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Lee JW, Hollingsworth EK, Shah AS, Szanton SL, Perrin N, Mixon AS, Vasilevskis EE, Boyd CM, Han HR, Green AR, Taylor JL, Simmons SF. Emergency department visits and hospital readmissions after a deprescribing intervention among hospitalized older adults. J Am Geriatr Soc 2024; 72:2038-2047. [PMID: 38725307 PMCID: PMC11226369 DOI: 10.1111/jgs.18945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 04/01/2024] [Accepted: 04/14/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Deprescribing is the planned/supervised method of dose reduction or cessation of medications that might be harmful, or no longer be beneficial. Though benefits of deprescribing are debatable in improving clinical outcomes, it has been associated with decreased number of potentially inappropriate medications, which may potentially reduce the risk of adverse events among hospitalized older adults. With unclear evidence for deprescribing in this population, this study aimed to examine time-to-first unplanned healthcare utilization, which included 90-day emergency department (ED) visits or hospital readmission and associated predictors, during a deprescribing intervention. METHODS A secondary data analysis of a clinical trial (Shed-MEDS NCT02979353) was performed. Cox regression was used to compare the time-to-first 90-day ED visit/readmission/death from hospital discharge for the intervention and control groups. Additionally, we performed exploratory analysis of predictors (comorbidities, functional health status, drug burden index (DBI), hospital length of stay, health literacy, food insecurity, and financial burden) associated with the time-to-first 90-day ED visit/readmission/death. RESULTS The hazard of first 90-day ED visits/readmissions/death was 15% lower in the intervention versus the control group (95% CI: 0.61-1.19, p = 0.352, respectively); however, this difference was not statistically significant. For every additional number of comorbidities (Hazard ratio (HR): 1.12, 95% CI: 1.04-1.21) and each additional day of hospital length of stay (HR: 1.04, 95% CI: 1.01-1.07) were significantly associated with a higher hazard of 90-day ED visit/readmission/death in the intervention group; whereas for each unit of increase in pre-hospital DBI score (HR: 1.08 and HR 1.16, respectively) was significantly associated with a higher hazard of 90-day ED visit/readmission/death in the control group. CONCLUSIONS The intervention and control groups had comparable time-to-first 90-day ED visit/readmission/death during a deprescribing intervention. This finding suggests that deprescribing did not result in a higher risk of ED visit/readmission/death during the 90-day period following hospital discharge.
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Affiliation(s)
- Ji Won Lee
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD 21205
| | - Emily Kay Hollingsworth
- Vanderbilt Center for Quality Aging, Vanderbilt University Medical Center, Division of Geriatrics, Nashville, TN, USA
| | - Avantika Saraf Shah
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sarah L. Szanton
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD 21205
| | - Nancy Perrin
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD 21205
| | - Amanda S. Mixon
- Vanderbilt Center for Quality Aging, Vanderbilt University Medical Center, Division of Geriatrics, Nashville, TN, USA
- VA Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center, Nashville, TN, USA
| | - Eduard Eric Vasilevskis
- Vanderbilt Center for Quality Aging, Vanderbilt University Medical Center, Division of Geriatrics, Nashville, TN, USA
- VA Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center, Nashville, TN, USA
- University of Wisconsin – Madison, School of Medicine and Public Health, Division of Hospital Medicine, Madison, WI, USA
| | - Cynthia M. Boyd
- Johns Hopkins School of Medicine, Center for Transformative Geriatric Research, 5200 Eastern Avenue, MFL Building, 3 Floor, Baltimore, MD 21224
| | - Hae-Ra Han
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD 21205
| | - Ariel R. Green
- Johns Hopkins School of Medicine, Center for Transformative Geriatric Research, 5200 Eastern Avenue, MFL Building, 3 Floor, Baltimore, MD 21224
| | - Janiece L. Taylor
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD 21205
| | - Sandra Faye Simmons
- Vanderbilt Center for Quality Aging, Vanderbilt University Medical Center, Division of Geriatrics, Nashville, TN, USA
- VA Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center, Nashville, TN, USA
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Bindhu S, Nattam A, Xu C, Vithala T, Grant T, Dariotis JK, Liu H, Wu DTY. Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review. Online J Public Health Inform 2024; 16:e50898. [PMID: 38506914 PMCID: PMC10993137 DOI: 10.2196/50898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Health literacy (HL) is the ability to make informed decisions using health information. As health data and information availability increase due to online clinic notes and patient portals, it is important to understand how HL relates to social determinants of health (SDoH) and the place of informatics in mitigating disparities. OBJECTIVE This systematic literature review aims to examine the role of HL in interactions with SDoH and to identify feasible HL-based interventions that address low patient understanding of health information to improve clinic note-sharing efficacy. METHODS The review examined 2 databases, Scopus and PubMed, for English-language articles relating to HL and SDoH. We conducted a quantitative analysis of study characteristics and qualitative synthesis to determine the roles of HL and interventions. RESULTS The results (n=43) were analyzed quantitatively and qualitatively for study characteristics, the role of HL, and interventions. Most articles (n=23) noted that HL was a result of SDoH, but other articles noted that it could also be a mediator for SdoH (n=6) or a modifiable SdoH (n=14) itself. CONCLUSIONS The multivariable nature of HL indicates that it could form the basis for many interventions to combat low patient understandability, including 4 interventions using informatics-based solutions. HL is a crucial, multidimensional skill in supporting patient understanding of health materials. Designing interventions aimed at improving HL or addressing poor HL in patients can help increase comprehension of health information, including the information contained in clinic notes shared with patients.
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Affiliation(s)
- Shwetha Bindhu
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States
- School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Anunita Nattam
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Catherine Xu
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Tripura Vithala
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Tiffany Grant
- University of Cincinnati Libraries Research and Data Services, University of Cincinnati, Cincinnati, OH, United States
| | - Jacinda K Dariotis
- Department of Human Development and Family Studies, The University of Illinois at Urbana-Champaign, Urbana, IL, United States
- The Family Resiliency Center, College of Agricultural, Consumer and Environmental Sciences, The University of Illinois at Urbana-Champaign, Urbana, IL, United States
- Department of Biomedical and Translational Sciences, The University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Hexuan Liu
- School of Criminal Justice, University of Cincinnati, Cincinnati, OH, United States
| | - Danny T Y Wu
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States
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Cabo JJ, Kaufman MR, Johnsen NV. Impact of sexual function domains on sexual satisfaction and quality of life: Importance across the age spectrum. Andrology 2024. [PMID: 38226963 DOI: 10.1111/andr.13594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND Sexual satisfaction is an important component of global quality life for many adult men. Substantial gaps exist in our appreciation of how age mediates sexual satisfaction in the context of functional sexual measures. We sought to evaluate modifiable factors associated with overall sexual satisfaction and health-related quality of life (HRQoL) in a large, age-stratified community-based sample of adult men. METHODS A sample of adult males registered with the online research service ResearchMatch completed a 75-item online questionnaire in this cross-sectional study. Queries included demographics, general health data, and validated sexual health measures including International Index of Erectile Function-5 (IIEF-5) and Premature Ejaculation Diagnostic Tool (PEDT). Multivariable regression was performed to assess associations with self-reported sexual satisfaction (defined by "moderately satisfied" or "very satisfied" on the 5-level Likert scale) and overall HRQoL (as measured by the EQ-5D-visual analog scale (VAS) stratified by age. RESULTS One thousand thirty-three men completed the survey and were stratified by age cohorts. IIEF-5 and PEDT scores were higher in younger cohorts. On multivariable regression analysis, higher IIEF-5, lower PEDT, better overall health-related quality of life, and the presence of a sexual partner within the last month were associated with an increased likelihood of overall sexual satisfaction. When stratified by age cohort, higher IIEF-5 scores were consistently positively associated with sexual satisfaction (Odds Ratio (OR) 1.18, 95% CI 1.15-1.22, P < 0.001), as well as independently associated with improved overall HRQoL by EQ-5D-VAS (β = 0.71, Standard Error (SE) = 0.08, P < 0.001). CONCLUSIONS The erectile function was independently associated with sexual satisfaction and quality of life across all age strata and predictive of both sexual satisfaction and global HRQoL. Low overall rates of sexual satisfaction across cohorts highlight the critical importance of evaluation and treatment of sexual health, regardless of age.
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Affiliation(s)
- Jackson J Cabo
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Melissa R Kaufman
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Niels V Johnsen
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Dijkman EM, ter Brake WWM, Drossaert CHC, Doggen CJM. Assessment Tools for Measuring Health Literacy and Digital Health Literacy in a Hospital Setting: A Scoping Review. Healthcare (Basel) 2023; 12:11. [PMID: 38200917 PMCID: PMC10778720 DOI: 10.3390/healthcare12010011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
Assessment of (digital) health literacy in the hospital can raise staff awareness and facilitate tailored communication, leading to improved health outcomes. Assessment tools should ideally address multiple domains of health literacy, fit to the complex hospital context and have a short administration time, to enable routine assessment. This review aims to create an overview of tools for measuring (digital) health literacy in hospitals. A search in Scopus, PubMed, WoS and CINAHL, following PRISMA guidelines, generated 7252 hits; 251 studies were included in which 44 assessment tools were used. Most tools (57%) were self-reported and 27% reported an administration time of <5 min. Almost all tools addressed the domain 'understanding' (98%), followed by 'access' (52%), 'apply' (50%), 'appraise' (32%), 'numeracy' (18%), and 'digital' (18%). Only four tools were frequently used: the Newest Vital Sign (NVS), the Short Test of Functional Health Literacy for Adults ((S)TOFHLA), the Brief Health Literacy Screener (BHLS), and the Health Literacy Questionnaire (HLQ). While the NVS and BHLS have a low administration time, they cover only two domains. HLQ covers the most domains: access, understanding, appraise, and apply. None of these four most frequently used tools measured digital skills. This review can guide health professionals in choosing an instrument that is feasible in their daily practice, and measures the required domains.
