigrant populations: a systematic review. Int Nurs Rev 2017; 65:54-64. [PMID: 28449363 DOI: 10.1111/inr.12373] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Health literacy is considered a social health determinant that influences improvement in health, patient empowerment and reduction in inequalities. There is a lack of health literacy interventions for vulnerable social groups (i.e. immigrants), and nurses have shown little familiarity with the concept. AIM This study aimed to identify and analyse whether interventions directed at immigrant populations improve the functional (basic reading, writing and arithmetic skills), interactive (social and cognitive skills) and critical (advanced cognitive and social skills in critically analyzing information and making informed decisions) dimensions of health literacy, taking into account the role played by nursing in these interventions. METHODS A systematic review of four databases including PubMed, PsycINFO, the Cochrane Library and ERIC was conducted to identify relevant articles published between 2000 and 2015. Thirty-four articles met the inclusion criteria, and nine articles used a validated instrument. RESULTS Few specific health literacy interventions for immigrant populations were found. The main findings of the studies showed positive changes in functional health literacy. However, the interventions were less effective in improving interactive and critical health literacy. LIMITATIONS Several of the findings of this review were based on studies that had their own limitations. The assessment of the articles was not blinded, and the review was restricted to articles written in Spanish and English. CONCLUSIONS The interventions studied were reported as being effective in improving health literacy in immigrants, particularly the functional aspects. Regarding the role played by nursing, this review observed little involvement. IMPLICATIONS FOR NURSING AND HEALTH POLICY It is important for educational strategies to include health literacy dimensions. The concept of health literacy should be included as a Nursing Outcomes Classification and in its subsequent validation taxonomy. To promote community health, health literacy must be a prioritized objective of health management and policies.
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Affiliation(s)
- M Fernández-Gutiérrez
- Nursing and Physiotherapy Department, Faculty of Nursing, University of Cadiz, Algeciras, Cádiz, Spain
| | - P Bas-Sarmiento
- Nursing and Physiotherapy Department, Faculty of Nursing, University of Cadiz, Algeciras, Cádiz, Spain
| | | | - O Paloma-Castro
- Nursing and Physiotherapy Department, Faculty of Nursing, University of Cadiz, Algeciras, Cádiz, Spain
| | - J M Romero-Sánchez
- Airbus, Research Development and Innovation Scheme CTS.391, University of Cadiz, Cádiz, Spain
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32
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Nutbeam D, McGill B, Premkumar P. Improving health literacy in community populations: a review of progress. Health Promot Int 2017; 33:901-911. [DOI: 10.1093/heapro/dax015] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Don Nutbeam
- Prevention Research Collaboration, Sydney School of Public Health, Charles Perkins Centre, University of Sydney, NSW, Australia
| | - Bronwyn McGill
- Prevention Research Collaboration, Sydney School of Public Health, Charles Perkins Centre, University of Sydney, NSW, Australia
| | - Pav Premkumar
- Southampton Education School, University of Southampton, Southampton, UK
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33
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Low Health Literacy among Immigrant Hispanics. J Racial Ethn Health Disparities 2016; 4:480-483. [DOI: 10.1007/s40615-016-0249-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 05/30/2016] [Accepted: 05/31/2016] [Indexed: 01/30/2023]
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34
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Muscat DM, Smith S, Dhillon HM, Morony S, Davis EL, Luxford K, Shepherd HL, Hayen A, Comings J, Nutbeam D, McCaffery K. Incorporating health literacy in education for socially disadvantaged adults: an Australian feasibility study. Int J Equity Health 2016; 15:84. [PMID: 27259476 PMCID: PMC4893249 DOI: 10.1186/s12939-016-0373-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 05/19/2016] [Indexed: 11/16/2022] Open
Abstract
Background Adult education institutions have been identified as potential settings to improve health literacy and address the health inequalities that stem from limited health literacy. However, few health literacy interventions have been tested in this setting. Methods Feasibility study for an RCT of the UK Skilled for Health Program adapted for implementation in Australian adult education settings. Implementation at two sites with mixed methods evaluation to examine feasibility, test for change in participants’ health literacy and pilot test health literacy measures. Results Twenty-two socially disadvantaged adults with low literacy participated in the program and received 80–90 hours of health literacy instruction. The program received institutional support from Australia’s largest provider of vocational education and training and was feasible to implement (100 % participation; >90 % completion; high teacher satisfaction). Quantitative results showed improvements in participants’ health literacy skills and confidence, with no change on a generic measure of health literacy. Qualitative analysis identified positive student and teacher engagement with course content and self-reported improvements in health knowledge, attitudes, and communication with healthcare professionals. Conclusions Positive feasibility results support a larger RCT of the health literacy program. However, there is a need to identify better, multi-dimensional measures of health literacy in order to be able to quantify change in a larger trial. This feasibility study represents the first step in providing the high quality evidence needed to understand the way in which health literacy can be improved and health inequalities reduced through Australian adult education programs. Electronic supplementary material The online version of this article (doi:10.1186/s12939-016-0373-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Danielle M Muscat
