Communicative health literacy in patients with non-communicable diseases in Ethiopia: a cross-sectional study

Health literacy among patients with non-communicable diseases at a tertiary level hospital in Nepal- A cross sectional study

Health literacy (HL) is crucial in achieving the Sustainable Development Goal of reducing one-third of premature mortality by 2030 from Non-Communicable Diseases (NCDs) and improving Universal Health Coverage. Low health literacy is linked to poor health outcomes, and evidence shows that levels of limited HL are high, even among highly educated individuals. This study aims to assess HL levels and related factors among patients with NCDs at Tribhuvan University Teaching Hospital (TUTH) in Nepal. A cross-sectional survey was conducted at TUTH among 303 patients with NCDs with Cardiovascular Diseases, Chronic Obstructive Pulmonary Disease, Diabetes Mellitus, Hypertension, Epilepsy, Asthma and Cancer who came for follow-up from December 2022 to February 2023. Data was collected via face-to-face interviews by the trained enumerators using a structured Health Literacy Questionnaire (HLQ) containing 44 items (divided into nine domains). Multivariate logistic regression analysis was performed using SPSS version 26, with statistical significance at 0.05, to determine the associated factors of HL. The mean ±SD age of the respondents was 47.4±16.18 years. More than half of the respondents were female (56.1%). The patients had higher HL in all HL domains except 'Navigating the healthcare system'. Educational status was significantly associated with six out of nine HL domains. Co-morbidity, attendance at health-related seminars, regular physical activity, and social connectedness were associated with at least one of the domains of HL. This study identified the important factors of HL, such as socio-demographic and medical factors among patients with NCDs. This highlights the need for a comprehensive approach to address identified gaps in HL, considering its multifaceted and composite nature and promoting interventions to improve HL in high-risk populations.

Assessment Tools for Measuring Health Literacy and Digital Health Literacy in a Hospital Setting: A Scoping Review

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.

Health Literacy in Ethiopia: Evidence Synthesis and Implications

Background

Health literacy plays a pivotal role in healthcare utilization and health-related lifestyle choices. This makes health literacy a pressing concern, particularly in low-income countries like Ethiopia, where there are intricate health challenges. Despite its significance, there is a dearth of studies on the issue in Ethiopia. This study aimed to provide a comprehensive synthesis of the available evidence on health literacy in Ethiopia, and to discuss the implications for healthcare practice, health promotion, and research endeavors.

Methods

A systematic scoping review was conducted to achieve the purpose of this study. A comprehensive search of databases such as PubMed, CINAHL, AJOL, and PLOS Global Public Health was conducted for eligible evidence. Searches were conducted from May 12 to September 9, 2022. The PRISMA flow diagram guideline was utilized to ensure transparent reporting of the reviews process. The data extraction tool used was based on the JBI methodology guidance for reviews.

Results

The search in total yielded 543 records. However, only 16 studies met the eligibility criteria after a thorough screening process. All eligible studies were conducted in health facilities and schools with limited scopes. The main findings of the eligible studies focused on health literacy levels, health information sources, and health literacy determinants among the studies participants. Many of the studies reported low health literacy levels and multiple predicting factors ranging from personal to socioeconomic conditions among the respondents.

Conclusion

This review has provided critical insights into the state of health literacy in Ethiopia. There is a need for comprehensive research and the development of context-appropriate health literacy measurements tailored to the Ethiopian context, as well as evidence-based health literacy interventions. Prioritizing health literacy as a key research and intervention area is essential for improving the health of individuals and populations and achieving health-related Sustainable Development Goals in Ethiopia.

Integration Challenges and Opportunity of Implementing Non-Communicable Disease Screening Intervention with Tuberculosis Patient Care: A Mixed Implementation Study

Background

Despite the comorbidity, early detection and treatment of the two diseases are highly recommended; however, a few pilot studies were conducted, which are mainly focused on diabetes mellitus screening and the integration opportunity and challenges were not known. The study aimed to identify integrated implementation challenges and opportunities of non-communicable disease and risk factors screening intervention with tuberculosis patient care.

