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Bather JR, Cuevas AG, Harris A, Kaphingst KA, Goodman MS. Associations between perceived discrimination over the life course, subjective social status, and health literacy: A racial/ethnic stratification analysis. PEC INNOVATION 2024; 5:100334. [PMID: 39257628 PMCID: PMC11384512 DOI: 10.1016/j.pecinn.2024.100334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 08/03/2024] [Accepted: 08/18/2024] [Indexed: 09/12/2024]
Abstract
Objective To analyze the relationship between perceived discrimination over the life course, social status, and limited health literacy (HL). Methods 5040 adults who participated in the 2023 Survey of Racism and Public Health. We applied stratified multilevel models adjusted for sociodemographic characteristics. Results The average age was 47 years, 48% identified as White, 20% as Latinx, and 17% as Black. In the overall sample, we observed associations of perceived discrimination (b = 0.05, 95% CI: 0.01, 0.09), subjective social status (b = -0.16, 95% CI: -0.23, -0.10), and their interaction (b = 0.02, 95% CI: 0.01, 0.03). More perceived discrimination was associated with lower HL in the White and Multiracial participants. Higher subjective social status was associated with higher HL in the White and Latinx participants. There was a statistically significant interaction between perceived discrimination and subjective social status on HL among the White, Latinx, and Multiracial participants. Conclusion This analysis has implications for public health practice, indicating that multi-level interventions are needed to address limited HL. Innovation Our findings provide novel insights for identifying key SDOH indicators to assess in clinical settings to provide health literate care.
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Affiliation(s)
- Jemar R Bather
- Center for Anti-racism, Social Justice & Public Health, New York University School of Global Public Health, New York, NY 10003, USA
- Department of Biostatistics, New York University School of Global Public Health, New York, NY 10003, USA
| | - Adolfo G Cuevas
- Center for Anti-racism, Social Justice & Public Health, New York University School of Global Public Health, New York, NY 10003, USA
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY 10003, USA
| | - Adrian Harris
- Center for Anti-racism, Social Justice & Public Health, New York University School of Global Public Health, New York, NY 10003, USA
| | - Kimberly A Kaphingst
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
- Department of Communication, University of Utah, Salt Lake City, UT 84112, USA
| | - Melody S Goodman
- Center for Anti-racism, Social Justice & Public Health, New York University School of Global Public Health, New York, NY 10003, USA
- Department of Biostatistics, New York University School of Global Public Health, New York, NY 10003, USA
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Bather JR, Kaphingst KA, Goodman MS. Racial Composition of Social Environments Over the Life Course Using the Pictorial Racial Composition Measure: Development and Validation Study. JMIR Public Health Surveill 2024; 10:e55461. [PMID: 39115929 PMCID: PMC11342016 DOI: 10.2196/55461] [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: 12/13/2023] [Revised: 01/28/2024] [Accepted: 05/21/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Studies investigating the impact of racial segregation on health have reported mixed findings and tended to focus on the racial composition of neighborhoods. These studies use varying racial composition measures, such as census data or investigator-adapted questions, which are currently limited to assessing one dimension of neighborhood racial composition. OBJECTIVE This study aims to develop and validate a novel racial segregation measure, the Pictorial Racial Composition Measure (PRCM). METHODS The PRCM is a 10-item questionnaire of pictures representing social environments across adolescence and adulthood: neighborhoods and blocks (adolescent and current), schools and classrooms (junior high and high school), workplace, and place of worship. Cognitive interviews (n=13) and surveys (N=549) were administered to medically underserved patients at a primary care clinic at the Barnes-Jewish Hospital. Development of the PRCM occurred across pilot and main phases. For each social environment and survey phase (pilot and main), we computed positive versus negative pairwise comparisons: mostly Black versus all other categories, half Black versus all other categories, and mostly White versus all other categories. We calculated the following validity metrics for each pairwise comparison: sensitivity, specificity, correct classification rate, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, false positive rate, and false negative rate. RESULTS For each social environment, the mostly Black and mostly White dichotomizations generated better validity metrics relative to the half Black dichotomization. Across all 10 social environments in the pilot and main phases, mostly Black and mostly White dichotomizations exhibited a moderate-to-high sensitivity, specificity, correct classification rate, positive predictive value, and negative predictive value. The positive likelihood ratio values were >1, and the negative likelihood ratio values were close to 0. The false positive and negative rates were low to moderate. CONCLUSIONS These findings support that using either the mostly Black versus other categories or the mostly White versus other categories dichotomizations may provide accurate and reliable measures of racial composition across the 10 social environments. The PRCM can serve as a uniform measure across disciplines, capture multiple social environments over the life course, and be administered during one study visit. The PRCM also provides an added window into understanding how structural racism has impacted minoritized communities and may inform equitable intervention and prevention efforts to improve lives.
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Affiliation(s)
- Jemar R Bather
- Center for Anti-racism, Social Justice & Public Health, School of Global Public Health, New York University, New York, NY, United States
- Department of Biostatistics, School of Global Public Health, New York University, New York, NY, United States
| | - Kimberly A Kaphingst
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
- Department of Communication, University of Utah, Salt Lake City, UT, United States
| | - Melody S Goodman
- Center for Anti-racism, Social Justice & Public Health, School of Global Public Health, New York University, New York, NY, United States
- Department of Biostatistics, School of Global Public Health, New York University, New York, NY, United States
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Odumegwu JN, Chavez-Yenter D, Goodman MS, Kaphingst KA. Associations between subjective social status and predictors of interest in genetic testing among women diagnosed with breast cancer at a young age. Cancer Causes Control 2024; 35:1201-1212. [PMID: 38700724 DOI: 10.1007/s10552-024-01878-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/02/2024] [Indexed: 07/24/2024]
Abstract
PURPOSE Genetic testing for gene mutations which elevate risk for breast cancer is particularly important for women diagnosed at a young age. Differences remain in access and utilization to testing across social groups, and research on the predictors of interest in genetic testing for women diagnosed at a young age is limited. METHODS We examined the relationships between subjective social status (SSS) and variables previously identified as possible predictors of genetic testing, including genome sequencing knowledge, genetic worry, cancer worry, health consciousness, decision-making preferences, genetic self-efficacy, genetic-related beliefs, and subjective numeracy, among a cohort of women who were diagnosed with breast cancer at a young age. RESULTS In this sample (n = 1,076), those who had higher SSS had significantly higher knowledge about the limitations of genome sequencing (Odds Ratio (OR) = 1.11; 95% CI = 1.01-1.21) and significantly higher informational norms (OR = 1.93; 95% CI = 1.19-3.14) than those with lower SSS. Similarly, education (OR = 2.75; 95% CI = 1.79-4.22), health status (OR = 2.18; 95% CI = 1.44-3.31) were significant predictors among higher SSS women compared to lower SSS women in our multivariate analysis. Lower SSS women with low self-reported income (OR = 0.13; 95% CI = 0.08-0.20) had lower odds of genetic testing interest. Our results are consistent with some prior research utilizing proxy indicators for socioeconomic status, but our research adds the importance of using a multidimensional indicator such as SSS to examine cancer and genetic testing predictor outcomes. CONCLUSION To develop interventions to improve genetic knowledge, researchers should consider the social status and contexts of women diagnosed with breast cancer at a young age (or before 40 years old) to ensure equity in the distribution of genetic testing benefits.
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Affiliation(s)
- Jonathan N Odumegwu
- Department of Biostatistics, NYU School of Global Public Health, New York, NY, USA
| | - Daniel Chavez-Yenter
- Department of Communication, University of Utah, Salt Lake City, UT, USA.
- Cancer Control & Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA.
| | - Melody S Goodman
- Department of Biostatistics, NYU School of Global Public Health, New York, NY, USA
| | - Kimberly A Kaphingst
- Department of Communication, University of Utah, Salt Lake City, UT, USA
- Cancer Control & Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
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Kor PPK, Yu CTK, Li Y, Tsang APL, Tan LHZ, Lam SC, Lee PH, Liu JYW, Leung AYM, Lee KC. Development and validation of a health literacy scale for family caregivers of older people with chronic illness. BMC Nurs 2024; 23:447. [PMID: 38951836 PMCID: PMC11218080 DOI: 10.1186/s12912-024-02057-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 06/03/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Family caregivers (FCs) encounter a variety of health problems in older people with chronic illness, necessitating a certain level of health literacy to access, understand, appraise and apply health information and services. This study aimed to develop and validate a scale for measuring health literacy among FCs of older people with chronic illness. METHODS Concept mapping was first employed to develop a conceptual model of health literacy of FCs. Scale domains were derived from the conceptual model, and item generation was performed using deductive and inductive methods. Quantitative methods, including merging scale dimensions and items, expert reviews, cognitive interviews, and item reduction analysis, were used to refine the scale. Confirmatory factor analysis was employed to validate the scale's structure. Concurrent validity, internal consistency, and test-retest reliability were also examined. RESULTS A 20-dimension conceptual model was developed, and 60 items were generated for the scale. Expert review (content validity index > 0.85) and cognitive interview with FCs confirmed the relevance and clarity of the majority of the generated scale items. Confirmatory factor analysis with 451 FCs of older people with chronic illness supported a 5-factor structure (symptom management, daily personal care and household tasks, care coordination, communication and relationship with the care recipient, and self-care of caregivers) with 42 finalized scale items, including four levels of health literacy skills (accessing, understanding, appraising and applying health information). Concurrent validity with the European Health Literacy Questionnaire (HLS-EU-Q47) was satisfactory (r = 0.67, p < 0.01). The Cronbach's α coefficient of the scale was 0.96, with subscales ranging from 0.84 to 0.91. The two-week test-retest reliability was 0.77 (p < 0.01). CONCLUSION This study developed a conceptual model explaining the concept and factors of health literacy among FCs of older people with chronic illness that could provide the groundwork for future studies in developing relevant evidence-based interventions. A new Health Literacy Scale-Family Caregiver (HLS-FC) with satisfactory psychometric properties was developed in this study, which can be utilized to identify caregivers with insufficient health literacy and facilitate timely interventions by healthcare professionals.
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Affiliation(s)
| | - Clare Tsz Kiu Yu
- Division of Psychiatry, University of College London, London, UK
| | - Yaqin Li
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Alex Pak Lik Tsang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Lexi Han Zhi Tan
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | | | - Paul Hong Lee
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Justina Yat Wa Liu
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
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Sajjadian F, Amiri-Farahani L, Haghani S, Pezaro S. Investigating the relationship between health literacy and preconceptual care components during the first 14 weeks of pregnancy: a cross-sectional study. BMC PRIMARY CARE 2024; 25:209. [PMID: 38862877 PMCID: PMC11165771 DOI: 10.1186/s12875-024-02467-5] [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: 08/19/2023] [Accepted: 06/04/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND AND AIM Preconceptual care aiming to improve health is influenced by various factors including health literacy. Considering the importance and necessity of high quality preconceptual care, this study aimed to determine the relationship between health literacy and receiving components of preconceptual care prior to pregnancy. METHODS This cross-sectional study included 693 participants with pregnancies of less than 14 weeks gestation referred to health centers and gynecologists in Shiraz city, Iran. Multi-stage sampling was done from May 2021 to February 2022 in 18 comprehensive urban health centers and 20 gynecology offices via proportional allocation method. The data collection tool comprised a questionnaire consisting of 3 parts: (1) individual and fertility characteristics, (2) information related to the components of preconceptual care and (3) health literacy for Iranian adults. This was completed by individual participants via the self-reporting method. RESULTS The majority of participants were between 30 and 34 years old. They also identified as women with a university education and were predominantly unemployed. The mean health literacy of participants was 76.81%. Health literacy obtained the highest mean score in the dimension of 'understanding' and the lowest mean score in the dimension of 'access'. The frequency of preconceptual counseling, folic acid supplement consumption, exercise, blood testing, dental visits, genetic counseling, Pap smear testing and rubella, diphtheria, and hepatitis vaccinations prior to pregnancy was 66.8%, 53.8%, 45.6%, 71.86%, 44.44%, 12%, 53.4%, 10.83%, respectively. Many (> 64%) received preconceptual care at specialist gynecology offices. Results demonstrated that health literacy had a statistically significant relationship with preconceptual care, folic acid consumption, exercise and dental care, (p < 0.001), along with blood testing and Pap smear testing (p < 0.05). CONCLUSION Overall, our results demonstrate that despite health literacy being optimal, uptakes of some components of preconceptual care are low. As such, it will be important to further raise awareness of the importance of preconceptual care for people prior to pregnancy as a priority in health promotion and education.
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Affiliation(s)
- Fatemeh Sajjadian
- Department of Reproductive Health and Midwifery, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Amiri-Farahani
- Department of Reproductive Health and Midwifery, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
| | - Shima Haghani
- Department of Biostatistics, Nursing and Midwifery Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sally Pezaro
- The Research Centre for Healthcare and Communities, Coventry University, Coventry, UK
- The University of Notre Dame, Notre Dame, Australia
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Agrawal P, Phadke M, Du N, Hosain F, Koons L, Brown C, O'Malley S, Cheng FY. Enhancing the health knowledge and health literacy of recently resettled refugees through classroom-based instructional methods. HEALTH EDUCATION RESEARCH 2024; 39:159-169. [PMID: 38244587 DOI: 10.1093/her/cyae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 12/18/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024]
Abstract
Health education can elevate health literacy, which is associated with health knowledge, health-seeking behaviors and overall improved health outcomes. Refugees are particularly vulnerable to the effects of low health knowledge and literacy, which can exacerbate already poor health stemming from their displacement experience. Traditional learning methods including classroom-based instruction are typically how health-related information is presented to refugees. Through a series of interactive classes focused on specific health topics relevant to the resettled refugee population, this study evaluated the effectiveness of a classroom-based health education model in enhancing the health knowledge of recently resettled refugees. We used the Wilcoxon signed-rank test to evaluate differences in pre- and post-class knowledge through test performance. We found a significant improvement in health knowledge in two refugee groups: females and those who were employed. Culturally and socially sensitive considerations including language inclusiveness, class timing, transportation and childcare provisions are important when creating an educational program for individuals with refugee backgrounds. Developing focused approaches to instruction that enhance health knowledge could lead to better health literacy and ultimately improve health-related behaviors and outcomes in the refugee population.