- The Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia. .,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Sian Smith
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia.,Concord Clinical School, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Suzanne Morony
- The Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Esther L Davis
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Karen Luxford
- Patient Based Care, Clinical Excellence Commission, Sydney, NSW, 2000, Australia
| | - Heather L Shepherd
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.,Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Andrew Hayen
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - John Comings
- Center for International Education, University of Massachusetts, Amherst, MA, 01003, USA
| | - Don Nutbeam
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Kirsten McCaffery
- The Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
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McCaffery KJ, Morony S, Muscat DM, Smith SK, Shepherd HL, Dhillon HM, Hayen A, Luxford K, Meshreky W, Comings J, Nutbeam D. Evaluation of an Australian health literacy training program for socially disadvantaged adults attending basic education classes: study protocol for a cluster randomised controlled trial. BMC Public Health 2016; 16:454. [PMID: 27233237 PMCID: PMC4884424 DOI: 10.1186/s12889-016-3034-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with low literacy and low health literacy have poorer health outcomes. Literacy and health literacy are distinct but overlapping constructs that impact wellbeing. Interventions that target both could improve health outcomes. METHODS/DESIGN This is a cluster randomised controlled trial with a qualitative component. Participants are 300 adults enrolled in basic language, literacy and numeracy programs at adult education colleges across New South Wales, Australia. Each adult education institute (regional administrative centre) contributes (at least) two classes matched for student demographics, which may be at the same or different campuses. Classes (clusters) are randomly allocated to receive either the health literacy intervention (an 18-week program with health knowledge and skills embedded in language, literacy, and numeracy training (LLN)), or the standard Language Literacy and Numeracy (LLN) program (usual LLN classes, specifically excluding health content). The primary outcome is functional health literacy skills - knowing how to use a thermometer, and read and interpret food and medicine labels. The secondary outcomes are self-reported confidence, more advanced health literacy skills; shared decision making skills, patient activation, health knowledge and self-reported health behaviour. Data is collected at baseline, and immediately and 6 months post intervention. A sample of participating teachers, students, and community health workers will be interviewed in-depth about their experiences with the program to better understand implementation issues and to strengthen the potential for scaling up the program. DISCUSSION Outcomes will provide evidence regarding real-world implementation of a health literacy training program with health worker involvement in an Australian adult education setting. The evaluation trial will provide insight into translating and scaling up health literacy education for vulnerable populations with low literacy. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12616000213448 .
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Affiliation(s)
- Kirsten J McCaffery
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia. .,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Suzanne Morony
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Danielle M Muscat
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Sian K Smith
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Heather L Shepherd
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.,Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia.,Concord Clinical School, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Andrew Hayen
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Karen Luxford
- Patient Based Care, Clinical Excellence Commission, Sydney, NSW, 2000, Australia
| | | | - John Comings
- Center for International Education, University of Massachusetts, Amherst, MA, 01003, USA
| | - Don Nutbeam
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
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Jacobson HE, Hund L, Soto Mas F. Predictors of English Health Literacy among U.S. Hispanic Immigrants: The importance of language, bilingualism and sociolinguistic environment. ACTA ACUST UNITED AC 2016; 24:43-64. [PMID: 27127416 PMCID: PMC4845726 DOI: 10.5130/lns.v24i1.4900] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In the United States, data confirm that Spanish-speaking immigrants are
particularly affected by the negative health outcomes associated with low health
literacy. Although the literature points to variables such as age, educational
background and language, only a few studies have investigated the factors that
may influence health literacy in this group. Similarly, the role that
bilingualism and/or multilingualism play in health literacy assessment continues
to be an issue in need of further research. The purpose of this study was to
examine the predictors of English health literacy among adult Hispanic
immigrants whose self-reported primary language is Spanish, but who live and
function in a bilingual community. It also explored issues related to the
language of the instrument. An analysis of data collected through a randomized
controlled study was conducted. Results identified English proficiency as the
strongest predictor of health literacy (p < 0.001). The results further
point to the importance of primary and secondary language in the assessment of
heath literacy level. This study raises many questions in need of further
investigation to clarify how language proficiency and sociolinguistic
environment affect health literacy in language minority adults; proposes
language approaches that may be more appropriate for measuring health literacy
in these populations; and recommends further place-based research to determine
whether the connection between language proficiency and health is generalizable
to border communities.
