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Yang XY, He CY, Chen XF, Wan S, Kong Y, Zhou J, Zheng ST. The support dilemma of stroke inpatients and family caregivers under COVID-19 prevention and control: a qualitative study in China. PSYCHOL HEALTH MED 2024; 29:15-21. [PMID: 36578132 DOI: 10.1080/13548506.2022.2162937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 12/13/2022] [Indexed: 12/30/2022]
Abstract
China has implemented a strict isolation system in hospitals since the COVID-19 pandemic, that adversely affected the psychology of inpatients and their caregivers. Face-to-face, semi-structured interviews with 22 stroke inpatients from two municipal hospitals were conducted to explore the psychological, emotional and related support needs of stroke inpatients and their family caregivers under this environment. Results which showed that external support for stroke inpatients and their family caregivers was insufficient highlight the necessity for developing specific nursing interventions that meet the psychological and emotional needs of inpatients and the caregivers.
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Affiliation(s)
- Xin-Yao Yang
- postgraduates majoring in Nursing, School of Nursing, Chengdu Medical College, Chengdu, China
| | - Chun-Yu He
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Xiao-Fang Chen
- School of Public Health, Chengdu Medical College, Chengdu, China
| | - Song Wan
- Teaching Centre of General Courses, Chengdu Medical College, Chengdu, China
| | - Ye Kong
- postgraduates majoring in Nursing, School of Nursing, Chengdu Medical College, Chengdu, China
| | - Jun Zhou
- postgraduates majoring in Nursing, School of Nursing, Chengdu Medical College, Chengdu, China
| | - Si-Ting Zheng
- postgraduates majoring in Nursing, School of Nursing, Chengdu Medical College, Chengdu, China
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Wang Y, Chen T, Gan W, Yin J, Song L, Qi H, Zhang Q. Association among high blood pressure health literacy, social support and health-related quality of life among a community population with hypertension: a community-based cross-sectional study in China. BMJ Open 2022; 12:e057495. [PMID: 35672078 PMCID: PMC9174780 DOI: 10.1136/bmjopen-2021-057495] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The prevalence of hypertension is increasing worldwide. Hypertensive patients in China have limited high blood pressure health literacy (HBP-HL) and social support (SS), which may have an impact on health-related quality of life (HRQoL) and lead to poorer clinical outcomes. However, the potential mechanism of HBP-HL, SS and HRQoL remains unclear. The aim of this study was to investigate the association among HBP-HL, SS and HRQoL among community patients with hypertension in China. DESIGN A community-based cross-sectional survey. SETTING The community health service center in Huzhou, China. PARTICIPANTS 406 community patients with hypertension were investigated from June to October 2019. PRIMARY OUTCOME MEASURES HRQoL was assessed using the Quality of Life Instruments for Chronic Diseases-Hypertension V2.0, HBP-HL was assessed with the HBP-Health Literacy Scale into Chines and SS was assessed with the Social Support Rating Scale. RESULTS Compared with moderate level of HRQoL and SS, HBP-HL of community hypertensive patients was significantly deficient. Overall, 93 patients (23.2%) lacked HBP-HL, 308 patients (76.8%) had a medium level of HBP-HL, and none of them had sufficient HBP-HL. Correlation analysis showed that HBP-HL, SS and HRQoL were positively correlated (p<0.01). The significant differences in HRQoL and SS were detected in HBP-HL level (p<0.001). In multiple linear regression models, HRQoL was significantly associated with 'Print HL' and 'Medication Label' of HBP-HL (p<0.05) and all three dimensions of SS (p<0.05). In addition, The bootstrap method was used to examine the indirect effect among variables. The results showed that SS played a mediating role between HBP-HL and HRQoL (p<0.001). CONCLUSION There is an association among HBP-HL, SS and HRQoL in community hypertension patients. HBP-HL can directly affect HRQoL, and through SS mediate the HRQoL. Community intervention for hypertension management should consider HBP-HL promotion and social engagement as the breakthrough points to increase the impact on patients' HRQoL.
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Affiliation(s)
- Yujie Wang
- School of Nursing, College of Medicine, Huzhou University, Huzhou, Zhejiang, China
| | - Ting Chen
- School of Nursing, College of Medicine, Huzhou University, Huzhou, Zhejiang, China
- Department of Nursing and Optometry, Jiangxi Teacher College, Shangrao, Jiangxi, China
| | - Wei Gan
- School of Nursing, College of Medicine, Huzhou University, Huzhou, Zhejiang, China
| | - Jinyu Yin
- School of Nursing, College of Medicine, Huzhou University, Huzhou, Zhejiang, China
| | - Li Song
- School of Nursing, College of Medicine, Huzhou University, Huzhou, Zhejiang, China
| | - Huan Qi
- School of Nursing, College of Medicine, Huzhou University, Huzhou, Zhejiang, China
- School of Nursing, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Qinghua Zhang
- School of Nursing, College of Medicine, Huzhou University, Huzhou, Zhejiang, China
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Gan W, Zhang Q, Yang D, Yin J, Wang Y, Song L, Chen T, Qi H. A behavior change wheel-based interactive pictorial health education program for hypertensive patients with low blood pressure health literacy: study protocol for a randomized controlled trial. Trials 2022; 23:369. [PMID: 35505379 PMCID: PMC9066838 DOI: 10.1186/s13063-022-06300-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background The prevalence of hypertension is increasing worldwide. Hypertension self-management usually involves the application and consideration of oral, written, or quantitative information. Hypertensive patients in China have limited high blood pressure health literacy (HBP-HL), which may lead to poorer clinical outcomes. This study aims to determine the feasibility and effectiveness of an interactive pictorial health education program based on behavior change wheel (BCW) theory and its effect on HBP-HL, self-efficacy, self-management ability, and health-related quality of life (HRQOL) in hypertensive patients with low HBP-HL. Methods This study is a randomized controlled trial (RCT). One of the municipal districts in Huzhou, China, will be randomly selected, and two communities with similar conditions within this district will be screened and selected. A total of 120 hypertensive patients aged 18 years and older will be recruited from these two community settings. One of the communities will be randomly allocated to an interactive pictorial health education program conducted by a comprehensive health literacy strategy that includes (i) training participants in effective health communication skills that address issues encountered in seeking medical care and (ii) the use of self-developed interactive pictorial hypertension education to improve patient understanding and behaviors versus a control group (routine community lecture health education only). The primary outcome measure is HBP-HL. Secondary outcomes are self-efficacy, self-management ability, HRQOL, social support, and improvement in blood pressure. Outcomes will be collected at 6, 9, and 12 months from trial entry. Discussion The strengths of this study are the establishment of a new health management program for hypertensive patients that closely combines BCW theory and health literacy. This trial has the potential to improve HBP-HL in hypertensive Chinese patients with low health literacy to improve the self-management of hypertension and help control blood pressure. Trial registration Clinical Trials.gov Protocol Registration and Results System ID NCT04327102. Prospectively registered on February 29, 2020
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Affiliation(s)
- Wei Gan
- School of Medicine & Nursing Sciences, HuZhou University, Huzhou, Zhejiang, China
| | - Qinghua Zhang
- School of Medicine & Nursing Sciences, HuZhou University, Huzhou, Zhejiang, China.