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Affiliation(s)
- Pooja Agrawal
- Department of Emergency Medicine, Yale University School of Medicine, 464 Congress Ave. Suite 260, New Haven, CT 06517, USA
| | - Manali Phadke
- Yale Center for Analytical Sciences, Yale School of Public Health, 300 George Street Suite 555, New Haven, CT 06510, USA
| | - Nan Du
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Fatima Hosain
- Department of Emergency Medicine, Yale University School of Medicine, 464 Congress Ave. Suite 260, New Haven, CT 06517, USA
| | - Leslie Koons
- IRIS-Integrated Refugee and Immigrant Services, 235 Nicoll Street, New Haven, CT 06511, USA
| | - Camille Brown
- Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street Suite LMP 4085, New Haven, CT 06520, USA
| | - Shannon O'Malley
- Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street Suite LMP 4085, New Haven, CT 06520, USA
| | - Frances Y Cheng
- Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street Suite LMP 4085, New Haven, CT 06520, USA
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Gheshlagh RG, Mahmoodi H, Pelikan JM, Afkhamzadeh A, Ebadi A. Psychometric evaluation of the Persian version of the European Health Literacy Instrument (P-HLS-EU-Q47). Health Promot Int 2023; 38:daad135. [PMID: 37864802 DOI: 10.1093/heapro/daad135] [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: 10/23/2023] Open
Abstract
Health literacy is one of the most critical determinants of health for effectively improving health services and reducing health inequalities. The importance of accurate measurement cannot be overstated. The European 47-item Health Literacy Questionnaire (HLS-EU-Q47) can provide precise measurements of health literacy. Therefore, this study aimed to evaluate the psychometric properties of the European Health Literacy Instrument in Iranian society (HLS-PV-Q47) for its Persian version. This cross-sectional study was conducted using a convenient sampling of 560 people referred to comprehensive healthcare centers. The construct validity was assessed by exploratory (280 people) and confirmatory factor (with 280 people). The internal consistency was calculated using Cronbach's alpha coefficients. Based on the exploratory factor analysis, three factors of healthcare, disease prevention, and health promotion explained 48.9% of the total variance of health literacy. Cronbach's alpha was 0.96 for the whole instrument. The Persian version of the European Health Literacy Instrument (P-HLS-EU-Q47) had good validity and reliability, which can be used in future studies due to its good psychometric properties.
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Affiliation(s)
- Reza Ghanei Gheshlagh
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Hassan Mahmoodi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Jürgen M Pelikan
- Institute of Sociology, University of Vienna, Vienna, Austria
- WHO-CC Health Promotion in Hospitals and Healthcare, Gesundheit Österreich GmbH, Vienna, Austria
| | - Abdorrahim Afkhamzadeh
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Fleisher L, Kenny C, Rusten C, Koren D, Landau Z. Right Information, Right Patient, Right Time: Utilizing the MyCareCompass Platform to Deliver Patient Education in the Oncology Setting. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1420-1428. [PMID: 37540339 PMCID: PMC10509046 DOI: 10.1007/s13187-023-02350-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 08/05/2023]
Abstract
Patient education is an important part of cancer care as it increases patient activation and informed decision-making, reduces anxiety, and improves outcomes. However, challenges to providing appropriate education to patients exist on both the health provider and patient side of the equation, e.g., time constraints and health literacy issues. Digital health education is a fast-growing field of interest that has been shown to improve health outcomes, increase effectiveness of medical treatments and education, lower medical costs, and enhance both clinical diagnosis and research opportunities by streamlining data collection, sharing, and analysis. In 2019, Fox Chase Cancer Center was selected by ARCHES, an established patient education software company, to pilot its award-winning digital patient engagement system MyCareCompass. During the pilot, patients scheduled for port insertions were sent electronic messages inviting them to review various online educational materials related to their procedure and subsequent concerns. The invitations and resources were seamlessly integrated into the scheduling system and timed to arrive when patients would most need them. There was high usage of the port-related materials and patients reported a high level of satisfaction with the delivery system and the information. This automated process of delivering high-quality and relevant patient education was able to be implemented smoothly with IT involvement, had a positive impact on patients without adding any extra burden to the care team, and highlighted opportunities to integrate these types of interventions into routine care.
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Affiliation(s)
- Linda Fleisher
- Fox Chase Cancer Center, Cancer Prevention and Control, PA Philadelphia, USA
| | - Cassidy Kenny
- Fox Chase Cancer Center, Cancer Prevention and Control, PA Philadelphia, USA
| | | | | | - Zoe Landau
- Fox Chase Cancer Center, Cancer Prevention and Control, PA Philadelphia, USA
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Bakare O, Akintujoye IA, Gbemudu PE, Mbaezue RN, Akinbolade AO, Olopade S. Medicaid Coverage and Emergency Department Utilization in Southeastern Pennsylvania. Cureus 2023; 15:e45464. [PMID: 37859924 PMCID: PMC10584275 DOI: 10.7759/cureus.45464] [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: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Overutilization of the emergency department (ED) is a significant problem in the United States (US), characterized mainly by patients with non-emergent conditions seeking care in a setting designed specifically for acute care. This has significantly increased healthcare costs in the US, a country with one of the most expensive healthcare systems in the world. ED overutilization was also found to be high among people with Medicaid coverage, especially since the Affordable Care Act was enacted with an expansion in Medicaid coverage. Using the 2018 South Eastern Pennsylvania (SEPA) Household Health Survey, we identified a significant bivariate relationship between emergency department visits and the following predictor variables: sex, race, education, employment status, 150% poverty level, and Medicaid recipient. Using a multivariable logistic regression model, Medicaid recipients had higher odds of presenting to the ED than non-Medicaid recipients [odds ratio (OR): 2.863, 95% confidence interval (CI): 2.164, 3.788]. Black people (OR: 1.647, 95% CI: 1.411, 1.923) and Native Americans (OR: 2.985, 95% CI: 1.536, 5.800) had higher odds than Whites. Respondents without a high school diploma had higher odds than college graduates (OR: 1.647, 95% CI: 1.96, 2.273). Respondents below the 150% poverty line had higher odds than those at or above the 150% poverty level (OR: 1.651, 95% CI: 1.386, 1.968). Unemployed respondents had higher odds than full-time employed respondents (OR: 1.703, 95% CI: 1.488, 1.953) or part-time (OR: 1.259, 95% CI: 1.036, 1.529). No difference was observed between the sexes. Addressing ED overutilization should take a multi-faceted approach with the ultimate goal of improving access to primary care.
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Affiliation(s)
- Olusegun Bakare
- Internal Medicine-Pediatrics, Tulane University School of Medicine, New Orleans, USA
| | | | - Paul E Gbemudu
- Internal Medicine-Pediatrics, Tulane University School of Medicine, New Orleans, USA
| | | | | | - Segun Olopade
- Medicine and Surgery, Igbinedion University Teaching Hospital, Okada, NGA
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Turnbull J, MacLellan J, Churruca K, Ellis LA, Prichard J, Browne D, Braithwaite J, Petter E, Chisambi M, Pope C. A multimethod study of NHS 111 online. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-104. [PMID: 37464813 DOI: 10.3310/ytrr9821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Background NHS 111 online offers 24-hour access to health assessment and triage. Objectives This study examined pathways to care, differential access and use, and workforce impacts of NHS 111 online. This study compared NHS 111 with Healthdirect (Haymarket, Australia) virtual triage. Design Interviews with 80 staff and stakeholders in English primary, urgent and emergency care, and 41 staff and stakeholders associated with Healthdirect. A survey of 2754 respondents, of whom 1137 (41.3%) had used NHS 111 online and 1617 (58.7%) had not. Results NHS 111 online is one of several digital health-care technologies and was not differentiated from the NHS 111 telephone service or well understood. There is a similar lack of awareness of Healthdirect virtual triage. NHS 111 and Healthdirect virtual triage are perceived as creating additional work for health-care staff and inappropriate demand for some health services, especially emergency care. One-third of survey respondents reported that they had not used any NHS 111 service (telephone or online). Older people and those with less educational qualifications are less likely to use NHS 111 online. Respondents who had used NHS 111 online reported more use of other urgent care services and make more cumulative use of services than those who had not used NHS 111 online. Users of NHS 111 online had higher levels of self-reported eHealth literacy. There were differences in reported preferences for using NHS 111 online for different symptom presentations. Conclusions Greater clarity about what the NHS 111 online service offers would allow better signposting and reduce confusion. Generic NHS 111 services are perceived as creating additional work in the primary, urgent and emergency care system. There are differences in eHealth literacy between users and those who have not used NHS 111 online, and this suggests that 'digital first' policies may increase health inequalities. Limitations This research bridged the pandemic from 2020 to 2021; therefore, findings may change as services adjust going forward. Surveys used a digital platform so there is probably bias towards some level of e-Literacy, but this also means that our data may underestimate the digital divide. Future work Further investigation of access to digital services could address concerns about digital exclusion. Research comparing the affordances and cost-benefits of different triage and assessment systems for users and health-care providers is needed. Research about trust in virtual assessments may show how duplication can be reduced. Mixed-methods studies looking at outcomes, impacts on work and costs, and ways to measure eHealth literacy, can inform the development NHS 111 online and opportunities for further international shared learning could be pursued. Study registration This study is registered at the research registry (UIN 5392). Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research Programme and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Joanne Turnbull
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Jennifer MacLellan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Jane Prichard
- School of Health Sciences, University of Southampton, Southampton, UK
| | | | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Emily Petter
- NHS Hampshire, Southampton and Isle of Wight Clinical Commissioning Group, Winchester, UK
| | - Matthew Chisambi
- Imperial College Health Partners, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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11
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Parikh C, Ostrovsky AM. Analysis of Trustworthiness and Readability of English and Spanish Hypo- and Hyperthyroid-Related Online Patient Education Information. J Patient Exp 2023; 10:23743735231179063. [PMID: 37323756 PMCID: PMC10265335 DOI: 10.1177/23743735231179063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
This study aims to determine the readability and trustworthiness of English and Spanish hypo- and hyperthyroid-related online information. Google searches were conducted for four search terms: hypothyroidism, Hashimoto's Disease, hyperthyroidism, and Graves' Disease. For each search term, the first 10 websites were analyzed with a total of 40 websites analyzed. Readability formulas were used to determine English and Spanish readability. Trustworthiness was determined using HONcode status, JAMA Benchmark Criteria, and NLM Trustworthy Score. Overall readability largely exceeded recommended grade levels. Only 1 website (2.5%) presented information below the eighth-grade reading level based on overall Readability Consensus score, while 31 websites (77.5%) exceeded this threshold for all measures. The mean (SD) English readability grade level was 9.6 (3.44); the mean (SD) Spanish grade was 8.5 (4.58). No significant relationships were found between the JAMA Benchmark Criteria, NLM Trustworthy Score, HONcode status, and readability. 67.5% of websites analyzed (n = 27) were certified with the Health on the Net Foundation's code of conduct. Websites about common thyroid-related conditions have overall poor readability. The availability of resources for Spanish-speaking patients is also poor. Steps should be taken to ensure that online health-related materials are comprehensible. Physicians should recognize that patients may have few trustworthy and easy-to-understand sources to access information. The readability and trustworthiness of sources should be considered when providing patients suggested sources for further reading. It may be particularly helpful for physicians to utilize websites with favorable readability scores such as the American Thyroid Association website.
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Affiliation(s)
- Chitra Parikh
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Adam M Ostrovsky
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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12
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Byrd JN, Huynh KA, Cho HE, Chung KC. Improving Perioperative Preparation for Patients Undergoing Surgical Treatment for Distal Radius Fractures. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4995. [PMID: 37360230 PMCID: PMC10287137 DOI: 10.1097/gox.0000000000004995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/23/2023] [Indexed: 06/28/2023]
Abstract
We aimed to review common patient concerns after surgical repair of distal radius fracture (DRF) to identify potential interventions to improve the gap between expectation and education for DRF patients. Methods We conducted a retrospective cohort study of 100 consecutive patients who underwent surgical repair of DRF at a level I trauma center. Patient-initiated communication notes were reviewed with thematic analysis to identify the common reasons patients required additional information. We used the Patient Education Materials Assessment Tool to score the available educational resources for DRF patients for the understandability and actionability of the educational materials provided to the patients. Results Of 165 patient communication episodes, 88.5% occurred postoperatively. The most common concerns were pain (30, 15.4%) and surgical site changes (24, 12.3%). Most communications (171, 83.4%) were resolved with patient education through instruction or reassurance. The reviewed materials did not address pain or surgical site changes. No reviewed materials provided actionable steps patients could take to facilitate recovery. Conclusions Pain management and normal wound healing were the most common surgical concerns of DRF patients. We identify opportunities to improve expectation-setting in online materials and during face-to-face education to create a more patient-centered perioperative experience.
