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Zakeri MA, Tavan A, Nadimi AE, Bazmandegan G, Zakeri M, Sedri N. Relationship Between Health Literacy, Quality of Life, and Treatment Adherence in Patients with Acute Coronary Syndrome. Health Lit Res Pract 2023; 7:e71-e79. [PMID: 37053051 PMCID: PMC10104679 DOI: 10.3928/24748307-20230320-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Acute coronary syndrome is a significant global health concern that can affect patients' health outcomes and quality of life. In addition, adherence to treatment and health literacy can affect health outcomes. OBJECTIVE This study aimed to investigate the relationship between treatment adherence, health literacy, and quality of life among patients with acute coronary syndrome. METHODS This cross-sectional study was conducted on 407 patients in Iran from April 2019 to November 2019. Patients were selected by convenience sampling method. Data were collected using demographic questionnaire, World Health Organization Quality of Life Brief Version, Adherence to Treatment Questionnaire, and Health Literacy for Iranian Adults questionnaire. SPSS 25 was used for statistical analysis. RESULTS Based on descriptive statistics in this study, most of the participants had good treatment adherence level (56.5%); 28.7% of the participants had insufficient health literacy level. The mean score of quality of life was 51.41 ± 12.03, which was greater than the midpoint of the questionnaire. Furthermore, Pearson's correlation coefficient showed a negative association between health literacy, treatment adherence (r = -0.167, p < .01), and quality of life (r = -0.153, p < .01), and a positive association between treatment adherence and quality of life (r = 0.169, p < .01). CONCLUSION The results of the current study showed a negative relationship between health literacy, quality of life, and treatment adherence among patients with acute coronary syndrome. [HLRP: Health Literacy Research and Practice. 2023;7(2):e71-e79.].
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Affiliation(s)
| | | | | | | | | | - Nadia Sedri
- Address correspondence to Nadia Sedri, MSc, Nursing Research Center, Kerman University of Medical Sciences, Hapht Bagh St. 7616913555, Kerman, Iran;
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Association between health literacy and medication adherence in chronic diseases: a recent systematic review. Int J Clin Pharm 2023; 45:38-51. [PMID: 36369411 DOI: 10.1007/s11096-022-01470-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Poor medication adherence is a serious barrier to successful chronic disease management. Previous reviews reported that low health literacy could be associated with medication non-adherence but conclusions were uncertain. AIM The aim of this systematic review was to clarify the relationship between health literacy and medication adherence in adults with chronic diseases. A secondary objective was to identify the factors that influence medication adherence. METHOD Publications analyzing the relationship between health literacy and adherence in adults with chronic diseases were identified through 6 databases between 2015 and 2020. A quality assessment was conducted in order to improve the interpretation of the relationship between health literacy and medication adherence. A narrative synthesis was then performed to describe the relationship between health literacy and medication adherence. The factors influencing medication adherence were then analyzed as a secondary outcome. RESULTS Among the 27 studies, 17 and 10 were considered to be of good and medium methodological quality, respectively. Concerning the relationship between health literacy and adherence, 14 reported a positive relationship, 1 study suggested a negative relationship, 3 found mixed results, and 9 reported not finding a relationship. Patient-related factors such as medication beliefs, self-efficacy, or medication knowledge, as well as demographic factors such as ethnic minority and incomes influence medication adherence. CONCLUSION The present review confirms an unclear relationship between health literacy and medication adherence. Although health literacy plays a substantial role in medication adherence, other factors must be taken into account when addressing non-adherence.
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3
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van der Gaag M, Heijmans M, Spoiala C, Rademakers J. The importance of health literacy for self-management: A scoping review of reviews. Chronic Illn 2022; 18:234-254. [PMID: 34402309 DOI: 10.1177/17423953211035472] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Self-management of chronic diseases is rather complex, especially for patients with limited health literacy. In this review, we aim to disentangle the specific difficulties patients with limited health literacy face in relation to self-management and their associated needs with respect to self-management support. METHODS We performed a literature search in five databases. We used a broad definition of health literacy and self-management was categorized into four types of activities: medical management, changing lifestyle, communicating and navigating through the health care system and coping. Included reviews described the relationship between health literacy and different domains of self-management and were published after 2010. RESULTS A total of 28 reviews were included. Some clear difficulties of patients with limited health literacy emerged, predominantly in the area of medical management (especially adherence), communication and knowledge. Other associations between health literacy and self-management were inconclusive. Barriers from the patients' perspective described mainly medical management and the communication and navigation of the health care system. DISCUSSION Patients with limited health literacy experience difficulties with specific domains of self-management. For a better understanding of the relationship between health literacy and self-management, a broader conceptualization of health literacy is warranted, including both cognitive and behavioural aspects.
