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Lane M, Dixon R, Donald KJ, Ware RS. Health literacy profiles of medical students in an Australian Doctor of Medicine programme: A cross-sectional study using the Health Literacy Questionnaire. Health Promot J Austr 2023. [PMID: 37556927 DOI: 10.1002/hpja.790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023] Open
Abstract
ISSUE ADDRESSED With the emerging focus on designing health-literate organisations and health care systems, it is essential to understand the health literacy profiles of the medical workforce including medical students, as medical professionals play a key role in within these systems. Medical professionals contribute to good patient health outcomes through enabling access to appropriate health care, provision of quality health information and collaborative shared decision-making, which are fundamental health literacy competencies. The aim of this study is to identify health literacy strengths and weaknesses of medical students enrolled in an Australian Doctor of Medicine programme. METHODS Students from all 4 years of an Australian Doctor of Medicine programme were invited to complete an anonymous, online survey in January 2021. Health literacy profiles were identified using the 9-domain, 44-item multi-dimensional Health Literacy Questionnaire, a validated tool which comprehensively evaluates health literacy strengths and weaknesses from diverse perspectives. Demographic characteristics and social attributes were also recorded. The results were compared with Australian Bureau of Statistics data. RESULTS Eighty-six participants completed the survey. Most participants were female students (57%) who spoke English at home (88%) with tertiary-educated fathers (60%) and resided in locations associated with high socioeconomic status during adolescence (61%). Males scored significantly higher in three domains which explored health information access and appraisal, and ability to actively engage with health care providers. Students' scores were significantly lower than the Australian general population in Domain 6 (Ability to actively engage with health care providers) and Domain 7 (Navigating the health care system). CONCLUSIONS Medical students' health literacy profiles indicate areas of weakness in their ability to engage with health care providers and to navigate the health system. Medical educators will need to create opportunities to address these weaknesses within medical curricula. Gender differences identified in self-rated ability to access and appraise health information requires further exploration. SO WHAT?: Further understanding of health literacy profiles of medical students may influence design of medical school curricula.
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Affiliation(s)
- Margo Lane
- School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia
- UQ Medical School, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Robyn Dixon
- Faculty of Medical and Health Sciences, Nursing, University of Auckland, Auckland, New Zealand
| | - Ken J Donald
- School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Robert S Ware
- School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Zaeh SE, Ramsey R, Bender B, Hommel K, Mosnaim G, Rand C. The Impact of Adherence and Health Literacy on Difficult-to-Control Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:386-394. [PMID: 34788658 DOI: 10.1016/j.jaip.2021.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/25/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022]
Abstract
Medication nonadherence and health literacy are key factors that influence the management of difficult-to-control asthma. Adherence, or the extent to which a patient follows a treatment plan, extends beyond asthma medication use and includes an appropriate inhaler technique. Assessment of adherence is critical before making a diagnosis of severe asthma and stepping up asthma therapy but is challenging in the clinical context. Health literacy, or the degree to which individuals can obtain, process, and understand health information and services needed to make health care decisions, is additionally important for asthma management and has been shown to impact medication adherence. Initiatives aiming to improve difficult-to-control asthma should address medication adherence and health literacy. Universal health literacy precautions are recommended while communicating with patients, in addition to the creation of low health literacy asthma action plans. To improve adherence, a comprehensive assessment of adherence should be conducted. Additional evidence-based interventions aiming to improve adherence focus on appropriate inhaler use, improved access to medications, the use of digital platforms, school-based asthma interventions, and the implementation of culturally tailored interventions. Data are limited regarding the use of these initiatives in patients with severe or difficult-to-control asthma.
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Affiliation(s)
- Sandra E Zaeh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Conn.
| | - Rachelle Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Bruce Bender
- Department of Pediatrics, National Jewish Health, Denver, Colo
| | - Kevin Hommel
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Giselle Mosnaim
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, NorthShore University Health System, Evanston, Ill
| | - Cynthia Rand
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Md
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The Role of Health Literacy in Health Behavior, Health Service Use, Health Outcomes, and Empowerment in Pediatric Patients with Chronic Disease: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312464. [PMID: 34886185 PMCID: PMC8656602 DOI: 10.3390/ijerph182312464] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022]
Abstract
About 8% of all children and adolescents worldwide are affected by chronic diseases. Managing chronic conditions requires pediatric patients to be health literate. The purpose of this review is to examine the existing evidence on the links between health literacy and its outcomes proposed by the model by Sørensen et al. in chronically ill pediatric patients. Four electronic databases (PubMed, Scopus, CINAHL, PsycINFO) were searched to identify pertinent articles published up to November 2021. The search was conducted independently by two researchers and restricted to observational studies. Of 11,137 initial results, 11 articles met eligibility criteria. Overall, 6 studies identified a significant association between health literacy and one of the considered outcomes. Regarding health behavior, none of the studies on adherence found significant associations with health literacy. The results in terms of health service use were inconclusive. Regarding health outcomes, health literacy did not affect most physiological parameters, but it significantly improved health-related quality of life. Overall, evidence remains inconclusive but suggests that health literacy is associated with self-efficacy, health-related quality of life, and health service use in pediatric patients. Further research should be undertaken to strengthen the evidence.
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Hargiss JB, St Jeor JD, Horn JL, Garrison GM. Rapid Independent Health Literacy Assessment: A Pilot Study Among Native English-speaking and Low English Proficiency Patients. J Prim Care Community Health 2021; 12:21501327211037773. [PMID: 34355598 PMCID: PMC8358576 DOI: 10.1177/21501327211037773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Health literacy is an individual's capacity to obtain, process, and understand basic health information needed to make appropriate health decisions. Failure to understand and correctly execute a plan of care often leads to poor health outcomes. Determining patient health literacy allows health care providers to tailor their plan of care instructions, increasing the probability of understanding, and adherence. Several validated health literacy tests have been developed to assess the health literacy of individuals and ethnic groups. However, because a proctor is required to administer these tests, their usefulness in clinical settings is limited. The issue of health literacy is especially relevant within minority groups. This research focused on producing a translatable assessment that can be administered quickly without a proctor. METHODS We developed a 15-question instrument (the RIHLA) in English using the Delphi method with a panel of bilingual experts and translated it into Spanish. Internal reliability was assessed using Cronbach's alpha for 3 groups: Native English-speaking College students (NESC), Native English-speaking patients (NES), and Limited English Proficient Spanish-speaking patients (LEP). External validity was assessed using Pearson's correlation coefficient to compare our instrument to a previously validated, proctored instrument measuring health literacy (the SAHL-E). RESULTS Four hundred fifteen subjects completed the RIHLA. Of these, 192 (46.3%) were NESC, 208 (50.1%) were NES, and 15 (3.6%) were LEP. The mean number of correct answers was 11.2, 11.6, and 8.3 respectively with the LEP group scoring lower (P < .01). Cronbach's alpha was >.70 for each group. Moderate correlation between the RIHLA and the previously validated instrument was present (P < .01) with Pearson's r = .47 (95% CI: 0.18-0.69). CONCLUSION The RIHLA is a non-proctored assessment tool that may provide a measure of patients' health literacy in multiple languages. Further studies with larger sample sizes are necessary to confirm the reliability, validity, and generalizability to a wider population.
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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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ARSLAN D, KOZANHAN B, TUTAR MS. Akut romatizmal ateşte internet tabanlı hasta eğitim materyallerinin okunabilirliğinin değerlendirilmesi. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.658528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Validation of the MMPI-A-RF for Youth with Mental Health Needs: a Systematic Examination of Clinical Correlates and Construct Validity. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2019. [DOI: 10.1007/s10862-019-09754-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Luo H, Patil SP, Wu Q, Bell RA, Cummings DM, Adams AD, Hambidge B, Craven K, Gao F. Validation of a combined health literacy and numeracy instrument for patients with type 2 diabetes. PATIENT EDUCATION AND COUNSELING 2018; 101:1846-1851. [PMID: 29805071 DOI: 10.1016/j.pec.2018.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/17/2018] [Accepted: 05/20/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES This study aimed to validate a new consolidated measure of health literacy and numeracy (health literacy scale [HLS] plus the subjective numeracy scale [SNS]) in patients with type 2 diabetes (T2DM). METHODS A convenience sample (N = 102) of patients with T2DM was recruited from an academic family medicine center in the southeastern US between September-December 2017. Participants completed a questionnaire that included the composite HLS/SNS (22 questions) and a commonly used objective measure of health literacy-S-TOFHLA (40 questions). Internal reliability of the HLS/SNS was assessed using Cronbach's alpha. Criterion and construct validity was assessed against the S-TOFHLA. RESULTS The composite HLS/SNS had good internal reliability (Cronbach's alpha = 0.83). A confirmatory factor analysis revealed there were four factors in the new instrument. Model fit indices showed good model-data fit (RMSEA = 0.08). The Spearman's rank order correlation coefficient between the HLS/SNS and the S-TOFHLA was 0.45 (p < 0.01). CONCLUSIONS Our study suggests that the composite HLS/SNS is a reliable, valid instrument.