| | - Dan Yang
- School of Medicine & Nursing Sciences, HuZhou University, Huzhou, Zhejiang, China
| | - Jinyu Yin
- School of Medicine & Nursing Sciences, HuZhou University, Huzhou, Zhejiang, China
| | - Yujie Wang
- School of Medicine & Nursing Sciences, HuZhou University, Huzhou, Zhejiang, China
| | - Li Song
- School of Medicine & Nursing Sciences, HuZhou University, Huzhou, Zhejiang, China
| | - Ting Chen
- Present address: Department of Nursing, Jiangxi Medical College, Shangrao, Jiangxi, China
| | - Huan Qi
- Present address: School of Nursing, Gannan Medical University, Ganzhou, Jiangxi, China
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McLachlan AJ, Carroll PR, Hunter DJ, Wakefield TAN, Stosic R. Osteoarthritis management: Does the pharmacist play a role in bridging the gap between what patients actually know and what they ought to know? Insights from a national online survey. Health Expect 2022; 25:936-946. [PMID: 34997667 PMCID: PMC9122430 DOI: 10.1111/hex.13429] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Guidelines encourage engagement in self-care activities for osteoarthritis (OA), but there are gaps in consumers' knowledge about suitable choices for self-care. Community pharmacists are in an ideal position to contribute to OA management through screening and supporting evidence-based pain management choices. Prior research established an association between health literacy and advice-seeking and appropriateness of analgesics choices (both lower in participants with limited health literacy) amongst people living with OA. This article explores the implications of these data for pharmacists in OA management. METHODS A national online survey was conducted amongst 628 adults aged 45-74 years, currently residing in Australia, with self-reported symptoms of OA. All data were collected using a customized online questionnaire, which was completed only once. 'Self-reported symptoms of OA' was based on six validated screening questions to identify people with OA without a formal clinical diagnosis. RESULTS Respondents matched the typical profile of people diagnosed with OA; more than half were female (56%), knees (59%) and hips (31%) were the primary affected joints and 74% were either overweight or obese. Self-identification of OA was limited (41%). Overall, 38% self-managed their pain, and limited health literacy was associated with less advice-seeking. Efficacy and ease of use were the main reasons cited for prompting use across all classes of nonprescription analgesic, with less than 20% reporting recommendation from a pharmacist. Participants were managing their pain with an average of 1.74 (95% confidence interval: 1.60-1.88) analgesics, but 73% reported inadequate pain relief and 54% had disrupted sleep. CONCLUSION Our findings highlight three key themes: lack of self-identification of OA, suboptimal pain relief and limited use of the community pharmacist as a source of management advice. Equipping community pharmacists with tools to identify OA could bridge this gap. More research is needed to determine if it will improve consumers' ability to appropriately manage OA pain. PATIENT OR PUBLIC CONTRIBUTION Consumers living with OA contributed to the study outcomes, reviewed the survey questionnaire for face validity and advised on plain language terminology.
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Affiliation(s)
- Andrew J McLachlan
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Peter R Carroll
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.,Department of Clinical Pharmacology, Royal North Shore Hospital, St. Leonards, New South Wales, Australia
| | - David J Hunter
- Department of Rheumatology, Royal North Shore Hospital, The University of Sydney, St. Leonards, New South Wales, Australia
| | | | - Rodney Stosic
- Bayer Australia Pty., Ltd., Pymble, New South Wales, Australia
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You X, Liu Y, Zhang M, Zhang M, Yu Y, Sang C. Modeling on Social Health Literacy Level Prediction. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2021; 2021:7049997. [PMID: 34917138 PMCID: PMC8670972 DOI: 10.1155/2021/7049997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022]
Abstract
Nowadays, the health level of residents has become the focus of people's attention. Under the background of the development of health service from "disease-centered" to "health-centered," it is very important to improve the level of urban health and clarify the factors affecting urban health. Therefore, this paper quantifies the relationship between residents' health literacy level and environment, average life expectancy, infectious disease mortality, and other indicators by selecting appropriate indicators and establishing a mathematical model. Based on the reciprocal linear combination of the collected index data and the corresponding health level value, the prediction model of social health literacy level (SPM) was established, and the qualitative prediction and quantitative analysis of citizens' health literacy level were studied in depth. Based on the SPM model, we can roughly predict the level of health literacy in a region only based on the main variables identified in this paper. The consistency of the experiment shows that the model is effective and robust, and it reveals that environmental factors are the most important factors affecting residents' health literacy level. The actual data show that THE SPM model is a timely and reasonable framework to measure the health literacy level of residents.