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Affiliation(s)
- Jacqueline N. Byrd
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich
- Department of Surgery, University of Texas Southwestern Medical School, Dallas, Tex
| | - Kristine A. Huynh
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich
- Department of Plastic Surgery, University of Texas Southwestern Medical School, Dallas, Tex
| | - Hoyune E. Cho
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich
- Department of Plastic Surgery, University of California, Irvine, School of Medicine, Orange, Calif
| | - Kevin C. Chung
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich
- Department of Surgery, University of Texas Southwestern Medical School, Dallas, Tex
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13
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Poureslami I, Hohn RE, Kopec JA, Sawatzky R, Aaron SD, Gupta S, Goldstein R, Boulet LP, Tregobov N, Shum J. Evaluation of a New Performance-Based Health Literacy Measurement Tool for Individuals With Chronic Airways Disease. Respir Care 2023; 68:638-648. [PMID: 36411057 PMCID: PMC10171345 DOI: 10.4187/respcare.10441] [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: 08/27/2022] [Accepted: 11/19/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Low health literacy is a global challenge. Health literacy is positively correlated with chronic airways disease desirable outcomes. Despite the importance of health literacy in disease management, current health literacy measurement tools are suboptimal. As part of a multi-stage project to develop a performance-based, disease-specific Vancouver Airways Health Literacy Tool (VAHLT) for individuals with chronic airways disease, this study assessed the relationships between the VAHLT scores and characteristics of patients with chronic airways disease. The primary aim of the study was to provide preliminary evidence of construct validity of the VAHLT. METHODS A cross-sectional study design was applied. Study subjects were recruited from 6 specialty care clinics to complete the VAHLT measurement tool. Demographic and clinical data, including quality of life and disease control, were collected via validated questionnaires. The study subjects also completed a spirometry test. Inferential analysis was conducted by using mean difference testing and correlational methods. RESULTS A total of 320 subjects were recruited, and, after imputing missing data, 315 were ultimately analyzed. The subjects were predominantly women (61%), white (83%), had a post-high-school education (74%), and a mean ± SD age of 65.2 ± 13.2 y. Age was significantly negatively correlated with the VAHLT scores (P = .004); the subjects with a post-high school education had significantly higher VAHLT scores than those with a high school education or less (P < .001). No significant sex or ethnicity related differences in VAHLT scores were observed. For clinical outcomes, no significant differences were found between the VAHLT scores and disease severity or measures of quality of life and asthma control. CONCLUSIONS We report a chronic airways disease-specific health literacy measurement tool developed with the involvement of patients and professionals. Age and education were highly correlated with health literacy, which emphasizes the importance of addressing these factors in health literacy interventions among patients with chronic airways disease.
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Affiliation(s)
- Iraj Poureslami
- Division of Respiratory Medicine, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.
- Canadian Multicultural Health Promotion Society, Burnaby, British Columbia, Canada
| | - Ric E Hohn
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Jacek A Kopec
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rick Sawatzky
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada
| | - Shawn D Aaron
- Division of Respiratory Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Samir Gupta
- Division of Respiratory Medicine, Department of Medicine, University of Toronto, Unity Health, Toronto, Ontario Canada
| | - Roger Goldstein
- Division of Respiratory Medicine, Department of Medicine, West Park Healthcare Centre, University of Toronto, Toronto, Ontario, Canada
| | - Louis-Philippe Boulet
- Division of Respiratory Medicine, Department of Medicine, Laval University, Quebec, Quebec, Canada
| | - Noah Tregobov
- Division of Respiratory Medicine, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
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Nwanaji-Enwerem JC, Smith-Wilkerson M, Gordon B, Okpere H, Jones T, Gizaw R, Husain I. Universal Precautions Plus: Physician-Directed Strategies for Improving Patient Health Literacy in the Emergency Department. West J Emerg Med 2023; 24:110-113. [PMID: 36602487 PMCID: PMC9897242 DOI: 10.5811/westjem.2022.10.57697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/07/2022] [Indexed: 01/06/2023] Open
Abstract
Working on the frontlines with safety-net populations, emergency physicians are uniquely positioned to take on a greater role in addressing the current health literacy crisis and specific barriers that may exist. Here, we review the concept of universal health literacy precautions and explore the application of these universal precautions in conjunction with other patient-centered strategies. More specifically, to improve patient understanding and outcomes, emergency physicians can pair universal health literacy precautions with strategies including multiple learning techniques, dual-code theory, empowerment counseling, family buy-in, and hands-on practice. We provide two examples of emergency department encounters where this combined approach was used differently yet successfully and efficiently. Ultimately, we aim to highlight the value of emergency physicians being equipped with basic skills in health literacy educational strategies.
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Affiliation(s)
- Jamaji C. Nwanaji-Enwerem
- Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia,Emory Rollins School of Public Health, Gangarosa Department of Environmental Health, Atlanta, Georgia
| | | | - Brittney Gordon
- Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia
| | - Helene Okpere
- Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia
| | - Terrell Jones
- Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia
| | - Rahel Gizaw
- Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia
| | - Irfan Husain
- Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia
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Strauß A, Zimmermann T, Schäfer I, Scherer M. Gesundheitskompetenz und Hausarztbindung nicht dringlicher Patientinnen und Patienten in Notaufnahmen: Ergebnisse der PiNo-Studie in Hamburg und Schleswig-Holstein. ZEITSCHRIFT FÜR EVIDENZ, FORTBILDUNG UND QUALITÄT IM GESUNDHEITSWESEN 2022; 175:50-58. [DOI: 10.1016/j.zefq.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/25/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022]
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Bánfai-Csonka H, Bánfai B, Jeges S, Betlehem J. Understanding Health Literacy among University Health Science Students of Different Nationalities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11758. [PMID: 36142030 PMCID: PMC9517253 DOI: 10.3390/ijerph191811758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/08/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
An adequate level of health literacy is essential for clear communication between patients and health care workers. The internationalization of universities is increasing in the field of health care. The aims of our research were to measure (1) the level of health literacy and its correlation among university students and (2) the relationship between the different instruments measuring health literacy. A cross-sectional study was conducted in the 2020/2021 academic year. The questionnaire included questions on sociodemographic status, study data, health status, and health literacy level. According to the HLS-EU-Q16 health literacy questionnaire, more than half of the students had a limited HL level in disease prevention (52.4%) and health promotion (58.4%) subindexes. Nationality was found to be an influencing factor (p < 0.001). According to the NVS, 80.1% of the students had an adequate HL level. A significant correlation was found between the results and nationality (p = 0.005). None of the Chew questions demonstrated a correlation with nationality (q1 p = 0.269, q2 p = 0.368, q3 p = 0.528). Nationality is a key factor in the level of subjective and functional health literacy. We need to measure both types of levels to see the real results.
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Affiliation(s)
- Henrietta Bánfai-Csonka
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
- Institute of Emergency Care and Pedagogy of Health, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
- Emergency Department, Clinical Center, University of Pécs, 7624 Pécs, Hungary
| | - Bálint Bánfai
- Institute of Emergency Care and Pedagogy of Health, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
| | - Sára Jeges
- Institute of Emergency Care and Pedagogy of Health, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
| | - József Betlehem
- Institute of Emergency Care and Pedagogy of Health, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
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Suleiman LI, Tucker K, Ihekweazu U, Huddleston JI, Cohen-Rosenblum AR. Caring for Diverse and High-Risk Patients: Surgeon, Health System, and Patient Integration. J Arthroplasty 2022; 37:1421-1425. [PMID: 35158005 DOI: 10.1016/j.arth.2022.02.017] [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: 12/03/2021] [Revised: 01/16/2022] [Accepted: 02/07/2022] [Indexed: 02/02/2023] Open
Abstract
Access and outcome disparities exist in hip and knee arthroplasty care. These disparities are associated with race, ethnicity, and social determinants of health such as income, housing, transportation, education, language, and health literacy. Additionally, medical comorbidities affecting postoperative outcomes are more prevalent in underresourced communities, which are more commonly communities of color. Navigating racial and ethnic differences in treating our patients undergoing hip and knee arthroplasty is necessary to reduce inequitable care. It is important to recognize our implicit biases and lessen their influence on our healthcare decision-making. Social determinants of health need to be addressed on a large scale as the current inequitable system disproportionally impacts communities of color. Patients with lower health literacy have a higher risk of postoperative complications and poor outcomes after hip and knee replacement. Low health literacy can be addressed by improving communication, reducing barriers to care, and supporting patients in their efforts to improve their own health. High-risk patients require more financial, physical, and mental resources to care for them, and hospitals, surgeons, and health insurance companies are often disincentivized to do so. By advocating for alternative payment models that adjust for the increased risk and take into account the increased perioperative work needed to care for these patients, surgeons can help reduce inequities in access to care. We have a responsibility to our patients to recognize and address social determinants of health, improve the diversity of our workforce, and advocate for improved access to care to decrease inequity and outcomes disparities in our field.
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Affiliation(s)
- Linda I Suleiman
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | | | | | - James I Huddleston
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA
| | - Anna R Cohen-Rosenblum
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
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18
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Recent Trends in Health Literacy Research, Health Status of the Population and Disease Prevention: An Editorial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148436. [PMID: 35886288 PMCID: PMC9317004 DOI: 10.3390/ijerph19148436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 02/01/2023]
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Emergency department utilisation among older adults—Protocol for a systematic review of determinants and conceptual frameworks. PLoS One 2022; 17:e0265423. [PMID: 35661153 PMCID: PMC9166351 DOI: 10.1371/journal.pone.0265423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 03/01/2022] [Indexed: 11/19/2022] Open
Abstract
Background Older adults aged 65 years and above have a disproportionately higher utilization of emergency healthcare, of which Emergency Department (ED) visits are a key component. They experience higher degree of multimorbidity and mobility issues compared to younger patients, and are consequently more likely to experience a health event which requires an ED visit. During their visit, older adults tend to require more extensive workup, therefore spending a greater amount of time in the ED. Compared to the younger population, older adults are more susceptible to adverse events following discharge. Considering these factors, investigating the determinants of ED utilisation would be valuable. In this paper, we present a protocol for a systematic review of the determinants of ED utilisation among communitydwelling older adults aged 65 years and above, applying Andersen and Newman’s model of healthcare utilisation. Furthermore, we aim to present other conceptual frameworks for healthcare utilisation and propose a holistic approach for understanding the determinants of ED utilisation by older persons. Methods The protocol is developed in accordance with the standards of Campbell Collaboration guidelines for systematic reviews, with reference to the Cochrane Handbook for Systematic Review of Interventions. Medline, Embase and Scopus will be searched for studies published from 2000 to 2020. Studies evaluating more than one determinant for ED utilisation among older adults aged 65 years and above will be included. Search process and selection of studies will be presented in a PRISMA flow chart. Statistically significant (p < 0.05) determinants of ED utilisation will be grouped according to individual and societal determinants. Quality of the studies will be assessed using Newcastle Ottawa Scale (NOS). Discussion In Andersen and Newman’s model, individual determinants include predisposing factors, enabling and illness factors, and societal determinants include technology and social norms. Additional conceptual frameworks for healthcare utilisation include Health Belief Model, Social Determinants of Health and Big Five personality traits. By incorporating the concepts of these models, we hope to develop a holistic approach of conceptualizing the factors that influence ED utilisation among older people. Systematic review registration This protocol is registered on 8 May 2021 with PROSPERO’s International Prospective Register of Systematic Reviews (CRD42021253770).
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Thomson S, Galletly C, Prener C, Garverich S, Liu D, Lincoln A. Associations between health literacy, cognitive function and general literacy in people with schizophrenia attending community mental health clinics in Australia. BMC Psychiatry 2022; 22:245. [PMID: 35392852 PMCID: PMC8986965 DOI: 10.1186/s12888-022-03901-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/24/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Health literacy (HL) has been defined as the ability of individuals to access, understand, and utilise basic health information. HL is crucial to patient engagement in treatment through supporting patient autonomy, informed consent and collaborative care. In people with physical disorders, poor HL is associated with poor health outcomes, but less is known about HL in people with severe mental illness. This study aimed to assess HL and investigate the associations between education, cognitive function, general literacy, and HL in participants with schizophrenia attending community mental health clinics. METHOD Fifty-two outpatients with schizophrenia attending a public community mental health clinic in Adelaide, Australia completed the Test of Functional Health Literacy in Adults-Short Form (S-TOFHLA) along with tests of cognition, aural and reading literacy and numeracy including Digit Symbol Coding (DSC), verbal fluency, the Wechsler Adult Intelligence Scale (WAIS-IV), Woodcock-Johnson III (Part 4 and 9) and the Lipkus numeracy scale. Sixty-one percent of participants were male. Participants had a mean age of 41.2 (SD 9.9) years and a mean of 11.02 (SD 1.5) years of education. RESULTS The majority of participants had very poor aural and verbal literacy and poorer literacy correlated with fewer years of education. On the S-TOFHLA, 81% of participants had adequate HL; 6% were marginal and 13% were inadequate. There was a positive correlation between education and HL, with those with more years of education scoring higher for HL. There was also a significant association between better HL and better working memory and attention. CONCLUSIONS Consistent with previous research in schizophrenia, our participants had reduced educational attainment, aural and reading literacy and cognitive function compared to population norms. However, HL was better than expected given that previous research has found that people with psychiatric disorders tend to have lower HL, compared to the general population. This may reflect effective case management of our participants whilst attending the community clinics and supports ongoing research and intervention regarding HL in people living with mental illness.
