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Cabrera Fernandez DL, Lopez KN, Bravo-Jaimes K, Mackie AS. The Impact of Social Determinants of Health on Transition From Pediatric to Adult Cardiology Care. Can J Cardiol 2024; 40:1043-1055. [PMID: 38583706 DOI: 10.1016/j.cjca.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/28/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024] Open
Abstract
Social determinants of health (SDoH) are the economic, social, environmental, and psychosocial factors that influence health. Adolescents and young adults with congenital heart disease (CHD) require lifelong cardiology follow-up and therefore coordinated transition from pediatric to adult healthcare systems. However, gaps in care are common during transition, and they are driven in part by pervasive disparities in SDoH, including race, ethnicity, socioeconomic status, access to insurance, and remote location of residence. These disparities often coexist and compound the challenges faced by patients and families. For example, Black and Indigenous individuals are more likely to be subject to systemic racism and implicit bias within healthcare and other settings, to be unemployed and poor, to have limited access to insurance, and to have a lower likelihood of transfer of care to adult CHD specialists. SDoH also are associated with acquired cardiovascular disease, a comorbidity that adults with CHD face. This review summarizes existing evidence regarding the impact of SDoH on the transition to adult care and proposes strategies at the individual, institutional, and population and/or system levels. to reduce inequities faced by transition-age youth. These strategies include routinely screening for SDoH in clinical settings with referral to appropriate services, providing formal transition education for all transition-age youth, including training on navigating complex medical systems, creating satellite cardiology clinics to facilitate access to care for those who live remote from tertiary centres, advocating for lifelong insurance coverage where applicable, mandating cultural-sensitivity training for providers, and increasing the diversity of healthcare providers in pediatric and adult CHD care.
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Affiliation(s)
- Diana L Cabrera Fernandez
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Keila N Lopez
- Section of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital and Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
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Ma J, Bai X, Li J, Wen B. Patient-caregiver dyad concordance of transition readiness assessment for adolescent with cancer: A network analysis. J Adv Nurs 2024. [PMID: 38787364 DOI: 10.1111/jan.16185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/07/2024] [Accepted: 03/22/2024] [Indexed: 05/25/2024]
Abstract
AIMS The concordance of adolescents with cancer and caregivers was examined, and the core elements of transition readiness were identified. METHODS In this cross-sectional study, 196 adolescent-caregiver dyads completed the Chinese version of Self-Management and Transition to Adulthood with Rx = Treatment Questionnaire and its parent version between March 2023 and August 2023. Intraclass correlation coefficients, paired t-tests and network analysis were used for data analysis. RESULTS Caregivers reported slightly lower scores for transition readiness than adolescents (3.28 vs. 3.32). Healthcare engagement and provider communication were core elements in transition readiness networks. At the dyad level, agreement between adolescents' and caregivers' transition readiness ranged from poor to fair (intraclass correlation coefficients 0.103-0.486), and a significant difference in structure was found between the two networks. CONCLUSIONS Caregivers tended to underestimate adolescents' transition readiness. Attaining better concordance between adolescents and family caregivers is critical to aligning roles and responsibilities in the transition process. IMPLICATIONS FOR PAEDIATRIC CANCER CARE This study extends the evidence on the variation in adolescents' transition readiness, clarifying the complex associative relationships among the elements of transition readiness, which can be potential pathways for improving transition readiness. Second, this study is the first to assess transition readiness from a dyad's perspective. The findings highlighted the patient-caregiver incongruence in rating patients' transition readiness, suggesting that targeted dyadic interventions should be developed and implemented to improve patient-caregiver transition readiness concordance, facilitate effective communication and mutuality between patients and caregivers, and contribute to their collaboration during the transition of adolescents and optimization of outcomes. WHAT PROBLEM DID THE STUDY ADDRESS?: Increased long-term survival rates of survivors of paediatric cancer highlighted the significant need for care continuity. Transitional readiness is an important predictor of adolescent survivor's ability to adapt to a long-term survival period. Assessments of adolescents' transition readiness are limited and overlook the synergies between family caregivers and adolescents in the transition period. WHAT WERE THE MAIN FINDINGS?: The levels of agreement on rating transition readiness varied from poor to fair among adolescent-caregiver dyads, and caregivers tended to underestimate adolescents' transition readiness. The findings highlighted the patient-caregiver incongruence in rating patients' transition readiness. Targeted dyadic interventions should be developed and implemented to improve patient-caregiver's transition readiness concordance, and facilitate effective communication and mutuality between patients and caregivers. REPORTING METHOD Study methods and results reported in adherence to the STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION No patients or members of the public were involved in the study. CONTRIBUTION TO THE WIDER GLOBAL CLINICAL COMMUNITY The main findings introduce pathways for improving transition readiness, which can enhance healthcare transition among other medical populations.
