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Wong CK, Lassemillante AC, White C, Belski R. Understanding the Health Literacy Experiences and Practices of Australian-Resettled Myanmar Refugees: Relevance for Nutrition and Dietetics Practice. Nutrients 2024; 16:3109. [PMID: 39339709 PMCID: PMC11435108 DOI: 10.3390/nu16183109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Revised: 09/06/2024] [Accepted: 09/13/2024] [Indexed: 09/30/2024] Open
Abstract
Background/Objectives: Refugees typically experience poorer health compared with people from non-refugee backgrounds, and health literacy may play a part in this discrepancy. Using the WHO's revised health literacy definitions as a framework, this qualitative study sought to examine the health literacy experiences and practices of Australian resettled refugees from Myanmar from refugee and service provider perspectives. Methods: Four refugee participant focus groups (n = 27) along with one focus group and four interviews with service providers (n = 7) were conducted in Melbourne, Australia, and analysed using deductive content analysis. Results: Our study found that in addition to individual health literacy, community literacy was practiced by Myanmar refugees, thus highlighting the relevance of social support to health literacy. Furthermore, our study found gaps in healthcare service provision and resourcing related to health literacy development and responsiveness by the healthcare system. Conclusions: Our study confirms the relevance of WHO's revised health literacy definitions to Myanmar refugees while also discussing, in the context of nutrition and dietetics practice, the importance of understanding the different aspects of health literacy and how this relates to working with those who are most marginalised to improve their health and wellbeing.
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Affiliation(s)
- Carrie K. Wong
- Sport, Performance and Nutrition Research Group, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia; (A.-C.L.); (R.B.)
- School of Health Sciences, Swinburne University of Technology, Melbourne, VIC 3122, Australia
| | - Annie-Claude Lassemillante
- Sport, Performance and Nutrition Research Group, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia; (A.-C.L.); (R.B.)
| | - Carolynne White
- Inclusion and Participation, Mind Australia, Burnley, VIC 3121, Australia;
| | - Regina Belski
- Sport, Performance and Nutrition Research Group, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia; (A.-C.L.); (R.B.)
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Bawa D, Darden D, Ahmed A, Garg J, Karst E, Kabra R, Pothineni K, Gopinathannair R, Mansour M, Winterfield J, Lakkireddy D. Lower-adherence direct oral anticoagulant use is associated with increased risk of thromboembolic events than warfarin. J Interv Card Electrophysiol 2024; 67:709-718. [PMID: 37556090 DOI: 10.1007/s10840-023-01585-x] [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: 03/08/2023] [Accepted: 06/01/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Real-world data have suggested inconsistent adherence to oral anticoagulation for thromboembolic event (TE) prevention in patients with Non valvular atrial fibrillation (NVAF), yet it remains unclear if event risk is elevated during gaps of non-adherence. OBJECTIVE To compare difference in outcomes between direct oral anticoagulant (DOAC) and warfarin based on adherence to the therapy in patients with NVAF. METHODS Using the MarketScan claims data, patients receiving prescription of warfarin or a DOAC for NVAF from January 2015 to June 2016 were included. Outcomes included hospitalization for TE (ischemic stroke or systemic embolism), hemorrhagic stroke, stroke of any kind, and major bleeding. Event rates were reported for warfarin and DOACs at a higher-adherence proportion of days covered (PDC > 80%) and lower-adherence (PDC 40-80%). RESULTS The cohort included 83,168 patients prescribed warfarin (51% [n = 42,639]) or DOAC (49% [n = 40,529]). Lower adherence occurred in 36% (n = 15,330) of patients prescribed warfarin and 26% (n = 10,956) prescribed DOAC. As compared to higher-adherence warfarin after multivariable adjustment, the risk of TE was highest in lower-adherence DOAC (HR 1.26; 95% CI, 1.14-1.33), and lowest in higher-adherence DOAC (HR, 0.93; 95% CI, 0.88-0.99). There was a significantly higher risk of hemorrhagic stroke and stroke of any kind in the lower-adherence groups. Major bleeding was more common with lower-adherence DOAC (HR, 1.43, 95% CI, 1.35-1.52) and lower-adherence warfarin (HR, 1.32, 95% CI, 1.26-1.39). CONCLUSIONS In this large real-world study, low adherence DOAC was associated with higher risk of TE events as compared to high and low adherence warfarin.