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Affiliation(s)
- Sumana Thomson
- Northern Adelaide Local Health Network, Adelaide, South, Australia. .,Adelaide Medical School, The University of Adelaide, Adelaide, South, Australia.
| | - Cherrie Galletly
- Northern Adelaide Local Health Network, Adelaide, South Australia ,grid.1010.00000 0004 1936 7304Adelaide Medical School, The University of Adelaide, Adelaide, South Australia ,Ramsay Health Care (SA) Mental Health Services, Adelaide, South Australia
| | - Christopher Prener
- grid.262962.b0000 0004 1936 9342 Department of Sociology and Anthropology, Saint Louis University, St. Louis, MO USA
| | - Suzanne Garverich
- grid.261112.70000 0001 2173 3359Institute for Health Equity and Social Justice Research, Northeastern University, Boston, MA USA
| | - Dennis Liu
- Northern Adelaide Local Health Network, Adelaide, South Australia ,grid.1010.00000 0004 1936 7304Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
| | - Alisa Lincoln
- grid.261112.70000 0001 2173 3359Institute for Health Equity and Social Justice Research, Northeastern University, Boston, MA USA
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Hesselink G, Cheng J, Schoon Y. A systematic review of instruments to measure health literacy of patients in emergency departments. Acad Emerg Med 2021; 29:890-901. [PMID: 34919316 PMCID: PMC9544178 DOI: 10.1111/acem.14428] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/22/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Knowledge of patient's health literacy (HL) in the emergency department (ED) can facilitate care delivery and reduce poor health outcomes. This systematic review investigates HL measurement instruments used in the ED and their psychometric properties, accuracy in detecting limited HL, and feasibility. METHODS We searched in five biomedical databases for studies published between 1990 and January 2021, evaluating HL measurement instruments tested in the ED on internal consistency, criterion validity, diagnostic accuracy, or feasibility. Reviewers screened studies for relevance and assessed methodologic quality with published criteria. Data were synthesized around study and instrument characteristics and outcomes of interest. RESULTS Of the 2,376 references screened, seven met our inclusion criteria. Studied instruments varied in objective (n = 5) and subjective (n = 6) measurement of HL skills, and in HL constructs measured. The Brief Health Literacy Screen (BHLS) and the Subjective Numeracy Scale demonstrate acceptable and good internal consistency across studies. None of the instruments perform consistently well on criterion validity. The Rapid Estimate of Adult Literacy in Medicine-Revised and the Newest Vital Sign, both objective tests with short administration times, demonstrate good accuracy in one study with high risk of bias. The BHLS, a short subjective measure, shows moderate accuracy across studies including one with low risk of bias. CONCLUSIONS Several short instruments seem valid in measuring HL and accurate in detecting limited HL among ED patients, each with its practical advantages and disadvantages and specific measurement of HL. Additional research is necessary to develop a robust evidence base supporting these instruments.
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Affiliation(s)
- Gijs Hesselink
- Department of Emergency Medicine Radboud Institute for Health Sciences Radboud University Medical Center Nijmegen the Netherlands
- IQ healthcare Radboud Institute for Health Sciences Radboud University Medical Center Nijmegen the Netherlands
| | - Joey Cheng
- Department of Emergency Medicine Radboud Institute for Health Sciences Radboud University Medical Center Nijmegen the Netherlands
| | - Yvonne Schoon
- Department of Emergency Medicine Radboud Institute for Health Sciences Radboud University Medical Center Nijmegen the Netherlands
- Department of Geriatrics Radboud Institute for Health Sciences Radboud University Medical Center Nijmegen the Netherlands
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22
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Chisolm DJ, Keedy HE, Hart LC, Chavez LJ, Dolce M, Morack J, Grannis C, Kelleher K. Exploring Health Literacy, Transition Readiness, and Healthcare Utilization in Medicaid Chronically Ill Youth. J Adolesc Health 2021; 69:622-628. [PMID: 33952419 PMCID: PMC8429056 DOI: 10.1016/j.jadohealth.2021.03.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/10/2021] [Accepted: 03/26/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Youths with special healthcare needs face challenges transitioning from pediatric to adult health care. Understanding possible mechanisms contributing to poor healthcare transition could improve care. This study explores associations between health literacy (HL), transition readiness, and healthcare utilization. METHODS Youths with special healthcare needs aged 12-18 years were recruited from a Medicaid accountable care organization (2012-2017). Outcome measures included transition readiness (Transition Readiness Assessment Questionnaire), and healthcare utilization (any well-check, hospitalization, emergency department [ED] visit, or ambulatory sensitive condition ED visit). Multivariate regression analyses examined whether HL (adequate vs. inadequate) predicted outcomes, after adjusting for covariates. Models were then created to examine whether the effect of HL on healthcare utilization was mediated by transition readiness. RESULTS Among 417 youths with special healthcare needs, 67.1% reported adequate HL. Relative to inadequate HL, teens with adequate HL had significantly higher average Transition Readiness Assessment Questionnaire-20 scores (β = .34, p < .001). Controlling for covariates, HL was a significant predictor of having an ambulatory sensitive condition ED visit and having any ED visits neared significance. There was a positive transition readiness mediation effect on having an ED visit, with higher transition readiness being associated with higher odds of having any ED visit in the mediation analysis. CONCLUSIONS HL is independently associated with higher transition readiness and lower ambulatory sensitive condition ED use, but pathways of action require further study.
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Affiliation(s)
- Deena J Chisolm
- Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; College of Public Health, The Ohio State University, Columbus, Ohio
| | - Hannah E Keedy
- Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio.
| | - Laura C Hart
- Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; College of Medicine, Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Laura J Chavez
- Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Millie Dolce
- Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Jennifer Morack
- Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Connor Grannis
- Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Kelly Kelleher
- Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; College of Medicine, Department of Pediatrics, The Ohio State University, Columbus, Ohio
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Health care utilization and health-related quality of life of injury patients: comparison of educational groups. BMC Health Serv Res 2021; 21:988. [PMID: 34538243 PMCID: PMC8451142 DOI: 10.1186/s12913-021-06913-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Differences in health care utilization by educational level can contribute to inequalities in health. Understanding health care utilization and health-related quality of life (HRQoL) of educational groups may provide important insights into the presence of these inequalities. Therefore, we assessed characteristics, health care utilization and HRQoL of injury patients by educational level. Method Data for this registry based cohort study were extracted from the Dutch Injury Surveillance System. At 6-month follow-up, a stratified sample of patients (≥25 years) with an unintentional injury reported their health care utilization since discharge and completed the EQ-5-Dimension, 5-Level (EQ-5D-5L) and visual analogue scale (EQ VAS). Logistic regression analyses, adjusting for patient and injury characteristics, were performed to investigate the association between educational level and health care utilization. Descriptive statistics were used to analyse HRQoL scores by educational level, for hospitalized and non-hospitalized patients. Results This study included 2606 patients; 47.9% had a low, 24.4% a middle level, and 27.7% a high level of education. Patients with low education were more often female, were older, had more comorbidities, and lived more often alone compared to patients with high education (p < 0.001). Patients with high education were more likely to visit a general practitioner (OR: 1.38; CI: 1.11–1.72) but less likely to be hospitalized (OR: 0.79; CI: 0.63–1.00) and to have nursing care at home (OR: 0.66; CI: 0.49–0.90) compared to their low educated counterparts. For both hospitalized an non-hospitalized persons, those with low educational level reported lower HRQoL and more problems on all dimensions than those with a higher educational level. Conclusion Post-discharge, level of education was associated with visiting the general practitioner and nursing care at home, but not significantly with use of other health care services in the 6 months post-injury. Additionally, patients with a low educational level had a poorer HRQoL. However, other factors including age and sex may also explain a part of these differences between educational groups. It is important that patients are aware of potential consequences of their trauma and when and why they should consult a specific health care service after ED or hospital discharge. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06913-3.
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Oslislo S, Kümpel L, Cantu RR, Möckel M, Heintze C, Holzinger F. [Am I an emergency patient? Emergency perception and decision-making competence in acute situations: a qualitative study of ED patients]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2021; 165:43-50. [PMID: 34391683 DOI: 10.1016/j.zefq.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The number of patients visiting emergency departments (ED) due to acute but less than urgent treatment needs is increasing. A deeper understanding of emergency perception and decision-making competencies of patients is fundamentally important for developing strategies to reduce ED utilization. The aim of this study was to assess ED patients' subjective understanding of an emergency in general as well as relating to their own specific consultation. Additionally, the patients' perspective on the ability to make appropriate decisions in acute situations should be explored. METHODS Seventeen qualitative semi-structured patient interviews were conducted and analyzed using qualitative content analysis. RESULTS The majority of participants attributed their ED consultation to a subjectively perceived emergency situation. Interviewees mostly understood an emergency as a serious or life-threatening constellation associated with impending long-term health damage. They believed that uncertainty concerning the interpretation of their symptoms and associated anxiety may particularly promote situations in which referring to an ED appears to be the only alternative. Patients' health competencies were assessed negatively by a majority of interviewees with regard to assessment of complaints and decision-making in acute situations ("insecure patients"). In contrast, few patients, including those with chronic disease and experience in dealing with health problems, were considered to have a high level of competence ("confident patients"). CONCLUSION Improving patients' health literacy skills to strengthen their assessment of acute situations and their decision-making is important in order to promote appropriate ED utilization.
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Affiliation(s)
- Sarah Oslislo
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institut für Allgemeinmedizin.
| | - Lisa Kümpel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institut für Allgemeinmedizin
| | - Rebecca Resendiz Cantu
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institut für Allgemeinmedizin; Charité - Universitätsmedizin Berlin, corporate member of Freien Universität Berlin and Humboldt Universität zu Berlin, Arbeitsbereich Notfallmedizin/Rettungsstellen, Campus Virchow Klinikum und Campus Charité Mitte
| | - Martin Möckel
- Charité - Universitätsmedizin Berlin, corporate member of Freien Universität Berlin and Humboldt Universität zu Berlin, Arbeitsbereich Notfallmedizin/Rettungsstellen, Campus Virchow Klinikum und Campus Charité Mitte
| | - Christoph Heintze
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institut für Allgemeinmedizin
| | - Felix Holzinger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institut für Allgemeinmedizin
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Thirumalai M, Zengul AG, Evans E. Challenges and Lessons Learned From a Telehealth Community Paramedicine Program for the Prevention of Hypoglycemia: Pre-Post Pilot Feasibility Study. JMIR Diabetes 2021; 6:e26941. [PMID: 34342593 PMCID: PMC8371490 DOI: 10.2196/26941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/26/2021] [Accepted: 06/17/2021] [Indexed: 12/03/2022] Open
Abstract
Background Prevention through Intervention is a community paramedicine program developed by Birmingham Fire and Rescue Services in Alabama. This program aims to reduce dependency on emergency medical services (EMS) for nonemergency-related events through education and to lower the frequency of emergency calls in underserved populations. A telehealth intervention with an emphasis on hypoglycemia was implemented to (1) tailor the intervention to meet the educational needs of participants and (2) facilitate follow-ups. A pre-post pilot feasibility evaluation of the telehealth intervention was conducted. Objective This paper describes the results of the feasibility evaluation, implementation challenges, and the lessons learned about the deployment of a hypoglycemia prevention program in an underserved area and its evaluation. Methods This single-arm pretest-posttest intervention included (1) an initial in-person visit (week 1), (2) 3 weekly telecoaching calls (weeks 2-4), (3) 1 biweekly call (week 6), and (4) a final in-person visit (week 8) for collecting posttest data from individuals who called EMS due to hypoglycemic events. In-person visits included educational sessions conducted by EMS personnel. Participants’ education included tailored content related to hypoglycemia. Weekly telecoaching calls focused on hypoglycemia symptom monitoring and education reinforcement via a telehealth dashboard. The primary measures focused on feasibility measures, and exploratory measures focused on the fear of hypoglycemia, self-efficacy, and a knowledge of diabetes. Results A total of 40 participants participated in the intervention. However, the study was marred with high attrition. The various factors behind the low retention rate were discussed. There was a decreasing trend in all three subdomains of the fear of hypoglycemia from pretest to posttest. There was also a significant increase in participants’ self-efficacy in hypoglycemia self-management (P=.03). Conclusions This study shows preliminary and promising results for a community-based intervention specifically for hypoglycemia. However, the socioeconomic setting in which the intervention was delivered may have resulted in high dropout rates and low attendance during the intervention, which are considerations for future telehealth studies. Trial Registration ClinicalTrials.gov NCT03665870; https://clinicaltrials.gov/ct2/show/NCT03665870
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Affiliation(s)
- Mohanraj Thirumalai
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ayse G Zengul
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Eric Evans
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States
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Ordonez E, Dowdell K, Navejar N, Dongarwar D, Itani A, Salihu H. An Assessment of the Social Determinants of Health in an Urban Emergency Department. West J Emerg Med 2021; 22:890-897. [PMID: 35354001 PMCID: PMC8328163 DOI: 10.5811/westjem.2021.4.50476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/03/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction: Social determinants of health (SDOH) have significant impacts on patients who seek care in the emergency department (ED). We administered a social needs screening tool and needs assessment survey to assess SDOH and evaluate for trends in the population of patients visiting our ED.
Methods: A survey was distributed via convenience sampling to adult ED patients to capture self-reported demographic information and data about social needs. We categorized the questions related to SDOH based on the International Classification of Diseases, Tenth Revision, Clinical Modification coding format and created a composite variable called “SDOH Strata” based on the SDOH Index scores (0-5-low, 6-10-middle, or ≥11-high). We conducted bivariate analyses using the sociodemographic characteristics of the patients and their SDOH Strata using Fisher’s exact test. We then conducted multinomial logistic regression to examine the association between the patients’ sociodemographic characteristics and the SDOH Strata.
Results: A total of 269 surveys were collected. We observed that Hispanic/Latino patients were more than two times as likely (odds ratio: 2.04, 95% confidence interval [CI], 1.12,-6.51) to be in the higher impact stratum than in the lower impact stratum. Those who were undocumented had 3.43 times increased adjusted odds (95% CI, 1.98, 9.53) of being in the higher than the lower impact stratum compared to US citizens. Additionally, people speaking Spanish as their primary language were 5.16 times as likely to be in the higher impact stratum compared to the reference (English-speaking and lower impact stratum).