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Affiliation(s)
- Jun Ma
- Xiangya School of Nursing, Central South University, Changsha, China
| | | | - Jing Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, China
| | - Binbin Wen
- Xiangya School of Nursing, Central South University, Changsha, China
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Kang N, Lee S. Psychological separation, health locus of control, and transition readiness in adolescents and young adults with type I diabetes. J Pediatr Nurs 2024; 76:38-44. [PMID: 38359543 DOI: 10.1016/j.pedn.2024.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE The purpose of this study was to examine the effects of psychological separation and health locus of control on the health care transition readiness of adolescents and young adults (AYAs) with type 1 diabetes. METHODS Data were collected between December 2020 and October 2021. One hundred twelve AYAs with type 1 diabetes treated at a tertiary hospital and under follow-up observation as well as AYAs with type 1 diabetes nationwide who were part of the type 1 diabetes internet community were enrolled. The Psychological Separation Inventory, the Multidimensional Health Locus of Control scale from C, and the Self-management and Transition to Adulthood with Therapeutics = Rx Questionnaire were used. RESULTS Multiple regression analysis indicated that age (β = 0.302, p = .001), hemoglobin A1c (HbA1c) (β = -0.174, p = .040), conflictual separation (β = 0.242, p = .005), functional separation (β = 0.200, p = .045) and attitudinal separation (β = -0.240 p = .015) were significantly associated with health management transition readiness; these predictors explained 27.6% of health care transition readiness (F = 8.062, p = .000). CONCLUSIONS AYAs with type 1 diabetes can enhance readiness for health care transition by fostering psychological separation from parents, effectively managing blood glucose levels, and taking into account age-related factors during the preparation process. At this point, it is essential for healthcare professionals to guide parents in recognizing adolescents' psychological independence and facilitating their supportive role through the process of redefining their roles. PRACTICE IMPLICATIONS Health care providers should promote psychological separation in AYAs. Additionally, taking into account the developmental characteristics of adolescence can facilitate a successful health care transition.
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Affiliation(s)
- Nuri Kang
- Department of Nursing, Asan Medical Center, Seoul, Republic of Korea
| | - Sunhee Lee
- College of Nursing, the Catholic University of Korea, Seoul, Republic of Korea.
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Baranwal P, Sathe M, Lobritto SJ, Vittorio J. The impact of health literacy on adolescent and young adult pediatric liver transplant recipients. Liver Transpl 2024; 30:386-394. [PMID: 37812071 DOI: 10.1097/lvt.0000000000000283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023]
Abstract
Pediatric liver transplant recipients have increased rates of morbidity and mortality following transfer to adult health care providers. The role of health literacy (HL) has not been adequately assessed in this population and may be an unrecognized barrier to successful health care transition. We sought to determine the impact of HL for patients and their caregivers on measures of transition readiness (TR), adherence, health-related quality of life, and medical outcomes following pediatric liver transplant. This is a single-center study of pediatric liver transplant recipients transplanted between the ages of 12 and 26 from October 2016 through August 2020. Patients and caregivers completed 4 surveys to evaluate TR, health-related quality of life, and HL. Clinical outcomes were stratified based on the presence or absence of adequate HL. Limited HL was identified in 57.0% of recipients and 47.4% of caregivers. Patients with limited HL were more likely to be younger in age ( p = 0.004), Hispanic ( p = 0.003), and less likely to have obtained a high school diploma or equivalent ( p < 0.001). Patients with adequate HL demonstrated significantly higher levels of TR ( p < 0.001). Patient HL did not impact health-related quality of life, adherence, or medical outcomes. Caregiver HL did not impact patient outcomes or adherence, though higher levels of caregiver education were associated with adequate patient HL ( p = 0.049). This study demonstrates that limited HL is associated with decreased measures of TR. Inadequate HL may be an unrecognized barrier to a successful health care transition. Regular assessment of HL may provide an opportunity for intervention prior to transfer of care. Future studies should investigate the impact of these interventions on long-term medical outcomes.
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Affiliation(s)
- Prerana Baranwal
- Division of Pediatric Gastroenterology, Nutrition, and Liver Diseases, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mihika Sathe
- Departments of Internal Medicine and Pediatrics, Inova Health, Annandale, Virginia, USA
| | - Steven J Lobritto
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Columbia University Irving Medical Center, New York, New York, USA
| | - Jennifer Vittorio
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, New York University (NYU) Langone Health, New York University School of Medicine, New York, New York, USA
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Dela Cruz R, Galbreath J, Butel J, Yamanaka AB, Wilkens LR, Aflague T, Coleman P, Shallcross L, McFall P, Novotny R. Social determinants of health literacy among parents and caregivers in the US-Affiliated Pacific. Health Promot Int 2024; 39:daae002. [PMID: 38294036 PMCID: PMC10828926 DOI: 10.1093/heapro/daae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
Health literacy is understudied in the US-Affiliated Pacific (USAP), where local populations have historically experienced social marginalization and disproportionate health inequities caused by the social determinants of health (SDOH). This cross-sectional study analyzed several SDOH indicators-acculturation, use of food assistance programs and demographic characteristics (race and ethnicity, household income, primary language spoken at home and educational attainment)-and their relationship to health literacy among 1305 parents/caregivers of young children ages 2-8 years old who participated in the Children's Healthy Living (CHL) program in Alaska, American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), Guam, and Hawai'i. Significantly increased odds of low health literacy were found among parents/caregivers with households where a language other than English was the primary language compared to English-only households (OR = 1.86, 95% CI = 1.22, 2.82), household income of <$35 000 compared to ≥$35 000 (OR = 2.15, 95% CI = 1.13, 4.07), parents/caregivers of Asian children compared to parents/caregivers of White children (OR = 2.68, 95% CI = 1.05, 6.84), parent/caregivers with less than or some high school education compared to high school completion (1st- to 8th-grade OR = 4.46, 95% CI = 2.09, 9.52; 9th- to 11th-grade OR 1.87, 95% CI = 1.06, 3.30) and parent/caregivers with acculturation status defined as marginalized as compared to integrated (OR = 2.31, 95% CI = 1.09, 4.86). This study indicates that some USAP parents/caregivers may lack the capacity to acquire health information, utilize health resources, and navigate health decision making. Future efforts to understand and improve health literacy in the USAP should be population specific, thoroughly assess personal and organizational health literacy, and inventory community health care capacity.