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Affiliation(s)
| | - Monique Heijmans
- 8123Nivel, Netherlands Institute for Health Services Research, the Netherlands
| | - Cristina Spoiala
- 8123Nivel, Netherlands Institute for Health Services Research, the Netherlands
| | - Jany Rademakers
- 8123Nivel, Netherlands Institute for Health Services Research, the Netherlands.,Department of Family Medicine, 168092Maastricht University, CAPHRI Care and Public Health Research Institute, the Netherlands
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Schönfeld MS, Pfisterer-Heise S, Bergelt C. Self-reported health literacy and medication adherence in older adults: a systematic review. BMJ Open 2021; 11:e056307. [PMID: 34916329 PMCID: PMC8679075 DOI: 10.1136/bmjopen-2021-056307] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To give an overview over the associations between self-reported health literacy and medication adherence in older adults. DESIGN A systematic literature review of quantitative studies published in English and German. DATA SOURCES MEDLINE via PubMed, CINAHL, Cochrane Library, Epistemonikos and LIVIVO were searched. ELIGIBILITY CRITERIA Included studies had to examine the associations between self-reported health literacy and medication adherence in the elderly (samples including ≥66% of ≥60 years old) and had to use a quantitative methodology and had to be written in English or German. DATA EXTRACTION AND SYNTHESIS All studies were screened for inclusion criteria by two independent reviewers. A narrative synthesis was applied to analyse all included studies thematically. Quality assessment was conducted using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. RESULTS We found 2313 studies, of which nine publications from eight studies were included in this review. Five studies reported a majority of participants with limited health literacy, one study reported a majority of participants with adequate health literacy, and three publications from two studies only reported mean levels of health literacy. Eight publications from seven studies used self-reports to measure medication adherence, while one study used the medication possession ratio. Overall, six publications from five studies reported significantly positive associations between health literacy and medication adherence while two studies reported positive but non-significant associations between both constructs and one study reported mixed results. CONCLUSION In this review, associations between self-reported health literacy and medication adherence are rather consistent, indicating positive associations between both constructs in older adults. However, concepts and measures of health literacy and medication adherence applied in the included studies still show a noteworthy amount of heterogeneity (eg, different use of cutoffs). These results reveal the need for more differentiated research in this area. PROSPERO REGISTRATION NUMBER CRD42019141028.
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Affiliation(s)
| | - Stefanie Pfisterer-Heise
- Department of Biochemistry and Molecular Cell Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Medical Psychology, University Medicine Greifswald, Greifswald, Germany
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5
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GÜR K, DANIŞ R, DERİNSU AC, TURAN A, AKSOY Z, TUNCEL A. Access to Health Services by the Parents of Individuals with Intellectual Disability according to their Health Literacy Levels. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.881581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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6
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Alexandre K, Campbell J, Bugnon M, Henry C, Schaub C, Serex M, Elmers J, Desrichard O, Peytremann-Bridevaux I. Factors influencing diabetes self-management in adults: an umbrella review of systematic reviews. JBI Evid Synth 2021; 19:1003-1118. [PMID: 33741836 DOI: 10.11124/jbies-20-00020] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The objective of this review was to identify and describe the factors influencing diabetes self-management in adults by summarizing the available evidence concerning their types, categories, and relative importance. INTRODUCTION A wide range of factors, acting simultaneously, influence diabetes self-management and interfere with its actual application by patients. There is a variety of systematic reviews of these factors; however, a more thorough examination of their influences was lacking. INCLUSION CRITERIA Systematic reviews of qualitative or quantitative literature focusing on factors influencing adult diabetes self-management in general or on individual behaviors (ie, management of oral antidiabetic medication and insulin injections, self-monitoring of blood glucose, foot care, healthy eating, regular exercise, and smoking cessation) will be included. METHODS We performed an extensive search of 11 bibliographic databases, including gray literature, up to June 2019. Quantitative and qualitative findings were summarized separately and labeled according to their types (eg, facilitator/barrier, strength and direction of association), categories (eg, demographic, social), and frequency of occurrence. RESULTS We identified 51 types of factors within 114 systematic reviews, which mostly addressed medication-taking behavior. Thirty-two (62.7%) factors were reported in both qualitative and quantitative literature. The predominant influences were psychological factors and behavioral attributes/skills factors. The most frequently reported facilitators of diabetes self-management were motivation to diabetes self-management, a favorable attitude to diabetes self-management, knowledge about the disease, medication and behaviors associated with diabetes self-management, skills, and self-efficacy/perceived behavioral control. The predominant barriers were the presence of depression, and polypharmacy or drug regimen complexity. The demographic factor of female sex was frequently reported for its negative influence on diabetes self-management, whereas older age was a positive factor. The social/cultural and physical environment were the least-studied categories. Other factors such as social support from family, friends, or networks; interventions led by health professionals; and a strong community environment with good social services favoring diabetes self-management were reported as major facilitators of diabetes self-management. CONCLUSIONS Essential components of interventions to promote effective diabetes self-management should aim to help adults manage the effects of specific factors related to their psychological and practical self-management experience. Screening for depression, in particular, should become an integral part of the support for adult diabetes self-management, as depression is a particular obstacle to the effectiveness of diabetes self-management. Future studies should more deeply examine the influence of factors identified in the sociocultural and physical environment categories. Research should properly consider and invest efforts in strengthening social support and innovative community care approaches, including pharmacist- and nurse-led care models for encouraging and improving adult diabetes self-management. Finally, researchers should examine non-modifiable factors - age, sex, or socioeconomic status - in the light of factors from other categories in order to deepen understanding of their real-world patterns of action on adult diabetes self-management. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42018084665.