Conclusion: In our patient population, patients noted to have the highest impact burden of the SDOH were those who identified as Hispanic/Latino, Spanish-speaking, and undocumented immigrant status.
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Affiliation(s)
- Edgardo Ordonez
- Baylor College of Medicine, Henry J.N. Taub Department of Emergency Medicine, Houston, Texas; Baylor College of Medicine Center of Excellence in Health Equity, Training and Research, Houston, Texas
| | - Katherine Dowdell
- Baylor College of Medicine, Henry J.N. Taub Department of Emergency Medicine, Houston, Texas
| | - Natasha Navejar
- Baylor College of Medicine Center of Excellence in Health Equity, Training and Research, Houston, Texas
| | - Deepa Dongarwar
- Baylor College of Medicine Center of Excellence in Health Equity, Training and Research, Houston, Texas
| | - Aya Itani
- Baylor College of Medicine, Henry J.N. Taub Department of Emergency Medicine, Houston, Texas
| | - Hamisu Salihu
- Baylor College of Medicine Center of Excellence in Health Equity, Training and Research, Houston, Texas
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Friis K, Pedersen MH, Aaby A, Lasgaard M, Maindal HT. Impact of low health literacy on healthcare utilization in individuals with cardiovascular disease, chronic obstructive pulmonary disease, diabetes and mental disorders. A Danish population-based 4-year follow-up study. Eur J Public Health 2021; 30:866-872. [PMID: 32335677 PMCID: PMC7536249 DOI: 10.1093/eurpub/ckaa064] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous research from the USA has shown that low health literacy is associated with higher hospitalization rates and higher rates of emergency service use. However, studies in a European context using more comprehensive health literacy definitions are lacking. The aim was to study the impact of low health literacy on healthcare utilization in a Danish context. METHODS In this prospective cohort study, baseline survey data from 2013 were derived from a large Danish health and morbidity survey and merged with individual-level longitudinal register data for a 4-year follow-up period. The study included people in the general population (n = 29 473) and subgroups of people with four different chronic conditions: cardiovascular disease (CVD) (n = 2389), chronic obstructive pulmonary disease (COPD) (n = 1214), diabetes (n = 1685) and mental disorders (n = 1577). RESULTS In the general population, low health literacy predicted slightly more visits to the general practitioner and admissions to hospital and longer hospitalization periods at 4 years of follow-up, whereas low health literacy did not predict planned outpatient visits or emergency room visits. In people with CVD, low health literacy predicted more days with emergency room visits. In people with mental disorders, difficulties in actively engaging with healthcare providers were associated with a higher number of hospital admission days. No significant association between health literacy and healthcare utilization was found for diabetes or COPD. CONCLUSIONS Even though Denmark has a universal healthcare system the level of health literacy affects healthcare use in the general population and in people with CVD and mental disorders.
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Affiliation(s)
- Karina Friis
- DEFACTUM, Central Denmark Region, 8200 Aarhus N, Denmark
| | | | - Anna Aaby
- Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, Aarhus, Denmark
| | | | - Helle Terkildsen Maindal
- Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, Aarhus, Denmark
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Health Literacy and Emergency Department Utilization Among Community Adults With Mental and Chronic Health Conditions. Adv Emerg Nurs J 2021; 42:293-303. [PMID: 33105184 DOI: 10.1097/tme.0000000000000325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Reducing unnecessary emergency department (ED) utilization is a national health care priority. Low health literacy is a little explored but suggested cause of excess ED utilization. This study investigated the association between health literacy and ED utilization among a community sample of adults with common mental and chronic health conditions. Cross-sectional health interview survey data from Schenectady, New York, were used. Adults (aged ≥18 years) who were diagnosed with anxiety/emotional disorders, depression, asthma, or diabetes were included in the study. Health literacy was assessed using the three-question screener developed and validated by L. D. Chew et al. (2004). ED visits in the previous 12 months specific to these health conditions were analyzed. Multivariable regression models were fitted for each condition with incremental covariate adjustments of demographics, health care access, and number of comorbidities. Odds ratio (OR) and 95% confidence intervals (CI) were reported. Sample sizes were 404, 509, 409, and 237 for anxiety/emotional disorders, depression, asthma, and diabetes, respectively. Inadequate health literacy was significantly higher among individuals who had depression and visited an ED compared with individuals with depression without an ED visit (28.1% vs. 16.9%, p = 0.029). Significant and independent associations between inadequate health literacy and ED utilization was found among adults with anxiety/emotional disorder (fully-adjusted OR 2.22 [CI: 1.03, 4.76]) and among adults with depression (fully-adjusted OR 2.29 [CI: 1.18, 4.44]). No significant association was found among adults with asthma or diabetes. This study presented evidence that inadequate health literacy is common and independently associated with ED utilization among adults with mental health conditions. It supports an initiative to prioritize individuals with mental health conditions, and systematically screen, identify, and provide assistance to those with inadequate health literacy to reduce excess ED utilization. Several existing health literacy screening tools suitable for an emergency care setting are suggested.
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Hutchinson CL, Curtis K, McCloughen A, Qian S, Yu P, Fethney J. Predictors and outcomes of patients that return unplanned to the Emergency Department and require critical care admission: A multicenter study. Australas Emerg Care 2021; 25:88-97. [PMID: 33994336 DOI: 10.1016/j.auec.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/21/2021] [Accepted: 04/15/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the incidence, characteristics (including timeframe) and predictors of patients discharged from the Emergency Department (ED) that later return and require admission. METHODS A retrospective cross-sectional study examining all return visits to three EDs in Sydney, Australia, over a 12-month period. Patients returning within 28 days from ED discharge with the same or similar complaint were classified as a return visit to ensure capture of all return visits. Descriptive and inferential statistics were used to analyse the data and logistic regression was performed to predict factors associated with return visits with general admission, and return visits admitted to critical care. RESULTS There were 1,798 (30%) return visits which resulted in admission, mostly to a non-critical care area (1,679, 93%). The current NSW 48 -h time frame used to define a return visit in NSW captured half of all admitted returns (49.5%) and just over half (59.2%) of critical care admissions. Variables associated with an admission to critical care were age (OR 1.02, 95% CI 1.01, 1.03), initial presentation (index visit) made to a lower level ED (OR 3.76 95% CI 2.06, 6.86), Triage Category 2 (OR 3.67 95% CI 2.04, 6.60) and a cardiac diagnosis (OR 5.76, 95% CI 3.01, 11.01). This model had adequate discriminant ability with AUROC = 0.825. CONCLUSION A small number of return visits result in admission, especially to critical care. These patients are at risk of poor outcomes. As such, clinicians should have increased index of suspicion for patients who return that are older, present with cardiac problems, or have previously presented to a lower level ED. Revision of the current timeframe that defines a return visit ought to be considered by policy makers to improve the accuracy of this widely used key performance indicator.
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Affiliation(s)
- Claire L Hutchinson
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Australia; Emergency Department, Canterbury Hospital, Campsie, Sydney, Australia.
| | - Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Australia; Illawarra Shoalhaven Local Health District, NSW, Australia; Illawarra Health and Medical Research Institute, NSW, Australia
| | - Andrea McCloughen
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Australia
| | - Siyu Qian
- Centre for IT-enabled Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Australia
| | - Ping Yu
- Centre for IT-enabled Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, NSW, Australia
| | - Judith Fethney
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Australia
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Wray A, Goubert R, Gadepally R, Boysen-Osborn M, Wiechmann W, Toohey S. Utilization of Educational Videos to Improve Communication and Discharge Instructions. West J Emerg Med 2021; 22:644-647. [PMID: 34125040 PMCID: PMC8202987 DOI: 10.5811/westjem.2021.1.48968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 01/04/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction When discharging a patient from the emergency department (ED), it is crucial to make sure that they understand their disposition and aftercare instructions. However, numerous factors make it difficult to ensure that patients understand their next steps. Our objective was to determine whether patient understanding of ED discharge and aftercare instructions could be improved through instructional videos in addition to standard written discharge instructions. Methods This was a prospective pre- and post-intervention study conducted at a single-center, academic tertiary care ED. Patients presenting with the five selective chief complaints (closed head injury, vaginal bleeding, laceration care, splint care, and upper respiratory infection) were given questionnaires after their discharge instructions to test comprehension. Once video discharge instructions were implemented, patients received standard discharge instructions in addition to video discharge instructions and were given the same questionnaire. A total of 120 patients were enrolled in each group. Results There were significantly better survey scores after video discharge instructions (VDI) vs standard discharge instructions (SDI) for the closed head injury (27% SDI vs 46% VDI, P = 0.003); upper respiratory infection (28% SDI vs 64% VDI; P < 0.0001); and vaginal bleeding in early pregnancy groups (20% SDI vs 60% VDI, P < 0.0001). There were no significant differences in survey scores between the splint care (53% SDI vs 66% VDI; P = 0.08) and suture care groups (29% SDI vs 31% VDI; P = 0.40). Conclusion Video discharge instructions supplementing standard written instructions can help improve patient comprehension and information retention. This better understanding of aftercare instructions is essential to patient follow-up and has been shown to improve patient outcomes.
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Affiliation(s)
- Alisa Wray
- University of California Irvine, Department of Emergency Medicine, Irvine, California
| | - Ronald Goubert
- University of California Irvine, Department of Emergency Medicine, Irvine, California
| | - Rishi Gadepally
- University of California Irvine, Department of Emergency Medicine, Irvine, California
| | - Megan Boysen-Osborn
- University of California Irvine, Department of Emergency Medicine, Irvine, California
| | - Warren Wiechmann
- University of California Irvine, Department of Emergency Medicine, Irvine, California
| | - Shannon Toohey
- University of California Irvine, Department of Emergency Medicine, Irvine, California
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Augustine J, Thurston MM, Gates AW, Manigault KR. Comparing perceptions of student abilities in diabetes self-management education and support among students, faculty and patients. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:409-416. [PMID: 33715804 DOI: 10.1016/j.cptl.2020.11.001] [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: 12/11/2019] [Revised: 10/16/2020] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND PURPOSE Diabetes self-management education and support (DSMES) equips patients with diabetes with the knowledge needed for appropriate management. The purpose of this study was to compare perceptions of student confidence/aptitude held by students, pharmacy faculty preceptors, and patients regarding student teaching of a DSMES class. EDUCATIONAL ACTIVITY AND SETTING The study was a prospective assessment of fourth-year ambulatory care advanced pharmacy practice experience students. Students taught a single DSMES class and evaluated their confidence using a 14-item survey before and after the class. Patients who participated in the class and a pharmacy faculty observer completed the same instrument. Responses were compared using Friedman and Wilcoxon signed-rank tests, as appropriate. FINDINGS Twenty-six students completed the survey. Overall, students' self-perceived confidence scores significantly increased for all questions after teaching the DSMES class (P < .001 for all questions). Confidence scores among students and faculty preceptors were similar with no significant differences in perceived confidence. There were some significant differences found among student and patient scores, with patients assessing student's perceived self-confidence higher than the students on three items (P < .05). SUMMARY Student pharmacists' perceptions of their own confidence and abilities improved from before to after teaching a DSMES class. Student and faculty preceptor confidence scores were similar. There were few differences between student and patient confidence scores, with patients rating students highly on their perceived confidence in teaching a DSMES class. Patient feedback is important to consider when evaluating student confidence and abilities.
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Affiliation(s)
- Jill Augustine
- Mercer University College of Pharmacy Department of Pharmacy Practice, 3001 Mercer University Drive, Atlanta, GA 30341, United States.
| | - Maria Miller Thurston
- Mercer University College of Pharmacy Department of Pharmacy Practice, 3001 Mercer University Drive, Atlanta, GA 30341, United States.
| | - Adam W Gates
- Atlanta Cancer Care, NE Float, 3400-C Old Milton Parkway, Suite 400, Alpharetta, GA 30005, United States
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Wehler M, Kalch A, Bilandzic H, Händl T. [Health literacy and nonurgent emergency department visits]. Notf Rett Med 2021; 25:427-433. [PMID: 33786013 PMCID: PMC7993414 DOI: 10.1007/s10049-021-00859-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 11/29/2022]
Abstract
Hintergrund Die Anzahl an Patienten in Notaufnahmen steigt seit Jahren an. Im Besonderen wächst der Anteil an Patienten mit einem nichtdringlichen Behandlungsbedarf. Bislang ist unklar, ob dies in Deutschland auch auf eine eingeschränkte Gesundheitskompetenz zurückgeführt werden kann. Ziel der Arbeit Ziel der Studie war es, die Gesundheitskompetenz (GK) von Notfallpatienten mit nichtdringlichem Behandlungsbedarf zu erfassen, mit allgemeinen Bevölkerungsdaten zur GK zu vergleichen und Zusammenhänge mit der subjektiv empfundenen notfallmedizinischen Versorgung zu betrachten. Material und Methode Es wurde eine Querschnittsbefragung in der zentralen Notaufnahme und der angeschlossenen kassenärztlichen Bereitschaftspraxis (KVB-Praxis) des Universitätsklinikums Augsburg durchgeführt. Insgesamt wurden 448 Patienten mit nichtdringlichem Versorgungsbedarf befragt. Ergebnisse Es zeigt sich, dass die GK der Notfallpatienten schlechter ausfällt als die der deutschen Gesamtpopulation. Patienten mit niedriger GK nehmen eine höhere subjektive Behandlungsdringlichkeit wahr, kennen signifikant seltener alternative Anlaufstellen zur Behandlung und möchten nach hausärztlicher Versorgung häufiger in der Notaufnahme oder der KVB-Praxis eine zweite Meinung einholen. Diskussion Die Ergebnisse zeigen einen Handlungsbedarf für eine Verbesserung der Gesundheitskompetenz auf. Dabei sind insbesondere die aktuellen strukturellen Veränderungen der Notfallversorgung in Deutschland zu berücksichtigen.