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Affiliation(s)
- Rica Dela Cruz
- Human Nutrition, Food and Animal Sciences Department, College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, 1955 East-West Rd, Honolulu, HI 96822, USA
| | - Jennifer Galbreath
- Human Nutrition, Food and Animal Sciences Department, College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, 1955 East-West Rd, Honolulu, HI 96822, USA
| | - Jean Butel
- Human Nutrition, Food and Animal Sciences Department, College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, 1955 East-West Rd, Honolulu, HI 96822, USA
| | - Ashley B Yamanaka
- Human Nutrition, Food and Animal Sciences Department, College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, 1955 East-West Rd, Honolulu, HI 96822, USA
| | - Lynne R Wilkens
- Population Sciences in the Pacific Program, University of Hawai‘i Cancer Center, 701 Ilalo St, Honolulu, HI 96813, USA
| | - Tanisha Aflague
- College of Natural and Applied Sciences, University of Guam, 303 University Drive, UOG Station, Mangilao, GU 96923, USA
| | - Patricia Coleman
- Cooperative Research, Extension and Education Services, Northern Marianas College, PO Box 501250, Saipan, MP 96950, USA
| | - Leslie Shallcross
- Cooperative Extension Service, University of Alaska Fairbanks, 1000 University Avenue, Fairbanks, AK 99709, USA
| | - Pauline McFall
- Human Nutrition, Food and Animal Sciences Department, College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, 1955 East-West Rd, Honolulu, HI 96822, USA
- Agriculture, Community, and Natural Resources, American Samoa Community College, PO Box 2609, Pago Pago, AS 96799, USA
| | - Rachel Novotny
- Human Nutrition, Food and Animal Sciences Department, College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, 1955 East-West Rd, Honolulu, HI 96822, USA
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Bailey K, Avolio J, Lo L, Gajaria A, Mooney S, Greer K, Martens H, Tami P, Pidduck J, Cunningham J, Munce S, Toulany A. Social and Structural Drivers of Health and Transition to Adult Care. Pediatrics 2024; 153:e2023062275. [PMID: 38084099 DOI: 10.1542/peds.2023-062275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 01/02/2024] Open
Abstract
CONTEXT Youth with chronic health conditions experience challenges during their transition to adult care. Those with marginalized identities likely experience further disparities in care as they navigate structural barriers throughout transition. OBJECTIVES This scoping review aims to identify the social and structural drivers of health (SSDOH) associated with outcomes for youth transitioning to adult care, particularly those who experience structural marginalization, including Black, Indigenous, and 2-spirit, lesbian, gay, bisexual, transgender, queer or questioning, and others youth. DATA SOURCES Medline, Embase, CINAHL, and PsycINFO were searched from earliest available date to May 2022. STUDY SELECTION Two reviewers screened titles and abstracts, followed by full-text. Disagreements were resolved by a third reviewer. Primary research studying the association between SSDOH and transition outcomes were included. DATA EXTRACTION SSDOH were subcategorized as social drivers, structural drivers, and demographic characteristics. Transition outcomes were classified into themes. Associations between SSDOH and outcomes were assessed according to their statistical significance and were categorized into significant (P < .05), nonsignificant (P > .05), and unclear significance. RESULTS 101 studies were included, identifying 12 social drivers (childhood environment, income, education, employment, health literacy, insurance, geographic location, language, immigration, food security, psychosocial stressors, and stigma) and 5 demographic characteristics (race and ethnicity, gender, illness type, illness severity, and comorbidity). No structural drivers were studied. Gender was significantly associated with communication, quality of life, transfer satisfaction, transfer completion, and transfer timing, and race and ethnicity with appointment keeping and transfer completion. LIMITATIONS Studies were heterogeneous and a meta-analysis was not possible. CONCLUSIONS Gender and race and ethnicity are associated with inequities in transition outcomes. Understanding these associations is crucial in informing transition interventions and mitigating health inequities.
