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Pasay-An E, Saguban R, Cabansag D, Alkubati S. Health literacy as mediator between perception of illness and self-medication behaviour among outpatients in the Kingdom of Saudi Arabia: implication to primary healthcare nursing. BMC Nurs 2024; 23:278. [PMID: 38664742 PMCID: PMC11046901 DOI: 10.1186/s12912-024-01950-9] [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: 05/30/2023] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Perception of illness (PI) and self-medication (SM) have been thoroughly explored in the existing literature. However, there is a lack of understanding about the mediating effect of health literacy on PI and SM in a non-homogenous population like Saudi Arabia. As such, primary healthcare nurses who have constant interaction with the outpatients have difficulty addressing self-medication. This study aimed to investigate health literacy as mediator between PI and SM among outpatients in the Kingdom of Saudi Arabia (KSA). METHODS This study employed a cross-sectional approach and was conducted at 10 major primary healthcare (PHC) clinics serving 30 million individuals in 13 different regions of KSA. The 424 outpatients who participated in this study were selected through convenience sampling. Data collection started in November 2022 and concluded in February 2023. RESULTS The mean of the Brief Health Literacy Screening Tool, self-medication scale (SMS), and PI scores were 13.01 ± 3.32, 27.46 ± 7.01, and 45.56 ± 7.69, respectively. There was a significant relationship between the age and BRIEF scores (p = 0.039), and the level of education was significantly related to all variables, as were nationality and BRIEF scores (p = 0.001). Finally, occupation was significantly related to BRIEF and SMS scores (p = 0.001 and 0.003, respectively). Completing college and being non-Saudi had positively significant effects on health literacy (p < 0.01). The structural equation model (SEM) found no effect of PI on health literacy or SM behaviour (p = 0.263 and 0.84, respectively), but health literacy did have an effect on SM behaviour (p<0.001). CONCLUSION Health literacy is an important factor in self-medication behavior and that PI is not directly related to health literacy or self-medication behavior, but that health literacy does influence self-medication behavior. Therefore, primary healthcare givers should promote public health literacy alongside the control of other conditions as one of the most effective ways to decrease the prevalence of self-medication and the risks associated with it.
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Affiliation(s)
- Eddieson Pasay-An
- Maternal and Child Nursing Department, College of Nursing, University of Hail, Hail City, Hail, Saudi Arabia.
| | - Reynita Saguban
- Department of Mental Health Nursing, AJA campus, College of Nursing, University of Hail, Hail City, Saudi Arabia
| | - Dolores Cabansag
- Medical-Surgical Nursing Department, College of Nursing, University of Hail, Hail City, Saudi Arabia
| | - Sameer Alkubati
- Medical-Surgical Nursing Department, College of Nursing, University of Hail, Hail City, Saudi Arabia
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Hogan A, Hughes L, Coyne E. Nurses' assessment of health literacy requirements for adult inpatients: An integrative review. Health Promot J Austr 2024; 35:504-517. [PMID: 37443427 DOI: 10.1002/hpja.780] [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: 12/24/2022] [Revised: 05/16/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
ISSUE ADDRESSED This paper reviews current research which examines nurses' assessment of patient's health literacy in the acute hospital setting. Research highlights, that patients with low health literacy have more frequent hospitalisations and are more likely to be re-admitted. Within the healthcare team, nurses are primarily responsible for teaching patients and deciphering health communication, to enhance understanding. Within the acute care setting, there remains a disparity in patient understanding of information, despite nurse-led education. The health literacy assessment and tailoring of information by nurses, is becoming more important with shorter stays, plus limited family visits and the wearing of masks with COVID-19 related changes. METHODS An integrative review across four nursing databases, from 2010 and June 2022 was conducted. The integrative framework included problem identification, literature search, data evaluation, data analysis with thematic analysis, and results presentation. RESULTS Nine studies were included. Common themes were nurses' overestimation of patients' health literacy, the use of universal precautions, and adapting communication techniques to improve education moments. CONCLUSION The findings of this review indicate a tendency among nurses to overestimate their patients' health literacy levels, which can result in ineffective health education and inadequate discharge planning. SO WHAT Nurses decipher health communication for their patients. Designing tailored patient communication and education could potentially be a cost saving measure for hospitals by reducing length of stay and reducing readmissions. Health literacy training should be incorporated into nursing practice.
