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Bather JR, Cuevas AG, Harris A, Kaphingst KA, Goodman MS. Associations between perceived discrimination over the life course, subjective social status, and health literacy: A racial/ethnic stratification analysis. PEC INNOVATION 2024; 5:100334. [PMID: 39257628 PMCID: PMC11384512 DOI: 10.1016/j.pecinn.2024.100334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 08/03/2024] [Accepted: 08/18/2024] [Indexed: 09/12/2024]
Abstract
Objective To analyze the relationship between perceived discrimination over the life course, social status, and limited health literacy (HL). Methods 5040 adults who participated in the 2023 Survey of Racism and Public Health. We applied stratified multilevel models adjusted for sociodemographic characteristics. Results The average age was 47 years, 48% identified as White, 20% as Latinx, and 17% as Black. In the overall sample, we observed associations of perceived discrimination (b = 0.05, 95% CI: 0.01, 0.09), subjective social status (b = -0.16, 95% CI: -0.23, -0.10), and their interaction (b = 0.02, 95% CI: 0.01, 0.03). More perceived discrimination was associated with lower HL in the White and Multiracial participants. Higher subjective social status was associated with higher HL in the White and Latinx participants. There was a statistically significant interaction between perceived discrimination and subjective social status on HL among the White, Latinx, and Multiracial participants. Conclusion This analysis has implications for public health practice, indicating that multi-level interventions are needed to address limited HL. Innovation Our findings provide novel insights for identifying key SDOH indicators to assess in clinical settings to provide health literate care.
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Affiliation(s)
- Jemar R Bather
- Center for Anti-racism, Social Justice & Public Health, New York University School of Global Public Health, New York, NY 10003, USA
- Department of Biostatistics, New York University School of Global Public Health, New York, NY 10003, USA
| | - Adolfo G Cuevas
- Center for Anti-racism, Social Justice & Public Health, New York University School of Global Public Health, New York, NY 10003, USA
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY 10003, USA
| | - Adrian Harris
- Center for Anti-racism, Social Justice & Public Health, New York University School of Global Public Health, New York, NY 10003, USA
| | - Kimberly A Kaphingst
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
- Department of Communication, University of Utah, Salt Lake City, UT 84112, USA
| | - Melody S Goodman
- Center for Anti-racism, Social Justice & Public Health, New York University School of Global Public Health, New York, NY 10003, USA
- Department of Biostatistics, New York University School of Global Public Health, New York, NY 10003, USA
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Bather JR, Kaphingst KA, Goodman MS. Racial Composition of Social Environments Over the Life Course Using the Pictorial Racial Composition Measure: Development and Validation Study. JMIR Public Health Surveill 2024; 10:e55461. [PMID: 39115929 PMCID: PMC11342016 DOI: 10.2196/55461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/28/2024] [Accepted: 05/21/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Studies investigating the impact of racial segregation on health have reported mixed findings and tended to focus on the racial composition of neighborhoods. These studies use varying racial composition measures, such as census data or investigator-adapted questions, which are currently limited to assessing one dimension of neighborhood racial composition. OBJECTIVE This study aims to develop and validate a novel racial segregation measure, the Pictorial Racial Composition Measure (PRCM). METHODS The PRCM is a 10-item questionnaire of pictures representing social environments across adolescence and adulthood: neighborhoods and blocks (adolescent and current), schools and classrooms (junior high and high school), workplace, and place of worship. Cognitive interviews (n=13) and surveys (N=549) were administered to medically underserved patients at a primary care clinic at the Barnes-Jewish Hospital. Development of the PRCM occurred across pilot and main phases. For each social environment and survey phase (pilot and main), we computed positive versus negative pairwise comparisons: mostly Black versus all other categories, half Black versus all other categories, and mostly White versus all other categories. We calculated the following validity metrics for each pairwise comparison: sensitivity, specificity, correct classification rate, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, false positive rate, and false negative rate. RESULTS For each social environment, the mostly Black and mostly White dichotomizations generated better validity metrics relative to the half Black dichotomization. Across all 10 social environments in the pilot and main phases, mostly Black and mostly White dichotomizations exhibited a moderate-to-high sensitivity, specificity, correct classification rate, positive predictive value, and negative predictive value. The positive likelihood ratio values were >1, and the negative likelihood ratio values were close to 0. The false positive and negative rates were low to moderate. CONCLUSIONS These findings support that using either the mostly Black versus other categories or the mostly White versus other categories dichotomizations may provide accurate and reliable measures of racial composition across the 10 social environments. The PRCM can serve as a uniform measure across disciplines, capture multiple social environments over the life course, and be administered during one study visit. The PRCM also provides an added window into understanding how structural racism has impacted minoritized communities and may inform equitable intervention and prevention efforts to improve lives.
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Affiliation(s)
- Jemar R Bather
- Center for Anti-racism, Social Justice & Public Health, School of Global Public Health, New York University, New York, NY, United States
- Department of Biostatistics, School of Global Public Health, New York University, New York, NY, United States
| | - Kimberly A Kaphingst
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
- Department of Communication, University of Utah, Salt Lake City, UT, United States
| | - Melody S Goodman
- Center for Anti-racism, Social Justice & Public Health, School of Global Public Health, New York University, New York, NY, United States
- Department of Biostatistics, School of Global Public Health, New York University, New York, NY, United States
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Genie MG, Poudel N, Paolucci F, Ngorsuraches S. Choice Consistency in Discrete Choice Experiments: Does Numeracy Skill Matter? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)02782-7. [PMID: 39094694 DOI: 10.1016/j.jval.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/05/2024] [Accepted: 07/17/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVES This study investigated the relationship between numeracy skills (NS) and choice consistency in discrete choice experiments (DCEs). METHODS A DCE was conducted to explore patients' preferences for kidney transplantation in Italy. Patients completed the DCE and answered 3-item numeracy questions. A heteroskedastic multinomial logit model was used to investigate the effect of numeracy on choice consistency. RESULTS Higher NS were associated with greater choice consistency, increasing the scale to 1.63 (P < .001), 1.39 (P < .001), and 1.18 (P < .001) for patients answering 3 of 3, 2 of 3, and 1 of 3 questions correctly, respectively, compared with those with no correct answers. This corresponded to 63%, 39%, and 18% more consistent choices, respectively. Accounting for choice consistency resulted in varying willingness-to-wait (WTW) estimates for kidney transplant attributes. Patients with the lowest numeracy (0/3) were willing to wait approximately 42 months [95% CI: 29.37, 54.68] for standard infectious risk, compared with 33 months [95% CI: 28.48, 38.09] for 1 of 3, 28 months [95% CI: 25.13, 30.32] for 2 of 3, and 24 months [95% CI: 20.51, 27.25] for 3 of 3 correct answers. However, WTW differences for an additional year of graft survival and neoplastic risk were not statistically significant across numeracy levels. Supplementary analyses of 2 additional DCEs on COVID-19 vaccinations and rheumatoid arthritis, conducted online, supported these findings: higher NS were associated with more consistent choices across different disease contexts and survey formats. CONCLUSIONS The findings suggested that combining patients with varying NS could bias WTW estimates, highlighting the need to consider numeracy in DCE data analysis and interpretation.
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Affiliation(s)
- Mesfin G Genie
- Newcastle Business School, College of Human and Social Futures, The University of Newcastle, Australia; Department of Population Health Sciences, Duke University, Durham, NC, USA; Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK.
| | - Nabin Poudel
- Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL, USA; Department of Practice, Sciences, and Health Outcomes Research, University of Maryland, School of Pharmacy, Baltimore, MD, USA
| | - Francesco Paolucci
- Newcastle Business School, College of Human and Social Futures, The University of Newcastle, Australia
| | - Surachat Ngorsuraches
- Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL, USA
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Bernard-Arevalo SP, Laforce RJ, Khayat O, Bouchard V, Bruneau MA, Brunelle S, Caron S, Chamelian L, Chénard M, Côté JF, Crépeau-Gendron G, Doré MC, Fortin MP, Gagnon N, Gagnon PR, Giroux C, Jean L, Létourneau G, Marceau É, Moreau V, Morin M, Ouellet C, Poulin S, Radermaker S, Rousseau K, Touchette C, Dumais A. Clinical Assessment of Judgment in Adults and the Elderly: Development and Validation of the Three Domains of Judgment Test-Clinical Version (3DJT-CV). J Clin Med 2023; 12:jcm12113740. [PMID: 37297934 DOI: 10.3390/jcm12113740] [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: 03/15/2023] [Revised: 05/16/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
(1) Background: This article discusses the first two phases of development and validation of the Three Domains of Judgment Test (3DJT). This computer-based tool, co-constructed with users and capable of being administered remotely, aims to assess the three main domains of judgment (practical, moral, and social) and learn from the psychometric weaknesses of tests currently used in clinical practice. (2) Method: First, we presented the 3DJT to experts in cognition, who evaluated the tool as a whole as well as the content validity, relevance, and acceptability of 72 scenarios. Second, an improved version was administered to 70 subjects without cognitive impairment to select scenarios with the best psychometric properties in order to build a future clinically short version of the test. (3) Results: Fifty-six scenarios were retained following expert evaluation. Results support the idea that the improved version has good internal consistency, and the concurrent validity primer shows that 3DJT is a good measure of judgment. Furthermore, the improved version was found to have a significant number of scenarios with good psychometric properties to prepare a clinical version of the test. (4) Conclusion: The 3DJT is an interesting alternative tool for assessing judgment. However, more studies are needed for its implementation in a clinical context.
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Affiliation(s)
- Simon-Pierre Bernard-Arevalo
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Robert Jr Laforce
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Department of Neurological Sciences, CHU de Québec-Université Laval, Quebec City, QC G1J 1Z4, Canada
| | - Olivier Khayat
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Vital Bouchard
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Marie-Andrée Bruneau
- Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Research Center of the Institut Universitaire de Gériatrie de Montréal, Montreal, QC H3W 1W4, Canada
| | - Sarah Brunelle
- Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal, Montreal, QC H3L 1K5, Canada
| | - Stéphanie Caron
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Laury Chamelian
- Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Department of Psychiatry, Centre Hospitalier Universitaire de Montréal, Montreal, QC H2X 0C1, Canada
| | - Marise Chénard
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Jean-François Côté
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Gabrielle Crépeau-Gendron
- Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal, Montreal, QC H3L 1K5, Canada
| | - Marie-Claire Doré
- Department of Neurological Sciences, CHU de Québec-Université Laval, Quebec City, QC G1J 1Z4, Canada
| | - Marie-Pierre Fortin
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Nadine Gagnon
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Pierre R Gagnon
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Chloé Giroux
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Léonie Jean
- Department of Neurological Sciences, CHU de Québec-Université Laval, Quebec City, QC G1J 1Z4, Canada
| | - Geneviève Létourneau
- Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île-de-Montréal, Montreal, QC H1T 2M4, Canada
| | - Émilie Marceau
- Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Vincent Moreau
- Institut de Réadaptation en Déficience Physique de Québec, Quebec City, QC G1W 1P7, Canada
| | - Michèle Morin
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, Sainte-Marie, QC G6E 3E2, Canada
| | - Christine Ouellet
- Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île-de-Montréal, Montreal, QC H1T 2M4, Canada
| | - Stéphane Poulin
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Steve Radermaker
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Katerine Rousseau
- Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île-de-Montréal, Montreal, QC H1T 2M4, Canada
| | - Catherine Touchette
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Alexandre Dumais
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Institut National de Psychiatrie Légale Philippe-Pinel, Montreal, QC H1C 1H1, Canada
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Yılmaz NG, Timmermans DR, Van Weert JC, Damman OC. Breast cancer patients' visual attention to information in hospital report cards: An eye-tracking study on differences between younger and older female patients. Health Informatics J 2023; 29:14604582231155279. [PMID: 36840473 DOI: 10.1177/14604582231155279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
To (1) explore how women visually attend to a hospital report card (HRC), (2) explore whether visual attention of younger and older women (patients and non-patients) differs. Eye-tracking study with a short survey. Participants (N = 37) were provided with a hypothetical realistic HRC. Total dwell times and fixation counts were measured while participants viewed the information. Overall, no differences existed between younger and older women. Visual attention to the hospital of choice (vs not of choice) and to indicators perceived as most important (vs least important) did not differ. However, women with higher health literacy looked longer at the HRC than women with lower health literacy. Also, per fixation, older patients (vs younger patients) looked longer at the hospital of choice and at indicators perceived most important. Pre-existing conceptions of what information is relevant might result in more in-depth information processing among older patients than younger patients. In general, differences in level of health literacy, rather than (chronological) age, seem to be relevant to take into account when designing and/or updating HRCs.
