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Schaeffer D, Griese L, Klinger J. [Navigational health literacy of the population in Germany]. DAS GESUNDHEITSWESEN 2024; 86:59-66. [PMID: 37813347 PMCID: PMC11248003 DOI: 10.1055/a-2148-5221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
AIM Many health care systems are characterized by their high complexity and intransparency. Finding one's way through the multitude of services and finding the right place requires high navigational health literacy (NHL). NHL is defined as the ability to manoeuvre through the health care system and deal with the information required to do so. However, so far, there has been a lack of data on the population's NHL. The objective of this article is to analyse empirically the NHL in Germany and its association with socio-demographic and economic factors. METHOD NHL was surveyed with an instrument (HLS19-NAV) newly developed by an international working group, measuring the self-assessed difficulties in relation to 12 navigation-related information tasks. The HLS19-NAV has already been used in 8 countries, including Germany. In Germany, data on NHL was collected from 2,151 adult residents in a representative cross-sectional study. The relationship between socio-demographic and economic factors, and NHL was examined by using methods of analysis of variance and multivariate linear regression analysis. RESULTS Approximately 80% of the respondents showed low NHL with a mean score of 41.5 out of a possible 100 points. Those with low socio-economic resources, people of advanced age, people who had migrated to Germany or who were limited by health issues had a particularly low NHL. However, even people with good resources had a relatively low NHL. In contrast, the mean score was significantly higher among health professionals. CONCLUSIONS In recent years, numerous efforts have been made to reduce navigational difficulties and to better guide patients through the German health care system. However, according to the results of the study, there is still need for further action. Above all, structural measures are required: this includes the creation of sufficient, reliable information on the health care system and its organizations as well as the implementation of navigation aids, health care pathways and the creation of a health-literate health care system including organizations and health professionals that contribute to strengthening NHL in general.
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Affiliation(s)
- Doris Schaeffer
- Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Germany
| | - Lennert Griese
- Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Germany
| | - Julia Klinger
- Wirtschafts- und Sozialwissenschaftliche Fakultät, Universität zu Köln, Institut für Soziologie und Sozialpsychologie, Köln, Germany
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Simpson G, Morrison L, Santer M, Hijryana M, Farmer A, Dambha-Miller H. Perceptions and experiences of living with and providing care for multimorbidity: A qualitative interview study. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2024; 14:26335565241240820. [PMID: 38529048 PMCID: PMC10962039 DOI: 10.1177/26335565241240820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/03/2024] [Indexed: 03/27/2024]
Abstract
Background Experiences of living with and seeking care for multimorbidity is a relatively under-researched field. By analysing experiences of people with multimorbidity, caregivers and care professionals, we can better understand the complex care needs of those with multimorbidity and identify improvements to care management. This paper reports findings from research that elicited the views of key stakeholders to inform future care practice and policy. Aim To elicit care recipient and care provider views to understand the care needs of those living with and seeking care for multimorbidity. Method A qualitative interview study using purposive sampling of those living with and providing care in multimorbidity. Results Increased support to those with multimorbidity and caregivers to navigate care systems was advocated. Establishing trusting care relationships featured prominently in participants accounts. Fragmented care, inadequate coordination and poor communication between care providers, were identified as system-wide challenges. There was agreement that integrated care models were needed, which delivered personalised care, such as shared decision-making, choice in care options and accessing services, and individualised care plans. Conclusion We found significant agreement among stakeholders on care need and management in multimorbidity. Understanding the experiences of those with multimorbidity, caregivers and care professionals, can inform future improvements in care management.