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Affiliation(s)
- Ketia Alexandre
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Joan Campbell
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Marie Bugnon
- Faculté de Psychologie et des Sciences de l'Education, University of Geneva, Geneva, Switzerland
| | - Cristina Henry
- Association Vaudoise d'Aide et de Soins À Domicile (AVASAD), Lausanne, Switzerland
| | - Corinne Schaub
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Magali Serex
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Jolanda Elmers
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Olivier Desrichard
- Faculté de Psychologie et des Sciences de l'Education, University of Geneva, Geneva, Switzerland
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Yu Y, He A, Zheng S, Jiang J, Liang J, Shrestha B, Wang P. How does health literacy affect the utilization of basic public health services in Chinese migrants? Health Promot Int 2021; 37:6220388. [PMID: 33842961 DOI: 10.1093/heapro/daab040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Previous studies have focused on the determinants of basic public health services utilization, such as socioeconomic status and mobility characteristics, rather than on health literacy. Thus, this study aimed to estimate the effect of health literacy on the utilization of basic public health services among Chinese migrants. Based on the 2016 China Migrants Dynamic Survey data (N = 2335), this study used propensity score matching approach to estimate the effect of health literacy on the utilization of basic public health services, including the establishment of health records and receipt of health education, and to explore heterogeneity in this effect based on educational attainment and urban-rural status. The findings show that high levels of health literacy increased the probability of establishing health records and receiving more health education. Also, high levels of health literacy had a positive effect on the utilization of basic public health services among Chinese migrants, especially those with less education or living in urban areas. Policy makers should more carefully consider the actual situation and needs of migrants who are living in urban areas or have less education, constructing more targeted service programs.
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Affiliation(s)
- Yan Yu
- Department of Social Medicine and Health Management, School of Health Sciences, Wuhan University, No.115 Donghu Road, Wuhan City 430071, China
| | - Anqi He
- Department of Social Medicine and Health Management, School of Health Sciences, Wuhan University, No.115 Donghu Road, Wuhan City 430071, China
| | - Si Zheng
- Department of Social Medicine and Health Management, School of Health Sciences, Wuhan University, No.115 Donghu Road, Wuhan City 430071, China
| | - Junfeng Jiang
- Department of Social Medicine and Health Management, School of Health Sciences, Wuhan University, No.115 Donghu Road, Wuhan City 430071, China
| | - Jing Liang
- Department of Social Medicine and Health Management, School of Health Sciences, Wuhan University, No.115 Donghu Road, Wuhan City 430071, China
| | - Bhawana Shrestha
- Department of Social Medicine and Health Management, School of Health Sciences, Wuhan University, No.115 Donghu Road, Wuhan City 430071, China
| | - Peigang Wang
- Department of Social Medicine and Health Management, School of Health Sciences, Wuhan University, No.115 Donghu Road, Wuhan City 430071, China
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8
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Savitz ST, Bailey SC, Dusetzina SB, Jones WS, Trogdon JG, Stearns SC. Treatment selection and medication adherence for stable angina: The role of area-based health literacy. J Eval Clin Pract 2020; 26:1711-1721. [PMID: 31994280 PMCID: PMC7552995 DOI: 10.1111/jep.13341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/28/2019] [Accepted: 11/29/2019] [Indexed: 01/09/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Clinical studies show equivalent health outcomes from interventional procedures and treatment with medication only for stable angina patients. However, patients may be subject to overuse or access barriers for interventional procedures and may exhibit suboptimal adherence to medications. Our objective is to evaluate whether community-level health literacy is associated with treatment selection and medication adherence patterns. METHOD The sample included Medicare fee-for-service beneficiaries (20% random sample) with stable angina in 2007-2013. We used an area-level health literacy variable because of the lack of an individual measure in claims. We measured the association between (a) area-based health literacy with treatment selection (medication only, percutaneous coronary intervention [PCI], or coronary artery bypass grafting (CABG) surgery) and (b) area-based health literacy with medication