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Affiliation(s)
- Alana Hogan
- School of Nursing and Midwifery, Griffith University, Nathan, Australia
- Caboolture Hospital, Caboolture, Queensland, Australia
| | - Lynda Hughes
- School of Nursing and Midwifery, Griffith University, Nathan, Australia
| | - Elisabeth Coyne
- School of Nursing and Midwifery, Griffith University, Nathan, Australia
- School of Nursing and Midwifery, University of Southern Denmark, Odense, Denmark
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Dijkman EM, ter Brake WWM, Drossaert CHC, Doggen CJM. Assessment Tools for Measuring Health Literacy and Digital Health Literacy in a Hospital Setting: A Scoping Review. Healthcare (Basel) 2023; 12:11. [PMID: 38200917 PMCID: PMC10778720 DOI: 10.3390/healthcare12010011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
Assessment of (digital) health literacy in the hospital can raise staff awareness and facilitate tailored communication, leading to improved health outcomes. Assessment tools should ideally address multiple domains of health literacy, fit to the complex hospital context and have a short administration time, to enable routine assessment. This review aims to create an overview of tools for measuring (digital) health literacy in hospitals. A search in Scopus, PubMed, WoS and CINAHL, following PRISMA guidelines, generated 7252 hits; 251 studies were included in which 44 assessment tools were used. Most tools (57%) were self-reported and 27% reported an administration time of <5 min. Almost all tools addressed the domain 'understanding' (98%), followed by 'access' (52%), 'apply' (50%), 'appraise' (32%), 'numeracy' (18%), and 'digital' (18%). Only four tools were frequently used: the Newest Vital Sign (NVS), the Short Test of Functional Health Literacy for Adults ((S)TOFHLA), the Brief Health Literacy Screener (BHLS), and the Health Literacy Questionnaire (HLQ). While the NVS and BHLS have a low administration time, they cover only two domains. HLQ covers the most domains: access, understanding, appraise, and apply. None of these four most frequently used tools measured digital skills. This review can guide health professionals in choosing an instrument that is feasible in their daily practice, and measures the required domains.
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Affiliation(s)
- Eline M. Dijkman
- Department of Health Technology and Services Research (HTSR), Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (E.M.D.)
- Department of Surgery, Isala Hospital, 8025 AB Zwolle, The Netherlands
| | - Wouter W. M. ter Brake
- Department of Health Technology and Services Research (HTSR), Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (E.M.D.)
| | | | - Carine J. M. Doggen
- Department of Health Technology and Services Research (HTSR), Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (E.M.D.)
- Clinical Research Center, Rijnstate Hospital, 6815 AD Arnhem, The Netherlands
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Dolezel D, Hewitt B. Social determinants of health literacy: a cross-sectional exploratory study. Health Promot Int 2023; 38:daad127. [PMID: 37804515 DOI: 10.1093/heapro/daad127] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/09/2023] Open
Abstract
Despite the importance of health literacy to health-promoting behaviors, few studies have assessed the social determinants of health literacy in a random sample of individuals from the USA. The study evaluated the association of sociodemographic factors with individual health literacy levels. This cross-sectional web-based observational study utilized the Health Literacy Questionnaire (HLQ), a multidimensional instrument measuring nine areas of literacy. Multivariate regression results revealed several factors associated with HLQ scores such as self-rated health rating, frequency of visits to healthcare providers, smoking, gender and rural versus urban residence. Low health literacy was associated with lower self-rated overall health and with less frequent visits to healthcare providers. Males scored higher on engaging with health providers, navigating, understanding the health system and understanding health information well enough to know what to do. These findings can guide healthcare professionals to focus on individuals from groups having lower health literacy scores to promote healthy behaviors.
