Exploring health literacy in patients with chronic kidney disease: a qualitative study

Trying to understand the illness: A qualitative investigation of health literacy of patients undergoing maintenance hemodialysis

Limited health literacy is high among patients with chronic kidney disease, which can pose challenges in health care. Evidence of health literacy in Indonesia, particularly regarding patients undergoing hemodialysis, is lacking. In this study, we aimed to explore health literacy in adult patients undergoing maintenance hemodialysis. An inductive qualitative study was conducted. Individual semi-structured interviews were conducted with 10 adult patients undergoing hemodialysis, four family caregivers, and four healthcare professionals. Interviews were transcribed verbatim and analyzed thematically. Three themes emerged from the data: "Trying to understand the illness," "searching and obtaining health information," and "applying health information." Understanding and accepting the illness included raising awareness of the changes in their lives and accepting these changes. Participants actively sought information from healthcare professionals and other sources and used it carefully. Behavioral changes included patients' adherence to therapy, although participants often felt bored during the illness trajectory. Understanding the illness and being willing to seek and critically evaluate health information before implementing it are important. These aspects may affect patient outcomes and require further intervention and research.

Trust, Multidimensional Health Literacy, and Medication Adherence among Patients Undergoing Long-Term Hemodialysis

BACKGROUND

Basic health literacy and trust in physicians can influence medication adherence in patients receiving dialysis. However, how high-order health literacy is associated with medication adherence and how trust in physicians mediates this association remain unclear. We assessed the inter-relationships between health literacy, trust in physicians, and medication adherence. We investigated the mediating role of trust in physicians in the relationship between health literacy and medication adherence.

METHODS

This multicenter cross-sectional study included Japanese adults receiving outpatient hemodialysis at six dialysis centers. Multidimensional health literacy was measured using the 14-item Functional, Communicative, and Critical Health Literacy scale. Trust in physicians was measured using the five-item Wake Forest Physician Trust scale. Medication adherence was measured using the 12-item Adherence Starts with Knowledge scale. A series of general linear models were created to analyze the associations between health literacy and Adherence Starts Knowledge scores with and without trust in physicians. Mediation analysis was performed to determine whether trust in physicians mediated this association.

RESULTS

In total, 455 patients were analyzed. Higher functional and communicative health literacies were associated with less adherence difficulties (per 1-point higher: -1.79 [95% confidence interval (CI): -2.59 to -0.99] and -2.21 [95% CI: -3.45 to -0.96], respectively), whereas higher critical health literacy was associated with greater adherence difficulties (per 1-point higher: 1.69 [95% CI: 0.44 to 2.94]). After controlling for trust in physicians, the magnitude of the association between health literacies and medication adherence decreased. Trust in physicians partially mediated the association between functional or communicative health literacy and medication adherence (especially beliefs) and completely mediated the association between critical health literacy and medication adherence (especially behaviors).

CONCLUSIONS

Functional and communicative health literacies were positively associated with medication adherence, whereas critical health literacy was negatively associated with it. Each association was mediated by trust in physicians.

Healthcare providers' support and outcomes in hemodialysis patients: The mediating effect of health literacy

OBJECTIVE

This study aimed to identify the mediating effect of health literacy (HL) on the relationship between healthcare providers' support and outcomes in patients on hemodialysis.

METHODS

A convenience sample of 149 hemodialysis patients participated in a cross-sectional survey. Mediation analysis with the percentile bootstrap method was used to identify the mediating effect of HL on the relationship between healthcare providers' support and patient outcomes.

RESULTS

Healthcare providers' support and HL were significant predictors of patient outcomes. HL mediated the relationship between healthcare providers' support and patient outcomes.

CONCLUSION

The HL of hemodialysis patients is essential in the relationship between healthcare providers' support and patient outcomes. Patient educators should implement a multifaceted HL-tailored intervention strategy to improve the HL of hemodialysis patients.

PRACTICE IMPLICATIONS

Hemodialysis patients' HL is a crucial mediating factor in the relationship between healthcare providers' support and patient outcomes. A multifaceted HL-tailored intervention strategy is needed to improve HL and, thus, health outcomes among hemodialysis patients.