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Affiliation(s)
- Eline M. Dijkman
- Department of Health Technology and Services Research (HTSR), Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (E.M.D.)
- Department of Surgery, Isala Hospital, 8025 AB Zwolle, The Netherlands
| | - Wouter W. M. ter Brake
- Department of Health Technology and Services Research (HTSR), Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (E.M.D.)
| | | | - Carine J. M. Doggen
- Department of Health Technology and Services Research (HTSR), Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (E.M.D.)
- Clinical Research Center, Rijnstate Hospital, 6815 AD Arnhem, The Netherlands
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Naidu V, Ganeshamoorthy A, Allwin C. The Mediating Effect of Self-Efficacy on the Relationship Between Medication Literacy and Medication Adherence Among Patients with Type 2 Diabetes [Letter]. Patient Prefer Adherence 2023; 17:1907-1908. [PMID: 37560146 PMCID: PMC10408652 DOI: 10.2147/ppa.s432752] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023] Open
Affiliation(s)
- Vishvan Naidu
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | | | - Caitlin Allwin
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
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Novick TK, Barrios F, Osuna M, Emery C, Ramirez D, Palau L, Ravi S, Lubetzky M, Cruz E, Crews DC, Cervantes L. Facilitating Medical Care for Latinx Individuals at Risk for CKD: A Pilot Intervention. Kidney Med 2023; 5:100679. [PMID: 37520781 PMCID: PMC10382664 DOI: 10.1016/j.xkme.2023.100679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Rationale and Objective Latinx individuals are at a higher risk for kidney failure than non-Latinx White individuals; however, they are less likely to receive pre-kidney failure medical care. The objective of this study was to determine the feasibility and acceptability of a community health worker (CHW) intervention that facilitated access to medical care for Latinx individuals. Study Design Single-arm prospective study. Setting and Participants Latinx adults were found to have albuminuria or risk factors for kidney disease at community screening events in Austin, Texas. Intervention A 6-month CHW intervention that facilitated the following: (1) obtaining medical insurance; (2) medical care coordination with primary and nephrology care; (3) kidney disease education; and (4) connection with local resources to address health-related social needs. Outcomes Recruitment, retention, medical care linkage, and participant and CHW-reported satisfaction with the intervention. Results Of the 173 individuals who attended the 2 community screening events, 49 agreed to participate in the study, of whom, 51% were men with a mean ± standard deviation (SD) age of 45 ± 14 years, and all self-identified as Mexican or Chicano. The mean ± SD estimated glomerular filtration rate (eGFR) was 110 ± 21 mL/min/1.73 m2 and 41% of the participants reported a urine albumin-creatinine ratio of ≥30 mg/g. Among those enrolled, 28 of the 49 (57%) completed at least 1 CHW visit, and 20 of 49 (41%) completed the intervention. 7 individuals who needed assistance with insurance obtained insurance, and 15 of 20 (75%) scheduled an appointment with a primary care physician within 180 days. Participants reported that the US health care previously seemed inaccessible but gained insurance, the ability to navigate the system, and the ability to help others in their community to access medical care because of the program. Limitations Small sample size and a single community may limit generalizability. Conclusions We reported the acceptability of a CHW intervention. We encountered challenges with feasibility and identified strategies to overcome them. Studies are needed to test the effect of CHW interventions on outcomes and kidney health disparities. Funding National Kidney Foundation young investigator research grant to Dr Novick. Plain Language Summary Latinx individuals are at a higher risk for kidney failure than non-Latinx White individuals; however, they are less likely to receive pre-kidney failure medical care. We piloted a community health worker intervention that connected people with risk factors or showed evidence of kidney dysfunction at community screening events with medical care. Our findings indicate the acceptability of the intervention. We encountered challenges with feasibility and identified strategies to overcome them.
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Affiliation(s)
- Tessa K. Novick
- Division of Nephrology, University of Texas at Austin, Dell Medical School, Austin, TX
- Department of Internal Medicine, University of Texas at Austin, Dell Medical School, Austin, TX
| | - Francisco Barrios
- Department of Internal Medicine, University of Texas at Austin, Dell Medical School, Austin, TX
| | - Michelle Osuna
- Department of Internal Medicine, University of Texas at Austin, Dell Medical School, Austin, TX
| | - Caroline Emery
- Department of Internal Medicine, University of Texas at Austin, Dell Medical School, Austin, TX
| | - Daniel Ramirez
- Department of Internal Medicine, University of Texas at Austin, Dell Medical School, Austin, TX
| | - Laura Palau
- Department of Internal Medicine, University of Texas at Austin, Dell Medical School, Austin, TX
| | - Sanjana Ravi
- Department of Internal Medicine, University of Texas at Austin, Dell Medical School, Austin, TX
| | - Michelle Lubetzky
- Division of Nephrology, University of Texas at Austin, Dell Medical School, Austin, TX
- Department of Internal Medicine, University of Texas at Austin, Dell Medical School, Austin, TX
| | - Evelyn Cruz
- Central Health, Department of Health Management Liasons, Austin, TX
| | - Deidra C. Crews
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lilia Cervantes
- Division of General Internal Medicine and Hospital Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO
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Gawlik A, Nacak Y, Kleinert J, Konerding U, Vitinius F. Theoretical Derivation of a Telephone-Based Health Coaching Intervention for Promoting Physical Activity and Healthy Nutrition. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6271. [PMID: 37444117 PMCID: PMC10341694 DOI: 10.3390/ijerph20136271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023]
Abstract
Present research regarding interventions to change behavior suffers from insufficient communication of their theoretical derivation. This insufficient communication is caused by the restrictions imposed by most of the relevant scientific journals. This impedes further intervention development. In this article, a telephone-based health coaching (TBHC) intervention is introduced using a format outside these restrictions. This intervention is seen as a combination of (1) the activities performed with the target persons, i.e., its core, and (2) measures to ensure the quality of the intervention. The theoretical derivation of the core is presented. The core is seen to consist of (1) the style of coach-patient interaction and (2) the contents of this interaction. The style of coach-patient interaction was derived from self-determination theory and was concretized using motivational interviewing techniques. The contents of the coach-patient interaction were derived from the health action process approach and were concretized using behavior-change techniques. The derivation led to (1) a set of 16 coaching tools referring to the different states in which a patient might be and containing state-specific recommendations for performing the coaching session, and (2) guidelines for selecting the appropriate coaching tool for each session. To ensure the quality of the intervention, a coach-training program before and supervision sessions during the TBHC were added.
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Affiliation(s)
- Angeli Gawlik
- Department of Health & Social Psychology, Institute of Psychology, German Sport University Cologne, 50933 Cologne, Germany;
| | - Yeliz Nacak
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50931 Cologne, Germany; (Y.N.); (F.V.)
| | - Jens Kleinert
- Department of Health & Social Psychology, Institute of Psychology, German Sport University Cologne, 50933 Cologne, Germany;
| | - Uwe Konerding
- Trimberg Research Academy, University of Bamberg, 96045 Bamberg, Germany;
- Department of Psychology and Psychotherapy, Witten/Herdecke University, 58455 Witten, Germany
| | - Frank Vitinius
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50931 Cologne, Germany; (Y.N.); (F.V.)
- Department of Psychosomatic Medicine, Robert-Bosch-Krankenhaus Stuttgart, 70376 Stuttgart, Germany
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Does Health Literacy Have an Impact on Adherence to Diabetes Mellitus Treatment? ENDOCRINES 2023. [DOI: 10.3390/endocrines4010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
(1) Background: Health literacy is the intersection of general literacy, health, and healthcare, but it can also incorporate elements of other types of literacies to varying degrees. The notion of literacy surfaced from the fear that individuals would require more than general literacy skills to manage the complexities of health and health system issues. There is a substantial overlap between general literacy and health literacy. Diabetes patients frequently misinterpret medication instructions, resulting in non-adherence and poor health outcomes. (2) Aim: This study sought to review the literature on the impacts of health literacy on adherence and compliance to diabetes mellitus treatment. (3) Methods: A Narrative Literature Review method was used to identify, analyze, assess, and interpret the available information on health literacy regarding prescribed medication instructions. The following databases and search engines were used to locate the literature: electronic databases, search engines, and hand searches. Fifty-three (53) quantitative and qualitative studies and two books were reviewed. (4) Result: The review pointed out the following: the importance of health literacy, the implications of health illiteracy versus medication non-adherence, factors influencing health literacy versus medication adherence, and the interventions to improve medication non-adherence. (5) Conclusion: Relatively few studies have been conducted on how people living with diabetes should carry out their treatment. Therefore, more research on how people living with diabetes carry out their treatment daily is required. (6) Contributions: This study has identified that health literacy plays a role in adherence to treatment and contributes to improved health outcomes.
