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Caridi TL, Mariño-Polo F, Farra CG, Mingus AM, Memon A, Grijalva MJ, Bates BR. Health literacy & Chagas disease knowledge: A cross-sectional study in Southern Loja Province, Ecuador. PEC INNOVATION 2024; 4:100287. [PMID: 38799258 PMCID: PMC11126796 DOI: 10.1016/j.pecinn.2024.100287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/22/2024] [Accepted: 05/04/2024] [Indexed: 05/29/2024]
Abstract
Objective Health literacy is associated with many patient outcomes. This study sought to determine the association between a person's level of health literacy and their knowledge about Chagas disease. Methods A cross-sectional survey was conducted with people living in two counties in rural Loja Province, Ecuador who attended a mobile health clinic. The communities in which the study was conducted are at high risk of Chagas disease and have limited access to both health care and educational resources. The Spanish version of Short Assessment for Health Literacy measured health literacy. The Chagas Disease Knowledge questionnaire measured knowledge of Chagas disease. T-tests and correlational analysis were used to assess associations. Results Overall 85 people participated in this study. A majority of the respondents were female (64.1%), and a plurality were married (40.7%) and had education less than secondary (40.7%). The average age of the sample was 44.31 ± 18.85. Health literacy levels and Chagas disease knowledge in the communities were low. About half of people had inadequate health literacy. No association between health literacy and Chagas knowledge was found. Conclusion Health literacy levels and Chagas disease knowledge were not found to be correlated. Explanations for the lack of association may include common causes of inadequate investment in Chagas disease education as well as neglect of health systems in rural Ecuador. Efforts to improve both health literacy and Chagas disease knowledge in poorer, rural areas of Ecuador are needed. Innovation This is the first study to assess relationships between health literacy and knowledge of Chagas disease in an uninfected population. For novel conditions, relationships between health literacy and disease knowledge should be investigated before communication campaigns are adapted.
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Affiliation(s)
- Talia L. Caridi
- Heritage College of Osteopathic Medicine, Ohio University, 6775 Bobcat Way Dublin, Ohio 43016, Dublin, OH, USA
| | - Fernanda Mariño-Polo
- Facultad de Medicina, Pontifical Catholic University of Ecuador, Avenida 12 de Octubre 1076, Quito 170143, Ecuador
| | - Cora G. Farra
- Department of Sociology & Anthropology, Bentley Annex 162, Ohio University, Athens, OH, USA
| | - Alison M. Mingus
- Honors Tutorial College, Ohio University, 35 Park Place, Athens, OH, USA
| | - Athar Memon
- School of Communication Studies, Ohio University, 418 Schoonover Center for Communication, 20 East Union Street, Athens, OH, USA
| | - Mario J. Grijalva
- Infectious and Tropical Disease Institute, Heritage College of Osteopathic Medicine, Ohio University, 191 West Union Street, Athens, OH, USA
- Biomedical Sciences Department, Heritage College of Osteopathic Medicine, Ohio University, Irvine Hall 112, Athens, OH, USA
- Center for Research on Health in Latin America, Pontifical Catholic University of Ecuador, Calle San Pedro y Pambacienda, Quito 170530, Ecuador
| | - Benjamin R. Bates
- School of Communication Studies, Ohio University, 418 Schoonover Center for Communication, 20 East Union Street, Athens, OH, USA
- Infectious and Tropical Disease Institute, Heritage College of Osteopathic Medicine, Ohio University, 191 West Union Street, Athens, OH, USA
- Center for Research on Health in Latin America, Pontifical Catholic University of Ecuador, Calle San Pedro y Pambacienda, Quito 170530, Ecuador
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Ibeh C, Marshall RS, Willey JZ. Race-ethnicity, age, and heart failure in ischemic stroke. J Stroke Cerebrovasc Dis 2024; 33:107809. [PMID: 38851547 PMCID: PMC11288767 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107809] [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: 01/19/2024] [Revised: 05/30/2024] [Accepted: 06/05/2024] [Indexed: 06/10/2024] Open
Abstract
OBJECTIVES Race-ethnic disparities contribute to cardiovascular morbidity. Heart failure (HF) is highly prevalent in acute ischemic stroke (AIS) and associated with worse outcomes. We hypothesized race-ethnic differences exist in the prevalence of HF among patients with AIS, particularly in younger patients, and in a manner not fully explained by cardiovascular profiles. METHODS Patients with AIS in the National Inpatient Sample (2016-2019) were categorized as young (<50 years), middle (50-64) and older (≥65) age. Interaction between age and race-ethnicity on the presence of comorbid HF was examined, adjusting for vascular risk factors. Effect modification on in-hospital mortality and prolonged hospitalization across race-ethnic groups and age was also examined. RESULTS Of 398,470 AIS patients, 16.2 % had HF. HF patients were older (73.7 vs. 69.5 years, P < 0.001), had a lower proportion of White, Hispanic and Asian/PI individuals but a larger proportion of patients of Black race (21.0 vs. 16.4 %, P < 0.001). Race-ethnicity modified the relationship between HF and age (Pinteraction < 0.001). Stroke patients of Black race had the greatest odds of having HF across all age groups, however differences between Black and White patients were most pronounced in young adults (OR: 2.08, 95 % CI: 1.91-2.27) after adjusting for vascular risk factors. Among patients with HF, Black race was associated with reduced risk of in-hospital mortality but greater likelihood of prolonged hospitalization at middle and older age. CONCLUSION HF is highly prevalent in stroke patients of Black race, particularly in younger cohorts, and in a manner not fully explained by cardiovascular profiles.
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Affiliation(s)
- Chinwe Ibeh
- Division of Stroke, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
| | - Randolph S Marshall
- Division of Stroke, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Joshua Z Willey
- Division of Stroke, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Yardimci Gürel T, Güner Ö. Health literacy as a predictor of cardiovascular disease risk factor knowledge level among women in Turkey: A community-based cross-sectional study. Medicine (Baltimore) 2024; 103:e38994. [PMID: 39029038 DOI: 10.1097/md.0000000000038994] [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: 07/21/2024] Open
Abstract
While more common in men globally, heart diseases also rank as the leading cause of death among women. This study aimed to examine the relationship between Turkish women's level of knowledge about cardiovascular disease (CVD) risk factors and their health literacy. Data for this descriptive and cross-sectional study were collected online by using Health Literacy Scale and CVD risk factor knowledge level scale from October 2022, to May 2023. The study sample consisted of 409 women. It was found that the total score average of the women on the CVD risk factor knowledge level was 20.65 ± 4.72 and the Health Literacy Scale was 107.06 ± 16.01. There was a moderate, significantly positive correlation between CVD knowledge levels and health literacy (r = .548, P = .000). It was found that women with high health literacy also had increased knowledge levels. Furthermore, all health literacy dimensions of access to information (P < .001), understanding information (P < .001), appraisal/evaluation (P < .001), and implementation (P < .001) were detected as the predictors of CVD risk factor knowledge levels. Factors such as educational level and economic status significantly influenced scores on both scales (P < .05). The study's findings highlight the challenges encountered by women with low socioeconomic status in accessing accurate information. It may be recommended that nurses provide health education and consultancy services to these women on the prevention and management of cardiovascular diseases. Also, public education programs should consider socioeconomic and educational levels, focusing on women who encounter difficulties accessing information.
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Affiliation(s)
- Tuğba Yardimci Gürel
- Department of Nursing, Sinop University Faculty of Health Sciences, Sinop, Turkey
| | - Özlem Güner
- Department of Midwifery, Sinop University Faculty of Health Sciences, Sinop, Turkey
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Sukys S, Trinkuniene L, Tilindiene I. Physical Education Teachers' Health Literacy: First Evidence from Lithuania. Healthcare (Basel) 2024; 12:1346. [PMID: 38998880 PMCID: PMC11241491 DOI: 10.3390/healthcare12131346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/25/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Promotion of health literacy is an important goal in the context of promoting whole school health. Physical education teachers are of particular importance in achieving this goal. However, very limited empirical studies have addressed the health literacy of physical education teachers. This research aimed to test the structural validity and reliability of the HLS19-Q12, to measure health literacy among physical education teachers, and to evaluate associations of health literacy with health- and lifestyle-related indicators. METHODS We conducted a cross-sectional study of Lithuanian physical education teachers. The participants completed a self-administered online survey that collected information on socio-demographics and health literacy (HLS19-Q12 for general health literacy and the optional package HLS19-DIGI to measure digital health literacy) as well as health behavior. RESULTS A total of 332 participants completed the survey. The HLS19-Q12 demonstrated acceptable internal consistency (Cronbach's α of 0.73 and McDonald's ω of 0.75) and satisfactory structural validity (CFI = 0.924, TLI = 0.917, RMSEA = 0.081). Participants had an average score of 85.09 (SD = 17.23) when using the HLS19-Q12, with 19.3% and 48.8% displaying excellent and sufficient levels of health literacy, respectively. Regression analyses revealed that a higher level of health literacy was significantly associated with better health evaluation (β = 0.15, p < 0.01), but no significant association was found with other health behavior and lifestyle indicators. CONCLUSIONS Overall, the results suggest that teachers' general health literacy is relatively high. Our findings highlight the importance of conducting more in-depth studies to pursue the understanding of the whole school teachers' health literacy.
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Affiliation(s)
- Saulius Sukys
- Department of Physical and Social Education, Lithuanian Sports University, Sporto 6, LT-44221 Kaunas, Lithuania; (L.T.); (I.T.)
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Corica B, Romiti GF, Simoni AH, Mei DA, Bucci T, Thompson JLP, Qian M, Homma S, Proietti M, Lip GYH. Educational status affects prognosis of patients with heart failure with reduced ejection fraction: A post-hoc analysis from the WARCEF trial. Eur J Clin Invest 2024; 54:e14152. [PMID: 38205865 DOI: 10.1111/eci.14152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/04/2023] [Accepted: 12/17/2023] [Indexed: 01/12/2024]
Abstract
AIMS The influence of social determinants of health (SDOH) on the prognosis of Heart Failure and reduced Ejection Fraction (HFrEF) is increasingly reported. We aim to evaluate the contribution of educational status on outcomes in patients with HFrEF. METHODS We used data from the WARCEF trial, which randomized HFrEF patients with sinus rhythm to receive Warfarin or Aspirin; educational status of patients enrolled was collected at baseline. We defined three levels of education: low, medium and high level, according to the highest qualification achieved or highest school grade attended. We analysed the impact of the educational status on the risk of the primary composite outcome of all-cause death, ischemic stroke (IS) and intracerebral haemorrhage (ICH); components of the primary outcome were also analysed as secondary outcomes. RESULTS 2295 patients were included in this analysis; of these, 992 (43.2%) had a low educational level, 947 (41.3%) had a medium education level and the remaining 356 (15.5%) showed a high educational level. Compared to patients with high educational level, those with low educational status showed a high risk of the primary composite outcome (adjusted hazard ratio [aHR]: 1.31, 95% confidence intervals [CI] 1.02-1.69); a non-statistically significant association was observed in those with medium educational level (aHR: 1.20, 95%CI: .93-1.55). Similar results were observed for all-cause death, while no statistically significant differences were observed for IS or ICH. CONCLUSION Compared to patients with high educational levels, those with low educational status had worse prognosis. SDOH should be considered in patients with HFrEF. CLINICAL TRIAL REGISTRATION NCT00041938.
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Affiliation(s)
- Bernadette Corica
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Amalie Helme Simoni
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark
| | - Davide Antonio Mei
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Biomedical, Cardiology Division, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Tommaso Bucci
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of General and Specialized Surgery, Sapienza University of Rome, Rome, Italy
| | - John L P Thompson
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Min Qian
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Shunichi Homma
- Cardiology Division, Columbia University Medical Center, New York, New York, USA
| | - Marco Proietti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark
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Olde Wolsink-van Harlingen A, Groen-van de Ven L, Vissers K, Hasselaar J, Jukema J, Uitdehaag M. Challenges to Exploring the Patient Perspective in Palliative Care Conversations: A Qualitative Study Among Chronic Obstructive Pulmonary Disease and Chronic Heart Failure Patients and Their Health Care Professionals. Palliat Med Rep 2024; 5:150-161. [PMID: 38596696 PMCID: PMC11002561 DOI: 10.1089/pmr.2023.0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 04/11/2024] Open
Abstract
Objectives The aim of this study was to reveal the challenges faced in exploring the patient's perspective as experienced by patients with chronic obstructive pulmonary disease or chronic heart failure and their health care professionals (HCPs), including the circumstances under which these challenges are experienced during palliative care conversations. Methods This is a qualitative, explorative study in the Netherlands using purposive sampling to create diversity in demographic variables of both patients and HCPs. Semistructured interviews with 12 patients and 7 HCPs were carried out with the use of topic lists. All interviews were audiorecorded, verbatim transcribed, and thematically analyzed. Results Patients find it challenging to express their wishes, preferences, and boundaries and say what is really preoccupying them, especially when they do not feel a good connection with their HCP. HCPs find it challenging to get to know the patient and discuss the patient's perspective particularly when patients are not proactive, open or realistic, or unable to understand or recall information. Conclusions Patients and HCPs seem to share the same aim: patients want to be known and understood and HCPs want to know and understand the patient as a unique individual. At the same time, they seem unable to personalize their conversations. To move beyond this impasse patients and HCPs need to take steps and be empowered to do so.