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Affiliation(s)
- Xuemei You
- Business School, Shandong Normal University, Jinan, Shandong 250014, China
| | - Yongdong Liu
- Business School, Shandong Normal University, Jinan, Shandong 250014, China
| | - Mingming Zhang
- Business School, Shandong Normal University, Jinan, Shandong 250014, China
| | - Man Zhang
- Business School, Shandong Normal University, Jinan, Shandong 250014, China
| | - Yangli Yu
- Business School, Shandong Normal University, Jinan, Shandong 250014, China
| | - Chengge Sang
- Business School, Shandong Normal University, Jinan, Shandong 250014, China
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McCarty D, Shanahan M. Theory-Informed Clinical Practice: How Physical Therapists Can Use Fundamental Interventions to Address Social Determinants of Health. Phys Ther 2021; 101:6308777. [PMID: 34174078 DOI: 10.1093/ptj/pzab158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/14/2021] [Accepted: 04/25/2021] [Indexed: 11/14/2022]
Abstract
UNLABELLED The American Physical Therapy Association's Vision Statement for the profession is guided by principles of innovation, access, equity, and advocacy, and calls on physical therapists to stretch their influence beyond the walls of the clinic and the individuals they treat. Access and equity are problems that span multiple health care professions and entities; yet, addressing social determinants of health is a paradigm shift that clinicians need continued support to achieve. This article has 2 objectives: (1) to define the Fundamental Cause Theory and the Socioecological Model within the context of physical therapy in order to promote best clinical practice, and (2) to apply the concept of "fundamental interventions" in clinical practice to mitigate the negative impact of downstream effects of social determinants of health across levels of the Socioecological Model-individual, interpersonal, institutional, community, and societal. This theoretical lens provides the conceptual framework necessary for physical therapists to think creatively about ways to change their practice in their own contexts to impact the life of individual patients and transform the movement health of society. IMPACT As health care providers, physical therapists have a responsibility to make every effort to meet the needs of their patients and optimize movement health in society; yet significant structural and systemic barriers often prevent patients from reaching their fullest potential. Clinicians can no longer subscribe to a narrow scope of practice focused on individual attainment of therapy goals. This Perspective discusses Fundamental Cause Theory and the Socioecological Model theoretical frameworks that can help physical therapists develop, test, and implement functional interventions to address the needs of society as a whole.
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Affiliation(s)
- Dana McCarty
- Division of Physical Therapy, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Meghan Shanahan
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Abstract
This article synthesizes what is known about the relationship between social disadvantage and measures of health literacy (HL), and reviews the research examining whether low HL is an explanatory factor connecting social disadvantage, health outcomes, and health disparities. Written from a United States perspective, this article offers a novel conceptual framework that presents how the social determinants of health might interact with HL to result in health disparities. The framework articulates relationships that reflect public health pathways and health care pathways, which include their related health literacies. The article continues with several cautionary statements based on the inherent limitations of current HL research, including problems and concerns specific to the attribution of HL as an explanatory factor for extant socioeconomic and racial/ethnic health disparities. The article closes with recommendations regarding future research directions. [HLRP: Health Literacy Research and Practice. 2021;5(3):e233–e243.]
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Affiliation(s)
- Dean Schillinger
- Address correspondence to Dean Schillinger, MD, Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Box 1364, San Francisco, CA 94143;
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Vina ER, Hannon MJ, Quinones C, Hausmann LRM, Ibrahim SA, Dagnino J, Kwoh CK. The Role of Knowledge and Attitudes About Nonsteroidal Anti-inflammatory Drugs in Determining Treatment Use. ACR Open Rheumatol 2021; 3:154-163. [PMID: 33570233 PMCID: PMC7966879 DOI: 10.1002/acr2.11235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/31/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate how patient knowledge and beliefs regarding nonsteroidal anti-inflammatory drugs (NSAIDs) may influence the use of NSAIDs for osteoarthritis (OA). METHODS Surveys of 334 adults with knee and/or hip OA were analyzed in this cross-sectional study. Familiarity with and perceptions of benefits/risks of NSAID use were measured to assess associations with the use of prescription and nonprescription oral NSAIDs. Multinomial logistic regression models were adjusted for sociodemographic and clinical variables. RESULTS In this sample, 35.9% and 35.6% reported use of oral prescription and nonprescription-only NSAIDs, respectively. Hispanic participants, compared with non-Hispanic White participants, had lower perceived benefit (P = 0.005) and risk (P = 0.001) of prescription NSAIDs. The following were associated with prescription NSAID use instead of no NSAID use: having family/friends who used prescription (relative risk ratio [RRR] 3.91; 95% confidence interval [CI] 2.05-7.47) and over-the-counter (OTC) (RRR 3.10; 95% CI 1.65-5.83) NSAIDs for OA, understanding the consequences of using both prescription (RRR 3.50; 95% CI 1.79-6.86) and OTC (RRR 2.80; 95% CI 1.39-5.65) NSAIDs, higher perceived benefit of both prescription (RRR 2.51; 95% CI 1.71-3.66) and OTC (RRR 1.44; 95% CI 1.01-2.06) NSAIDs, and lower perceived risk of both types of NSAIDs (prescription: RRR 0.63 [95% CI 0.46-0.87]; OTC: RRR 0.53 [95% CI 0.37-0.75]). Similar results were found when we assessed the relationship between these variables and OTC NSAID use versus no oral NSAID use. CONCLUSION Adults with knee and/or hip OA were more likely to use NSAIDs if they were more familiar with, had an increased perceived benefit of, and had a decreased perceived risk of these drugs. Patients' perceptions and beliefs about NSAIDs should be evaluated when considering them for treatment.