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Affiliation(s)
- Glenn Simpson
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Leanne Morrison
- Primary Care Research Centre, University of Southampton, Southampton, UK
- School of Psychology, University of Southampton, Southampton, UK
| | - Miriam Santer
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Marisza Hijryana
- Institute of Epidemiology and Health Care, University College London (UCL), London, UK
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Lee PSS, Chew EAL, Koh HL, Quak SXE, Ding YY, Subramaniam M, Vaingankar JA, Lee ES. How do older adults with multimorbidity navigate healthcare?: a qualitative study in Singapore. BMC PRIMARY CARE 2023; 24:239. [PMID: 37957559 PMCID: PMC10644451 DOI: 10.1186/s12875-023-02195-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Patients living with multimorbidity may require frequent visits to multiple healthcare institutions and to follow diverse medical regimens and advice. Older adults with multimorbidity could face additional challenges because of declining cognitive capability, frailty, increased complexity of diseases, as well as limited social and economic resources. Research on how this population navigates the healthcare system in Singapore also remains unknown. This study investigates the challenges older adults with multimorbidity face in navigating healthcare in Singapore. METHODS Twenty older adults with multimorbidity from a public primary care setting were purposively sampled. Interviews conducted inquired into their experiences of navigating the healthcare system with multiple conditions. Inductive thematic analysis was performed by independent coders who resolved differences through discussion. RESULTS Older adults with multimorbidity form a population with specific characteristics and challenges. Their ability to navigate the healthcare system well was influenced by these themes including patient-related factors (autonomy and physical mobility, literacy and technological literacy, social support network), healthcare system-related factors (communication and personal rapport, fragmented system, healthcare staff as advocate) and strategies for navigation (fitting in, asking for help, negotiating to achieve goals, managing the logistics of multimorbidity). DISCUSSION Older adults with multimorbidity should not be treated as a homogenous group but can be stratified according to those with less serious or disruptive conditions (less burden of illness and burden of treatment) and those with more severe conditions (more burden of illness and burden of treatment). Among the latter, some became navigational experts while others struggled to obtain the resources needed. The variations of navigational experiences of the healthcare system show the need for further study of the differential needs of older adults with multimorbidity. To be truly patient-centred, healthcare providers should consider factors such as the existence of family support networks, literacy, technological literacy and the age-related challenges older adults face as they interact with the healthcare system, as well as finding ways to improve healthcare systems through personal rapport and strategies for reducing unnecessary burden of treatment for patients with multimorbidity.
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Affiliation(s)
- Poay Sian Sabrina Lee
- Clinical Research Unit, National Healthcare Group Polyclinics, 3 Fusionopolis Link #06-13, Singapore, 138543, Singapore
| | - Evelyn Ai Ling Chew
- Clinical Research Unit, National Healthcare Group Polyclinics, 3 Fusionopolis Link #06-13, Singapore, 138543, Singapore
| | - Hui Li Koh
- Clinical Research Unit, National Healthcare Group Polyclinics, 3 Fusionopolis Link #06-13, Singapore, 138543, Singapore
| | - Stephanie Xin En Quak
- Clinical Research Unit, National Healthcare Group Polyclinics, 3 Fusionopolis Link #06-13, Singapore, 138543, Singapore
| | - Yew Yoong Ding
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | | | | | - Eng Sing Lee
- Clinical Research Unit, National Healthcare Group Polyclinics, 3 Fusionopolis Link #06-13, Singapore, 138543, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
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Abstract
OBJECTIVES People with chronic illness are particularly dependent on navigating and using the health care system. This requires navigational health literacy (HL-NAV). The article aims to examine the distribution and predictors of HL-NAV in a sample of chronically ill individuals. METHODS Data of 1,105 people with chronic illness from the general population in Germany were collected in December 2019 and January 2020. HL-NAV was assessed by 12 items (score 0-100). Bivariate and multiple linear regression analysis were performed. RESULTS HL-NAV score was 39.1 (SD 27.3). In bivariate analyses, HL-NAV was lower among chronically ill persons aged 65 or above, with low education, limited functional health literacy, low social status, financial deprivation, poor social support, multiple chronic conditions, and an illness duration of 6-10 years. In multivariate analyses, advanced age, lower education, less functional health literacy, lower social status, and less social support remained associated with lower HL-NAV. DISCUSSION The results underline the importance of promoting HL-NAV among people with chronic illness. Strategies should aim at strengthening individual competencies taking into account the social and situational factors but also at reducing the demands placed on chronically ill people by providing user-friendly and trustworthy information on the health care system along the illness trajectory.