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Affiliation(s)
- Huabin Luo
- Department of Public Health, Brody School of Medicine, East Carolina University, USA.
| | - Shivajirao P Patil
- Department of Family Medicine, Brody School of Medicine, East Carolina University, USA
| | - Qiang Wu
- Department of Biostatistics, College of Allied Health Sciences, East Carolina University, USA
| | - Ronny A Bell
- Department of Public Health, Brody School of Medicine, East Carolina University, USA
| | - Doyle M Cummings
- Department of Family Medicine, Brody School of Medicine, East Carolina University, USA
| | - Alyssa D Adams
- Department of Family Medicine, Brody School of Medicine, East Carolina University, USA
| | - Bertha Hambidge
- Department of Family Medicine, Brody School of Medicine, East Carolina University, USA
| | - Kay Craven
- Department of Family Medicine, Brody School of Medicine, East Carolina University, USA
| | - Fei Gao
- Department of Public Health, Brody School of Medicine, East Carolina University, USA
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Williams R, Moeller L, Willis S. Barriers and enablers to improved access to health information for patients with low health literacy in the radiotherapy department. Radiography (Lond) 2018; 24 Suppl 1:S11-S15. [DOI: 10.1016/j.radi.2018.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 06/24/2018] [Accepted: 06/28/2018] [Indexed: 11/26/2022]
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Walker ME, Chuang C, Moores CR, Webb ML, Buonocore SD, Grant Thomson J. The Hand Surgeon Consultation Improves Patient Knowledge in a Hand Surgery Mission to Honduras. J Hand Surg Asian Pac Vol 2018; 23:11-17. [PMID: 29409417 DOI: 10.1142/s2424835518500017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The purpose of this study was to assess impact of the surgeon consultation and informed consent process on patient education in an international hand surgery mission compared with a US academic hand surgery practice. These two groups were selected to evaluate communication difficulties in a surgical mission setting compared with standard of care in a high-income country. METHODS A multi-part survey was administered to patients presenting to a hand surgery mission during March 2012 and new patients of a university hand center in a 3-month period during 2011. Surveys were administered prior to and following surgeon consultation with one fellowship-trained hand surgeon. The survey assessed knowledge of basic hand anatomy, physiology, disease, individual diagnosis, and surgical risks. RESULTS 71 patients participated in the study (university n=36, mission n=35). Pre-consultation quiz score averaged 58% in the university group versus 27% in the mission group. Post-consultation quiz scores averaged 62% in the university group versus 40% in the mission group. Only the mission group's quiz score increase was statistically significant. 93% of the university group reported learning about their condition and diagnosis, but only 40% demonstrated correct insight into their diagnosis. In the mission group, 73% reported learning about their condition and diagnosis while 53% demonstrated correct insight into their diagnosis. Although all consultations involved discussion of surgical risks, only 62% of the university group and 52% of the mission group recalled discussing surgical risks. CONCLUSIONS The hand surgeon consultation was more effective in improving hand knowledge in the surgery mission group compared to in a university hand practice. This suggests that the surgeon consultation should be pursued despite communication barriers in surgical missions. However, the discrepancy between patient perception of knowledge gains and correct insight into diagnosis, and the deficit of patient retention of surgical risks need to be improved.
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Affiliation(s)
- Marc E Walker
- * Section of Plastic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Carolyn Chuang
- * Section of Plastic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Craig R Moores
- * Section of Plastic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Matthew L Webb
- * Section of Plastic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Samuel D Buonocore
- * Section of Plastic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - J Grant Thomson
- * Section of Plastic Surgery, Yale University School of Medicine, New Haven, CT, USA
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Williams MM, Rogers R, Sharf AJ, Ross CA. Faking Good: An Investigation of Social Desirability and Defensiveness in an Inpatient Sample With Personality Disorder Traits. J Pers Assess 2018; 101:253-263. [DOI: 10.1080/00223891.2018.1455691] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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McEvoy A, Sauder MB, McDonald K, Suter P, Pouliot A, Zemek R, Kanigsberg N, Vaillancourt R, Ramien ML. Derivation, Evaluation, and Validation of Illustrations of Key Counselling Points for a Pediatric Eczema Action Plan. J Cutan Med Surg 2017; 22:147-153. [PMID: 29098866 DOI: 10.1177/1203475417741260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Current eczema action plans (EAP) are based on written instructions without illustrations. Incorporating validated illustrations into EAPs can significantly improve comprehension and usability. OBJECTIVE To produce and validate a set of illustrations for key counselling points of a pediatric EAP. METHODS Illustrations were developed using key graphic elements and refined by subject experts. Illustrations were evaluated during one-on-one structured interviews with parents/caregivers of children ages 9 and younger, as well as with children ages 10 to 17 years between September 2015 and June 2016. The concepts of transparency, translucency, and short-term recall were assessed for validation. RESULTS Of 245 participants, 81.3% were parents and/or caregivers of children 0 to 9 years old, and 18.7% were children between 10 and 17 years old. A total of 15 illustrations and 2 storyboards were evaluated; 9 illustrations and 2 storyboards were redesigned to reach the preset validation targets. Overall, 13 illustrations and 2 storyboards were validated. CONCLUSION A set of illustrations for use in an EAP was prospectively designed and validated, achieving acceptable transparency, translucency, and recall, with input from patients and a multidisciplinary medical team. The incorporation of validated illustrations into eczema action plans benefits patients with limited health literacy. Future studies should evaluate if illustrations improve understanding of eczema management and translate into improved clinical outcomes.
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Affiliation(s)
- Alana McEvoy
- 1 Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Maxwell B Sauder
- 2 Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Phillipe Suter
- 4 Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Annie Pouliot
- 4 Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Roger Zemek
- 5 Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Nordau Kanigsberg
- 1 Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Michele L Ramien
- 1 Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,6 Division of Rheumatology (Dermatology), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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Manganello JA, Colvin KF, Chisolm DJ, Arnold C, Hancock J, Davis T. Validation of the Rapid Estimate for Adolescent Literacy in Medicine Short Form (REALM-TeenS). Pediatrics 2017; 139:peds.2016-3286. [PMID: 28557740 PMCID: PMC5404728 DOI: 10.1542/peds.2016-3286] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study was designed to develop and validate a brief adolescent health literacy assessment tool (Rapid Estimate of Adolescent Literacy in Medicine Short Form [REALM-TeenS]). METHODS We combined datasets from 2 existing research studies that used the REALM-Teen (n = 665) and conducted an item response theory analysis. The correlation between scores on the original 66-item REALM-Teen and the proposed REALM-TeenS was calculated, along with the decision consistency across forms with respect to grade level assignment of each adolescent and coefficient α. The proposed REALM-TeenS was validated with original REALM-Teen data from a third independent study (n = 174). RESULTS Items with the largest discriminations across the scale, from low to high health literacy, were selected for inclusion in REALM-TeenS. From those, a set of 10 items was selected that maintained a reasonable level of SE across ability estimates and correlated highly (r = 0.92) with the original REALM-Teen scores. The coefficient α for the 10-item REALM-TeenS was .82. There was no evidence of model misfit (root mean square error of approximation < 0.001). In the validation sample, REALM-TeenS scores correlated highly with scores on the original REALM-Teen (r = 0.92), and the decision consistency across both forms was 80%. In pilot testing, administration took ∼20 seconds. CONCLUSIONS The REALM-TeenS offers researchers and clinicians a brief validated screening tool that can be used to assess adolescent health literacy in a variety of settings. Scoring guidelines ensure that reading level assessment is appropriate by age and grade.