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Affiliation(s)
- Markus Wehler
- Zentrale Notaufnahme und IV. Medizinische Klinik, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156 Augsburg, Deutschland
| | - Anja Kalch
- Institut für Medien, Wissen und Kommunikation, Universität Augsburg, Augsburg, Deutschland
| | - Helena Bilandzic
- Institut für Medien, Wissen und Kommunikation, Universität Augsburg, Augsburg, Deutschland
| | - Thomas Händl
- Zentrale Notaufnahme, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Deutschland
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Jafari A, Tavakoly Sany SB, Peyman N. The Status of Health Literacy in Students Aged 6 to 18 Old Years: A Systematic Review Study. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:448-458. [PMID: 34178792 PMCID: PMC8214623 DOI: 10.18502/ijph.v50i3.5584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Adolescents and children are a core target population for health literacy (HL) studies and practice. There is limited knowledge regarding the HL skills and abilities that help young people and children in making health decisions. This study aimed to evaluate the status of HL in ongoing school students. Methods Literature searching was performed using nine databases (Web of Science, PubMed, Scopus, Google Scholar, Iranmedex, Magiran, Scientific Information Database) without restriction in time until January 2019, and database searches were supplemented with reference hand searches and gray literature. Cross-sectional and experimental studies with focuses on validated measures of HL in ongoing students were included. Results This systematic review of identified 17 studies and 199714 samples specifically studied on ongoing school students aged 6-18 years. Students and their mothers have a moderate level of HL in four dimensions of menstrual health, physical activity, breast self-test, and iron deficiency anemia, and most of them have a high level of HL only in terms of nutrition. The relationship of HL with health outcomes, health promotion behaviors, self-efficacy, self-mutilating behaviors, and self-care abilities was statistically significant. HL status is related to parents' education level, socio-economic determinants (culture, family income, and environmental contextual factors), age groups, and media/digital communication channels. Conclusion This review identified seven main determinates that significantly affect HL status in the target group. This systematic review shows most of the ongoing school students had an inadequate level of HL skills. HL strategies have a potential impact on improving students' health behaviors and life quality.
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Affiliation(s)
- Alireza Jafari
- Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Seyedeh Belin Tavakoly Sany
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Health Education and Health Promotion, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nooshin Peyman
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Health Education and Health Promotion, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
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Alsallakh MA, Rodgers SE, Lyons RA, Sheikh A, Davies GA. Association of socioeconomic deprivation with asthma care, outcomes, and deaths in Wales: A 5-year national linked primary and secondary care cohort study. PLoS Med 2021; 18:e1003497. [PMID: 33577558 PMCID: PMC7880491 DOI: 10.1371/journal.pmed.1003497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 01/15/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Socioeconomic deprivation is known to be associated with worse outcomes in asthma, but there is a lack of population-based evidence of its impact across all stages of patient care. We investigated the association of socioeconomic deprivation with asthma-related care and outcomes across primary and secondary care and with asthma-related death in Wales. METHODS AND FINDINGS We constructed a national cohort, identified from 76% (2.4 million) of the Welsh population, of continuously treated asthma patients between 2013 and 2017 using anonymised, person-level, linked, routinely collected primary and secondary care data in the Secure Anonymised Information Linkage (SAIL) Databank. We investigated the association between asthma-related health service utilisation, prescribing, and deaths with the 2011 Welsh Index of Multiple Deprivation (WIMD) and its domains. We studied 106,926 patients (534,630 person-years), 56.3% were female, with mean age of 47.5 years (SD = 20.3). Compared to the least deprived patients, the most deprived patients had slightly fewer total asthma-related primary care consultations per patient (incidence rate ratio [IRR] = 0.98, 95% CI 0.97-0.99, p-value < 0.001), slightly fewer routine asthma reviews (IRR = 0.98, 0.97-0.99, p-value < 0.001), lower controller-to-total asthma medication ratios (AMRs; 0.50 versus 0.56, p-value < 0.001), more asthma-related accident and emergency (A&E) attendances (IRR = 1.27, 1.10-1.46, p-value = 0.001), more asthma emergency admissions (IRR = 1.56, 1.39-1.76, p-value < 0.001), longer asthma-related hospital stay (IRR = 1.64, 1.39-1.94, p-value < 0.001), and were at higher risk of asthma-related death (risk ratio of deaths with any mention of asthma 1.56, 1.18-2.07, p-value = 0.002). Study limitations include the deprivation index being area based and the potential for residual confounders and mediators. CONCLUSIONS In this study, we observed that the most deprived asthma patients in Wales had different prescribing patterns, more A&E attendances, more emergency hospital admissions, and substantially higher risk of death. Interventions specifically designed to improve treatment and outcomes for these disadvantaged groups are urgently needed.
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Affiliation(s)
- Mohammad A. Alsallakh
- Swansea University Medical School, Swansea, United Kingdom
- Health Data Research UK, Swansea and Edinburgh, United Kingdom
- Asthma UK Centre for Applied Research, Edinburgh, United Kingdom
| | - Sarah E. Rodgers
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Ronan A. Lyons
- Swansea University Medical School, Swansea, United Kingdom
- Health Data Research UK, Swansea and Edinburgh, United Kingdom
| | - Aziz Sheikh
- Health Data Research UK, Swansea and Edinburgh, United Kingdom
- Asthma UK Centre for Applied Research, Edinburgh, United Kingdom
- Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Gwyneth A. Davies
- Swansea University Medical School, Swansea, United Kingdom
- Asthma UK Centre for Applied Research, Edinburgh, United Kingdom
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McCrea Z, Power K, Kiersey R, White M, Breen A, Murphy S, Healy L, Kearney H, Dunleavy B, O'Donoghue S, Lambert V, Delanty N, Doherty C, Fitzsimons M. Coproducing health and well-being in partnership with patients, families, and healthcare providers: A qualitative study exploring the role of an epilepsy patient portal. Epilepsy Behav 2021; 115:107664. [PMID: 33334718 DOI: 10.1016/j.yebeh.2020.107664] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Coproduced epilepsy care sees people with epilepsy (PwE), their care-proxies, and healthcare providers (HCPs), working together as partners to build strong relationships, improve communication, trust, and share decision-making. Coproduction underpins good quality patient- and family-centered care (PFCC) that is responsive to individual patient needs, preferences, and values. By facilitating information sharing and exchange between partners, electronic patient portals (ePortal) can enable coproduction. This paper explores what HCPs, PwE, and their care-proxies value from their user experience of PiSCES, the Irish epilepsy ePortal. METHODS A purposeful sample of actors involved in the receipt and delivery of epilepsy care and services were recruited via adult epilepsy centers at St James's and Beaumont Hospitals in Dublin. Interactive codesign sessions, surveys, and focus groups were used to elicit perspectives from PwE, care-proxies, and HCPs to understand their perception of how PiSCES could enhance or inhibit the epilepsy care process. RESULTS Results illustrate that participants welcome the role PiSCES can play in: empowering PwE/care-proxies, strengthening confidence in the healthcare system; aiding memory; advancing health literacy, motivating PwE to understand their condition better; acting as a passport of care between different clinical settings; and creating a foundation for stronger coproduction partnerships. PiSCES was generally embraced; however, some HCPs expressed plausible concerns about how clinical implementation might impact their work practices. CONCLUSION "Nothing about me without me" is a core value of the PiSCES initiative, recognizing that people need to be included in the planning of their own treatment and care. Our data show that PwE, their care-proxies, and HCPs value PiSCES potential, particularly in bolstering healthcare partnerships that foster inclusion, confidence, and trust.
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Affiliation(s)
- Zita McCrea
- FutureNeuro SFI Research Centre, For Rare and Chronic Diseases, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kevin Power
- FutureNeuro SFI Research Centre, For Rare and Chronic Diseases, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rachel Kiersey
- FutureNeuro SFI Research Centre, For Rare and Chronic Diseases, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maire White
- FutureNeuro SFI Research Centre, For Rare and Chronic Diseases, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Annette Breen
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Sinead Murphy
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; Epilepsy Ireland, 249 Crumlin Rd, Crumlin, Dublin, Ireland
| | - Laura Healy
- Academic Unit of Neurology, St. James's Hospital, Dublin, Ireland
| | - Hugh Kearney
- FutureNeuro SFI Research Centre, For Rare and Chronic Diseases, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Brendan Dunleavy
- ERGO IT Solutions, 1st Floor, Block T, East Point Business Park, Dublin 3, Ireland
| | - Sean O'Donoghue
- ERGO IT Solutions, 1st Floor, Block T, East Point Business Park, Dublin 3, Ireland
| | - Veronica Lambert
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Norman Delanty
- FutureNeuro SFI Research Centre, For Rare and Chronic Diseases, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Neurology, Beaumont Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences (PBS), The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Colin Doherty
- FutureNeuro SFI Research Centre, For Rare and Chronic Diseases, Royal College of Surgeons in Ireland, Dublin, Ireland; Academic Unit of Neurology, St. James's Hospital, Dublin, Ireland
| | - Mary Fitzsimons
- FutureNeuro SFI Research Centre, For Rare and Chronic Diseases, Royal College of Surgeons in Ireland, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences (PBS), The Royal College of Surgeons in Ireland, Dublin, Ireland.
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Poureslami I, Tregobov N, Shum J, McMillan A, Akhtar A, Kassay S, Starnes K, Mahjoob M, FitzGerald JM. A conceptual model of functional health literacy to improve chronic airway disease outcomes. BMC Public Health 2021; 21:252. [PMID: 33516200 PMCID: PMC7847605 DOI: 10.1186/s12889-021-10313-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 01/21/2021] [Indexed: 11/19/2022] Open
Abstract
Background Current conceptual models of health literacy (HL) illustrate the link between HL and health outcomes. However, these models fail to recognize and integrate certain elements of disease management, health system factors, and socio-demographic factors into their framework. This article outlines the development of Chronic Airway Disease (CAD) Management and Health Literacy (CADMaHL) conceptual model that integrates the aforementioned elements and factors into a single framework. Methods Information obtained during the following stages informed the development of our model: (1) a systematic review of existing CAD HL measurement tools that apply core HL domains; (2) patient-oriented focus group sessions to understand HL barriers to CAD self-management practices; (3) key-informant interviews to obtain potential strategies to mitigate CAD management barriers, and validate disease self-management topics; (4) elicited the perspectives of Canadian respirologist’s on the ideal functional HL skills for asthma and COPD patients. Results Throughout the study process many stakeholders (i.e., patients, key-informants, and an international HL advisory panel) contributed to and reviewed the model. The process enabled us to organize the CADMaHL model into 6 primary modules, including: INPUT, consisting of four HL core components (access, understand, communicate, evaluate,) and numeracy skills; OUTPUT, including application of the obtained information; OUTCOME, covering patient empowerment in performing self-management practices by applying HL skills; ASSESSMENT, consisting of information about functionality and relevancy of CADMaHL; IMPACT, including mediators between HL and health outcomes; CROSSCUTTING FACTORS, consisting of diverse socio-demographics and health-system factors with applicability across the HL domains. Conclusions We developed the CADMaHL model, with input from key-stakeholders, which addresses a knowledge gap by integrating various disease management, health-system and socio-demographic factors absent from previous published frameworks. We anticipate that our model will serve as the backbone for the development of a comprehensive HL measurement tool, which may be utilized for future HL interventions for CAD patients. Trial registration NCT01474928- Date of registration: 11/26/2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10313-x.
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Affiliation(s)
- Iraj Poureslami
- University of British Columbia and VGH Divisions of Respiratory Medicine, Centre for Lung Health, Vancouver Coastal Health Research Institute, Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Noah Tregobov
- University of British Columbia and VGH Divisions of Respiratory Medicine, Centre for Lung Health, Vancouver Coastal Health Research Institute, Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.,Queen's University, 94 University Avenue, Kingston, ON, K7L 3N6, Canada
| | - Jessica Shum
- Respiratory Medicine Division, Department of Medicine, University of British Columbia, Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Austin McMillan
- Queen's University, 94 University Avenue, Kingston, ON, K7L 3N6, Canada
| | - Alizeh Akhtar
- School of Medicine, Brookfield Health Sciences Complex, University College Cork, College Road, T12 AK54, Cork, IE-M, Ireland
| | - Saron Kassay
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Kassandra Starnes
- Faculty of Law, University of Windsor, 401 Sunset Ave, Windsor, ON, N9B 3P4, Canada
| | - Maryam Mahjoob
- University of British Columbia and VGH Divisions of Respiratory Medicine, Centre for Lung Health, Vancouver Coastal Health Research Institute, Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - J Mark FitzGerald
- University of British Columbia and VGH Divisions of Respiratory Medicine, Centre for Lung Health, Vancouver Coastal Health Research Institute, Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
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Luo Q, Shi K, Hung P, Wang SY. Associations Between Health Literacy and End-of-Life Care Intensity Among Medicare Beneficiaries. Am J Hosp Palliat Care 2021; 38:626-633. [PMID: 33472379 DOI: 10.1177/1049909120988506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Despite well-documented disparities in end-of-life (EOL) care, little is known about whether patients with low health literacy (LHL) received aggressive EOL care. OBJECTIVE This study examined the association between health literacy (HL) and EOL care intensity among Medicare beneficiaries. METHOD We conducted a retrospective analysis of Medicare fee-for-service decedents who died in July-December, 2011. ZIP-code-level HL scores were estimated from the 2010-2011 Health Literacy Data Map, where a score of 225 or lower was defined as LHL. Aggressive EOL care measures included repeated hospitalizations within the last 30 days of life, no hospice enrollment within the last 6 months of life, in-hospital death, and any of above. Using hierarchical generalized linear models, we examined the association between HL and aggressive EOL care. RESULTS Of 649,556 decedents, the proportion of decedents who received any aggressive EOL care among those in LHL areas was 82.7%, compared to 72.7% in HHL areas. In multivariable analyses, decedents residing in LHL areas, compared to those in HHL areas, had 31% higher odds of aggressive EOL care (adjusted odds ratio [AOR] 1.31; 95% confidence interval [CI]:1.21-1.42), including higher odds of no hospice use (AOR 1.35; 95% CI: 1.27-1.44), repeated hospitalization (AOR 1.07; 95% CI: 1.01-1.14) and in-hospital death (AOR 1.21; 95% CI: 1.13-1.29). CONCLUSION Medicare beneficiaries who resided in LHL areas were likely to receive aggressive EOL care. Tailored efforts to improve HL and facilitate patient-provider communications in LHL areas could reduce EOL care intensity.