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Affiliation(s)
| | | | | | - L. R. M. Hausmann
- US Department of Veterans Affairs Pittsburgh Healthcare System and University of PittsburghPittsburghPennsylvania
| | - S. A. Ibrahim
- Weill Cornell MedicineCornell UniversityNew YorkNew York
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Voices of African American Older Adults on the Implications of Social and Healthcare-Related Policies for Osteoarthritis Pain Care. Pain Manag Nurs 2020; 22:50-57. [PMID: 33162338 PMCID: PMC7887012 DOI: 10.1016/j.pmn.2020.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/29/2020] [Accepted: 09/01/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Chronic pain is a distressing symptom that older adults with osteoarthritis (OA) seek to minimize through management. Research consistently points out the disparities that older African Americans face when managing chronic pain conditions, but a major gap in the literature is how pain care policy at the federal, state, and local level protects or exposes older African Americans to disadvantaged care. AIMS The purpose of this original research is to examine policy issues and care enhancement opportunities that emerge from the narratives and personal stories of older African Americans living with chronic OA pain. DESIGN A secondary qualitative data analysis. METHODS African Americans (≥50 years) with OA pain living in Louisiana were interviewed to gather global perspectives and specific information about how they manage OA pain. Narrative analytic techniques were applied to 18 individual, semistructured interviews. RESULTS Three policy-related pain management issues and implications surfaced from the older African Americans' rich narratives: (1) "Access to and navigation of the healthcare system," (2) "Affordability of natural supplements, medications, and treatments," and (3) "Expansion of pain palliative care and community programs." CONCLUSIONS African American older adults face numerous challenges in managing pain well. Navigating the healthcare system is an abiding issue, and perceived injustice in care was a common thread throughout the narratives. On the positive side, older African Americans also proposed practice- and policy-related solutions to counter the pain treatment challenges. Nurses are natural advocates for patients, and should work to change healthcare policies that unfairly marginalize ethnic/racial older adults' long-term ability to manage chronic pain.
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Schillinger D. The Intersections Between Social Determinants of Health, Health Literacy, and Health Disparities. Stud Health Technol Inform 2020; 269:22-41. [PMID: 32593981 DOI: 10.3233/shti200020] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This chapter synthesizes what is known about the relationship between social disadvantage and measures of low health literacy (LHL), and reviews the research examining whether LHL is an explanatory factor connecting social disadvantage, health outcomes, and health disparities. Written from a U.S. perspective, the chapter then offers a novel conceptual framework that presents how the social determinants of health might interact with LHL to result in health disparities. The framework articulates relationships that reflect public health pathways and healthcare pathways, which include their related health literacies. In addition, the chapter highlights as an exemplar one important potential causal mechanism in the healthcare pathway by exploring the communication model in outpatient care, as communication has been very well-studied with respect to both health disparities and HL. The chapter then, provides two examples of HL interventions aligned with the conceptual framework, one of which addresses the health care literacy pathway, and the other addresses the public health literacy pathway. The chapter continues with a number of cautionary statements based on the inherent limitations of current HL research, including problems and concerns specific to the attribution of HL as an explanatory factor for extant socioeconomic and racial/ethnic health disparities. The chapter closes with recommendations regarding future research directions.
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Safari R, Jackson J, Sheffield D. Digital Self-Management Interventions for People With Osteoarthritis: Systematic Review With Meta-Analysis. J Med Internet Res 2020; 22:e15365. [PMID: 32706657 PMCID: PMC7428148 DOI: 10.2196/15365] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 11/13/2019] [Accepted: 02/26/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Osteoarthritis (OA) is not curable, but the symptoms can be managed through self-management programs (SMPs). Owing to the growing burden of OA on the health system and the need to ensure high-quality integrated services, delivering SMPs through digital technologies could be an economic and effective community-based approach. OBJECTIVE This study aims to analyze the effectiveness of digital-based structured SMPs on patient outcomes in people with OA. METHODS A total of 7 web-based and 3 gray literature databases were searched for randomized controlled trials assessing digital-based structured SMPs on self-reported outcomes including pain, physical function, disability, and health-related quality of life (QoL) in people with OA. Two reviewers independently screened the search results and reference lists of the identified papers and related reviews. Data on the intervention components and delivery and behavioral change techniques used were extracted. A meta-analysis, risk of bias sensitivity analysis, and subgroup analysis were performed where appropriate. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to assess the quality of evidence. RESULTS A total of 8 studies were included in this review involving 2687 patients with knee (n=2); knee, hip, or both (n=5); and unspecified joint (n=1) OA. SMPs were delivered via telephone plus audio and video, internet, or mobile apps. Studies reported that digital-based structured SMPs compared with the treatment as usual control group (n=7) resulted in a significant, homogeneous, medium reduction in pain and improvement in physical function (standardized mean difference [SMD] -0.28, 95% CI -0.38 to -0.18 and SMD -0.26, 95% CI -0.35 to -0.16, respectively) at posttreatment. The digital-based structured SMP effect on pain and function reduced slightly at the 12-month follow-up but remained to be medium and significant. The posttreatment effect of digital-based structured SMPs was small and significant for disability, but nonsignificant for QoL (SMD -0.10, 95% CI -0.17 to 0.03 and SMD -0.17, 95% CI -0.47 to 0.14, respectively; each reported in 1 study only). The 12-month follow-up effect of the intervention was very small for disability and QoL. The quality of evidence was rated as moderate for pain and physical function and low and very low for disability and QoL, respectively, using the GRADE approach. CONCLUSIONS Digital-based structured SMPs may result in improvement in pain and physical function that is largely sustained at the 12-month follow-up in people with knee and hip OA. The effects on disability and QoL are smaller and less clear. The quality of evidence is moderate to low, and further research is required to confirm the findings of the review and assess the effects of digital-based structured SMPs on other health-related outcomes.