Methods

A mixed implementation study design was used. Data were collected from a sample of 443 tuberculosis patients, 21 key informants and facility observations. For quantitative data, descriptive statistics for proportion were summarized in tables and figures. Four distinct implementation frame was adapted for thematic analysis of audio recordings, daily verbatim transcription, and descriptive field notes.

Results

The prevalence of hypertension and diabetes mellitus among tuberculosis patients were 6.55% and 5.64%, respectively. Totally 9 subthemes and 21 new codes were developed, of which 13 and 8 new codes were developed for integrated implementation challenges and opportunities, respectively. The absence of medical equipment, skill and knowledge training, record and report system, cooperative integration, feedback, referral system, shortage of supporting agencies, and services not free were external challenges, whereas lack of trained health workers, focal persons, and increased workload and absence of awareness creation were internal challenges. Despite the challenges, the presence of health extension programs, non-governmental organizations, community health care insurance and associations for diabetes mellitus were external opportunities. Availability of assigned focal persons, trained stakeholders, guidelines, information systems and compatible tuberculosis program structure were internal opportunities.

Conclusion

The majority of TB patients were not comorbid with NCDs. We build a favourable system for integrated implementation developing an integration platform and structural authority at a different organization by addressing identified challenges and applying facilitators is crucial.

Predictors of Tuberculosis and Non-Communicable Disease Comorbidities Among Newly Enrolled Tuberculosis Patients, Southern Ethiopia

Introduction

Non-communicable diseases are comorbid with tuberculosis, however only a few record review based studies have been conducted, which are more concentrated on elevated glucose levels. This study aimed to assess non-communicable disease comorbidity and its predictors among tuberculosis patients.

Methods

A prospective cross-sectional study design was used and the data were collected by a previously validated tool from a sample of 443 tuberculosis patients using cluster random sampling methods. Multinomial logistic regression was interpreted by relative risk to predict the association of comorbidity status with independent variables.

Results

The majority (87.81%) of TB patients were not comorbid with NCDs. The prevalence of hypertension and diabetes mellitus among tuberculosis patients were 6.55%, and 5.64%, respectively. The people who had a risk score >8 were 6.47 times more likely to have tuberculosis comorbid with one non-communicable disease compared to those with a risk score ≤8. The relative risk of tuberculosis patients with BMI >25 is 3.33 times compared to those with a BMI <23 of being comorbid with one non-communicable disease vs tuberculosis patients without non-communicable diseases. Those tuberculosis patients with an awareness of non-communicable disease comorbidities are 9.33 times more likely to have tuberculosis with multi-comorbidities compared to those who are unaware.

Conclusion

The majority of TB patients were not comorbid with NCDs. The person's weight, family size of more than five, monthly income >3000 birr, risk score >8 and BMI >25 significantly predict comorbidity with one non-communicable disease compared to those without a comorbidity. The presence of non-communicable disease comorbidity, treatment awareness, and being aged 50+ years significantly predict the presence of multi-comorbidities compared to those without comorbidity. For early detection and management of both diseases, establishing bidirectional screening platforms in tuberculosis care programs is urgently required.

Health literacy and health information sources in relation to foodborne and waterborne diseases among adults in Gedeo zone, southern Ethiopia, 2022: A community-based cross-sectional study

Introduction

Foodborne and waterborne illnesses affect billions of people each year and impose a significant burden on public health globally. To reduce the prevalence of foodborne and waterborne illness in resource-constrained settings like Ethiopia, it is essential to recognize and address the factors that influence health literacy and the sources of health information. We explored health literacy and health information sources regarding foodborne and waterborne illnesses among adults in the Gedeo zone.

Methods

A community-based quantitative study was undertaken between March and April 2022 in the Gedeo zone in southern Ethiopia. A semi-structured, pretested, and interviewer-administered questionnaire was used to collect data from 1,175 study participants selected through a systematic sampling technique. Data were entered in Epidata version 4.6 and analyzed in STATA version 14.2. Data were analyzed using descriptive statistics and the Chi-square test, and multivariate logistic regression analysis was used to assess the associations between variables at a significance level of 0.05. Further, a structural equation model or path analysis was also used in the data analysis.