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Affiliation(s)
- Nida Gizem Yılmaz
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, 1209Vrije Universiteit Amsterdam, The Netherlands; Department of Communication Science, Amsterdam School of Communication Research/ASCoR, 118065University of Amsterdam, Netherlands
| | - Danielle Rm Timmermans
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, 1209Vrije Universiteit Amsterdam, The Netherlands
| | - Julia Cm Van Weert
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, 118065University of Amsterdam, Netherlands
| | - Olga C Damman
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, 1209Vrije Universiteit Amsterdam, The Netherlands
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Wilkey ED, Shanley L, Sabb F, Ansari D, Cohen JC, Men V, Heller NA, Clarke B. Sharpening, focusing, and developing: A study of change in nonsymbolic number comparison skills and math achievement in 1st grade. Dev Sci 2021; 25:e13194. [PMID: 34800342 DOI: 10.1111/desc.13194] [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] [Received: 11/05/2020] [Revised: 10/06/2021] [Accepted: 11/08/2021] [Indexed: 01/29/2023]
Abstract
Children's ability to discriminate nonsymbolic number (e.g., the number of items in a set) is a commonly studied predictor of later math skills. Number discrimination improves throughout development, but what drives this improvement is unclear. Competing theories suggest that it may be due to a sharpening numerical representation or an improved ability to pay attention to number and filter out non-numerical information. We investigate this issue by studying change in children's performance (N = 65) on a nonsymbolic number comparison task, where children decide which of two dot arrays has more dots, from the middle to the end of 1st grade (mean age at time 1 = 6.85 years old). In this task, visual properties of the dot arrays such as surface area are either congruent (the more numerous array has more surface area) or incongruent. Children rely more on executive functions during incongruent trials, so improvements in each congruency condition provide information about the underlying cognitive mechanisms. We found that accuracy rates increased similarly for both conditions, indicating a sharpening sense of numerical magnitude, not simply improved attention to the numerical task dimension. Symbolic number skills predicted change in congruent trials, but executive function did not predict change in either condition. No factor predicted change in math achievement. Together, these findings suggest that nonsymbolic number processing undergoes development related to existing symbolic number skills, development that appears not to be driving math gains during this period. Children's ability to discriminate nonsymbolic number improves throughout development. Competing theories suggest improvement due to sharpening magnitude representations or changes in attention and inhibition. The current study investigates change in nonsymbolic number comparison performance during first grade and whether symbolic number skills, math skills, or executive function predict change. Children's performance increased across visual control conditions (i.e., congruent or incongruent with number) suggesting an overall sharpening of number processing. Symbolic number skills predicted change in nonsymbolic number comparison performance.
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Affiliation(s)
- Eric D Wilkey
- Brain & Mind Institute, Western University, London, Ontario, Canada
| | - Lina Shanley
- Center on Teaching and Learning, University of Oregon, Eugene, Oregon, USA
| | - Fred Sabb
- Center on Teaching and Learning, University of Oregon, Eugene, Oregon, USA
| | - Daniel Ansari
- Brain & Mind Institute, Western University, London, Ontario, Canada
| | - Jason C Cohen
- Center on Teaching and Learning, University of Oregon, Eugene, Oregon, USA
| | - Virany Men
- Center on Teaching and Learning, University of Oregon, Eugene, Oregon, USA
| | - Nicole A Heller
- Center on Teaching and Learning, University of Oregon, Eugene, Oregon, USA
| | - Ben Clarke
- Center on Teaching and Learning, University of Oregon, Eugene, Oregon, USA
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Silva-Junior MF, Rosário de Sousa MDL, Batista MJ. Health literacy on oral health practice and condition in an adult and elderly population. Health Promot Int 2021; 36:933-942. [PMID: 33277894 DOI: 10.1093/heapro/daaa135] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The objective of this study was to investigate the impact of health literacy (HL) on health practices and oral health outcomes in an adult and elderly population in Brazil. A cross-sectional study nested in a cohort study was followed up over a period of four years (2011 and 2015) and assessed individuals between 23 and 69 years old from Piracicaba, São Paulo, Brazil. Data were collected by means of oral examinations (coronal caries, periodontal disease and visible biofilm) and interviews (socioeconomic, demographic, oral health-related quality of life, health practices and HL). The 14-item Health Literacy Scale (HLS) was used for HL data, which was the main explanatory variable. The result of the sum of the HLS-14 questionnaire for each participant was dichotomized into the median (46 points): 'high' and 'low' HL. Binary/multinomial logistic regressions were performed on health practice and oral health outcomes, controlled by age and sex (Model 1) and age, sex and socioeconomic status (Model 2; p < 0.05). The final sample consisted of 137 subjects and 43.8% (n = 60) presented low HL (LHL). LHL was associated with health practices, such as use of public dental services in Model 1 (odds ratio [OR] = 0.34, 95% CI: 0.14-0.87) and use of dental services for emergency in Model 1 (OR = 2.69, 95% CI: 1.29-5.51) and Model 2 (OR = 2.93, 95% CI: 1.17-7.30). Based on age and sex, LHL was associated with use of public dental service and use of emergency dental visits. Based on age, sex and socioeconomic status, LHL was associated with use of emergency dental visits.
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Affiliation(s)
- Manoelito Ferreira Silva-Junior
- Department of Dentistry, State University of Ponta Grossa, Av. Gen. Carlos Cavalcanti 4748, Ponta Grossa, Paraná, 84030-900, Brazil
| | - Maria da Luz Rosário de Sousa
- Department of Community Dentistry, Piracicaba Dental School, University of Campinas, Av. Limeira 901, Piracicaba, São Paulo, 13414-018, Brazil
| | - Marília Jesus Batista
- Department of Community Dentistry, Piracicaba Dental School, University of Campinas, Av. Limeira 901, Piracicaba, São Paulo, 13414-018, Brazil.,Department of Health Sciences and Pediatric Dentistry, Faculty of Medicine Jundiaí, R. Francisco Teles 250, Jundiaí, São Paulo, 13202-550, Brazil
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8
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Danya H, Yonekura Y, Nakayama K. Effects of graphic presentation on understanding medical risks and benefits among Japanese adults. COGENT MEDICINE 2021. [DOI: 10.1080/2331205x.2021.1907894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Hitomi Danya
- Department of Nursing Informatics, Graduate School of Nursing Science, St. Luke’s International University, Tokyo, Japan
| | - Yuki Yonekura
- Department of Nursing Informatics, Graduate School of Nursing Science, St. Luke’s International University, Tokyo, Japan
| | - Kazuhiro Nakayama
- Department of Nursing Informatics, Graduate School of Nursing Science, St. Luke’s International University, Tokyo, Japan
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Bittermann T, Dwinnells K, Chadha S, Wolf MS, Olthoff KM, Serper M. Low Health Literacy Is Associated With Frailty and Reduced Likelihood of Liver Transplant Listing: A Prospective Cohort Study. Liver Transpl 2020; 26:1409-1421. [PMID: 32567232 PMCID: PMC8809114 DOI: 10.1002/lt.25830] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 01/13/2023]
Abstract
The effect of low health literacy (HL) on outcomes in end-stage liver disease (ESLD) is largely unknown. The association of low HL on clinical outcomes was investigated in a prospective cohort of outpatients with ESLD undergoing liver transplantation (LT) evaluation. From 2014 to 2017, 276 patients underwent LT evaluation with assessments of liver disease severity, medical and psychosocial comorbidities, physical frailty, and malnutrition. Literacy was measured with the Newest Vital Sign, a brief validated assessment. Multivariate models assessed relationships between HL and clinical outcomes adjusting for clinical and psychosocial variables. The median Model for End-Stage Liver Disease-sodium score of the study sample was 15 (interquartile range, 11-19), 71 (25.7%) of candidates were frail, 117 (42.4%) had malnutrition, 151 (54.7%) had hepatic encephalopathy, 104 (37.7%) had low HL, and 85 (39.2%) had marginal or poor social support. Adjusting for education level, socioeconomic factors, and severity of illness, low HL was independently associated with physical frailty (adjusted odds ratio [aOR], 3.59; 95% confidence interval [CI], 1.50-8.59; P = 0.004) and not being wait-listed (aOR 1.96; 95% CI, 1.03-3.75; P = 0.04). Strong social support attenuated the relationship between low HL and not being wait-listed (aOR, 1.58; 95% CI, 0.74-3.36; P = 0.24). Low HL is common and a largely unrecognized risk factor for poor health outcomes among patients with ESLD. Patient-oriented infrastructure and support are needed at the health system level to ensure all patients can successfully navigate the complex process of LT evaluation and wait-listing.
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Affiliation(s)
- Therese Bittermann
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA;,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Kristen Dwinnells
- Nutrition Counseling and Services, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Sakshum Chadha
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michael S. Wolf
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL,Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kim M. Olthoff
- Division of Transplant Surgery, University of Pennsylvania, Philadelphia, PA
| | - Marina Serper
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA;,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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Kuyinu YA, Femi-Adebayo TT, Adebayo BI, Abdurraheem-Salami I, Odusanya OO. Health literacy: Prevalence and determinants in Lagos State, Nigeria. PLoS One 2020; 15:e0237813. [PMID: 32790756 PMCID: PMC7425911 DOI: 10.1371/journal.pone.0237813] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 08/02/2020] [Indexed: 02/07/2023] Open
Abstract
Background Poor health literacy has been associated with poorer physical and mental health function, and higher emergency department and hospital utilizations. The study was conducted to measure the prevalence of health literacy and its determinants among Lagos State residents. Methods A descriptive cross-sectional study was conducted in three local government areas in Lagos State. Health literacy was assessed using the Brief Health Literacy Screening tool (BHLS), a three-item tool with possible scores ranging between 3 and 15. Health literacy was classified as inadequate (≤ 9) or adequate (>9). Results A total of 1831 respondents participated in the study, among whom, 952 (52%) were women. The mean age of respondents was 31.7 (±10.5) years. Three-quarters (74.8%) of respondents had adequate health literacy. Adequate levels of health literacy were associated with being female (OR, 1.35; 95% CI, 1.07–1.71), frequent use of the broad cast media as source of information (OR, 1.33; 95% CI, 1.03–1.70), frequent use of the internet as source of information (OR, 1.49; 95% CI, 1.13–1.96). Adequate health literacy was also associated with having knowledge of a frequently prescribed antibiotic (OR, 1.67; 95% CI, 1.32–2.12) and being more comfortable with the use of the English language (OR, 1.71; 95% CI, 1.32–2.22). Conclusion Gender, the use of broadcast media and the internet are predictive of adequate health literacy and should be taken into consideration in planning health interventions.