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Affiliation(s)
- Annet Olde Wolsink-van Harlingen
- Research Group Smart Health, Saxion University of Applied Sciences, Deventer/Enschede, the Netherlands
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc University Medical Center, Nijmegen, the Netherlands
| | - Leontine Groen-van de Ven
- Research Group Living Well with Dementia, Windesheim University of Applied Sciences, Zwolle, the Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc University Medical Center, Nijmegen, the Netherlands
| | - Jeroen Hasselaar
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc University Medical Center, Nijmegen, the Netherlands
- Nivel Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Jan Jukema
- Research Group Smart Health, Saxion University of Applied Sciences, Deventer/Enschede, the Netherlands
| | - Madeleen Uitdehaag
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc University Medical Center, Nijmegen, the Netherlands
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Kianian R, Hu MYY, Lavold AJ, Andino JJ, Morrison JC, Eleswarapu SV, Mills JN. Patient-Directed Vasectomy Information: How Readable Is It? World J Mens Health 2024; 42:408-414. [PMID: 37853530 PMCID: PMC10949024 DOI: 10.5534/wjmh.230033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/17/2023] [Accepted: 04/25/2023] [Indexed: 10/20/2023] Open
Abstract
PURPOSE To assess the quality and readability of online health information on vasectomy using validated readability and quality assessment tools. MATERIALS AND METHODS The top 50 search results for "vasectomy" on Google, Bing, and Yahoo were selected. Duplicate links, advertisements, blog posts, paid webpages, and information intended for healthcare providers were excluded. Flesch Reading Ease score, Flesch-Kincaid Grade level, Gunning Fog Index, and Simple Measure of Gobbledygook (SMOG) index were used to assess readability, with optimal readability level for online health information established as being at sixth grade reading level. DISCERN Instrument and JAMA Benchmark were used to assess the quality of selected webpages. Inter-assessment score correlation and results by webpage type were analyzed. RESULTS We analyzed 44 webpages, including 16 academic, 5 hospital-affiliated, 6 commercial, 13 non-profit health advocacy, and 4 uncategorized sources. The average readability of the evaluated webpages was at a 10th grade reading level as measured by the Flesch Kincaid Assessment tool, and an undergraduate reading level per the SMOG and Gunning Fog indices. Non-profit health advocacy webpages had the best reading level but still was not at the recommended level of grade 6 to 7. The overall DISCERN quality of the webpages was "fair", with non-profit health advocacy pages performing best. CONCLUSIONS The assessed webpages offer education on vasectomy in a language that is too complex for the general population to understand. Furthermore, several sources for online health information, such as non-profits, outperformed webpages by academic institutions. Increased healthcare collaboration and dedication to producing quality online patient resources is necessary to address these shortcomings and build trust among patients to increase utilization of vasectomy and decrease decisional regret.
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Affiliation(s)
- Reza Kianian
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angele, CA, USA
| | - Ming-Yeah Y Hu
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angele, CA, USA
| | - Abigail J Lavold
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angele, CA, USA
| | - Juan J Andino
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angele, CA, USA
| | - Jeffrey C Morrison
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angele, CA, USA
| | - Sriram V Eleswarapu
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angele, CA, USA
| | - Jesse N Mills
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angele, CA, USA.
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Borkowski P, Borkowska N. The Impact of Social Determinants of Health on Outcomes Among Individuals With HIV and Heart Failure: A Literature Review. Cureus 2024; 16:e55913. [PMID: 38601377 PMCID: PMC11003873 DOI: 10.7759/cureus.55913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 04/12/2024] Open
Abstract
This narrative review examines the complex interplay between social determinants of health (SDoH) and the outcomes for individuals living with human immunodeficiency virus (HIV) and heart failure (HF), two conditions that pose significant socioeconomic burdens globally. With millions affected by these conditions, the review delves into how socioeconomic status, education, geography, and immigration status influence health outcomes. It further explores the exacerbating roles of stigma and mental health issues, underscoring the need for comprehensive interventions and the importance of enhancing health literacy and community support. Key findings suggest that lower socioeconomic status, limited education, rural residency, and immigrant status are associated with poorer health outcomes in individuals with HIV and HF. These factors contribute to increased morbidity and mortality and decreased quality of life, highlighting the necessity of addressing SDoH to improve patient care and outcomes. There is a critical need for integrated care models that consider the medical, social, and psychological factors affecting those with HIV and HF. Strategies proposed include improving access to care, addressing socioeconomic disparities, enhancing educational efforts, and fostering community engagement. Moreover, the importance of mental healthcare integration into the management of HIV and HF is strongly advocated to improve patient outcomes. By taking a comprehensive look at the various social challenges, embracing integrated care models, and making sure everyone has fair access to healthcare services, we can make real progress in enhancing the lives of those affected by HIV and HF. This approach cannot only lower death rates but also significantly improve the quality of life for these individuals.
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Affiliation(s)
- Pawel Borkowski
- Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, New York, USA
| | - Natalia Borkowska
- Pediatrics, SPZOZ (Samodzielny Publiczny Zakład Opieki Zdrowotnej) Krotoszyn, Krotoszyn, POL
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Rouhi AD, Ghanem YK, Yolchieva L, Saleh Z, Joshi H, Moccia MC, Suarez-Pierre A, Han JJ. Can Artificial Intelligence Improve the Readability of Patient Education Materials on Aortic Stenosis? A Pilot Study. Cardiol Ther 2024; 13:137-147. [PMID: 38194058 PMCID: PMC10899139 DOI: 10.1007/s40119-023-00347-0] [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: 11/05/2023] [Accepted: 12/13/2023] [Indexed: 01/10/2024] Open
Abstract
INTRODUCTION The advent of generative artificial intelligence (AI) dialogue platforms and large language models (LLMs) may help facilitate ongoing efforts to improve health literacy. Additionally, recent studies have highlighted inadequate health literacy among patients with cardiac disease. The aim of the present study was to ascertain whether two freely available generative AI dialogue platforms could rewrite online aortic stenosis (AS) patient education materials (PEMs) to meet recommended reading skill levels for the public. METHODS Online PEMs were gathered from a professional cardiothoracic surgical society and academic institutions in the USA. PEMs were then inputted into two AI-powered LLMs, ChatGPT-3.5 and Bard, with the prompt "translate to 5th-grade reading level". Readability of PEMs before and after AI conversion was measured using the validated Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook Index (SMOGI), and Gunning-Fog Index (GFI) scores. RESULTS Overall, 21 PEMs on AS were gathered. Original readability measures indicated difficult readability at the 10th-12th grade reading level. ChatGPT-3.5 successfully improved readability across all four measures (p < 0.001) to the approximately 6th-7th grade reading level. Bard successfully improved readability across all measures (p < 0.001) except for SMOGI (p = 0.729) to the approximately 8th-9th grade level. Neither platform generated PEMs written below the recommended 6th-grade reading level. ChatGPT-3.5 demonstrated significantly more favorable post-conversion readability scores, percentage change in readability scores, and conversion time compared to Bard (all p < 0.001). CONCLUSION AI dialogue platforms can enhance the readability of PEMs for patients with AS but may not fully meet recommended reading skill levels, highlighting potential tools to help strengthen cardiac health literacy in the future.
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Affiliation(s)
- Armaun D Rouhi
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yazid K Ghanem
- Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Laman Yolchieva
- College of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Zena Saleh
- Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Hansa Joshi
- Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Matthew C Moccia
- Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | | | - Jason J Han
- Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
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Kirchberger I, Fischer S, Raake P, Linseisen J, Meisinger C, Schmitz T. Depression mediates the association between health literacy and health-related quality of life after myocardial infarction. Front Psychiatry 2024; 15:1341392. [PMID: 38419900 PMCID: PMC10899501 DOI: 10.3389/fpsyt.2024.1341392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction So far, health literacy (HL) and its related factors in patients with acute myocardial infarction received little attention. Thus, the objective of this study was to investigate the associations between the different dimensions of HL and disease-specific health-related quality of life (HRQOL), and factors that may affect these relations in patients after acute myocardial infarction (AMI). Methods All survivors of AMI between June 2020 and September 2021, from the Myocardial Infarction Registry Augsburg (n=882) received a postal questionnaire on HL [Health Literacy Questionnaire (HLQ)], HRQOL (MacNew Heart Disease HRQOL questionnaire) and depression (Patient Health Questionnaire). From the 592 respondents, 546 could be included in the analysis. Multivariable linear regression models were performed to investigate the associations between the nine subscales of the HLQ and the total score and three subscales of the MacNew questionnaire. A mediation analysis was performed to estimate direct and indirect effects of HL on HRQOL taking into account the mediating effect of depression. Results In the sample of 546 patients (72.5% male, mean age 68.5 ± 12.2 years), patients with poor education showed significantly lower HLQ scores. Significant associations between the subscales of the HLQ and the MacNew were found, which remained significant after adjustment for sociodemographic variables with few exceptions. More than 50% of the association between HL and HRQOL was mediated by depression in seven HLQ subscales and a complete mediating effect was found for the HLQ subscales 'Actively managing my health' and 'Appraisal of health information'. Discussion Depression mediates the associations between HL and disease-specific HRQOL in patients with myocardial infarction.
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Affiliation(s)
- Inge Kirchberger
- Epidemiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Simone Fischer
- Epidemiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Philip Raake
- Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Augsburg, Germany
| | - Jakob Linseisen
- Epidemiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians Universität Munich, Munich, Germany
| | - Christine Meisinger
- Epidemiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Timo Schmitz
- Epidemiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
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Kunnath AJ, Sack DE, Wilkins CH. Relative predictive value of sociodemographic factors for chronic diseases among All of Us participants: a descriptive analysis. BMC Public Health 2024; 24:405. [PMID: 38326799 PMCID: PMC10851469 DOI: 10.1186/s12889-024-17834-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/20/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Although sociodemographic characteristics are associated with health disparities, the relative predictive value of different social and demographic factors remains largely unknown. This study aimed to describe the sociodemographic characteristics of All of Us participants and evaluate the predictive value of each factor for chronic diseases associated with high morbidity and mortality. METHODS We performed a cross-sectional analysis using de-identified survey data from the All of Us Research Program, which has collected social, demographic, and health information from adults living in the United States since May 2018. Sociodemographic data included self-reported age, sex, gender, sexual orientation, race/ethnicity, income, education, health insurance, primary care provider (PCP) status, and health literacy scores. We analyzed the self-reported prevalence of hypertension, coronary artery disease, any cancer, skin cancer, lung disease, diabetes, obesity, and chronic kidney disease. Finally, we assessed the relative importance of each sociodemographic factor for predicting each chronic disease using the adequacy index for each predictor from logistic regression. RESULTS Among the 372,050 participants in this analysis, the median age was 53 years, 59.8% reported female sex, and the most common racial/ethnic categories were White (54.0%), Black (19.9%), and Hispanic/Latino (16.7%). Participants who identified as Asian, Middle Eastern/North African, and White were the most likely to report annual incomes greater than $200,000, advanced degrees, and employer or union insurance, while participants who identified as Black, Hispanic, and Native Hawaiian/Pacific Islander were the most likely to report annual incomes less than $10,000, less than a high school education, and Medicaid insurance. We found that age was most predictive of hypertension, coronary artery disease, any cancer, skin cancer, diabetes, obesity, and chronic kidney disease. Insurance type was most predictive of lung disease. Notably, no two health conditions had the same order of importance for sociodemographic factors. CONCLUSIONS Age was the best predictor for the assessed chronic diseases, but the relative predictive value of income, education, health insurance, PCP status, race/ethnicity, and sexual orientation was highly variable across health conditions. Identifying the sociodemographic groups with the largest disparities in a specific disease can guide future interventions to promote health equity.
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Affiliation(s)
- Ansley J Kunnath
- Vanderbilt University Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Daniel E Sack
- Vanderbilt University Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Consuelo H Wilkins
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End, Suite 600, Nashville, TN, 37203, USA.
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12
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Pavlovic N, Ndumele CE, Saylor MA, Szanton SL, Lee CS, Shah AM, Chang PP, Florido R, Matsushita K, Himmelfarb C, Leoutsakos JM. Identification of Fatigue Subtypes and Their Correlates in Prevalent Heart Failure: A Secondary Analysis of the Atherosclerosis Risk in Communities Study. Circ Cardiovasc Qual Outcomes 2024; 17:e010115. [PMID: 38240158 PMCID: PMC10922158 DOI: 10.1161/circoutcomes.123.010115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/31/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Among patients with heart failure (HF), fatigue is common and linked to quality of life and functional status. Fatigue is hypothesized to manifest as multiple types, with general and exertional components. Unique subtypes of fatigue in HF may require differential assessment and treatment to improve outcomes. We conducted this study to identify fatigue subtypes in persons with prevalent HF in the ARIC study (Atherosclerosis Risk in Communities) and describe the distribution of characteristics across subtypes. METHODS We performed a cross-sectional analysis of 1065 participants with prevalent HF at ARIC visit 5 (2011-2013). We measured exertional fatigue using the Modified Medical Research Council Breathlessness scale and general fatigue using the Patient Reported Outcomes Measurement Information System fatigue scale. We used latent class analysis to identify subtypes of fatigue. Number of classes was determined using model fit statistics, and classes were interpreted and assigned fatigue severity rating based on the conditional probability of endorsing survey items given class. We compared characteristics across classes using multinomial regression. RESULTS Overall, participants were 54% female and 38% Black with a mean age of 77. We identified 4 latent classes (fatigue subtypes): (1) high general/high exertional fatigue (18%), (2) high general/low exertional fatigue (27%), (3) moderate general/moderate exertional fatigue (20%), and (4) low/no general and exertional fatigue (35%). Female sex, Black race, lower education level, higher body mass index, increased depressive symptoms, and higher prevalence of diabetes were associated with higher levels of general and exertional fatigue. CONCLUSIONS We identified unique subtypes of fatigue in patients with HF who have not been previously described. Within subtype, general and exertional fatigue were mostly concordant in severity, and exertional fatigue only occurred in conjunction with general fatigue, not alone. Further understanding these fatigue types and their relationships to outcomes may enhance our understanding of the symptom experience and inform prognostication and secondary prevention efforts for persons with HF.
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Affiliation(s)
| | | | | | - Sarah L. Szanton
- Johns Hopkins School of Nursing, Baltimore, MD
- Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | | | | | - Kunihiro Matsushita
- Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Cheryl Himmelfarb
- Johns Hopkins School of Nursing, Baltimore, MD
- Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jeannie Marie Leoutsakos
- Johns Hopkins School of Medicine, Baltimore, MD
- Boston College Connell School of Nursing, Boston, MA
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13
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Milam AJ, Ogunniyi MO, Faloye AO, Castellanos LR, Verdiner RE, Stewart JW, Chukumerije M, Okoh AK, Bradley S, Roswell RO, Douglass PL, Oyetunji SO, Iribarne A, Furr-Holden D, Ramakrishna H, Hayes SN. Racial and Ethnic Disparities in Perioperative Health Care Among Patients Undergoing Cardiac Surgery: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 83:530-545. [PMID: 38267114 DOI: 10.1016/j.jacc.2023.11.015] [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: 08/15/2023] [Accepted: 11/08/2023] [Indexed: 01/26/2024]
Abstract
There has been little progress in reducing health care disparities since the 2003 landmark Institute of Medicine's report Unequal Treatment. Despite the higher burden of cardiovascular disease in underrepresented racial and ethnic groups, they have less access to cardiologists and cardiothoracic surgeons, and have higher rates of morbidity and mortality with cardiac surgical interventions. This review summarizes existing literature and highlights disparities in cardiovascular perioperative health care. We propose actionable solutions utilizing multidisciplinary perspectives from cardiology, cardiac surgery, cardiothoracic anesthesiology, critical care, medical ethics, and health disparity experts. Applying a health equity lens to multipronged interventions is necessary to eliminate the disparities in perioperative health care among patients undergoing cardiac surgery.