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Zhuang M, Li CC, Chen SY, Tu XH, Liu L, Chen XL, Xu CW, Wang J. Development and validation of a Systemic Sclerosis Health Literacy Scale. Front Public Health 2023; 11:1038019. [PMID: 36908416 PMCID: PMC9996225 DOI: 10.3389/fpubh.2023.1038019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/31/2023] [Indexed: 02/25/2023] Open
Abstract
Background and aim Health literacy levels are strongly associated with clinical outcomes and quality of life in patients with chronic diseases, and patients with limited health literacy often require more medical care and achieve poorer clinical outcomes. Among the large number of studies on health literacy, few studies have focused on the health literacy of people with systemic sclerosis (SSc), and there is no specific tool to measure health literacy in this group. Therefore, this study plans to develop a health literacy scale for patients with SSc. Methods This study included 428 SSc patients from the outpatient and inpatient departments of the Department of Rheumatology and Immunology, the first affiliated Hospital of Anhui Medical University and the first affiliated Hospital of University of Science and Technology of China. The formulation of the scale was completed by forming the concept of health literacy of SSc patients, establishing the item pool, screening items, and evaluating reliability and validity. Classical measurement theory was used to screen items, factor analysis was used to explore the construct validity of the scale, and Cronbach's alpha coefficient was used to assess the internal consistency. Results Our study population was predominantly middle-aged women, with a male to female ratio of 1:5.7 and a mean age of 51.57 ± 10.99. A SSc Health Literacy scale with 6 dimensions and 30 items was developed. The six dimensions are clinic ability, judgment/evaluation information ability, access to information ability, social support, treatment compliance and application information ability. The Cronbach's alpha coefficient of the scale is 0.960, retest reliability is 0.898, split-half reliability is 0.953, content validity is 0.983, which has good reliability and validity. Conclusion The Systemic Sclerosis Health Literacy Scale may become a valid tool to evaluate the health literacy level of patients with SSc.
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Affiliation(s)
- Meng Zhuang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.,Medical Data Processing Center, Anhui Medical University, Hefei, China
| | - Cheng-Cheng Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.,Medical Data Processing Center, Anhui Medical University, Hefei, China
| | - Shan-Yu Chen
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xin-Hua Tu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.,Medical Data Processing Center, Anhui Medical University, Hefei, China
| | - Lian Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.,Medical Data Processing Center, Anhui Medical University, Hefei, China
| | - Xi-Lai Chen
- Department of Statistics, College of Statistics and Applied Mathematics, Anhui University of Finance and Economics, Bengbu, China
| | - Cheng-Wei Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.,Medical Data Processing Center, Anhui Medical University, Hefei, China
| | - Jing Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.,Medical Data Processing Center, Anhui Medical University, Hefei, China
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Assessing health literacy and subsequent implementation of an animated video to enhance understanding for patients with nephrolithiasis. Curr Urol 2022. [DOI: 10.1097/cu9.0000000000000172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Spivakovsky S, Suh YW, Janal MN. Development of KROHL, a tool for evaluating oral health knowledge. PEC INNOVATION 2022; 1:100100. [PMID: 37213780 PMCID: PMC10194188 DOI: 10.1016/j.pecinn.2022.100100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 10/06/2022] [Accepted: 11/07/2022] [Indexed: 05/23/2023]
Abstract
Objectives The authors aim to evaluate a scale assessing oral health knowledge, the KROHL (Knowledge Related to Oral Health Literacy) including the inter-rater reliability for scoring open-ended questions, internal consistency of the hypothesized scales, the discriminant validity of the resulting scale and its relationship to existing measures of oral health literacy. Methods The questionnaire was administered via face-to-face interviews to 144 volunteers recruited in the waiting areas of clinics throughout the NYU College of Dentistry.The KROHL questionnaire evaluates oral health knowledge by asking open-ended questions about the appearance, cause, treatment and prevention of caries, gum disease, oral cancer, tooth loss and malocclusion. Those 20 questions were scored to produce scale scores. Demographic information, a self-reported measure of HL and the CMOHK (Comprehensive Measure of Oral Health Knowledge) were also collected.Data were analyzed using Pearson correlation coefficients and principal components analysis, by computing Cronbach's alpha and Cohen's kappa, and by comparing group means with ANOVA. Results Kappa indicated good to excellent agreement among raters for the full and the individual subscales of the KROHL. Cronbach's alpha indicated good consistency of the full scale score, but not the individual scales. The mean (SD) KROHL score was lower in the patient group than in the dental students (13.3 (5.9) vs. 26.1 (4.7), p < .001), and varied directly with education level within the patients. KROHL scores were unrelated to existing measures of health literacy. Conclusions The KROHL scale is an innovative, reliable and valid tool to assess overall oral health knowledge and provide information to customize educational interventions. Further research is needed to determine the validity and reliability of the scale in multiple settings. Innovation The innovation of the KROHL tool of assessment of oral health knowledge lies in its ability to scale depth of knowledge within the domains of identification, causes, prevention, and treatment for the most common oral conditions.
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Affiliation(s)
- Silvia Spivakovsky
- Department of Oral and Maxillofacial Pathology, Radiology & Medicine, NYU College of Dentistry, New York, NY, USA
- Corresponding author at: 345 East 24 Street, room 829, New York, NY 10010, USA.
| | - Yoon Weon Suh
- New York University School of Dentistry, New York, NY, USA
- University of the Pacific Arthur A. Dugoni School of Dentistry, San Francisco, CA, USA
| | - Malvin N. Janal
- Department of Epidemiology and Health Promotion, NYU College of Dentistry, New York, NY, USA
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Tavousi M, Mohammadi S, Sadighi J, Zarei F, Kermani RM, Rostami R, Montazeri A. Measuring health literacy: A systematic review and bibliometric analysis of instruments from 1993 to 2021. PLoS One 2022; 17:e0271524. [PMID: 35839272 PMCID: PMC9286266 DOI: 10.1371/journal.pone.0271524] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 07/04/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND It has been about 30 years since the first health literacy instrument was developed. This study aimed to review all existing instruments to summarize the current knowledge on the development of existing measurement instruments and their possible translation and validation in other languages different from the original languages. METHODS The review was conducted using PubMed, Web of Science, Scopus, and Google Scholar on all published papers on health literacy instrument development and psychometric properties in English biomedical journals from 1993 to the end of 2021. RESULTS The findings were summarized and synthesized on several headings, including general instruments, condition specific health literacy instruments (disease & content), population- specific instruments, and electronic health. Overall, 4848 citations were retrieved. After removing duplicates (n = 2336) and non-related papers (n = 2175), 361 studies (162 papers introducing an instrument and 199 papers reporting translation and psychometric properties of an original instrument) were selected for the final review. The original instruments included 39 general health literacy instruments, 90 condition specific (disease or content) health literacy instruments, 22 population- specific instruments, and 11 electronic health literacy instruments. Almost all papers reported reliability and validity, and the findings indicated that most existing health literacy instruments benefit from some relatively good psychometric properties. CONCLUSION This review highlighted that there were more than enough instruments for measuring health literacy. In addition, we found that a number of instruments did not report psychometric properties sufficiently. However, evidence suggest that well developed instruments and those reported adequate measures of validation could be helpful if appropriately selected based on objectives of a given study. Perhaps an authorized institution such as World Health Organization should take responsibility and provide a clear guideline for measuring health literacy as appropriate.
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Affiliation(s)
- Mahmoud Tavousi
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Samira Mohammadi
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Jila Sadighi
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Fatemeh Zarei
- Faculty of Medical Sciences, Department of Health Education, Tarbiat Modares University, Tehran, Iran
| | - Ramin Mozafari Kermani
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Rahele Rostami
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Ali Montazeri
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
- Faculty of Humanity Sciences, University of Science and Culture, Tehran, Iran
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Chouinard MC, Lambert M, Lavoie M, Lambert SD, Hudon É, Dumont-Samson O, Hudon C. Measuring Health Literacy in Primary Healthcare: Adaptation and Validation of a French-Language Version of the Brief Health Literacy Screening among Patients with Chronic Conditions Seen in Primary Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137669. [PMID: 35805333 PMCID: PMC9265285 DOI: 10.3390/ijerph19137669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/13/2022] [Accepted: 06/20/2022] [Indexed: 02/05/2023]
Abstract
Background: The Brief Health Literacy Screening (BHLS) is a short self-report instrument developed to identify patients with inadequate health literacy. This study aimed to translate the BHLS into French Canadian (BHLS-FCv) and to evaluate its psychometric properties among patients with chronic conditions in primary care. Methods: The BHLS was translated into French using the Hawkins and Osborne’s method. Content validity was evaluated through cognitive interviews. A validation study of the BHLS-FCv was conducted in two primary care clinics in the province of Quebec (Canada) among adult patients with chronic conditions. Psychometric properties evaluated included: internal consistency (Cronbach’s alpha); test–retest reliability (intraclass correlation coefficient); and concurrent validity (Spearman’s correlations with the Health Literacy Questionnaire (HLQ)). Results: 178 participants completed the questionnaire at baseline and 47 completed the questionnaire two weeks later over the telephone. The average score was 13.3. Cronbach’s alpha for internal consistency was 0.77. The intraclass correlation coefficient for test–retest reliability was 0.69 (95% confidence interval: 0.45–0.83). Concurrent validity with Spearman’s correlation coefficient with three subscales of HLQ ranged from 0.28 to 0.58. Conclusions: The BHLS-FCv demonstrated acceptable psychometric properties and could be used in a population with chronic conditions in primary care.
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Affiliation(s)
- Maud-Christine Chouinard
- Faculté des Sciences Infirmières, Université de Montréal, 2375, Chemin de la Côte-Ste-Catherine, Montréal, QC H3T 1A8, Canada;
| | - Mireille Lambert
- Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, 305 Saint-Vallier, Saguenay, QC G7H 5H6, Canada;
| | - Mélissa Lavoie
- Département des Sciences de la Santé, Université du Québec à Chicoutimi, 555, Boulevard de l’Université, Saguenay, QC G7H 2B1, Canada; (M.L.); (É.H.)
| | - Sylvie D. Lambert
- Ingram School of Nursing, St. Mary’s Research Centre, 680 Sherbrooke West, Suite 1800, Montréal, QC H3A 2M7, Canada;
| | - Émilie Hudon
- Département des Sciences de la Santé, Université du Québec à Chicoutimi, 555, Boulevard de l’Université, Saguenay, QC G7H 2B1, Canada; (M.L.); (É.H.)