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Affiliation(s)
- Yetunde Abiola Kuyinu
- Department of Community Health and Primary Healthcare, Lagos State University Teaching Hospital, Ikeja, Nigeria
- Department of Community Health and Primary Healthcare, Lagos State University College of Medicine, Ikeja, Nigeria
- * E-mail:
| | | | - Bisola Ibironke Adebayo
- Department of Community Health and Primary Healthcare, Lagos State University College of Medicine, Ikeja, Nigeria
| | - Ibipo Abdurraheem-Salami
- Department of Community Health and Primary Healthcare, Lagos State University Teaching Hospital, Ikeja, Nigeria
| | - Olumuyiwa Omotola Odusanya
- Department of Community Health and Primary Healthcare, Lagos State University Teaching Hospital, Ikeja, Nigeria
- Department of Community Health and Primary Healthcare, Lagos State University College of Medicine, Ikeja, Nigeria
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Batista MJ, Marques ACDP, Silva Junior MF, Alencar GP, Sousa MDLRD. Translation, cross-cultural adaptation and psychometric evaluation of Brazilian Portuguese version of the 14-item Health Literacy Scale. CIENCIA & SAUDE COLETIVA 2020; 25:2847-2857. [PMID: 32667566 DOI: 10.1590/1413-81232020257.22282018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 11/26/2018] [Indexed: 12/12/2022] Open
Abstract
We evaluated the psychometric properties of the Health Literacy Scale - 14 (HLS-14), the Brazilian Portuguese version. In the methodological study with a cross-sectional design, the following were performed: translation, cross-cultural adaptation and evaluation of the psychometric properties. After being subjected to a committee of experts, translated and adapted, the instrument was pre-tested with 52 adults and applied to 143 adults and older people of Piracicaba-SP. Internal consistency was assessed based on the Kendall correlation coefficient and Cronbach's alpha (>0.70), and the confirmatory factor analysis (CFA) was conducted using the chi-square test, the Standardized Residual Mean Square Root (SRMR), the Root Mean Square Error of Approximation (RMSEA) (<0.05), the Comparative Fit Index (CFI) (>0.95) and the Tucker-Lewis Index (TLI) (>0.95). The analysis of operational equivalence showed agreement between most of the questions, exception questions 6, 8, 9 and 14. Cronbach's alpha was 0.82. There was reasonable adjustment in the CFA: CFI=0.886, TLI=0.86, RMSEA=0.085 (90%CI: 0.065-0.105), SRMR=0.071, chi-square (74 degrees of freedom) = 149.510, p<0.001. The exclusion of question 5 increased the adjustment level to satisfactory. The Brazilian Portuguese version of HLS-14 can be considered a valid health literacy assessment instrument.
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Affiliation(s)
- Marília Jesus Batista
- Departamento de Ciências da Saúde e Odontologia Infantil, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas. Av. Limeira 901, Bairro Areião. 13414-903 Piracicaba SP Brasil.
| | - Ana Carolina de Paula Marques
- Departamento de Ciências da Saúde e Odontologia Infantil, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas. Av. Limeira 901, Bairro Areião. 13414-903 Piracicaba SP Brasil.
| | | | - Gizelton Pereira Alencar
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo. São Paulo SP Brasil
| | - Maria da Luz Rosário de Sousa
- Departamento de Ciências da Saúde e Odontologia Infantil, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas. Av. Limeira 901, Bairro Areião. 13414-903 Piracicaba SP Brasil.
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12
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Boudewyns V, Kelly B, Southwell BG. Social science and price transparency in direct-to-consumer prescription drug advertisements. Res Social Adm Pharm 2020; 16:733-735. [DOI: 10.1016/j.sapharm.2019.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
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13
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Salampessy BH, Bijlsma WR, van der Hijden E, Koolman X, Portrait FRM. On selecting quality indicators: preferences of patients with breast and colon cancers regarding hospital quality indicators. BMJ Qual Saf 2019; 29:576-585. [PMID: 31831636 PMCID: PMC7362772 DOI: 10.1136/bmjqs-2019-009818] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 11/10/2019] [Accepted: 11/21/2019] [Indexed: 12/05/2022]
Abstract
Background There is an increasing number of quality indicators being reported publicly with aim to improve the transparency on hospital care quality. However, they are little used by patients. Knowledge on patients’ preferences regarding quality may help to optimise the information presented to them. Objective To measure the preferences of patients with breast and colon cancers regarding publicly reported quality indicators of Dutch hospital care. Methods From the existing set of clinical quality indicators, participants of patient group discussions first assessed an indicator’s suitability as choice information and then identified the most relevant ones. We used the final selection as attributes in two discrete choice experiments (DCEs). Questionnaires included choice vignettes as well as a direct ranking exercise, and were distributed among patient communities. Data were analysed using mixed logit models. Results Based on the patient group discussions, 6 of 52 indicators (breast cancer) and 5 of 21 indicators (colon cancer) were selected as attributes. The questionnaire was completed by 84 (breast cancer) and 145 respondents (colon cancer). In the patient group discussions and in the DCEs, respondents valued outcome indicators as most important: those reflecting tumour residual (breast cancer) and failure to rescue (colon cancer). Probability analyses revealed a larger range in percentage change of choice probabilities for breast cancer (10.9%–69.9%) relative to colon cancer (7.9%–20.9%). Subgroup analyses showed few differences in preferences across ages and educational levels. DCE findings partly matched with those of direct ranking. Conclusion Study findings show that patients focused on a subset of indicators when making their choice of hospital and that they valued outcome indicators the most. In addition, patients with breast cancer were more responsive to quality information than patients with colon cancer.
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Affiliation(s)
- Benjamin H Salampessy
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Ward R Bijlsma
- Department of Healthcare Procurement, Menzis, Enschede, The Netherlands
| | - Eric van der Hijden
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Xander Koolman
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - France R M Portrait
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
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14
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Rodgers J, Kakarmath S, Denis V, Encinas-Martin M, Subramanian SV. Association between numeracy and self-rated poor health in 33 high- and upper middle- income countries. Prev Med 2019; 129:105872. [PMID: 31644897 DOI: 10.1016/j.ypmed.2019.105872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
The association between numeracy proficiency and health outcomes has been the subject of several studies. However, it is not known if this association is independent of educational attainment and literacy proficiency. In this study, we used logistic regression to model numeracy proficiency as a predictor of self-rated poor health after accounting for educational attainment and literacy proficiency. The prevalence of self-rated poor health among 166,863 adults aged 16-65 years from 33 high- and upper middle-income countries was 24%. Compared to those with the highest numeracy proficiency (level 4), the odds ratio of self-rated poor health for those with the lowest numeracy proficiency (level 1) was 2.2 (95% CI 1.9-2.7) and attenuated to 1.8 (95% CI 1.5-2.1) and 1.5 (95% CI 1.1, 2.0), respectively, after sequential addition of self-education and literacy proficiency. For those who were assessed to have low levels of both numeracy and literacy proficiency, the odds ratio of self-rated poor health was 1.4 (95% CI 1.3 to 1.5), relative to those who had high levels of both numeracy and literacy proficiencies. Numeracy and literacy proficiencies show both independent and interdependent correlations with poor self-rated health. Further, these associations varied by sociodemographic characteristics and across countries. Policies aimed at improving numeracy and literacy may be beneficial in preventing adverse health outcomes.
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Affiliation(s)
- Justin Rodgers
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA 02138, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Sujay Kakarmath
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Vanessa Denis
- Directorate for Education and Skills, Organisation for Economic Co-operation and Development, 2 Rue André Pascal, 75116 Paris, France
| | - Marta Encinas-Martin
- Directorate for Education and Skills, Organisation for Economic Co-operation and Development, 2 Rue André Pascal, 75116 Paris, France
| | - S V Subramanian
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA 02138, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
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15
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Liu D, Juanchich M, Sirota M, Orbell S. People overestimate verbal quantities of nutrients on nutrition labels. Food Qual Prefer 2019. [DOI: 10.1016/j.foodqual.2019.103739] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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16
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Wilkey ED, Ansari D. Challenging the neurobiological link between number sense and symbolic numerical abilities. Ann N Y Acad Sci 2019; 1464:76-98. [PMID: 31549430 DOI: 10.1111/nyas.14225] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/25/2019] [Accepted: 08/06/2019] [Indexed: 01/29/2023]
Abstract
A significant body of research links individual differences in symbolic numerical abilities, such as arithmetic, to number sense, the neurobiological system used to approximate and manipulate quantities without language or symbols. However, recent findings from cognitive neuroscience challenge this influential theory. Our current review presents an overview of evidence for the number sense account of symbolic numerical abilities and then reviews recent studies that challenge this account, organized around the following four assertions. (1) There is no number sense as traditionally conceived. (2) Neural substrates of number sense are more widely distributed than common consensus asserts, complicating the neurobiological evidence linking number sense to numerical abilities. (3) The most common measures of number sense are confounded by other cognitive demands, which drive key correlations. (4) Number sense and symbolic number systems (Arabic digits, number words, and so on) rely on distinct neural mechanisms and follow independent developmental trajectories. The review follows each assertion with comments on future directions that may bring resolution to these issues.
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Affiliation(s)
- Eric D Wilkey
- Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Daniel Ansari
- Brain and Mind Institute, Western University, London, Ontario, Canada
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17
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Canaway R, Bismark M, Dunt D, Kelaher M. Public reporting of hospital performance data: views of senior medical directors in Victoria, Australia. AUST HEALTH REV 2019; 42:591-599. [PMID: 28988569 DOI: 10.1071/ah17120] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/14/2017] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to better understand senior medical directors' perceptions of public reporting of hospital performance data, how public reporting affects institutional behavioural change towards quality improvement and how it could be improved. Methods Interviews were undertaken with 17 medical directors representing 26 metropolitan and regional public hospitals in Victoria, Australia, between June and August 2016. Data were analysed thematically. Results Medical directors are well placed to comment on clinical and administrative aspects of quality, safety and performance monitoring in public hospitals. Their responses largely suggested that public reporting of hospital performance data in Australia is immature and not fulfilling its potential. There was little consensus among informants around what public reporting is, who it is for or its purpose. Although public reporting was considered to have important functions for hospitals and consumers, it was generally considered to lack robustness and have underutilised potential to inform consumers, build trust and drive quality and performance improvements within hospitals. Conclusions The next steps needed to advance public reporting of hospital performance data in Australia include engaging clinicians and patients in selection and development of metrics, improving timeliness of reporting, and improving communication of information so that it is accessible and meaningful for different audiences. What is known about the topic? Public reporting of hospital performance data is a mechanism increasingly used in the Australian health system, but it has attracted little research. What does this paper add? This paper reveals a lack of shared understanding among medical directors in Victoria, Australia, on what public reporting of hospital performance data is, who it is for and its purpose. The paper highlights the potential importance of public reporting of hospital performance data for rural and regional healthcare consumers and how it may be strengthened. What are the implications for practitioners? Stronger systems of public reporting of hospital performance data have the potential to increase consumer engagement and improve hospital performance, quality and safety. Awareness of the discourse around public reporting of hospital performance data can increase practitioners' engagement in debate and development of reporting systems.
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Affiliation(s)
- Rachel Canaway
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, Vic. 3053, Australia.
| | - Marie Bismark
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, Vic. 3053, Australia.
| | - David Dunt
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, Vic. 3053, Australia.
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, Vic. 3053, Australia.
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18
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Yamashita T, Bardo AR, Cummins PA, Millar RJ, Sahoo S, Liu D. The Roles of Education, Literacy, and Numeracy in Need for Health Information during the Second Half of Adulthood: A Moderated Mediation Analysis. JOURNAL OF HEALTH COMMUNICATION 2019; 24:271-283. [PMID: 30982431 DOI: 10.1080/10810730.2019.1601303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We examine complex pathways that link health information seeking behavior with education and health literacy (decomposed into general literacy and numeracy), and how these pathways differ by perceived health status (need) among a nationally representative sample of Americans age 50 and older (n = 2,750). Data come from the Program for International Assessment of Adult Competencies (PIAAC). Multi-group structural equation models were used to examine the use of eight health information sources (newspapers, magazines, internet, radio, TV, books, friends/family, and health professionals). Findings partially support the long-standing notion that health seeking behaviors are directly linked to educational attainment, and provide some of the first nationally representative evidence for how education functions through distinct health literacy components to shape health information seeking behaviors by health status. Findings from this moderated mediation analysis point to the importance of examining, and addressing, health literacy disparities in access to and use of health information.