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Affiliation(s)
- Diane Dolezel
- Department of Health Information Management, Texas State University, 100 Bobcat Way, Nursing Bldg., Room 238, Round Rock, TX 78665, USA
| | - Barbara Hewitt
- Department of Health Information Management, Texas State University, 100 Bobcat Way, Nursing Bldg., Room 238, Round Rock, TX 78665, USA
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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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A cross-sectional health literacy profile of Australian regional adults using the Health Literacy Questionnaire©. Aust N Z J Public Health 2023; 47:100009. [PMID: 36640631 DOI: 10.1016/j.anzjph.2022.100009] [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: 12/01/2021] [Revised: 07/01/2022] [Accepted: 08/01/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Health literacy is the resources and abilities required to make and enact health decisions. This study aimed to describe the health literacy of a diverse cross-section of adults in regional Victoria. METHODS Participants were recruited from two primary care clinics differing in socioeconomic scope and through non-clinical recruitment via the town's largest football club. Health Literacy Questionnaire© measured nine distinct scales, and comprehensive demographic data were also collected. Effect-sizes and regression were used for health literacy comparison between groups. RESULTS In this sample of 351 adults, health literacy strengths were observed in Scale 1: 'Feeling understood and supported by healthcare providers' (mean 3.29/4 ±0.5) and Scale 9: 'Understanding health information well enough to know what to do' (mean 4.10/5 ±0.6). Challenging areas were Scale 5: 'Appraising health information' (mean 2.88/4 ±0.5) and Scale 7: 'Navigating the healthcare system' (mean 3.84/5 ±0.6). After adjustment, living alone predicted lower scores across most scales. CONCLUSIONS This study showed greater health literacy barriers experienced by certain groups, particularly those who live alone and those who weren't clinically recruited. IMPLICATIONS FOR PUBLIC HEALTH These findings have implications for further research into addressing health literacy barriers in marginalised individuals and non-clinical settings. Results from this study may inform interventions which address identified barriers.
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Cristofori E, Zeffiro V, Alvaro R, D’Agostino F, Zega M, Cocchieri A. Health Literacy in Patients’ Clinical Records of Hospital Settings: A Systematic Review. SAGE Open Nurs 2022; 8:23779608221078555. [PMID: 35284632 PMCID: PMC8905211 DOI: 10.1177/23779608221078555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/30/2021] [Accepted: 01/17/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Health literacy (HL) can be defined as the individual's ability to understand and process health information. A low level of HL can be viewed as a stronger predictor of a person's health status than age, education level, and race. Although HL is an important determinant of health, it is often underestimated. This systematic review investigates the evidence on HL assessment in hospital settings. Methods PubMed Medline, CINAHL, Scopus, Web of Science and Educational Resources Information Centre databases were searched, with the date last searched being 16 March 2020. The PRISMA guidelines were applied, and the protocol of the study was registered with PROSPERO (CRD42021236029). The quality of the included studies was appraised using the STrengthening the Reporting of OBservational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies. Results Five studies reported HL assessments in hospital patients’ clinical records. Four main strategies were used to implement HL routine assessment in hospitals: multidisciplinary teams, stakeholders, training, and monitoring. Different performance measures were used to monitor the feasibility of incorporating HL assessment into electronic health records (EHRs). Conclusion This review examined how inpatients’ HL is recorded in hospital settings. HL is poorly measured in a hospital setting. These results guide hospital leadership in involving nurses in HL assessment implementation in hospitals and support nurses in creating a specific performance measure dashboard to monitor effective HL assessments in hospitals.
