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Lima ACP, Maximiano-Barreto MA, Martins TCR, Luchesi BM. Factors associated with poor health literacy in older adults: A systematic review. Geriatr Nurs 2024; 55:242-254. [PMID: 38070263 DOI: 10.1016/j.gerinurse.2023.11.016] [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: 09/14/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 02/06/2024]
Abstract
OBJECTIVES To identify factors associated with poor health literacy in older adults. METHODS A systematic literature review was conducted, employing the descriptors "Aged" and "Health Literacy". PROSPERO - CRD 42022350140. RESULTS Out of 23,500 articles screened, 176 were selected. Several factors associated with poor health literacy in older adults were identified, such as sociodemographic (e.g., advanced age, low educational level, non-white population, and others), social (e.g., poor family/social support, loneliness, social isolation, few social activities, and others), economic (e.g., lower income and/or lower socioeconomic status) and health aspects (e.g., poor health, chronic conditions, mental health challenges, hospitalizations, frailty, physical inactivity, cognitive impairment, and others). CONCLUSIONS The factors associated with poor health literacy in older adults identified in this review could contribute to future research, support interventions to improve health literacy, and assist professionals in planning educational activities and public policies.
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Affiliation(s)
- Ana Caroline Pinto Lima
- Campus de Três Lagoas, Programa de Pós-Graduação em Enfermagem, Federal University of Mato Grosso do Sul, Três Lagoas, MS, Brazil
| | | | - Tatiana Carvalho Reis Martins
- Campus de Três Lagoas, Programa de Pós-Graduação em Enfermagem, Federal University of Mato Grosso do Sul, Três Lagoas, MS, Brazil; Instituto Integrado de Saúde, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Bruna Moretti Luchesi
- Campus de Três Lagoas, Programa de Pós-Graduação em Enfermagem, Federal University of Mato Grosso do Sul, Três Lagoas, MS, Brazil; Research Group on Mental Health, Cognition and Aging, Federal University of São Carlos, São Carlos, SP, Brazil.
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Rasmussen SP, Schougaard LMV, Hjøllund NH, Christiansen DH. Patient-reported outcome measures as determinants for the utilization of health care among outpatients with epilepsy: a prognostic cohort study. J Patient Rep Outcomes 2023; 7:103. [PMID: 37861867 PMCID: PMC10589170 DOI: 10.1186/s41687-023-00641-4] [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: 02/14/2023] [Accepted: 10/02/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Patient-reported outcome (PRO) measures can inform clinical decision making and planning of treatment in the health care system. The aim of this study was to examine whether patient-reported health domains influence the use of health care services in outpatients with epilepsy. METHODS This was a prognostic cohort study of 2,426 epilepsy outpatients referred to PRO-based follow-up at the Department of Neurology, Aarhus University Hospital, Denmark. Patients filled out a questionnaire covering health literacy areas, self-efficacy, well-being and general health. The main outcome was a record of contact to the epilepsy outpatient clinic, inpatient ward and/or emergency room within 1 year, retrieved from health register data. Associations were analysed by multivariable binomial logistic regression. RESULTS A total of 2,017 patients responded to the questionnaire and 1,961 were included in the final analyses. An outpatient contact was more likely among patients with very low health literacy ('social support'): odds ratio (OR) 1.5 (95% CI: 1.1-2.1), very low and low self-efficacy: OR 1.7 (95% CI: 1.2-2.3) and OR 1.4 (95% CI: 1.0-1.8), low and medium well-being: OR 2.2 (95% CI: 1.6-3.0) and OR 1.4 (95% CI: 1.1-1.9), and patients rating their general health as fair: OR 2.8 (95% CI: 1.7-4.6). Inpatient contact and emergency room contact were associated with the health domains of self-efficacy and general health. CONCLUSIONS PRO questionnaire data indicated that patients with low health literacy ("social support"), well-being, self-efficacy and self-rated general health had an increased use of health care services at 1 year.These results suggest that PRO measures may provide useful information in relation to the possibility of proactive efforts and prevention of disease-related issues and to help identify efficiency options regarding resource utilization.
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Affiliation(s)
- Stine Primdahl Rasmussen
- Department of Occupational Medicine, Danish Ramazzini Centre, Gødstrup Hospital, Hospitalsparken 15, Herning, 7400, Denmark
- AmbuFlex - Center for Patient-reported Outcomes, Central Denmark Region, Gødstrup Hospital, Møllegade 16, Herning, 7400, Denmark
| | - Liv Marit Valen Schougaard
- AmbuFlex - Center for Patient-reported Outcomes, Central Denmark Region, Gødstrup Hospital, Møllegade 16, Herning, 7400, Denmark
| | - Niels Henrik Hjøllund
- AmbuFlex - Center for Patient-reported Outcomes, Central Denmark Region, Gødstrup Hospital, Møllegade 16, Herning, 7400, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Blvd. 82, Aarhus, 8200, Denmark
| | - David Høyrup Christiansen
- Department of Occupational Medicine, Danish Ramazzini Centre, Gødstrup Hospital, Hospitalsparken 15, Herning, 7400, Denmark.
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Blvd. 82, Aarhus, 8200, Denmark.
- Elective Surgery Centre, Silkeborg Regional Hospital, Falkevej 1A, Silkeborg, 8600, Denmark.
- Centre for Research in Health and Nursing, Research, Regional Hospital Central Jutland, Heibergs Allé 2K, Viborg, 8800, Denmark.
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Shon EJ, Lee L. Effects of Vaccine Literacy, Health Beliefs, and Flu Vaccination on Perceived Physical Health Status among Under/Graduate Students. Vaccines (Basel) 2023; 11:vaccines11040765. [PMID: 37112677 PMCID: PMC10141033 DOI: 10.3390/vaccines11040765] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
Physicians highlight that receiving the flu vaccine is critical, especially during the COVID-19 pandemic period. Younger groups' flu vaccination coverage is very low, and this tendency is potentially related to a lower level of vaccine literacy and perceptions toward vaccination. This study investigated the relationship between flu vaccine literacy, health beliefs, and flu vaccinations (benefit, barrier, severity, and susceptibility) and their impact on perceived health status controlling for socioeconomic factors. It used the Health Belief Model andHealth Literacy Skills Framework with under/graduate students (N = 382) in Ohio, U.S. Path analyses were performed to examine the causal process using SPSS and Amos 23.0. Indicators of CFI, RMSEA, SRMR, and the chi-square/df of the path models were good-acceptable. Vaccine literacy directly impacted on health beliefs and vaccination. Susceptibility belief directly influenced perceived health status. The mediation effects of health beliefs (benefit, barrier) between vaccine literacy and vaccination were confirmed. The study highlights the need for healthcare providers and governments to work together to improve flu vaccine literacy and reduce negative perceptions toward vaccination among younger populations. Educational programs and official communication channels can be used to address concerns and provide accurate information about vaccines to increase flu vaccination rates and protect public health.
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Affiliation(s)
- En-Jung Shon
- Department of Social Welfare, Duksung Women's University, Seoul 01369, Republic of Korea
| | - Lena Lee
- Department of Teaching, Curriculum, and Educational Inquiry, Miami University, Oxford, OH 45056, USA
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Moon PK, Qian ZJ, Noel JE, Orloff LA, Seeley H, Hartman GE, Josephs S, Meister KD. Sociodemographic Disparities in the Diagnostic Management of Pediatric Thyroid Nodules. JAMA Otolaryngol Head Neck Surg 2022; 148:2797390. [PMID: 36227590 PMCID: PMC9562096 DOI: 10.1001/jamaoto.2022.3167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/23/2022] [Indexed: 11/14/2022]
Abstract
Importance Thyroid cancer is the most common pediatric endocrine malignant neoplasm. Disparities in the workup of thyroid nodules may be significantly associated with thyroid cancer outcomes. Objective To determine the association of sociodemographic factors with the odds of receiving a biopsy, timeliness of the procedure, and risk of nodule malignancy. Design, Setting, and Participants This was a retrospective cross-sectional study using insurance claims data from the Optum Clinformatics Data Mart database. The study cohort comprised pediatric patients diagnosed with single thyroid nodules between 2003 and 2020. Data analysis was performed from January 1, 2003, to June 30, 2020. Main Outcomes and Measures Multivariable logistic regression models were used to identify demographic variables associated with biopsy and nodule malignant neoplasm. A multivariable linear regression model was used to assess the time between thyroid nodule diagnosis and biopsy. Results Of 11 643 children (median [IQR] age at diagnosis or procedure, 15 [12-17] years; 8549 [73.2%] were female and 3126 [26.8%] were male) diagnosed with single thyroid nodules, 2117 (18.2%) received a biopsy. Among the patients who received a biopsy, 304 (14.4%) were found to have a malignant nodule. Greater parental education was associated with a shorter diagnosis-to-biopsy interval (mean difference, -7.24 days; 95% CI, -13.75 to -0.73). Older age at nodule diagnosis (odds ratio [OR], 1.11; 95% CI, 1.09-1.13) and female gender (OR, 1.25; 95% CI, 1.11-1.40) were associated with increased odds of receiving a biopsy, while Black/African American (OR, 0.80; 95% CI, 0.65-0.99) and Hispanic (OR, 0.84; 95% CI, 0.72-0.99) patients had lower odds of receiving a biopsy compared with White patients. Finally, female gender (OR, 1.08; 95% CI, 0.80-1.47) was not associated with lower odds of nodule malignant neoplasm. Conclusions and Relevance Findings of this cross-sectional study highlight disparities in the diagnostic management of pediatric thyroid nodules. These results call for future work to ensure equitable access to thyroid care for all children.