Identifying individual enablers and barriers to the use of digital technology for the self-management of long-term conditions by older adults

Evidence suggests that much of the digital technology available and provided to older adults to enable self-management of long-term conditions is under-utilised. This research focuses on three conditions prevalent amongst older adults: diabetes, dementia and chronic kidney disease and explores the individual enablers and barriers to the use of digital self-management technology. The paper reports findings from a series of three systematic reviews of qualitative research (qualitative evidence syntheses). These reviews informed the design of a Delphi study. The first round of the Delphi involving 15 expert interviews is reported. The findings highlight common themes across the three conditions: how technology is used; barriers to use; assessing individual needs when selecting technology; support requirements; multi-functional self-management technologies; trust, privacy and data sharing; achieving accessible and aspirational design. Some emerging recommendations have been suggested to guide the design, and provision of technology to older adults. These will extended and refined through subsequent rounds of the Delphi method.

Development of health literacy in persons and caregivers living with dementia: A qualitative directed content analysis

BACKGROUND

Persons living with dementia and their caregivers need health information to understand and manage daily life. Previous studies focused on the associations of health literacy and cognitive impairment with less exploring if and how individuals develop health literacy during the course of the disease.

PURPOSE

This descriptive qualitative study aimed to explore the development of health literacy competencies among persons living with dementia and their caregivers.

METHODS

Directed content analysis of six focus groups conducted in the community setting (15 persons living with dementia and 28 caregivers) was completed, using predetermined categories from the Integrated Model of Health Literacy: access, understand, appraise, and apply health information.

FINDINGS

Participants described developing health literacy competencies over time, moving from a dependence on health care providers to becoming their own experts. Although health care providers were involved in the diagnosis and medication management, most participants admitted that they provided very little information on how to manage their daily life with dementia and often failed to inform them of community resources.

CONCLUSION

Participants seemed to find dementia resources on their own for both education and support, often stumbling upon them by accident. Health care providers should promote the health literacy competencies of their patients and caregivers by more intentionally providing dementia health and community resource information.

Individual and organizational health literacies: moderating psychological distress for individuals with chronic conditions

BACKGROUND

People with chronic conditions experience high psychological distress.

METHODS

Using the National Health Survey in Australia during 2017-18, the study assessed whether and which health literacies moderated the relationship between chronic conditions and psychological distress for diabetes, chronic kidney disease (CKD), cardiovascular disease (CVD), arthritis, other musculoskeletal conditions, asthma, other chronic lower respiratory diseases and cancer. Psychological distress was regressed on chronic diseases, health literacy domains and their interactions, controlling for demographic, socioeconomic and health factors.

RESULTS

Of 5790 adults, 4212 (72.75%) aged 18-64; 846 (14.6%) had high or very high psychological distress, 1819 (31.4%) had diabetes, CKD or CVD, 2645 (45.7%) musculoskeletal conditions, and 910 (15.7%) lower respiratory conditions. Having sufficient information from healthcare providers was associated with the lowest level of psychological distress for CKD and cancer. Social support was associated with significantly lower levels of psychological distress for cardiovascular, musculoskeletal and lower respiratory conditions. Understanding health information was associated with the largest improvement in psychological distress for diabetes.

CONCLUSIONS

Higher health literacies were associated with reduced risks of psychological distress among individuals managing chronic conditions. Interventions for improving self-management and health inequalities should incorporate disease-specific health literacy enhancement strategies at individual and organizational levels.

A scoping review of the role of health literacy in chronic kidney disease self-management

BACKGROUND

Chronic kidney disease is a serious health condition and is increasing globally. Effective self-management could slow disease progression and improve health outcomes, although the contribution of health literacy and knowledge for self-management is not well known.

AIM

To investigate the recent evidence of health literacy and the relationship between health literacy, knowledge and self-management of chronic kidney disease.

METHODS

Arksey and O'Malley's framework informed this scoping review. Eligible studies involving adults with any grade of chronic kidney disease, measuring all dimensions of health literacy (i.e., functional, communicative, and critical), disease-specific knowledge and self-management, published in English between January 2005 and March 2020, were included.

RESULTS

The scoping review found 12 eligible studies, with 11 assessing all dimensions of health literacy. No study examined health literacy, knowledge and self-management. When individuals had greater health literacy, this was associated with greater knowledge about the disease. Communicative health literacy was a significant predictor of medication, diet and fluid adherence, and overall self-management behaviours.

CONCLUSION

This scoping review shows that disease-specific knowledge is important for health literacy and that health literacy is essential for effective self-management of chronic kidney disease. The implications of these relationships can inform strategies for the development of evidence-based patient education to support increased self-management. There is also a need for further research to explore these associations.