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Affiliation(s)
- Danish Bawa
- The Kansas City Heart Rhythm Institute (KCHRI) @ HCA Midwest, the University of Missouri - Columbia, 12200, W 106Th Street, Overland Park Regional Medical Center, Overland Park, KS, 66215, USA
| | - Douglas Darden
- The Kansas City Heart Rhythm Institute (KCHRI) @ HCA Midwest, the University of Missouri - Columbia, 12200, W 106Th Street, Overland Park Regional Medical Center, Overland Park, KS, 66215, USA
| | - Adnan Ahmed
- The Kansas City Heart Rhythm Institute (KCHRI) @ HCA Midwest, the University of Missouri - Columbia, 12200, W 106Th Street, Overland Park Regional Medical Center, Overland Park, KS, 66215, USA
| | - Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, CA, USA
| | | | - Rajesh Kabra
- The Kansas City Heart Rhythm Institute (KCHRI) @ HCA Midwest, the University of Missouri - Columbia, 12200, W 106Th Street, Overland Park Regional Medical Center, Overland Park, KS, 66215, USA
| | - Krishna Pothineni
- The Kansas City Heart Rhythm Institute (KCHRI) @ HCA Midwest, the University of Missouri - Columbia, 12200, W 106Th Street, Overland Park Regional Medical Center, Overland Park, KS, 66215, USA
| | - Rakesh Gopinathannair
- The Kansas City Heart Rhythm Institute (KCHRI) @ HCA Midwest, the University of Missouri - Columbia, 12200, W 106Th Street, Overland Park Regional Medical Center, Overland Park, KS, 66215, USA
| | | | - Jeffrey Winterfield
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Dhanunjaya Lakkireddy
- The Kansas City Heart Rhythm Institute (KCHRI) @ HCA Midwest, the University of Missouri - Columbia, 12200, W 106Th Street, Overland Park Regional Medical Center, Overland Park, KS, 66215, USA.
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Bacchi S, Kovoor JG, Goh R, Gupta AK, Tan S, Ovenden CD, To MS, Moey A, Sanders P, Chew DP, Schultz D, Kovoor P, Kleinig T, Jannes J. Pre-stroke anticoagulation for atrial fibrillation in primary English speakers and non-primary English speakers: a multicentre retrospective cohort study. Intern Med J 2024; 54:620-625. [PMID: 37860995 DOI: 10.1111/imj.16253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/16/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Anticoagulation can prevent most strokes in individuals with atrial fibrillation (AF); however, many people presenting with stroke and known AF are not anticoagulated. Language barriers and poor health literacy have previously been associated with decreased patient medication adherence. The association between language barriers and initiation of anticoagulation therapy for AF is uncertain. AIMS The aims of this study were to determine whether demographic factors, including non-English primary language, were (1) associated with not being initiated on anticoagulation for known AF prior to admission with stroke, and (2) associated with non-adherence to anticoagulation in the setting of known AF prior to admission with stroke. METHODS A multicentre retrospective cohort study was conducted for consecutive individuals admitted to the three South Australian tertiary hospitals with stroke units over a 5-year period. RESULTS There were 6829 individuals admitted with stroke. These cases included 5835 ischaemic stroke patients, 1333 of whom had pre-existing AF. Only 40.0% presenting with ischaemic stroke in the setting of known pre-existing AF were anticoagulated. When controlling for demographics, socioeconomic status and past medical history (including the components of the CHADS2VASC score and anticoagulation contraindications), having a primary language other than English was associated with a lower likelihood of having been commenced on anticoagulant for known pre-stroke AF (odds ratio: 0.52, 95% confidence interval: 0.36-0.77, P = 0.001), but was not associated with a differing likelihood of anticoagulation adherence. CONCLUSIONS A significant proportion of patients with stroke have pre-existing unanticoagulated AF; these rates are substantially higher if the primary language is other than English. Targeted research and interventions to minimise evidence-treatment gaps in this cohort may significantly reduce stroke burden.