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Affiliation(s)
- Elena Cristofori
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Valentina Zeffiro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Fabio D’Agostino
- UniCamillus, Saint Camillus International University of Health Sciences, Via di Sant'Alessandro 8, 00131 Rome, Italy
| | - Maurizio Zega
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Antonello Cocchieri
- Section of Hygiene, Woman and Child Health and Public health, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
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Gurmu Dugasa Y. Level of Patient Health Literacy and Associated Factors Among Adult Admitted Patients at Public Hospitals of West Shoa Oromia, Ethiopia. Patient Prefer Adherence 2022; 16:853-859. [PMID: 35387256 PMCID: PMC8977217 DOI: 10.2147/ppa.s357741] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/23/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Health literacy is a capacity of individual to gain knowledge that helps to use health information in different levels as needed for self-management and to communicate with health providers. Health literacy has a significant impact on patient health outcomes. The aim of this study was to assess level of patient health literacy and associated factors among adult admitted patients at public hospitals of West Shoa zone, Oromia, Ethiopia. METHODS A cross-sectional, quantitative study was carried out among adult admitted patients at public hospitals of West Shoa Oromia, Ethiopia. An interviewer-administered Health Literacy Questionnaire (HLQ) instrument tool was used to assess patients' health literacy. All statistical analysis were performed using SPSS for windows program version 21. RESULTS A total of 403 patients participated in this study. Majority of the participants were males 235 (58.3%) and aged 40-59 years (n = 164, 40.7%). Overall, 59.1% (n = 238) of the participants have high health literacy. Those respondents who are above grade 12 (tertiary) were 2.45 times more likely to have high health literacy (AOR = 2.45, 95% CI: 1.21, 4.98) compared to those respondents not able to read and write . Participants who had age greater or equal to sixty were 65% less likely to have high health literacy (AOR: 0.35, 95% CI: 0.18, 0.70). CONCLUSION AND RECOMMENDATION Forty percent of the participants have low health literacy. Age and education are significant factors in health literacy. Ethiopian ministry of health, Oromia regional health bureau, West shoa zonal office and healthcare professionals have to provide an intervention in enhancing the level of health literacy by mass media and written material.
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Affiliation(s)
- Yonas Gurmu Dugasa
- Department of Nursing, College of Medicine & Health Sciences, Ambo University, Ambo, Ethiopia
- Correspondence: Yonas Gurmu Dugasa, Department of Nursing, College of Medicine & Health Sciences, Ambo University, P. O. Box: 19, Ambo, Ethiopia, Email
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Bakker MM, Putrik P, Rademakers J, van de Laar M, Vonkeman H, Kok MR, Voorneveld-Nieuwenhuis H, Ramiro S, de Wit M, Buchbinder R, Batterham R, Osborne RH, Boonen A. Addressing Health Literacy Needs in Rheumatology: Which Patient Health Literacy Profiles Need the Attention of Health Professionals? Arthritis Care Res (Hoboken) 2021; 73:100-109. [PMID: 33026713 PMCID: PMC7839720 DOI: 10.1002/acr.24480] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 10/01/2020] [Indexed: 12/16/2022]
Abstract
Objective To identify and describe health literacy profiles of patients with rheumatic diseases and explore whether the identified health literacy profiles can be generalized to a broader rheumatology context. Methods Patients with rheumatoid arthritis, spondyloarthritis, and gout from 3 hospitals in different regions in The Netherlands completed the Health Literacy Questionnaire (HLQ). Hierarchical cluster analysis was used to identify patients’ health literacy profiles based on 9 HLQ domains. A multinomial regression model with the identified health literacy profiles as the dependent variable was fitted to assess whether patients with a given disease type or attending a given hospital were more likely to belong to a specific profile. Results Among 895 participating patients, the lowest mean HLQ domain scores (indicating most difficulty) were found for “critical appraisal,” “navigating the health system,” and “finding good health information.” The 10 identified profiles revealed substantial diversity in combinations of strengths and weaknesses. While 42% of patients scored moderate to high on all 9 domains (profiles 1 and 3), another 42% of patients (profiles 2, 4, 5, and 6) clearly struggled with 1 or several aspects of health literacy. Notably, 16% (profiles 7–10) exhibited difficulty across a majority of health literacy domains. The probability of belonging to one of the profiles was independent of the hospital where the patient was treated or the type of rheumatic disease. Conclusion Ten distinct health literacy profiles were identified among patients with rheumatic diseases, independent of disease type and treating hospital. These profiles can be used to facilitate the development of health literacy interventions in rheumatology.