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Affiliation(s)
- Adam J Milam
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona, USA.
| | - Modele O Ogunniyi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA; Grady Health System, Atlanta, Georgia, USA
| | - Abimbola O Faloye
- Department of Anesthesiology, Emory University, Atlanta, Georgia, USA. https://twitter.com/bfaloyeMD
| | - Luis R Castellanos
- Division of Cardiovascular Medicine, Department of Medicine, University of California-San Diego, La Jolla, California, USA. https://twitter.com/lrcastel
| | - Ricardo E Verdiner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona, USA. https://twitter.com/VerdinerMD
| | - James W Stewart
- Yale School of Medicine, Department of Surgery, New Haven, Connecticut, USA. https://twitter.com/stewartwjames
| | - Merije Chukumerije
- Department of Cardiovascular Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA. https://twitter.com/DrMerije
| | - Alexis K Okoh
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA. https://twitter.com/OkohMD
| | - Steven Bradley
- Department of Anesthesia and Critical Care, Moffitt Cancer Center, Tampa, Florida, USA. https://twitter.com/stevenbradleyMD
| | - Robert O Roswell
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell Health, New York, New York, USA. https://twitter.com/DrRobRoswell
| | - Paul L Douglass
- Center for Cardiovascular Care, Wellstar Atlanta Medical Center, Atlanta, Georgia, USA
| | - Shakirat O Oyetunji
- Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington, USA. https://twitter.com/LaraOyetunji
| | - Alexander Iribarne
- Department of Cardiothoracic Surgery, Staten Island University Hospital, Northwell Health, Staten Island, New York, USA
| | - Debra Furr-Holden
- Department of Epidemiology, School of Global Public Health, New York University, New York, New York, USA. https://twitter.com/DrDebFurrHolden
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA. https://twitter.com/SharonneHayes
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14
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Wang A, Wan J, Zhu L, Chang W, Wen L, Tao X, Jin Y. Frailty and medication adherence among older adult patients with hypertension: a moderated mediation model. Front Public Health 2023; 11:1283416. [PMID: 38115848 PMCID: PMC10728772 DOI: 10.3389/fpubh.2023.1283416] [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: 08/26/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
Objective Medication adherence has a critical impact on the well-being of older adult patients with hypertension. As such, the current study aimed to investigate the mediating role of health literacy between frailty and medication adherence and the moderating role of educational level. Methods This cross-sectional study included patients admitted to the geriatric unit of a hospital. Participants were interviewed using the four-item Morisky Medication Adherence Scale, the Frailty Phenotype Scale, and the Health Literacy Management Scale. Spearman's correlation coefficients were used to assess the association between variables. Mediation and moderated mediation analyses were performed using Process version 4.1 via Model 4 and 14, respectively. Results Data from 388 participants were analyzed. The median (IQR [P25-P75]) score for medication adherence was 4.00 (2.00-4.00). Results revealed that after controlling for age, sex, hypertension complication(s) and body mass index, frailty significantly contributed to medication adherence (βtotal -0.236 [95% confidence interval (CI) -0.333 to -0.140]). Medication adherence was influenced by frailty (βdirect -0.192 [95% CI -0.284 to -0.099]) both directly and indirectly through health literacy (βindirect -0.044 [95% CI -0.077 to -0.014]). Educational level moderated the pathway mediated by health literacy; more specifically, the conditional indirect effect between frailty and medication adherence was significant among older adult hypertensive patients with low, intermediate, and high educational levels (effect -0.052 [95% CI -0.092 to -0.106]; effect -0.041 [95% CI -0.071 to -0.012]; effect -0.026 [95% CI -0.051 to -0.006]). The relationship between frailty and medication adherence in older adult patients with hypertension was found to have mediating and moderating effects. Conclusion A moderated mediation model was proposed to investigate the effect of frailty on medication adherence. It was effective in strengthening medication adherence by improving health literacy and reducing frailty. More attention needs to be devoted to older adult patients with hypertension and low educational levels.
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Affiliation(s)
- Anshi Wang
- School of Public Health, Wannan Medical College, Wuhu, China
- Institutes of Brain Science, Wannan Medical College, Wuhu, China
| | - Jingjing Wan
- Department of Nursing, Anhui College of Traditional Chinese Medicine, Wuhu, China
| | - Lijun Zhu
- School of Public Health, Wannan Medical College, Wuhu, China
| | - Weiwei Chang
- School of Public Health, Wannan Medical College, Wuhu, China
| | - Liying Wen
- School of Public Health, Wannan Medical College, Wuhu, China
| | - Xiubin Tao
- Nursing Department, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Yuelong Jin
- School of Public Health, Wannan Medical College, Wuhu, China
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15
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Khosravirad Z, Rostamzadeh M, Azizi S, Khodashenas M, Khodadoustan Shahraki B, Ghasemi F, ghorbanzadeh M. The Efficacy of Self-care Behaviors, Educational Interventions, and Follow-up Strategies on Hospital Readmission and Mortality Rates in Patients with Heart Failure. Galen Med J 2023; 12:1-7. [PMID: 38774856 PMCID: PMC11108665 DOI: 10.31661/gmj.v12i.3116] [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: 07/11/2023] [Indexed: 05/24/2024] Open
Abstract
Heart failure (HF), a worldwide epidemic with significant morbidity and mortality risks, is frequently secondary to cardiovascular disorders and probably is the common final way to survive patients. Almost 25% of hospitalized patients with acute HF are expected to be readmitted within 30 days post-discharge, and the rates of rehospitalization increase to almost one-third at 60 days and 60 percent within one year of discharge. Although care planning for patients with heart failure is complex, multidisciplinary, and resource-dependent, optimal self-care management along with appropriate educational intervention and follow-up strategy could be able to reduce readmissions, decline the duration of hospitalization, increase life expectancy, decrease the rates of mortality, and reduce costs of healthcare services for patients with HF. However, there are contradictions in previous reports about the efficacy of self-care, mainly due to patients' non-adherence to self-care behaviors. Therefore, the current study aimed to review the investigations on the effectiveness of self-care of HF patients in reducing hospital readmissions and increasing quality of life, and discuss novel approaches for predischarge educational interventions and postdischarge follow-up strategies.
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Affiliation(s)
| | - Mohammad Rostamzadeh
- Department of Cardiology, School of Medicine, Ardabil University of Medical
Sciences, Ardabil, Iran
| | - Shiva Azizi
- Department of Nursing, School of Nursing, North Khorasan University of Medical
Sciences, Bojnurd, Iran
| | | | | | - Farangis Ghasemi
- Department of Biology, Jahrom Branch, Islamic Azad University, Jahrom, Iran
| | - Maryam ghorbanzadeh
- Department of Nursing, School of Nursing, North Khorasan University of Medical
Sciences, Bojnurd, Iran
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16
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Browder SE, Rosamond WD. Preventing Heart Failure Readmission in Patients with Low Socioeconomic Position. Curr Cardiol Rep 2023; 25:1535-1542. [PMID: 37751036 PMCID: PMC10863623 DOI: 10.1007/s11886-023-01960-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE OF REVIEW This review aims to summarize the current burden of heart failure (HF) in the United States, specifically in patients with low socioeconomic position (SEP), and synthesize recommendations to prevent HF-related hospital readmissions in this vulnerable population. RECENT FINDINGS As treatments have improved, HF-related mortality has declined over time, resulting in more patients living with HF. This has led to an increase in hospitalizations, however, putting excess strain on our healthcare system. HF patients with low SEP are a particularly vulnerable group, as they experience higher rates of hospitalization and readmission compared to their high SEP counterparts. The Hospital Readmission Reduction Program (HRRP) was created to motivate interventions that reduce hospital readmissions across diseases, with HF being a primary target. Numerous readmission prevention efforts have been suggested to target the pre-hospitalization, hospitalization, and post-hospitalization phases, including addressing social determinants of health (SDoH), improving coordination of care, optimizing discharge plans, and improving adherence to follow-up care and medication regimens. Many of these proposed interventions show promise in reducing HF-related readmissions and issues surrounding adequate caregiver support may be particularly important to reduce readmissions among persons in low SEP. Reducing HF-related hospital readmissions is possible, even in vulnerable populations like those with low SEP, but this will require coordinated efforts across the healthcare system and throughout the life course of these patients. Caregiver support is a necessary part of optimized care for low SEP HF patients and future efforts should consider interventions that support these caregivers.
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Affiliation(s)
- Sydney E Browder
- UNC Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC, USA.
| | - Wayne D Rosamond
- UNC Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC, USA
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17
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Trutner ZD, Furlough K, Martinez A, Vetter I, Uhler LM, Haynes A, Jayakumar P. Is Health Literacy Associated With Surgical Outcomes? A Systematic Review. J Surg Res 2023; 291:720-733. [PMID: 37572516 DOI: 10.1016/j.jss.2023.06.044] [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: 12/12/2022] [Revised: 06/15/2023] [Accepted: 06/27/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION Low levels of health literacy have been shown to increase healthcare utilization and negatively affect health outcomes within medical specialties. However, the relationship of health literacy with clinical, patient-centered, and process-oriented surgical outcomes is not as well understood. MATERIALS AND METHODS We sought to systematically review the current evidence base regarding the relationship between health literacy and a range of outcomes in patients experiencing surgical care. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched six databases and then identified and extracted data from 25 cross-sectional or cohort studies deemed eligible for a systematic review. RESULTS Among included studies, strong evidence exists to support an association between low health literacy and worse patient-centered outcomes, as well as an association between low health literacy and poorer process-oriented surgical outcomes. However, the relationship between health literacy and clinical outcomes remains unclear. CONCLUSIONS Substantial opportunities remain to improve our understanding of the impact of health literacy on surgical outcomes. Future work should expand the range of institutional and specialized surgical settings studied, implement a standardized set of validated health literacy assessment tools, include more diverse patient populations, and investigate a comprehensive range of patient-reported outcomes.
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Affiliation(s)
- Zoe D Trutner
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas.
| | - Kenneth Furlough
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Anuska Martinez
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Imelda Vetter
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Lauren M Uhler
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Alex Haynes
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Prakash Jayakumar
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas
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18
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Contreras J, Tinuoye EO, Folch A, Aguilar J, Free K, Ilonze O, Mazimba S, Rao R, Breathett K. Heart Failure with Reduced Ejection Fraction and COVID-19, when the Sick Get Sicker: Unmasking Racial and Ethnic Inequities During a Pandemic. Cardiol Clin 2023; 41:491-499. [PMID: 37743072 PMCID: PMC10267502 DOI: 10.1016/j.ccl.2023.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Minoritized racial and ethnic groups have the highest incidence, prevalence, and hospitalization rate for heart failure. Despite improvement in medical therapies and overall survival, the morbidity and mortality of these groups remain elevated. The reasons for this disparity are multifactorial, including social determinant of health (SDOH) such as access to care, bias, and structural racism. These same factors contributed to higher rates of COVID-19 infection among minoritized racial and ethnic groups. In this review, we aim to explore the lessons learned from the COVID-19 pandemic and its interconnection between heart failure and SDOH. The pandemic presents a window of opportunity for achieving greater equity in the health care of all vulnerable populations.
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Affiliation(s)
- Johanna Contreras
- Division of Cardiovascular Medicine, The Mount Sinai Health System, 1190 5th Avenue, 1st Floor, New York, NY 10029, USA
| | - Elizabeth O Tinuoye
- Division of Cardiovascular Medicine, The Mount Sinai Health System, 1190 5th Avenue, 1st Floor, New York, NY 10029, USA
| | - Alejandro Folch
- Division of Cardiovascular Medicine, The Mount Sinai Health System, 1190 5th Avenue, 1st Floor, New York, NY 10029, USA
| | - Jose Aguilar
- Division of Cardiovascular Medicine, The Mount Sinai Health System, 1190 5th Avenue, 1st Floor, New York, NY 10029, USA
| | - Kendall Free
- Department of Biofunction Research, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Onyedika Ilonze
- Division of Cardiovascular Medicine, Indiana University, 1800 North Capitol Avenue, Indianapolis, IN 46202, USA
| | - Sula Mazimba
- Division of Cardiovascular Medicine, University of Virginia, 1215 Lee Street, Charlottesville, VA 22908-0158, USA
| | - Roopa Rao
- Division of Cardiovascular Medicine, Indiana University, 1800 North Capitol Avenue, Indianapolis, IN 46202, USA
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Indiana University, 1800 North Capitol Avenue, Indianapolis, IN 46202, USA.
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19
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Nunes WB, Firmino RT, Marinho AMCL, Barreto LDS, Sousa MLC, Silva SED, Costa EMMDB, Perazzo MF, Granville-Garcia AF. Clarity of publications on HPV in Instagram profiles of official health agencies in Brazil. Braz Oral Res 2023; 37:e103. [PMID: 38055521 DOI: 10.1590/1807-3107bor-2023.vol37.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/02/2023] [Indexed: 12/08/2023] Open
Abstract
The study analyzed the clarity of publications on human papillomavirus (HPV) in the Instagram profiles of official Brazilian health agencies. An infodemiological study analyzed publications on HPV in the 81 Instagram profiles selected from the Health Ministry, States' Health Departments, and dental councils and associations. The following data were collected: classification of content, type of profiles, type of media, how the content was addressed, number of posts, frequency, likes, comments, viewings, and hashtags, and how the HPV vaccine was addressed. The clarity of the educational publications was assessed using the Brazilian version of the Clear Communication Index (BR-CDC-CCI). Data analysis was performed with Spearman's correlation and the Mann-Whitney test (p < 0.05). A total of 504 publications on HPV were found. The average number of likes was 528.3 (SD = 2388.2) and the average BR-CDC-CCI score was 67.1 (SD = 14.1). The quality and clarity of the information was considered adequate (BR-CDC-CCI score ≥ 90) in 6.9% of the publications. A weak positive correlation was found between the number of likes and both the BR-CDC-CCI score (r = 0.195) and number of posts (r = 0.124). Publications from the Health Ministry had a significantly higher BR-CDC-CCI score (72.9) compared to the other profiles analyzed (p = 0.01). Most publications concerned government actions, had low engagement, and written educational information was of low clarity and quality. However, the effort to reach the population was evident, with an increase in publications over the years.