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC J1H 5N4, Canada
| | - Olivier Dumont-Samson
- Département de Médecine de Famille et de Médecine d’Urgence, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC J1H 5N4, Canada;
| | - Catherine Hudon
- Département de Médecine de Famille et de Médecine d’Urgence, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC J1H 5N4, Canada;
- Correspondence:
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Ahlstedt Karlsson S, Henoch I, Olofsson Bagge R, Wallengren C. An intervention mapping-based support program that empowers patients with endocrine therapy management. EVALUATION AND PROGRAM PLANNING 2022; 92:102071. [PMID: 35307615 DOI: 10.1016/j.evalprogplan.2022.102071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/10/2021] [Accepted: 03/13/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND For women diagnosed with hormone-receptor-positive breast cancer, endocrine therapy (ET) is recommended. Patients experience diverse side effects, and difficulties in managing these side effects have been identified as obstacles for treatment continuation. The aim of this study was to describe the development of a support program for patients prescribed ET. METHODS Intervention mapping (IM) a comprehensive theory-based approach was used in the support program development. A participatory design was used and four advisory groups was formed including both patients and healthcare professionals. RESULTS This study employed the systematic stages of IM to develop a theory-based support program with the goal to empower patients prescribed ET to manage ETrelated symptoms and problems, and to illuminate the healthcare structure. The needs assessment identified three performance objectives: (1) Patients have knowledge of and understand their symptoms and their management strategies. (2) Patients have the knowledge and confidence to express their care needs and to ask for guidance from healthcare professionals. (3) Patients are active in and lead their healthcare process. CONCLUSION This is a systematic developed model, built upon aspects of ET both from a patient´ perspective as well as from healthcare professionals' perspectives.
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Affiliation(s)
- Susanne Ahlstedt Karlsson
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, University of Gothenburg, Gothenburg, Sweden.
| | - Ingela Henoch
- Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, University of Gothenburg, Gothenburg, Sweden
| | - Roger Olofsson Bagge
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Catarina Wallengren
- Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, University of Gothenburg, Gothenburg, Sweden
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15
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Blanchard BE, Mata-Greve F, Johnson M, Fortney JC. Knowledge about Treatment (KaT) in Mental Health Services. MEASUREMENT AND EVALUATION IN COUNSELING AND DEVELOPMENT 2022; 56:81-98. [PMID: 37378000 PMCID: PMC10292725 DOI: 10.1080/07481756.2022.2041439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study developed and psychometrically evaluated a brief measure of mental health treatment knowledge (N = 726). Scores from Knowledge about Treatment (KaT) demonstrated a unidimensional measure with good model fit, internal consistency reliability, convergent and predictive validity, test-retest reliability, and measurement invariance across gender, ethnicity, education, and poverty status.
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Affiliation(s)
- Brittany E. Blanchard
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Felicia Mata-Greve
- Department of Veterans Affairs, Mental Health Service Line, Puget Sound VA Healthcare System, Seattle, WA, USA
| | - Morgan Johnson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - John C. Fortney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Department of Veterans Affairs, Center of Innovation for Veteran-Centered and Value-Driven Care, Puget Sound VA Healthcare System, Seattle, WA, USA
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Fan ZY, Yang Y, Yin RY, Tang L, Zhang F. Effect of Health Literacy on Decision Delay in Patients With Acute Myocardial Infarction. Front Cardiovasc Med 2021; 8:754321. [PMID: 34917660 PMCID: PMC8669267 DOI: 10.3389/fcvm.2021.754321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Health literacy (HL) is a risk factor for adverse outcomes in patients with cardiovascular disease, and shorter pre-hospital delay time is crucial for successful treatment of acute myocardial infraction (AMI) patients. Most previous studies focused on the influencing factors of pre-hospital delay but ignore the essential contribution of decision delay. Aims: Therefore, the purpose of this study was to explore the effect of HL on decision delay. Methods: Continuously included AMI patients admitted to a grade A class three hospital in Chongqing. HL level was assessed using Brief Health Literacy Screen and categorized as adequate or inadequate. Mann-Whitney U-test and Chi-square test were used to compare the differences between groups, and binary logistic regression was used to analyze the association between HL and decision delay. Results: A total of 217 AMI patients were enrolled in this study, including 166 males (76.5%) and 51 females (23.5%), with the median age was 68 years old; 135 (62.2%) patients had delayed decision-making while 82 (37.8%) did not; 157 (72.7%) patients had inadequate HL and 59 (27.3%) had adequate HL. The total HL score of non-delayed group was higher than that in delayed group (9.22 vs. 7.02, P < 0.000). Conclusion: After adjusting for covariates, HL was significantly negatively associated with decision time. AMI patients with inadequate HL were more likely to delay seeking timely medical care.
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Affiliation(s)
- Zhao-Ya Fan
- Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Yuan Yang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ruo-Yun Yin
- Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Lei Tang
- Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Fan Zhang
- Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing, China
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Konerding U, Redaèlli M, Ackermann K, Altin S, Appelbaum S, Biallas B, Bödecker AW, Botzenhardt S, Chermette C, Cichocki M, Dapper I, Dehnen K, Funke C, Gawlik A, Giesen L, Goetz J, Graf C, Hagen B, Heßbrügge M, Höhne PH, Kleinert J, Könnecke H, Küppers L, Kuth N, Lehmann L, Lendt C, Majjouti K, Nacak Y, Neuhausen A, Pilic L, Schneider L, Scholl M, Simic D, Sönnichsen A, Thielmann A, Van der Arend I, Vitinius F, Weltermann B, Wild D, Wilm S, Stock S. A pragmatic randomised controlled trial referring to a Personalised Self-management SUPport Programme (P-SUP) for persons enrolled in a disease management programme for type 2 diabetes mellitus and/or for coronary heart disease. Trials 2021; 22:659. [PMID: 34579783 PMCID: PMC8475316 DOI: 10.1186/s13063-021-05636-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 09/15/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) and coronary heart disease (CHD) are two chronic diseases that cause a tremendous burden. To reduce this burden, several programmes for optimising the care for these diseases have been developed. In Germany, so-called disease management programmes (DMPs), which combine components of Disease Management and the Chronic Care Model, are applied. These DMPs have proven effective. Nevertheless, there are opportunities for improvement. Current DMPs rarely address self-management of the disease, make no use of peer support, and provide no special assistance for persons with low health literacy and/or low patient activation. The study protocol presented here is for the evaluation of a programme that addresses these possible shortcomings and can be combined with current German DMPs for T2DM and CHD. This programme consists of four components: 1) Meetings of peer support groups 2) Personalised telephone-based health coaching for patients with low literacy and/or low patient activation 3) Personalised patient feedback 4) A browser-based web portal METHODS: Study participants will be adults enrolled in a DMP for T2DM and/or CHD and living in North Rhine-Westphalia, a state of the Federal Republic of Germany. Study participants will be recruited with the assistance of their general practitioners by the end of June 2021. Evaluation will be performed as a pragmatic randomised controlled trial with one intervention group and one waiting control group. The intervention group will receive the intervention for 18 months. During this time, the waiting control group will continue with usual care and the usual measures of their DMPs. After 18 months, the waiting control group will also receive a shortened intervention. The primary outcome is number of hospital days. In addition, the effects on self-reported health-state, physical activity, nutrition, and eight different psychological variables will be investigated. Differences between values at month 18 and at the beginning will be compared to judge the effectiveness of the intervention. DISCUSSION If the intervention proves effective, it may be included into the DMPs for T2DM and CHD. TRIAL REGISTRATION The study was registered in the German Clinical Trials Registry (Deutsches Register Klinischer Studien (DRKS)) in early 2019 under the number 00020592. This registry has been affiliated with the WHO Clinical Trials Network ( https://www.drks.de/drks_web/setLocale_EN.do ) since 2008. It is based on the WHO template, but contains some additional categories for which information has to be given ( https://www.drks.de/drks_web/navigate.do?navigationId=entryfields&messageDE=Beschreibung%20der%20Eingabefelder&messageEN=Description%20of%20entry%20fields ). A release and subsequent number assignment only take place when information for all categories has been given.