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Affiliation(s)
- Peter K. Moon
- School of Medicine, Stanford University, Stanford, California
| | - Z. Jason Qian
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Stanford, California
| | - Julia E. Noel
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Stanford, California
| | - Lisa A. Orloff
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Stanford, California
| | - Hilary Seeley
- Department of Pediatrics–Endocrinology and Diabetes, Stanford University, Stanford, California
| | - Gary E. Hartman
- Department of Surgery–Pediatric Surgery, Stanford University, Stanford, California
| | - Shellie Josephs
- Department of Radiology–Pediatric Radiology, Stanford University, Stanford, California
| | - Kara D. Meister
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Stanford, California
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Li M, Sonoda N, Koh C, Yasumoto R, Morimoto A. Meta-analysis of the association between health literacy and smoking. POPULATION MEDICINE 2022. [DOI: 10.18332/popmed/152572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Amoah PA, Musalia J, Abrefa Busia K. Health Behaviors and Health Literacy: Questing the Role of Weak Social Ties Among Older Persons in Rural and Urban Ghana. Front Public Health 2022; 10:777217. [PMID: 35296048 PMCID: PMC8919952 DOI: 10.3389/fpubh.2022.777217] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/24/2022] [Indexed: 11/15/2022] Open
Abstract
Background Older persons are one of the most vulnerable groups as regards low health literacy. However, little is known about the extent of limitations and multi-faceted nature of their health literacy, such as its characteristics and social and geographical dimensions. Additionally, most existing studies have predominantly treated health literacy as a risk factor of health and wellbeing of older persons as opposed to an outcome that must be pursued. Objectives This study investigated the moderating role of weak social ties (bridging social capital) in the relationship between health behaviors, such as smoking, alcohol intake, voluntary body check-up and physical exercise, and health literacy among older persons in rural and urban Ghana. Methods Data was drawn from a cross-sectional survey comprising 522 respondents across five administrative regions in Ghana. Ordinary Least Squares regression technique was used to analyse the data. Results Older persons in urban areas had higher health literacy [Mean/Standard deviation (SD) = 9.1/4.1 vs. 10.1/4.2] as well as higher bridging social capital (Mean/SD = 2.0/1.2 vs. 1.6/0.9) than their rural counterparts. Bridging social capital was negatively associated with the health literacy of urban residents (B = −0.997, p < 0.01). We found evidence that smoking (B = −0.787, p < 0.05) and undertaking physical activities (B = 0.812, p < 0.01) were associated with health literacy of older persons in rural areas. Having voluntary body check-ups (B = 0.155, p < 0.01) was associated with health literacy in urban areas. Bridging social capital negatively moderated the association of smoking with health literacy in rural areas (B = −5.032, p < 0.01), but it instead positively modified the relationship between alcohol intake and health literacy in urban areas (B = 0.185, p < 0.05). Conclusion For policymakers and practitioners aiming to promote older persons' health literacy as a public health asset at individual and community levels, an important starting point to achieving such goals is to understand the fundamental indicators (e.g., health behaviors) and the role that social and geographical factors play in shaping their health literacy.
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Affiliation(s)
- Padmore Adusei Amoah
- Department of Applied Psychology, School of Graduate Studies, Institute of Policy Studies, Lingnan University, Tuen Mun, Hong Kong SAR, China
| | - John Musalia
- Department of Sociology and Criminology, Western Kentucky University, Bowling Green, KY, United States
| | - Kwaku Abrefa Busia
- Department of Sociology and Social Policy, Lingnan University, Tuen Mun, Hong Kong SAR, China
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Sullivan-Baca E, Babicz MA, Choudhury TK, Miller BI. The Relationship between Health Literacy and Comfort with Teleneuropsychology in a Veteran Sample. Arch Clin Neuropsychol 2022; 37:292-301. [PMID: 34599332 PMCID: PMC8500040 DOI: 10.1093/arclin/acab079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Health literacy is a strong psychosocial determinant of health disparities and has been found to relate to various aspects of health-related technology use. With the increased implementation of neuropsychological services performed via telehealth during the coronavirus disease 2019 pandemic, the relationship between health literacy and comfort with teleneuropsychology warrants further investigation. METHOD The present study examined 77 Veterans participating in neuropsychological evaluations as a part of standard clinical care. The sample was diverse in terms of age ethnicity, and psychiatric and neurocognitive diagnoses. In addition to a fixed-flexible neuropsychological battery, the Brief Health Literacy Screening Tool (BRIEF) was administered to evaluate health literacy. Self-reported comfort with the teleneuropsychological evaluation was assessed using an informal 10-point scale, and qualitative comfort responses were also recorded. RESULTS Independent samples t-tests revealed older adults were more likely to participate in the evaluation via telephone than with VA Video Connect. Although health literacy was not related to telehealth modality, it was correlated with comfort with the teleneuropsychological evaluation (r = .34, p < .01), although it is notable that average comfort levels were high across modalities (M = 8.16, SD = 2.50). CONCLUSIONS Findings support the notion that teleneuropsychological services may feasibly be implemented with a diverse group of patients, although flexibility with modality may be necessary. Those performing these services should also be aware that patients with lower health literacy may feel less comfortable with teleneuropsychology as they seek to build rapport and optimize evaluation engagement.
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Affiliation(s)
- Erin Sullivan-Baca
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Michelle A Babicz
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Tabina K Choudhury
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Brian I Miller
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Degan TJ, Kelly PJ, Robinson LD, Deane FP, Baker AL. Health literacy and healthcare service utilisation in the 12-months prior to entry into residential alcohol and other drug treatment. Addict Behav 2022; 124:107111. [PMID: 34562775 DOI: 10.1016/j.addbeh.2021.107111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/21/2021] [Accepted: 09/01/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Health literacy refers to an individual's capacity to gather, process and understand health information, make appropriate health decisions, and engage adequately with healthcare services. Inadequate health literacy has been linked to an increase in acute healthcare utilisation. Research suggests that people living with substance use disorders also access acute healthcare services at high rates. The study investigates whether overall health literacy is related to this population's use of general healthcare services. METHODS A total of 568 participants were recruited from residential substance use treatment services located in NSW, Australia, as part of a randomised controlled trial; the Continuing Care Project. All participants completed a face-to face baseline questionnaire, which included the Health Literacy Questionnaire; a measure of multidimensional health literacy. Latent profile analysis was used to examine health literacy profiles, with multinominal regression analysis examining if healthcare service utilisation was related to these profiles. RESULTS Three profiles of health literacy were identified and termed lowest (n = 86, 15.1%), moderate (n = 338, 59.5%) and highest health literacy (n = 144, 25.4%). The sample accessed both primary and acute healthcare services at high rates. When controlling for demographic variables, there were no significant differences identified between health literacy profiles and service use. DISCUSSION/CONCLUSIONS This study was the first to use a multidimensional health literacy tool to examine health literacy and general healthcare service utilisation for people attending residential substance use disorder treatment. This population access high levels of healthcare services, however the role that health literacy may play in helping reduce acute healthcare use requires further investigation.
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Affiliation(s)
- Tayla J Degan
- School of Psychology, Faculty of Social Sciences, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong
| | - Peter J Kelly
- School of Psychology, Faculty of Social Sciences, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong
| | - Laura D Robinson
- School of Psychology, Faculty of Social Sciences, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong
| | - Frank P Deane
- School of Psychology, Faculty of Social Sciences, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong
| | - Amanda L Baker
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Australia
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The association of self-efficacy and health literacy to chemotherapy self-management behaviors and health service utilization. Support Care Cancer 2022; 30:603-613. [PMID: 34347182 DOI: 10.1007/s00520-021-06466-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 07/25/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Increasing demands on Canada's healthcare system require patients to take on more active roles in their health. Effective self-management has been linked to improved health outcomes; and there is evidence that effective behaviors, and subsequent healthcare utilization, are linked to self-efficacy and health literacy; however, this link has had minimal testing in the cancer context. Our aim is to examine the association between self-efficacy, health literacy, chemotherapy self-management behaviors, and health service utilization. DESIGN AND METHODS A cross-sectional survey that included validated measures of self-efficacy, health literacy, chemotherapy self-management, and health service utilization was completed by participants (N = 213). Multivariable modeling using hierarchical linear regression was used to examine the association between variables. RESULTS Self-efficacy contributed significantly to explaining variation in chemotherapy self-management score. Health literacy was not significantly associated with any of the dependent variables. CONCLUSION Participants with higher self-efficacy had higher chemotherapy self-management scores compared to participants with low self-efficacy. Contrary to evidence in the chronic disease self-management literature, this study demonstrated that health literacy was not associated with chemotherapy self-management behavior nor was it associated with self-efficacy. Building patient self-efficacy in the context of chemotherapy self-management could be particularly helpful both in the cancer center and in the domain of oral chemotherapy management at home where patients are required to take on significant responsibility for self-management.
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Akhtar SS, Heydon S, Norris P. What do Pakistani women know about New Zealand’s healthcare system? J Prim Health Care 2022; 14:214-220. [DOI: 10.1071/hc22036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/06/2022] [Indexed: 11/23/2022] Open
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The Role of Health Literacy in Health Behavior, Health Service Use, Health Outcomes, and Empowerment in Pediatric Patients with Chronic Disease: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312464. [PMID: 34886185 PMCID: PMC8656602 DOI: 10.3390/ijerph182312464] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022]
Abstract
About 8% of all children and adolescents worldwide are affected by chronic diseases. Managing chronic conditions requires pediatric patients to be health literate. The purpose of this review is to examine the existing evidence on the links between health literacy and its outcomes proposed by the model by Sørensen et al. in chronically ill pediatric patients. Four electronic databases (PubMed, Scopus, CINAHL, PsycINFO) were searched to identify pertinent articles published up to November 2021. The search was conducted independently by two researchers and restricted to observational studies. Of 11,137 initial results, 11 articles met eligibility criteria. Overall, 6 studies identified a significant association between health literacy and one of the considered outcomes. Regarding health behavior, none of the studies on adherence found significant associations with health literacy. The results in terms of health service use were inconclusive. Regarding health outcomes, health literacy did not affect most physiological parameters, but it significantly improved health-related quality of life. Overall, evidence remains inconclusive but suggests that health literacy is associated with self-efficacy, health-related quality of life, and health service use in pediatric patients. Further research should be undertaken to strengthen the evidence.