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Affiliation(s)
- Wanúbia Barbosa Nunes
- Universidade Estadual da Paraíba - UEPB, Post-Graduation Program in Dentistry, Campina Grande, PB, Brazil
| | - Ramon Targino Firmino
- Universidade Federal de Campina Grande - UFCG, Academic Unit of Biological Sciences, Patos, PB, Brazil
| | | | - Lílian de Sá Barreto
- Universidade Estadual da Paraíba - UEPB, Department of Dentistry, Campina Grande, PB, Brazil
| | | | - Samara Ellen da Silva
- Universidade Estadual da Paraíba - UEPB, Department of Dentistry, Campina Grande, PB, Brazil
| | | | - Matheus França Perazzo
- Universidade Federal de Goiás - UFG, Dental School, Department of Oral Health, Goiânia, GO, Brazil
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Johnson KT, You H, Kandel M, Oyesanya TO. How Subjective and Objective Factors in Research and Practice May Perpetuate Health Disparities Among Patients With Traumatic Brain Injury. Am J Phys Med Rehabil 2023; 102:923-925. [PMID: 37205611 PMCID: PMC10524542 DOI: 10.1097/phm.0000000000002271] [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] [Indexed: 05/21/2023]
Abstract
ABSTRACT Research shows disparities exist in traumatic brain injury (TBI)-related outcomes and are associated with objective and subjective factors. Objective factors (e.g., age, sex, race/ethnicity, health insurance status, and socioeconomic status) are defined as variables that are frequently measured, not easily modifiable, and not easily influenced by individual perceptions, opinions, or experiences. Conversely, subjective factors (e.g., personal health literacy, cultural competence, patient/family-clinician communication, implicit bias, and trust) are defined as variables that may be less frequently measured, more easily modifiable, and more easily influenced by individual perceptions, opinions, or experiences. The purpose of this analysis and perspective is to provide recommendations for further examination of subjective factors within TBI research and practice, with the overarching goal of reducing TBI-related disparities. Establishing reliable and valid measures of subjective factors is recommended to allow for further examination of the influence of both objective factors and subjective factors in the TBI population. Providers and researchers must also engage in education and training to recognize their biases and how bias influences decision making. The influence of subjective factors in practice and research must also be considered to ensure that knowledge needed to advance health equity is generated and disparities in outcomes for patients with TBI are reduced.
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Affiliation(s)
- Karen T. Johnson
- Duke University Health System, Department of Physical and Occupational Therapy
| | | | - Melissa Kandel
- Duke University Health System, Department of Physical and Occupational Therapy
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21
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Meraz R, McGee J, Caldwell EP, Ke W, Osteen K. The Impact of Resilience, Health Literacy, and Social Support on Medication Adherence and Self-care Among Adults With Heart Failure. J Cardiovasc Nurs 2023; 38:415-424. [PMID: 36103430 DOI: 10.1097/jcn.0000000000000948] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Personal and psychological factors, such as depression, have a considerable influence on nonadherence to medications and self-care in those with heart failure. More evidence is needed about positive personal factors that motivate adherence to medications and self-care in those with heart failure. OBJECTIVE The purpose of this study was to investigate whether there was a relationship between the personal resources of resilience, hope, health literacy, social support, and self-care activation and adherence to HF self-care and medications and whether race impacts adherence. METHODS This study used a cross-sectional, correlational design. Stepwise regression was used to test whether resilience, hope, health literacy, self-care activation, and race significantly predicted medication adherence and self-care. A diverse sample was recruited for this study. RESULTS Of the 174 participants, 51% were female, 51.7% were White, and the mean age was 62 years. After adjustment for differences in age and depressive symptoms, a predictive relationship remained between resilience, health literacy, and medication adherence. Hope, activation, and race were not selected in the final regression model. A high level of perceived social support was the only predictor of better HF self-care. CONCLUSION Persons with heart failure may have better medication adherence and overall self-care if sufficiently resilient, health literate, and supported regardless of their degree of hope or activation. Race and age may be important factors to consider. More research is needed to understand the connection between resilience and medication adherence.
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22
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Makana J, Polomeno V. [Two-way teaching of the elderly in the context of heart failure]. SOINS. GERONTOLOGIE 2023; 28:36-42. [PMID: 37716780 DOI: 10.1016/j.sger.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
In Canada, heart failure (HF) is the second leading cause of hospitalization among the elderly. Heart failure could be improved by the teach-back approach. There are no articles in the French literature describing this educational approach, especially in the context of elderly people living with HF. The aim of this article is to provide French-speaking healthcare professionals, including nurses, with knowledge about this approach, that also includes a specific component on self-care in HF.
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Affiliation(s)
- Judith Makana
- Hôpital Montfort, 713 chemin Montréal, Ottawa, Ontario, Canada, K1K 0T2; Université d'Ottawa, 451 chemin Smyth, Ottawa, Ontario, Canada K1H 8M5.
| | - Viola Polomeno
- Université d'Ottawa, 451 chemin Smyth, Ottawa, Ontario, Canada K1H 8M5
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23
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Haywood HB, Sauer AJ, Allen LA, Albert NM, Devore AD. The Promise and Risks of mHealth in Heart Failure Care. J Card Fail 2023; 29:1298-1310. [PMID: 37479053 DOI: 10.1016/j.cardfail.2023.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/04/2023] [Accepted: 07/01/2023] [Indexed: 07/23/2023]
Abstract
Mobile health (mHealth) is an emerging approach to health care. It involves wearable, connected technologies that facilitate patient-symptom or physiological monitoring, support clinical feedback to patients and physicians, and promote patients' education and self-care. Evolving algorithms may involve artificial intelligence and can assist in data aggregation and health care teams' interpretations. Ultimately, the goal is not merely to collect data; rather, it is to increase actionability. mHealth technology holds particular promise for patients with heart failure, especially those with frequently changing clinical status. mHealth, ideally, can identify care opportunities, anticipate clinical courses and augment providers' capacity to implement, titrate and monitor interventions safely, including evidence-based therapies. Although there have been marked advancements in the past decade, uncertainties remain for mHealth, including questions regarding optimal indications and acceptable payment models. In regard to mHealth capability, a better understanding is needed of the incremental benefit of mHealth data over usual care, the accuracy of specific mHealth data points in making clinical care decisions, and the efficiency and precision of algorithms used to dictate actions. Importantly, emerging regulations in the wake of COVID-19, and now the end of the federal public health emergency, offer both opportunity and risks to the broader adoption of mHealth-enabled services. In this review, we explore the current state of mHealth in heart failure, with particular attention to the opportunities and challenges this technology creates for patients, health care providers and other stakeholders.
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Affiliation(s)
- Hubert B Haywood
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Andrew J Sauer
- Saint Luke's Mid America Heart Institute, Kansas City, MO
| | - Larry A Allen
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
| | - Nancy M Albert
- Nursing Institute and Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, OH
| | - Adam D Devore
- Department of Medicine, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
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Mancebo-Salas N, Cobo-Sánchez JL, Arroyo-Toca B, Vaquero-Viadero S, Fernández-Martínez V, Tuells J, Blázquez-González P, Camacho-Arroyo MT, Moro-Tejedor MN. [Protocolo para la evaluación de una intervención de alfabetización en salud sobre morbimortalidad y calidad de vida en pacientes con insuficiencia cardíaca.]. Rev Esp Salud Publica 2023; 97:e202308068. [PMID: 37970887 PMCID: PMC10540934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 06/07/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE Heart failure (HF) is a complex clinical syndrome that impairs the ability to achieve proper filling or ejection, in which patients have typical symptoms and signs. It is a major Public Health problem with a high incidence and prevalence associated with high morbidity and mortality. The management of the patient with HF is complex, requiring in its treatment the work of specialized multidisciplinary teams in which the management of cardiac-healthy habits and self-care will play a leading role. Knowing the health literacy (HL) level of patients is a fundamental piece that will help us to provide a holistic attention, based on individual needs, promoting in this way the empowerment of the patient. Our aim will be to evaluate the effectiveness of an HL intervention for improving quality of life and decreasing morbidity/mortality. METHODS A two-arm randomized controlled clinical trial will be conducted, with concealment of randomization. Patients with diagnosis of HF attended in cardiology and internal medicine consultations of 5 hospitals in Spain will be included.
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Affiliation(s)
- Noelia Mancebo-Salas
- Dirección General de Servicios Sociales e Integración; Consejería de Familia, Juventud y Asuntos Sociales de la Comunidad de Madrid. Madrid. España
| | - José Luis Cobo-Sánchez
- Hospital Universitario Marqués de Valdecilla; IDIVAL. Santander. España
- Escuela Universitaria de Enfermería Hospital Mompía. Mompía (Santa Cruz de Bezana). España
- Universidad Católica de Ávila. Ávila. España
| | | | | | | | - José Tuells
- Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia; Universidad de Alicante. Alicante. España
| | | | | | - Mª Nieves Moro-Tejedor
- Unidad de Apoyo a la Investigación en Enfermería; Hospital General Universitario Gregorio Marañon. Madrid. España
- Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM). Madrid. España
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Sepassi A, Garcia S, Tanjasiri S, Lee S, Bounthavong M. Predicted Health Literacy Disparities Between Immigrant and US-Born Racial/Ethnic Minorities: a Nationwide Study. J Gen Intern Med 2023; 38:2364-2373. [PMID: 36849863 PMCID: PMC10406741 DOI: 10.1007/s11606-023-08082-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/30/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Racial/ethnic minorities in the USA exhibit reduced health literacy (HL) proficiency, leading to increased health disparities. It is unclear how the effect of birth status (immigrant/US-born) affects HL proficiency among racial/ethnic minorities. OBJECTIVE To identify the direct, indirect, and total effects of birth status on HL proficiency among a nationally representative population of racial/ethnic minority adults in the USA. DESIGN A cross-sectional study of 2019 data from the Medial Expenditure Panel Survey. PARTICIPANTS Participants aged 18 or older reporting as racial/ethnic minorities (Black, Asian, or Hispanic) with non-missing data. MAIN MEASURES We predicted HL proficiency for each participant using a previously published model. Path analysis was used to estimate the direct, indirect, and total effects of birth status on HL proficiency, accounting for several other covariates. Prevalence ratios were estimated using adjusted Poisson regression to evaluate differences in the "Below Basic" HL category. KEY RESULTS An estimated weighted 81,092,505 participants were included (57.5% US-born, 42.5% immigrant). More racial/ethnic minority immigrant participants fell into the lowest category of HL proficiency, "Below Basic" (14.3% vs 5.5%, p < 0.05). Results of the path analysis indicated a significant, negative direct effect of birth status on HL proficiency (standardized coefficient = - 0.24, SE = 0.01, 95%CI: - 0.26, - 0.23) in addition to an indirect effect mediated through insurance status, health-system resource use, and English proficiency. The total effect of birth status on HL proficiency was found to be - 0.29. The immigrant participant group had 81% higher prevalence of falling into the "Below Basic" HL category compared to US-born participants (prevalence ratio = 1.81, 95%CI: 1.52, 2.16). CONCLUSIONS Immigrant status has a strong, negative, direct effect on HL proficiency among racial/ethnic minorities in the USA. This may be a result of barriers that prevent equitable access to resources that improve proper HL proficiency. US policymakers may consider several methods to reduce this disparity at the health-system-, provider-, and patient-levels.
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Affiliation(s)
- Aryana Sepassi
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, 802 W Peltason Dr., Irvine, CA, 92617, USA.
| | - Samantha Garcia
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
- Keck School of Medicine, Los Angeles, CA, USA
| | - Sora Tanjasiri
- Department of Epidemiology & Biostatistics, Program of Public Health, University of California, Irvine, Irvine, CA, USA
| | - Sunmin Lee
- Department of Medicine, School of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Mark Bounthavong
- Division of Clinical Pharmacy, Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, USA
- Department of Veteran Affairs, Health Economic Resource Center, Menlo Park, CA, USA
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26
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Huang J, He Z, Xu M, Du J, Zhao YT. Socioeconomic status may affect association of vegetable intake with risk of ischemic cardio-cerebral vascular disease: a Mendelian randomization study. Front Nutr 2023; 10:1161175. [PMID: 37599701 PMCID: PMC10436213 DOI: 10.3389/fnut.2023.1161175] [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: 02/21/2023] [Accepted: 06/23/2023] [Indexed: 08/22/2023] Open
Abstract
Background Previous studies found that increasing vegetable intake benefits are reduced after adjustment for socioeconomic factors. Using genetic variation as an instrumental variable for vegetable intake and socioeconomic status, we investigated the relationship between vegetable intake and ischemic cardio-cerebral vascular diseases and focused on whether socioeconomic status was a possible confounder. Methods From three independent genome-wide association studies, we extracted instrumental variables reflecting raw and cooked vegetable intake, which were used to perform Mendelian randomization analysis. To evaluate the effects of socioeconomic factors on vegetable intake, univariate and multivariate Mendelian randomization analyses were performed using single nucleotide polymorphisms representing education attainment and household income reported in the literature. We also performed outlier assessment and a series of sensitivity analyses to confirm the results. Results Genetically predicted raw and cooked vegetable intake were not associated with any ischemic cardio-cerebral vascular diseases and lipid components after Bonferroni correction. Univariate Mendelian randomized analysis revealed that raw vegetable intake was positively correlated with education attainment (β = 0.04, p = 0.029) and household income (β = 0.07, p < 0.001). Multivariate Mendelian randomized model showed a positive correlation between household income and raw vegetable intake (β = 0.06, p = 0.004). Socioeconomic status was closely associated with eating habits and lifestyle related to the risk of cardiovascular diseases. Conclusion Genetically determined raw and cooked vegetable intake was not associated with significant benefits in terms of ischemic cardio-cerebral vascular diseases while genetically determined socioeconomic status may have an impact on vegetable intake. Socioeconomic status, which was closely associated with other eating habits and lifestyle, may affect the association between vegetable intake and ischemic cardio-cerebral vascular diseases.