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Affiliation(s)
- Lennert Griese
- School of Public Health, Interdisciplinary Centre for Health Literacy Research [ICHL], 9167Bielefeld University, Bielefeld, Germany
| | - Doris Schaeffer
- School of Public Health, Interdisciplinary Centre for Health Literacy Research [ICHL], 9167Bielefeld University, Bielefeld, Germany
| | - Eva-Maria Berens
- School of Public Health, Interdisciplinary Centre for Health Literacy Research [ICHL], 9167Bielefeld University, Bielefeld, Germany
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Griese L, Finbråten HS, Francisco R, De Gani SM, Griebler R, Guttersrud Ø, Jaks R, Le C, Link T, Silva da Costa A, Telo de Arriaga M, Touzani R, Vrdelja M, Pelikan JM, Schaeffer D. HLS 19-NAV-Validation of a New Instrument Measuring Navigational Health Literacy in Eight European Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13863. [PMID: 36360755 PMCID: PMC9654211 DOI: 10.3390/ijerph192113863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
To manoeuvre a complex and fragmented health care system, people need sufficient navigational health literacy (NAV-HL). The objective of this study was to validate the HLS19-NAV measurement scale applied in the European Health Literacy Population Survey 2019-2021 (HLS19). From December 2019 to January 2021, data on NAV-HL was collected in eight European countries. The HLS19-NAV was translated into seven languages and successfully applied in and validated for eight countries, where language and survey method differed. The psychometric properties of the scale were assessed using confirmatory factor analysis (CFA) and Rasch modelling. The tested CFA models sufficiently well described the observed correlation structures. In most countries, the NAV-HL data displayed acceptable fit to the unidimensional Rasch partial credit model (PCM). For some countries, some items showed poor data-model fit when tested against the PCM, and some items displayed differential item functioning for selected person factors. The HLS19-NAV demonstrated high internal consistency. To ensure content validity, the HLS19-NAV was developed based on a conceptual framework. As an estimate of discriminant validity, the Pearson correlations between the NAV-HL and general health literacy (GEN-HL) scales were computed. Concurrent predictive validity was estimated by testing whether the HLS19-NAV, like general HL measures, follows a social gradient and whether it forms a predictor of general health status as a health-related outcome of general HL. In some countries, adjustments at the item level may be beneficial.
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Affiliation(s)
- Lennert Griese
- School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
| | - Hanne S. Finbråten
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, 2418 Elverum, Norway
| | - Rita Francisco
- Católica Research Centre for Psychological, Family and Social Well-Being, Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal
| | - Saskia M. De Gani
- Careum Foundation, Careum Center for Health Literacy, 8032 Zurich, Switzerland
- Careum School of Health, Kalaidos University of Applied Sciences, 8006 Zurich, Switzerland
| | - Robert Griebler
- Competence Centre for Health Promotion and Health System, Austrian National Public Health Institute, A-1010 Vienna, Austria
| | - Øystein Guttersrud
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
| | - Rebecca Jaks
- Careum Foundation, Careum Center for Health Literacy, 8032 Zurich, Switzerland
| | - Christopher Le
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, 2418 Elverum, Norway
- Department of Social Determinants of Health, Division of Prevention and Public Health, Norwegian Directorate of Health, 0213 Oslo, Norway
| | - Thomas Link
- Department of Quality Measurement and Patient Survey, Austrian National Public Health Institute, A-1010 Vienna, Austria
| | - Andreia Silva da Costa
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), 1049-005 Lisboa, Portugal
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-026 Lisboa, Portugal
| | - Miguel Telo de Arriaga
- Católica Research Centre for Psychological, Family and Social Well-Being, Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal
- Direção-Geral da Saúde, 1049-005 Lisboa, Portugal
| | - Rajae Touzani
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe CANBIOS Labellisée Ligue 2019, 13009 Marseille, France
- Institut Paoli-Calmettes, SESSTIM U1252, 13009 Marseille, France
| | - Mitja Vrdelja
- Communication Unit, National Institute of Public Health, 1000 Ljubljana, Slovenia
| | - Jürgen M. Pelikan
- WHO-CC Health Promotion in Hospitals and Health Care, Austrian National Public Health Institute, A-1010 Vienna, Austria
| | - Doris Schaeffer
- School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
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