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Schäfer I, Menzel A, Oltrogge JH, Slagman A, Möckel M, Lühmann D, Scherer M. Is subjectively perceived treatment urgency of patients in emergency departments associated with self-reported health literacy and the willingness to use the GP as coordinator of treatment? Results from the multicentre, cross-sectional, observational study PiNo Bund. BMJ Open 2021; 11:e053110. [PMID: 34819288 PMCID: PMC8614139 DOI: 10.1136/bmjopen-2021-053110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Aim of this study was to analyse if subjectively perceived treatment urgency of patients in emergency departments is associated with self-reported health literacy and the willingness to use the general practitioner (GP) as coordinator of treatment. DESIGN A multicentre, cross-sectional, observational study. SETTING Emergency departments in five hospitals. Each hospital was visited 14 times representing two 8-hour shifts on each day of the week. Calendar dates were randomly assigned. PARTICIPANTS All patients of legal age registered at the emergency department or hospital reception desk. Exclusion criteria included immediate or very urgent need of treatment, high level of symptom burden and severe functional impairments in terms of hearing, vision and speech. We conducted standardised personal interviews. Additionally, clinical data were extracted from patient records. PRIMARY AND SECONDARY OUTCOME MEASURES Our target variable was subjectively perceived treatment urgency. Predictor variables included age, sex, education, health-related quality of life (EuroQol Five-Dimension Scale, value set UK), anxiety and depression (Hospital Anxiety and Depression Scale), somatic symptoms (Patient Health Questionnaire, 15 items version), self-reported health literacy (European Health Literacy Questionnaire, 16 questions version) and the commitment to the GP (Fragebogen zur Intensität der Hausarztbindung, 'F-HaBi'). Data were analysed by multilevel, multivariable linear regression adjusted for random effects at the hospital level. RESULTS Our sample comprised 276 patients with a mean age of 50.1 years and 51.8% women. A low treatment urgency (defined as 0-5 points on a Numerical Rating Scale) was reported by 111 patients (40.2%). In the final model, lower subjective treatment urgency was associated with male sex (β=0.84; 95% CI 0.11/1.57, p=0.024), higher health-related quality of life (-2.27 to -3.39/-1.15, p<0.001), lower somatic symptoms score (0.09, 0.004/0.17, p=0.040), higher anxiety score (-0.13 to -0.24/-0.01, p=0.027) and lower commitment to the GP (0.08, 0.01/0.14, p=0.029). CONCLUSIONS A lower level of subjectively perceived treatment urgency was predicted by a lower willingness to use the GP as coordinator of treatment. Self-reported health literacy did not predict the patients' urgency rating.
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Affiliation(s)
- Ingmar Schäfer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Agata Menzel
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Hendrik Oltrogge
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Slagman
- Department of Emergency and Acute Medicine, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Martin Möckel
- Department of Emergency and Acute Medicine, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Dagmar Lühmann
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Bouclaous C, Haddad I, Alrazim A, Kolanjian H, El Safadi A. Health literacy levels and correlates among refugees in Mount Lebanon. Public Health 2021; 199:25-31. [PMID: 34534886 DOI: 10.1016/j.puhe.2021.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/04/2021] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The study aimed to assess the levels and correlates of health literacy among refugees. STUDY DESIGN This is a cross-sectional study design. METHODS Health literacy was assessed through face-to-face interviews in eight primary healthcare centers (PHCs) in Mount Lebanon. The questionnaire consisted of the Arabic Functional Health literacy scale, the short version of the European Health Literacy Survey (HLS-EU-Q16), socio-economic questions (sex, age, nationality, marital status, educational level, and ability to pay for medical fees at PHCs), and health-related questions (self-perceived health, long-term illness, recent visit to health care, and freedom to make health decisions). Statistical analyses were performed to evaluate the association between functional health literacy (FHL), comprehensive health literacy (CHL), and potential explanatory variables. RESULTS Of 263 participants (61.6% females), mean age 38.49 ± 12.80 years, 52.1% had inadequate FHL and 35.7% had inadequate CHL. The likelihood of having inadequate CHL was higher in refugees who were ever married (odds ratio [OR] = 2.794; 95% confidence interval [CI]: 1.187-6.576) or had average ability to pay for medical expenses at PHC (OR = 4.562; 95% CI: 1.554-13.393). The odds of having inadequate FHL was lower in refugees with some level of education (OR = 0.211; 95% CI: 0.077-0.580). Furthermore, their perceived lack of freedom to make personal health decisions was associated with inadequate levels of CHL (OR = 5.195; 95% CI: 2.693-10.022) and FHL (OR = 4.676; 95% CI: 2.610-8.376). CONCLUSIONS Health messages and delivery should be tailored to refugee health literacy levels. Initiatives should seek to improve refugee interaction with the health system, promote uptake of available health services and facilitate health-related decision-making in daily life.
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Affiliation(s)
- C Bouclaous
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon.
| | - I Haddad
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - A Alrazim
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - H Kolanjian
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - A El Safadi
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
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Muslu L, Sarvan S, Oncel S, Ugur E. Determination of Health Literacy in Different Generations. THE JOURNAL OF SCHOOL HEALTH 2021; 91:617-624. [PMID: 34169537 DOI: 10.1111/josh.13052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 02/27/2020] [Accepted: 06/03/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND The development of health literacy (HL) is critical in reducing lifestyle-related diseases. The purpose of this study was to determine levels of HL and related variables among members of Generations X and Z. METHODS This study was a descriptive survey conducted in the city of Antalya, Turkey. Participants were 350 Generation Z students and 150 Generation X parents. We created a personal data form for both students and parents, and used the Secondary Education HL Scale and Adult HL Scale for data collection. RESULTS The average HL score of Generation Z was 20.98 ± 6.19 and that of Generation X 17.38 ± 3.54. The HL levels of 75% of the Generation Z were low to marginal and those of 33.1% of the Generation X were below average. CONCLUSIONS More than half of the Generation Z students and about one-third of Generation X parents were found to have low HL. Health professionals and nurses can give direction to the different generations to improve overall HL.
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Affiliation(s)
- Leyla Muslu
- Assistant Professor, , PhD, Faculty of Nursing, Public Health Nursing, Akdeniz University, Campus, Dumlupınar Boulevard, Antalya, Konyaaltı, 07058, Turkey
| | - Sureyya Sarvan
- Lecturer, , PhD, Faculty of Nursing, Pediatric Nursing, Akdeniz University, Campus, Dumlupınar Boulevard, Antalya, Konyaalti, 07058, Turkey
| | - Selma Oncel
- Professor, , PhD, Faculty of Nursing, Public Health Nursing, Akdeniz University, Campus, Dumlupınar Boulevard, Antalya, Konyaaltı, 07058, Turkey
| | - Emine Ugur
- Psychological Counsellor, Guidance Teacher, , Turk Telekom Anatolian High School Muratpaşa, Antalya, Turkey
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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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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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Shatenko S, Harder S, Gair J. Why you should Mini-Med School: Mini-Med School as an intervention to increase health literacy. CANADIAN MEDICAL EDUCATION JOURNAL 2020; 11:e72-e78. [PMID: 33349756 PMCID: PMC7749679 DOI: 10.36834/cmej.67817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Health literacy is an increasingly important topic in healthcare given that low health literacy is widely prevalent and linked to poorer health outcomes and higher healthcare costs. We sought to determine if a Mini-Med School delivered by medical students could prove to be an effective intervention to improve health literacy in the elderly. METHODS This study took place in the context of the University of British Columbia Medical Doctorate Undergraduate Program's Flexible and Enhanced Learning course. It aimed to evaluate the effectiveness of a Mini-Med School lecture series as an intervention to increase health literacy in 24 volunteer participants from the University of Victoria Retirees Association. This was a cross sectional study comparing health literacy pre- and post-intervention using the validated Health Literacy Questionnaire. RESULTS There was a statistically significant improvement in seven of nine scales of health literacy when participants repeated the Health Literacy Questionnaire six weeks post-intervention as well as positive outcomes from both a student learning and community outreach perspective. DISCUSSION This study demonstrates that a Mini-Med School program is an effective way to increase health literacy; adds to the minimal research surrounding Mini-Med Schools; and should further encourage Canadian medical schools to use Mini-Medical Schools as a method of engagement and advocacy with their communities.