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Affiliation(s)
- Qingying Luo
- Department of Chronic Disease Epidemiology, 5755Yale University School of Public Health, New Haven, CT, USA
| | - Kewei Shi
- Department of Chronic Disease Epidemiology, 5755Yale University School of Public Health, New Haven, CT, USA
| | - Peiyin Hung
- Department of Health Services Policy and Management, Arnold School of Public Health, 5755University of South Carolina, SC, USA.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and 5755Yale University School of Medicine, New Haven, CT, USA
| | - Shi-Yi Wang
- Department of Chronic Disease Epidemiology, 5755Yale University School of Public Health, New Haven, CT, USA.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and 5755Yale University School of Medicine, New Haven, CT, USA
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Friis K, Aaby A, Lasgaard M, Pedersen MH, Osborne RH, Maindal HT. Low Health Literacy and Mortality in Individuals with Cardiovascular Disease, Chronic Obstructive Pulmonary Disease, Diabetes, and Mental Illness: A 6-Year Population-Based Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249399. [PMID: 33333909 PMCID: PMC7765354 DOI: 10.3390/ijerph17249399] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The objective of the study was to examine the impact of health literacy on mortality in the general population and among individuals with cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), diabetes, and mental illness. METHODS Data from a large Danish health survey (n = 29,473) from 2013 were linked with national mortality registry data to permit a 6-year follow-up. RESULTS Individuals reporting difficulties in understanding information about health, had higher risk of dying during follow-up (hazard rate (HR) 1.38 (95% CI 1.11-1.73)) compared with those without difficulties. Higher risk was also observed among people reporting CVD (HR 1.47 (95% CI 1.01-2.14)), diabetes (HR 1.91 (95% CI 1.13-3.22)) and mental illness (HR 2.18 (95% CI 1.25-3.81)), but not for individuals with COPD. Difficulties in actively engaging with healthcare providers was not associated with an increase in the risk of dying in the general population or in any of the four long-term condition groups. CONCLUSIONS Aspects of health literacy predict a higher risk of dying during a 6-year follow-up period. Our study serves as a reminder to healthcare organizations to consider the health literacy responsiveness of their services in relation to diverse health literacy challenges and needs.
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Affiliation(s)
- Karina Friis
- DEFACTUM, Central Denmark Region, 8200 Aarhus, Denmark; (M.L.); (M.H.P.)
- Correspondence: ; Tel.: +45-78414335
| | - Anna Aaby
- Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, 8000 Aarhus, Denmark; (A.A.); (H.T.M.)
| | - Mathias Lasgaard
- DEFACTUM, Central Denmark Region, 8200 Aarhus, Denmark; (M.L.); (M.H.P.)
| | | | - Richard H. Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne 3025, Australia;
| | - Helle Terkildsen Maindal
- Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, 8000 Aarhus, Denmark; (A.A.); (H.T.M.)
- Health Promotion, Steno Diabetes Centre Copenhagen, 2820 Gentofte, Denmark
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Nguyen DD, Marchese M, Ozambela M, Bhojani N, Ortega G, Trinh QD, Friedlander DF. Ambulatory-Based Bladder Outlet Procedures Offer Significant Cost Savings and Comparable 30-Day Outcomes Relative to Inpatient Procedures. J Endourol 2020; 34:1248-1254. [PMID: 32178528 PMCID: PMC7757614 DOI: 10.1089/end.2019.0684] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction and Objectives: Budgetary constraints and novel minimally invasive surgical approaches have resulted in surgical care being increasingly provided at ambulatory centers rather than traditional inpatient settings. Despite increasing use of ambulatory-based procedure for bladder outlet obstruction (BOO) procedures, little is known about the effect of care setting on perioperative outcomes and costs. We sought to compare 30-day readmissions rates and costs of BOO procedure performed in the ambulatory vs inpatient setting. Methods: Using Florida and New York all-payer data from the 2014 Healthcare Cost and Utilization Project State Databases, we identified patients who underwent transurethral resection, thermotherapy, or laser/photovaporization for BOO. Patient demographics, regional data, 30-day readmissions rates, and costs (from converted charges) associated with the index procedure and revisits were analyzed. Predictors of 30-day revisits were also identified by fitting a multivariate logistic regression model with facility-level clustering. Results: Of the 15,094 patients identified, 1444 (9.6%) had a 30-day revisit at a median cost of $4263.43. The 30-day readmission rate for inpatient cases was significantly higher than that of surgeries performed in the ambulatory setting (12.0% vs 8.1%, p < 0.001). Payer status (private vs Medicare: odds ratio [OR] = 0.77, 95% confidence interval [CI] = 0.62-0.95; p = 0.02) and index care setting (ambulatory vs inpatient: OR = 0.48, 95% CI = 0.40-0.57; p < 0.001) predicted 30-day revisits. Conclusions: We identified that index care setting and payer status are independent predictors of 30-day revisit after BOO procedure, with the inpatient setting and Medicare insurance associated with higher odds of revisit. Ambulatory procedures are significantly less costly than procedures performed in the inpatient setting, even after accounting for ambulatory procedures leading to an admission. There is an obvious cost benefit of offering BOO procedure in the ambulatory setting to the appropriate patient. In the context of value-based health care initiatives, our findings have important implications for policymakers seeking to reduce variation in nonclinical sources of perioperative costs and outcomes.
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Affiliation(s)
- David-Dan Nguyen
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Maya Marchese
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Manuel Ozambela
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Naeem Bhojani
- Division of Urology, University of Montreal Hospital Center, Université de Montréal, Montreal, Canada
| | - Gezzer Ortega
- Center for Surgery and Public Health, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - David F. Friedlander
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Abstract
Overcoming overuse in musculoskeletal health care requires an understanding of its drivers. In this, the third article in a series on "Overcoming Overuse" of musculoskeletal health care, we consider the drivers of overuse under 4 domains: (1) the culture of health care consumption, (2) patient factors and experiences, (3) clinician factors and experiences, and (4) practice environment. These domains are interrelated, interact, and influence the clinician-patient interaction. We map drivers to potential solutions to overcome overuse. J Orthop Sports Phys Ther 2020;50(12):657-660. doi:10.2519/jospt.2020.0111.
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Sheikh S, Booth-Norse A, Smotherman C, Kalynych C, Lukens-Bull K, Guerrido E, Henson M, Gautam S, Hendry P. Predicting Pain-Related 30-Day Emergency Department Return Visits in Middle-Aged and Older Adults. PAIN MEDICINE (MALDEN, MASS.) 2020; 21:2748-2756. [PMID: 32875332 PMCID: PMC8557807 DOI: 10.1093/pm/pnaa213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The objective of this study was to determine predictive factors for pain-related emergency department returns in middle-aged and older adults. Design, Setting, and Subjects. This was a subanalysis of patients > 55 years of age enrolled in a prospective observational study of adult patients presenting within 30 days of an index visit to a large, urban, academic center. METHODS Demographic and clinical data were collected and compared to determine significant differences between patients who returned for pain and those who did not. Multiple logistic regressions were used to determine significant predictive variables for return visits. RESULTS The majority of the 130 enrolled patients > 55 years of age returned for pain (57%), were African American (78%), were younger (55-64 years old, 67%), had a high emergency department acuity level (level 1 or 2) at their index visit (56%), had low health literacy (Rapid Estimate of Adult Literacy in Medicine [REALM] score, 62%), lived in an area of extreme deprivation (69%), and were admitted (61%) during their index visit. Age (odds ratio [OR] = 0.9, 95% CI = 0.8-0.9, P = 0.047), health literacy (REALM scores; OR = 3.1, 95% CI = 1.3-7.5, P = 0.011), and index visit pain scores (OR = 1.1, 95% CI = 1.0-1.2, P = 0.004) were predictive of emergency department returns for pain in middle-aged and older adults. CONCLUSIONS The likelihood of emergency department return visits for pain in middle-aged and older adults decreased with older age, increased with higher health literacy (REALM scores), and increased with increase in pain scores.
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Affiliation(s)
- Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Florida
| | - Ashley Booth-Norse
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Florida
| | - Carmen Smotherman
- Center for Health Equity and Quality Research, University of Florida College of Medicine, Jacksonville, Florida
| | - Colleen Kalynych
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Florida
| | - Katryne Lukens-Bull
- Center for Health Equity and Quality Research, University of Florida College of Medicine, Jacksonville, Florida
| | - Erika Guerrido
- Center for Health Equity and Quality Research, University of Florida College of Medicine, Jacksonville, Florida
| | - Morgan Henson
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Florida
| | - Shiva Gautam
- Department of Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Phyllis Hendry
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Florida
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Pollack CE, Du S, Blackford AL, Herring B. Experiment To Decrease Neighborhood Poverty Had Limited Effects On Emergency Department Use. Health Aff (Millwood) 2020; 38:1442-1450. [PMID: 31479355 DOI: 10.1377/hlthaff.2019.00452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Neighborhood environments are increasingly thought to affect emergency department (ED) use. However, because people decide where to live based on a range of factors, it can be challenging to identify the causal impact of living in higher-poverty neighborhoods on increased rates of ED visits. Our study leveraged the Moving to Opportunity for Fair Housing Demonstration Program, a social experiment beginning in 1994 that randomly assigned approximately 4,600 households that received federal housing assistance to different neighborhood conditions. We linked program participants in four states with an average of twelve years of administrative data on ED use (up to twenty-one years after randomization). Contrary to our expectations, we did not find a consistently significant connection between neighborhood poverty and overall ED use during this follow-up period. This result was observed for both adults and people who were children at the time of randomization, as well as for various classifications of ED visits. The findings can help direct future research that seeks to clarify the relationship between neighborhood environments and health care use.
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Affiliation(s)
- Craig E Pollack
- Craig E. Pollack ( ) is an associate professor in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Shawn Du
- Shawn Du was formerly a PhD student in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. He is now an associate at Analysis Group in New York City
| | - Amanda L Blackford
- Amanda L. Blackford is a principal biostatistician in the Division of Biostatistics and Bioinformatics, Department of Oncology, Johns Hopkins School of Medicine, in Baltimore
| | - Bradley Herring
- Bradley Herring is an associate professor in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
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McGuinness MJ, Bucher J, Karz J, Pardee C, Patti L, Ohman-Strickland P, McCoy JV. Feasibility of Health Literacy Tools for Older Patients in the Emergency Department. West J Emerg Med 2020; 21:1270-1274. [PMID: 32970585 PMCID: PMC7514378 DOI: 10.5811/westjem.2020.5.46594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 05/19/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction This study evaluates the feasibility of using a volunteer research associate (RA) to administer two separate health literacy assessment tools in the emergency department (ED), specifically in an older population of patients. The outcomes measured were administration time and interruptions. Methods Using a prospective, cross-sectional study with a convenience sample, adult patients over the age of 55 presenting between June–August 2018 to one urban, academic ED were evaluated by a volunteer RA using either the Newest Vital Sign (NVS) or the Short Assessment of Health Literacy (SAHL). All patients 55 years of age or older who consented to participate were included. We excluded from this study the following: patients with dementia or other disability involving reading, speech, or cognitive function, as noted in their medical record or by their attending physician; prisoners; and those subjectively deemed in extremis or too ill to participate by their attending physician. Results Health literacy was assessed in 202 patients using either the NVS or SAHL. Mean time of administration was 214.0 seconds for the NVS, and 206.8 for the SAHL. The maximum time of administration for the NVS was 563 seconds, compared to 607 seconds for the SAHL. We found that 95.2% of NVS and 93.9% of SAHL tests incurred no interruptions during administration. Conclusion No significant difference was found between the length of time needed to administer the NVS or SAHL to older patients in the ED. Both tools averaged an administration time of around three to four minutes, and neither incurred regular interruptions to its administration by a volunteer RA. Further study is needed to assess validity of these tools in an ED setting.