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Affiliation(s)
- Jiutian Huang
- Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Ziyi He
- Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Minhui Xu
- Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Jianing Du
- Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Yun-tao Zhao
- Department of Cardiology, Aerospace Center Hospital, Beijing, China
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27
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Bobinac A. Access to Healthcare and Health Literacy in Croatia: Empirical Investigation. Healthcare (Basel) 2023; 11:1955. [PMID: 37444789 DOI: 10.3390/healthcare11131955] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
Health literacy is related to different health-related outcomes. However, the nature of the relationship between health literacy and health outcomes is not well understood. One pathway may lead from health literacy to health outcomes by means of access to healthcare. The goal of the current study is to explore the association between health literacy and the particular measure of access to healthcare-unmet medical need-for the first time in Croatia and, to the best of our knowledge, for the first time in the EU context. We use data obtained from face-to-face interviews in a large nationally representative sample of the Croatian population (n = 1000) to estimate the level of health literacy and self-reported access to care and investigate the association between health literacy and self-perceived barriers to access. Our study showed that limited and problematic health literacy is prevalent and associated with higher rates of unmet medical need. Unmet need is largely caused by long waiting lists. It is therefore essential to design health services fitting the needs of those who have limited and/or problematic health literacy as well as enhance health education with the potential of improving the access to care and health outcomes as well as design policies that reduce waiting times.
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Affiliation(s)
- Ana Bobinac
- Center for Health Economics and Pharmacoeconomics (CHEP), Faculty of Economics and Business, University of Rijeka, 51 000 Rijeka, Croatia
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28
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Fritz CD, Khan J, Kontoyiannis PD, Cao EM, Lawrence A, Love LD. Analysis of a Community Health Screening Program and the Factors Affecting Access to Care. Cureus 2023; 15:e41907. [PMID: 37588327 PMCID: PMC10425604 DOI: 10.7759/cureus.41907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/18/2023] Open
Abstract
Introduction Free community health fairs and screening initiatives can be effective in broadening access to care and improving health outcomes in historically marginalized communities. UTHealthCares is a community health-focused organization developed at the University of Texas Health Science Center in Houston. At the beginning of 2023, UTHealthCares oversaw a free community health fair in the Eastex-Jensen Area - a medically underserved area in Northeast Houston. The health fair consisted of four stations - vitals and body mass index collection, vision screening, blood glucose screening, and dental screening. Participants also received coronavirus disease 2019 vaccinations, referrals, and health education. The purpose of this study is to evaluate the effectiveness of the UTHealthCares community health fair while assessing the factors that influence participants' access to medical care. Methods After completing the health fair, participants filled out an optional questionnaire. The questionnaire contained items that assessed satisfaction with the health fair, improvements in managing health, and access to resources. We calculated descriptive statistics, including mean response and 95% confidence intervals for rating scale questions. We used the chi-squared test to evaluate the independence of categorical variables and the Mann-Whitney U test to evaluate differences in means between distributions. Results A total of 111 people participated in the health fair, 91 of which completed a questionnaire. When participants rated their satisfaction with the health fair, the average response was 4.62 out of five. Participants also reported that they were more comfortable managing areas of health related to the stations offered at the fair. Many participants reported limited access to fresh food and long travel times to the physician. Participants that traveled further to reach one resource also tended to have significantly higher travel times for the other: X2 (4, N=78)=28.04, p<0.0001. However, 77.8% of respondents reported that the lack of insurance or cost was their greatest barrier to seeing a medical provider, while only 2.47% reported the lack of transportation as their greatest barrier. Participants who reported having health insurance also had a significantly higher probability of visiting a medical provider when they had a health issue: U=928.5, p=0.0006. Conclusion Overall, participants reported high satisfaction with the health fair. Participants also gave valuable feedback for improving future community health initiatives. Although many participants reported travel times greater than 30 minutes to reach community resources, very few participants indicated that transportation was their largest barrier to accessing medical care. Instead, the lack of insurance and high costs seem to be participants' most significant hindrances. Therefore, interventions in the Eastex-Jensen area focused on expanding access to care should also include components that improve access to insurance.
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Affiliation(s)
- Connor D Fritz
- Public Health, University of Texas Health Science Center at Houston John P. and Katherine G. McGovern Medical School, Houston, USA
| | - Jeanana Khan
- Public Health, University of Texas Health Science Center at Houston John P. and Katherine G. McGovern Medical School, Houston, USA
| | - Panayiotis D Kontoyiannis
- Public Health, University of Texas Health Science Center at Houston John P. and Katherine G. McGovern Medical School, Houston, USA
| | - Emily M Cao
- Dermatology, University of Texas Health Science Center at Houston John P. and Katherine G. McGovern Medical School, Houston, USA
| | - Alexandria Lawrence
- Pediatrics, University of Texas Health Science Center at Houston John P. and Katherine G. McGovern Medical School, Houston, USA
| | - LaTanya D Love
- Pediatrics, University of Texas Health Science Center at Houston John P. and Katherine G. McGovern Medical School, Houston, USA
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Azzam AP, Fidelis T, Nunes A, Valdiviesso R, Limpo T, Moreira E, Silva-Cardoso J, Castro SL. Portuguese adaptation of the Chronic Heart Failure Knowledge Questionnaire (KQCHF). BMC Cardiovasc Disord 2023; 23:307. [PMID: 37337171 PMCID: PMC10280838 DOI: 10.1186/s12872-023-03325-5] [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: 12/20/2022] [Accepted: 05/29/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND A patient's knowledge of heart failure (HF) is associated with better outcomes. The more information patients have about their illness, the less likely they are to be readmitted to the hospital. Such knowledge includes the cause, symptoms, probable duration, and expected evolution of the clinical picture. In Portugal, a tool for testing patient knowledge is an unmet need. Therefore, this study aimed to adapt and test the Chronic Heart Failure Knowledge Questionnaire (KQCHF) for the Portuguese context. METHODS This work includes three cross-sectional studies. In Study 1, subjects were divided between before and after receiving information about HF. In Study 2, participants answered the questionnaire before and after reading the brochure. In Study 3, KQCHF was applied to patients with HF. Studies 1 and 2 were carried out in the general population. Study 3 was carried out with HF outpatients. Convenience sampling was applied to participants in the three studies. RESULTS In Study 1 (n = 45), those who received information had better scores (9.2 ± 1.9) than those who did not (6.0 ± 2.3). In Study 2 (n = 21), the scores were higher after reading the brochure (10.4 ± 1.7 vs. 6.5 ± 2.9). In Study 3 (n = 169), women had better scores than men (9.1 ± 2.1 vs. 8.3 ± 2.2, overall: 8.5 ± 2.2), and knowledge was correlated with education (r = .340, p < .001) and age (r = -.170, p = .030). CONCLUSION The Portuguese adaptation of KQCHF captured relevant knowledge about HF and has shown promising results for clinical and research purposes. The questionnaire can be useful in assessing HF patients' knowledge of their disease and as a basis for the implementation of general and personalised educational strategies to improve HF knowledge and, therefore, promote health literacy and self-care.
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Affiliation(s)
- Ana Paula Azzam
- Faculty of Psychology and Educational Sciences of the University of Porto, Rua Alfredo Allen, S/N, 4200-135, Porto, Portugal.
| | - Tatiane Fidelis
- Faculty of Psychology and Educational Sciences of the University of Porto, Rua Alfredo Allen, S/N, 4200-135, Porto, Portugal
| | - Andreia Nunes
- Faculty of Psychology and Educational Sciences of the University of Porto, Rua Alfredo Allen, S/N, 4200-135, Porto, Portugal
| | - Rui Valdiviesso
- Faculty of Nutrition and Food Sciences of the University of Porto, Porto, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Teresa Limpo
- Faculty of Psychology and Educational Sciences of the University of Porto, Rua Alfredo Allen, S/N, 4200-135, Porto, Portugal
| | - Emília Moreira
- CINTESIS@RISE, Knowledge Management Unit, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - José Silva-Cardoso
- CINTESIS@RISE, Department of Medicine, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Cardiology, University Hospital Center of São João, Porto, Portugal
| | - São Luís Castro
- Faculty of Psychology and Educational Sciences of the University of Porto, Rua Alfredo Allen, S/N, 4200-135, Porto, Portugal
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Vallée A. Association between socio-economic status and estimated atherosclerotic cardiovascular disease risk: results from a middle-aged population-based study. Public Health 2023; 221:1-9. [PMID: 37331308 DOI: 10.1016/j.puhe.2023.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/30/2023] [Accepted: 05/13/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVES The association between cardiovascular disease (CVD) risk and socio-economic status (SES) remains poorly studied. The purpose of this study was to investigate the relationship between SES and estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk among the general UK Biobank population. STUDY DESIGN This was a population-based study. METHODS Among 311,928 volunteers (47.7% men) of the UK Biobank population, SES was assessed by a questionnaire, and ASCVD risk was calculated using pooled cohort equation models. Associations between SES and ASCVD risk were estimated using multiple gender-specific regressions. RESULTS The findings from this study showed that men had higher estimated 10-year ASCVD risk than women (8.6% vs 2.7%; P < 0.001), higher education level (38.3% vs 36.2%; P < 0.001), higher income level (31.0% vs 25.1%; P < 0.001), higher levels of employment (65.4% vs 60.5%; P < 0.001) and higher scores of Townsend deprivation (P < 0.001). Using the multiple logistic regression model, a decreased 10-year ASCVD risk in men was associated with high income level (odds ratio [OR] = 0.64 [95% confidence interval {CI} 0.61-0.68]; P < 0.001), high educational level (OR = 0.71 [95% CI 0.68-0.74]; P < 0.001), higher Townsend deprivation quintile (OR = 0.81 [95% CI 0.78-0.85]; P < 0.001) and employed status (OR = 0.74 [95% CI 0.69-0.80]; P < 0.001). The same results were observed in women, with high income level (OR = 0.68 [95% CI 0.55-0.68]; P < 0.001), high educational level (OR = 0.87 [95% CI 0.82-0.93]; P < 0.001), higher Townsend deprivation quintile (OR = 0.74 [95% CI 0.69-0.80]; P < 0.001) and employed status (OR = 0.53 [95% CI 0.45-0.63]; P < 0.001) being associated with a lower 10-year ASCVD risk. When considering the false discovery rate logworth analysis, SES factors presented a similar contribution to CVD risk as lifestyle factors. CONCLUSIONS Health policies should consider the SES factors identified in this study, in addition to traditional risk factors, when designing prevention campaigns for CVD. Further research is required to improve the ASCVD risk prediction models among different SES variables.
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Affiliation(s)
- Alexandre Vallée
- Department of Epidemiology-Data-Biostatistics, Foch Hospital, Suresnes, 92150, France.
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31
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Cathro CJ, Brenn T, Chen SLF. Education Level and Self-Reported Cardiovascular Disease in Norway-The Tromsø Study, 1994-2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5958. [PMID: 37297563 PMCID: PMC10252247 DOI: 10.3390/ijerph20115958] [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: 04/18/2023] [Revised: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is a leading source of morbidity and mortality, and research has shown education level to be a risk factor for the disease. The aim of this study was to investigate the association between education level and self-reported CVD in Tromsø, Norway. METHODS This prospective cohort study included 12,400 participants enrolled in the fourth and seventh surveys of the Tromsø Study (Tromsø4 and Tromsø7) in 1994-1995 and 2015-2016, respectively. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS For every 1-level increase in education, the age-adjusted risk of self-reported CVD decreased by 9% (OR = 0.91, 95% CI: 0.87-0.96), but after adjustment for covariates, the association was weaker (OR = 0.96, 95% CI: 0.92-1.01). The association was stronger for women (OR = 0.86, 95% CI: 0.79-0.94) than men (OR = 0.91, 95% CI: 0.86-0.97) in age-adjusted models. After adjustment for covariates, the associations for women and men were similarly weak (women: OR = 0.95, 95% CI: 0.87-1.04; men: OR = 0.97, 95% CI: 0.91-1.03). In age-adjusted-models, higher education level was associated with a lower risk of self-reported heart attack (OR = 0.90, 95% CI: 0.84-0.96), but not stroke (OR = 0.97, 95% CI: 0.90-1.05) or angina (OR = 0.98, 95% CI: 0.90-1.07). There were no clear associations observed in the multivariable models for CVD components (heart attack: OR = 0.97, 95% CI: 0.91-1.05; stroke: OR = 1.01, 95% CI: 0.93-1.09; angina: OR = 1.04, 95% CI: 0.95-1.14). CONCLUSIONS Norwegian adults with a higher education level were at lower risk of self-reported CVD. The association was present in both genders, with a lower risk observed in women than men. After accounting for lifestyle factors, there was no clear association between education level and self-reported CVD, likely due to covariates acting as mediators.
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Affiliation(s)
- Celina Janene Cathro
- Department of Community Medicine, UiT—The Arctic University of Norway, 9019 Tromsø, Norway
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Mefford MT, Zhou H, Fan D, Fang MC, Prasad PA, Go AS, Portugal C, Chang JM, Reynolds K. Health Literacy and Treatment Satisfaction Among Patients with Venous Thromboembolism. J Gen Intern Med 2023; 38:1585-1592. [PMID: 36326991 PMCID: PMC10212857 DOI: 10.1007/s11606-022-07852-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) treatment requires complex management, and patients with limited health literacy (HL) may perceive higher burden and lower benefits associated with their treatment. OBJECTIVE To examine the association of HL with treatment satisfaction among patients with VTE. DESIGN Retrospective cohort study PARTICIPANTS: Kaiser Permanente Southern and Northern California members who were taking oral anticoagulants (OAC) for incident VTE between 2015 and 2018 were surveyed. Main Measures HL was assessed using a 3-item HL assessment and dichotomized as having adequate or limited HL. High treatment burden and low treatment benefit were defined as Anti-Clot Treatment Scale (ACTS) scores below the 25th percentile of the distributions for ACTS Burdens and Benefits survey components, respectively. Using Poisson regression, multivariable adjusted risk ratios (RR) and 95% confidence intervals (CI) were calculated for the association of HL with high treatment burden and low treatment benefits. RESULTS Among 2154 respondents, 397 (18.4%) had limited HL. Patients with limited vs adequate HL were older (47.9% vs 27.5% aged ≥ 75 years, p<0.001), more likely to use a non-English language when discussing their health (10.8% vs 1.7%, p<0.001), to have less than high school education (10.1% vs 1.7%, p<0.001), and to self-rate their health as fair or poor (47.6% vs 25.5%, p<0.001). After multivariable adjustment, patients with limited HL were more likely to have higher perceived treatment burden (RR 1.24, 95% CI 1.07, 1.45) and lower perceived treatment benefits (RR 1.21, 95% CI 1.08, 1.37). CONCLUSIONS Limited HL was associated with lower OAC treatment satisfaction, though absolute differences in satisfaction scores were small. Further examination of the intersection of HL with VTE treatment satisfaction and compliance among older and non-English speaking patients is warranted.