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Affiliation(s)
- Sergiy Shatenko
- Island Medical Program, University of Victoria, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Samuel Harder
- Island Medical Program, University of Victoria, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Jane Gair
- Island Medical Program, University of Victoria, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, British Columbia, Canada
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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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Cosic F, Porter T, Norsworthy C, Price R, Bedi H. Comparison of health literacy in privately insured and public hospital orthopaedic patients. AUST HEALTH REV 2020; 43:399-403. [PMID: 29754593 DOI: 10.1071/ah17209] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/25/2018] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to quantify and compare patient health literacy between privately insured and public orthopaedic patients. Methods As part of the present cross-sectional study, elective postoperative orthopaedic patients across two sites were recruited and asked to complete a questionnaire at the first postoperative out-patient review. Patients were divided into three groups: (1) a public group (Public); (2) a private group (Private-pre); and (3) a private group that completed the questionnaire immediately after the out-patient review (Private-post). The questionnaire consisted of six questions regarding surgical management, expected recovery time and postoperative instructions. Patients were further asked to grade their satisfaction regarding information received throughout their management. Results In all, 150 patients completed the questionnaire, 50 in each of the three groups. Patients in the Public, Private-pre and Private-post groups answered a mean 2.74, 3.24 and 4.70 of 6 questions correctly respectively. The Private-pre group was 1.46-fold more likely to demonstrate correct health literacy than the Public group, whereas the Private-post group was 2.44-fold more likely to demonstrate improved health literacy than the Private-pre group. Patient satisfaction with information received was not associated with health literacy. Conclusion Limited health literacy in orthopaedic patients continues to be an area of concern. Both private and public orthopaedic patients demonstrated poor health literacy, but private patients demonstrated significant improvement after the out-patient review. What is known about the topic? Limited health literacy is a growing public health issue worldwide, with previous literature demonstrating a prevalence of low health literacy of 26% and marginal health literacy of 20% among all patient populations. Of concern, limited health literacy has been shown to result in a range of adverse health outcomes, including increased mortality and chronic disease morbidity. It has also been associated with an increased rate of hospitalisation and use of healthcare resources. Previous work in the orthopaedic trauma setting has found poor levels of health literacy and poor understanding of diagnosis, management and prognosis in the Australian public health system. Promisingly, it has been shown that simple, targeted interventions can improve patient health literacy. What does this paper add? This study further highlights that health literacy exhibited by orthopaedic patients is poor, particularly among patients in the public healthcare system. The present study is the first to have demonstrated that health literacy is poor among patients in both the public and private healthcare systems, despite these patients having distinctly different demographics. Promisingly, the present study shows that, unlike public orthopaedic out-patient review, private orthopaedic out-patient review appears to be effective in increasing patient health literacy regarding their orthopaedic condition and its management. What are the implications for practitioners? Health literacy is essential for patients to effectively communicate with doctors and achieve good health outcomes. Healthcare professionals need to be aware that a large proportion of patients have poor health literacy and difficulty understanding health-related information, particularly pertaining to that surrounding diagnosis, management and prognosis. This study highlights the need for healthcare professionals to ensure that they communicate with patients at an appropriate level to ensure patient understanding during the pre-, peri- and postoperative stages of management. Further, healthcare professionals should be aware that there is potential to improve patient health literacy at routine out-patient review, provided that this opportunity is used as an educational resource.
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Affiliation(s)
- Filip Cosic
- School of Medicine Monash University, Wellington Rd, Clayton, Vic. 3800, Australia
| | - Tabitha Porter
- OrthoSport Victoria, The Epworth, 89 Bridge Road, Richmond, Vic. 3121, Australia. ;
| | - Cameron Norsworthy
- OrthoSport Victoria, The Epworth, 89 Bridge Road, Richmond, Vic. 3121, Australia. ;
| | - Rohan Price
- OrthoSport Victoria, The Epworth, 89 Bridge Road, Richmond, Vic. 3121, Australia. ;
| | - Harvinder Bedi
- OrthoSport Victoria, The Epworth, 89 Bridge Road, Richmond, Vic. 3121, Australia. ;
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Slesinger NC, Yost KJ, Choi SW, Hahn EA. Validation of a Short Form for Health Literacy Assessment Using Talking Touchscreen Technology. Health Lit Res Pract 2020; 4:e200-e207. [PMID: 33034662 PMCID: PMC7544526 DOI: 10.3928/24748307-20200909-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/04/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Health literacy is an area of growing research and clinical interest, necessitating short, accurate measures of this complex construct. Health Literacy Assessment Using Talking Touchscreen Technology (Health LiTT) measures prose, document, and quantitative literacy by self-administration on a touchscreen computer. OBJECTIVE The objective of this study was to assess the validity of a short form of Health LiTT and to identify a meaningful cutoff score for adequate health literacy. METHODS A subsample of 137 participants from the Literacy and Cognitive Function among Older Adults study completed a 10-item Health LiTT short form and three interviewer-administered health literacy measures: Test of Functional Health Literacy in Adults (TOFHLA), Rapid Estimate of Adult Literacy in Medicine (REALM), and Newest Vital Sign (NVS). Convergent validity was assessed by correlating scores for all measures, and known-groups validity was assessed by comparing mean Health LITT scores across TOFHLA levels (inadequate, marginal, adequate). Internal consistency reliability was estimated with Cronbach's alpha. A cutoff score for adequate health literacy was established using the TOFHLA cutoff for adequate versus inadequate/marginal health literacy. KEY RESULTS Spearman correlations between Health LiTT scores and total TOFHLA, REALM, and NVS scores were 0.65, 0.69, and 0.56, respectively (all p < .001). Mean Health LiTT scores were significantly and meaningfully different across inadequate (40.4), marginal (50.1), and adequate (57.1) TOFHLA categories (F = 60.6; p < .001). Cronbach's alpha for the Health LiTT short form was .73. A cutoff score of 55 on Health LiTT showed acceptable sensitivity and specificity to identify adequate health literacy. CONCLUSIONS This 10-item Health LiTT short form demonstrated excellent convergent and known-groups validity and acceptable internal consistency reliability in older adults. The established cutoff also showed excellent sensitivity and specificity. Validation of other custom Health LiTT short forms with varying items from the bank and computer adaptive test-generated Health LiTT scores is ongoing. [HLRP: Health Literacy Research and Practice. 2020;4(4):e200-e207.] PLAIN LANGUAGE SUMMARY: This article provides evidence of the need for and psychometric properties of a valid and reliable short form of the flexible, technologically advanced Health Literacy Assessment Using Talking Touchscreen Technology measure, as well as a cutoff score to note adequate versus marginal/inadequate health literacy.
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Affiliation(s)
- Noël C. Slesinger
- Address correspondence to Noël C. Slesinger, MS, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 2700, Chicago, IL 60611;
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Matchanova A, Babicz M, Medina LD, Fazeli PL, Vance DE, Woods SP. Latent structure of health literacy and its association with health-related management and decision-making in HIV. Psychol Health 2020; 36:985-1002. [PMID: 32897101 DOI: 10.1080/08870446.2020.1817453] [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: 10/23/2022]
Abstract
OBJECTIVE Determine the latent structure of health literacy in persons living with HIV (PLWH) and its association with health management and decision-making. Method: Participants included 220 PLWH and 123 seronegative participants from Southern California and Alabama who completed a battery of well-validated health literacy measures, along with assessments of health management self-efficacy, health-related decision-making, depression, and basic clinical laboratory measures. Results: Exploratory factor analysis in HIV - participants showed that the shared variance between a battery of health literacy measures, including health word reading, verbal comprehension, numeracy, and self-reported problems was best explained by a single factor. Similarly, a confirmatory factor analysis in PLWH also supported a single factor structure, but for a re-specified four-test solution based on the core performance-based measures of health literacy. In analyses adjusting for demographics, PLWH demonstrated significantly lower health literacy composite scores as compared to their HIV - counterparts. Among PLWH, lower health literacy was independently associated with lower self-efficacy for health management and poorer health-related decision-making. Conclusions: Findings suggest that numeracy, word recognition, and verbal comprehension and reasoning comprise a unitary construct of health literacy that is lower in PLWH as compared to seronegatives and is independently associated with important downstream aspects of health management and decision-making.
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Affiliation(s)
| | - Michelle Babicz
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Luis D Medina
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Steven Paul Woods
- Department of Psychology, University of Houston, Houston, Texas, USA
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Relation between Health Literacy and Cancer Information Overload in People Applying To Primary Healthcare. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2020. [DOI: 10.21673/anadoluklin.760739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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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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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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Gaffari-fam S, Babazadeh T, Oliaei S, Behboodi L, Daemi A. Adherence to a Health Literacy and Healthy Lifestyle with Improved Blood Pressure Control in Iran. Patient Prefer Adherence 2020; 14:499-506. [PMID: 32184576 PMCID: PMC7061438 DOI: 10.2147/ppa.s244820] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 02/27/2020] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION AND AIM High blood pressure is the leading and most important modifiable risk factor for cardiovascular disease. Health literacy and lifestyle are two paramount key factors behind better control of hypertension. This study was conducted to examine the current situation of health literacy and health-promoting lifestyle and its association with blood pressure control among people affected by hypertension in the population over age 30 of Northwest Iran. PATIENTS AND METHODS This was a cross-sectional study conducted in October and December 2018 on the over 30-year-old population among subjects suffering from hypertension (n= 210). A self-reported questionnaire was used for assessing health literacy dimensions and lifestyle. RESULTS In hierarchical linear analysis, the HL explained 33.9% of the variance in healthy lifestyle. Among HL dimensions, the ability to access health information and decision-making were significantly associated with healthy lifestyle. The health literacy dimensions contributed to an additional significant increase in 4.7% of the variance explained in hypertension, furthermore, the health-promoting lifestyle items were explained an additional 14.8% of the hypertension variance. In total, lifestyle and health literacy dimensions were able to explain 21.7% of the variance in hypertension. CONCLUSION Our study encourages efforts to monitor health literacy in people with hypertension and investigate associations with involvement with health-promoting lifestyle.
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Affiliation(s)
- Saber Gaffari-fam
- School of Nursing of Miandoab City, Urmia University of Medical Sciences, Urmia, Iran
| | - Towhid Babazadeh
- Department of Public Health, Sarab Faculty of Medical Sciences, Sarab, Iran
- Correspondence: Towhid Babazadeh Department of Public Health, Sarab Faculty of Medical Sciences, Sarab, IranTel +98 41 4322 4586Fax +984143237412 Email
| | - Shahram Oliaei
- Center of Submarine and Hyperbaric Medicine, Health Deputy of the Iranian Navy, Tehran, Iran
| | - Leila Behboodi
- Department of Health Education and Promotion, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amin Daemi
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
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Tayhan A, Özmen D. Erkeklerin prostat kanseri taraması konusundaki bilgi düzeyleri ve sağlık okuryazarlığı arasındaki ilişki. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.560673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Nilsen ML, Moskovitz J, Lyu L, Harrison C, Randazza E, Peddada SD, Johnson JT. Health literacy: Impact on quality of life in head and neck cancer survivors. Laryngoscope 2019; 130:2354-2359. [PMID: 31800111 DOI: 10.1002/lary.28360] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 07/03/2019] [Accepted: 09/23/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Although inadequate health literacy has been shown to impact health outcomes in other cancers, little is known about its impact in head and neck cancer (HNC). This study aimed to determine the prevalence and predictors of inadequate health literacy and evaluate the association between health literacy and quality of life (QOL) in HNC survivors. METHODS We conducted a retrospective analysis of HNC survivors evaluated in a multidisciplinary HNC survivorship clinic. Survivors had to be ≥1-year postcompletion of treatment to be included in the analysis. Health literacy was assessed via self-report with the Brief Health Literacy Screen (score <10 indicating inadequate health literacy), and QOL was measured using the University of Washington QOL questionnaire. Linear regression with robust standard errors was utilized to evaluate the association between health literacy and QOL. RESULTS Of the 218 survivors evaluated, 13.8% (n = 30) demonstrated inadequate health literacy. After adjusting for age, marital status, site, stage, treatment modality, and years since treatment completion, social-emotional QOL scores for survivors with adequate health literacy were estimated to be 10.67 points higher than those with inadequate health literacy (P = .013). Health literacy was not significantly associated with physical QOL after adjusting for covariates (P = .130). CONCLUSION Inadequate health literacy is associated with a lower social QOL in HNC survivors, and among those with inadequate health literacy, interventions to ameliorate the impact on QOL are needed. LEVEL OF EVIDENCE 4 Laryngoscope, 130:2354-2359, 2020.