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Affiliation(s)
- Reza Safari
- Health and Social Care Research Centre, University of Derby, Derby, United Kingdom
| | - Jessica Jackson
- Health and Social Care Research Centre, University of Derby, Derby, United Kingdom
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Booker S, Herr K, Tripp-Reimer T. Black American older adults' motivation to engage in osteoarthritis treatment recommendations for pain self-management: A mixed methods study. Int J Nurs Stud 2019; 116:103510. [PMID: 32169337 PMCID: PMC7314646 DOI: 10.1016/j.ijnurstu.2019.103510] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Osteoarthritis is a long-term condition, and four core treatments are recommended to minimize the interference of pain and symptoms on their daily function. However, older Black Americans have traditionally been at a disadvantage in regard to knowledge of and engagement in chronic disease self-management and self-care. Surprisingly, minimal research has addressed understanding motivational factors key to self-management behaviors. Thus, it is important to understand if older Black Americans' self-management is supported by current recommendations for the management of symptomatic osteoarthritis and what factors limit or motivate engagement in recommended treatments. OBJECTIVE Our objectives are to: (1) identify stage of engagement in four core recommended treatments for osteoarthritis, (2) describe the barriers and motivators to these recommended treatments, and (3) construct an understanding of the process of pain self-management motivation. DESIGN A mixed-methods concurrent parallel design. SETTING Participants were recruited from communities in northern Louisiana, USA. PARTICIPANTS Black Americans (≥50 years of age) with clinical osteoarthritis and/or provider-diagnosed osteoarthritis were enrolled. One hundred ten participants completed the study, and 18 of these individuals were also interviewed individually. METHODS Data were collected using in-person surveys and interviews. Over a period of 11 months, close- and open-ended surveys and in-depth interviews were conducted with participants. Descriptive statistics describe utilization/engagement level as well as barriers and motivators of recommended treatments for non-surgical osteoarthritis. Content and thematic analyses of interviews summarized perspectives on the process and role of motivation in pain self-management. RESULTS Overall, engagement levels in treatments ranged from very low to high. Over 55% of older Black Americans were actively engaged in two of the recommended treatments: land-based exercise and strength training. Major motivators included reduction in pain and stiffness and maintenance of mobility and good health. The majority of participants were not using water-based exercise and self-management education. Primary barriers were lack of access, time, and knowledge of resources. CONCLUSIONS In order to maximize the benefits of osteoarthritis pain self-management, older Black Americans must be equipped with the motivation, resources, information and skills, and time to engage in recommended treatment options. Their repertoire of behavioral self-management did not include two key treatments and is inconsistent with what is recommended, predominantly due to barriers that are difficult to overcome. In these cases, motivation alone is not optimal in promoting self-management. Providers, researchers, and community advocates should work collaboratively to expand access to self-management resources, particularly when personal and community motivation are high.
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Affiliation(s)
- Staja Booker
- University of Florida, College of Nursing, PO Box 100197, Gainesville, FL 32610, United States.
| | - Keela Herr
- The University of Iowa, College of Nursing, 50 Newton Road, Iowa City, IA 52242, United States.
| | - Toni Tripp-Reimer
- The University of Iowa, College of Nursing, 50 Newton Road, Iowa City, IA 52242, United States.
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Neter E, Brainin E. Association Between Health Literacy, eHealth Literacy, and Health Outcomes Among Patients With Long-Term Conditions. EUROPEAN PSYCHOLOGIST 2019. [DOI: 10.1027/1016-9040/a000350] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abstract. The objective of this paper is to synthesize and update findings from systematic review on health literacy and health outcomes among patients with long-term conditions, and extend the review to the digital domain. Health outcomes include clinical outcomes, processes of care, and health service use. Data sources are the following: (1) studies which appeared in two previous systematic reviews in 2004 and 2011 whose participants were people with long-term conditions or elderly ( n = 54); (2) articles on health literacy and health outcomes identified in an updated 2011–2016 search ( n = 26); (3) articles on eHealth literacy and its association with health outcomes ( n = 8). Strength of evidence was determined by a qualitative assessment of risk of bias, consistency, and directness. There was a lack of consistent evidence on the relationship between health literacy and clinical outcomes despite the consistent evidence on the association with mortality. There was low to insufficient evidence on the association between health literacy and self-rated health/function and emotional states of anxiety and depression, alongside high evidence on lack of association with quality of life. There was insufficient to low evidence on the association between health literacy and behavioral outcomes (medication adherence, other health behaviors) and finally also low to moderate evidence on the association between health literacy and use of health services such as hospitalization and emergency department. In the eHealth literacy domain, there were few studies reporting association with health behaviors and self-rated health with inconsistent results. In conclusion, it is advocated to examine performed heath literacy and eHealth literacy in large longitudinal studies.
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Affiliation(s)
- Efrat Neter
- Department of Behavioral Sciences, Ruppin Academic Center, Emeq Hefer, Israel
| | - Esther Brainin
- Department of Behavioral Sciences, Ruppin Academic Center, Emeq Hefer, Israel
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Lacey RJ, Campbell P, Lewis M, Protheroe J. The Impact of Inadequate Health Literacy in a Population with Musculoskeletal Pain. Health Lit Res Pract 2018; 2:e215-e220. [PMID: 31294297 PMCID: PMC6608902 DOI: 10.3928/24748307-20181101-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/01/2018] [Indexed: 01/22/2023] Open
Abstract
Musculoskeletal conditions are a major cause of ill health and disability. Inadequate health literacy may partly explain why musculoskeletal self-management programs are not effective for some patients. This study prospectively evaluated the impact of patients' health literacy level on their musculoskeletal pain and physical function (PF) following usual primary care. Primary care patients (N = 4,720) who had consulted for musculoskeletal pain were mailed a baseline questionnaire; responders were sent a 6-month follow-up questionnaire. The measure of health literacy used was the single-item Literary Screener at baseline, and the outcomes were PF and pain intensity at the 6-months follow-up. Analysis was conducted by linear regression. The number of patients who responded was 1,890 (40%); 17.3% (95% CI [15.6%–19%]) of them had inadequate health literacy. Inadequate health literacy was associated with older age (p < .05), lower education, mental health, and comorbidities (all p < .001), but not by gender (p = .642). At the 6-month follow-up stage, patients with inadequate health literacy had lower PF (mean difference −12.2; 95% CI [−16.7, −7.6]) and higher pain intensity (mean difference 1; 95% CI [0.6, 1.4]), which was adjusted for age, gender, education, mental health, and comorbidities. Differences in PF and particularly pain scores between patients with inadequate and adequate health literacy increased over 6 months. Future studies should develop interventions that better support patients who have musculoskeletal pain with inadequate health literacy to successfully manage their pain. [HLRP: Health Literacy Research and Practice. 2018;2(4):e214–e220.]