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Affiliation(s)
- Katherine Bailey
- Temerty Faculty of Medicine
- Institute of Health Policy, Management and Evaluation
| | | | - Lisha Lo
- Centre for Quality Improvement and Patient Safety
| | - Amy Gajaria
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Margaret and Wallace McCain Centre for Child, Youth, and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sarah Mooney
- Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
- Alberta Strategy for Patient Oriented Research Support Unit
- Faculty of Nursing, Grant MacEwan University, Edmonton, Alberta, Canada
| | - Katelyn Greer
- Alberta Strategy for Patient Oriented Research Support Unit
| | - Heather Martens
- Patient and Community Engagement Research (PaCER) Program, University of Calgary, Calgary, Alberta,Canada
- Alberta Health Services, Edmonton, Alberta, Canada
- KickStand, Mental Health Foundation, Edmonton, Alberta, Canada
| | - Perrine Tami
- Public Health and Preventative Medicine, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Sarah Munce
- Rehabilitation Sciences Institute
- Department of Occupational Science and Occupational Therapy
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Alene Toulany
- Temerty Faculty of Medicine
- Institute of Health Policy, Management and Evaluation
- Department of Pediatrics, Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health and Evaluative Sciences, Sickkids Research Institute, Toronto, Ontario, Canada
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Karam S, Cohen DL, Jaoude PA, Dionne J, Ding FL, Garg A, Tannor EK, Chanchlani R. Approach to Diagnosis and Management of Hypertension: A Comprehensive and Combined Pediatric and Adult Perspective. Semin Nephrol 2023; 43:151438. [PMID: 37951795 DOI: 10.1016/j.semnephrol.2023.151438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
The global prevalence of primary hypertension has been increasing both in children and in the adolescent and adult populations and can be attributed to changes in lifestyle factors with an obesity epidemic, increased salt consumption, and sedentary lifestyles. Childhood blood pressure is the strongest predictor of adult hypertension. Although hypertension in adults is associated strongly with an increased risk for cardiovascular disease, chronic kidney disease, and mortality, outcomes in children are defined less clearly. In adults, major guidelines agree on a threshold of less than 120/80 mm Hg as the optimal blood pressure (BP) and recommend a target of less than 130/80 mm Hg for treatment in most cases. In children, international pediatric guidelines recommend using thresholds based on the normative distribution of BP in healthy normal-weight children. Out-of-office BP assessment is extremely useful for confirming the diagnosis of hypertension and monitoring response to treatment. Lifestyle modifications are instrumental whether coupled or not with pharmacologic management. New agents such as nonsteroidal mineralocorticoid-receptor antagonists, aminopeptidase A inhibitors, aldosterone synthase inhibitors, and dual endothelin antagonists hold significant promise for resistant hypertension. The transition from pediatric to adult care can be challenging and requires careful planning and effective coordination within a multidisciplinary team that includes patients and their families, and pediatric and adult providers.
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Affiliation(s)
- Sabine Karam
- Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, MN.
| | - Debbie L Cohen
- Renal, Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Pauline Abou Jaoude
- Division of Pediatric Nephrology, Hotel-Dieu de France-University Medical Center, Beirut, Lebanon
| | - Janis Dionne
- Division of Nephrology, Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - FangChao Linda Ding
- Division of Nephrology, Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Anika Garg
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Elliot Koranteng Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Ghana; Renal Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Rahul Chanchlani
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Rhee H, Choi Y, Tumiel-Berhalter L. Transition readiness in middle and older adolescents with asthma and associated factors: a descriptive study. J Asthma 2023; 60:991-999. [PMID: 36040871 PMCID: PMC10011012 DOI: 10.1080/02770903.2022.2119864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/04/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Asthma is the leading chronic health condition in adolescents, yet little is known about adolescents' readiness to transition into adult-focused care. This study examines transition readiness in middle and late adolescents with asthma. METHODS This cross-sectional descriptive study was conducted in 2019 with 41 adolescents (16-20 years old) with asthma. Transition readiness was measured with the 20-item Transition Readiness Assessment Questionnaire (TRAQ), which comprises five subscales. RESULTS Slight majorities of the sample comprised females (58.5%) and minority adolescents (56%). The sample's overall mean score on the TRAQ was 3.89 (±0.63; possible range 1-5). Managing daily activities was associated with talking with providers subscale (r = 0.36; p < 0.01), but not with other TRAQ subscales. Females reported greater scores for managing medications than did males, with mean = 4.2 vs. 3.6 (t = -2.15, p = 0.04). Transition readiness did not differ by race or health insurance type. However, scores on arranging transportation to medical appointments were lower among minority adolescents than whites (4.17 vs. 4.8, t = 2.56, p = 0.01). Better asthma control was associated with higher scores on talking with providers (r = -0.42; p < 0.01), but not with other subscale domains. CONCLUSIONS Overall transition readiness is suboptimal in middle to late adolescents with asthma. Adolescents' capacity to manage daily activities is not a valid indicator of transition readiness in disease self-management. It is important to consider gender, race, and asthma control in understanding transition readiness in adolescents with asthma.