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Affiliation(s)
- Marci Lee Nilsen
- University of Pittsburgh, School of Nursing, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Jessica Moskovitz
- University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Lingyun Lyu
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, U.S.A
| | - Christine Harrison
- University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Evan Randazza
- UPMC, Department of Otolaryngology, Pittsburgh, Pennsylvania, U.S.A
| | - Shyamal Das Peddada
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, U.S.A
| | - Jonas T Johnson
- University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, U.S.A
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Toçi E, Burazeri G, Kamberi H, Toçi D, Roshi E, Jerliu N, Bregu A, Brand H. Health literacy and body mass index: a population-based study in a South-Eastern European country. J Public Health (Oxf) 2019; 43:123-130. [DOI: 10.1093/pubmed/fdz103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 07/05/2019] [Accepted: 08/02/2019] [Indexed: 11/13/2022] Open
Abstract
ABSTRACT
Background
The relationship of health literacy (HL) with objective measures including anthropometric measurements remains an under-researched topic to date.
Objective
To assess the association between body mass index (BMI) and HL among Albanian adults.
Methods
A cross-sectional study was conducted in Tirana, Albania, in 2012–2014 including a population-based sample of 1154 individuals aged ≥18 years. HL was assessed by the use of HLS-EU-Q instrument. Anthropometrics included measurement of weight and height based on which BMI was calculated. Information on socio-demographic characteristics was also collected. Logistic regression was employed to assess the independent association of BMI and HL controlling all socio-demographic factors.
Results
One-fifth of the participants reported an inadequate HL level, whereas almost one-third (31%) reported an excellent HL level. About 41% of study participants were overweight and further 22% were obese. In multivariate analysis, there was evidence of a strong and significant association between BMI and HL: the odds of overweight/obesity were two times higher (OR = 2.0, 95% CI = 1.3–3.1) among inadequate HL individuals compared with excellent HL participants.
Conclusion
Our findings, pertinent to a transitional country in the South East Europe, point to a strong, consistent and highly significant association between BMI and HL, irrespective of a wide array of socio-demographic characteristics.
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Affiliation(s)
- Ervin Toçi
- Department of Public Health, Faculty of Medicine, University of Medicine, Tirana 1005, Albania
- Department of International Health, School CAPHRI (Care and Public Health Research Institute), Maastricht University, Maastricht 6200, The Netherlands
| | - Genc Burazeri
- Department of Public Health, Faculty of Medicine, University of Medicine, Tirana 1005, Albania
- Department of International Health, School CAPHRI (Care and Public Health Research Institute), Maastricht University, Maastricht 6200, The Netherlands
| | - Haxhi Kamberi
- Faculty of Medicine, University of Gjakova “Fehmi Agani”, Gjakova 50000, Republic of Kosovo
- Regional Hospital “Isa Grezda”, Gjakove 50000, Republic of Kosovo
| | - Dorina Toçi
- Department of Public Health, Faculty of Medicine, University of Medicine, Tirana 1005, Albania
| | - Enver Roshi
- Department of Public Health, Faculty of Medicine, University of Medicine, Tirana 1005, Albania
| | - Naim Jerliu
- Faculty of Medicine, University of Prishtina, Prishtina 10000, Republic of Kosovo
- National Institute of Public Health of Kosovo, Prishtina 10000, Republic of Kosovo
| | - Arjan Bregu
- Department of Public Health, Faculty of Medicine, University of Medicine, Tirana 1005, Albania
| | - Helmut Brand
- Department of International Health, School CAPHRI (Care and Public Health Research Institute), Maastricht University, Maastricht 6200, The Netherlands
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Sheikh S. Risk Factors Associated with Emergency Department Recidivism in the Older Adult. West J Emerg Med 2019; 20:931-938. [PMID: 31738721 PMCID: PMC6860386 DOI: 10.5811/westjem.2019.7.43073] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/29/2019] [Accepted: 07/28/2019] [Indexed: 01/09/2023] Open
Abstract
Our objective was to review risk factors predictive of older adult recidivism in the emergency department. Certain risk factors and themes commonly occurred in the literature. These recurring factors included increasing age, male gender, certain diagnoses (abdominal pain, traumatic injuries, and respiratory complaints), psychosocial factors (depression, anxiety, poor social support, and limited health literacy), and poor general health (cognitive health and physical functioning). Many of the identified risk factors are not easily modifiable posing a significant challenge in the quest to develop and implement effective intervention strategies.
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Affiliation(s)
- Sophia Sheikh
- University of Florida-Jacksonville, Department of Emergency Medicine, Jacksonville, Florida
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O'Meara L, Williams SL, Ames K, Lawson C, Saluja S, Vandelanotte C. Low Health Literacy Is Associated With Risk of Developing Type 2 Diabetes in a Nonclinical Population. DIABETES EDUCATOR 2019; 45:431-441. [PMID: 31226913 DOI: 10.1177/0145721719857548] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to examine associations among risk of type 2 diabetes (T2D), health literacy levels, and sociodemographic characteristics in a nonclinical adult population to assist in the development of effective T2D prevention programs. METHODS The Health Literacy Questionnaire and Australian Type 2 Diabetes Risk Assessment Tool were included in an online survey. Participants were a random sample of adults residing in each Australian state and territory. Data were analyzed with descriptive statistics and multinomial logistic regression. RESULTS A total of 1279 Australian adults participated (52% female; mean ± SD age, 61 ± 12 years). Most were at medium (42.4%) or high (46.9%) risk of developing T2D. The lowest health literacy scores were found for the domains "critical appraisal of health information" and "navigating the health care system." After controlling for covariates, participants at the highest risk of developing T2D were significantly more likely to be unemployed, have ≥1 chronic conditions, or have a mental health condition. Furthermore, they were significantly more likely to develop T2D if they scored low in 1 of the following health literacy domains: critical appraisal of health information, navigating the health care system, actively managing health, social support, and health care provider support. CONCLUSIONS Health literacy was associated with increased risk for developing T2D and should therefore be part of diabetes prevention initiatives. Specifically, new health promotion initiatives need to help people develop skills required to critically appraise health information and navigate the health care system. Health practitioners and educators should ensure that health information developed for consumers is uncomplicated and easily understood.
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Affiliation(s)
- Lydia O'Meara
- School of Health, Medical and Applied Sciences, CQUniversity, Cairns, Australia
| | - Susan L Williams
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Australia
| | - Kate Ames
- School of Education and the Arts, CQUniversity, Rockhampton, Australia
| | - Celeste Lawson
- School of Education and the Arts, CQUniversity, Rockhampton, Australia
| | - Sonia Saluja
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Australia
| | - Corneel Vandelanotte
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Australia
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Moura NDS, Lopes BB, Teixeira JJD, Oriá MOB, Vieira NFC, Guedes MVC. Literacy in health and self-care in people with type 2 diabetes mellitus. Rev Bras Enferm 2019; 72:700-706. [DOI: 10.1590/0034-7167-2018-0291] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 01/15/2019] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To evaluate the effect of educational intervention in the adherence to self-care activities and functional health literacy and numeracy in people with type 2 diabetes mellitus. Methods: This was a quasi-experimental study conducted in two units of the Brazilian Family Health Strategy, involving people with diabetes. Educational interventions occurred in three meetings, weekly, lasting 60 minutes on average. Data were collected using the Questionário de Autocuidado com o Diabetes, before and after the interventions. Results: 55 people participated in the study. After the interventions, the greatest difference for a better adherence to self-care was the item “inspecting the inside of the shoes before putting them on”, with 3.29 days in the week delta at analytical level. The worst was “taking insulin shots as recommended”, with 0.00 days a week delta at basic level. Conclusion: Educational interventions had a positive effect on adherence to self-care and functional literacy in health.
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Glassman SD, Carreon LY, Brown ME, Jones JS, Edward J, Li J, Williams MV. The impact of health literacy on health status and resource utilization in lumbar degenerative disease. Spine J 2019; 19:711-716. [PMID: 30395960 DOI: 10.1016/j.spinee.2018.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/23/2018] [Accepted: 10/23/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Health literacy, defined as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions," has been demonstrated to affect access to care and appropriate healthcare utilization. PURPOSE To determine the impact of health literacy in the evaluation and management of patients with chronic low back pain. STUDY DESIGN Cross sectional. PATIENT SAMPLE Patients seen at a multisurgeon spine specialty clinic. OUTCOME MEASURES Oswestry Disability Index, EQ-5D, and Numeric Rating Scales (0-10) for back and leg pain. METHODS The Newest Vital Sign (NVS) and Health Literacy Survey, Oswestry Disability Index, EQ-5D and pain scales were administered to patients undergoing evaluation and treatment for lumbar degenerative disease in the outpatient setting. Patients were surveyed regarding their use of medication, therapy, and pain management modalities. RESULTS Of 201 patients approached for participation, 186 completed the health literacy surveys. Thirty (17%) were assessed as having limited literacy, 52 (28%) as possibly having limited literacy and 104 (56%) having adequate literacy based on their NVS scores. The cohort with low NVS scores also had low Health Literacy Survey Scores. Patients with limited literacy had worse back and leg pain scores compared with patients with possibly limited literacy and adequate literacy. Patients with adequate health literacy were more likely to use medications (80% vs. 53%, p = .017) and were more likely to see a specialist (34% vs. 17%) compared with those with limited literacy. Patients with limited health literacy were not more likely to see a chiropractor (7% vs. 7%), but reported more visits (19 vs. 8). CONCLUSIONS Patients with lower health literacy reported worse back and leg pain scores, indicating either more severe disease or a fundamental difference in their responses to standard health-related quality of life measures. This study also suggests that patients with limited health literacy may underutilize some resources and overutilize other resources. Further study is needed to clarify these patterns, and to examine their impact on health status and clinical outcomes.