Result

1,107 (about 51% men) study participants were included in the analysis. About 25.5% of the participants had a foodborne or waterborne illness in the last six months before the survey. Family members and/or close friends were the most-used channel of health information (43.3%), and the internet or online sources were the least-used (14.5%). The result of path analysis shows that seeking health information, having adequate health literacy, and foodborne and waterborne literacy were significantly associated with lower incidences of foodborne or waterborne illness.

Conclusion

Our findings showed that individuals with a higher level of health literacy and foodborne and waterborne illness literacy had a lower incidence of foodborne and waterborne illness. Similarly, obtaining health information is positively associated with lowering the incidence of foodborne and waterborne illnesses. Importantly, our findings show mass media has the potential to reach a large audience when educating adults about foodborne and waterborne illnesses.

Level of Patient Health Literacy and Associated Factors Among Adult Admitted Patients at Public Hospitals of West Shoa Oromia, Ethiopia

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.

Integrating tuberculosis and noncommunicable diseases care in low- and middle-income countries (LMICs): A systematic review

BACKGROUND

Low- and middle-income countries (LMICs) are facing a combined affliction from both tuberculosis (TB) and noncommunicable diseases (NCDs), which threatens population health and further strains the already stressed health systems. Integrating services for TB and NCDs is advantageous in tackling this joint burden of diseases effectively. Therefore, this systematic review explores the mechanisms for service integration for TB and NCDs and elucidates the facilitators and barriers for implementing integrated service models in LMIC settings.

METHODS AND FINDINGS

A systematic search was conducted in the Cochrane Library, MEDLINE, Embase, PubMed, Bibliography of Asian Studies, and the Global Index Medicus from database inception to November 4, 2021. For our search strategy, the terms "tuberculosis" AND "NCDs" (and their synonyms) AND ("delivery of healthcare, integrated" OR a range of other terms representing integration) were used. Articles were included if they were descriptions or evaluations of a management or organisational change strategy made within LMICs, which aim to increase integration between TB and NCD management at the service delivery level. We performed a comparative analysis of key themes from these studies and organised the themes based on integration of service delivery options for TB and NCD services. Subsequently, these themes were used to reconfigure and update an existing framework for integration of TB and HIV services by Legido-Quigley and colleagues, which categorises the levels of integration according to types of services and location where services were offered. Additionally, we developed themes on the facilitators and barriers facing integrated service delivery models and mapped them to the World Health Organization's (WHO) health systems framework, which comprises the building blocks of service delivery, human resources, medical products, sustainable financing and social protection, information, and leadership and governance. A total of 22 articles published between 2011 and 2021 were used, out of which 13 were cross-sectional studies, 3 cohort studies, 1 case-control study, 1 prospective interventional study, and 4 were mixed methods studies. The studies were conducted in 15 LMICs in Asia, Africa, and the Americas. Our synthesised framework explicates the different levels of service integration of TB and NCD services. We categorised them into 3 levels with entry into the health system based on either TB or NCDs, with level 1 integration offering only testing services for either TB or NCDs, level 2 integration offering testing and referral services to linked care, and level 3 integration providing testing and treatment services at one location. Some facilitators of integrated service include improved accessibility to integrated services, motivated and engaged providers, and low to no cost for additional services for patients. A few barriers identified were poor public awareness of the diseases leading to poor uptake of services, lack of programmatic budget and resources, and additional stress on providers due to increased workload. The limitations include the dearth of data that explores the experiences of patients and providers and evaluates programme effectiveness.

CONCLUSIONS

Integration of TB and NCD services encourages the improvement of health service delivery across disease conditions and levels of care to address the combined burden of diseases in LMICs. This review not only offers recommendations for policy implementation and improvements for similar integrated programmes but also highlights the need for more high-quality TB-NCD research.