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Affiliation(s)
- Stephen Bacchi
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joshua G Kovoor
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Rudy Goh
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Sheryn Tan
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher D Ovenden
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Minh-Son To
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Andrew Moey
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Prashanthan Sanders
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Derek P Chew
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - David Schultz
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Pramesh Kovoor
- Westmead Private Hospital, Sydney, New South Wales, Australia
| | - Timothy Kleinig
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jim Jannes
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Suzuki T, Mizuno A, Yasui H, Noma S, Ohmori T, Rewley J, Kawai F, Nakayama T, Kondo N, Tsukada YT. Scoping Review of Screening and Assessment Tools for Social Determinants of Health in the Field of Cardiovascular Disease. Circ J 2024; 88:390-407. [PMID: 38072415 DOI: 10.1253/circj.cj-23-0443] [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] [Indexed: 02/23/2024]
Abstract
BACKGROUND Despite the importance of implementing the concept of social determinants of health (SDOH) in the clinical practice of cardiovascular disease (CVD), the tools available to assess SDOH have not been systematically investigated. We conducted a scoping review for tools to assess SDOH and comprehensively evaluated how these tools could be applied in the field of CVD. METHODS AND RESULTS We conducted a systematic literature search of PubMed and Embase databases on July 25, 2023. Studies that evaluated an SDOH screening tool with CVD as an outcome or those that explicitly sampled or included participants based on their having CVD were eligible for inclusion. In addition, studies had to have focused on at least one SDOH domain defined by Healthy People 2030. After screening 1984 articles, 58 articles that evaluated 41 distinct screening tools were selected. Of the 58 articles, 39 (67.2%) targeted populations with CVD, whereas 16 (27.6%) evaluated CVD outcome in non-CVD populations. Three (5.2%) compared SDOH differences between CVD and non-CVD populations. Of 41 screening tools, 24 evaluated multiple SDOH domains and 17 evaluated only 1 domain. CONCLUSIONS Our review revealed recent interest in SDOH in the field of CVD, with many useful screening tools that can evaluate SDOH. Future studies are needed to clarify the importance of the intervention in SDOH regarding CVD.
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Affiliation(s)
- Takahiro Suzuki
- Department of Cardiovascular Medicine, St. Luke's International Hospital
| | - Atsushi Mizuno
- Department of Cardiovascular Medicine, St. Luke's International Hospital
- Leonard Davis Institute for Health Economics, University of Pennsylvania
| | - Haruyo Yasui
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Satsuki Noma
- Department of Cardiovascular Medicine, Nippon Medical School
| | | | - Jeffrey Rewley
- Leonard Davis Institute for Health Economics, University of Pennsylvania
- The MITRE Corporation
| | - Fujimi Kawai
- Department of Academic Resources, St. Luke's International University
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University
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Portela-Pino I, Hernaiz-Sanchez A, Lomba-Portela L. Evaluation of health literacy and its predictive formative factors among Spanish military personnel. MILITARY PSYCHOLOGY 2023:1-8. [PMID: 37921646 DOI: 10.1080/08995605.2023.2274755] [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: 03/09/2023] [Accepted: 10/10/2023] [Indexed: 11/04/2023]
Abstract
Health literacy (HL) is an aspect that has been widely studied. However, in the military population there are hardly any studies on the influence of educational variables. Knowing the level of health literacy of military professionals is important as it has an impact on adequate health decision making, avoids the abuse of health services and makes it possible to ask for help when needed, especially in aspects related to mental health. The aim of this study was to measure the level of literacy, as well as its association with other training variables in a sample of military personnel. The study was carried out in 695 military personnel of the Spanish Army. A cross-sectional observational design was used, using a survey with the HLS-EU-Q47 scale. Among the results, it stands out that the level of health literacy of the military is high compared to the rest of the population. The results showed that the level of HL does not seem to be influenced by the level of languages, nor by the degree they hold, nor by experiences abroad. On the other hand, it was observed that the performance of professional internships and work in multidisciplinary teams, extracurricular training, does influence the level of HL, especially in the dimension related to health promotion. This fact seems to mean that the military have learned during these experiences to keep abreast of health-related issues, to understand, to value and to form a considered opinion on health-related information.