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Affiliation(s)
| | | | | | - Joanne Protheroe
- Address correspondence to Joanne Protheroe, PhD, FRCGP, Arthritis Research United Kingdom (UK) Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire ST5 5BG, UK;
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15
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Rosenbaum JE, Johnson BK, Deane AE. Health literacy and digital media use: Assessing the Health Literacy Skills Instrument - Short Form and its correlates among African American college students. Digit Health 2018; 4:2055207618770765. [PMID: 29942630 PMCID: PMC6016563 DOI: 10.1177/2055207618770765] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/20/2018] [Indexed: 11/17/2022] Open
Abstract
Improving health literacy is increasingly seen as a solution to health problems and inequalities. This study assesses how one of the more recent measures of health literacy, the Health Literacy Skills Instrument – Short Form, performs among African American college students, and ascertains if and how media use relates to health literacy. Results indicate that both the use of health-related websites and apps as well as overall time spent with the media were positively, but conditionally, linked to health literacy. However, findings also pointed to the need for further test development.
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Affiliation(s)
| | - Benjamin K Johnson
- Department of Communication Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Amber E Deane
- Research Institute, Doctors Hospital at Renaissance, USA
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16
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Hausmann LRM, Ibrahim SA, Kwoh CK, Youk A, Obrosky DS, Weiner DK, Vina E, Gallagher RM, Mauro GT, Parks A. Rationale and design of the Staying Positive with Arthritis (SPA) Study: A randomized controlled trial testing the impact of a positive psychology intervention on racial disparities in pain. Contemp Clin Trials 2017; 64:243-253. [PMID: 28893676 DOI: 10.1016/j.cct.2017.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/31/2017] [Accepted: 09/07/2017] [Indexed: 12/18/2022]
Abstract
Knee osteoarthritis is a painful, disabling condition that disproportionately affects African Americans. Existing arthritis treatments yield small to moderate improvements in pain and have not been effective at reducing racial disparities in the management of pain. The biopsychosocial model of pain and evidence from the positive psychology literature suggest that increasing positive psychological skills (e.g., gratitude, kindness) could improve pain and functioning and reduce disparities in osteoarthritis pain management. Activities to cultivate positive psychological skills have been developed and validated; however, they have not been tested in patients with osteoarthritis, their effects on racial differences in health outcomes have not been examined, and evidence of their effects on health outcomes in patients with other chronic illnesses is of limited quality. In this article we describe the rationale and design of Staying Positive with Arthritis (SPA) study, a randomized controlled trial in which 180 African American and 180 White primary care patients with chronic pain from knee osteoarthritis will be randomized to a 6-week program of either positive skill-building activities or neutral control activities. The primary outcomes will be self-reported pain and functioning as measured by the WOMAC Osteoarthritis Index. We will assess these primary outcomes and potential, exploratory psychosocial mediating variables at an in-person baseline visit and by telephone at 1, 3, and 6months following completion of the assigned program. If effective, the SPA program would be a novel, theoretically-informed psychosocial intervention to improve quality and equity of care in the management of chronic pain from osteoarthritis.
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Affiliation(s)
- Leslie R M Hausmann
- Veterans Affairs Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, PA, United States; University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States.
| | - Said A Ibrahim
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Center for Health Equity Research and Promotion, Philadelphia, PA, United States; University of Pennsylvania, School of Medicine, Philadelphia, PA, United States
| | - C Kent Kwoh
- University of Arizona, College of Medicine and University of Arizona Arthritis Center, Tucson, AZ, United States
| | - Ada Youk
- Veterans Affairs Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, PA, United States; University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA, United States
| | - D Scott Obrosky
- Veterans Affairs Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, PA, United States
| | - Debra K Weiner
- University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States; Veterans Affairs Pittsburgh Healthcare System, Geriatric Research, Education & Clinical Center, Pittsburgh, PA, United States
| | - Ernest Vina
- University of Arizona, College of Medicine and University of Arizona Arthritis Center, Tucson, AZ, United States
| | - Rollin M Gallagher
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Center for Health Equity Research and Promotion, Philadelphia, PA, United States; University of Pennsylvania, School of Medicine, Philadelphia, PA, United States
| | - Genna T Mauro
- Veterans Affairs Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, PA, United States
| | - Acacia Parks
- Hiram College, Department of Psychology, Hiram, OH, United States; Happify, New York, NY, United States
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Bennell KL, Campbell PK, Egerton T, Metcalf B, Kasza J, Forbes A, Bills C, Gale J, Harris A, Kolt GS, Bunker SJ, Hunter DJ, Brand CA, Hinman RS. Telephone Coaching to Enhance a Home‐Based Physical Activity Program for Knee Osteoarthritis: A Randomized Clinical Trial. Arthritis Care Res (Hoboken) 2016; 69:84-94. [DOI: 10.1002/acr.22915] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/24/2016] [Accepted: 04/12/2016] [Indexed: 01/22/2023]
Affiliation(s)
| | | | | | - Ben Metcalf
- University of MelbourneMelbourne Victoria Australia
| | | | | | | | - Janette Gale
- HealthChange AustraliaSydney New South Wales Australia
| | | | | | - Stephen J. Bunker
- Medibank, Docklands, Victoria, Australia, and Monash UniversityMelbourne Victoria Australia
| | - David J. Hunter
- Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of SydneySydney New South Wales Australia
| | - Caroline A. Brand
- Melbourne EpiCentre, University of Melbourne, Melbourne Health, and Monash UniversityMelbourne Victoria Australia
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18
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Zhang Q, Huang F, Liu Z, Zhang N, Mahapatra T, Tang W, Lei Y, Dai Y, Tang S, Zhang J. Cross-Cultural Validation of the High Blood Pressure Health Literacy Scale in a Chinese Community. PLoS One 2016; 11:e0152182. [PMID: 27116336 PMCID: PMC4846086 DOI: 10.1371/journal.pone.0152182] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 03/09/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Considering the importance of health literacy (HL) for the maximum yield from the hypertension control programs, development of a reliable and valid instrument of hypertension-related HL is critical. This study aimed to translate and validate the High Blood Pressure-Health Literacy Scale (HBP-HLS) into Chinese (C-HBP-HLS) and evaluate its psychometric properties in Chinese context. METHOD Between June 2013 and January 2014, a cross-sectional study was conducted among recruited hypertensive patients belonging to the Han and Kazakh-Chinese communities in Urumqi, Xinjiang, China. RESULTS A pilot sample (n = 242) was selected for the exploratory factor analysis of the translated and modified instrument. Another sample (n = 308) was recruited for the confirmatory factor analysis. C-HBP-HLS consisted of five dimensions (Print Health Literacy, Medication Label, Understanding Ability, Newest Vital Sign Test, and Avoiding Food Allergy) containing 15 items, accounting for 77.7% of the total variance. The 5-factor model demonstrated a good overall fit. The scale-level content validity index was 0.85. Cronbach's alpha of the overall scale was 0.78 and test-retest reliability was 0.96. Education level had a strong positive correlation with the scores for items Q1, Q2, and Q3(r = 0.481, 0.492, 0.475, respectively). Health Literacy scores among Kazakh patients were significantly lower than Han (7.13±7.90 vs. 30.10±13.42, Z = -14.573, P<0.001). CONCLUSION C-HBP-HLS demonstrated suitable factor structure and robust psychometric properties for measuring health literacy level among hypertensive patients in China.