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Affiliation(s)
- Steven D Glassman
- Norton Leatherman Spine Center, 210 East Gray St, Suite 900, Louisville, KY 40202, USA
| | - Leah Y Carreon
- Norton Leatherman Spine Center, 210 East Gray St, Suite 900, Louisville, KY 40202, USA.
| | - Morgan E Brown
- Norton Leatherman Spine Center, 210 East Gray St, Suite 900, Louisville, KY 40202, USA
| | - Jeffrey S Jones
- University of Louisville School of Medicine, 323 E Chestnut St, Louisville, KY 40202, USA
| | - Jean Edward
- Center for Health Services Research, University of Kentucky, 740 South Limestone, Lexington, KY 40536, USA
| | - Jing Li
- Center for Health Services Research, University of Kentucky, 740 South Limestone, Lexington, KY 40536, USA
| | - Mark V Williams
- Center for Health Services Research, University of Kentucky, 740 South Limestone, Lexington, KY 40536, USA
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Relationship of health literacy with utilization of health-care services in a general Japanese population. Prev Med Rep 2019; 14:100811. [PMID: 30815332 PMCID: PMC6377410 DOI: 10.1016/j.pmedr.2019.01.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 01/18/2019] [Accepted: 01/23/2019] [Indexed: 12/11/2022] Open
Abstract
Many studies have explored the association between health literacy and health-care utilization; however, the majority assessed functional health literacy in terms of basic skills. Japan's health-care and medical examination system in workplaces is different from that of other major countries. This study examined the relationship of health literacy with health-care use (emergency visit, hospitalization, dental checkup, and health checkup or cancer screening); it focused on differences by occupation and health-care service utilization among general Japanese using the communicative and critical health literacy scale. We conducted a cross-sectional observational study of 1002 Japanese residents. Through a questionnaire, we investigated socioeconomic status, health status, health-care use, and health literacy. Among all participants and non-workers, logistic regression analyses revealed that health literacy was significantly associated with health checkup or cancer screening after adjusting for sex, age, marital status, education, and having a disease or disorder (adjusted odds ratio [OR] = 1.431, 95% confidence interval [CI], 1.131–1.810; adjusted OR = 1.614, 95% CI, 1.114–2.339, respectively). Among workers, we observed no significant association between health literacy and health-care utilization. These results indicate that health literacy is closely related to use of preventive health-care. Japan's health-care system in workplaces may promote use of preventive health-care services regardless of health literacy, whereas improving health literacy may be more critical among non-workers. Health literacy was not related to use of necessary health-care among Japanese. Health literacy was related to use of preventive health-care among non-workers. Health literacy was not related to use of preventive health-care among worker.
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Neter E, Brainin E. Association Between Health Literacy, eHealth Literacy, and Health Outcomes Among Patients With Long-Term Conditions. EUROPEAN PSYCHOLOGIST 2019. [DOI: 10.1027/1016-9040/a000350] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abstract. The objective of this paper is to synthesize and update findings from systematic review on health literacy and health outcomes among patients with long-term conditions, and extend the review to the digital domain. Health outcomes include clinical outcomes, processes of care, and health service use. Data sources are the following: (1) studies which appeared in two previous systematic reviews in 2004 and 2011 whose participants were people with long-term conditions or elderly ( n = 54); (2) articles on health literacy and health outcomes identified in an updated 2011–2016 search ( n = 26); (3) articles on eHealth literacy and its association with health outcomes ( n = 8). Strength of evidence was determined by a qualitative assessment of risk of bias, consistency, and directness. There was a lack of consistent evidence on the relationship between health literacy and clinical outcomes despite the consistent evidence on the association with mortality. There was low to insufficient evidence on the association between health literacy and self-rated health/function and emotional states of anxiety and depression, alongside high evidence on lack of association with quality of life. There was insufficient to low evidence on the association between health literacy and behavioral outcomes (medication adherence, other health behaviors) and finally also low to moderate evidence on the association between health literacy and use of health services such as hospitalization and emergency department. In the eHealth literacy domain, there were few studies reporting association with health behaviors and self-rated health with inconsistent results. In conclusion, it is advocated to examine performed heath literacy and eHealth literacy in large longitudinal studies.
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Affiliation(s)
- Efrat Neter
- Department of Behavioral Sciences, Ruppin Academic Center, Emeq Hefer, Israel
| | - Esther Brainin
- Department of Behavioral Sciences, Ruppin Academic Center, Emeq Hefer, Israel
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Ownby RL, Acevedo A, Waldrop-Valverde D. Enhancing the Impact of Mobile Health Literacy Interventions to Reduce Health Disparities. QUARTERLY REVIEW OF DISTANCE EDUCATION 2019; 20:15-34. [PMID: 31537979 PMCID: PMC6752043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Health literacy is a key factor in health outcomes that should be considered when creating mobile health promotion apps. In this paper, we detail our work over the past 10 years in developing the theory and practice of targeting the content of mobile apps at a level appropriate for the intended audience. We include a review of our theory of health literacy as expertise, the ASK model, and integrate it with the Theory of Planned Behavior. We then provide data that support both the model and its use. More recently, we have developed a predictive analytic model that uses demographic information and patient performance on a 10-item screening measure to determine patient level of health literacy at a high level of accuracy. The predictive model will enable apps to automatically provide content to users at an appropriate level of health literacy. This strategy, along with other aspects of tailoring, will allow apps to be more personally relevant to users, enhancing their effects in promoting health behavior change.
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Affiliation(s)
- Raymond L Ownby
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale, FL
| | - Amarilis Acevedo
- College of Psychology, Nova Southeastern University, Fort Lauderdale, FL
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Krishnan S, Rohman A, Welter J, Dozor AJ. Relationship Between Health Literacy in Parents and Asthma Control in Their Children: A Prospective Study in a Diverse Suburban Population. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2018. [DOI: 10.1089/ped.2018.0929] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sankaran Krishnan
- New York Medical College and Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York
| | | | - John Welter
- New York Medical College and Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York
| | - Allen J. Dozor
- New York Medical College and Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York
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Papadakos JK, Hasan SM, Barnsley J, Berta W, Fazelzad R, Papadakos CJ, Giuliani ME, Howell D. Health literacy and cancer self-management behaviors: A scoping review. Cancer 2018; 124:4202-4210. [DOI: 10.1002/cncr.31733] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 07/04/2018] [Accepted: 07/30/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Janet K. Papadakos
- Cancer Health Literacy Research Centre; Cancer Education, Princess Margaret Cancer Centre Toronto Ontario Canada
- Patient Education; Cancer Care Ontario Toronto Ontario Canada
| | - Salwa M. Hasan
- Undergraduate Medical Education, Faculty of Medicine; University of Toronto; Toronto Ontario Canada
| | - Jan Barnsley
- Institute of Health Policy, Management, and Evaluation; University of Toronto; Toronto Ontario Canada
| | - Whitney Berta
- Institute of Health Policy, Management, and Evaluation; University of Toronto; Toronto Ontario Canada
| | - Rouhi Fazelzad
- Library and Information Services; Princess Margaret Cancer Centre Toronto Ontario Canada
| | - Christine J. Papadakos
- Cancer Health Literacy Research Centre; Cancer Education, Princess Margaret Cancer Centre Toronto Ontario Canada
- Patient Education; Cancer Care Ontario Toronto Ontario Canada
| | - Meredith E. Giuliani
- Cancer Health Literacy Research Centre; Cancer Education, Princess Margaret Cancer Centre Toronto Ontario Canada
- Radiation Medicine Program; Princess Margaret Cancer Centre Toronto Ontario Canada
- Department of Radiation Oncology, Faculty of Medicine; University of Toronto; Toronto Ontario Canada
| | - Doris Howell
- Division of Psychosocial Oncology and Palliative Care; Ontario Cancer Institute; Princess Margaret Cancer Centre Toronto Ontario Canada
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Alokozai A, Bernstein DN, Sheikholeslami N, Uhler L, Ring D, Kamal RN. Impact of Health Literacy on Time Spent Seeking Hand Care. Hand (N Y) 2018; 13:538-546. [PMID: 28513193 PMCID: PMC6109906 DOI: 10.1177/1558944717708027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with limited health literacy may have less knowledge and fewer resources for efficient access and navigation of the health care system. We tested the null hypothesis that there is no correlation between health literacy and total time spent seeking hand surgery care. METHODS New patients visiting a hand surgery clinic at a suburban academic medical center were asked to complete a questionnaire to determine demographics, total time spent seeking hand surgery care, and outcomes. A total of 112 patients were included in this study. RESULTS We found health literacy levels did not correlate with total time seeking hand surgery care or from booking an appointment to being evaluated in clinic. CONCLUSIONS In this suburban academic medical center, patients with low health literacy do not spend more time seeking hand surgery care and do have longer delays between seeking and receiving care. The finding that-at least in this setting-health literacy does not impact patient time seeking hand care suggests that resources to improve health disparities can be focused elsewhere in the care continuum.