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Affiliation(s)
| | - Joshua Bucher
- Rutgers Robert Wood Johnson Medical School, Department of Emergency Medicine, New Brunswick, New Jersey
| | - James Karz
- Rutgers Robert Wood Johnson Medical School, Department of Emergency Medicine, New Brunswick, New Jersey
| | - Carla Pardee
- Rutgers Robert Wood Johnson Medical School, Department of Emergency Medicine, New Brunswick, New Jersey
| | - Laryssa Patti
- Rutgers Robert Wood Johnson Medical School, Department of Emergency Medicine, New Brunswick, New Jersey
| | | | - Jonathan V McCoy
- Rutgers Robert Wood Johnson Medical School, Department of Emergency Medicine, New Brunswick, New Jersey
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Health literacy among participants from neighbourhoods with different socio-economic statuses in the southern region of Hungary: a pilot study. BMC Public Health 2020; 20:1060. [PMID: 32799828 PMCID: PMC7429903 DOI: 10.1186/s12889-020-08959-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 01/24/2023] Open
Abstract
Background Health literacy (HL) has a deep impact on people’s decisions about their health and health care system. Measurement and improvement of HL level is essential to develop an appropriate health care system. The aim of the study was to (1) conduct a pilot study among the population of Baranya County in Hungary with different socio-economic statuses, (2) evaluate the HL level and (3) found the correlations between socio-economic data, emergency departments’ visits, medical history and HL. Methods In a cross-sectional study conducted in 2019 with 186 participants, socio-economic status, health status, HL level and knowledge about the triage system were measured. The questionnaire included questions on socio-economic status, previous chronic diseases, and satisfaction with the emergency care system as well as the standardised European Health Literacy Survey Questionnaire (HLS-EU-Q47). Descriptive statistical analysis (mean, SD, mode) and mathematical statistical analysis (ANOVA, chi2 test, Pearson Correlations, Two sample t-test) were applied. SPSS 24.0 statistical software was used to analyse the data. Relationships were considered significant at the p < 0.05 level. Results One hundred and eighty-six people were involved in the research, but 45 of them were excluded (N = 141). The participation rate was 75.8%. There were significant differences in HL levels by gender and educational level (p = 0.017), health education (p = 0.032) and presence of children in the household (p = 0.049). Educational level (p = 0.002) and type of settlement (p = 0.01) had strong impacts on economic status. We found that 46.1% of the participants had limited comprehensive HL (cHL) level. This proportion was slightly lower for the disease prevention sub-index (33.3%). The average cHL index score was 34.8 ± 8.7 points, the average health care sub-index score was 34.6 ± 9.7 points, the average disease prevention sub-index score was 35.8 ± 9.9 points, and the average health promotion sub-index score was 34.2 ± 9.4 points. 46.1% of the examined population in Hungary had limited HL level. Conclusions Socio-economic status has a strong influence on HL level. It is not enough to improve awareness but we need to improve knowledge and cooperation with the doctors and health care system.
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Kim MT, Kim KB, Ko J, Murry N, Xie B, Radhakrishnan K, Han HR. Health Literacy and Outcomes of a Community-Based Self-Help Intervention: A Case of Korean Americans With Type 2 Diabetes. Nurs Res 2020; 69:210-218. [PMID: 31972848 PMCID: PMC7266039 DOI: 10.1097/nnr.0000000000000409] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although scientific reports increasingly document the negative impact of inadequate health literacy on health-seeking behaviors, health literacy's effect on health outcomes in patients with diabetes is not entirely clear, owing to insufficient empirical studies, mixed findings, and insufficient longitudinal research. OBJECTIVE The aim of this study was to empirically examine underlying mechanisms of health literacy's role in diabetes management among a group of Korean Americans with Type 2 diabetes mellitus. METHODS Data from a randomized clinical trial of a health literacy-focused Type 2 diabetes self-management intervention conducted during 2012-2016 in the Korean American community were collected at baseline and at 3, 6, 9, and 12 months. A total of 250 Korean Americans with Type 2 diabetes participated (intervention, 120; control, 130). Participants were first-generation Korean American immigrants. Health literacy knowledge was measured with the original Rapid Estimate of Adult Literacy in Medicine and the diabetes mellitus-specific Rapid Estimate of Adult Literacy in Medicine. Functional health literacy was measured with the numeracy subscale of the Test of Functional Health Literacy in Adults and the Newest Vital Sign screening instrument, which also uses numeracy. Primary outcomes included glucose control and diabetes quality of life. Multivariate analyses included latent variable modeling. RESULTS A series of path analyses identified self-efficacy and self-care skills as significant mediators between health literacy and glucose control and quality of life. Education and acculturation were the most significant correlates of health literacy. DISCUSSION Despite inconsistent findings in the literature, this study indicates that health literacy may indirectly influence health outcomes through mediators such as self-care skills and self-efficacy. The study highlights the importance of health literacy, as well as underlying mechanisms with which health literacy influences processes and outcomes of diabetes self-management.
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Affiliation(s)
- Miyong T Kim
- Miyong T. Kim, PhD, RN, FAAN, is Professor, School of Nursing, The University of Texas at Austin. Kim B. Kim, PhD, is President, Korean Resource Center, Ellicott City, Maryland. Jisook Ko, PhD, RN, is Assistant Professor, The University of Texas Health Science Center at San Antonio. Nicole Murry, RN, PhD, is Assistant Professor, School of Nursing, The University of Texas at Austin. Bo Xie, PhD, is Professor, School of Nursing, The University of Texas at Austin. Kavita Radhakrishnan, RN, PhD, is Associate Professor, School of Nursing, The University of Texas at Austin. Hae-Ra Han, PhD, RN, FAAN, is Professor, Johns Hopkins University School of Nursing, Baltimore, Maryland
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Schiavone S, Attena F. Measuring Health Literacy in Southern Italy: A cross-sectional study. PLoS One 2020; 15:e0236963. [PMID: 32760150 PMCID: PMC7410250 DOI: 10.1371/journal.pone.0236963] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/16/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Health Literacy (HL) is an important determinant of individual health. Limited HL is an increasing problem affecting the general population. This study aims to assess the level of HL in patients attending outpatient medical facilities in general medicine located in Naples and Caserta and investigate the association of HL with health behaviours and health status. MATERIALS AND METHODS The study involved patients attending outpatient medical facilities in general medicine. The questionnaire had four sections-the sociodemographic information, the 16-items version of the European Health Literacy Survey questionnaire, the general self-efficacy scale (GSE) and the health status scale (EQ-VAS). Univariate and multivariate analyses were performed to investigate the sociodemographic determinants of HL. The Pearson correlation coefficients were determined to compare HL with health behaviours (GSE) and health status (EQ-VAS). RESULTS The study showed that 61.6% of 503 patients had a low level of HL. After the multivariate analysis, HL was found to be higher among patients with higher education level and general self-efficacy score ≥30. There were no differences in HL between the age groups and people with or without chronic diseases. HL was stronger correlated with GSE than with EQ-VAS (0.53 vs 0.27). CONCLUSION This is the first study on HL for Southern Italy. It showed a low level of HL. As the sample was not representative of the reference population, we cannot derive a corresponding conclusion for the general population of Southern Italy. Therefore, more data in Italy are needed to plan actions for improving HL.
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Affiliation(s)
- Sara Schiavone
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Francesco Attena
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
- * E-mail:
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Beyond Access Block: Understanding the Role of Health Literacy and Self-Efficacy in Low-Acuity Emergency Department Patients. Ochsner J 2020; 20:161-169. [PMID: 32612470 PMCID: PMC7310186 DOI: 10.31486/toj.19.0047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Health literacy, self-efficacy, and patient satisfaction are factors associated with healthcare utilization. The relationships among these factors and their combined impact on patients’ self-rated health have historically been studied in chronic disease populations. This study assessed low-acuity emergency department (ED) patients’ ratings of these factors, the relationships among these factors, and their effect on re-presentation rates to the ED. Methods: In this single-arm cohort survey, patients provided demographic data, completed health literacy and self-efficacy assessments prior to being seen by a physician, and completed a discharge perceptions questionnaire that included a global satisfaction question at the time of departure. Three months later, patients answered a telephone survey to measure post-ED visit health outcomes. Results: Health literacy (r=0.114, P=0.023) and self-efficacy (r=0.469, P<0.001) were both independently and positively associated with self-rated health. Neither factor was associated with patient satisfaction. Self-rated health was negatively associated with return ED visits (r=–0.137, P=0.011). Conclusion: Existing research shows that health literacy has a linear association with self-efficacy and self-rated health. The results of this study suggest that in the context of low-acuity ED patients, health literacy and self-efficacy affect patients’ understanding of their health status (self-rated health) but do not lead to better utilization of healthcare resources. Improvement of health literacy and self-efficacy, specifically to increase self-rated health, may provide a future avenue of intervention to reduce low-acuity ED patient re-presentation.
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Poureslami I, Shum J, Goldstein R, Gupta S, Aaron SD, Lavoie KL, Poirier C, Kassay S, Starnes K, Akhtar A, FitzGerald JM. Asthma and COPD patients' perceived link between health literacy core domains and self-management of their condition. PATIENT EDUCATION AND COUNSELING 2020; 103:1415-1421. [PMID: 32087989 DOI: 10.1016/j.pec.2020.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/23/2020] [Accepted: 02/07/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Health literacy (HL) is a person's ability to practically apply a wide range of cognitive and non-cognitive skills, to make health-related decisions. Currently, no tool applies all HL core domains to capture necessary data to measures HL in adult asthma and COPD patients. We endeavored to develop a comprehensive, function-based tool that adequately and accurately measures HL skills of this patient population. We explored the perspectives of patients related to each core HL domain, with an emphasis on self-management practices. METHODS Sixteen focus groups were conducted (n = 93; 40 asthma and 53 COPD) across Canada. Data was analyzed using NVivo12. RESULTS Thirteen subthemes were identified within five HL domains: (a) access: active access; passive access; lack of access; (b) understanding: how to improve understanding; (c) trustworthiness; relevancy and validity of information: pre- and post- application of information; (d) communication: barriers to proper communication; (e) application of information: making health decisions. CONCLUSIONS Participants provided valuable insight in terms of disease management topics and corresponding items to include in our HL tool. PRACTICE IMPLICATIONS Involvement of patients from initial stage allowed us to develop a tool that will serve as a first ever developed HL tool for asthma and COPD patient group.
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Affiliation(s)
- Iraj Poureslami
- Division of Respiratory Medicine, Department of Medicine, Institute for Heart and Lung Health, The University of British Columbia, Vancouver, BC, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Jessica Shum
- Division of Respiratory Medicine, Department of Medicine, Institute for Heart and Lung Health, The University of British Columbia, Vancouver, BC, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Roger Goldstein
- West Park's Respiratory Rehabilitation Service Toronto, West Park Hospital, University of Toronto, Toronto, ON, Canada
| | - Samir Gupta
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Shawn D Aaron
- Division of Respirology in Department of Medicine U-Ottawa, Ottawa, ON, Canada
| | - Kim L Lavoie
- Department of Psychology, University of Quebec at Montreal (UQAM), Montreal, QC, Canada
| | - Claude Poirier
- Centre Hospital, University of Montreal (CHUM), Montreal, QC, Canada
| | - Saron Kassay
- Division of Respiratory Medicine, Department of Medicine, Institute for Heart and Lung Health, The University of British Columbia, Vancouver, BC, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Kassie Starnes
- Division of Respiratory Medicine, Department of Medicine, Institute for Heart and Lung Health, The University of British Columbia, Vancouver, BC, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Alizeh Akhtar
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, BC, Canada
| | - J Mark FitzGerald
- Division of Respiratory Medicine, Department of Medicine, Institute for Heart and Lung Health, The University of British Columbia, Vancouver, BC, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, BC, Canada.
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Edward J. Effective Cost Conversations: Addressing Financial Toxicity and Cost-Related Health Literacy. Clin J Oncol Nurs 2020; 24:209-213. [PMID: 32196003 DOI: 10.1188/20.cjon.209-213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cancer survivors have greater risk of experiencing financial toxicity, or the undue financial burden and stress that patients face related to the costs of cancer care. Cost-related health literacy promotion should begin at the point of care with effective cost-of-care conversations that help to identify and manage patient financial needs. Nurses are uniquely positioned and often sought out as trusted sources of cost-of-care information and play a key role in engaging in effective cost conversations that help consumers to understand and manage their costs of care.
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Merchant RC, Marks SJ, Clark MA, Carey MP, Liu T. Limited Ability of Three Health Literacy Screening Items to Identify Adult English- and Spanish-Speaking Emergency Department Patients With Lower Health Literacy. Ann Emerg Med 2020; 75:691-703. [PMID: 32200999 DOI: 10.1016/j.annemergmed.2020.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 01/11/2020] [Accepted: 01/15/2020] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE Brief, easily administered, and valid health literacy assessment tools are needed to optimize health care delivery in the emergency medicine setting. Three health literacy screening items have been proposed to assess health literacy in outpatient settings. We investigated their ability to identify English- and Spanish-speaking adult emergency department (ED) patients with lower health literacy. METHODS Participants were Spanish- or English-speaking adult patients randomly selected from 4 geographically spread, US, urban, safety-net EDs. Participants completed the 3 health literacy screening items, as well as the Short Assessment of Health Literacy-Spanish and English (SAHL-S&E). Test performance characteristics, including receiver operating characteristics area under the curve, of the 3 health literacy screening items were estimated, as compared with the SAHL-S&E. RESULTS According to the SAHL-S&E, 36% of the 1,165 English speakers and 35% of the 1,605 Spanish speakers had lower health literacy. Areas under the curve for each health literacy screening item individually were: needing others to help read materials (English 0.59, 95% confidence interval [CI] 0.56 to 0.62; Spanish 0.58, 95% CI 0.56 to 0.61), problems learning because of difficulty reading (English 0.63, 95% CI 0.60 to 0.66; Spanish 0.59, 95% CI 0.56 to 0.62), and confidence with completing forms (English 0.62, 95% CI 0.59 to 0.65; Spanish 0.60, 95% CI 0.57 to 0.63). Areas under the curve for the 3 screening items combined were: English 0.66 (95% CI 0.63 to 0.70) and Spanish 0.62 (95% CI 0.59 to 0.64). CONCLUSION The 3 health literacy screening items performed poorly in identifying adult ED patients with lower health literacy. Higher-validity screening measures are needed to better serve the health care needs of this vulnerable population in the ED setting.
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Affiliation(s)
- Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Sarah J Marks
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Melissa A Clark
- Department of Health Services Policy and Practice, School of Public Health, Brown University, Providence, RI; Department of Obstetrics and Gynecology, Alpert Medical School, Brown University, Providence, RI
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI
| | - Tao Liu
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, RI
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