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Affiliation(s)
- Mark M Bakker
- Maastricht UMC+ and Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Polina Putrik
- Maastricht UMC+ and Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Jany Rademakers
- Nivel Netherlands Institute for Health Services Research, Utrecht, and Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Mart van de Laar
- Medisch Spectrum Twente, Arthritis Center Twente and University of Twente, Enschede, The Netherlands
| | - Harald Vonkeman
- Medisch Spectrum Twente, Arthritis Center Twente and University of Twente, Enschede, The Netherlands
| | - Marc R Kok
- Maasstad Hospital, Rotterdam, The Netherlands
| | | | - Sofia Ramiro
- Leiden University Medical Center, Leiden, and Zuyderland Medical Center, Heerlen, The Netherlands
| | - Maarten de Wit
- Tools2use patient association, Amsterdam, The Netherlands
| | | | - Roy Batterham
- Swinburne University of Technology, Centre for Global Health and Equity, Melbourne, Victoria, Australia, and Thammasat University, Bangkok, Thailand
| | - Richard H Osborne
- Swinburne University of Technology, Centre for Global Health and Equity, Melbourne, Victoria, Australia
| | - Annelies Boonen
- Maastricht UMC+ and Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Hobbs K, Muscat DM, Ceprnja D, Gibson JA, Blumenthal C, Milad R, Burns C, Dennis S, Lau T, Flood V. Assessing health literacy among adult outpatients attending allied health clinics in western sydney: A cross-sectional survey using a multidimensional instrument. Health Promot J Austr 2021; 33:83-90. [PMID: 33428797 DOI: 10.1002/hpja.456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 01/06/2021] [Indexed: 11/08/2022] Open
Abstract
ISSUE ADDRESSED Low health literacy disproportionately affects adults from culturally and linguistically diverse backgrounds. This study investigated the health literacy of adults attending outpatient allied health services in western Sydney, a highly diverse region in Sydney with residents from a range of cultural and linguistic backgrounds. METHODS A cross-sectional survey was undertaken between March and April 2017 using the Health Literacy Questionnaire (HLQ). Participants, aged over 18 years and with a primary language of English, Arabic, Chinese or Hindi, were recruited from outpatient allied health clinics at Westmead Hospital. Means (standard deviation) for each of the nine HLQ domains were calculated and associations with demographic variables were investigated using analysis of variance (ANOVA). RESULTS Two hundred and thirty people were included with mean age of 45.1 years (SD = 19.0), the majority were female (75.5%), over half were born overseas (55.7%) and 77.6% reported speaking English at home. The highest mean score on a HLQ domain (out of 5) was "Understanding health information well enough to know what to do" (M = 4.19; SD = 0.67), and the lowest mean score (out of 4) was "Appraisal of health information" (M = 2.97; SD = 0.54). Participants who did not speak English at home had significantly lower scores on seven of the nine HLQ domains. CONCLUSIONS Important health literacy strengths and limitations of a diverse sample of adults attending outpatient allied health services in western Sydney were identified. Findings should be considered in the light of the cross-sectional survey methodology with non-random sampling. SO WHAT Data will inform future interventions to improve health literacy and health outcomes among vulnerable population groups in western Sydney.