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Affiliation(s)
- Matthew T Mefford
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
| | - Hui Zhou
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Dongjie Fan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Margaret C Fang
- Divison of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Priya A Prasad
- Divison of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Alan S Go
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Department of Medicine and Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Departments of Medicine, Health Research and Policy, Stanford University, Palo Alto, CA, USA
| | - Cecilia Portugal
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - John M Chang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
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van der Scheer-Horst E, Rutten G, Stortenbeker I, Borkent J, Swormink WK, Das E, Staal JB, van Lankveld W. Limited health literacy in primary care physiotherapy: Does a physiotherapist use techniques to improve communication? PATIENT EDUCATION AND COUNSELING 2023; 109:107624. [PMID: 36657334 DOI: 10.1016/j.pec.2023.107624] [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: 05/24/2022] [Revised: 12/08/2022] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Research shows that health professionals should adapt their communication when addressing patients with limited health literacy (HL). However, the extent to which physiotherapists apply recommended communication techniques is unclear. METHODS We conducted a two phase mixed-method study, first holding focus group interviews among patients and experts on communication to explore the need for adjusted communication in physiotherapist-patient interaction. Second, we manually coded audio recordings of primary care physiotherapy consultations to investigate the extent to which physiotherapists applied these recommended communication techniques, and adjusted their communication towards patients with lower education. RESULTS Focus group interviews identified four categories of communication elements: the teach-back method, medical jargon explanation, summarizing patient's narratives, and checking patient's understanding. In 50 audio recordings we identified 2670 clauses. We report limited use of the recommended communication techniques; the teach-back method was used in 2% of consultations (95%CI: 0.4%-10.5%) while medical jargon explanation was used in 84% (95%CI: 71.5%-91.7%). Mixed effects logistic regression models showed no association between lower education and communication techniques. CONCLUSION Although physiotherapists need to adjust their communication to patients with lower education, they rarely apply the recommended communication techniques. PRACTICE IMPLICATIONS Knowledge about limited HL among physiotherapists needs to be increased.
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Affiliation(s)
| | - Geert Rutten
- HAN University of Applied Sciences, School for Allied Health, Nijmegen, the Netherlands.
| | - Inge Stortenbeker
- Centre for Language Studies, Radboud University, Nijmegen, the Netherlands.
| | - Jos Borkent
- HAN University of Applied Sciences, School for Allied Health, Nijmegen, the Netherlands.
| | | | - Enny Das
- Centre for Language Studies, Radboud University, Nijmegen, the Netherlands.
| | - J Bart Staal
- Radboud Institute for Health Sciences, Radboud University Medical Centre, IQ healthcare, Nijmegen, the Netherlands; HAN University of Applied Sciences, School for Allied Health, Nijmegen, The Netherlands, Radboud University Medical Centre, IQ healthcare, Nijmegen, the Netherlands.
| | - Wim van Lankveld
- HAN University of Applied Sciences, School for Allied Health, Nijmegen, the Netherlands.
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Suutari AM, Thor J, Nordin A, Josefsson KA. Improving heart failure care with an Experience-Based Co-Design approach: what matters to persons with heart failure and their family members? BMC Health Serv Res 2023; 23:294. [PMID: 36978125 PMCID: PMC10044106 DOI: 10.1186/s12913-023-09306-w] [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: 10/11/2022] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Heart failure is a chronic heart condition. Persons with heart failure often have limited physical capability, cognitive impairments, and low health literacy. These challenges can be barriers to healthcare service co-design with family members and professionals. Experience-Based Co-Design is a participatory healthcare quality improvement approach drawing on patients', family members' and professionals' experiences to improve healthcare. The overall aim of this study was to use Experience-Based Co-Design to identify experiences of heart failure and its care in a Swedish cardiac care setting, and to understand how these experiences can translate into heart failure care improvements for persons with heart failure and their families. METHODS A convenience sample of 17 persons with heart failure and four family members participated in this single case study as a part of an improvement initiative within cardiac care. In line with Experienced-Based Co-Design methodology, field notes from observations of healthcare consultations, individual interviews and meeting minutes from stakeholders' feedback events, were used to gather participants' experiences of heart failure and its care. Reflexive thematic analysis was used to develop themes from data. RESULTS Twelve service touchpoints, organized within five overarching themes emerged. The themes told a story about persons with heart failure and family members struggling in everyday life due to a poor quality of life, lack of support networks, and difficulties understanding and applying information about heart failure and its care. To be recognized by professionals was reported to be a key to good quality care. Opportunities to be involved in healthcare varied, Further, participants' experiences translated into proposed changes to heart failure care such as improved information about heart failure, continuity of care, improved relations, and communication, and being invited to be involved in healthcare. CONCLUSIONS Our study findings offer knowledge about experiences of life with heart failure and its care, translated into heart failure service touchpoints. Further research is warranted to explore how these touchpoints can be addressed to improve life and care for persons with heart failure and other chronic conditions.
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Affiliation(s)
- Anne-Marie Suutari
- The Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
- Department of Internal Medicine and Geriatrics, the Highland Hospital (Höglandssjukhuset), Region Jönköping County, Eksjö, Sweden.
| | - Johan Thor
- The Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Annika Nordin
- The Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Kristina Areskoug Josefsson
- The Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- The Department of Health Sciences, University West, Trollhättan, Sweden
- Department of Behavioral Science, Oslo Metropolitan University, Oslo, Norway
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da Costa AC, da Conceição AP, Butcher HK, Butcher RDCGES. Factors that influence health literacy in patients with coronary artery disease. Rev Lat Am Enfermagem 2023; 31:e3878. [PMID: 36995856 PMCID: PMC10077861 DOI: 10.1590/1518-8345.6211.3878] [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: 05/02/2022] [Accepted: 11/06/2022] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVE to investigate the factors that exert an influence on health literacy in patients with coronary artery disease. METHODS a crosssectional study, including 122 patients with coronary diseases (60.7% male; 62.07 ± 8.8 years old). Health literacy and specific knowledge about the disease were evaluated through interviews with the participants by means of the Short Test of Functional Health Literacy in Adults and the Short version of the coronary artery disease education questionnaire. The data were described by means of central tendency measures and frequencies. The factors that exert an influence on health literacy were determined by means of a linear regression model. The significance level adopted was 5%. The study was approved by the Research Ethics Committee. RESULTS age and arterial hypertension presented an inverse and significant relationship with health literacy. On the other hand, higher schooling levels and having a job were associated with better scores in the health literacy instrument. Specific knowledge about the disease did not exert any influence on health literacy. The variables included in the regression model explained 55.3% of inadequate literacy. CONCLUSION this study, knowledge about the disease exerts no influence on health literacy: however, the professionals should consider the sociodemographic and clinical factors to plan the interventions.
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Affiliation(s)
- Ana Caroline da Costa
- Faculdade Wenceslau Braz, Departamento de Enfermagem, Itajubá, MG, Brasil
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brasil
| | - Ana Paula da Conceição
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brasil
- Instituto Dante Pazzanese de Cardiologia, Departamento de Enfermagem, São Paulo, SP, Brasil
| | - Howard Karl Butcher
- Florida Atlantic University, Christine E. Lynn College of Nursing, Boca Raton, Florida, Estados Unidos da América
| | - Rita de Cassia Gengo e Silva Butcher
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brasil
- Florida Atlantic University, Christine E. Lynn College of Nursing, Boca Raton, Florida, Estados Unidos da América
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Dellafiore F, Ghizzardi G, Vellone E, Magon A, Conte G, Baroni I, De Angeli G, Vangone I, Russo S, Stievano A, Arrigoni C, Caruso R. A Single-Center, Randomized Controlled Trial to Test the Efficacy of Nurse-Led Motivational Interviewing for Enhancing Self-Care in Adults with Heart Failure. Healthcare (Basel) 2023; 11:773. [PMID: 36900778 PMCID: PMC10000833 DOI: 10.3390/healthcare11050773] [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: 02/01/2023] [Revised: 02/21/2023] [Accepted: 03/05/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The role of nurse-led motivational interviewing (MI) in improving self-care among patients with heart failure (HF) is promising, even if it still requires further empirical evidence to determine its efficacy. For this reason, this study tested its efficacy in enhancing self-care maintenance (primary endpoint), self-care management, and self-care confidence after three months from enrollment in adults with HF compared to usual care, and assessed changes in self-care over follow-up times (3, 6, 9, and 12 months). METHODS A single-center, randomized, controlled, parallel-group, superiority study with two experimental arms and a control group was performed. Allocation was in a 1:1:1 ratio between intervention groups and control. RESULTS MI was effective in improving self-care maintenance after three months when it was performed only for patients (arm 1) and for the patients-caregivers dyad (arm 2) (respectively, Cohen's d = 0.92, p-value < 0.001; Cohen's d = 0.68, p-value < 0.001). These effects were stable over the one-year follow-up. No effects were observed concerning self-care management, while MI moderately influenced self-care confidence. CONCLUSIONS This study supported the adoption of nurse-led MI in the clinical management of adults with HF.
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Affiliation(s)
- Federica Dellafiore
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, 27100 Pavia, Italy
| | - Greta Ghizzardi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
- Department of Nursing and Obstetrics, Wroclaw Medical University, 50-368 Wrocław, Poland
| | - Arianna Magon
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
| | - Gianluca Conte
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
| | - Irene Baroni
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
| | - Giada De Angeli
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
| | - Ida Vangone
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, 27100 Pavia, Italy
| | - Sara Russo
- Nursing Degree Course, Section Istituti Clinici di Pavia e Vigevano S.p.a., University of Pavia, 27100 Pavia, Italy
| | - Alessandro Stievano
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
- Centre of Excellence for Nursing Scholarship, OPI, 00136 Rome, Italy
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, 27100 Pavia, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
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Kanejima Y, Izawa KP, Kitamura M, Ishihara K, Ogura A, Kubo I, Nagashima H, Tawa H, Matsumoto D, Shimizu I. Relationship between health literacy and physical function of patients participating in phase I cardiac rehabilitation: a multicenter clinical study. Heart Vessels 2023. [PMID: 36864154 DOI: 10.1007/s00380-023-02255-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Health literacy (HL) is an important decision factor for health. Both low HL and low physical function cause adverse events in cardiovascular disease patients, but their relationship is not well documented. To clarify the relationship between HL and physical function of patients participating in cardiac rehabilitation and calculate the cutoff value of the 14-item HL scale (HLS) for low handgrip strength, this multicenter clinical study named the Kobe-Cardiac Rehabilitation project for people around the World (K-CREW) was conducted among four affiliated hospitals with patients who underwent cardiac rehabilitation. We used the 14-item HLS to assess HL, and the main outcomes were handgrip strength and Short Physical Performance Battery (SPPB) score. The study included 167 cardiac rehabilitation patients with a mean age of 70.5 ± 12.8 years, and the ratio of males was 74%. Among them, 90 patients (53.9%) had low HL and scored significantly lower in both handgrip strength and SPPB. Multiple linear regression analysis revealed that HL was a determinant factor (β = 0.118, p = 0.04) for handgrip strength. Receiver operating characteristic analysis revealed the cutoff value of the 14-item HLS for screening for low handgrip strength was 47.0 points, and the area under the curve was 0.73. This study showed that HL was significantly associated with handgrip strength and SPPB in cardiac rehabilitation patients and suggests the possibility of early screening for low HL to improve physical function in cardiac rehabilitation patients with low HL.
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Affiliation(s)
- Yuji Kanejima
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-Chome, Suma-Ku, Kobe, 654-0142, Japan
- Cardiovascular Stroke Renal Project (CRP), Kobe, Japan
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kazuhiro P Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-Chome, Suma-Ku, Kobe, 654-0142, Japan.
- Cardiovascular Stroke Renal Project (CRP), Kobe, Japan.
| | - Masahiro Kitamura
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-Chome, Suma-Ku, Kobe, 654-0142, Japan
- Cardiovascular Stroke Renal Project (CRP), Kobe, Japan
- School of Physical Therapy, Faculty of Rehabilitation, Reiwa Health Sciences University, Fukuoka, Japan
| | - Kodai Ishihara
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-Chome, Suma-Ku, Kobe, 654-0142, Japan
- Cardiovascular Stroke Renal Project (CRP), Kobe, Japan
- Department of Rehabilitation, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Asami Ogura
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-Chome, Suma-Ku, Kobe, 654-0142, Japan
- Cardiovascular Stroke Renal Project (CRP), Kobe, Japan
- Department of Rehabilitation, Sanda City Hospital, Sanda, Japan
| | - Ikko Kubo
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-Chome, Suma-Ku, Kobe, 654-0142, Japan
- Cardiovascular Stroke Renal Project (CRP), Kobe, Japan
- Department of Rehabilitation, Yodogawa Christian Hospital, Osaka, Japan
| | - Hitomi Nagashima
- Department of Rehabilitation, Shinyukuhashi Hospital, Yukuhashi, Japan
| | - Hideto Tawa
- Department of Cardiology, Sanda City Hospital, Sanda, Japan
| | - Daisuke Matsumoto
- Department of Cardiovascular Medicine, Yodogawa Christian Hospital, Osaka, Japan
| | - Ikki Shimizu
- Department of Diabetes, Sakakibara Heart Institute of Okayama, Okayama, Japan
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Tsami A, Koutelekos I, Gerogianni G, Pavlatou N, Kalogianni A, Kapadohos T, Toulia G, Polikandrioti M. Measuring Importance of Physical Self-Care Behavior in Patients with Heart Failure: Validation and Reliability Analysis of 14-item IPSC Scale. Clin Pract 2023; 13:357-366. [PMID: 36961057 PMCID: PMC10037647 DOI: 10.3390/clinpract13020032] [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: 11/02/2022] [Revised: 01/11/2023] [Accepted: 02/22/2023] [Indexed: 03/25/2023] Open
Abstract
INTRODUCTION Heart failure (HF) is a complex clinical syndrome associated with increased disability, morbidity and mortality globally. HF is characterized by recurrent exacerbations and a high rate of hospital readmissions. Self-care is a crucial component of treatment. The way patients assess the importance of self-care may shed light on planning effective individualized interventions. The aim of this study was to conduct a validity and reliability analysis of the new 14-item IPSC scale, which measures how important HF patients consider their physical self-care behavior (IPSC, Importance of Physical Self-Care). MATERIAL AND METHODS The 14-item IPSC scale was created by the researchers to explore how important HF patients consider their physical self-care behavior. The validation of the IPSC scale included face and content validity, construct validity, internal consistency, repeatability and discriminant validity. Patients' characteristics were also included. RESULTS In the present study, 52 hospitalized HF patients were enrolled, of whom 55.8% were female, 34.6% above 70 years old, 48.1% of NYHA class III and 32.7% suffered this illness from 6 to 10 years. The total IPSC score had a possible range of 14-56, with higher scores indicating a low importance of self-care. The descriptive statistics in the IPSC scale showed a mean score of 27.9 ± 4.9 and a median score of 29, indicating that HF patients evaluated self-care behavior as moderately important. All items were found to be statistically significantly correlated with total scale scores (p ≤ 0.05), with correlation coefficients rho > 0.250, indicating moderate to strong correlations and meaning that all items are important in the calculation of the final score (construct validity). The internal consistency of the items that constituted the total score was found to be high (Cronbach's a > 0.7). Furthermore, it was found that scores had high repeatability (p ≤ 0.001 and ICCs > 0.7). Regarding discriminant validity, a statistically significant association was observed between the importance of physical self-care behavior and both years suffering the illness (p = 0.007) and the NYHA class (p = 0.030). CONCLUSION The 14-item IPSC scale is a reliable instrument that help nurses in clinical settings to gain a better and prompt understanding of the importance which patients invest in their physical self-care behavior.