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Affiliation(s)
- Takashi Yamashita
- a Department of Sociology, Anthropology, and Health Administration and Policy , University of Maryland , Baltimore County, Baltimore , MD , USA
| | - Anthony R Bardo
- b Department of Sociology , University of Kentucky , Lexington , KY , USA
| | - Phyllis A Cummins
- c The Scripps Gerontology Center , Miami University , Oxford , OH , USA
| | - Roberto J Millar
- a Department of Sociology, Anthropology, and Health Administration and Policy , University of Maryland , Baltimore County, Baltimore , MD , USA
- d Gerontology Doctoral Program , University of Maryland , Baltimore County, Baltimore , MD , USA
| | - Shalini Sahoo
- d Gerontology Doctoral Program , University of Maryland , Baltimore County, Baltimore , MD , USA
| | - Darren Liu
- e Department of Public Health , Des Moines University , Des Moines , IA , USA
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Wilkey ED, Price GR. Attention to number: The convergence of numerical magnitude processing, attention, and mathematics in the inferior frontal gyrus. Hum Brain Mapp 2019; 40:928-943. [PMID: 30387895 PMCID: PMC6615546 DOI: 10.1002/hbm.24422] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 09/27/2018] [Accepted: 10/03/2018] [Indexed: 02/03/2023] Open
Abstract
Research indicates that the neurocognitive system representing nonsymbolic numerical magnitudes is foundational for the development of mathematical competence. However, recent studies found that the most common task used to measure numerical acuity, the nonsymbolic number comparison task, is heavily influenced by non-numerical visual parameters of stimuli that increase executive function demands. Further, this influence may be a confound invalidating theoretical accounts of the relation between number comparison performance and mathematical competence. Instead of acuity, the relation may depend on one's ability to attend to numerical information in the face of competing, non-numerical cues. The current study investigated this issue by measuring neural activity associated with numerical magnitude processing acuity, domain-general attention, and selective attention to number via functional magnetic resonance imaging while children 8-11 years old completed a nonsymbolic number comparison task and a flanker task. Results showed that activation in the right inferior frontal gyrus during incongruent versus congruent trials of the comparison task, our construct for attention to number, predicted mathematics achievement after controlling for verbal IQ, flanker accuracy rate, and the neural congruency effect from the flanker task. In contrast, activity in frontal and parietal regions responding to differences in difficulty of numerical comparisons, our construct for numerical magnitude processing acuity, did not correlate with achievement. Together, these findings suggest a need to reframe existing models of the relation between number processing and math competence to include the interaction between attention and use of numerical information, or in other words "attention to number."
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Affiliation(s)
- Eric D. Wilkey
- Department of Psychology and Human DevelopmentPeabody College, Vanderbilt UniversityNashvilleTennessee
| | - Gavin R. Price
- Department of Psychology and Human DevelopmentPeabody College, Vanderbilt UniversityNashvilleTennessee
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20
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Wilkey ED, Pollack C, Price GR. Dyscalculia and Typical Math Achievement Are Associated With Individual Differences in Number-Specific Executive Function. Child Dev 2018; 91:596-619. [PMID: 30597527 DOI: 10.1111/cdev.13194] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Deficits in numerical magnitude perception characterize the mathematics learning disability developmental dyscalculia (DD), but recent studies suggest the relation stems from inhibitory control demands from incongruent visual cues in the nonsymbolic number comparison task. This study investigated the relation among magnitude perception during differing congruency conditions, executive function, and mathematics achievement measured longitudinally in children (n = 448) from ages 4 to 13. This relation was investigated across achievement groups and as it related to mathematics across the full range of achievement. Only performance on incongruent trials related to achievement. Findings indicate that executive function in a numerical context, beyond magnitude perception or executive function in a non-numerical context, relates to DD and mathematics across a wide range of achievement.
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Salampessy BH, Alblas MM, Portrait FRM, Koolman X, van der Hijden EJE. The effect of cost-sharing design characteristics on use of health care recommended by the treating physician; a discrete choice experiment. BMC Health Serv Res 2018; 18:797. [PMID: 30342542 PMCID: PMC6195970 DOI: 10.1186/s12913-018-3598-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 10/02/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Cost-sharing programs are often too complex to be easily understood by the average insured individual. Consequently, it is often difficult to determine the amount of expenses in advance. This may preclude well-informed decisions of insured individuals to adhere to medical treatment advised by the treating physician. Preliminary research has showed that the uncertainty in these cost-sharing payments are affected by four design characteristics, i.e. 1) type of payments (copayments, coinsurances or deductibles), 2) rate of payments, 3) annual caps on cost-sharing and 4) moment that these payments must be made (directly at point of care or billed afterwards by the insurer). METHODS An online discrete choice experiment was used to assess the extent to which design characteristics of cost-sharing programs affect the decision of individuals to adhere to recommended care (prescribed medications, ordered diagnostic tests and referrals to medical specialist care). Analyses were performed using mixed multinomial logits. RESULTS The questionnaire was completed by 7921 members of a patient organization. Analyses showed that 1) cost-sharing programs that offer clear information in advance on actual expenses that are billed afterwards, stimulate adherence to care recommended by the treating physician; 2) the relative importance of the design characteristics differed between respondents who reported to have forgone health care due to cost-sharing and those who did not; 3) price-awareness among respondents was limited; 4) the utility derived from attributes and respondents' characteristics were positively correlated; 5) an optimized cost-sharing program revealed an adherence of more than 72.9% among those who reported to have forgone health care. CONCLUSIONS The analyses revealed that less complex cost-sharing programs stimulate adherence to recommended care. If these programs are redesigned accordingly, individuals who had reported to have forgone a health service recommended by their treating physician due to cost-sharing, would be more likely to use this service. Such redesigned programs provide a policy option to reduce adverse health effects of cost-sharing in these groups. Considering the upcoming shift from volume-based to value-based health care provision, insights into the characteristics of a cost-sharing program that stimulates the use of recommended care may help to design value-based insurance plans.
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Affiliation(s)
- Benjamin H. Salampessy
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Maaike M. Alblas
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
- Department of Public Health, Erasmus Medical Centre - University Medical Center Rotterdam, P.O. 2040, 3000 CA Rotterdam, The Netherlands
| | - France R. M. Portrait
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Xander Koolman
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Eric J. E. van der Hijden
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
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Metcalfe D, Rios Diaz AJ, Olufajo OA, Massa MS, Ketelaar NABM, Flottorp SA, Perry DC. Impact of public release of performance data on the behaviour of healthcare consumers and providers. Cochrane Database Syst Rev 2018; 9:CD004538. [PMID: 30188566 PMCID: PMC6513271 DOI: 10.1002/14651858.cd004538.pub3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND It is becoming increasingly common to publish information about the quality and performance of healthcare organisations and individual professionals. However, we do not know how this information is used, or the extent to which such reporting leads to quality improvement by changing the behaviour of healthcare consumers, providers, and purchasers. OBJECTIVES To estimate the effects of public release of performance data, from any source, on changing the healthcare utilisation behaviour of healthcare consumers, providers (professionals and organisations), and purchasers of care. In addition, we sought to estimate the effects on healthcare provider performance, patient outcomes, and staff morale. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and two trials registers on 26 June 2017. We checked reference lists of all included studies to identify additional studies. SELECTION CRITERIA We searched for randomised or non-randomised trials, interrupted time series, and controlled before-after studies of the effects of publicly releasing data regarding any aspect of the performance of healthcare organisations or professionals. Each study had to report at least one main outcome related to selecting or changing care. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies for eligibility and extracted data. For each study, we extracted data about the target groups (healthcare consumers, healthcare providers, and healthcare purchasers), performance data, main outcomes (choice of healthcare provider, and improvement by means of changes in care), and other outcomes (awareness, attitude, knowledge of performance data, and costs). Given the substantial degree of clinical and methodological heterogeneity between the studies, we presented the findings for each policy in a structured format, but did not undertake a meta-analysis. MAIN RESULTS We included 12 studies that analysed data from more than 7570 providers (e.g. professionals and organisations), and a further 3,333,386 clinical encounters (e.g. patient referrals, prescriptions). We included four cluster-randomised trials, one cluster-non-randomised trial, six interrupted time series studies, and one controlled before-after study. Eight studies were undertaken in the USA, and one each in Canada, Korea, China, and The Netherlands. Four studies examined the effect of public release of performance data on consumer healthcare choices, and four on improving quality.There was low-certainty evidence that public release of performance data may make little or no difference to long-term healthcare utilisation by healthcare consumers (3 studies; 18,294 insurance plan beneficiaries), or providers (4 studies; 3,000,000 births, and 67 healthcare providers), or to provider performance (1 study; 82 providers). However, there was also low-certainty evidence to suggest that public release of performance data may slightly improve some patient outcomes (5 studies, 315,092 hospitalisations, and 7502 providers). There was low-certainty evidence from a single study to suggest that public release of performance data may have differential effects on disadvantaged populations. There was no evidence about effects on healthcare utilisation decisions by purchasers, or adverse effects. AUTHORS' CONCLUSIONS The existing evidence base is inadequate to directly inform policy and practice. Further studies should consider whether public release of performance data can improve patient outcomes, as well as healthcare processes.
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Affiliation(s)
- David Metcalfe
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)John Radcliffe HospitalHeadley WayOxfordUKOX3 9DU
| | - Arturo J Rios Diaz
- Thomas Jefferson University HospitalDepartment of Surgery1100 Walnut StreetPhiladelphiaPAUSA19107
| | - Olubode A Olufajo
- Howard‐Harvard Health Sciences Outcomes Research Center Howard University College of MedicineDepartment of Surgery2041 Georgia Ave, NWWashingtonDCUSA20060
| | - M. Sofia Massa
- University of OxfordNuffield Department of Population HealthBig Data Institute, Old Road CampusOxfordUKOX3 7LF
| | - Nicole ABM Ketelaar
- Saxion University of Applied SciencesSocial Work Research GroupEnschedeNetherlands
| | - Signe A. Flottorp
- Norwegian Institute of Public HealthPO box 222 SkøyenOsloNorway0213
- University of OsloInstitute of Health and SocietyP.O box 1130 BlindernOsloNorway0318
| | - Daniel C Perry
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)John Radcliffe HospitalHeadley WayOxfordUKOX3 9DU
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Galeshi R, Sharman J, Cai J. Influence of ethnicity, gender, and immigration status on millennials’ behavior related to seeking health information. EQUALITY, DIVERSITY AND INCLUSION: AN INTERNATIONAL JOURNAL 2018. [DOI: 10.1108/edi-05-2017-0102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to understand the behavior diversities that exist among young millennials’ subgroups in ways they seek health-related information.
Design/methodology/approach
The authors ran several sets of analyses on the 2012–2014 US Program for the International Assessment of Adult Competencies (PIAAC) Data using Stata. The population was stratified into four specific subgroups based on their gender, ethnicity—blacks, Hispanics and whites—immigration status, college status—whether they were enrolled in a program of study at the time of the survey. The outcome variables were sources of health information including print (books/magazines/brochures), traditional media (Radio/TV), internet, family/friends/co-workers and health professionals. The independent variables were gender, ethnicity, educational status and immigration status. The authors utilized the appropriate sample weight derived by Organization for Economic Cooperation and Development so the findings can be generalized to the populations. The analysis included several descriptive statistics and χ2 test of independence.
Findings
Despite similarities, young adults’ health seeking behavior is complex influenced by gender, ethnicity, immigration status and education. The results indicated that while the internet is the primary source of health-related information for all young adults, there are subtle differences in utilizing other available resources. For example while more educated young adults seek help from their family members, the less educated peers use the media to obtain health-related information. Ethnicity has also an effect on young adults’ information seeking behavior. The number of Hispanics and blacks that obtain their information from traditional media is significantly higher than their white counterparts.
Research limitations/implications
This study has several limitations. First, the authors did not consider the effect of young adults’ digital literacy skills, problem solving skills and numeracy skills on their health seeking approach. Including these cognitive skills could reveal key information about young adults approach to information seeking that is not apparent by race, ethnicity and gender only. Another limitation of this study is the lack of the ability to claim causation, PIAAC data are designed strictly for cross-sectional analysis.
Practical implications
Although, behaviors often do not change simply by presenting information, trying to change behavior without improving individuals’ understanding of the issue by providing accurate information is likely to fail. Providing standardized health-related information sources that are accessible to all is vitally important. The results indicate that while the majority of young adults use the internet as their primary source of information only a few percentage of young adults seek information from health professional. Consequently, there is a need for an easily accessible and standardized online health-related source of information.