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Affiliation(s)
- Hyekyun Rhee
- University of Texas at Austin School of Nursing, 1710 Red River St. Austin, TX 78712
| | - Yuri Choi
- University of Rochester School of Nursing, 601 Elmwood Ave, Box SON, Rochester, NY 14642
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Bae EJ, Jang AR, Park H, Yoon JY. Investigating knowledge structure and research trends in child and adolescent health literacy research through network text analysis. J Pediatr Nurs 2022; 67:57-63. [PMID: 35952487 DOI: 10.1016/j.pedn.2022.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/26/2022] [Accepted: 08/01/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE This study aims to investigate the knowledge structure and research trends in child and adolescent health literacy research over the past 30 years by using network text analysis. METHOD The study was conducted in four steps: 1) collecting abstracts, 2) keyword extraction and preprocessing, 3) creation of co-occurrence matrix, and 4) text network analysis. RESULTS As a result of the centrality analysis, the upper-ranked core keywords were "health care," "health behavior," "prevention," "treatment," and "health promotion." In contrast to earlier times, "barrier," "caregiver," "school setting," and "QOL" have recently emerged as core keywords. CONCLUSIONS Over the past 30 years, child and adolescent health literacy has been importantly addressed in both clinical and public health approaches. The results of the current study provide references for future research in child and adolescent health literacy. IMPLICATION FOR PRACTICE AND RESEARCH This study suggests the need for additional research on school-based practices that can improve health literacy and for identifying validated and reliable multidimensional health literacy assessment instruments.
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Affiliation(s)
- Eun Jung Bae
- College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Ah Ram Jang
- College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Hyena Park
- College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Ju Young Yoon
- College of Nursing, Seoul National University, Seoul, Republic of Korea; Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea; Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) four project, College of Nursing, Seoul National University, Republic of Korea.
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Transition of Chronic Pediatric Nephrological Patients to Adult Care Excluding Patients on Renal Replacement Therapy with Literature Review. CHILDREN 2022; 9:children9070959. [PMID: 35883943 PMCID: PMC9317370 DOI: 10.3390/children9070959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022]
Abstract
(1) Background: The transition of children with chronic kidney disease to adult care has become a well-handled issue. However, other patients with normal or mildly decreased renal function also requiring further management and transition are neglected. (2) Methods: A questionnaire was sent to patients with kidney pathology, aged 17 years and older.(3) Results: The patients were mostly high-school (55%) or college students (39%), living with their parents (94%). One third did not know how their disease affected their choice of profession and reproductive health. Furthermore, 46% of the respondents did not know who would continue with their care, and 44% still had a primary pediatrician. (4) Conclusions: A review of the literature on the topic was performed and summarized here. Regular education is the key for successful transfer, not only in chronic kidney and transplant patients, but also in others in whom a decline in renal function can be expected in the future.
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Pruette CS, Ranch D, Shih WV, Ferris MDG. Health Care Transition in Adolescents and Young Adults With Chronic Kidney Disease: Focus on the Individual and Family Support Systems. Adv Chronic Kidney Dis 2022; 29:318-326. [PMID: 36084978 DOI: 10.1053/j.ackd.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 02/03/2022] [Accepted: 02/15/2022] [Indexed: 11/11/2022]
Abstract
Health care transition (HCT) from pediatric to adult-focused services is a longitudinal process driven by the collaboration and interactions of adolescent/young adult patients, their families, providers, health care agencies, and environment. Health care providers in both pediatric and adult-focused settings must collaborate, as patients' health self-management skills are acquired in the mid-20s, after they have transferred to adult-focused care. Our manuscript discusses the individual and family support systems as they relate to adolescents and young adults with chronic or end-stage kidney disease. In the individual domain, we discuss demographic/socioeconomic characteristics, disease complexity/course, cognitive capabilities, and self-management/self-advocacy. In the family domain, we discuss family composition/culture factors, family function, parenting style, and family unit factors. We provide a section dedicated to patients with cognitive and developmental disability. Furthermore, we discuss barriers for HCT preparation and offer solutions as well as activities for HCT preparation.
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Affiliation(s)
| | - Daniel Ranch
- Department of Pediatrics, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health at San Antonio, San Antonio, TX
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Mannemuddhu SS, Macumber I, Samuels JA, Flynn JT, South AM. When Hypertension Grows Up: Implications for Transitioning Care of Adolescents and Young Adults With Hypertension From Pediatric to Adult Health Care Providers. Adv Chronic Kidney Dis 2022; 29:263-274. [PMID: 36084973 DOI: 10.1053/j.ackd.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/01/2021] [Accepted: 11/15/2021] [Indexed: 11/11/2022]
Abstract
Hypertension (HTN) is an important cause of morbidity and mortality in children as well as adults. HTN and related adverse cardiovascular health develop and progress on a continuum across an individual's life course. Pediatric HTN, or even isolated elevated blood pressure as a child, increases the risk of sustained HTN and cardiovascular disease in later adulthood. Transitioning the care of adolescents and young adults who have HTN is an important but unmet health care need that could potentially have a dramatic effect on mitigating the risk of cardiovascular disease in adulthood. However, very little has been published about the transition process in this population, and considerable gaps in the field remain. We discuss the epidemiology, etiology, and management approach in youth with HTN and how they differ from adults. We contextualize HTN and cardiovascular health on a continuum across the life course. We discuss key considerations for the transition process for adolescents and young adults with HTN including the major barriers that exist. Finally, we review key immediate health care needs that are particularly important around the time of the transfer of care.