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Affiliation(s)
- Jennifer A. Manganello
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, Rensselaer, New York
| | - Kimberly F. Colvin
- Department of Education and Counseling Psychology, School of Education, University at Albany, Albany, New York
| | - Deena J. Chisolm
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio; and
| | | | | | - Terry Davis
- Pediatrics and Medicine, LSU Health Sciences Center-Shreveport, Shreveport, Louisiana
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Ernstmann N, Halbach S, Kowalski C, Pfaff H, Ansmann L. Measuring attributes of health literate health care organizations from the patients' perspective: Development and validation of a questionnaire to assess health literacy-sensitive communication (HL-COM). ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2017; 121:58-63. [PMID: 28545615 DOI: 10.1016/j.zefq.2016.12.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/28/2016] [Accepted: 12/21/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Studies addressing the organizational contexts of care that may help increase the patients' ability to cope with a disease and to navigate through the health care system are still rare. Especially instruments allowing the assessment of such organizational efforts from the patients' perspective are missing. The aim of our study was to develop a survey instrument assessing organizational health literacy (HL) from the patients' perspective, i. e., health care organizations' responsiveness to patients' individual needs. METHODS A pool of 30 items was developed by a group of experts based on a literature review. The items were developed, tested and prioritized according to their importance in 11 semi-structured interviews and cognitive think-aloud interviews with cancer patients. The resulting 16 items were rated in a standardized postal survey involving a total of N=453 colon and breast cancer patients treated in cancer centers in Germany. An exploratory factor analysis, a confirmatory factor analysis and structural equation modelling were conducted. Item properties were analyzed. RESULTS 83.2 % of the patients were diagnosed with breast cancer, 16.8 % had a diagnosis of colon cancer. The patients' mean age was 61 (26-88), 89.4 % were female. The most common comorbidities were hypertension (34.0 %) and cardiovascular disease (11.0 %). The final prediction model included nine items measuring the degree of health literacy-sensitivity of communication. The model showed an acceptable model fit. The nine items showed corrected item-total correlations between .622 and .762 and item difficulties between 0.77 and 0.87. Cronbach's α was .912. DISCUSSION In a comprehensive development process, the original item pool comprising several aspects of organizational HL was reduced to a one-dimensional scale. The instrument measures an important aspect of organizational HL; i.e., the degree of health literacy-sensitivity of communication (HL-COM). HL-COM was found to impact patient enablement, mediated through the support by physicians. Future research will have to test these associations in the context of other diseases or institutions.
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Affiliation(s)
- Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany; Center for Integrated Oncology Köln Bonn, Germany.
| | - Sarah Halbach
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | | | - Holger Pfaff
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | - Lena Ansmann
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
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Vaillancourt R, Truong Y, Karmali S, Kraft A, Manji S, Villarreal G, Pouliot A. Instructions for masking the taste of medication for children: Validation of a pictogram tool. Can Pharm J (Ott) 2016; 150:52-59. [PMID: 28286593 DOI: 10.1177/1715163516669383] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Medications that taste unpleasant can be a struggle to administer to children, most often resulting in low adherence rates. Pictograms can be useful tools to improve adherence by conveying information to patients in a way that they will understand. METHODS One-on-one structured interviews were conducted with parents/guardians and with children between the ages of 9 and 17 years at a pediatric hospital. The questionnaire evaluated the comprehension of 12 pictogram sets that described how to mask the taste of medications for children. Pictograms understood by >85% of participants were considered validated. Short-term recall was assessed by asking participants to recall the meaning of each pictogram set. RESULTS There were 51 participants in the study-26 (51%) were children aged 9 to 17 years and 25 (49%) were parents or guardians. Most children (54%) had health literacy levels of grade 10 or higher. Most parents and guardians (92%) had at least a high school health literacy level. Six of the 12 pictogram sets (50%) were validated. Eleven of 12 pictogram sets (92%) had a median translucency score greater than 5. All 12 pictogram sets (100%) were correctly identified at short-term recall and were therefore validated. CONCLUSION The addition of validated illustrations to pharmaceutical labels can be useful to instruct on how to mask the taste of medication in certain populations. Further studies are needed to assess the clinical impact of providing illustrated information to populations with low health literacy.
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Affiliation(s)
| | - Yen Truong
- Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | | | - Amanda Kraft
- Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Selina Manji
- Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | | | - Annie Pouliot
- Children's Hospital of Eastern Ontario, Ottawa, Ontario
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Reisfield GM, Paulian GD, Wilson GR. “Johnny can’t read”: Another cause “ of failed analgesia. Am J Hosp Palliat Care 2016; 22:433-6. [PMID: 16323713 DOI: 10.1177/104990910502200608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Gary M Reisfield
- Division of Palliative Medicine, Department of Community Health and Family Medicine, University of Florida Health Science Center, Jacksonville, USA
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Kools M, Ruiter RAC, van de Wiel MWJ, Kok G. Increasing Readers’ Comprehension of Health Education Brochures: A Qualitative Study Into How Professional Writers Make Texts Coherent. HEALTH EDUCATION & BEHAVIOR 2016; 31:720-40. [PMID: 15539544 DOI: 10.1177/1090198104263340] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to gain insight into the extent to which health education text writers apply writing principles derived from cognitive psychological theory. Seventeen professional text writers of health education materials participated in a qualitative study, consisting of a rewriting task combined with a think-aloud procedure and a semistructured interview. The verbal data were explored carefully in light of seven text coherence principles that have proven effective in cognitive psychological research to increase text comprehension. Findings indicate text writers vary in their ideas and use of coherence principles to make a text comprehensible. It is argued that the health education profession can benefit greatly from knowledge about cognitive text processing and cognitive coherence principles for realizing effective comprehension of written health education messages.
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Affiliation(s)
- Marieke Kools
- Department of Experimental Psychology, Maastricht University, Maastricht, The Netherlands.
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Abstract
Medication noncompliance is a pervasive problem resulting in significant morbidity and mortality. There are many terms used to describe medication-taking behavior including compliance, adherence, intelligent compliance, and drug forgiveness. More recently, clinicians have focused on the need for a collaborative partnership with patients to attain medication adherence. Problems identified include the patient’s failing to initiate therapy, under using or overusing a drug, stopping a drug too soon, and mistiming or skipping doses. Adherence to medications is a complex health behavior. There are many risk factors associated with decreased compliance, and many strategies have been shown to improve drug-taking behavior and patient outcomes. By careful assessment, the pharmacist can identify the high-risk patient, recommend an individualized care plan, and provide the follow-up necessary to successfully change patient behavior. Pharmacists should focus on improving their own application of behavior modification principles and patient communication skills. Improved medication compliance results in improved humanistic, clinical, and economic outcomes.
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Affiliation(s)
- Patricia A. Tabor
- Blackstock Family Practice Academic Associates, University of Texas at Austin, Pharmacy Practice Division, One University Station A1910, Austin, TX 78712-0127,
| | - Debra A. Lopez
- Scott & White Hospital, Health Plan, and Clinic, University of Texas College of Pharmacy, Scott & White Clinic, 4945 Williams Drive, Georgetown, TX 78628
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Levandowski BA, Sharma P, Lane SD, Webster N, Nestor AM, Cibula DA, Huntington S. Parental Literacy and Infant Health: An Evidence-Based Healthy Start Intervention. Health Promot Pract 2016; 7:95-102. [PMID: 16410425 DOI: 10.1177/1524839904266517] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Syracuse Healthy Start, a federally funded infant mortality prevention project in Onondaga County, New York, has undertaken a range of interventions to address parental low literacy as a risk factor for infant mortality. A growing number of studies advocate for health-related information that is easy to read, of a low literacy level, and culturally appropriate. Creation of an evidence-based public health intervention involves analyzing local data, reviewing published studies, assessing available materials, initiating programmatic interventions, and evaluating the outcomes. Preparing health educational materials that are clear, culturally sensitive, and at appropriate reading levels follows Paulo Freire’s lead in empowering the disadvantaged to positively affect their health and the health of their infants toward the reduction of infant mortality.
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Affiliation(s)
- Brooke A Levandowski
- Department of Obstetrics and Gynecology at the State University of New York Upstate Medical University in Syracuse, New York, NY, USA
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Youmans SL, Schillinger D. Functional Health Literacy and Medication Use: The Pharmacist's Role. Ann Pharmacother 2016; 37:1726-9. [PMID: 14565798 DOI: 10.1345/aph.1d070] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Sharon L Youmans
- Department of Clinical Pharmacy, School of Pharmacy, University of California-San Francisco, San Francisco, CA 94143-0622, USA.
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21
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Jones DL, Sued O, Cecchini D, Bofill L, Cook R, Lucas M, Bordato A, Cassetti I, Cahn P, Weiss SM. Improving Adherence to Care Among "Hard to Reach" HIV-Infected Patients in Argentina. AIDS Behav 2016; 20:987-97. [PMID: 26152608 DOI: 10.1007/s10461-015-1133-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Many HIV-infected patients fail to achieve undetectable viral load and are not retained in care. This pilot study examined patients lost to care in public and private clinics in Buenos Aires, Argentina. The impact of patient and provider interventions was compared separately and collectively. In Phase 1, participants prescribed antiretrovirals and non-adherent to treatment in the prior 3-6 months (n = 60) were randomized to patient intervention or standard of care (SOC) and assessed over 12 months. In Phase 2, providers were trained in interviewing techniques and 60 additional patients were randomized to patient intervention or SOC condition. Averaged across patient intervention status, Phase 2 provider intervention patients reported the most improved adherence and viral suppression at 6 and 12 months. Adherence in "patient intervention only" improved at midpoint and returned to baseline at 12 months. Results suggest provider training sustained patient adherence and viral suppression among "hard to reach" patients.