Social implications
Healthcare facilities and health related industries have the resources and the ability to develop a reliable infrastructure that could potentially provide reliable information that is easy to understand and navigate for adults with a variety of literacy and skills to use. Perhaps adopting the Universal Design for Learning approach and providing information that is accessible to a variety of individuals regardless of their education, learning skills and language skills. Flexible learning resources provided within a standard infrastructure accessible to all can help individuals find trustworthy and consistent information that they can trust.
Originality/value
Despite the unique characteristics of the millennials and the profound change in the way young adults seek information, there is a paucity of research on the ways young adults seek health-related information. Most existing literature is based on locally developed surveys and convenient sampling with limited reliability and validity information. Consequently making a sweeping statement based on their findings is considered as hasty generalization. The PIAAC, on the other hand, is a nationally representative data, extensively examined for its validity and reliability.
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Rademakers J, Heijmans M. Beyond Reading and Understanding: Health Literacy as the Capacity to Act. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1676. [PMID: 30087254 PMCID: PMC6121645 DOI: 10.3390/ijerph15081676] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/11/2018] [Accepted: 07/24/2018] [Indexed: 11/16/2022]
Abstract
Many health literacy interventions have a limited focus on functional/cognitive skills. In psychosocial models, the capacity to act however is seen as a major driver of behavioural change. This aspect is often lacking in health literacy concepts. In this study, we examine the impact of both aspects of health literacy (functional/cognitive and capacity to act) on specific healthcare outcomes (healthcare use, experiences with patient-centered care, shared-decision making, and self-management). In a sample of a national panel of people with a chronic disease (NPCD), questions about health literacy, patient activation, and outcomes were asked. The results indicated that 39.9% had limited HL levels and 36.9% had a low activation score. Combined, 22.7% of the sample scored low on both aspects, whereas 45.8% had adequate levels on both. Patients who score low on both use more healthcare and have less positive experiences with patient-centered care, shared decision making, and self-management. Patients who have adequate competency levels in both respects have the best outcomes. Both cognitive and non-cognitive aspects of health literacy are important, and they enhance each other. The capacity to act is especially important for the extent to which people feel able to self-manage.
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Affiliation(s)
- Jany Rademakers
- Netherlands Institute for Health Services Research, 3500 BN Utrecht, The Netherlands.
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, 6200 MD Maastricht, The Netherlands.
| | - Monique Heijmans
- Netherlands Institute for Health Services Research, 3500 BN Utrecht, The Netherlands.
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When do people choose to be informed? Predictors of information-seeking in the choice of primary care provider in Sweden. HEALTH ECONOMICS POLICY AND LAW 2018; 15:210-224. [PMID: 30073937 DOI: 10.1017/s1744133118000373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Improving the ability of patients to make informed choices of health care provider can give providers more incentive to compete based on quality. Still, it is not evident to what extent and when people search for information when choosing a provider. The aim of this study is to identify under what circumstances individuals seek information when choosing a primary care provider. Research to date has mostly focused on individuals' demographic and socio-economic characteristics and the poor availability of information as barriers to information-seeking and use. Our results highlight the importance of taking individuals' personal motivations and situational context into account when studying information-seeking behavior. Overall, these results suggest that not even individuals who are likely to search for information since they switched or considered switching primary care provider, do so to any greater extent. However, those motivated to change providers by internal factors such as dissatisfaction or a belief that other providers may provide superior services actively sought out information to a greater extent than those motivated by external factors such as the closure of their current provider, or by moving house. Gender, employment status, place of residence and education level was also significantly associated with information-seeking.
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Storino A, Guetter C, Castillo-Angeles M, Watkins AA, Mancias JD, Bullock A, James Moser A, Kent TS. What Patients Look for When Browsing Online for Pancreatic Cancer: The Bait Behind the Byte. World J Surg 2018; 42:4097-4106. [PMID: 29971463 DOI: 10.1007/s00268-018-4719-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Suitability is a patient-centered metric defined as how appropriately health information is targeted to specific populations to increase knowledge. However, suitability is most commonly evaluated exclusively by healthcare professionals without collaboration from intended audiences. Suitability (as rated by intended audiences), accuracy and readability have not been evaluated on websites discussing pancreatic cancer. METHODS Ten healthy volunteers evaluated fifty pancreatic cancer websites using the suitability assessment of materials (SAM instrument) for the materials' overall suitability. Readability and accuracy were correlated. RESULTS Ten recruited volunteers (ages 23-63, 50% female) found websites to be on average "adequate" or "superior" in suitability. Surgery, radiotherapy and nonprofit websites had higher suitability scores as compared to counterparts (p ≤ 0.03). There was no correlation between readability and accuracy levels and suitability scores (p ≥ 0.3). Presence of visual aids was associated with better suitability scores after controlling for website quality (p ≤ 0.01). CONCLUSION Suitability of websites discussing pancreatic cancer treatments as rated by lay audiences differed based on therapy type and website affiliation, and was independent of readability level and accuracy of information. Nonprofit affiliation websites focusing on surgery or radiotherapy were most suitable. Online information should be assessed for suitability by target populations, in addition to readability level and accuracy, to ensure information reaches the intended audience.
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Affiliation(s)
- Alessandra Storino
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Camila Guetter
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Manuel Castillo-Angeles
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ammara A Watkins
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Joseph D Mancias
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Bullock
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - A James Moser
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tara S Kent
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
- Surgical Education, Beth Israel Deaconess Medical Center, LMOB 9B, 110 Francis Street, Boston, MA, 02215, USA.
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Iezzoni LI, Heaphy D, Warsett KS, Marsella SA. Description of YESHealth: A consumer-directed intervention in a randomized trial of methods to improve quality of care for persons with disability. Disabil Health J 2018; 11:545-554. [PMID: 29983376 DOI: 10.1016/j.dhjo.2018.06.003] [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] [Received: 04/06/2017] [Revised: 06/25/2018] [Accepted: 06/27/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Persons leading their own evaluations of care quality offers the promise of generating maximally meaningful information to ensure person-centered care. OBJECTIVES To describe an intervention where persons with disability engage other persons with disability, develop their own metrics to assess their care, and provide these care evaluations directly to primary care practitioners, with the goal of improving care. The context was a research study involving One Care, a Massachusetts demonstration program with capitated reimbursement for individuals ages 18-64 dually eligible for Medicare and Medicaid. METHODS Individuals with serious mental illness or significant physical disability designed and implemented "YESHealth: Your Experience, Speak up for better health care." To solicit and communicate with YESHealth members, they mailed postcards announcing YESHealth to potential participants, created a website, sponsored a Facebook group, and staffed telephones in English and Spanish. YESHealth also involved reaching out to numerous disability advocacy organizations, developing and conducting short quarterly surveys about quality concerns they identified, and reporting survey results to YESHealth members and their primary care practitioners. RESULTS Over 12 months, YESHealth staff visited 60 community organizations to recruit participants. Recruiting participants was challenging and ultimately required offering monetary compensation. Participants preferred telephone to online communication. Efforts to engage targeted primary care practitioners had very limited success. CONCLUSIONS Despite these challenges, YESHealth represents a unique model for consumers' voices to try to affect change in care delivery. A randomized trial has evaluated whether the YESHealth intervention affected care quality for One Care members with disability.
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Affiliation(s)
- Lisa I Iezzoni
- Mongan Institute Health Policy Center, Massachusetts General Hospital, United States; Department of Medicine, Harvard Medical School, Boston, MA, United States.
| | - Dennis Heaphy
- Disability Policy Consortium, Malden, MA, United States
| | | | - Sarah A Marsella
- Mongan Institute Health Policy Center, Massachusetts General Hospital, United States
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Li H, Zhang M, Wang X, Ding X, Si J. The Central Executive Mediates the Relationship Between Children's Approximate Number System Acuity and Arithmetic Strategy Utilization in Computational Estimation. Front Psychol 2018; 9:943. [PMID: 30013492 PMCID: PMC6036804 DOI: 10.3389/fpsyg.2018.00943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 05/23/2018] [Indexed: 01/29/2023] Open
Abstract
Studies investigating the relationship between working memory (WM) and approximate number system (ANS) acuity in the area of arithmetic strategy utilization are scarce. The choice/no choice method paradigm was used in the present study to determine whether and how ANS acuity and WM components affected strategy utilization. The results showed that the central executive (CE) mediated the relationship between ANS acuity and strategy utilization. Furthermore, quantile regression analyses revealed that the association between CE and strategy choice was robust from the first to highest quantile. Notably, the relationship between ANS acuity and strategy choice was significant at the median and higher quantiles (i.e., 0.5, 0.75, and 0.85 quantiles), but not significant at lower quantiles (i.e., 0.15 and 0.25 quantiles). These results suggest that domain-general skills play a crucial role in the relationship between children's ANS acuity and mathematical ability. The impact of ANS acuity and CE on strategy choice was dependent on the distribution of the strategy utilization level. These results provide a further understanding of the utilization of cognitive strategies.
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Affiliation(s)
- Hongxia Li
- School of Psychology, Shandong Normal University, Jinan, China
| | - Mingliang Zhang
- School of Psychology, Shandong Normal University, Jinan, China
- Shandong Academy of Governance, Jinan, China
| | - Xiangyan Wang
- School of Psychology, Shandong Normal University, Jinan, China
| | - Xiao Ding
- School of Psychology, Shandong Normal University, Jinan, China
| | - Jiwei Si
- School of Psychology, Shandong Normal University, Jinan, China
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Gaspar R, Domingos S, Demétrio P. Serving science to the public: Deliberations by a sample of older adults upon exposure to a serving size recommendation for meat. Food Qual Prefer 2018. [DOI: 10.1016/j.foodqual.2018.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ladin K, Buttafarro K, Hahn E, Koch-Weser S, Weiner DE. "End-of-Life Care? I'm not Going to Worry About That Yet." Health Literacy Gaps and End-of-Life Planning Among Elderly Dialysis Patients. THE GERONTOLOGIST 2018; 58:290-299. [PMID: 28329829 PMCID: PMC5946914 DOI: 10.1093/geront/gnw267] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 12/31/2016] [Indexed: 11/14/2022] Open
Abstract
Purpose Between 2000 and 2012, the incident dialysis population in the United States increased by nearly 60%, most sharply among adults 75 years and older. End-of-life (EOL) conversations among dialysis patients are associated with better patient-centered outcomes and lower use of aggressive interventions in the last month of life. This study examined how health literacy may affect engagement, comprehension, and satisfaction with EOL conversations among elderly dialysis patients. Design and Methods Qualitative/descriptive study with semi-structured interviews about health literacy, EOL conversations, and goals of care with 31 elderly dialysis patients at 2 centers in Boston. Themes were interpreted in the context of Nutbeam's health literacy framework. Results Despite high mortality risk in this population, only 13% of patients had discussed EOL preferences with physicians, half had discussed EOL with their social network, and 25% of participants explicitly stated that they had never considered EOL preferences. Less than 30% of participants could correctly define terminology commonly used in EOL conversations. Analyses yielded 5 themes: (1) Misunderstanding EOL terminology; (2) Nephrologists reluctant to discuss EOL; (3) Patients conforming to socially constructed roles; (4) Discordant expectations and dialysis experiences; and (5) Reconciling EOL values and future care. Patients had limited understanding of EOL terminology, lacked of opportunities for meaningful EOL discussion with providers and family, resulting in uncertainty about future care. Implications Limited health literacy presents a substantial barrier to communication and could lead to older adults committing to an intensive pattern of care without adequate information. Clinicians should consider health literacy when discussing dialysis initiation.