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Affiliation(s)
- Sai Sudha Mannemuddhu
- East Tennessee Children's Hospital, Knoxville, TN; Department of Medicine, University of Tennessee Health Science Center-College of Medicine, Knoxville, TN
| | - Ian Macumber
- Department of Pediatrics, Keck School of Medicine, Division of Nephrology, Children's Hospital Los Angeles, Los Angeles, CA
| | - Joshua A Samuels
- Department of Pediatrics, Pediatric Nephrology & Hypertension, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - Joseph T Flynn
- Department of Pediatrics, University of Washington, Division of Nephrology, Seattle Children's Hospital, Seattle, WA.
| | - Andrew M South
- Department of Pediatrics, Section of Nephrology, Wake Forest School of Medicine and Brenner Children's Hospital, Winston Salem, NC; Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC; Cardiovascular Sciences Center, Wake Forest School of Medicine, Winston Salem, NC
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Dahir K, Dhaliwal R, Simmons J, Imel EA, Gottesman GS, Mahan JD, Prakasam G, Hoch AI, Ramesan P, Díaz-González de Ferris M. Health Care Transition From Pediatric- to Adult-Focused Care in X-linked Hypophosphatemia: Expert Consensus. J Clin Endocrinol Metab 2022; 107:599-613. [PMID: 34741521 PMCID: PMC8852209 DOI: 10.1210/clinem/dgab796] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Indexed: 12/02/2022]
Abstract
CONTEXT X-linked hypophosphatemia (XLH) is an inherited skeletal disorder that can lead to lifelong deleterious musculoskeletal and functional consequences. Although often perceived as a childhood condition, children and adults both experience the negative effects of XLH. Adolescents and young adults (AYAs) benefit from effective health care transition (HCT) preparation to support the transfer from pediatric- to adult-focused care. Whereas transition timelines, milestones, and educational tools exist for some chronic conditions, they do not meet the unique needs of patients with XLH. EVIDENCE ACQUISITION To produce the first expert recommendations on HCT preparation for AYAs with XLH developed by clinical care investigators and transition experts, a formal literature search was conducted and discussed in an advisory board meeting in July 2020. A modified Delphi method was used to refine expert opinion and facilitate a consensus position. EVIDENCE SYNTHESIS We identified the need for psychosocial and access-related resources for disease education, genetic counseling, family planning, and AYA emancipation from caregiver-directed care. Additionally, we recognized that it is necessary to facilitate communication with patients through channels familiar and accessible to AYAs and teach patients to advocate for their health care/access to specialists. CONCLUSION Clear HCT preparation guidelines and treatment-related goals are defined. Individualized timelines and practical strategies for HCT preparation are proposed to optimize health outcomes resulting from continuous clinical care throughout the patient lifecycle. We provide an expert consensus statement describing a tailored HCT preparation program specifically for AYAs with XLH to aid in the effective transfer from pediatric- to adult-focused health care.
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Affiliation(s)
- Kathryn Dahir
- Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA
| | - Ruban Dhaliwal
- SUNY Upstate Medical University, Syracuse, New York 13210, USA
| | - Jill Simmons
- Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA
| | - Erik A Imel
- Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
| | - Gary S Gottesman
- Shriners Hospitals for Children–St Louis, St Louis, Missouri 63110,USA
| | - John D Mahan
- Nationwide Children’s Hospital, Columbus, Ohio 43205, USA
| | | | - Allison I Hoch
- Ultragenyx Pharmaceutical Inc, Novato, California 94949, USA
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Urstad KH, Andersen MH, Larsen MH, Borge CR, Helseth S, Wahl AK. Definitions and measurement of health literacy in health and medicine research: a systematic review. BMJ Open 2022; 12:e056294. [PMID: 35165112 PMCID: PMC8845180 DOI: 10.1136/bmjopen-2021-056294] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES The way health literacy is understood (conceptualised) should be closely linked to how it is measured (operationalised). This study aimed to gain insights into how health literacy is defined and measured in current health literacy research and to examine the relationship between health literacy definitions and instruments. DESIGN Systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. DATA SOURCES The MEDLINE, PsycINFO, ERIC and CINAHL databases were searched for articles published during two randomly selected months (March and October) in 2019. ELIGIBILITY CRITERIA We included articles with a quantitative design that measured health literacy, were peer-reviewed and original, were published in the English language and included a study population older than 16 years. DATA EXTRACTION AND SYNTHESIS Six researchers screened the articles for eligibility and extracted the data independently. All health literacy definitions and instruments were considered in relation to category 1 (describing basic reading and writing skills, disease-specific knowledge and practical skills) and category 2 (social health literacy competence and the ability to interpret and critically assess health information). The categories were inspired by Nutbeam's descriptions of the different health literacy levels. RESULTS 120 articles were included in the review: 60 within public health and 60 within clinical health. The majority of the articles (n=77) used instruments from category 1. In total, 79 of the studies provided a health literacy definition; of these, 71 were in category 2 and 8 were in category 1. In almost half of the studies (n=38), health literacy was defined in a broad perspective (category 2) but measured with a more narrow focus (category 1). CONCLUSION Due to the high degree of inconsistency between health literacy definitions and instruments in current health literacy research, there is a risk of missing important information about health literacy considered be important to the initial understanding of the concept recognised in the studies. PROSPERO REGISTRATION NUMBER CRD42020179699.