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Affiliation(s)
- Kim Hobbs
- Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Danielle Marie Muscat
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Dragana Ceprnja
- Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Jodi-Anne Gibson
- Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Caron Blumenthal
- Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Rula Milad
- Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Chris Burns
- Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Sarah Dennis
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,South West Sydney Local Health District, Sydney, Australia
| | - Timothea Lau
- Westmead Hospital, Western Sydney Local Health District, Sydney, Australia.,Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Victoria Flood
- Westmead Hospital, Western Sydney Local Health District, Sydney, Australia.,Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Vu M, Carvalho N, Clarke PM, Buchbinder R, Tran-Duy A. Impact of Comorbid Conditions on Healthcare Expenditure and Work-related Outcomes in Patients With Rheumatoid Arthritis. J Rheumatol 2020; 48:1221-1229. [PMID: 33323533 DOI: 10.3899/jrheum.200231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the effect of comorbid conditions on direct healthcare expenditure and work-related outcomes in patients with rheumatoid arthritis (RA). METHODS This is a retrospective analysis of the Medical Expenditure Panel Survey from 2006 to 2015 in 4967 adults with RA in the United States. Generalized linear models were used for healthcare expenditure and income, logistic models for employment status, and zero-inflated negative binomial models for absenteeism. Thirteen comorbid conditions were included as potential predictors of direct cost- and work-related outcomes. The models were adjusted for sociodemographic factors including sex, age, region, marital status, race/ethnicity, income, education, and smoking status. RESULTS Patients with RA with heart failure (HF) had the highest incremental annual healthcare expenditure (US$8205, 95% CI $3683-$12,726) compared to those without the condition. Many comorbid conditions including hypertension (HTN), diabetes, depression, chronic obstructive pulmonary disease, cancer, stroke, and HF reduced the chance of patients with RA aged between 18-64 years being employed. Absenteeism of employed patients with RA was significantly affected by HTN, depression, disorders of the eye and adnexa, or stroke. On average, RA patients with HF earned US$15,833 (95% CI $4435-$27,231) per year less than RA patients without HF. CONCLUSION Comorbid conditions in patients with RA were associated with higher annual healthcare expenditure, lower likelihood of employment, higher rates of absenteeism, and lower income. Despite its low prevalence, HF was associated with the highest incremental healthcare expenditure and the lowest likelihood of being employed compared to other common comorbid conditions.
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Affiliation(s)
- Martin Vu
- M. Vu, MPH, N. Carvalho, PhD, A. Tran-Duy, PhD, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Natalie Carvalho
- M. Vu, MPH, N. Carvalho, PhD, A. Tran-Duy, PhD, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Philip M Clarke
- P.M. Clarke, PhD, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia, and Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rachelle Buchbinder
- R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute, and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - An Tran-Duy
- M. Vu, MPH, N. Carvalho, PhD, A. Tran-Duy, PhD, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia;
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12
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González-De Paz L, Gálvez-Henández P, Navarro-Rubio MD. Development and psychometric study of a simple instrument to assess patient communication and comprehension skills: the AsCkS. Fam Pract 2020; 37:568-573. [PMID: 31796958 DOI: 10.1093/fampra/cmz087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Instruments to examine patients' communication skills are impractical for daily clinical practice in primary health care, and it is assumed that health care professionals are always aware of the communication and comprehension status of patients. OBJECTIVE To design and examine the psychometric properties of a new questionnaire (AsCkS) to screen patients' risk of low communication and comprehension skills. METHODS Designing the new questionnaire involved: (i) a content validity study to generate a set of items, (ii) administration of a questionnaire in a sample of patients and (iii) study of the psychometric properties using a Rasch probabilistic model. The test probability function was used to detect patients at risk of having low communication and comprehension skills, and the associated factors were studied using multivariate logistic regression. RESULTS Five items were generated and 369 patients screened. In the Rasch analysis, one item was removed due to a lack of goodness-of-fit (Outfit = 3.64). The final set of four items showed good reliability (person separation index = 0.90). Convergent validity was moderate for the health literacy construct (r = 0.53) and low for the patient activation (r = 0.38): 77 patients (20.86%) were at risk of having low communication and comprehension skills. After adjustment, the associated factors were age (p < 0.001) and lower educational level (p < 0.001). CONCLUSION The AsCkS is a reliable and valid instrument and may be used to detect patients requiring a greater effort by the physician to communicate health care messages.