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Affiliation(s)
| | | | | | | | | | - Robin N. Kamal
- Stanford University, Redwood City, CA,
USA,Robin N. Kamal, Department of Orthopaedic
Surgery, Stanford University, 450 Broadway Street, Pavilion C, 440, Redwood
City, CA 94063, USA.
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O'Hara J, Hawkins M, Batterham R, Dodson S, Osborne RH, Beauchamp A. Conceptualisation and development of the Conversational Health Literacy Assessment Tool (CHAT). BMC Health Serv Res 2018; 18:199. [PMID: 29566755 PMCID: PMC5863801 DOI: 10.1186/s12913-018-3037-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 03/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to develop a tool to support health workers’ ability to identify patients’ multidimensional health literacy strengths and challenges. The tool was intended to be suitable for administration in healthcare settings where health workers must identify health literacy priorities as the basis for person-centred care. Methods Development was based on a qualitative co-design process that used the Health Literacy Questionnaire (HLQ) as a framework to generate questions. Health workers were recruited to participate in an online consultation, a workshop, and two rounds of pilot testing. Results Participating health workers identified and refined ten questions that target five areas of assessment: supportive professional relationships, supportive personal relationships, health information access and comprehension, current health behaviours, and health promotion barriers and support. Conclusions Preliminary evidence suggests that application of the Conversational Health Literacy Assessment Tool (CHAT) can support health workers to better understand the health literacy challenges and supportive resources of their patients. As an integrated clinical process, the CHAT can supplement existing intake and assessment procedures across healthcare settings to give insight into patients’ circumstances so that decisions about care can be tailored to be more appropriate and effective.
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Affiliation(s)
- Jonathan O'Hara
- Health Systems Improvement Unit, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, VIC, 3220, Australia
| | - Melanie Hawkins
- Health Systems Improvement Unit, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, VIC, 3220, Australia
| | - Roy Batterham
- Health Systems Improvement Unit, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, VIC, 3220, Australia.,Faculty of Economics, Dhurakij Pundit University, Bangkok, Thailand
| | - Sarity Dodson
- Health Systems Improvement Unit, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, VIC, 3220, Australia.,The Fred Hollows Foundation, Melbourne, Australia
| | - Richard H Osborne
- Health Systems Improvement Unit, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, VIC, 3220, Australia
| | - Alison Beauchamp
- Health Systems Improvement Unit, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, VIC, 3220, Australia. .,Department of Rural Health, Monash University, Moe, Australia.
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Yang P, Dunzhu C, Widdowson MA, Wu S, Ciren P, Duoji D, Pingcuo W, Dun B, Ma C, Li J, Pang X, Wang Q. Infectious disease-specific health literacy in Tibet, China. Health Promot Int 2018; 33:84-91. [PMID: 27476868 PMCID: PMC5831159 DOI: 10.1093/heapro/daw054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This study was aimed to develop an instrument to assess infectious disease-specific health literacy (IDSHL) in the general population of Tibet, China and identify the association between IDSHL and reported infectious disease-related symptoms. A survey using a standardized questionnaire, which included 25 questions on knowledge, behaviors and skills regarding infectious diseases, was conducted in the general population of Tibet, China between September 2011 and November 2011. The 25 questions formed the index system of the instrument assessing IDSHL (total scores: 25 scores). Factors associated with index scores of IDSHL were identified by general linear model. The association between the index score of IDSHL and the occurrence of the five selected infectious disease symptoms (fever, diarrhea, rash, jaundice or conjunctivitis) were investigated using multivariate unconditional logistic regression. Among 5717 eligible participants in the survey, 4631 participants completed all of the 25 questions in the instrument. The instrument was reliable and valid as measured by the Cronbach's alpha coefficient and split-half coefficient, and the confirmatory factor analysis. Only 1.0% (48/4631) answered ≥80% of the 25 questions correctly (score ≥ 20). Significant factors associated with lower health literacy score included female gender, older age, Tibetan group, lower education level, underlying diseases and more undeveloped area. For each increasing score of IDSHL, reports of fever, diarrhea or jaundice in the prior year were significantly decreased by 3% (p = 0.015), 4% (p = 0.004) and 16% (p < 0.001), respectively. Accurately measuring IDSHL could help identify those individuals with poor IDSHL, who could be targeted with specific interventions to improve health.
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Affiliation(s)
- Peng Yang
- Beijing Center for Disease Prevention and Control, Beijing, China
- Beijing Research Center for Preventive Medicine, Beijing
- School of Public Health, Captial Medical University, Beijing
| | - Ciren Dunzhu
- Tibet Center for Disease Prevention and Control, Tibet, China
| | - Marc-Alain Widdowson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shuangsheng Wu
- Beijing Center for Disease Prevention and Control, Beijing, China
- Beijing Research Center for Preventive Medicine, Beijing
- School of Public Health, Captial Medical University, Beijing
| | - Pengcuo Ciren
- Tibet Center for Disease Prevention and Control, Tibet, China
| | - Dunzhu Duoji
- Tibet Center for Disease Prevention and Control, Tibet, China
| | | | - Bian Dun
- Pulan County Center for Disease Prevention and Control, Tibet, China
| | - Chunna Ma
- Beijing Center for Disease Prevention and Control, Beijing, China
- Beijing Research Center for Preventive Medicine, Beijing
- School of Public Health, Captial Medical University, Beijing
| | - Jie Li
- Beijing Center for Disease Prevention and Control, Beijing, China
- Beijing Research Center for Preventive Medicine, Beijing
- School of Public Health, Captial Medical University, Beijing
| | - Xinghuo Pang
- Beijing Center for Disease Prevention and Control, Beijing, China
- Beijing Research Center for Preventive Medicine, Beijing
- School of Public Health, Captial Medical University, Beijing
| | - Quanyi Wang
- Beijing Center for Disease Prevention and Control, Beijing, China
- Beijing Research Center for Preventive Medicine, Beijing
- School of Public Health, Captial Medical University, Beijing
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Adolescent health literacy and health behaviors: A systematic review. J Adolesc 2018; 62:116-127. [DOI: 10.1016/j.adolescence.2017.11.010] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 10/12/2017] [Accepted: 11/17/2017] [Indexed: 12/18/2022]
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Della Pelle C, Orsatti V, Cipollone F, Cicolini G. Health literacy among caregivers of patients with heart failure: A multicentre cross-sectional survey. J Clin Nurs 2017; 27:859-865. [PMID: 29076583 DOI: 10.1111/jocn.14137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To assess the levels of health literacy of Italian caregivers of patients with heart failure. BACKGROUND Health literacy is related to patients' health outcomes. Low health literacy has been found in older people with heart failure, and less is known on the health literacy of caregivers whose patients are suffering from heart failure. DESIGN Observational, multicentre, cross-sectional study. METHODS From July 2015-May 2016, caregivers were recruited in five hospitals from Central and Southern Italy. To assess health literacy, the Italian version of the Short Test of Functional Health Literacy tool was used. RESULTS A total of 173 caregivers participated in the research, the majority being females (60.1%), aged between 46-60 years (52.6%) and 96 (55.5%) were from Central Italy. 33.5% of caregivers were patients' children, and 16.2% were paid caregivers of foreign origins. The average level of health literacy was adequate; however, lower levels were found among patients' spouses and those of older age. CONCLUSION Our results, in contrast with previous studies, showed adequate health literacy levels of caregivers. However, caregivers older in age and with a low education level showed the lowest health literacy, emphasising the need for healthcare workers, to check caregivers' health literacy, before entrusting them with the care of patients. RELEVANCE TO CLINICAL PRACTICE As this research gives, for the first time, an overview on Italian caregivers' levels of health literacy, its results may be used to improve Italian healthcare professionals' knowledge of caregivers' health literacy, before entrusting them with the care of patients.
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Affiliation(s)
- Carlo Della Pelle
- Department of Medicine and Science of Aging, G.d'Annunzio University - Chieti-Pescara, Pescara, Italy.,ASL02Abruzzo - SAPS Chieti, Chieti Scalo, Italy
| | | | - Francesco Cipollone
- Department of Medicine and Science of Aging, G.d'Annunzio University - Chieti-Pescara, Pescara, Italy
| | - Giancarlo Cicolini
- Department of Medicine and Science of Aging, G.d'Annunzio University - Chieti-Pescara, Pescara, Italy.,ASL02Abruzzo - SAPS Chieti, Chieti Scalo, Italy
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Mantwill S, Schulz PJ. Low health literacy and healthcare utilization among immigrants and non-immigrants in Switzerland. PATIENT EDUCATION AND COUNSELING 2017; 100:2020-2027. [PMID: 28559092 DOI: 10.1016/j.pec.2017.05.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 03/21/2017] [Accepted: 05/12/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study aimed at investigating the association between functional health literacy and knowledge on when to seek medical help for potentially harmless (overutilization) or serious (underutilization) situations among immigrants and non-immigrants in Switzerland. METHODS Data was collected among three immigrant groups and the native population (N=1146) in the German- and Italian-speaking part of Switzerland. Health literacy was assessed with the Short Test of Functional Health Literacy (S-TOFHLA) and three Brief Health Literacy Screeners. Over- and underutilization of healthcare services was assessed with items asking participants about when to seek medical help for minor, respectively major, physical symptoms. RESULTS Immigrants were more likely to seek medical help when unwarranted (overutilization). Health literacy, when assessed with the S-TOFHLA, was significantly associated with over- and underutilization. Yet, once controlled for covariates, the association between health literacy and overutilization was negative. Immigration background and micro-cultural differences emerged as important predictors of utilization. CONCLUSIONS Results suggest that functional health literacy is directly related to healthcare utilization. The effects might be amplified by (micro-)cultural differences. PRACTICE IMPLICATIONS Healthcare providers should be aware of differences in health literacy and utilization patterns among different population groups. Communication between patients and providers should be literacy and culturally sensitive.