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Affiliation(s)
- Kristin Hjorthaug Urstad
- Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway
- Faculty of Health Sciences, VID Specialized University, Oslo, Akershus, Norway
| | - Marit Helen Andersen
- Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
- Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Marie Hamilton Larsen
- Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
- Lovisenberg Diaconal University College, Oslo, Akershus, Norway
| | - Christine Råheim Borge
- Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
- Lovisenberg Diakonale Hospital, Oslo, Norway
| | - Sølvi Helseth
- Faculty of Health Scienes, Oslo Metropolitan University, Oslo, Norway
- Department of Health and Nursing Sciences, University of Agder, Kristiansand, Norway
| | - Astrid Klopstad Wahl
- Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
- Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
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15
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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: 11] [Impact Index Per Article: 3.7] [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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16
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Chisolm DJ, Keedy HE, Hart LC, Chavez LJ, Dolce M, Morack J, Grannis C, Kelleher K. Exploring Health Literacy, Transition Readiness, and Healthcare Utilization in Medicaid Chronically Ill Youth. J Adolesc Health 2021; 69:622-628. [PMID: 33952419 PMCID: PMC8429056 DOI: 10.1016/j.jadohealth.2021.03.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/10/2021] [Accepted: 03/26/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Youths with special healthcare needs face challenges transitioning from pediatric to adult health care. Understanding possible mechanisms contributing to poor healthcare transition could improve care. This study explores associations between health literacy (HL), transition readiness, and healthcare utilization. METHODS Youths with special healthcare needs aged 12-18 years were recruited from a Medicaid accountable care organization (2012-2017). Outcome measures included transition readiness (Transition Readiness Assessment Questionnaire), and healthcare utilization (any well-check, hospitalization, emergency department [ED] visit, or ambulatory sensitive condition ED visit). Multivariate regression analyses examined whether HL (adequate vs. inadequate) predicted outcomes, after adjusting for covariates. Models were then created to examine whether the effect of HL on healthcare utilization was mediated by transition readiness. RESULTS Among 417 youths with special healthcare needs, 67.1% reported adequate HL. Relative to inadequate HL, teens with adequate HL had significantly higher average Transition Readiness Assessment Questionnaire-20 scores (β = .34, p < .001). Controlling for covariates, HL was a significant predictor of having an ambulatory sensitive condition ED visit and having any ED visits neared significance. There was a positive transition readiness mediation effect on having an ED visit, with higher transition readiness being associated with higher odds of having any ED visit in the mediation analysis. CONCLUSIONS HL is independently associated with higher transition readiness and lower ambulatory sensitive condition ED use, but pathways of action require further study.
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Affiliation(s)
- Deena J Chisolm
- Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; College of Public Health, The Ohio State University, Columbus, Ohio
| | - Hannah E Keedy
- Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio.