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Affiliation(s)
- Uwe Konerding
- Trimberg Research Academy, University of Bamberg, D-96045 Bamberg, Germany
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, D-58448 Witten, Germany
| | - Marcus Redaèlli
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne (Institut für Gesundheitsökonomie und Klinische Epidemiologie, Universitätsklinikum Köln), D-50924 Köln, Germany
| | - Karolin Ackermann
- Department of Psychosomatics and Psychotherapy, University Hospital Cologne (Klinik und Poliklinik für Psychosomatik und Psychotherapie, Universitätsklinikum Köln), Weyertal 76, 50931 Köln, Germany
| | - Sibel Altin
- General Local Health Insurance, Rheinland/Hamburg (Allgemeine Ortskrankenkasse, Rheinland/Hamburg), Kasernenstraße 61, D-40213 Düsseldorf, Germany
| | - Sebastian Appelbaum
- Trimberg Research Academy, University of Bamberg, D-96045 Bamberg, Germany
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, D-58448 Witten, Germany
| | - Bianca Biallas
- Institute of Movement Therapy and Movement-oriented Prevention and Rehabilitation, German Sport University Cologne (Institut für Bewegungstherapie und bewegungsorientierte Prävention und Rehabilitation, Deutsche Sporthochschule Köln), Am Sportpark Müngersdorf 6, D-50933 Köln, Germany
| | - August-Wilhelm Bödecker
- Teaching Unit of General Practice, University Hospital Cologne (Schwerpunkt Allgemeinmedizin, Universitätsklinikum Köln), D-50924 Köln, Germany
| | - Suzan Botzenhardt
- Institute of General Practice, University Duisburg-Essen (Institut für Allgemeinmedizin, Universität Duisburg-Essen), Hufelandstr. 55, D-45122 Essen, Germany
| | - Chloé Chermette
- Institute of Psychology, German Sport University Cologne (Institut für Psychologie, Deutsche Sporthochschule Köln), Am Sportpark Müngersdorf 6, D-50933 Köln, Germany
| | - Martin Cichocki
- Department of General Practice and Family Medicine, Medical University of Vienna (Abteilung für Allgemeinmedizin und Familienmedizin, Medizinischen Universität Wien), Kinderspitalgasse 15/1.Stock, A-1090 Wien, Austria
| | - Iris Dapper
- Teaching Unit of General Practice, University Hospital Cologne (Schwerpunkt Allgemeinmedizin, Universitätsklinikum Köln), D-50924 Köln, Germany
| | - Katja Dehnen
- Institute of General Practice, University Duisburg-Essen (Institut für Allgemeinmedizin, Universität Duisburg-Essen), Hufelandstr. 55, D-45122 Essen, Germany
| | - Christian Funke
- Institute of General Practice, Heinrich Heine University Düsseldorf (Institut für Allgemeinmedizin, Heinrich-Heine-Universität Düsseldorf), Post Office Box 10 10 07, D-40001 Düsseldorf, Germany
| | - Angeli Gawlik
- Institute of Psychology, German Sport University Cologne (Institut für Psychologie, Deutsche Sporthochschule Köln), Am Sportpark Müngersdorf 6, D-50933 Köln, Germany
| | - Lisa Giesen
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne (Institut für Gesundheitsökonomie und Klinische Epidemiologie, Universitätsklinikum Köln), D-50924 Köln, Germany
| | - Johannes Goetz
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne (Institut für Gesundheitsökonomie und Klinische Epidemiologie, Universitätsklinikum Köln), D-50924 Köln, Germany
| | - Christian Graf
- Barmer Health Insurance (Barmer Krankenversicherung), BARMER, Heerdter Lohweg 35, D-40549 Düsseldorf, Germany
| | - Bernd Hagen
- Central Research Institute of Ambulatory Health Care in Germany (Zentralinstitut für die Kassenärztliche Versorgung in Deutschland), Salzufer 8, D-10587 Berlin, Germany
| | - Martina Heßbrügge
- Institute of General Practice, University Duisburg-Essen (Institut für Allgemeinmedizin, Universität Duisburg-Essen), Hufelandstr. 55, D-45122 Essen, Germany
| | - Phillip Hendrick Höhne
- General Local Health Insurance, Rheinland/Hamburg (Allgemeine Ortskrankenkasse, Rheinland/Hamburg), Kasernenstraße 61, D-40213 Düsseldorf, Germany
| | - Jens Kleinert
- Institute of Psychology, German Sport University Cologne (Institut für Psychologie, Deutsche Sporthochschule Köln), Am Sportpark Müngersdorf 6, D-50933 Köln, Germany
| | - Helene Könnecke
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne (Institut für Gesundheitsökonomie und Klinische Epidemiologie, Universitätsklinikum Köln), D-50924 Köln, Germany
| | - Lucas Küppers
- Institute of Family Medicine and General Practice, University of Bonn (Institut für Hausarztmedizin, Universität Bonn), Venusberg-Campus 1, D-53127 Bonn, Germany
| | - Nicole Kuth
- Teaching Area of General Practice, University Hospital RWTH Aachen (Lehrgebiet für Allgemeinmedizin Uniklinik RWTH Aachen), Pauwelsstraße 30, D-52074 Aachen, Germany
| | - Lion Lehmann
- Teaching Unit of General Practice, University Hospital Cologne (Schwerpunkt Allgemeinmedizin, Universitätsklinikum Köln), D-50924 Köln, Germany
| | - Claas Lendt
- Institute of Movement Therapy and Movement-oriented Prevention and Rehabilitation, German Sport University Cologne (Institut für Bewegungstherapie und bewegungsorientierte Prävention und Rehabilitation, Deutsche Sporthochschule Köln), Am Sportpark Müngersdorf 6, D-50933 Köln, Germany
| | - Khalid Majjouti
- Institute of Family Medicine and General Practice, University of Bonn (Institut für Hausarztmedizin, Universität Bonn), Venusberg-Campus 1, D-53127 Bonn, Germany
| | - Yeliz Nacak
- Department of Psychosomatics and Psychotherapy, University Hospital Cologne (Klinik und Poliklinik für Psychosomatik und Psychotherapie, Universitätsklinikum Köln), Weyertal 76, 50931 Köln, Germany
| | - Aliza Neuhausen
- Department of Psychosomatics and Psychotherapy, University Hospital Cologne (Klinik und Poliklinik für Psychosomatik und Psychotherapie, Universitätsklinikum Köln), Weyertal 76, 50931 Köln, Germany
| | - Larisa Pilic
- Teaching Unit of General Practice, University Hospital Cologne (Schwerpunkt Allgemeinmedizin, Universitätsklinikum Köln), D-50924 Köln, Germany
| | - Lara Schneider
- Department of Psychosomatics and Psychotherapy, University Hospital Cologne (Klinik und Poliklinik für Psychosomatik und Psychotherapie, Universitätsklinikum Köln), Weyertal 76, 50931 Köln, Germany
| | - Maximilian Scholl
- Institute of Movement Therapy and Movement-oriented Prevention and Rehabilitation, German Sport University Cologne (Institut für Bewegungstherapie und bewegungsorientierte Prävention und Rehabilitation, Deutsche Sporthochschule Köln), Am Sportpark Müngersdorf 6, D-50933 Köln, Germany
| | - Dusan Simic
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne (Institut für Gesundheitsökonomie und Klinische Epidemiologie, Universitätsklinikum Köln), D-50924 Köln, Germany
| | - Andreas Sönnichsen
- Department of General Practice and Family Medicine, Medical University of Vienna (Abteilung für Allgemeinmedizin und Familienmedizin, Medizinischen Universität Wien), Kinderspitalgasse 15/1.Stock, A-1090 Wien, Austria
| | - Anika Thielmann
- Institute of Family Medicine and General Practice, University of Bonn (Institut für Hausarztmedizin, Universität Bonn), Venusberg-Campus 1, D-53127 Bonn, Germany
| | - Ines Van der Arend
- Teaching Area of General Practice, University Hospital RWTH Aachen (Lehrgebiet für Allgemeinmedizin Uniklinik RWTH Aachen), Pauwelsstraße 30, D-52074 Aachen, Germany
| | - Frank Vitinius
- Department of Psychosomatics and Psychotherapy, University Hospital Cologne (Klinik und Poliklinik für Psychosomatik und Psychotherapie, Universitätsklinikum Köln), Weyertal 76, 50931 Köln, Germany
| | - Birgitta Weltermann
- Institute of Family Medicine and General Practice, University of Bonn (Institut für Hausarztmedizin, Universität Bonn), Venusberg-Campus 1, D-53127 Bonn, Germany
| | - Dorothea Wild
- Institute of Family Medicine and General Practice, University of Bonn (Institut für Hausarztmedizin, Universität Bonn), Venusberg-Campus 1, D-53127 Bonn, Germany
| | - Stefan Wilm
- Institute of General Practice, Heinrich Heine University Düsseldorf (Institut für Allgemeinmedizin, Heinrich-Heine-Universität Düsseldorf), Post Office Box 10 10 07, D-40001 Düsseldorf, Germany
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne (Institut für Gesundheitsökonomie und Klinische Epidemiologie, Universitätsklinikum Köln), D-50924 Köln, Germany
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Sherman KA, Kilby CJ, Pehlivan M, Smith B. Adequacy of measures of informed consent in medical practice: A systematic review. PLoS One 2021; 16:e0251485. [PMID: 34043651 PMCID: PMC8159027 DOI: 10.1371/journal.pone.0251485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/28/2021] [Indexed: 11/19/2022] Open
Abstract
As a critical component of medical practice, it is alarming that patient informed consent does not always reflect (1) adequate information provision, (2) comprehension of provided information, and (3) a voluntary decision. Consequences of poor informed consent include low patient satisfaction, compromised treatment adherence, and litigation against medical practitioners. To ensure a well-informed, well-comprehended, and voluntary consent process, the objective and replicable measurement of these domains via psychometrically sound self-report measures is critical. This systematic review aimed to evaluate the adequacy of existing measures in terms of the extent to which they assess the three domains of informed consent, are psychometrically sound and acceptable for use by patients. Extensive searching of multiple databases (PsychINFO, PubMed, Sociological Abstracts, CINAHL, AMED) yielded 10,000 potential studies, with 16 relevant scales identified. No existing scale was found to measure all three consent domains, with most only narrowly assessing aspects of any one domain. Information provision was the most frequently assessed domain, followed by comprehension, and then voluntariness. None of the identified scales were found to have adequate evidence for either high quality psychometric properties or patient user acceptability. No existing scale is fit for purpose in comprehensively assessing all domains of informed consent. In the absence of any existing measure meeting the necessary criteria relating to information, comprehension and voluntariness, there is an urgent need for a new measure of medical consent to be developed that is psychometrically sound, spans all three domains and is acceptable to patients and clinicians alike. These findings provide the impetus and justification for the redesign of the informed consent process, with the aim to provide a robust, reliable and replicable process that will in turn improve the quality of the patient experience and care provided.