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Affiliation(s)
- Sarah Mantwill
- Institute of Communication & Health, University of Lugano, Via Giuseppe Buffi 13, 6904 Lugano, Switzerland.
| | - Peter J Schulz
- Institute of Communication & Health, University of Lugano, Via Giuseppe Buffi 13, 6904 Lugano, Switzerland.
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Schulz PJ, Fitzpatrick MA, Hess A, Sudbury-Riley L, Hartung U. Effects of eHealth Literacy on General Practitioner Consultations: A Mediation Analysis. J Med Internet Res 2017; 19:e166. [PMID: 28512081 PMCID: PMC5449647 DOI: 10.2196/jmir.6317] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 12/06/2016] [Accepted: 03/15/2017] [Indexed: 11/28/2022] Open
Abstract
Background Most evidence (not all) points in the direction that individuals with a higher level of health literacy will less frequently utilize the health care system than individuals with lower levels of health literacy. The underlying reasons of this effect are largely unclear, though people’s ability to seek health information independently at the time of wide availability of such information on the Internet has been cited in this context. Objective We propose and test two potential mediators of the negative effect of eHealth literacy on health care utilization: (1) health information seeking and (2) gain in empowerment by information seeking. Methods Data were collected in New Zealand, the United Kingdom, and the United States using a Web-based survey administered by a company specialized on providing online panels. Combined, the three samples resulted in a total of 996 baby boomers born between 1946 and 1965 who had used the Internet to search for and share health information in the previous 6 months. Measured variables include eHealth literacy, Internet health information seeking, the self-perceived gain in empowerment by that information, and the number of consultations with one’s general practitioner (GP). Path analysis was employed for data analysis. Results We found a bundle of indirect effect paths showing a positive relationship between health literacy and health care utilization: via health information seeking (Path 1), via gain in empowerment (Path 2), and via both (Path 3). In addition to the emergence of these indirect effects, the direct effect of health literacy on health care utilization disappeared. Conclusions The indirect paths from health literacy via information seeking and empowerment to GP consultations can be interpreted as a dynamic process and an expression of the ability to find, process, and understand relevant information when that is necessary.
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Affiliation(s)
- Peter Johannes Schulz
- Institute of Communication and Health, Faculty of Communication Science, Università della Svizzera italiana, Lugano, Switzerland
| | | | - Alexandra Hess
- School of Communication, Journalism and Marketing, Massey University, Auckland, New Zealand
| | | | - Uwe Hartung
- Institute of Communication and Health, Faculty of Communication Science, Università della Svizzera italiana, Lugano, Switzerland
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Yeh YC, Lin HW, Chang EH, Huang YM, Chen YC, Wang CY, Liu JW, Ko Y. Development and validation of a Chinese medication literacy measure. Health Expect 2017; 20:1296-1301. [PMID: 28474423 PMCID: PMC5689244 DOI: 10.1111/hex.12569] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2017] [Indexed: 11/29/2022] Open
Abstract
Background Despite the impact of medication literacy (ML) on patients’ safe use of medications, existing instruments are mostly for general health literacy measurement or designed for specific disease populations, with few specifically designed for ML. Objective To develop and validate the first Chinese medication literacy measure (ChMLM). Methods The ChMLM was developed by a multidisciplinary and bilingual expert panel and subsequently pilot‐tested. The final version had 17 questions in four sections: vocabulary, non‐prescription drug, prescription drug and drug advertisement. Face‐to‐face interviews were administered in a convenience sample of adults with diverse sociodemographic characteristics. Internal consistency was assessed by Cronbach's alpha. Content validity was confirmed by the expert panel, and hypothesis testing was performed to assess construct validity. Results A total of 634 adults were interviewed. The mean (SD) total ChMLM score was 13.0 (2.8). The internal validity was acceptable (Cronbach's alpha=0.72). Nine of the ten a priori hypotheses were fulfilled. Younger age, higher income and higher education levels were significantly associated with a higher ChMLM score. Furthermore, higher scores on the ChMLM were associated with higher confidence or less difficulty in writing, reading, speaking and listening abilities in a health‐care encounter. No association was found between ChMLM total scores and frequency of doctor's visits. Conclusion The ChMLM is a valid and reliable ML measure. It may help pharmacists and other health‐care providers to target patients and problem areas that need interventions with the ultimate goal of preventing medication errors and harm.
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Affiliation(s)
- Ying-Chih Yeh
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Hsiang-Wen Lin
- School of Pharmacy and Graduate Institute, China Medical University, Taichung, Taiwan
| | - Elizabeth H Chang
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.,Research Center for Pharmacoeconomics, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.,Department of Pharmacy, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yen-Ming Huang
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Yu-Chieh Chen
- Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Yu Wang
- Taiwan Society of Health-System Pharmacists, Taipei, Taiwan.,Department of Pharmacy, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Jen-Wei Liu
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.,Taiwan Society of Health-System Pharmacists, Taipei, Taiwan
| | - Yu Ko
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.,Research Center for Pharmacoeconomics, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
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Schapira MM, Mozal C, Shofer FS, Gonzalez R, Apter AJ. Alignment of Patient Health Numeracy with Asthma Care Instructions in the Patient Portal. Health Lit Res Pract 2017; 1:e1-e10. [PMID: 31294245 PMCID: PMC6607833 DOI: 10.3928/24748307-20170307-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 01/23/2017] [Indexed: 11/20/2022] Open
Abstract
Background After Visit Summary (AVS) instructions provided through the patient portal of the electronic medical record can support asthma self-management if patients have the skills to interpret and apply the health information provided. Print literacy demands of patient materials are often higher than the reading ability of patients. However, less is known regarding the numeric demand of patient education materials and how well it aligns with patient health numeracy. Objectives This study (1) developed measures of numeric demand for use in the AVS, (2) described the health numeracy demand of AVS instructions for asthma care, and (3) evaluated the association between numeracy demand of materials and patient health numeracy. Methods We reviewed personalized AVS instructions for an index visit from 74 adults with moderate or severe asthma recruited from clinics serving low-income urban communities. Using measures of numeric complexity and density developed for this study, numeracy demand of the AVS was compared to the numeracy skills of patients using the validated Asthma Numeracy Questionnaire. Key Results The numeric complexity and density scales demonstrated content and face validity. The median (range) of the numeric complexity score for AVS instructions was 2.5 (0-46), and density of numeric information was 8% (0%-33%). The median (range) of the Asthma Numeracy Questionnaire was 2 (0-4). There was no association between patient asthma-related health numeracy and the complexity (p = .29) or density (p = .81) of numeric information. Conclusions Patient instructions regarding medications and self-management often include numeric information. Lack of alignment of the numeracy demand of materials with health numeracy skill may be a barrier to communication, particularly among patients of lower health numeracy. [Health Literacy Research and Practice. 2017;1(1):e1-e10.]. Plain Language Summary This study developed a way to measure the frequency and complexity of numeric information in instructions given to patients with asthma. No association was found between the difficulty of numeric information provided and the numeracy level of patients. This poses a potential barrier to communication, especially for patients with low health numeracy.
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Affiliation(s)
- Marilyn M. Schapira
- Address correspondence to Marilyn M. Schapira, MD, MPH, 1110 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104;
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Abstract
OBJECTIVE This study aimed to determine the level of health literacy in a postoperative orthopaedic trauma population and to evaluate the efficacy of a simple predischarge discussion strategy, targeted at improving health literacy. DESIGN A pre-post intervention study was conducted from April 2014 to January 2015. SETTING Academic Level 1 trauma center. PARTICIPANTS One hundred ninety consecutive orthopaedic trauma patients with operatively managed lower limb fractures were recruited. All eligible participants agreed to participate. INTERVENTION The first ninety-nine patients received usual care (UC). The following 91 patients received a structured predischarge discussion, including x-rays, written and verbal information, from the orthopaedic staff (DG). Patients were then randomized into health literacy evaluation before first outpatient review or after first outpatient review. MAIN OUTCOME MEASURES The primary outcome measure was a questionnaire determining health literacy. RESULTS Ninety-six (97%) of the UC patients and 87 (96%) of the discussion patients (DG) completed the interview. UC preoutpatient (n = 46) demonstrated a mean score of 4.67 of a maximum 8. UC postoutpatient (n = 50) demonstrated a mean score of 5.42. DG preoutpatient (n = 47) demonstrated a mean score of 6.70. DG postoutpatient (n = 40) demonstrated a mean score of 7.08. CONCLUSIONS Australian orthopaedic trauma patients demonstrate poor health literacy, with this not showing improvement after their first outpatient follow-up visit. The use of a time efficient, structured predischarge discussion improved patient health literacy. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Kim YS, Khatiwoda P, Park BH, Lee HY. Health Literacy and Its Link to Healthcare Service Utilization Among Older Adults in Korea. SOCIAL WORK IN PUBLIC HEALTH 2016; 31:467-473. [PMID: 27175556 DOI: 10.1080/19371918.2015.1137519] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Existing studies report a negative association between health literacy and hospital/emergency room use. Despite substantial research on this topic among older Americans, little is known about the link between health literacy and healthcare services use among older Koreans. This study investigates this link, using a sample of 596 adults, 65 and older, from Korea's three largest cities. Andersen's behavior model guided the study. Findings revealed that participants with higher health literacy were significantly less likely to use emergent health services. Enhanced health literacy will likely promote better health outcomes for older Koreans and reduce Korea's healthcare costs.
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Affiliation(s)
- Young Sun Kim
- a Graduate School of East-West Medical Science, Kyung Hee University , Gyeonggi-Do , South Korea
| | - Parmananda Khatiwoda
- b Department of Organizational Leadership, Policy, and Development , University of Minnesota , Twin Cities, Minneapolis , Minnesota , USA
| | - Byung Hyun Park
- c Department of Social Welfare , Pusan National University , Busan , South Korea
| | - Hee Yun Lee
- d School of Social Work, University of Minnesota , Twin Cities, St. Paul , Minnesota , USA
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