| | - Laura C Hart
- Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; College of Medicine, Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Laura J Chavez
- Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Millie Dolce
- Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Jennifer Morack
- Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Connor Grannis
- Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Kelly Kelleher
- Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; College of Medicine, Department of Pediatrics, The Ohio State University, Columbus, Ohio
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17
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Rague JT, Kim S, Hirsch JA, Meyer T, Rosoklija I, Larson JE, Swaroop VT, Bowman RM, Bowen DK, Cheng EY, Gordon EJ, Chu DI, Isakova T, Yerkes EB, Chu DI. Assessment of Health Literacy and Self-reported Readiness for Transition to Adult Care Among Adolescents and Young Adults With Spina Bifida. JAMA Netw Open 2021; 4:e2127034. [PMID: 34581795 PMCID: PMC8479582 DOI: 10.1001/jamanetworkopen.2021.27034] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Health literacy has been shown to play an important role in transitions of care in adult populations, with low health literacy associated with adverse health outcomes. The role of health literacy in the transition from pediatric to adult care has been less well studied. Among adolescents and young adults with spina bifida, high rates of unsuccessful transition have been shown, but how patient health literacy affects transition readiness remains unknown. OBJECTIVE To determine whether health literacy is associated with transition readiness in adolescents and young adults with spina bifida. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study involved collection of patient-reported questionnaires between June 2019 and March 2020 at a multidisciplinary spina bifida center at a single, free-standing children's hospital. Patient demographic and clinical characteristics were obtained from medical record review. Patients were aged 12 years or older with a diagnosis of spina bifida (myelomeningocele and nonmyelomeningocele) whose primary language was English or Spanish. Data analysis was performed from October 2020 to March 2021. EXPOSURES Health literacy as assessed by the Brief Health Literacy Screening Tool. MAIN OUTCOMES AND MEASURES The primary outcome was total Transition Readiness Assessment Questionnaire (TRAQ) score, normalized into units of SD. Nested, multivariable linear regression models assessed the association between health literacy and TRAQ scores. RESULTS The TRAQ and Brief Health Literacy Screening Tool were completed by 200 individuals (median [range] age, 17.0 [12.0-31.0] years; 104 female participants [52.0%]). Most of the patients were younger than 18 years (110 participants [55.0%]) and White (136 participants [68.0%]) and had myelomeningocele (125 participants [62.5%]). The mean (SD) TRAQ score was 3.3 (1.1). Sixty-six participants (33.0%) reported inadequate health literacy, 60 participants (30.0%) reported marginal health literacy, and 74 participants (37.0%) reported adequate health literacy. In univariable analysis, health literacy, age, type of spina bifida, level of education, self-administration vs completion of the questionnaires with assistance, ambulatory status, and urinary incontinence were associated with total TRAQ score. In all nested, sequentially adjusted, multivariable models, higher health literacy remained a significant, stepwise, independent variable associated with higher TRAQ score. In the fully adjusted model, having adequate compared with inadequate health literacy was associated with an increase in normalized TRAQ score of 0.49 SD (95% CI, 0.19-0.79). CONCLUSIONS AND RELEVANCE Patient-reported transition readiness is associated with health literacy, even after adjustment for education level and other demographic and clinical factors. Developing and implementing health literacy-sensitive care programs during the transition process may improve patient transition readiness.
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Affiliation(s)
- James T. Rague
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Soojin Kim
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Josephine A. Hirsch
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Theresa Meyer
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Ilina Rosoklija
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Jill E. Larson
- Division of Orthopedic Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Vineeta T. Swaroop
- Division of Orthopedic Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Robin M. Bowman
- Division of Neurosurgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Diana K. Bowen
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Earl Y. Cheng
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Elisa J. Gordon
- Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel I. Chu
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham
| | - Tamara Isakova
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth B. Yerkes
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - David I. Chu
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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18
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Boonstra MD, Reijneveld SA, Foitzik EM, Westerhuis R, Navis G, de Winter AF. How to tackle health literacy problems in chronic kidney disease patients? A systematic review to identify promising intervention targets and strategies. Nephrol Dial Transplant 2020; 36:gfaa273. [PMID: 33351936 PMCID: PMC8237988 DOI: 10.1093/ndt/gfaa273] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Limited health literacy (LHL) is associated with multiple adverse health outcomes in chronic kidney disease (CKD). Interventions are needed to improve this situation, but evidence on intervention targets and strategies is lacking. This systematic review aims to identify potential targets and strategies by summarizing the evidence on: (i) patient- and system-level factors potentially mediating the relation between LHL and health outcomes; and (ii) the effectiveness of health literacy interventions customized to CKD patients. METHODS We performed a systematic review of peer-reviewed research articles in Medline, Embase and Web of Science, 2009-19. We assessed the quality of the studies and conducted a best-evidence synthesis. RESULTS We identified 860 publications and included 48 studies. Most studies were of low quality (n = 26) and focused on dialysis and transplantation (n = 38). We found strong evidence for an association of LHL with smoking and having a suboptimal transplantation process. Evidence was weak for associations between LHL and a variety of factors related to self-care management (n = 25), utilization of care (n = 23), patient-provider interaction (n = 8) and social context (n = 5). Six interventions were aimed at improving knowledge, decision-making and health behaviours, but evidence for their effectiveness was weak. CONCLUSIONS Study heterogeneity, low quality and focus on kidney failure largely impede the identification of intervention targets and strategies for LHL. More and higher quality studies in earlier CKD stages are needed to unravel how LHL leads to worse health outcomes, and to identify targets and strategies to prevent disease deterioration. Healthcare organizations need to develop and evaluate efforts to support LHL patients.
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Affiliation(s)
- Marco D Boonstra
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Elisabeth M Foitzik
- Institute for Applied Health Sciences, Coburg University of Applied Sciences and Arts, Coburg, Germany
| | - Ralf Westerhuis
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerjan Navis
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Andrea F de Winter
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Cicero AFG, Fogacci F, Borghi C. Cost-effectiveness analysis of different hypertension management strategies. Intern Emerg Med 2020; 15:181-182. [PMID: 31321710 DOI: 10.1007/s11739-019-02153-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 07/09/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Arrigo F G Cicero
- Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, Bologna, Italy.
| | - Federica Fogacci
- Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Claudio Borghi
- Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, Bologna, Italy
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