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Affiliation(s)
- Athanasia Tsami
- Department of Nursing, University of West Attica, 12243 Athens, Greece
| | | | | | - Niki Pavlatou
- Department of Nursing, University of West Attica, 12243 Athens, Greece
| | | | | | - Georgia Toulia
- Department of Nursing, University of West Attica, 12243 Athens, Greece
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Loizeau V, Kilpatrick K, Bertrand DP, Rothan-Tondeur M. Exploring Strategies for Developing Enabling Environments for People with Chronic Heart Disease: An Ethnographic Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2680. [PMID: 36768045 PMCID: PMC9916140 DOI: 10.3390/ijerph20032680] [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: 12/17/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
The impact of chronic diseases on people's daily lives and the exponential number of people affected is a major public health issue. The consequences on individuals and their families is significant, particularly in terms of quality of life. In the literature, this phenomenon is well described in terms of care policy and cost. Although there is a link between a supportive environment and empowerment, there is little literature describing a supportive environment and the daily lives of people living with cardiovascular disease. The objectives of this study are to identify the strategies people use to develop an enabling environment. It will be a qualitative ethnographic study that will address both human behavior and the notion of culture in a broad sense. In the context of this study, an orientation towards critical ethnography will be considered for its particular interest in vulnerable people and in the power relations that may exist in the socio-cultural system. Data will be collected directly in people's homes through observations and interviews with 10 people with cardiovascular disease. For each person, the data collection will take place over three days and will represent approximately 210 h of observation. This protocol was registered in the Research Register on 30 June 2021 and its number is 6933. This study will explore strategies for developing an enabling environment for people living with heart disease and eventually provide recommendations for nursing practices in terms of support.
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Affiliation(s)
- Valérie Loizeau
- Centre Hospitalier Poissy Saint Germain-GHT Yvelines Nord, 78300 Poissy, France
- Nursing Sciences Research Chair, Laboratory Education and Health Promotion (LEPS UR 3412), UFR SMBH, Université Sorbonne Paris Nord, 1 Rue de Chablis, 93000 Bobigny, France
| | - Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, QC H3A 2M7, Canada
| | - Dominique Pougheon Bertrand
- Laboratory Education and Health Promotion (LEPS UR 3412), UFR SMBH, Université Sorbonne Paris Nord, 1 Rue de Chablis, 93000 Bobigny, France
| | - Monique Rothan-Tondeur
- Nursing Sciences Research Chair, Laboratory Education and Health Promotion (LEPS UR 3412), UFR SMBH, Université Sorbonne Paris Nord, 1 Rue de Chablis, 93000 Bobigny, France
- AP HP, Nursing Sciences Research Chair, 55 Boulevard Diderot, 75012 Paris, France
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Readability of Online Patient Education Materials for Total Joint Arthroplasty: A Systematic Review. J Arthroplasty 2023:S0883-5403(23)00052-9. [PMID: 36716898 DOI: 10.1016/j.arth.2023.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND As the demand for total joint arthroplasty continues to grow, patients increasingly turn to internet sources for accessible orthopaedic health information. We sought to evaluate the readability of online hip and knee arthroplasty patient education materials (PEMs). METHODS Our systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-P guidelines (PROSPERO registration of the study protocol: CRD42022358872, September 19th, 2022). PubMed, EBSCOhost, Medline, and Google Scholar electronic databases were utilized to identify all studies evaluating online PEMs related to total joint arthroplasty between January 1, 2000, and August 1, 2022. The quality of studies was assessed with the Joanna Briggs Institute scale. RESULTS Our initial search yielded 360 publications which were then screened for appropriate studies aligned with our review's purpose. A total of eleven cross-sectional studies were included. The total sample size across the studies consisted of 662 PEMs. Five studies evaluated professional or academic orthopaedic websites, six evaluated PEMs through web engines, and three evaluated apps or commercial websites. Most included studies found PEMs to be well above the recommended 6th-grade reading level. CONCLUSION Arthroplasty PEMs produced by orthopaaedic websites, web searches, and apps have readability scores well above the recommended levels. Given the importance of health literacy on patient outcomes and satisfaction, work needs to be done to improve the readability of these materials.
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Pedretti RFE, Hansen D, Ambrosetti M, Back M, Berger T, Ferreira MC, Cornelissen V, Davos CH, Doehner W, de Pablo Y Zarzosa C, Frederix I, Greco A, Kurpas D, Michal M, Osto E, Pedersen SS, Salvador RE, Simonenko M, Steca P, Thompson DR, Wilhelm M, Abreu A. How to optimize the adherence to a guideline-directed medical therapy in the secondary prevention of cardiovascular diseases: a clinical consensus statement from the European Association of Preventive Cardiology. Eur J Prev Cardiol 2023; 30:149-166. [PMID: 36098041 DOI: 10.1093/eurjpc/zwac204] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/20/2022] [Accepted: 09/07/2022] [Indexed: 01/27/2023]
Abstract
A key factor to successful secondary prevention of cardiovascular disease (CVD) is optimal patient adherence to treatment. However, unsatisfactory rates of adherence to treatment for CVD risk factors and CVD have been observed consistently over the last few decades. Hence, achieving optimal adherence to lifestyle measures and guideline-directed medical therapy in secondary prevention and rehabilitation is a great challenge to many healthcare professionals. Therefore, in this European Association of Preventive Cardiology clinical consensus document, a modern reappraisal of the adherence to optimal treatment is provided, together with simple, practical, and feasible suggestions to achieve this goal in the clinical setting, focusing on evidence-based concepts.
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Affiliation(s)
| | - Dominique Hansen
- REVAL/BIOMED, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, ASST Crema, Santa Marta Hospital, Rivolta D'Adda, Italy
| | - Maria Back
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Thomas Berger
- Cardiomed Linz, St.John of God Hospital Linz, Linz, Austria
| | - Mariana Cordeiro Ferreira
- Psychologist, Centro de Reabilitação Cardiovascular do Centro Universitário Hospitalar Lisboa Norte, Portugal
| | | | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Wolfram Doehner
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiology (Virchow Klinikum), Charité Universitätsmedizin Berlin and German, Berlin, Germany
- Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Ines Frederix
- Heart Centre Hasselt, Jessa Hospital Hasselt Belgium, Hasselt University, Hasselt, Belgium
- Faculty of Medicine and Life Sciences Diepenbeek Belgium, University of Antwerp, Antwerp, Belgium
- Faculty of Medicine and Health Sciences Antwerp Belgium, Antwerp University Hospital, Edegem, Belgium
| | - Andrea Greco
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Donata Kurpas
- Department of Family Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Elena Osto
- Institute of Clinical Chemistry & Department of Cardiology, Heart Center, University & University Hospital Zurich, Zurich, Switzerland
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Maria Simonenko
- Heart Transplantation Outpatient Department, Cardiopulmonary Exercise Test Research Department, Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Patrizia Steca
- Department of Psychology, University of Milan-Bicocca, Milano, Italy
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Matthias Wilhelm
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ana Abreu
- Department of Cardiology of Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Institute of Preventive Medicine and Institute of Environmental Health of the Faculty of Medicine of University of Lisbon, Centre of Cardiovascular Investigation of University of Lisbon (CCUL) and Academic Centre of Medicine of University of Lisbon (CAML), Lisbon, Portugal
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Elbashir M, ElHajj MS, Rainkie D, Kheir N, Hamou F, Abdulrhim S, Mahfouz A, Alyafei S, Awaisu A. Evaluation of Health Literacy Levels and Associated Factors Among Patients with Acute Coronary Syndrome and Heart Failure in Qatar. Patient Prefer Adherence 2023; 17:89-105. [PMID: 36642998 PMCID: PMC9835006 DOI: 10.2147/ppa.s385246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/17/2022] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To determine the prevalence of inadequate health literacy and its associated risk factors among patients with acute coronary syndrome (ACS) and/or heart failure (HF) in Qatar. PATIENTS AND METHODS This cross-sectional observational study was conducted among patients with ACS and/or HF attending the national Heart Hospital in Qatar. Health literacy was assessed using the abbreviated version of the Test of Functional Health Literacy in Adults (S-TOFHLA) and the Three-item Brief Health Literacy Screen (3-item BHLS). RESULTS Three hundred patients with ACS and/or HF, majority male (88%) and non-Qatari (94%), participated in the study. The median (IQR) age of the participants was 55 (11) years. The prevalence of inadequate to marginal health literacy ranged between 36% and 54%. There were statistically significant differences in health literacy level between patients based on their marital status (p=0.010), education (p≤0.001), ability to speak any of Arabic, English, Hindi, Urdu, Malayalam, or other languages (p-values ≤0.001 to 0.035), country of origin (p≤0.001), occupation (p≤0.001), and receiving information from a pharmacist (p=0.008), a physiotherapist (p≤0.001), or a nurse (p=0.004). CONCLUSION Inadequate health literacy is common among patients with ACS and/or HF. This study suggests a need for developing strategies to assist healthcare professionals in improving health literacy skills among patients with ACS and HF. A combination of interventions may be needed to improve patients' understanding of their disease and medications, and ultimately overall health outcomes.
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Affiliation(s)
- Marwa Elbashir
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
- Pharmacy Department, Airport Health Center, Primary Health Care Corporation, Doha, Qatar
| | - Maguy Saffouh ElHajj
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Daniel Rainkie
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Nadir Kheir
- College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
| | - Fatima Hamou
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Sara Abdulrhim
- Pharmacy Department, Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
| | - Ahmed Mahfouz
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Sumaya Alyafei
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Awaisu
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
- Correspondence: Ahmed Awaisu, Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar, Tel +974 4403 5596, Fax +974 4403 5551, Email
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Exploring Health Literacy Categories in Patients With Heart Failure: A Latent Class Analysis. J Cardiovasc Nurs 2023; 38:13-22. [PMID: 36508237 DOI: 10.1097/jcn.0000000000000889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although a growing number of studies have demonstrated that patients' health literacy is associated with health outcomes, the exact relationship between them is not clear. AIMS AND OBJECTIVES The aim of this study was to explore latent classes of health literacy in patients with heart failure and analyze the differences among different groups. DESIGN AND METHODS This is a cross-sectional survey. Patients diagnosed with heart failure were selected from 3 tertiary hospitals in Tianjin, China, from March 2019 to November 2019. We measured patients' health literacy using the Health Literacy Scale for Chronic Patients. Latent class analysis was carried out based on the patients' Health Literacy Scale for Chronic Patients scores. Multinomial logistic regression was used to identify the predictive indicators of the latent classes. RESULTS The health literacy of patients with heart failure was divided into 3 different latent classes, named "high health literacy group," "low literacy high dependence group," and "moderate literacy high willingness group." There were statistically significant differences in gender, age, smoking history, marital status, education level, household income level, and quality of life among different health literacy classes. Low education level and household income level predicted poor health literacy. CONCLUSION There were 3 latent classes for the health literacy of patients with heart failure. Different health literacy classes exhibited their own distinctive characteristics. Patients in the "moderate literacy high willingness group" had the worst quality of life. Understanding the specific types of health literacy in patients with heart failure facilitates targeted nursing interventions to improve their quality of life.
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Hirooka N, Kusano T, Kinoshita S, Aoyagi R. Association of Health Literacy With the Prevalence of Cardiovascular Diseases and Their Risk Factors Among Older Japanese Health Management Specialists. Gerontol Geriatr Med 2023; 9:23337214231189059. [PMID: 37492034 PMCID: PMC10363860 DOI: 10.1177/23337214231189059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/26/2023] [Accepted: 07/03/2023] [Indexed: 07/27/2023] Open
Abstract
In this study, we aimed to determine the association between health literacy and the development of cardiovascular diseases (CVDs), among an older population. This cross-sectional study was conducted among Japanese health management specialists (N = 593). Higher levels (communicative and critical) of health literacy and CVD risk factors (diabetes mellitus, hypertension, dyslipidemia, and obesity) were measured. The mean patient age was 71.3 years. Logistic regression analyses showed statistically significant associations between higher levels of health literacy and the prevalence of CVDs (β coefficient = -.091, p < .05) and metabolic risk factors (β coefficient = -.084, p < .01). There was a statistically significant association between health literacy and the count of CVDs (and its risk factors) (β coefficients of Poisson regression = -.036, p < .05). The results show health literacy to be fundamentally related to low prevalence of cardiovascular diseases and their associated metabolic risk factors.
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45
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The development and validation of Chinese Health Literacy Scale (CHLS) for older people. Geriatr Nurs 2023; 49:164-169. [PMID: 36565590 DOI: 10.1016/j.gerinurse.2022.11.020] [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: 07/19/2022] [Revised: 11/25/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES We tried to develop a more concise health literacy scale for Chinese older adults. METHODS A draft scale based on the Health Literacy Questionnaire (HLQ) was developed, and revised by experts. We conducted a pilot study to test the readability and establish a standard inquiry method within 10 residents. We tested the validity and internal consistency using a field test with 3,739 participants. RESULTS Overall standardized Cronbach's α of Chinese Health Literacy Scale (CHLS) was 0.86 and that of each dimension ranged from 0.69 to 0.81. Nearly all dimensions had satisfactory factor loadings (0.33-0.98). The correlation coefficient between the score of each item and its dimension ranged from 0.59 to 0.92. CONCLUSIONS The performance of CHLS was almost the same as the HLQ but more concise. It might play a role in reflecting the health literacy of older adults in China and further promoting their health.