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Affiliation(s)
- Luis González-De Paz
- Transverse Group for Research in Primary Care, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,Les Corts Primary Healthcare Center, Consorci d'Atenció Primària de Salut Barcelona Esquerra, Barcelona, Spain.,University Institute for Patient Care, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Pablo Gálvez-Henández
- University Institute for Patient Care, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
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13
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Wahl AK, Hermansen Å, Osborne RH, Larsen MH. A validation study of the Norwegian version of the Health Literacy Questionnaire: A robust nine-dimension factor model. Scand J Public Health 2020; 49:471-478. [PMID: 32508258 PMCID: PMC8135233 DOI: 10.1177/1403494820926428] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objective: This study aimed to undertake a rigorous psychometric evaluation of the nine-scale Norwegian version of the Health Literacy Questionnaire (HLQ) based on data from a sample of people with psoriasis. Methods: Cross-sectional survey data were collected from 825 adults with psoriasis who previously participated in the Norwegian Climate Heliotherapy programme. To investigate the factorial validity of the Norwegian HLQ, confirmatory factor analyses were carried out using Stata. Results: A highly restricted model fit with no cross-loadings or correlated residuals was acceptable for three of the nine scales (‘Feeling understood and supported by health-care providers’, ‘Appraisal of health information’ and ‘Ability to find good health information’). After minor model adjustments of the other scales, one-factor models were acceptable. All scales showed acceptable internal consistency, with Cronbach’s alpha ranging from 0.71 to 0.87. Except for three items, all items had high to acceptable factor loadings. Conclusions: This study of the Norwegian HLQ replicates the original factor structure of the Australian HLQ, indicating the questionnaire has cogent and independent scales with good reliability. Researchers, programme implementers and policymakers could use the Norwegian version of the HLQ with confidence to generate reliable information on health literacy for different purposes.
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Affiliation(s)
- Astrid K. Wahl
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Norway
- Astrid K. Wahl, Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, PB 1089 Blindern, 0317 Oslo, Norway. E-mail:
| | - Åsmund Hermansen
- Department of Social Work, Child Welfare and Social Policy, Faculty of Social Sciences, Oslo Metropolitan University, Norway
| | - Richard H. Osborne
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Australia
| | - Marie Hamilton Larsen
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Norway
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14
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Griva K, Yoong RKL, Nandakumar M, Rajeswari M, Khoo EYH, Lee VYW, Kang AWC, Osborne RH, Brini S, Newman SP. Associations between health literacy and health care utilization and mortality in patients with coexisting diabetes and end‐stage renal disease: A prospective cohort study. Br J Health Psychol 2020; 25:405-427. [DOI: 10.1111/bjhp.12413] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/09/2020] [Indexed: 01/20/2023]
Affiliation(s)
- Konstadina Griva
- Centre for Population Health Sciences Lee Kong Chian School of Medicine Imperial College and Nanyang Technological University Singapore City Singapore
| | | | | | | | - Eric Y. H. Khoo
- Department of Medicine Yong Loo Lin School of Medicine National University Singapore Singapore
- Division of Endocrinology University Medicine Cluster National University Health System Singapore City Singapore
| | | | | | - Richard H. Osborne
- Centre for Global Health and Equity Faculty of Health, Arts and Design Swinburne University of Technology Melbourne Australia
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15
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Degan TJ, Kelly PJ, Robinson LD, Deane FP, Wolstencroft K, Turut S, Meldrum R. Health literacy in people living with mental illness: A latent profile analysis. Psychiatry Res 2019; 280:112499. [PMID: 31398576 DOI: 10.1016/j.psychres.2019.112499] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
Abstract
Health literacy comprises cognitive and social skills that enable people to understand health information and maintain good health. Research examining the health literacy of people living with mental illness is scarce. The aim of the present study was to identify distinct subgroups of health literacy in individuals attending mental health treatment and determine if profiles and health literacy levels differ from other populations accessing healthcare services and on health characteristics. Participants (N = 325) were attending Neami National Australia services. Participants completed the multidimensional Health Literacy Questionnaire. Latent profile analysis was conducted to identify health literacy profiles. Participants reported lowest health literacy scores in appraising health information, navigating the healthcare system, and finding good health information. Three health literacy profiles were identified; low (20.4%), moderate (61.3%), and high (18.3%). Compared to the other populations (i.e. private hospital patients, men with prostate cancer, older individuals with diabetes, general population, people attending substance dependence treatment), the current sample tended to have lower health literacy scores. The findings highlight the need to increase overall health literacy and consider an individualised approach to enhance specific health literacy domains.