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Affiliation(s)
- Iago Portela-Pino
- Department of Health Sciences, Faculty of Health Sciences, Isabel I University, Burgos, Spain
| | | | - Lucía Lomba-Portela
- Department of Didactics, School Organisation and Research, University of Vigo, Vigo, Spain
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García-García D, Pérez-Rivas FJ. Health Literacy and Its Sociodemographic Predictors: A Cross-Sectional Study of a Population in Madrid (Spain). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11815. [PMID: 36142082 PMCID: PMC9517037 DOI: 10.3390/ijerph191811815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Health literacy enhances a population's self-care capacity and helps to reduce health inequalities. This work examines the health literacy of a population attending primary care services and explores its relationship with sociodemographic factors. METHODS This cross-sectional study, conducted at a healthcare center in the Madrid region (Spain), involved adult patients requiring primary care nursing services. One hundred and sixty-six participants were recruited via systematic random sampling. Health literacy was measured using the Health Literacy Questionnaire (HLQ). RESULTS The studied population showed higher health literacy scores for literacy dimensions 1 (feeling understood and supported by healthcare providers) and 4 (social support for health); the lowest scores were recorded for dimensions 5 (appraisal of health information) and 8 (ability to find good health information). People with a better perceived health status showed a higher level of health literacy. People over 65 years of age, those with an incomplete secondary education, and those who were unemployed returned lower scores for several literacy dimensions. CONCLUSIONS The results contribute to our understanding of the factors that influence health literacy. Identifying the areas in which patients show the poorest health literacy may help us comprehend their needs and better support them.
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Affiliation(s)
| | - Francisco Javier Pérez-Rivas
- Grupo de Investigación UCM “Salud Pública-Estilos de Vida, Metodología Enfermera y Cuidados en el Entorno Comunitario”, Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud—RICAPPS—(RICORS), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
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Zhang Y, Zhang H, Li S, Li Y, Hu C, Li H. Development of a short-form Chinese health literacy scale for low salt consumption (CHLSalt-22) and its validation among hypertensive patients. BMC Nutr 2022; 8:101. [PMID: 36096877 PMCID: PMC9465139 DOI: 10.1186/s40795-022-00594-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background With the accelerated pace of people’s life and the changing dietary patterns, the number of chronic diseases is increasing and occurring at a younger age in today’s society. The speedily rising hypertensive patients have become one of the main risk factors for chronic diseases. People should focus on health literacy related to salt consumption and reach a better quality of life. Currently, there is a lack of local assessment tools for low salt consumption in mainland China. Objective To develop a short-form version of the Chinese Health Literacy Scale For Low Salt Consumption instrument for use in mainland China. Methods A cross-sectional design was conducted on a sample of 1472 people in Liaoxi, China. Participants completed a sociodemographic questionnaire, the Chinese version of the CHLSalt-22, the measuring change in restriction of salt (sodium) in the diet in hypertensives (MCRSDH-SUST), the Brief Illness Perception Questionnaire (BIPQ), and the Benefit-Finding Scales (BFS) to test the hypothesis. Exploratory factor analysis and confirmatory factor analyses were performed to examine the underlying factor structure of the CHLSalt-22. One month later, 37 patients who participated in the first test were recruited to evaluate the test-retest reliability. Results The CHLSalt-22 demonstrated adequate internal consistency, good test-retest reliability, satisfactory construct validity, convergent validity and discriminant validity. The CHLSalt-22 count scores were correlated with age, sex, body mass index (BMI), education level, income, occupation, the Measuring Change in Restriction of Salt (sodium) in Diet in Hypertensives (MCRSDH-SUST), the Brief Illness Perception Questionnaire (BIPQ), and the Benefit-Finding Scales (BFS). Conclusion The results indicate that the Chinese Health Literacy Scale For Low Salt Consumption (CHLSalt-22) version has good reliability and validity and can be considered a tool to assess health literacy related to salt consumption in health screenings.
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