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Alahmadi YM. Evaluation of Health Literacy and Associated Factors Among Adults Living in Saudi Arabia: A Cross-Sectional Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231161428. [PMID: 36932856 PMCID: PMC10026131 DOI: 10.1177/00469580231161428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
In this westernized culture, maintaining a healthy lifestyle has become a major health concern internationally. Health literacy is an emerging concept and requires effective measures and reform to improve the health status and health of individuals at both national and international levels, and has become one of the important determinants of individual health and healthcare service. This study aimed to assess health literacy among adults in Saudi Arabia. A cross-sectional study was conducted among a randomly selected population using a structured validated questionnaire over 4 months in 2021. The questionnaires designed for the study included 26 items divided into 5 domains assessed on a five-point Likert scale. Data were analyzed using IBM SPSS Statistics 26 (IBM Inc., Chicago, IL, USA) and IBM SPSS 26 (IBM Inc.). The mean score for reading, access to information, understanding, appraisal, and decision-making was 12.01 ± 4.37, 20.16 ± 7.17, 24.84 ± 8.37, 11.85 ± 4.90, and 36.94 ± 10.41 respectively. The mean scores of reading and understanding domains were found to have significant differences concerning gender (P < .05). Additionally, participants' age was significantly associated with the mean score of reading and decision-making (P < .006 and P < .049). The findings reported a prevalence of inadequate HL in the population of Saudi Arabia was 54.4%, and the determinants associated with the scores of HL were age, gender, and education.
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Affiliation(s)
- Yaser M Alahmadi
- Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Al Madinah Al Munawarah, Saudi Arabia
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Kanejima Y, Izawa KP, Kitamura M, Ishihara K, Ogura A, Kubo I, Nagashima H, Tawa H, Matsumoto D, Shimizu I. Health Literacy Is Associated with Activities of Daily Living of Patients Participating in Cardiac Rehabilitation: A Multicenter Clinical Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416550. [PMID: 36554430 PMCID: PMC9779210 DOI: 10.3390/ijerph192416550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 06/12/2023]
Abstract
The activities of daily living (ADL) in patients with cardiac disease tend to decline. A previous study revealed that ADL relates to physical and cognitive functions associated with health literacy (HL). However, the relationship between HL and ADL is not well documented. This study aimed to clarify this relationship among patients participating in cardiac rehabilitation. This multicenter study, the Kobe-Cardiac Rehabilitation project for people around the World (K-CREW), included patients who participated in cardiac rehabilitation from October 2020 to December 2021. Patients with probable dementia and difficulty walking alone were excluded. We used the 14-item Health Literacy Scale (HLS-14) to assess HL and the Functional Independence Measure (FIM) to assess ADL at discharge. Patients were divided by their HLS-14 score into the low HL group (<50 points) or the high HL group (≥50 points). We analyzed the relationship between the HLS-14 and FIM scores. We investigated 268 cardiac rehabilitation patients (median age, 71.0 years; male ratio, 76.9%). Low HL patients accounted for 51.1% of all patients and had significantly lower motor and cognitive FIM scores. Functional HL related better to the FIM scores (r = 0.28-0.36) than did other HL subclasses. Multiple regression analysis identified HLS-14 as an explanatory variable (p = 0.002) for the total FIM score. Patients with low HL had significantly lower ADL than those with high HL. These findings underscore the importance of considering HL in cardiac rehabilitation.
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Affiliation(s)
- Yuji Kanejima
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe 654-0142, Japan
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe 650-0047, Japan
| | - Kazuhiro P. Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe 654-0142, Japan
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan
| | - Masahiro Kitamura
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe 654-0142, Japan
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan
- Department of Physical Therapy, Faculty of Rehabilitation, Reiwa Health Sciences University, Fukuoka 811-0213, Japan
| | - Kodai Ishihara
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe 654-0142, Japan
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan
- Department of Rehabilitation, Sakakibara Heart Institute of Okayama, Okayama 700-0804, Japan
| | - Asami Ogura
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe 654-0142, Japan
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan
- Department of Rehabilitation, Sanda City Hospital, Sanda 669-1311, Japan
| | - Ikko Kubo
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe 654-0142, Japan
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan
- Department of Rehabilitation, Yodogawa Christian Hospital, Osaka 533-0024, Japan
| | - Hitomi Nagashima
- Department of Rehabilitation, Shinyukuhashi Hospital, Yukuhashi 824-0026, Japan
| | - Hideto Tawa
- Department of Cardiology, Sanda City Hospital, Sanda 669-1311, Japan
| | - Daisuke Matsumoto
- Department of Cardiovascular Medicine, Yodogawa Christian Hospital, Osaka 533-0024, Japan
| | - Ikki Shimizu
- Department of Diabetes, Sakakibara Heart Institute of Okayama, Okayama 700-0804, Japan
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Huy LD, Truong NLT, Hoang NY, Nguyen NTH, Nguyen TTP, Dang LT, Hsu YHE, Huang CC, Chang YM, Shih CL, Carbone ET, Yang SH, Duong TV. Insight into global research on health literacy and heart diseases: A bibliometric analysis. Front Cardiovasc Med 2022; 9:1012531. [PMID: 36505390 PMCID: PMC9729531 DOI: 10.3389/fcvm.2022.1012531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Health literacy (HL) has shown its important role on reducing the burden of heart diseases. However, no study has provided a comprehensive worldwide view of the data regarding HL and heart diseases. The study aimed to provide insight into: (1) the intellectual structure, (2) research trends, and (3) research gaps on HL and heart diseases; and (4) to explore HL scales commonly utilized in heart studies. Materials and methods Studies related to HL and heart diseases were retrieved from Web of Science, Scopus, and PubMed. All publications published between 2000 and 2021 were included after conducting keyword searches on "heart diseases" in general or on specific types of heart diseases (e.g., "heart failure") and "health literacy". Bibliometric analyses were carried out using the Bibliometrix R package and VOSviewer 1.6.14. Findings A total of 388 original research articles and reviews on HL and heart diseases were included in our study. The studies were primarily conducted in the United States and developed countries. A total of 337 studies (86.9%) focused on heart failure (200 studies, 51.5%) and ischemic heart diseases (137 studies, 35.3%). Sixty-two studies (16.0%) focused on other heart diseases (e.g., valvular diseases and rheumatic heart diseases). The number of interventional studies was limited (52 studies, 13.4%) and fluctuated from 2000 to 2021. The most common questionnaires measuring health literacy among patients with heart diseases were the Test of Functional Health Literacy in Adults (TOFHLA), Short Test of Functional Health Literacy in Adults (STOFHLA), and Brief Health Literacy Screen (BHLS). Use of the eHealth Literacy Scale (eHEALS) has become the latest trend among patients with heart diseases. Conclusion Health literacy and heart diseases were most often studied in the United States and developed countries. Several HL tools were used; eHEALS has been lately used in this field. These findings suggest the need to conduct more empirical studies on HL and heart diseases in different settings (e.g., developing or poor countries) and with different types of heart diseases (e.g., valvular and rheumatic disorders). Additionally, it is necessary to develop heart disease-specified HL scales for research and practice.
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Affiliation(s)
- Le Duc Huy
- Health Personnel Training Institute, University of Medicine and Pharmacy, Hue University, Hue, Thua Thien Hue, Vietnam
| | - Nguyen L. T. Truong
- School of Medicine, Vietnam National University, Ho Chi Minh City, Vietnam,Pharmacy Department, Thong Nhat Hospital, Ho Chi Minh City, Vietnam
| | - Nhi Y. Hoang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| | - Nhi Thi Hong Nguyen
- Health Personnel Training Institute, University of Medicine and Pharmacy, Hue University, Hue, Thua Thien Hue, Vietnam,School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Thao T. P. Nguyen
- Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Loan T. Dang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan,Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi, Vietnam
| | - Yi-Hsin Elsa Hsu
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan,Executive Master Program of Business Administration in Biotechnology, College of Management, Taipei Medical University, Taipei, Taiwan,International Ph.D. Program in Biotech and Healthcare Management, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Chung-Chien Huang
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan,International Ph.D. Program in Biotech and Healthcare Management, College of Management, Taipei Medical University, Taipei, Taiwan,Department of Long-Term Care and School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan,School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Yao-Mao Chang
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan,Research Center of Health and Welfare Policy, Taipei Medical University, Taipei, Taiwan
| | | | - Elena T. Carbone
- Department of Nutrition, University of Massachusetts, Amherst, MA, United States
| | - Shwu-Huey Yang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan,Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan,Research Center of Geriatric Nutrition, Taipei Medical University, Taipei, Taiwan,*Correspondence: Shwu-Huey Yang,
| | - Tuyen V. Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan,International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan,Tuyen V. Duong,
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van Harlingen AOW, van de Ven LG, Hasselaar J, Thalen J, Jukema J, Vissers K, Uitdehaag M. Developing a toolkit for patients with COPD or chronic heart failure and their informal caregivers to improve person-centredness in conversations with healthcare professionals: A Design Thinking approach. PATIENT EDUCATION AND COUNSELING 2022; 105:3324-3330. [PMID: 35843846 DOI: 10.1016/j.pec.2022.07.002] [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: 12/22/2021] [Revised: 03/22/2022] [Accepted: 07/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The perspective of patients and informal caregivers is often not expressed in conversations with healthcare professionals which can have a negative impact on quality of care and quality of life. OBJECTIVE Describe the development of a toolkit for patients with COPD or chronic heart failure and their informal caregivers enabling them to explore and express their perspective in conversations with healthcare professionals. Patient involvement: Patients, informal caregivers and healthcare professionals were involved in the design process from problem definition to solution development. METHOD Design Thinking Approach using eight co-creation sessions and qualitative data-collection methods. Nineteen patients, ten informal caregivers and thirteen healthcare professionals participated in one or more co-creation sessions. Homogenous subgroups of participants were used in session 1, 2 and 4 and mixed groups were used in session 3, 5 and 6. Session 7 and 8 were used to test prototype toolkits. RESULTS Three challenges to expressing the personal perspective to healthcare professionals, four statements defining the desired situation for conversations, eleven design criteria for the toolkit and ten selection criteria for tools were identified. This information was used to develop a prototype toolkit. DISCUSSION Most patients and informal caregivers had moderate to high levels of education and all participating healthcare professionals were female with a majority of nurses and only three physicians. It is possible that this has influenced the design of the toolkit. PRACTICAL VALUE The toolkit can support patients and informal caregivers in exploring and expressing their perspective in conversations with healthcare professionals. Feasibility of the toolkit and implications for healthcare professionals will be examined in a pilot implementation study.
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Affiliation(s)
- Annet Olde Wolsink- van Harlingen
- Saxion University of Applied Sciences, Research Group Smart Health, Enschede, Netherlands; Radboudumc Medical Centre, Department of Anaesthesiology, Pain and Palliative Medicine Nijmegen, Netherlands.
| | - Leontine Groen- van de Ven
- Windesheim University of Applied Sciences, Research Group Living Well With Dementia, Zwolle, Netherlands
| | - Jeroen Hasselaar
- Radboudumc Medical Centre, Department of Anaesthesiology, Pain and Palliative Medicine Nijmegen, Netherlands; Nivel Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Jos Thalen
- Saxion University of Applied Sciences, Research Group Industrial Design, Enschede, Netherlands
| | - Jan Jukema
- Saxion University of Applied Sciences, Research Group Smart Health, Enschede, Netherlands
| | - Kris Vissers
- Radboudumc Medical Centre, Department of Anaesthesiology, Pain and Palliative Medicine Nijmegen, Netherlands
| | - Madeleen Uitdehaag
- Radboudumc Medical Centre, Department of Anaesthesiology, Pain and Palliative Medicine Nijmegen, Netherlands
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50
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Stewart JW, Zoulek S, Hussain S, Kathawate VG, Valbuena V, Bonner S, Thompson M, Barnes GD, Likosky DS, Aaronson K, Colvin MM, Breathett K, Cascino T. Readability and Non-English Language Resources of Heart Transplant Center Websites in the United States. J Card Fail 2022; 29:531-535. [PMID: 36283645 DOI: 10.1016/j.cardfail.2022.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/07/2022] [Accepted: 09/25/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE Health literacy is associated with heart failure (HF) care and outcomes. Online resources offer important educational materials for patients seeking access to heart transplantation but tend to be complex and potentially ineffective for non-English speakers and those with low reading levels. The purpose of this study was to evaluate both the readability of patient-level information posted on United States heart transplant center websites and the availability of non-English resources. METHODS AND RESULTS We performed a review of patient-facing information on websites of U.S. heart transplant centers identified through the United Network for Organ Sharing in August 2022. Written English text was extracted and assessed for readability by using the Fry Graph Readability score. Websites were additionally evaluated for non-English language text and translator tools. Standard ANOVA analysis was used to compare readability levels across transplant regions. The median Fry readability level to understand a piece of text for all regions was 15, which is equivalent to a college-junior reading level (range: 7-17, 7th grade to postgraduate level). There was no statistical difference in median Fry readability levels among regions (P = 0.16). Of the 139 eligible heart transplant center websites, only 56.1% (78/139) had non-English resources available for patients. Regions 5 (75% [15/20]) and 6 (75% [3/4]) had the highest percentage of non-English resources, and region 2 had the lowest (38% [6/16]). CONCLUSIONS Heart transplant center online resources are inadequate, and many do not provide translations of the English language. Additional work is needed to standardize heart-transplant patient information for a diverse U.S. PATIENT POPULATION
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Affiliation(s)
- James W Stewart
- Department of Surgery, University of Michigan, Ann Arbor, MI; Department of Surgery, Yale School of Medicine, New Haven, CT; VA Healthcare System, Ann Arbor, MI.
| | - Shannon Zoulek
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Sheehan Hussain
- Department of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI
| | - Varun G Kathawate
- Department of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI
| | | | - Sidra Bonner
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Michael Thompson
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI
| | - Geoffrey D Barnes
- Department of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI
| | - Donald S Likosky
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI
| | - Keith Aaronson
- Department of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI
| | - Monica M Colvin
- Department of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI
| | - Khadijah Breathett
- Department of Cardiology, Indiana University School of Medicine, Indianapolis, IN
| | - Thomas Cascino
- Department of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI
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