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Affiliation(s)
- Qinghua Zhang
- Xiang Ya Nursing School, Central South University, Changsha, Hunan, China
- School of Nursing, XinJiang Medical University, Urumqi, XinJiang, China
| | - Feifei Huang
- School of Nursing, FuJian Medical University, Fu Zhou, Fu Jian, China
| | - Zaoling Liu
- School of Public Health, XinJiang Medical University, Urumqi, XinJiang, China
| | - Na Zhang
- School of Public Health, University of Hong Kong, Hong Kong, China
| | - Tanmay Mahapatra
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, United States of America
| | - Weiming Tang
- University of North Carolina Project-China, Guangzhou, China
| | - Yang Lei
- Xiang Ya Nursing School, Central South University, Changsha, Hunan, China
| | - Yali Dai
- School of Nursing, XinJiang Medical University, Urumqi, XinJiang, China
| | - Songyuan Tang
- University of North Carolina Project-China, Guangzhou, China
| | - Jingping Zhang
- Xiang Ya Nursing School, Central South University, Changsha, Hunan, China
- * E-mail:
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Mantwill S, Monestel-Umaña S, Schulz PJ. The Relationship between Health Literacy and Health Disparities: A Systematic Review. PLoS One 2015; 10:e0145455. [PMID: 26698310 PMCID: PMC4689381 DOI: 10.1371/journal.pone.0145455] [Citation(s) in RCA: 199] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 12/03/2015] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Health literacy is commonly associated with many of the antecedents of health disparities. Yet the precise nature of the relationship between health literacy and disparities remains unclear. A systematic review was conducted to better understand in how far the relationship between health literacy and health disparities has been systematically studied and which potential relationships and pathways have been identified. METHODS Five databases, including PubMed/MEDLINE and CINAHL, were searched for peer-reviewed studies. Publications were included in the review when they (1) included a valid measure of health literacy, (2) explicitly conceived a health disparity as related to a social disparity, such as race/ethnicity or education and (3) when results were presented by comparing two or more groups afflicted by a social disparity investigating the effect of health literacy on health outcomes. Two reviewers evaluated each study for inclusion and abstracted relevant information. Findings were ordered according to the disparities identified and the role of health literacy in explaining them. RESULTS 36 studies were included in the final synthesis. Most of the studies investigated racial/ethnic disparities, followed by some few studies that systematically investigated educational disparities. Some evidence was found on the mediating function of health literacy on self-rated health status across racial/ethnic and educational disparities, as well as on the potential effect of health literacy and numeracy on reducing racial/ethnic disparities in medication adherence and understanding of medication intake. CONCLUSION Overall the evidence on the relationship between health literacy and disparities is still mixed and fairly limited. Studies largely varied with regard to health(-related) outcomes under investigation and the health literacy assessments used. Further, many studies lacked a specific description of the nature of the disparity that was explored and a clear account of possible pathways tested.
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Affiliation(s)
- Sarah Mantwill
- Institute of Communication & Health, University of Lugano, Lugano, Switzerland
- * E-mail:
| | | | - Peter J. Schulz
- Institute of Communication & Health, University of Lugano, Lugano, Switzerland
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Role of Health Literacy in Self-Reported Musculoskeletal Disorders. ARTHRITIS 2015; 2015:607472. [PMID: 26357571 PMCID: PMC4556058 DOI: 10.1155/2015/607472] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 08/03/2015] [Indexed: 01/29/2023]
Abstract
Self-report of musculoskeletal conditions is often used to estimate population prevalence and to determine disease burden and influence policy. However, self-report of certain musculoskeletal conditions is frequently inaccurate, suggesting inadequate communication to the patient of their diagnosis. The aim of this study is to determine the association between functional health literacy (FHL) and self-reported musculoskeletal conditions in a representative population survey. FHL was measured using Newest Vital Sign in 2824 randomly selected adults. Participants also self-reported medically diagnosed arthritis, gout, and osteoporosis. Multiple logistic regression was adjusted for age and sex. The prevalence of self-reported arthritis, gout, and osteoporosis was 25.2%, 4.9%, and 5.6%, respectively. The prevalence of those at risk for inadequate FHL was 24.0% and high likelihood of inadequate FHL was 21.0%. However, over 50% of respondents with arthritis or gout had at risk/inadequate FHL, increasing to 70% of those self-reporting osteoporosis. After adjustment for age and sex, respondents in the arthritis subgroup of "don't know" and self-reported osteoporosis were significantly more likely to have inadequate FHL than the general population. This study indicates a substantial burden of low health literacy amongst people with musculoskeletal disease. This has implications for provider-patient communication, individual healthcare, population estimates of musculoskeletal disease, and impact of public health messages.