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Affiliation(s)
- Kerry A. Sherman
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
- * E-mail:
| | | | - Melissa Pehlivan
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Brittany Smith
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
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Fabbri M, Murad MH, Wennberg AM, Turcano P, Erwin PJ, Alahdab F, Berti A, Manemann SM, Yost KJ, Finney Rutten LJ, Roger VL. Health Literacy and Outcomes Among Patients With Heart Failure: A Systematic Review and Meta-Analysis. JACC-HEART FAILURE 2021; 8:451-460. [PMID: 32466837 DOI: 10.1016/j.jchf.2019.11.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/04/2019] [Accepted: 11/06/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The purpose of this study was to determine if health literacy is associated with mortality, hospitalizations, or emergency department (ED) visits among patients living with heart failure (HF). BACKGROUND Growing evidence suggests an association between health literacy and health-related outcomes in patients with HF. METHODS We searched Embase, MEDLINE, PsycINFO, and EBSCO CINAHL from inception through January 1, 2019, with the help of a medical librarian. Eligible studies evaluated health literacy among patients with HF and assessed mortality, hospitalizations, and ED visits for all causes with no exclusion by time, geography, or language. Two reviewers independently selected studies, extracted data, and assessed the methodological quality of the identified studies. RESULTS We included 15 studies, 11 with an overall high methodological quality. Among the observational studies, an average of 24% of patients had inadequate or marginal health literacy. Inadequate health literacy was associated with higher unadjusted risk for mortality (risk ratio [RR]: 1.67; 95% confidence interval [CI]: 1.18 to 2.36), hospitalizations (RR: 1.19; 95% CI: 1.09 to 1.29), and ED visits (RR: 1.17; 95% CI: 1.03 to 1.32). When the adjusted measurements were combined, inadequate health literacy remained statistically associated with mortality (RR: 1.41; 95% CI: 1.06 to 1.88) and hospitalizations (RR: 1.12; 95% CI: 1.01 to 1.25). Among the 4 interventional studies, 2 effectively improved outcomes among patients with inadequate health literacy. CONCLUSIONS In this study, the estimated prevalence of inadequate health literacy was high, and inadequate health literacy was associated with increased risk of death and hospitalizations. These findings have important clinical and public health implications and warrant measurement of health literacy and deployment of interventions to improve outcomes.
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Affiliation(s)
- Matteo Fabbri
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - M Hassan Murad
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota; Mayo Clinic Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Fares Alahdab
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota; Mayo Clinic Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota
| | - Alvise Berti
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sheila M Manemann
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Kathleen J Yost
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Lila J Finney Rutten
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Véronique L Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
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van Wijk L, van der Snee L, Buis CI, Hentzen JEKR, Haveman ME, Klaase JM. A prospective cohort study evaluating screening and assessment of six modifiable risk factors in HPB cancer patients and compliance to recommended prehabilitation interventions. Perioper Med (Lond) 2021; 10:5. [PMID: 33593437 PMCID: PMC7887817 DOI: 10.1186/s13741-020-00175-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/28/2020] [Indexed: 02/07/2023] Open
Abstract
Introduction Despite improvements in perioperative care, major abdominal surgery continues to be associated with significant perioperative morbidity. Accurate preoperative risk stratification and optimisation (prehabilitation) are necessary to reduce perioperative morbidity. This study evaluated the screening and assessment of modifiable risk factors amendable for prehabilitation interventions and measured the patient compliance rate with recommended interventions. Method Between May 2019 and January 2020, patients referred to our hospital for HPB surgery were screened and assessed on six modifiable preoperative risk factors. The risk factors and screening tools used, with cutoff values, included (i) low physical fitness (a 6-min walk test < 82% of patient’s calculated norm and/or patient’s activity level not meeting the global recommendations on physical activity for health). Patients who were unfit based on the screening were assessed with a cardiopulmonary exercise test (anaerobic threshold ≤ 11 mL/kg/min); (ii) malnutrition (patient-generated subjective global assessment ≥ 4); (iii) iron-deficiency anaemia (haemoglobin < 12 g/dL for women, < 13 g/dL for men and transferrin saturation ≤ 20%); (iv) frailty (Groningen frailty indicator/Robinson frailty score ≥ 4); (v) substance use (smoking and alcohol use of > 5 units per week) and (vi) low psychological resilience (Hospital Anxiety and Depression Scale ≥ 8). Patients had a consultation with the surgeon on the same day as their screening. High-risk patients were referred for necessary interventions. Results One hundred consecutive patients were screened at our prehabilitation outpatient clinic. The prevalence of high-risk patients per risk factor was 64% for low physical fitness, 42% for malnutrition, 32% for anaemia (in 47% due to iron deficiency), 22% for frailty, 12% for smoking, 18% for alcohol use and 21% for low psychological resilience. Of the 77 patients who were eventually scheduled for surgery, 53 (68.8%) needed at least one intervention, of whom 28 (52.8%) complied with 100% of the necessary interventions. The median (IQR) number of interventions needed in the 77 patients was 1.0 (0–2). Conclusion It is feasible to screen and assess all patients referred for HPB cancer surgery for six modifiable risk factors. Most of the patients had at least one risk factor that could be optimised. However, compliance with the suggested interventions remains challenging. Supplementary Information The online version contains supplementary material available at 10.1186/s13741-020-00175-z.
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Affiliation(s)
- Laura van Wijk
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Centre Groningen, PO Box 30001, 9700, RB, Groningen, The Netherlands.
| | - Lizzel van der Snee
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Centre Groningen, PO Box 30001, 9700, RB, Groningen, The Netherlands
| | - Carlijn I Buis
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Centre Groningen, PO Box 30001, 9700, RB, Groningen, The Netherlands
| | - Judith E K R Hentzen
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Centre Groningen, PO Box 30001, 9700, RB, Groningen, The Netherlands
| | - Marjolein E Haveman
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Centre Groningen, PO Box 30001, 9700, RB, Groningen, The Netherlands
| | - Joost M Klaase
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Centre Groningen, PO Box 30001, 9700, RB, Groningen, The Netherlands
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Perrin A, Siqueira do Prado L, Duché A, Schott AM, Dima AL, Haesebaert J. Using the Brief Health Literacy Screen in Chronic Care in French Hospital Settings: Content Validity of Patient and Healthcare Professional Reports. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E96. [PMID: 33375574 PMCID: PMC7795429 DOI: 10.3390/ijerph18010096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 12/19/2022]
Abstract
Person-centered care has led healthcare professionals (HCPs) to be more attentive to patients' ability to understand and apply health-related information, especially those with chronic conditions. The concept of health literacy (HL) is essential in understanding patients' needs in routine care, but its measurement is still controversial, and few tools are validated in French. We therefore considered the brief health literacy screen (BHLS) for assessing patient-reported HL in chronic care settings, and also developed an HCP-reported version of the BHLS with the aim of using it as a research instrument to assess HCPs' evaluation of patients' HL levels. We assessed the content validity of the French translation of both the patient-reported and HCP-reported BHLS in chronic care within hospital settings, through cognitive interviews with patients and HCPs. We performed qualitative analysis on interview data using the survey response Tourangeau model. Our results show that the BHLS is easy and quick to administer, but some terms need to be adapted to the French chronic care settings. Health-related information was observed to be mainly communicated orally, hence a useful direction for future literacy measures would be to also address verbal HL.
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Affiliation(s)
- Adèle Perrin
- Health Services and Performance Research, Université Claude Bernard Lyon 1, 69100 Lyon, France; (A.P.); (L.S.d.P.); (A.D.); (A.-M.S.); (A.L.D.)
| | - Luiza Siqueira do Prado
- Health Services and Performance Research, Université Claude Bernard Lyon 1, 69100 Lyon, France; (A.P.); (L.S.d.P.); (A.D.); (A.-M.S.); (A.L.D.)
| | - Amélie Duché
- Health Services and Performance Research, Université Claude Bernard Lyon 1, 69100 Lyon, France; (A.P.); (L.S.d.P.); (A.D.); (A.-M.S.); (A.L.D.)
| | - Anne-Marie Schott
- Health Services and Performance Research, Université Claude Bernard Lyon 1, 69100 Lyon, France; (A.P.); (L.S.d.P.); (A.D.); (A.-M.S.); (A.L.D.)
- Pôle de Santé Publique, Hospices Civils de Lyon, 69002 Lyon, France
| | - Alexandra L. Dima
- Health Services and Performance Research, Université Claude Bernard Lyon 1, 69100 Lyon, France; (A.P.); (L.S.d.P.); (A.D.); (A.-M.S.); (A.L.D.)
| | - Julie Haesebaert
- Health Services and Performance Research, Université Claude Bernard Lyon 1, 69100 Lyon, France; (A.P.); (L.S.d.P.); (A.D.); (A.-M.S.); (A.L.D.)
- Pôle de Santé Publique, Hospices Civils de Lyon, 69002 Lyon, France
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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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Nair D, Finkelstein FO. Pruritus as a Patient-Reported Primary Trial End Point in Hemodialysis: Evaluation and Implications. Am J Kidney Dis 2020; 76:148-151. [PMID: 32334827 DOI: 10.1053/j.ajkd.2020.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 01/19/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Devika Nair
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Center for Kidney Disease, Nashville, TN
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24
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Hawkins M, Elsworth GR, Hoban E, Osborne RH. Questionnaire validation practice within a theoretical framework: a systematic descriptive literature review of health literacy assessments. BMJ Open 2020; 10:e035974. [PMID: 32487577 PMCID: PMC7265003 DOI: 10.1136/bmjopen-2019-035974] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Validity refers to the extent to which evidence and theory support the adequacy and appropriateness of inferences based on score interpretations. The health sector is lacking a theoretically-driven framework for the development, testing and use of health assessments. This study used the Standards for Educational and Psychological Testing framework of five sources of validity evidence to assess the types of evidence reported for health literacy assessments, and to identify studies that referred to a theoretical validity testing framework. METHODS A systematic descriptive literature review investigated methods and results in health literacy assessment development, application and validity testing studies. Electronic searches were conducted in EBSCOhost, Embase, Open Access Theses and Dissertations and ProQuest Dissertations. Data were coded to the Standards' five sources of validity evidence, and for reference to a validity testing framework. RESULTS Coding on 46 studies resulted in 195 instances of validity evidence across the five sources. Only nine studies directly or indirectly referenced a validity testing framework. Evidence based on relations to other variables is most frequently reported. CONCLUSIONS The health and health equity of individuals and populations are increasingly dependent on decisions based on data collected through health assessments. An evidence-based theoretical framework provides structure and coherence to existing evidence and stipulates where further evidence is required to evaluate the extent to which data are valid for an intended purpose. This review demonstrates the use of the Standards' theoretical validity testing framework to evaluate sources of evidence reported for health literacy assessments. Findings indicate that theoretical validity testing frameworks are rarely used to collate and evaluate evidence in validation practice for health literacy assessments. Use of the Standards' theoretical validity testing framework would improve evaluation of the evidence for inferences derived from health assessment data on which public health and health equity decisions are based.