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Affiliation(s)
- Holly E Jacobson
- Department of Linguistics, MSC 03 2130, 1 University of New Mexico, Albuquerque, NM 87131-0001, Voice), ,
| | - Lauren Hund
- Department of Family and Community Medicine, Public Health Program, University of New Mexico, ;
| | - Francisco Soto Mas
- Department of Family and Community Medicine, Public Health Program, University of New Mexico, ;
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Soto Mas F, Cordova C, Murrietta A, Jacobson HE, Ronquillo F, Helitzer D. A multisite community-based health literacy intervention for Spanish speakers. J Community Health 2016; 40:431-8. [PMID: 25319468 DOI: 10.1007/s10900-014-9953-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The National Action Plan to Improve Health Literacy emphasizes the importance of community-based opportunities for education, such as English as a second language (ESL) programs. It recommends collaborations among the adult literacy and ESL communities. However, limited attention has been given to researching the effectiveness of community-based interventions that combine ESL and health literacy. The purpose of this study was to explore the feasibility of using different community settings for improving health literacy among adult Spanish speakers through an English language program. The study used a pre-experimental, single arm pretest-posttest design, and implemented the Health Literacy and ESL Curriculum. A collaborative was established between the community and university researchers. Participants were recruited at three distinctive sites. Health literacy was assessed using the Spanish version of the Test of Functional Health Literacy in Adults (TOFHLA). Analysis included descriptive and paired-group t test. Forty-nine participants completed the intervention and post-tests (92% retention rate). Overall--all sites--posttest scores significantly improved for total TOFHLA, raw numeracy, and reading comprehension (p < 0.0001). Similarly, all three sites yielded significantly better mean differences for the total TOFHLA score while numeracy and reading comprehension significantly improved in some sites. Results suggest that community sites are viable venues for delivering health literacy/language instruction to Spanish speaking adults. The study also points to community engagement and ESL programs as two essential components of effective health literacy interventions among Spanish speakers.
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Affiliation(s)
- F Soto Mas
- Public Health Program, Department of Family and Community Medicine, MSC09 5060, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA,
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Chen X, Goodson P, Acosta S. Blending Health Literacy With an English as a Second Language Curriculum: A Systematic Literature Review. JOURNAL OF HEALTH COMMUNICATION 2015; 20 Suppl 2:101-111. [PMID: 26513037 DOI: 10.1080/10810730.2015.1066467] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
About 21% of the U.S. population ages 5 and older speaks a language other than English at home, and many of them cannot communicate in English fluently. A possible intervention to improve health literacy for people with limited English proficiency is the use of an English as a second language curriculum. The purpose of this systematic review is to assess the characteristics (e.g., theoretical framework, developing processes, classroom activities, goals and topics) and effectiveness of English as a second language health literacy curricula that are currently available in English-dominant countries. We searched the online databases of ERIC, Sage, Springer, PubMed, Medline, and Scopus, identifying 7 curricula within 18 published reports. We synthesize the strengths and weaknesses of the reviewed curricula and provide recommendations for improving future health literacy interventions and research.
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Affiliation(s)
- Xuewei Chen
- a Department of Health & Kinesiology , Texas A&M University , College Station , Texas , USA
| | - Patricia Goodson
- a Department of Health & Kinesiology , Texas A&M University , College Station , Texas , USA
| | - Sandra Acosta
- b Department of Educational Psychology , Texas A&M University , College Station , Texas , USA
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