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Affiliation(s)
- Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Leonard M. Miller School of Medicine, 1400 NW 10th Ave., Miami, FL, 33136, USA.
| | - Omar Sued
- Clinical Research Department, Fundación Huésped, Buenos Aires, Argentina
| | | | - Lina Bofill
- Department of Psychiatry and Behavioral Sciences, University of Miami Leonard M. Miller School of Medicine, 1400 NW 10th Ave., Miami, FL, 33136, USA
| | - Ryan Cook
- Department of Psychiatry and Behavioral Sciences, University of Miami Leonard M. Miller School of Medicine, 1400 NW 10th Ave., Miami, FL, 33136, USA
| | - Mar Lucas
- Clinical Research Department, Fundación Huésped, Buenos Aires, Argentina
| | | | | | - Pedro Cahn
- Clinical Research Department, Fundación Huésped, Buenos Aires, Argentina
| | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Leonard M. Miller School of Medicine, 1400 NW 10th Ave., Miami, FL, 33136, USA
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Chiu HH, Dimaras H, Downie R, Gallie B. Breaking down barriers to communicating complex retinoblastoma information: can graphics be the solution? Can J Ophthalmol 2016; 50:230-5. [PMID: 26040224 DOI: 10.1016/j.jcjo.2015.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 12/08/2014] [Accepted: 02/01/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the impact of a graphical timeline summarizing bilateral retinoblastoma disease and treatment outcomes on parents' understanding of complex medical information. DESIGN Cross-sectional survey. PARTICIPANTS Parents of children with retinoblastoma who were being actively managed at The Hospital for Sick Children were recruited. Forty-five parents from 42 families participated. METHODS After a standardized presentation on retinoblastoma and visual tool named Disease-Specific electronic Patient Illustrated Clinical Timeline (DePICT), parents completed a 19-item questionnaire designed to assess their understanding of treatment choices for 2 eyes in bilateral retinoblastoma as communicated using DePICT. SPSS was used to perform statistical analysis. RESULTS Forty-five parents from 42 families participated (65% female). Median age of participants was 34 years. Median level of participant education was completion of college/trade school. The median level of annual income was $40,000 to $70,000 CDN. Median time since diagnosis of retinoblastoma in their child was 13.5 months. Twenty-three (51%) participants were parents of children with unilateral retinoblastoma, and 22 (49%) were parents of children with bilateral retinoblastoma. Median number of correct answers was 15 of 19, and mean score was 77%. Normal distribution of scores was noted. English as a first language was significantly associated with score (p = 0.01). No significant association was observed between other variables and score in all analyses. CONCLUSIONS This study builds on the validation of DePICT by demonstrating that parents can achieve good comprehension even when considering choices for treatment for 2 eyes with bilateral retinoblastoma. Clinical application of this tool can enhance the consent process.
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Affiliation(s)
- Hannah H Chiu
- Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto
| | - Helen Dimaras
- Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto
| | - Rob Downie
- Research, Policy and Planning, Fanshawe College, London
| | - Brenda Gallie
- Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto; Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children; Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Ont..
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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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D'Agostino McGowan L, Stafford JD, Thompson VL, Johnson-Javois B, Goodman MS. Quantitative Evaluation of the Community Research Fellows Training Program. Front Public Health 2015; 3:179. [PMID: 26236703 PMCID: PMC4504145 DOI: 10.3389/fpubh.2015.00179] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 06/29/2015] [Indexed: 11/13/2022] Open
Abstract
Context The community research fellows training (CRFT) program is a community-based participatory research (CBPR) initiative for the St. Louis area. This 15-week program, based on a Master in Public Health curriculum, was implemented by the Division of Public Health Sciences at Washington University School of Medicine and the Siteman Cancer Center. Objectives We measure the knowledge gained by participants and evaluate participant and faculty satisfaction of the CRFT program both in terms of meeting learning objectives and actively engaging the community in the research process. Participants We conducted analyses on 44 community members who participated in the CRFT program and completed the baseline and follow-up knowledge assessments. Main outcome measures Knowledge gain is measured by a baseline and follow-up assessment given at the first and final session. Additionally, pre- and post-tests are given after the first 12 sessions. To measure satisfaction, program evaluations are completed by both the participants and faculty after each topic. Mid-way through the program, a mid-term evaluation was administered to assess the program’s community engagement. We analyzed the results from the assessments, pre- and post-tests, and evaluations. Results The CRFT participants’ knowledge increased at follow-up as compared with baseline on average by a 16.5 point difference (p < 0.0001). Post-test scores were higher than pre-test scores for 11 of the 12 sessions. Both participants and faculty enjoyed the training and rated all session well. Conclusion The CRFT program was successful in increasing community knowledge, participant satisfaction, and faculty satisfaction. This success has enhanced the infrastructure for CBPR as well as led to CBPR pilot projects that address health disparities in the St. Louis Greater Metropolitan Area.
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Affiliation(s)
- Lucy D'Agostino McGowan
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine , St. Louis, MO , USA
| | - Jewel D Stafford
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine , St. Louis, MO , USA
| | - Vetta Lynn Thompson
- George Warren Brown School of Social Work, Washington University in St. Louis , St. Louis, MO , USA
| | | | - Melody S Goodman
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine , St. Louis, MO , USA
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25
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Affiliation(s)
- RL Ettinger
- Department of Prosthodontics and Dows Institute for Dental Research; The University of Iowa; USA
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26
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Tse CK, Bridges SM, Srinivasan DP, Cheng BS. Social media in adolescent health literacy education: a pilot study. JMIR Res Protoc 2015; 4:e18. [PMID: 25757670 PMCID: PMC4376152 DOI: 10.2196/resprot.3285] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 10/23/2014] [Accepted: 11/23/2014] [Indexed: 12/31/2022] Open
Abstract
Background While health literacy has gained notice on a global stage, the initial focus on seeking associations with medical conditions may have overlooked its impact across generations. Adolescent health literacy, specifically in dentistry, is an underexplored area despite the significance of this formative stage on an individual’s approach to healthy lifestyles and behaviors. Objective The aim is to conduct a pilot study to evaluate the efficacy of three major social media outlets - Twitter, Facebook, and YouTube - in supporting adolescents’ oral health literacy (OHL) education. Methods A random sample of 22 adolescents (aged 14-16 years) from an English-medium international school in Hong Kong provided informed consent. Sociodemographic information, including English language background, social media usage, and dental experience were collected via a questionnaire. A pre- and post-test of OHL (REALD-30) was administered by two trained, calibrated examiners. Following pre-test, participants were randomly assigned to one of three social media outlets: Twitter, Facebook, or YouTube. Participants received alerts posted daily for 5 consecutive days requiring online accessing of modified and original OHL education materials. One-way ANOVA ( analysis of variance) was used to compare the mean difference between the pre- and the post-test results among the three social media. Results No associations were found between the social media allocated and participants’ sociodemographics, including English language background, social media usage, and dental experience. Of the three social media, significant differences in literacy assessment scores were evident for participants who received oral health education messages via Facebook (P=.02) and YouTube (P=.005). Conclusions Based on the results of the pilot study, Facebook and YouTube may be more efficient media outlets for OHL promotion and education among adolescent school children when compared to Twitter. Further analyses with a larger study group is warranted.
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Affiliation(s)
- Carrie Kw Tse
- The University of Hong Kong, Hong Kong, China (Hong Kong)
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27
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Coats JV, Stafford JD, Sanders Thompson V, Johnson Javois B, Goodman MS. Increasing research literacy: the community research fellows training program. J Empir Res Hum Res Ethics 2014; 10:3-12. [PMID: 25742661 DOI: 10.1177/1556264614561959] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The Community Research Fellows Training (CRFT) Program promotes the role of underserved populations in research by enhancing the capacity for community-based participatory research (CBPR). CRFT consists of 12 didactic training sessions and 3 experiential workshops intended to train community members in research methods and evidence-based public health. The training (a) promotes partnerships between community members and academic researchers, (b) enhances community knowledge of public health research, and (c) trains community members to become critical consumers of research. Fifty community members participated in training sessions taught by multidisciplinary faculty. Forty-five (90%) participants completed the program. Findings demonstrate that the training increased awareness of health disparities, research knowledge, and the capacity to use CBPR as a tool to address disparities.