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Affiliation(s)
- Melanie Hawkins
- Faculty of Health, Deakin University School of Health and Social Development, Burwood, Victoria, Australia
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Gerald R Elsworth
- Faculty of Health, Deakin University School of Health and Social Development, Burwood, Victoria, Australia
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Elizabeth Hoban
- Faculty of Health, Deakin University School of Health and Social Development, Burwood, Victoria, Australia
| | - Richard H Osborne
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria, Australia
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Applying the Medications at Transitions and Clinical Handoffs Toolkit in a Rural Primary Care Clinic: Implications for Nursing, Patients, and Caregivers. J Nurs Care Qual 2020; 35:233-239. [PMID: 32433146 PMCID: PMC7247934 DOI: 10.1097/ncq.0000000000000454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is Available in the Text. Background: Adequate medication reconciliation is related to patients' safety. Rural populations are at increased risk of adverse drug events due to errors in medication reconciliation and often receiving medical care across multiple health care entities and across long distances with separate electronic medical records. Methods: This study examined the implementation of Medications at Transitions and Clinical Handoffs Toolkit (MATCH) in a rural primary care clinic and assessed the acceptability and feasibility of implementation. Intervention: MATCH was developed as a workflow process intervention to improve medication reconciliation. Results: Findings from MATCH implementation indicate that the process improved medication reconciliation workflow. A shared definition of current medications across providers and patients was essential. Conclusions: Empowering patients and caregivers with tools and language to work with providers, particularly nurses, to conduct medication reconciliation during primary care clinic visits is key to improving patient medication reconciliation in rural settings.
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26
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Haddad N, Paranjpe R, Rizk E, Basit SA, McNamara C, Okoro E, Gilmore J, Liebl M, Swan JT. Value of pharmacy services in an outpatient, preoperative, anesthesia clinic. J Am Pharm Assoc (2003) 2020; 60:e264-e278. [PMID: 32303426 DOI: 10.1016/j.japh.2020.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/11/2020] [Accepted: 03/14/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This pilot study assessed the expansion of pharmacy services to a preoperative, anesthesia clinic. SETTING Tertiary care academic medical center. PRACTICE DESCRIPTION Medication histories were routinely obtained by clinic nurses, and pharmacy services were not available. PRACTICE INNOVATION A prospective, single-center, pilot study enrolled English-speaking patients aged 65 years or older in a preoperative clinic before a scheduled surgery. Patient attributes including health literacy and preparatory activities were measured using verbal and written questionnaires. Home medication lists were obtained by both clinic nurses (routine care) and a pharmacist (research), and the 2 lists were compared to identify medication discrepancies for each patient. Discrepancies were categorized by type and severity. EVALUATION This study evaluated the potential impact of medication histories obtained by pharmacists compared with those obtained by clinic nurses during geriatric preoperative clinic visits. RESULTS Of the 44 patients who gave their consent and were included in this pilot study, 25% (n = 11) had limited/marginal written and verbal health literacy, and 20% (n = 9) had limited/marginal numerical health literacy. Of the 38 patients who completed the pharmacist medication history interview, only 21% (n = 8) brought a complete list of their current medications to the preoperative clinic, 95% (n = 36) had at least 1 medication discrepancy, and 61% (n = 23) had at least 1 clinically meaningful discrepancy. Clinically meaningful discrepancies were identified for 8% (35 of 459) of medications and occurred most commonly for blood pressure medications, nonsteroidal anti-inflammatory drugs, and beta blockers. CONCLUSION In this study, medication history discrepancies identified by pharmacists suggest that the expansion of pharmacy services into the preoperative clinic is feasible and could potentially prevent meaningful medication errors among geriatric patients being admitted for a scheduled surgery.
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Wang C, Wang P, Dong H, Zhang L, Wu T. The influence of value reference point and risk preference on adherence in hypertensive patients in a low-income area of China. Postgrad Med 2020; 132:132-140. [PMID: 31900018 DOI: 10.1080/00325481.2019.1702849] [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: 12/25/2022]
Abstract
Aims: Prevention and control of hypertension can be achieved by improving patient adherence to long-term treatment regimens. Non-adherence is an obstacle to chronic disease management. We studied the impact of value reference point and risk preference on patient adherence and influencing factors from the perspective of behavioral economics so as to offer targeted recommendations to improving patient adherence in low-income areas.Methods: A representative impoverished area, Qianjiang District in Chongqing was selected as the sample district. A cross-sectional survey using questionnaire augmented with an interview was conducted to collect information with 321 patients previously diagnosed with hypertension stage 3. Preference experiments conducted through scenario simulation were used to elicit and measure patients' value and risk preferences. We constructed a structural equation model to verify the impact of value reference points and risk preference on adherence behavior decision-making. Logistic regression models were constructed to analyze other factors that may influence adherence.Results: Adherence was determined by patients' value reference points (path coefficient = 0.876, p < 0.01) and risk preference (path coefficient = 0.715, p < 0.01). The factor loadings of all indicators on the latent variables were significant (p < 0.01). Hypertensive patients in our cohort adhered poorly to health management and were heavily influenced by knowledge of hypertension, expectation, health literacy and opportunity costs. Certainty effect, overconfidence and optimism significantly affected patients' risk preference in decision-making progress. In the face of the uncertain benefits of adherence, patients preferred to delay treatment until condition affected their quality of life, resulting in poor adherence. Satisfaction with current services and relationship with physicians, as well as type of drugs also influenced adherence.Conclusions: Adherence may be improved by changing patients' value reference points and perceptions through health education and better health service resources. One of the key to increasing adherence is through identifying and eliminating bias.
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Affiliation(s)
- Chenli Wang
- China Hospital Development Institute, School of Public Health, Shanghai Jiaotong University, Shanghai, China
| | - Peilong Wang
- Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hengjin Dong
- School of Public Health, Zhejiang University, Hangzhou, China
| | - Liang Zhang
- School of Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Wu
- School of Medicine, Shanghai Jiaotong University, Shanghai, China
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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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O'Brien KH. Social determinants of health: the how, who, and where screenings are occurring; a systematic review. SOCIAL WORK IN HEALTH CARE 2019; 58:719-745. [PMID: 31431190 DOI: 10.1080/00981389.2019.1645795] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Screening for social determinants of health allows health care teams to assess and address social factors that influence one's health, mental health, and access to care. These social factors include poverty, health literacy, social support, exposure to trauma, food insecurity, and housing instability. The objective of this study was to examine what screening tools for social determinants of health are being used, in what contexts, and with what populations. Findings suggest that health literacy is the most commonly screened for, followed by trauma history, social support, food insecurity and housing across diverse contexts and populations. Results from this study can be used to inform providers of available screening tools and resources that can be readily utilized in practice.
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Affiliation(s)
- Kyle H O'Brien
- School of Health and Human Services, Department of Social Work, Southern Connecticut State University , New Haven , CT , USA
- Department of Health and Movement Sciences, Southern Connecticut State University , New Haven , CT , USA
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Health literacy and health-related quality of life in patients with anorectal malformations: A comparison between a charity hospital in Honduras and a tertiary care center in the United States. J Pediatr Surg 2018; 53:1951-1954. [PMID: 29550037 DOI: 10.1016/j.jpedsurg.2018.02.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/23/2018] [Accepted: 02/14/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND/PURPOSE We conduct an annual medical mission to Hospital Ruth Paz para Niños Quemados y Cirugía Pediátrica in Honduras to operate on cases of anorectal malformations (ARM). To improve our knowledge of these patients, we compared their health-related quality of life (HRQoL), and the health literacy of their caregivers from this hospital and ours in the United States. METHODS The BRIEF Health Literacy Screen (BHLS) and Pediatric Quality of Life Inventory 4.0 (PedsQL) were used, respectively, to assess the health literacy and HRQoL of their guardians. All patients scheduled for an ARM-related operation in October 2016 were eligible for inclusion, and a matched population was selected in Nationwide Children's Hospital, Columbus, Ohio. RESULTS The sample comprised 127 patients, with 22 from Honduras and 105, the US. About 13.6% and 80% of Honduran and American caregivers, respectively, had adequate literacy. Honduran and American caregivers of patients aged 12 months and below rated the HRQoL of their children at 87 and 82, respectively; aged between two and four years, at 84 and 77; aged between two and four years, at 85 and 79; and of teens, at 59 and 66. For adults, the rate was 71 and 77 in Honduras and the US, respectively. CONCLUSION Although health literacy is extremely low in the Honduran group, its HRQoL was comparable to that of its American counterpart. Improving health literacy by educating caregivers could be an additional goal for medical missions in the future. LEVEL OF EVIDENCE Level III.