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Rini C, Porter LS, Somers TJ, McKee DC, DeVellis RF, Smith M, Winkel G, Ahern DK, Goldman R, Stiller JL, Mariani C, Patterson C, Jordan JM, Caldwell DS, Keefe FJ. Automated Internet-based pain coping skills training to manage osteoarthritis pain: a randomized controlled trial. Pain 2015; 156:837-848. [PMID: 25734997 PMCID: PMC4402249 DOI: 10.1097/j.pain.0000000000000121] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Osteoarthritis (OA) places a significant burden on worldwide public health because of the large and growing number of people affected by OA and its associated pain and disability. Pain coping skills training (PCST) is an evidence-based intervention targeting OA pain and disability. To reduce barriers that currently limit access to PCST, we developed an 8-week, automated, Internet-based PCST program called PainCOACH and evaluated its potential efficacy and acceptability in a small-scale, 2-arm randomized controlled feasibility trial. Participants were 113 men and women with clinically confirmed hip or knee OA and associated pain. They were randomized to a group completing PainCOACH or an assessment-only control group. Osteoarthritis pain, pain-related interference with functioning, pain-related anxiety, self-efficacy for pain management, and positive and negative affect were measured before intervention, midway through the intervention, and after intervention. Findings indicated high acceptability and adherence: 91% of participants randomized to complete PainCOACH finished all 8 modules over 8 to 10 weeks. Linear mixed models showed that, after treatment, women who received the PainCOACH intervention reported significantly lower pain than that in women in the control group (Cohen d = 0.33). Intervention effects could not be tested in men because of their low pain and small sample size. Additionally, both men and women demonstrated increases in self-efficacy from baseline to after intervention compared with the control group (d = 0.43). Smaller effects were observed for pain-related anxiety (d = 0.20), pain-related interference with functioning (d = 0.13), negative affect (d = 0.10), and positive affect (d = 0.24). Findings underscore the value of continuing to develop an automated Internet-based approach to disseminate this empirically supported intervention.
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Affiliation(s)
- Christine Rini
- Thurston Arthritis Research Center and Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | | | | | | | - Robert F. DeVellis
- Thurston Arthritis Research Center and Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | | | - Gary Winkel
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - David K. Ahern
- Harvard Medical School/Brigham and Women's Hospital, Boston, MA
| | | | - Jamie L. Stiller
- Thurston Arthritis Research Center and Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Cara Mariani
- Duke University Medical Center, Durham, North Carolina
| | - Carol Patterson
- Thurston Arthritis Research Center and Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Joanne M. Jordan
- Thurston Arthritis Research Center and Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
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Phillips LR, Salem BE, Jeffers KS, Kim H, Ruiz ME, Salem N, Woods DL. Developing and Proposing the Ethno-Cultural Gerontological Nursing Model. J Transcult Nurs 2014; 26:118-28. [DOI: 10.1177/1043659614563615] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
By 2050, for the first time in U.S. history, almost half of elders will be from ethnic minority groups. To meet the needs of this rapidly diversifying population, nurses need to be able to marry transcultural nursing knowledge with gerontological nursing knowledge. The purpose of this article is to propose a new theoretical model for explaining health outcomes and health responses for older individuals in unique ethno-cultural groups and to discuss implications and applications of the model to transcultural gerontological nursing practice and research. The discussion will include (1) an overview of currently available theoretical knowledge in the area, (2) a description of the theory development process, (3) presentation of the proposed ethno-cultural gerontological nursing theoretical model, and (4) discussion of how this model can enhance nursing’s contributions to reducing health disparities. This model is presented not as a finished product but as a basis for future discussion and refinement.
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Affiliation(s)
| | | | | | - Haesook Kim
- UCLA School of Nursing, Los Angeles, CA, USA
| | | | - Nancy Salem
- UCLA School of Nursing, Los Angeles, CA, USA
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Press VG, Shapiro MI, Mayo AM, Meltzer DO, Arora VM. More than meets the eye: relationship between low health literacy and poor vision in hospitalized patients. JOURNAL OF HEALTH COMMUNICATION 2013; 18 Suppl 1:197-204. [PMID: 24093356 PMCID: PMC3807095 DOI: 10.1080/10810730.2013.830346] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Patient-centered care includes involving patients and their families in self-management of chronic diseases. Identifying and addressing barriers to self-management, including those related to health literacy and vision limitations, may enhance one's ability to self-manage. A set of brief verbal screening questions (BVSQ) that does not rely on sufficient vision to assess health literacy was developed by Chew and colleagues in the outpatient setting. The authors aimed to evaluate the usefulness of this tool for hospitalized patients and to determine the prevalence of poor vision among inpatients. In a prospective study, the BVSQ and the Rapid Estimate of Adult Learning in Medicine-Revised (REALM-R; among participants with sufficient vision, ≥ 20/50 Snellen) were administered to general medicine inpatients. Of 893 participants, 79% were African American, and 57% were female; the mean age was 53 years. Among 668 participants who completed both tools, the proportion with low health literacy was 38% with the BVSQ versus 47% with the REALM-R (p = .0001). Almost one fourth of participants had insufficient vision; participants with insufficient vision were more likely to be identified as having low health literacy by the BVSQ, compared with those with sufficient vision (59% vs. 38%, p < .001).
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Affiliation(s)
- Valerie G. Press
- Section of Hospital Medicine, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
- Address correspondence to Valerie G. Press, Section of Hospital Medicine, Department of Medicine, University of Chicago Medicine, 5841 S. Maryland Ave MC 5000, Chicago, IL 60637, USA. E-mail:
| | | | - Ainoa M. Mayo
- Section of Hospital Medicine, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - David O. Meltzer
- Section of Hospital Medicine, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Vineet M. Arora
- Section of General Internal Medicine, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
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