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Affiliation(s)
- Keren Ladin
- Department of Occupational Therapy, Tufts University, Medford, Massachusetts
- Research on Aging, Ethics, and Community Health, Tufts University, Medford, Massachusetts
| | - Katie Buttafarro
- Department of Occupational Therapy, Tufts University, Medford, Massachusetts
- Research on Aging, Ethics, and Community Health, Tufts University, Medford, Massachusetts
| | - Emily Hahn
- Research on Aging, Ethics, and Community Health, Tufts University, Medford, Massachusetts
| | - Susan Koch-Weser
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Daniel E Weiner
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts
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Dobbs T, Neal G, Hutchings HA, Whitaker IS, Milton J. The Readability of Online Patient Resources for Skin Cancer Treatment. Oncol Ther 2017. [DOI: 10.1007/s40487-017-0051-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Pross C, Busse R, Geissler A. Hospital quality variation matters - A time-trend and cross-section analysis of outcomes in German hospitals from 2006 to 2014. Health Policy 2017; 121:842-852. [PMID: 28733067 DOI: 10.1016/j.healthpol.2017.06.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/19/2017] [Accepted: 06/25/2017] [Indexed: 11/17/2022]
Abstract
Awareness of care variation and associated differences in outcome quality is important for patients to recognize and leverage the benefits of hospital choice and for policy makers, providers, and suppliers to adapt initiatives to improve hospital quality of care. We examine panel data on outcome quality in German hospitals between 2006 and 2014 for cholecystectomy, pacemaker implantation, hip replacement, percutaneous coronary intervention (PCI), stroke, and acute myocardial infarction (AMI). We use risk-adjusted and unadjusted outcomes based on 16 indicators. Median outcome and outcome variation trends are examined via box plots, simple linear regressions and quintile differences. Outcome trends differ across treatment areas and indicators. We found positive quality trends for hip replacement surgery, stroke and AMI 30-day mortality, and negative quality trends for 90-day stroke and AMI readmissions and PCI inpatient mortality. Variation of risk-adjusted outcomes ranges by a factor of 3-12 between the 2nd and 5th quintile of hospitals, both at the national and regional level. Our results show that simply measuring and reporting hospital outcomes without clear incentives or regulation - "carrots and sticks" - to improve performance and to centralize care in high performing hospitals has not led to broad quality improvements. More substantial efforts must be undertaken to narrow the outcome spread between high- and low-quality hospitals.
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Affiliation(s)
- Christoph Pross
- Berlin University of Technology, Department of Health Care Management, Germany
| | - Reinhard Busse
- Berlin University of Technology, Department of Health Care Management, Germany; European Observatory on Health Systems and Policies, Berlin Centre of Health Economics Research, Germany
| | - Alexander Geissler
- Berlin University of Technology, Department of Health Care Management, Germany.
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Schumacher JR, Lutz BJ, Hall AG, Pines JM, Jones AL, Hendry P, Kalynych C, Carden DL. Feasibility of an ED-to-Home Intervention to Engage Patients: A Mixed-Methods Investigation. West J Emerg Med 2017; 18:743-751. [PMID: 28611897 PMCID: PMC5468082 DOI: 10.5811/westjem.2017.2.32570] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/31/2017] [Accepted: 02/13/2017] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Older, chronically ill patients with limited health literacy are often under-engaged in managing their health and turn to the emergency department (ED) for healthcare needs. We tested the impact of an ED-initiated coaching intervention on patient engagement and follow-up doctor visits in this high-risk population. We also explored patients' care-seeking decisions. METHODS We conducted a mixed-methods study including a randomized controlled trial and in-depth interviews in two EDs in northern Florida. Participants were chronically ill older ED patients with limited health literacy and Medicare as a payer source. Patients were assigned to an evidence-based coaching intervention (n= 35) or usual post-ED care (n= 34). Qualitative interviews (n=9) explored patients' reasons for ED use. We assessed average between-group differences in patient engagement over time with the Patient Activation Measure (PAM) tool, using logistic regression and a difference-in-difference approach. Between-group differences in follow-up doctor visits were determined. We analyzed qualitative data using open coding and thematic analysis. RESULTS PAM scores fell in both groups after the ED visit but fell significantly more in "usual care" (average decline -4.64) than "intervention" participants (average decline -2.77) (β=1.87, p=0.043). There were no between-group differences in doctor visits. Patients described well-informed reasons for ED visits including onset and severity of symptoms, lack of timely provider access, and immediate and comprehensive ED care. CONCLUSION The coaching intervention significantly reduced declines in patient engagement observed after usual post-ED care. Patients reported well-informed reasons for ED use and will likely continue to make ED visits unless strategies, such as ED-initiated coaching, are implemented to help vulnerable patients better manage their health and healthcare.
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Affiliation(s)
| | - Barbara J. Lutz
- University of North Carolina-Wilmington, College of Health and Human Services, School of Nursing, Wilmington, North Carolina
| | - Allyson G. Hall
- University of Alabama at Birmingham, Department of Health Services Administration, Birmingham, Alabama
| | - Jesse M. Pines
- The George Washington University School of Medicine, Department of Emergency Medicine and Health Policy & Management, Washington, DC
| | - Andrea L. Jones
- University of North Carolina-Wilmington, College of Health and Human Services, School of Social Work, Wilmington, North Carolina
| | - Phyllis Hendry
- University of Florida, College of Medicine, Department of Emergency Medicine, Jacksonville, Florida
| | - Colleen Kalynych
- University of Florida, College of Medicine, Department of Emergency Medicine, Jacksonville, Florida
| | - Donna L. Carden
- University of Florida, Department of Emergency Medicine, Gainesville, Florida
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Garcia-Retamero R, Cokely ET. Designing Visual Aids That Promote Risk Literacy: A Systematic Review of Health Research and Evidence-Based Design Heuristics. HUMAN FACTORS 2017; 59:582-627. [PMID: 28192674 DOI: 10.1177/0018720817690634] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Background Effective risk communication is essential for informed decision making. Unfortunately, many people struggle to understand typical risk communications because they lack essential decision-making skills. Objective The aim of this study was to review the literature on the effect of numeracy on risk literacy, decision making, and health outcomes, and to evaluate the benefits of visual aids in risk communication. Method We present a conceptual framework describing the influence of numeracy on risk literacy, decision making, and health outcomes, followed by a systematic review of the benefits of visual aids in risk communication for people with different levels of numeracy and graph literacy. The systematic review covers scientific research published between January 1995 and April 2016, drawn from the following databases: Web of Science, PubMed, PsycINFO, ERIC, Medline, and Google Scholar. Inclusion criteria were investigation of the effect of numeracy and/or graph literacy, and investigation of the effect of visual aids or comparison of their effect with that of numerical information. Thirty-six publications met the criteria, providing data on 27,885 diverse participants from 60 countries. Results Transparent visual aids robustly improved risk understanding in diverse individuals by encouraging thorough deliberation, enhancing cognitive self-assessment, and reducing conceptual biases in memory. Improvements in risk understanding consistently produced beneficial changes in attitudes, behavioral intentions, trust, and healthy behaviors. Visual aids were found to be particularly beneficial for vulnerable and less skilled individuals. Conclusion Well-designed visual aids tend to be highly effective tools for improving informed decision making among diverse decision makers. We identify five categories of practical, evidence-based guidelines for heuristic evaluation and design of effective visual aids.
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Case K, Guo Y, Nixon SJ, Muller K, Huo T, Prather R, Morris H, Stoner D, Shenkman E. Exploring the Role of Executive Functioning Capacity in Patient Activation and Health Outcomes Among Medicaid Members With Multiple Comorbidities. Med Care Res Rev 2017; 76:444-461. [DOI: 10.1177/1077558717709419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient activation, the perceived capacity to manage one’s health, is positively associated with better health outcomes and lower costs. Underlying characteristics influencing patient activation are not completely understood leading to gaps in intervention strategies designed to improve patient activation. We suggest that variability in executive functioning influences patient activation and ultimately has an impact on health outcomes. To examine this hypothesis, 440 chronically ill Medicaid enrollees completed measures of executive functioning, patient activation, and health-related quality of life. Mediation analyses revealed that executive functioning: (a) directly affected patient activation and mental health-related quality of life, (b) indirectly affected mental health-related quality of life through patient activation, and (c) was unrelated to physical health-related quality of life. These data indicate that further study of the relationships among neurocognitive processes, patient activation, and health-related quality of life is needed and reinforces previous work demonstrating the association between patient activation and self-reported outcomes.
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Affiliation(s)
| | - Yi Guo
- University of Florida, Gainesville, FL, USA
| | | | | | | | | | | | - Dena Stoner
- Department of State Health Services, Austin, TX, USA
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Storr T, Maher J, Swanepoel E. Online nutrition information for pregnant women: a content analysis. MATERNAL & CHILD NUTRITION 2017; 13:e12315. [PMID: 27353248 PMCID: PMC6865949 DOI: 10.1111/mcn.12315] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/10/2016] [Accepted: 02/11/2016] [Indexed: 11/30/2022]
Abstract
Pregnant women actively seek health information online, including nutrition and food-related topics. However, the accuracy and readability of this information have not been evaluated. The aim of this study was to describe and evaluate pregnancy-related food and nutrition information available online. Four search engines were used to search for pregnancy-related nutrition web pages. Content analysis of web pages was performed. Web pages were assessed against the 2013 Australian Dietary Guidelines to assess accuracy. Flesch-Kincaid (F-K), Simple Measure of Gobbledygook (SMOG), Gunning Fog Index (FOG) and Flesch reading ease (FRE) formulas were used to assess readability. Data was analysed descriptively. Spearman's correlation was used to assess the relationship between web page characteristics. Kruskal-Wallis test was used to check for differences among readability and other web page characteristics. A total of 693 web pages were included. Web page types included commercial (n = 340), not-for-profit (n = 113), blogs (n = 112), government (n = 89), personal (n = 36) and educational (n = 3). The accuracy of online nutrition information varied with 39.7% of web pages containing accurate information, 22.8% containing mixed information and 37.5% containing inaccurate information. The average reading grade of all pages analysed measured by F-K, SMOG and FOG was 11.8. The mean FRE was 51.6, a 'fairly difficult to read' score. Only 0.5% of web pages were written at or below grade 6 according to F-K, SMOG and FOG. The findings suggest that accuracy of pregnancy-related nutrition information is a problem on the internet. Web page readability is generally difficult and means that the information may not be accessible to those who cannot read at a sophisticated level. © 2016 John Wiley & Sons Ltd.
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Affiliation(s)
- Tayla Storr
- School of Health and Sports Science, Faculty of Science, Health, Engineering and EducationUniversity of the Sunshine CoastSippy DownsQueensland Australia
| | - Judith Maher
- School of Health and Sports Science, Faculty of Science, Health, Engineering and EducationUniversity of the Sunshine CoastSippy DownsQueensland Australia
| | - Elizabeth Swanepoel
- School of Health and Sports Science, Faculty of Science, Health, Engineering and EducationUniversity of the Sunshine CoastSippy DownsQueensland Australia
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Factors That Matter to Low-Income and Racial/Ethnic Minority Mothers When Choosing a Pediatric Practice: a Mixed Methods Analysis. J Racial Ethn Health Disparities 2017; 4:1051-1060. [PMID: 28275998 DOI: 10.1007/s40615-016-0309-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pediatric practices' scores on healthcare quality measures are increasingly available to the public. However, patients from low-income and racial/ethnic minority populations rarely use these data. We sought to understand potential barriers to using quality data by assessing what factors mattered to women when choosing a pediatric practice. METHODS As part of a randomized trial to overcome barriers to using quality data, we recruited women from a prenatal clinic serving an underserved population. Women reported how much 12 factors mattered when they chose a pediatric practice (5-point Likert scale), what other factors mattered to them, and which factors mattered the most. We assessed whether factor importance varied with selected participant characteristics and qualitatively analyzed the "other" factors named. RESULTS Participants' (n = 367) median age was 23 years, and they were largely Hispanic (60.4%), white (21.2%), or black (16.9%). Insurance acceptance "mattered a lot" to the highest percentage of women (93.2%), while online information about what other parents think of a practice "mattered a lot" to the fewest (7.4%). Major themes from our qualitative analysis of "other" factors that mattered included physicians' interpersonal skills and pediatrician-specific traits. Factors related to access "mattered the most" to the majority of women. CONCLUSIONS Pediatrician characteristics and factors related to access to care may be more important to low-income and racial/ethnic minority women than more commonly reported quality metrics. Aligning both the content and delivery of publicly reported quality data with women's interests may increase use of pediatric quality data. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov NCT01784575.