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Affiliation(s)
- Tayla J Degan
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia.
| | - Peter J Kelly
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia
| | - Laura D Robinson
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia
| | - Frank P Deane
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia
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16
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Jessup RL, Osborne RH, Beauchamp A, Bourne A, Buchbinder R. Differences in health literacy profiles of patients admitted to a public and a private hospital in Melbourne, Australia. BMC Health Serv Res 2018; 18:134. [PMID: 29471836 PMCID: PMC5824469 DOI: 10.1186/s12913-018-2921-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 02/06/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Health literacy refers to an individual's ability to find, understand and use health information in order to promote and maintain health. An individual's health literacy may also be influenced by the way health care organisations deliver care. The aim of this study was to investigate the influence of hospital service type (public versus private) on individual health literacy. METHODS Two cross-sectional surveys were conducted using the Health Literacy Questionnaire (HLQ), a multi-dimensional self-report instrument covering nine health literacy domains. Recently discharged private patients (n = 3121) were sent the survey in English, public patients (n = 384) were sent the survey in English, Arabic, Chinese, Vietnamese, Italian or Greek. Eligibility included hospitalisation ≥24 h in last 30 days, aged ≥18 years, no cognitive impairment. Odds ratios were used to assess differences between hospital sociodemographic and health related variables. ANOVA and Cohen's effect sizes compared HLQ scores between hospitals. Chi square and multiple logistic regression were used to determine whether differences between private and public hospital HLQ scores was independent of hospital population sociodemographic differences. ANOVA was used to review associations between HLQ scores and subgroups of demographic, health behaviour and health conditions and these were then compared across the two hospital populations. RESULTS Public hospital participants scored lower than private hospital participants on eight of the nine health literacy domains of the HLQ (scores for Active Appraisal did not differ between the two samples). Six domains, five of which in part measure the impact of how care is delivered on health literacy, remained lower among public hospital participants after controlling for age, education, language and income. Across both hospital populations, participants who were smokers, those who had low physical activity, those with depression and/or anxiety and those with 3 or more chronic conditions reported lower scores on some HLQ domains. CONCLUSIONS Our finding of lower health literacy among patients who had received care at a public hospital in comparison to a private hospital, even after adjustment for sociodemographic and language differences, suggests that private hospitals may possess organisational attributes (environment, structure, values, practices and/or workforce competencies) that result in improved health literacy responsiveness.
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Affiliation(s)
- Rebecca L. Jessup
- Health Systems Improvement Unit, Centre of Population Health Research, School of Health and Social Development, Deakin University, Geelong, Australia
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia
| | - Richard H. Osborne
- Health Systems Improvement Unit, Centre of Population Health Research, School of Health and Social Development, Deakin University, Geelong, Australia
| | - Alison Beauchamp
- Health Systems Improvement Unit, Centre of Population Health Research, School of Health and Social Development, Deakin University, Geelong, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Allison Bourne
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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