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Wong PKK, Christie L, Johnston J, Bowling A, Freeman D, Joshua F, Bird P, Chia K, Bagga H. How well do patients understand written instructions?: health literacy assessment in rural and urban rheumatology outpatients. Medicine (Baltimore) 2014; 93:e129. [PMID: 25437024 PMCID: PMC4616379 DOI: 10.1097/md.0000000000000129] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to assess health literacy (word recognition and comprehension) in patients at a rural rheumatology practice and to compare this to health literacy levels in patients from an urban rheumatology practice.Inclusion criteria for this cross-sectional study were as follows: ≥18-year-old patients at a rural rheumatology practice (Mid-North Coast Arthritis Clinic, Coffs Harbour, Australia) and an urban Sydney rheumatology practice (Combined Rheumatology Practice, Kogarah, Australia). Exclusion criteria were as follows: ill-health precluding participation; poor vision/hearing, non-English primary language. Word recognition was assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM). Comprehension was assessed using the Test of Functional Health Literacy in Adults (TOFHLA). Practical comprehension and numeracy were assessed by asking patients to follow prescribing instructions for 5 common rheumatology medications.At the rural practice (Mid-North Coast Arthritis Clinic), 124/160 patients agreed to participate (F:M 83:41, mean age 60.3 ± 12.2) whereas the corresponding number at the urban practice (Combined Rheumatology Practice) was 99/119 (F:M 69:30, mean age 60.7 ± 17.5). Urban patients were more likely to be born overseas, speak another language at home, and be employed. There was no difference in REALM or TOFHLA scores between the 2 sites, and so data were pooled. REALM scores indicated 15% (33/223) of patients had a reading level ≤Grade 8 whereas 8% (18/223) had marginal or inadequate functional health literacy as assessed by the TOFHLA. Dosing instructions for ibuprofen and methotrexate were incorrectly understood by 32% (72/223) and 21% (46/223) of patients, respectively.Up to 15% of rural and urban patients had low health literacy and <1/3 of patients incorrectly followed dosing instructions for common rheumatology drugs.There was no significant difference in word recognition, functional health literacy, and numeracy between rural and urban rheumatology patients.
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Affiliation(s)
- Peter K K Wong
- From the Mid-North Coast Arthritis Clinic (PKKW, DF, HB); Rural Clinical School, University of New South Wales (PKKW, LC, KC); School of Education, Southern Cross University, Coffs Harbour (JJ); School of Health and Human Sciences, Southern Cross University, Coffs Harbour (AB); Combined Rheumatology Practice, Kogarah (FJ, PB); and Department of Rheumatology, Prince of Wales Hospital, Randwick (FJ), New South Wales, Australia
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Is the cloze procedure appropriate to evaluate health literacy in older individuals? Age effects in the test of functional health literacy in adults. J Aging Res 2014; 2014:194635. [PMID: 25295191 PMCID: PMC4180388 DOI: 10.1155/2014/194635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/26/2014] [Accepted: 08/26/2014] [Indexed: 12/04/2022] Open
Abstract
Health literacy has received increasing attention because of its importance for older individuals' health, as studies have shown a close relation between older individuals' health literacy and their health. Research also suggests that older individuals have low levels of health literacy, but this finding is variable and may depend on which health literacy test is used. Older individuals assessed with the Test of Functional Health Literacy (TOFHLA) score lower than younger individuals, but a previous study suggested that this may result from age-related differential item functioning (DIF) on the TOFHLA. The study reported here assessed age-related DIF in a sample of community-dwelling volunteers. Twenty-two percent of items were differentially more difficult for older individuals independent of their overall ability, and when these items were eliminated from the total score, age differences were no longer found. Performance on a working memory task predicted older but not younger individuals' performance on the age-related items. At least part of older individuals' apparent deficits in health literacy when assessed by the TOFHLA may be related to DIF on its items. The TOFHLA, and any measure that employs the cloze procedure to evaluate reading comprehension, should be used cautiously in older individuals.
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How can health literacy influence outcomes in heart failure patients? Mechanisms and interventions. Curr Heart Fail Rep 2014; 10:232-43. [PMID: 23873404 DOI: 10.1007/s11897-013-0147-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Health literacy is discussed in papers from 25 countries where findings suggest that approximately a third up to one half of the people in developed countries have low health literacy. Specifically, health literacy is the mechanism by which individuals obtain and use health information to make health decisions about individual treatments in the home, access care in the community, promote provider-patient interactions, structure self-care, and navigate health care programs both locally and nationally. Further, health literacy is a key determinant of health and a critical dimension for assessing individuals' needs, and, importantly, their capacity for self-care. Poorer health knowledge/status, more medication errors, costs, and higher rates of morbidity, readmissions, emergency room visits, and mortality among patients with health illiteracy have been demonstrated. Individuals at high risk for low health literacy include the elderly, disabled, Blacks, those with a poverty-level income, some or less high school education, either no insurance or Medicare or Medicaid, and those for whom English is a second language. As a consequence, health literacy is a complex, multifaceted, and evolving construct including aspects of social, psychological, cultural and economic circumstances. The purpose of this paper is to describe the mechanisms and consequences of health illiteracy. Specifically, the prevalence, associated demographics, and models of health literacy are described. The mechanism of health illiteracy's influence on outcomes in heart failure is proposed. Tools for health literacy assessment are described and compared. Finally, the health outcomes and general interventions to enhance the health outcomes in heart failure are discussed.
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Chari R, Warsh J, Ketterer T, Hossain J, Sharif I. Association between health literacy and child and adolescent obesity. PATIENT EDUCATION AND COUNSELING 2014; 94:61-66. [PMID: 24120396 DOI: 10.1016/j.pec.2013.09.006] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 08/02/2013] [Accepted: 09/07/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE We tested the association between child and parental health literacy (HL) and odds of child and adolescent obesity. METHODS We conducted an anonymous cross-sectional survey of a convenience sample of English-speaking child-parent dyads. Newest Vital Sign (NVS) measured HL. We used multivariable logistic regression to test adjusted association between child and parental NVS and obesity. Analyses were stratified for school-aged children (aged 7-11) vs. adolescents (aged 12-19). RESULTS We surveyed 239 child-parent dyads. Median child age was 11 [inter-quartile range 9-13]; 123 (51%) were male; 84% Medicaid recipients; 27% obese. For children, the odds of obesity [adjusted odds ratio (95% confidence interval)] decreased with higher parent NVS [0.75 (0.56,1.00)] and increased with parent obesity [2.53 (1.08,5.94)]. For adolescents, odds of obesity were higher for adolescents with the lowest category of NVS [5.00 (1.26, 19.8)] and older parental age [1.07 (1.01,1.14)] and lower for Medicaid recipients [0.21 (0.06,0.78)] and higher parental education [0.38 (0.22,0.63)]. CONCLUSION Obesity in school-aged children is associated with parental factors (obesity, parental HL); obesity in adolescents is strongly associated with the adolescent's HL. PRACTICE IMPLICATIONS Strategies to prevent and treat obesity should consider limited HL of parents for child obesity and of adolescents for adolescent obesity.
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Affiliation(s)
- Roopa Chari
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA; Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joel Warsh
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA; Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Tara Ketterer
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA; Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jobayer Hossain
- Nemours Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA; Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Iman Sharif
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA; Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
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Williams KP, Templin TN. Bringing the real world to psychometric evaluation of cervical cancer literacy assessments with Black, Latina, and Arab women in real-world settings. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2013; 28:738-43. [PMID: 24072456 PMCID: PMC3848266 DOI: 10.1007/s13187-013-0549-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This research describes the development and evaluation of a new scale for assessing functional cervical cancer health literacy, the Cervical Cancer Literacy Assessment Tool (C-CLAT). In phase 1, 35 items in English, Spanish, and Arabic for C-CLAT were generated, taking into account three content domains-Awareness, Knowledge, and Prevention/Control. After content validation, 24 items were retained for psychometric evaluation. In phase 2, the 24-item C-CLAT was evaluated in three racial/ethnic populations of urban women (N = 543). Psychometric methods included item analysis, multifactor item response theory modeling, and concurrent correlations. The final C-CLAT consisted of 16 items, with an internal consistency reliability of 0.72. C-CLAT reliabilities in Black, Latina, and Arab women were 0.73, 0.76, and 0.60, respectively. The rank order correlations of item difficulties across racial/ethnic groups was high (r's = 0.97 to 0.98). The C-CLAT was positively related to educational level, and Arab women scored significantly higher than the Black and Latina participants. This study presents a psychometrically sound instrument that measures health literacy related to cervical cancer. The C-CLAT is a tool that can be orally administered by a lay person and used in a community-based health promotion intervention.