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Griffey RT, McNaughton CD, McCarthy DM, Shelton E, Castaneda-Guarderas A, Young-Brinn A, Fowler D, Grudszen C. Shared Decision Making in the Emergency Department Among Patients With Limited Health Literacy: Beyond Slower and Louder. Acad Emerg Med 2016; 23:1403-1409. [PMID: 27641236 PMCID: PMC6103446 DOI: 10.1111/acem.13104] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/25/2016] [Accepted: 09/07/2016] [Indexed: 01/24/2023]
Abstract
Although studies suggest that patients with limited health literacy and/or low numeracy skills may stand to gain the most from shared decision making (SDM), the impact of these conditions on the effective implementation of SDM in the emergency department (ED) is not well understood. In this article from the proceedings of the 2016 Academic Emergency Medicine Consensus Conference on Shared Decision Making in the Emergency Department we discuss knowledge gaps identified and propose consensus-driven research priorities to help guide future work to improve SDM for this patient population in the ED.
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Affiliation(s)
- Richard T Griffey
- Department of Emergency Medicine, Washington University in St. Louis, St. Louis, MO
| | - Candace D McNaughton
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | | | - Erica Shelton
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD
| | - Ana Castaneda-Guarderas
- Department of Emergency Medicine & Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Angela Young-Brinn
- Division of Community Engagement, Charles R. Drew University of Medicine and Science, Los Angeles, CA
| | - Donna Fowler
- Department of Emergency Medicine, University of Florida, Gainesville, FL
| | - Corita Grudszen
- Departments of Emergency Medicine and Population Health, New York University, New York, NY
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Development and Validation of the Spanish Numeracy Understanding in Medicine Instrument. J Gen Intern Med 2016; 31:1345-1352. [PMID: 27312095 PMCID: PMC5071279 DOI: 10.1007/s11606-016-3759-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 12/28/2015] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Spanish-speaking population in the U.S. is large and growing and is known to have lower health literacy than the English-speaking population. Less is known about the health numeracy of this population due to a lack of health numeracy measures in Spanish. OBJECTIVE we aimed to develop and validate a short and easy to use measure of health numeracy for Spanish-speaking adults: the Spanish Numeracy Understanding in Medicine Instrument (Spanish-NUMi). DESIGN Items were generated based on qualitative studies in English- and Spanish-speaking adults and translated into Spanish using a group translation and consensus process. Candidate items for the Spanish NUMi were selected from an eight-item validated English Short NUMi. Differential Item Functioning (DIF) was conducted to evaluate equivalence between English and Spanish items. Cronbach's alpha was computed as a measure of reliability and a Pearson's correlation was used to evaluate the association between test scores and the Spanish Test of Functional Health Literacy (S-TOFHLA) and education level. PARTICIPANTS Two-hundred and thirty-two Spanish-speaking Chicago residents were included in the study. KEY RESULTS The study population was diverse in age, gender, and level of education and 70 % reported Mexico as their country of origin. Two items of the English eight-item Short NUMi demonstrated DIF and were dropped. The resulting six-item test had a Cronbach's alpha of 0.72, a range of difficulty using classical test statistics (percent correct: 0.48 to 0.86), and adequate discrimination (item-total score correlation: 0.34-0.49). Scores were positively correlated with print literacy as measured by the S- TOFHLA (r = 0.67; p < 0.001) and varied as predicted across grade level; mean scores for up to eighth grade, ninth through twelfth grade, and some college experience or more, respectively, were 2.48 (SD ± 1.64), 4.15 (SD ± 1.45), and 4.82 (SD ± 0.37). CONCLUSIONS The Spanish NUMi is a reliable and valid measure of important numerical concepts used in communicating health information.
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Rademakers J, Maindal HT, Steinsbekk A, Gensichen J, Brenk-Franz K, Hendriks M. Patient activation in Europe: an international comparison of psychometric properties and patients' scores on the short form Patient Activation Measure (PAM-13). BMC Health Serv Res 2016; 16:570. [PMID: 27729079 PMCID: PMC5059995 DOI: 10.1186/s12913-016-1828-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 10/08/2016] [Indexed: 11/28/2022] Open
Abstract
Background To allow better assessment of patients’ individual competencies for self-management, the Patient Activation Measure (PAM) has been developed in the USA. Because the American studies have shown the PAM to be a valuable tool, several European countries have translated the instrument into their native languages (Danish, Dutch, German, Norwegian). The aim was to compare the psychometric properties in studies from the different countries and establish whether the scores on the PAM vary between the studies. Methods Data from the four separate studies were subjected to the same data cleaning procedures and statistical analyses. The psychometric properties of the instruments were established with measures of data quality and scale structure. The mean patient activation score and distribution across four predefined activation levels were described and the differences between the four studies were tested with ANOVA (unadjusted and adjusted) followed by a post-hoc Tukey HSD test and the Pearson chi-squared test respectively. Results The total N of the four studies was 5184. The percentage of missing values was low in all datasets, confirming the good quality of the datasets. Factor analyses revealed moderate to strong factor loadings on the first factor in all datasets. Cronbach’s α was high for all version, ranging from .80 (German) to .88 (Dutch). Item-rest correlations varied between .32 and .66, indicating a moderate to strong correlation of the individual items to the sum scale. Both the mean PAM score and the distribution across activation levels differed between the four datasets. After adjustment of the PAM score, patients in Norway in particular had a higher patient activation level. Conclusions The European translations of PAM-13 (into Danish, Dutch, German and Norwegian) resulted in four instruments with good psychometric capabilities for measuring patient activation. The mean PAM score and the distribution across activation levels differed between the four datasets.
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Affiliation(s)
- Jany Rademakers
- NIVEL - Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Utrecht, Netherlands. .,Maastricht University, CAPHRI School for Public Health and Primary Care, Maastricht, Netherlands.
| | - Helle Terkildsen Maindal
- Department of Public Health / Section of Health Promotion and Health Services Research, Aarhus University, Aarhus, Denmark
| | - Aslak Steinsbekk
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jochen Gensichen
- Jena University Hospital, Friedrich-Schiller-University, Institute of General Practice and Family Medicine, Jena, Germany.,Institute of General Practice / Family Medicine, University Hospital of LMU Munich, München, Germany
| | - Katja Brenk-Franz
- Jena University Hospital, Friedrich-Schiller-University, Institute of General Practice and Family Medicine, Jena, Germany
| | - Michelle Hendriks
- NIVEL - Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Utrecht, Netherlands
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Goff SL, Mazor KM, Pekow PS, White KO, Priya A, Lagu T, Guhn-Knight H, Murphy L, Youssef Budway Y, Lindenauer PK. Patient Navigators and Parent Use of Quality Data: A Randomized Trial. Pediatrics 2016; 138:peds.2016-1140. [PMID: 27600316 PMCID: PMC5051210 DOI: 10.1542/peds.2016-1140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Consumers rarely use publicly reported health care quality data. Despite known barriers to use, few studies have explored the effectiveness of strategies to overcome barriers in vulnerable populations. METHODS This randomized controlled trial tested the impact of a patient navigator intervention to increase consumer use of publicly reported quality data. Patients attending an urban prenatal clinic serving a vulnerable population enrolled between May 2013 and January 2015. The intervention consisted of 2 in-person sessions in which women learned about quality performance and viewed scores for local practices on the Massachusetts Health Quality Partners Web site. Women in both the intervention and control arms received a pamphlet about health care quality. Primary study outcomes were mean clinical quality and patient experience scores of the practices women selected (range 1-4 stars). RESULTS Nearly all (726/746; 97.3%) women completed the study, 59.7% were Hispanic, and 65.1% had a high school education or less. In both unadjusted and adjusted models, women in the intervention group chose practices with modestly higher mean clinical quality (3.2 vs 3.0 stars; P = .001) and patient experience (3.0 vs 2.9 stars; P = .05) scores. When asked to rate what factors mattered the most in their decision, few cited quality scores. CONCLUSIONS An intervention to reduce barriers to using publicly reported health care quality data had a modest effect on patient choice. These findings suggest that factors other than performance on common publicly reported quality metrics have a stronger influence on which pediatric practices women choose.
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Affiliation(s)
- Sarah L. Goff
- The Center for Quality of Care Research and Department of Medicine, Baystate Medical Center/Tufts University School of Medicine, Springfield, Massachusetts
| | | | - Penelope S. Pekow
- The Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts
| | - Katharine O. White
- Department of Obstetrics and Gynecology, Boston Medical Center/Boston University, Boston, Massachusetts
| | - Aruna Priya
- The Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts
| | - Tara Lagu
- The Center for Quality of Care Research and Department of Medicine, Baystate Medical Center/Tufts University School of Medicine, Springfield, Massachusetts
| | - Haley Guhn-Knight
- The Center for Quality of Care Research and Department of Medicine, Baystate Medical Center/Tufts University School of Medicine, Springfield, Massachusetts
| | - Lorna Murphy
- Renal Transplant Associates of New England, Springfield, Massachusetts; and
| | - Yara Youssef Budway
- Massachusetts General Hospital, Physician Analytics and Business Intelligence, Boston, Massachusetts
| | - Peter K. Lindenauer
- The Center for Quality of Care Research and Department of Medicine, Baystate Medical Center/Tufts University School of Medicine, Springfield, Massachusetts
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Almalki M, Gray K, Martin-Sanchez F. Activity Theory as a Theoretical Framework for Health Self-Quantification: A Systematic Review of Empirical Studies. J Med Internet Res 2016; 18:e131. [PMID: 27234343 PMCID: PMC4909388 DOI: 10.2196/jmir.5000] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/16/2015] [Accepted: 03/21/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Self-quantification (SQ) is a way of working in which, by using tracking tools, people aim to collect, manage, and reflect on personal health data to gain a better understanding of their own body, health behavior, and interaction with the world around them. However, health SQ lacks a formal framework for describing the self-quantifiers' activities and their contextual components or constructs to pursue these health related goals. Establishing such framework is important because it is the first step to operationalize health SQ fully. This may in turn help to achieve the aims of health professionals and researchers who seek to make or study changes in the self-quantifiers' health systematically. OBJECTIVE The aim of this study was to review studies on health SQ in order to answer the following questions: What are the general features of the work and the particular activities that self-quantifiers perform to achieve their health objectives? What constructs of health SQ have been identified in the scientific literature? How have these studies described such constructs? How would it be possible to model these constructs theoretically to characterize the work of health SQ? METHODS A systematic review of peer-reviewed literature was conducted. A total of 26 empirical studies were included. The content of these studies was thematically analyzed using Activity Theory as an organizing framework. RESULTS The literature provided varying descriptions of health SQ as data-driven and objective-oriented work mediated by SQ tools. From the literature, we identified two types of SQ work: work on data (ie, data management activities) and work with data (ie, health management activities). Using Activity Theory, these activities could be characterized into 6 constructs: users, tracking tools, health objectives, division of work, community or group setting, and SQ plan and rules. We could not find a reference to any single study that accounted for all these activities and constructs of health SQ activity. CONCLUSIONS A Health Self-Quantification Activity Framework is presented, which shows SQ tool use in context, in relation to the goals, plans, and competence of the user. This makes it easier to analyze issues affecting SQ activity, and thereby makes it more feasible to address them. This review makes two significant contributions to research in this field: it explores health SQ work and its constructs thoroughly and it adapts Activity Theory to describe health SQ activity systematically.
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Affiliation(s)
- Manal Almalki
- Health and Biomedical Informatics Centre, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.