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Harnett S. Promoting Health Literacy in the Inpatient Setting: Assessment and Interventions. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2017. [DOI: 10.1080/15398285.2017.1377543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Susan Harnett
- Medical Information Services Librarian, Borland Health Sciences Library, University of Florida, Jacksonville, FL, USA
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Dingemans AJM, Reck CA, Vilanova-Sanchez A, Gonzalez DO, Gasior AC, Weaver LJ, Gagnon R, Hoover E, Sraha G, Levitt MA, Wood RJ. Does clinic visit education within a multidisciplinary center improve health literacy scores in caregivers of children with complex colorectal conditions? J Pediatr Surg 2017; 52:1997-2000. [PMID: 29223544 DOI: 10.1016/j.jpedsurg.2017.08.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Health literacy is low in an estimated one-third of the US population. Little is known about the health literacy of caregivers of children with colorectal conditions. The objective of this study was to investigate whether a timed health literacy intervention could improve health literacy in this population. METHODS We used the BRIEF Health Literacy screening (BHLS) tool on caregivers of children who came to our colorectal clinic. Health literacy was categorized as inadequate, marginal, or adequate. The number of caregivers with adequate health literacy was compared to the number of clinic visits and socioeconomic status. RESULTS We included 233 caregivers. The average number of clinic visits was 3.5 over 1.2years. At the first clinic visit, 70% (n=98) of caregivers had "adequate" health literacy. Scores improved to 88% (p=0.024) after the fourth visit. Socioeconomic factors were not associated with health literacy. Patients of caregivers with "adequate" health literacy visited our clinic 3.8 times, compared to 2.7 times for those with lower literacy (p=0.006). CONCLUSION Emphasis on providing an education-based approach at each visit increased health literacy significantly. As expected, health literacy was lowest during the first visit, which we believe is the optimal time to implement educational interventions. TYPE OF STUDY Case Control/Retrospective Comparative Study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Alexander J M Dingemans
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH.
| | - Carlos A Reck
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH
| | | | - Dani O Gonzalez
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH
| | - Alessandra C Gasior
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH
| | - Laura J Weaver
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH
| | - Renae Gagnon
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH
| | - Erin Hoover
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH
| | - Gabriel Sraha
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH
| | - Marc A Levitt
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH
| | - Richard J Wood
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH
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Wetta RE, Severin RD, Gruhler H, Lewis N. Capturing health literacy assessment in the electronic health record through evidence-based concept creation: A review of the literature and recommendations for action. Health Informatics J 2017; 25:1025-1037. [PMID: 29113528 DOI: 10.1177/1460458217739341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Health literacy is the capacity to understand and act upon health-related information and navigate the healthcare system. Published evidence demonstrates a relationship between health literacy and health status. Because of this, there are increasingly calls for a health literacy assessment to be collected and stored in the electronic health record for use by the healthcare team. This article describes the results of a literature review of health literacy assessment instruments with the goal of formulating semantically interoperable concepts that may be used to store the interpretation of the health literacy assessment in the electronic health record. The majority of health literacy instruments could be stored in the electronic health record using a three-concept solution of inadequate, marginal and adequate health literacy. This three-concept solution fully supports semantic interoperability needs across the patient care spectrum.
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Affiliation(s)
- Ruth E Wetta
- Cerner Corporation, USA; University of Kansas, USA
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Cox SR, Liebl MG, McComb MN, Chau JQ, Wilson AA, Achi M, Garey KW, Wallace D. Association between health literacy and 30-day healthcare use after hospital discharge in the heart failure population. Res Social Adm Pharm 2016; 13:754-758. [PMID: 28277275 DOI: 10.1016/j.sapharm.2016.09.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 09/19/2016] [Indexed: 01/29/2023]
Abstract
BACKGROUND Low health literacy increases the risk for hospital readmissions. Despite this, the measurement and use of health literacy to guide discharge counseling and planning in heart failure patients is not commonly performed. A short 3-Question Brief Health Literacy Screen (BHLS) is available and takes less than three minutes to complete, but has never been evaluated to help determine whether health literacy affects healthcare use after discharge in patients with heart failure. OBJECTIVE The purpose of this study was to assess 30-day readmissions and emergency department visits based on health literacy evaluated by the BHLS in an acute care heart failure population. METHODS This was a prospective observational cohort study conducted at a large quaternary health system. Hospitalized patients with a diagnosis of heart failure were assessed for health literacy using the BHLS. Unplanned healthcare use after discharge including 30-day, all-cause ED visits and hospital readmissions was assessed using univariate and logistic regression models. RESULTS Two hundred and sixty four patients aged 66.6 ± 14.3 (mean ± SD) years met inclusion/exclusion criteria of whom 175 (66.3%) had a BHLS score >9 (adequate health literacy) and 89 (33.7%) had a BHLS score ≤9 (low health literacy). Predictors of low health literacy included older age (p = 0.019), lower education level (p < 0.001) and unemployed (p = 0.048). After controlling for potential confounders, low health literacy was independently associated with 30-day healthcare use after hospital discharge (OR:1.80; 95% CI: 1.04-3.11; p = 0.035). CONCLUSION Using a short, 3-question validated survey instrument, it was demonstrated that low health literacy was associated with increased 30-day unplanned healthcare use after discharge in this heart failure population. These results provide a clinically useful, easily incorporated tool that could identify high-risk patients at need for clinical interventions.
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Affiliation(s)
- Sarah R Cox
- Department of Pharmacy, Houston Methodist Hospital, 6565 Fannin St., Houston, TX 77030, USA; University of Houston College of Pharmacy, 1441 Moursund Street, Houston, TX 77030, USA.
| | - Michael G Liebl
- Department of Pharmacy, Houston Methodist Hospital, 6565 Fannin St., Houston, TX 77030, USA.
| | - Meghan N McComb
- Department of Pharmacy, Houston Methodist Hospital, 6565 Fannin St., Houston, TX 77030, USA.
| | - Jason Q Chau
- Department of Pharmacy, Houston Methodist Hospital, 6565 Fannin St., Houston, TX 77030, USA.
| | - Allison A Wilson
- Department of Pharmacy, Houston Methodist Hospital, 6565 Fannin St., Houston, TX 77030, USA.
| | - May Achi
- Department of Pharmacy, Houston Methodist Hospital, 6565 Fannin St., Houston, TX 77030, USA.
| | - Kevin W Garey
- University of Houston College of Pharmacy, 1441 Moursund Street, Houston, TX 77030, USA.
| | - David Wallace
- University of Houston College of Pharmacy, 1441 Moursund Street, Houston, TX 77030, USA.
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Sand-Jecklin K, Daniels CS, Lucke-Wold N. Incorporating Health Literacy Screening Into Patients’ Health Assessment. Clin Nurs Res 2016; 26:176-190. [PMID: 26749208 DOI: 10.1177/1054773815619592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Low health literacy (HL) has been associated with several negative health outcomes, yet routine HL screening is not commonplace. This study’s purpose was to determine the feasibility of incorporating HL screening into the electronic health record (EHR) of patients admitted to a large Mid-Atlantic teaching hospital. After Registered Nurse (RN) training, the HL screening was implemented for all adult patients upon admission. After implementation, RNs were surveyed about the feasibility of HL screening, and patient EHRs were reviewed for HL status. Results indicated that RNs were receptive to HL screening. Approximately 20% of all patients screened were at risk for low HL, with HL scores decreasing as age increased. Patients with low HL had significantly higher hospital readmissions, even when controlling for age and number of health conditions. Further research is needed to determine how healthcare providers alter their patient interactions if they have knowledge that patients are at risk for having low HL.
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Manganello JA, DeVellis RF, Davis TC, Schottler-Thal C. Development of the Health Literacy Assessment Scale for Adolescents (HAS-A). JOURNAL OF COMMUNICATION IN HEALTHCARE 2015; 8:172-184. [PMID: 27656257 PMCID: PMC5027646 DOI: 10.1179/1753807615y.0000000016] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Health literacy has been found to be a crucial component of successful communication and navigation in health care. Various tools have been developed to measure health literacy skills, but few have been developed specifically for adolescents, and most require in-person administration. This study sought to develop a self-report health literacy scale for adolescents to assess four key health literacy domains: the ability to obtain, communicate, understand, and process health information. METHODS We collected data from 272 youth aged 12-19 recruited from a pediatrics clinic (37%) and the community (63%). We administered the Rapid Estimate of Adolescent Literacy in Medicine-Teen, Newest Vital Sign, and three surveys, and used factor analysis to identify scale items. RESULTS Using multiple health literacy assessments, it was clear that many teens struggle with low health literacy skills. When identifying items that can be used as self-report items in future research, factor analysis identified three subscales; a 5-item communication scale (alpha = 0.77), a 4-item confusion scale (alpha = 0.73), and a 6-item functional health literacy scale (alpha = 0.76). The scales performed reasonably well when compared with validation items. CONCLUSIONS Self-report items can be used to assess health literacy skills for adolescents when in-person administration is not possible or feasible. Such items will allow for greater study of how health literacy impacts communication in not only health care settings, but for all levels of health communication. The tool will also allow researchers to better understand how adolescent health literacy is related to a variety of health outcomes. Further testing of these scales with different populations is warranted.
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Affiliation(s)
- Jennifer A. Manganello
- Department of Health Policy, Management & Behavior, University at Albany School of Public Health, USA
| | - Robert F. DeVellis
- Department of Health Behavior, School of Public Health, University of North Carolina at Chapel Hill, USA
| | - Terry C. Davis
- Department of Medicine, Louisiana State University Health Sciences Center-Shreveport, USA
- Department of Pediatrics, Louisiana State University Health Sciences Center-Shreveport, USA
| | - Carrin Schottler-Thal
- Division of General Pediatrics, The Children’s Hospital at Albany Medical College, USA
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