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Affiliation(s)
- Karen Patricia Williams
- Michigan State University, College of Human Medicine, Obstetrics, Gynecology & Reproductive Biology, 965 Fee Rd., Room 626B, East Lansing, MI 48824
| | - Thomas N. Templin
- Wayne State University, College of Nursing, 5557 Cass Avenue, 319 Cohn Building, Detroit, MI 48202
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Dowrick C, Chew-Graham C, Lovell K, Lamb J, Aseem S, Beatty S, Bower P, Burroughs H, Clarke P, Edwards S, Gabbay M, Gravenhorst K, Hammond J, Hibbert D, Kovandžić M, Lloyd-Williams M, Waheed W, Gask L. Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study. PROGRAMME GRANTS FOR APPLIED RESEARCH 2013. [DOI: 10.3310/pgfar01020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundEvidence-based interventions exist for common mental health problems. However, many people are unable to access effective care because it is not available to them or because interactions with caregivers do not address their needs. Current policy initiatives focus on supply-side factors, with less consideration of demand.Aim and objectivesOur aim was to increase equity of access to high-quality primary mental health care for underserved groups. Our objectives were to clarify the mental health needs of people from underserved groups; identify relevant evidence-based services and barriers to, and facilitators of, access to such services; develop and evaluate interventions that are acceptable to underserved groups; establish effective dissemination strategies; and begin to integrate effective and acceptable interventions into primary care.Methods and resultsExamination of evidence from seven sources brought forward a better understanding of dimensions of access, including how people from underserved groups formulate (mental) health problems and the factors limiting access to existing psychosocial interventions. This informed a multifaceted model with three elements to improve access: community engagement, primary care quality and tailored psychosocial interventions. Using a quasi-experimental design with a no-intervention comparator for each element, we tested the model in four disadvantaged localities, focusing on older people and minority ethnic populations. Community engagement involved information gathering, community champions and focus groups, and a community working group. There was strong engagement with third-sector organisations and variable engagement with health practitioners and commissioners. Outputs included innovative ways to improve health literacy. With regard to primary care, we offered an interactive training package to 8 of 16 practices, including knowledge transfer, systems review and active linking, and seven agreed to participate. Ethnographic observation identified complexity in the role of receptionists in negotiating access. Engagement was facilitated by prior knowledge, the presence of a practice champion and a sense of coproduction of the training. We developed a culturally sensitive well-being intervention with individual, group and signposting elements and tested its feasibility and acceptability for ethnic minority and older people in an exploratory randomised trial. We recruited 57 patients (57% of target) with high levels of unmet need, mainly through general practitioners (GPs). Although recruitment was problematic, qualitative data suggested that patients found the content and delivery of the intervention acceptable. Quantitative analysis suggested that patients in groups receiving the well-being intervention improved compared with the group receiving usual care. The combined effects of the model included enhanced awareness of the psychosocial intervention among community organisations and increased referral by GPs. Primary care practitioners valued community information gathering and access to the Improving Access to Mental Health in Primary Care (AMP) psychosocial intervention. We consequently initiated educational, policy and service developments, including a dedicated website.ConclusionsFurther research is needed to test the generalisability of our model. Mental health expertise exists in communities but needs to be nurtured. Primary care is one point of access to high-quality mental health care. Psychosocial interventions can be adapted to meet the needs of underserved groups. A multilevel intervention to increase access to high-quality mental health care in primary care can be greater than the sum of its parts.Study registrationCurrent Controlled Trials ISRCTN68572159.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- C Dowrick
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - C Chew-Graham
- Institute of Population Health, University of Manchester, Manchester, UK
- Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - K Lovell
- Institute of Population Health, University of Manchester, Manchester, UK
| | - J Lamb
- Institute of Population Health, University of Manchester, Manchester, UK
| | - S Aseem
- Institute of Population Health, University of Manchester, Manchester, UK
| | - S Beatty
- Institute of Population Health, University of Manchester, Manchester, UK
| | - P Bower
- Institute of Population Health, University of Manchester, Manchester, UK
| | - H Burroughs
- Institute of Population Health, University of Manchester, Manchester, UK
- Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - P Clarke
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - S Edwards
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
- College of Medicine, Swansea University, Swansea, UK
| | - M Gabbay
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - K Gravenhorst
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - J Hammond
- Institute of Population Health, University of Manchester, Manchester, UK
| | - D Hibbert
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - M Kovandžić
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - M Lloyd-Williams
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - W Waheed
- Institute of Population Health, University of Manchester, Manchester, UK
| | - L Gask
- Institute of Population Health, University of Manchester, Manchester, UK
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Ding R, Zeger SL, Steinwachs DM, Ortmann MJ, McCarthy ML. The Validity of Self-Reported Primary Adherence Among Medicaid Patients Discharged From the Emergency Department With a Prescription Medication. Ann Emerg Med 2013; 62:225-34. [DOI: 10.1016/j.annemergmed.2013.01.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 01/10/2013] [Accepted: 01/28/2013] [Indexed: 11/15/2022]
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McCarthy ML, Ding R, Roderer NK, Steinwachs DM, Ortmann MJ, Pham JC, Bessman ES, Kelen GD, Atha W, Retezar R, Bessman SC, Zeger SL. Does Providing Prescription Information or Services Improve Medication Adherence Among Patients Discharged From the Emergency Department? A Randomized Controlled Trial. Ann Emerg Med 2013; 62:212-23.e1. [DOI: 10.1016/j.annemergmed.2013.02.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 01/28/2013] [Accepted: 02/04/2013] [Indexed: 11/30/2022]
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Young BA. Health literacy in nephrology: why is it important? Am J Kidney Dis 2013; 62:3-6. [PMID: 23773837 DOI: 10.1053/j.ajkd.2013.04.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 04/12/2013] [Indexed: 01/10/2023]
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Osborn CY, Wallston KA, Shpigel A, Cavanaugh K, Kripalani S, Rothman RL. Development and validation of the General Health Numeracy Test (GHNT). PATIENT EDUCATION AND COUNSELING 2013; 91:350-6. [PMID: 23433635 PMCID: PMC3644342 DOI: 10.1016/j.pec.2013.01.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 11/26/2012] [Accepted: 01/01/2013] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Because existing numeracy measures may not optimally assess 'health numeracy', we developed and validated the General Health Numeracy Test (GHNT). METHODS An iterative pilot testing process produced 21 GHNT items that were administered to 205 patients along with validated measures of health literacy, objective numeracy, subjective numeracy, and medication understanding and medication adherence. We assessed the GHNT's internal consistency reliability, construct validity, and explored its predictive validity. RESULTS On average, participants were 55.0 ± 13.8 years old, 64.9% female, 29.8% non-White, and 51.7% had incomes ≤$39K with 14.4 ± 2.9 years of education. Psychometric testing produced a 6-item version (GHNT-6). The GHNT-21 and GHNT-6 had acceptable-good internal consistency reliability (KR-20=0.87 vs. 0.77, respectively). Both versions were positively associated with income, education, health literacy, objective numeracy, and subjective numeracy (all p<.001). Furthermore, both versions were associated with participants' understanding of their medications and medication adherence in unadjusted analyses, but only the GHNT-21 was associated with medication understanding in adjusted analyses. CONCLUSIONS The GHNT-21 and GHNT-6 are reliable and valid tools for assessing health numeracy. PRACTICE IMPLICATIONS Brief, reliable, and valid assessments of health numeracy can assess a patient's numeracy status, and may ultimately help providers and educators tailor education to patients.
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Affiliation(s)
- Chandra Y Osborn
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232-8300, USA.
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Sperber NR, Bosworth HB, Coffman CJ, Lindquist JH, Oddone EZ, Weinberger M, Allen KD. Differences in osteoarthritis self-management support intervention outcomes according to race and health literacy. HEALTH EDUCATION RESEARCH 2013; 28:502-511. [PMID: 23525779 DOI: 10.1093/her/cyt043] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We explored whether the effects of a telephone-based osteoarthritis (OA) self-management support intervention differed by race and health literacy. Participants included 515 veterans with hip and/or knee OA. Linear mixed models assessed differential effects of the intervention compared with health education (HE) and usual care (UC) on pain (Arthritis Impact Measurement Scales-2 [AIMS2] and Visual Analogue Scale), function (AIMS2 mobility and walking/bending), affect (AIMS2) and arthritis self-efficacy by: (i) race (white/non-white), (ii) health literacy (high/low) and (iii) race by health literacy. AIMS2 mobility improved more among non-whites than whites in the intervention compared with HE and UC (P = 0.02 and 0.008). AIMS2 pain improved more among participants with low than high literacy in the intervention compared with HE (P = 0.05). However, we found a differential effect of the intervention on AIMS2 pain compared with UC according to the combination of race and health literacy (P = 0.05); non-whites with low literacy in the intervention had the greatest improvement in pain. This telephone-based OA intervention may be particularly beneficial for patients with OA who are racial/ethnic minorities and have low health literacy. These results warrant further research designed specifically to assess whether this type of intervention can reduce OA disparities.
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Affiliation(s)
- Nina R Sperber
- Health Services Research and Development Service, Durham VA Medical Center, Durham, NC, USA.