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Garcia-Retamero R, Andrade A, Sharit J, Ruiz JG. Is patients' numeracy related to physical and mental health? Med Decis Making 2016; 35:501-11. [PMID: 25943579 DOI: 10.1177/0272989x15578126] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE There is compelling evidence showing that health literacy influences health outcomes. However, there is a dearth of research investigating this issue in the vast literature on numeracy-the ability to accurately interpret numerical information about risk, a skill that is only moderately correlated with health literacy. In a cross-sectional study, we investigated whether objective and subjective numeracy is related to objective and subjective health outcomes. Objective (subjective) numeracy is actual (self-reported) numerical competence. Objective outcomes include prevalence of comorbidity and prescribed medications. Subjective outcomes include perceptions of physical and mental health. METHODS A convenience sample of 502 male individuals receiving outpatient care at a Veterans Affairs Medical Center reported their demographics and answered a survey measuring objective and subjective numeracy, trust in physicians, satisfaction with role in medical decision making, perceptions of physical and mental health, and risky habits. We computed patients' body mass index (BMI) and their age-adjusted Charlson index-an extensively studied comorbidity index for predicting mortality in clinical research. We retrieved number of prescribed medications from medical records. RESULTS Compared with patients who had high objective numeracy, patients with low objective numeracy showed higher prevalence of comorbidities and took more prescribed medications. Compared with patients who had high subjective numeracy, patients with low subjective numeracy had more negative perceptions of their physical and mental health. These conclusions held after controlling for the effect of demographics, risky habits, BMI, trust in physicians, and satisfaction with role in decision making, suggesting that numeracy has a unique, significant contribution to health outcomes beyond the effect of these factors. CONCLUSIONS Our research documents for the first time that self-reported numeracy is related to perceptions of health, whereas objective numeracy is related to actual health, laying the groundwork for future research on the effect of numeracy on health outcomes.
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Affiliation(s)
- Rocio Garcia-Retamero
- Department of Experimental Psychology, University of Granada, Granada, Spain (RGR),Center for Adaptive Behavior and Cognition, Max Planck Institute for Human Development, Berlin, Germany (RGR)
| | - Allen Andrade
- Laboratory of E-learning and Multimedia Research, Bruce W. Carter VA Geriatric Research Education and Clinical Center (GRECC), Miami, FL, USA (AA, JS, JGR),University of Miami Miller School of Medicine, Miami, FL, USA (AA, JS, JGR)
| | - Joseph Sharit
- Laboratory of E-learning and Multimedia Research, Bruce W. Carter VA Geriatric Research Education and Clinical Center (GRECC), Miami, FL, USA (AA, JS, JGR),University of Miami Miller School of Medicine, Miami, FL, USA (AA, JS, JGR),University of Miami College of Engineering, Miami, FL, USA (JS)
| | - Jorge G Ruiz
- Laboratory of E-learning and Multimedia Research, Bruce W. Carter VA Geriatric Research Education and Clinical Center (GRECC), Miami, FL, USA (AA, JS, JGR),University of Miami Miller School of Medicine, Miami, FL, USA (AA, JS, JGR)
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Examining Associations between Health Information Seeking Behavior and Adult Education Status in the U.S.: An Analysis of the 2012 PIAAC Data. PLoS One 2016; 11:e0148751. [PMID: 26882339 PMCID: PMC4755661 DOI: 10.1371/journal.pone.0148751] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 01/22/2016] [Indexed: 11/28/2022] Open
Abstract
This paper presents data from the Program for the International Assessment of Adult Competencies with a focus on the interrelationships among health information seeking behavior (HISB), and health status or use of preventive health measures for U.S. adults both with and without a high school diploma. Key results of ordinal and binary logistic regression analyses indicated that, after controlling for demographic factors, (1) adults with a high school diploma use more text-based health information sources while adults without a high school diploma use more oral sources, (2) using the Internet as a source of health information is more strongly related to reporting excellent/very good health status than having a high school diploma, (3) those without a high school diploma who use the Internet report the largest increase in health status over any other health information source, and (4) for those with learning disability or vision problem, a high facility in reading English is an important predictor of whether the Internet is used as a health information source. The Internet appears to play a key role in both enhancing health status and enabling use of preventive measures for those with and without a high school diploma; although, individuals without a high school diploma who use the Internet for health information derive substantial benefit in health status.
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45
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Schapira MM, Shea JA, Duey KA, Kleiman C, Werner RM. The Nursing Home Compare Report Card: Perceptions of Residents and Caregivers Regarding Quality Ratings and Nursing Home Choice. Health Serv Res 2016; 51 Suppl 2:1212-28. [PMID: 26867949 DOI: 10.1111/1475-6773.12458] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the perceived usefulness of publicly reported nursing home quality indicators. STUDY SETTING Primary data were collected from October 2013 to August 2014 among a convenience sample of persons (or family member) recently admitted or anticipating admission to a nursing home within 75 miles of the city of Philadelphia. STUDY DESIGN Structured interviews were conducted to assess the salience of data on the Medicare Nursing Home Compare website, including star ratings, clinical quality measures, and benchmarking of individual nursing home quality with state and national data. DATA COLLECTION Interviews were transcribed verbatim, independently coded by two reviewers, and agreement determined. A thematic analysis of transcripts was undertaken. PRINCIPAL FINDINGS Thirty-five interviews were completed. Eighty-three percent (n = 29) were caregivers and 17 percent (n = 6) were residents. Star ratings, clinical quality measures, and benchmarking information were salient to decision making, with preferred formats varying across participants. Participants desired additional information on the source of quality data. Confusion was evident regarding the relationship between domain-specific and overall star quality ratings. CONCLUSIONS The Nursing Home Compare website provides salient content and formats for consumers. Increased awareness of this resource and clarity regarding the definition of measures could further support informed decision making regarding nursing home choice.
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Affiliation(s)
- Marilyn M Schapira
- Division of General Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA
| | - Judy A Shea
- Division of General Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Katia A Duey
- Division of General Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Carly Kleiman
- Division of General Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rachel M Werner
- Division of General Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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Sivakumar H, Hanoch Y, Barnes AJ, Federman AD. Cognition, Health Literacy, and Actual and Perceived Medicare Knowledge Among Inner-City Medicare Beneficiaries. JOURNAL OF HEALTH COMMUNICATION 2016; 21:155-163. [PMID: 27676124 DOI: 10.1080/10810730.2016.1193921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Poor Medicare knowledge is associated with worse health outcomes, especially in low-income patients. We examined the association of health literacy and cognition with actual and perceived Medicare knowledge in a sample of inner-city older adults. We conducted a cross-sectional analysis of data on 336 adults ages 65 years and older with Medicare coverage recruited from senior centers and low-income housing facilities in Manhattan, New York. Actual Medicare knowledge was determined by a summary score of 9 true/false questions about the Medicare program and perceived Medicare knowledge with a single item. Validated measures were used to assess health literacy and general cognition. Among respondents, 63.1% had high actual Medicare knowledge, and 36.0% believed that they knew what they needed to know about Medicare. Actual and perceived Medicare knowledge were poorly correlated (r = -.01, p > .05). In multivariable models, low health literacy was significantly associated with actual Medicare knowledge (β = -8.30, SE = 2.71, p < .01) but not perceived Medicare knowledge (β = 0.37, SE = 0.22, p = .09). Individuals with low health literacy were more likely to perceive their Medicare knowledge as adequate when actual Medicare knowledge was low (adjusted odds ratio = 3.30, 95% confidence interval [1.20, 9.05], p < .05). These results show that older adults with low health literacy are more likely to have poor understanding of the Medicare program and yet more likely to believe that their understanding of the program is adequate. This combination of factors may place them at increased risk for poor access to information about the Medicare program and diminish their ability to make fully informed choices.
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Affiliation(s)
- Haran Sivakumar
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , New York , USA
| | - Yaniv Hanoch
- b Department of Healthcare Behavior and Policy , Virginia Commonwealth University School of Medicine , Richmond , Virginia , USA
| | - Andrew J Barnes
- c School of Psychology , Plymouth University , Plymouth , United Kingdom
| | - Alex D Federman
- d Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , New York , USA
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Sheikh S, Hendry P, Kalynych C, Owensby B, Johnson J, Kraemer DF, Carden D. Assessing patient activation and health literacy in the ED. Am J Emerg Med 2016; 34:93-6. [DOI: 10.1016/j.ajem.2015.09.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/26/2015] [Accepted: 09/30/2015] [Indexed: 11/29/2022] Open
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Smith SG, Pandit A, Rush SR, Wolf MS, Simon C. The association between patient activation and accessing online health information: results from a national survey of US adults. Health Expect 2015; 18:3262-73. [PMID: 25475371 PMCID: PMC5810745 DOI: 10.1111/hex.12316] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND There are increasing opportunities for the public to access online health information, but attitudinal barriers to use are less well-known. Patient activation is associated with key health outcomes, but its relationship with using online health information is not known. OBJECTIVE We examined the relationship between patient activation and the likelihood of accessing a range of different types of online health information in a nationally representative US sample. DESIGN Cross-sectional nationally representative survey. SETTING AND PARTICIPANTS Data were from an online (n = 2700) and random digit dial telephone survey (n = 700) of US adults (total n = 3400). MAIN VARIABLES STUDIED Respondent characteristics and the Patient Activation Measure. MAIN OUTCOME MEASURES Self-reported access of five types of online health information in the past 12 months (online medical records, cost estimation tools, quality comparison tools, health information about a specific condition, preventive health information). RESULTS Approximately, one-fifth of the sample had accessed their medical record (21.6%), treatment cost estimation tools (17.3%) and hospital and physician quality comparison tools (21.8%). Nearly half of the sample had accessed information about medical conditions or treatments (48.3%) or preventive health and well-being (45.9%). In multivariable analyses adjusted for participant characteristics, respondents with greater patient activation were more likely to have accessed all types of health information other than cost estimation tools. DISCUSSION AND CONCLUSIONS Activated people are more likely to make use of online heath information. Increasing patient activation could improve the public's ability to participate in health care and personal health self-management by encouraging health information seeking.
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Affiliation(s)
- Samuel G. Smith
- Department of General Internal Medicine and GeriatricsNorthwestern UniversityChicagoILUSA
- Wolfson Institute of Preventive MedicineQueen Mary University of LondonLondonUK
| | - Anjali Pandit
- Department of General Internal Medicine and GeriatricsNorthwestern UniversityChicagoILUSA
| | | | - Michael S. Wolf
- Department of General Internal Medicine and GeriatricsNorthwestern UniversityChicagoILUSA
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A Qualitative Study of Vulnerable Patient Views of Type 2 Diabetes Consumer Reports. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2015; 9:231-40. [DOI: 10.1007/s40271-015-0146-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Duell P, Wright D, Renzaho AMN, Bhattacharya D. Optimal health literacy measurement for the clinical setting: A systematic review. PATIENT EDUCATION AND COUNSELING 2015; 98:1295-1307. [PMID: 26162954 DOI: 10.1016/j.pec.2015.04.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 12/05/2014] [Accepted: 04/04/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To identify the optimal measurement instrument for assessing health literacy in a clinical setting. METHODS Seven databases were searched for studies evaluating health literacy instruments used with patients. Standardised systematic review methods were used by two reviewers independently assessing eligibility, extracting data and evaluating study quality. A narrative summary was produced. RESULTS The searches identified 626 articles of which 64 were eligible. Forty-three different health literacy instruments were identified. The quality of these instruments, based on their psychometric properties, varied considerably. The majority of health literacy instruments were found to only assess communicative health literacy of which the numeracy element was often not represented. The NVS instrument was found to be the most practical health literacy instrument to use. CONCLUSION There is an urgent need to develop and psychometrically test a more encompassing health literacy instrument applicable in clinical settings as well as health promotion in general. PRACTICE IMPLICATIONS In the absence of a more comprehensive health literacy instrument, the NVS is a practical instrument to quickly assess for health literacy in a clinical setting.
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Affiliation(s)
- Paul Duell
- University of East Anglia, School of Pharmacy, Norwich Research Park, Norwich, UK.
| | - David Wright
- University of East Anglia, School of Pharmacy, Norwich Research Park, Norwich, UK
| | - Andre M N Renzaho
- School of Social Sciences and Psychology, University of Western Sydney, Sydney, Australia
| | - Debi Bhattacharya
- University of East Anglia, School of Pharmacy, Norwich Research Park, Norwich, UK
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