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Effing TW, Williams MT, Frith PA. Health literacy: how much is lost in translation? Chron Respir Dis 2013; 10:61-3. [PMID: 23620438 DOI: 10.1177/1479972313484481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Middleton KR, Ward MM, Haaz S, Velummylum S, Fike A, Acevedo AT, Tataw-Ayuketah G, Dietz L, Mittleman BB, Wallen GR. A pilot study of yoga as self-care for arthritis in minority communities. Health Qual Life Outcomes 2013; 11:55. [PMID: 23548052 PMCID: PMC3637098 DOI: 10.1186/1477-7525-11-55] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 03/22/2013] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND While arthritis is the most common cause of disability, non-Hispanic blacks and Hispanics experience worse arthritis impact despite having the same or lower prevalence of arthritis compared to non-Hispanic whites. People with arthritis who exercise regularly have less pain, more energy, and improved sleep, yet arthritis is one of the most common reasons for limiting physical activity. Mind-body interventions, such as yoga, that teach stress management along with physical activity may be well suited for investigation in both osteoarthritis and rheumatoid arthritis. Yoga users are predominantly white, female, and college educated. There are few studies that examine yoga in minority populations; none address arthritis. This paper presents a study protocol examining the feasibility and acceptability of providing yoga to an urban, minority population with arthritis. METHODS/DESIGN In this ongoing pilot study, a convenience sample of 20 minority adults diagnosed with either osteoarthritis or rheumatoid arthritis undergo an 8-week program of yoga classes. It is believed that by attending yoga classes designed for patients with arthritis, with racially concordant instructors; acceptability of yoga as an adjunct to standard arthritis treatment and self-care will be enhanced. Self-care is defined as adopting behaviors that improve physical and mental well-being. This concept is quantified through collecting patient-reported outcome measures related to spiritual growth, health responsibility, interpersonal relations, and stress management. Additional measures collected during this study include: physical function, anxiety/depression, fatigue, sleep disturbance, social roles, and pain; as well as baseline demographic and clinical data. Field notes, quantitative and qualitative data regarding feasibility and acceptability are also collected. Acceptability is determined by response/retention rates, positive qualitative data, and continuing yoga practice after three months. DISCUSSION There are a number of challenges in recruiting and retaining participants from a community clinic serving minority populations. Adopting behaviors that improve well-being and quality of life include those that integrate mental health (mind) and physical health (body). Few studies have examined offering integrative modalities to this population. This pilot was undertaken to quantify measures of feasibility and acceptability that will be useful when evaluating future plans for expanding the study of yoga in urban, minority populations with arthritis. TRIAL REGISTRATION ClinicalTrials.gov: NCT01617421.
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Affiliation(s)
- Kimberly R Middleton
- National Institutes of Health, Clinical Center, Nursing Department, 10 Center Drive, Bethesda, MD, USA
| | - Michael M Ward
- National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases, 31 Center Dr, Bethesda, MD, USA
| | | | - Sinthujah Velummylum
- National Institutes of Health, Clinical Center, Nursing Department, 10 Center Drive, Bethesda, MD, USA
| | - Alice Fike
- National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases, 31 Center Dr, Bethesda, MD, USA
| | - Ana T Acevedo
- National Institutes of Health, Clinical Center, Rehabilitation Medicine, 10 Center Drive, Bethesda, MD, USA
| | - Gladys Tataw-Ayuketah
- National Institutes of Health, Clinical Center, Nursing Department, 10 Center Drive, Bethesda, MD, USA
| | - Laura Dietz
- National Institutes of Health, Clinical Center, Rehabilitation Medicine, 10 Center Drive, Bethesda, MD, USA
| | - Barbara B Mittleman
- National Institutes of Health, Office of Science Policy, Office of the Director, Building 1, Bethesda, MD, USA
| | - Gwenyth R Wallen
- National Institutes of Health, Clinical Center, Nursing Department, 10 Center Drive, Bethesda, MD, USA
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Christy SM, Perkins SM, Tong Y, Krier C, Champion VL, Skinner CS, Springston JK, Imperiale TF, Rawl SM. Promoting colorectal cancer screening discussion: a randomized controlled trial. Am J Prev Med 2013; 44:325-329. [PMID: 23498096 PMCID: PMC3601582 DOI: 10.1016/j.amepre.2012.11.032] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 11/19/2012] [Accepted: 11/21/2012] [Indexed: 01/04/2023]
Abstract
BACKGROUND Provider recommendation is a predictor of colorectal cancer (CRC) screening. PURPOSE To compare the effects of two clinic-based interventions on patient-provider discussions about CRC screening. DESIGN Two-group RCT with data collected at baseline and 1 week post-intervention. SETTING/PARTICIPANTS African-American patients that were non-adherent to CRC screening recommendations (n=693) with a primary care visit between 2008 and 2010 in one of 11 urban primary care clinics. INTERVENTION Participants received either a computer-delivered tailored CRC screening intervention or a nontailored informational brochure about CRC screening immediately prior to their primary care visit. MAIN OUTCOME MEASURES Between-group differences in odds of having had a CRC screening discussion about a colon test, with and without adjusting for demographic, clinic, health literacy, health belief, and social support variables, were examined as predictors of a CRC screening discussion using logistic regression. Intervention effects on CRC screening test order by PCPs were examined using logistic regression. Analyses were conducted in 2011 and 2012. RESULTS Compared to the brochure group, greater proportions of those in the computer-delivered tailored intervention group reported having had a discussion with their provider about CRC screening (63% vs 48%, OR=1.81, p<0.001). Predictors of a discussion about CRC screening included computer group participation, younger age, reason for visit, being unmarried, colonoscopy self-efficacy, and family member/friend recommendation (all p-values <0.05). CONCLUSIONS The computer-delivered tailored intervention was more effective than a nontailored brochure at stimulating patient-provider discussions about CRC screening. Those who received the computer-delivered intervention also were more likely to have a CRC screening test (fecal occult blood test or colonoscopy) ordered by their PCP. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT00672828.
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Affiliation(s)
- Shannon M Christy
- Department of Psychology, Purdue School of Science, Indiana University-Purdue University Indianapolis, Indiana
| | - Susan M Perkins
- School of Medicine, Indiana University, Indianapolis, Indiana
| | - Yan Tong
- School of Medicine, Indiana University, Indianapolis, Indiana
| | - Connie Krier
- School of Nursing, Indiana University, Indianapolis, Indiana
| | | | - Celette Sugg Skinner
- Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeffrey K Springston
- College of Journalism and Mass Communication, University of Georgia, Athens, Georgia
| | | | - Susan M Rawl
- School of Nursing, Indiana University, Indianapolis, Indiana.
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Hjertstedt J, Barnes SL, Sjostedt JM. Investigating the impact of a community-based geriatric dentistry rotation on oral health literacy and oral hygiene of older adults. Gerodontology 2013; 31:296-307. [PMID: 23347095 DOI: 10.1111/ger.12038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2012] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This study investigated the impact of a community-based geriatric dentistry rotation on older adults' oral health literacy and oral hygiene. MATERIALS AND METHODS A pre-post study design was used to assess the impact of the educational intervention. The study sample consisted of 67 older adults, who resided in independent or assisted living apartments (age: M = 84, SD = 7.3). Over the course of the programme, participants received patient education pertaining to oral health and oral hygiene. Oral health literacy was assessed using the Rapid Estimation of Adult Literacy in Dentistry (REALD-30) test at baseline and on the final visit. Oral hygiene was measured on four visits using the O'Leary, Drake and Naylor Plaque Control Record (PI). RESULTS REALD-30 scores significantly increased, and PI scores significantly decreased for all subjects following participation in the programme (p < 0.001, and p < 0.01, respectively). Hierarchical multiple regression demonstrated that neither study subjects' individual characteristics nor their health literacy significantly predicted the change in oral hygiene. CONCLUSION This study demonstrated that a community-based geriatric dentistry rotation involving multiple interactions with dental students can in the short term significantly and positively impact older adults' oral health literacy and oral hygiene status.
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Affiliation(s)
- Jadwiga Hjertstedt
- Department of Clinical Services, School of Dentistry, Marquette University, Milwaukee, WI, USA
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Sharp LK, Ureste PJ, Torres LA, Bailey L, Gordon HS, Gerber BS. Time to sign: The relationship between health literacy and signature time. PATIENT EDUCATION AND COUNSELING 2013; 90:18-22. [PMID: 23154148 DOI: 10.1016/j.pec.2012.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 10/05/2012] [Accepted: 10/19/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To evaluate the relationship between amount of time taken to sign one's name and health literacy. METHODS A prospective, one time assessment was conducted on a convenience sample of 98 patients recruited in an inner-city outpatient internal medicine clinic. The amount of time required to sign (i.e. initiation to completion of writing) was measured by stopwatch. Health literacy was measured with the REALM. RESULTS The sample averaged 54.1 (SD 16.2) years of age. Twenty-seven percent had less than high school education and 33% had a terminal general equivalency diploma or high school degree. The time required to sign ranged from 0.91 to 21.3s. Sixty-two percent of the sample had health literacy challenges. Signature time was longest for those with inadequate health literacy (mean 10.0 s), compared with marginal (7.3s) and adequate (4.7s, p ≤ 0.001). Signature time remained significant in a logistic regression model after controlling for education and age (AOR = 0.785, CI = 0.661-0.932). CONCLUSION Individuals with signatures completed in six seconds or less were highly likely to display adequate health literacy. PRACTICE IMPLICATIONS Signature time may offer a practical and quick approach to health literacy screening in the health care setting.
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Affiliation(s)
- Lisa K Sharp
- Section of Health Promotion Research, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago 60608, USA.
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Videos to influence: a systematic review of effectiveness of video-based education in modifying health behaviors. J Behav Med 2012. [DOI: 10.1007/s10865-012-9480-7] [Citation(s) in RCA: 176] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Evaluation of health literacy among Spanish-speaking primary care patients along the US--Mexico border. South Med J 2012; 105:334-8. [PMID: 22766658 DOI: 10.1097/smj.0b013e31825b2468] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Health literacy (HL) is a measure of the communication skills that are needed by an individual to effectively navigate the healthcare system. Hispanic adults have lower average levels of HL than any other racial/ethnic group; however, the prevalence of adequate HL among Hispanics along the US-Mexico border is unknown. METHODS We performed a cross-sectional survey of 200 adult primary care patients who attended four low-income community clinics along the US-Mexico border. Patients were included in the study if they were self-described Hispanics whose first language was Spanish or bilingual patients who reported that they were primarily Spanish speakers. Adequate HL was defined as having a score of ≥38 on the Short Assessment of Health Literacy for Spanish Adults-50. RESULTS Three patients (1.5%) had inadequate HL. Because of the high proportion of patients having adequate HL, we found no statistical differences between patients with adequate HL versus inadequate HL by age, sex, educational attainment, health coverage, or self-reported health status; however, all three patients with inadequate HL were found to be 60 years old or older and had less than a high school education. CONCLUSIONS The results of HL assessment varied according to the tool and setting used in measuring Spanish-speaking Hispanics. In certain clinical scenarios, current tools may underestimate the actual prevalence of adequate HL. Further development and assessment of HL tools appropriate for Spanish-speaking Hispanics is needed as a first step in developing interventions to limit disparities in health care among all Americans.
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Ciampa PJ, Vaz LME, Blevins M, Sidat M, Rothman RL, Vermund SH, Vergara AE. The association among literacy, numeracy, HIV knowledge and health-seeking behavior: a population-based survey of women in rural Mozambique. PLoS One 2012; 7:e39391. [PMID: 22745747 PMCID: PMC3382184 DOI: 10.1371/journal.pone.0039391] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 05/24/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Limited literacy skills are common in the United States (US) and are related to lower HIV knowledge and worse health behaviors and outcomes. The extent of these associations is unknown in countries like Mozambique, where no rigorously validated literacy and numeracy measures exist. METHODS A validated measure of literacy and numeracy, the Wide Range Achievement Test, version 3 (WRAT-3) was translated into Portuguese, adapted for a Mozambican context, and administered to a cross-section of female heads-of-household during a provincially representative survey conducted from August 8 to September 25, 2010. Construct validity of each subscale was examined by testing associations with education, income, and possession of socioeconomic assets, stratified by Portuguese speaking ability. Multivariable regression models estimated the association among literacy/numeracy and HIV knowledge, self-reported HIV testing, and utilization of prenatal care. RESULTS Data from 3,557 women were analyzed; 1,110 (37.9%) reported speaking Portuguese. Respondents' mean age was 31.2; 44.6% lacked formal education, and 34.3% reported no income. Illiteracy was common (50.4% of Portuguese speakers, 93.7% of non-Portuguese speakers) and the mean numeracy score (10.4) corresponded to US kindergarten-level skills. Literacy or numeracy was associated (p<0.01) with education, income, age, and other socioeconomic assets. Literacy and numeracy skills were associated with HIV knowledge in adjusted models, but not with HIV testing or receipt of clinic-based prenatal care. CONCLUSION The adapted literacy and numeracy subscales are valid for use with rural Mozambican women. Limited literacy and numeracy skills were common and associated with lower HIV knowledge. Further study is needed to determine the extent to which addressing literacy/numeracy will lead to improved health outcomes.
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Affiliation(s)
- Philip J Ciampa
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
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Sundar RP, Becker MW, Bello NM, Bix L. Quantifying age-related differences in information processing behaviors when viewing prescription drug labels. PLoS One 2012; 7:e38819. [PMID: 22719955 PMCID: PMC3375290 DOI: 10.1371/journal.pone.0038819] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 05/11/2012] [Indexed: 12/01/2022] Open
Abstract
Adverse drug events (ADEs) are a significant problem in health care. While effective warnings have the potential to reduce the prevalence of ADEs, little is known about how patients access and use prescription labeling. We investigated the effectiveness of prescription warning labels (PWLs, small, colorful stickers applied at the pharmacy) in conveying warning information to two groups of patients (young adults and those 50+). We evaluated the early stages of information processing by tracking eye movements while participants interacted with prescription vials that had PWLs affixed to them. We later tested participants' recognition memory for the PWLs. During viewing, participants often failed to attend to the PWLs; this effect was more pronounced for older than younger participants. Older participants also performed worse on the subsequent memory test. However, when memory performance was conditionalized on whether or not the participant had fixated the PWL, these age-related differences in memory were no longer significant, suggesting that the difference in memory performance between groups was attributable to differences in attention rather than differences in memory encoding or recall. This is important because older adults are recognized to be at greater risk for ADEs. These data provide a compelling case that understanding consumers' attentive behavior is crucial to developing an effective labeling standard for prescription drugs.
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Affiliation(s)
- Raghav Prashant Sundar
- School of Packaging, Michigan State University, East Lansing, Michigan, United States of America
| | - Mark W. Becker
- Department of Psychology, Michigan State University, East Lansing, Michigan, United States of America
| | - Nora M. Bello
- Department of Statistics, Kansas State University, Manhattan, Kansas, United States of America
| | - Laura Bix
- School of Packaging, Michigan State University, East Lansing, Michigan, United States of America
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Martin D, Kripalani S, DuRapau V. Improving Medication Management Among At-Risk Older Adults. J Gerontol Nurs 2012. [DOI: 10.3928/00989134-20120507-50] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Martin D, Kripalani S, Durapau VJ. Improving medication management among at-risk older adults. J Gerontol Nurs 2012; 38:24-34; quiz 36-7. [PMID: 22587641 PMCID: PMC3785231 DOI: 10.3928/00989134-20120509-01] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 01/27/2012] [Indexed: 12/12/2022]
Abstract
Low health literacy is common among Medicare recipients and affects their understanding of complex medication regimens. Interventions are needed to improve medication use among older adults, while addressing low health literacy. Community-dwelling older adults in this study were enrolled at an inner-city adult day center. They completed a baseline measure of health literacy, medication self-efficacy, and medication adherence. They were provided with a personalized, illustrated daily medication schedule (PictureRx™). Six weeks later, their medication self-efficacy and adherence were assessed. Among the 20 participants in this pilot project, 70% had high likelihood of limited health literacy and took an average of 13.20 prescription medications. Both self-efficacy and medication adherence increased significantly after provision of the PictureRx cards (p < 0.001 and p < 0.05, respectively). All participants rated the PictureRx cards as very helpful in terms of helping them remember the medication's purpose and dosing. Illustrated daily medication schedules improve medication self-efficacy and adherence among at-risk, community-dwelling older adults.
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Affiliation(s)
- Delinda Martin
- Department of Nursing and Allied Health, Our Lady of Holy Cross College, New Orleans, LA, USA.
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Wang J, Thombs BD, Schmid MR. The Swiss Health Literacy Survey: development and psychometric properties of a multidimensional instrument to assess competencies for health. Health Expect 2012; 17:396-417. [PMID: 22390287 DOI: 10.1111/j.1369-7625.2012.00766.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Growing recognition of the role of citizens and patients in health and health care has placed a spotlight on health literacy and patient education. OBJECTIVE To identify specific competencies for health in definitions of health literacy and patient-centred concepts and empirically test their dimensionality in the general population. METHODS A thorough review of the literature on health literacy, self-management, patient empowerment, patient education and shared decision making revealed considerable conceptual overlap as competencies for health and identified a corpus of 30 generic competencies for health. A questionnaire containing 127 items covering the 30 competencies was fielded as a telephone interview in German, French and Italian among 1255 respondents randomly selected from the resident population in Switzerland. FINDINGS Analyses with the software MPlus to model items with mixed response categories showed that the items do not load onto a single factor. Multifactorial models with good fit could be erected for each of five dimensions defined a priori and their corresponding competencies: information and knowledge (four competencies, 17 items), general cognitive skills (four competencies, 17 items), social roles (two competencies, seven items), medical management (four competencies, 27 items) and healthy lifestyle (two competencies, six items). Multiple indicators and multiple causes models identified problematic differential item functioning for only six items belonging to two competencies. CONCLUSIONS The psychometric analyses of this instrument support broader conceptualization of health literacy not as a single competence but rather as a package of competencies for health.
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Affiliation(s)
- Jen Wang
- Research Epidemiologist, Institute for Social and Preventive Medicine, University of Zurich, Zurich, SwitzerlandSenior Researcher, Institute for Social and Preventive Medicine, University of Zurich, Zurich, SwitzerlandAssistant Professor, Department of Psychiatry, McGill University, Montréal, QC, Canada
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