adherence. We controlled for other factors including demographics, co-morbidity burden, dual eligibility, and area deprivation index. RESULTS We identified 8300 patients of whom 8.7% lived in a low health literacy area. Overall, 56% of patients received medication only, 28% received PCI, and 15% received CABG. Patients in low health literacy areas were less likely to receive CABG (-3.5 percentage points; 95% CI, -6.8 to -0.3) than were patients in high health literacy areas, but the significance was sensitive to specification. Overall, 81.5% and 71.5% of patients were adherent to antianginals and statins, respectively. Living in low health literacy areas was associated with lower adherence to antianginals (-3.3 percentage points; 95% CI, -6.1 to -0.6) but not statins. CONCLUSIONS Low area-based health literacy was associated with being less likely to receive CABG and lower adherence, but the differences between low and high health literacy areas were small and sensitive to model specification. Individual factors such as dual eligibility status and race/ethnicity had stronger associations with outcomes than had area-based health literacy, suggesting that this area-based measure was inadequate to account for social determinants in this study.
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Affiliation(s)
- Samuel T. Savitz
- Department of Health Policy & Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill
- Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill
| | - Stacy Cooper Bailey
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University
| | | | - W. Schuyler Jones
- Department of Medicine, Duke Heart Center, Duke University Medical Center
| | - Justin G. Trogdon
- Department of Health Policy & Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill
| | - Sally C. Stearns
- Department of Health Policy & Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill
- Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill
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9
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Pithara C, Pufulete M, Johnson TW, Redwood S. Patient perspectives of nuisance bleeding and adherence to dual antiplatelet therapy: a qualitative study. Open Heart 2020; 7:openhrt-2020-001405. [PMID: 33060141 PMCID: PMC7566423 DOI: 10.1136/openhrt-2020-001405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To understand the experiences of patients with dual antiplatelet therapy (DAPT) and nuisance bleeding, and their perspectives of the impact of nuisance bleeding on medication adherence and information seeking. METHODS We conducted focus groups with patients who had undergone percutaneous coronary intervention, coronary artery bypass graft and conservatively managed acute coronary syndrome patients. Two focus groups were with patients at the early stages of treatment (0-3 months), and two with patients coming to the end of treatment (9-12 months). Group discussions were audio recorded, and recordings were transcribed verbatim, anonymised and analysed using framework analysis. FINDINGS Nine patients taking DAPT for up to 3 months, and 12 taking DAPT between 9 and 12 months participated in the focus groups. We found that: (1) participants adhered to treatment when they believed DAPT was important to health outcomes; (2) those who experienced nuisance bleeding reported symptoms to be mild and manageable; (3) participants' and their family's understanding of DAPT risks and benefits, and their ability to manage symptoms, influenced perspectives of and experiences with adherence. Factors influencing DAPT knowledge included access to medication counselling, engaging with information communicated during medication counselling, and access to timely, relevant and expert information and advice after discharge from hospital. CONCLUSIONS Positive attitudes towards adherence were facilitated by knowledge and understanding of DAPT and confidence in dealing with symptoms caused by DAPT, but hindered by lack of opportunities to access relevant, timely and appropriate medication counselling. Education interventions should aim to support medication literacy through family-centred approaches and involve patients and families at all stages of intervention design and evaluation.
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Affiliation(s)
- Christalla Pithara
- National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK .,Population Health Sciences, University of Bristol, Bristol, UK
| | - Maria Pufulete
- Bristol Trials Centre (Clinical Trials and Evaluation Unit), University of Bristol, Bristol, UK
| | | | - Sabi Redwood
- National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.,Population Health Sciences, University of Bristol, Bristol, UK
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10
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Conceptualization, Development and Psychometric Evaluations of a New Medication-Related Health Literacy Instrument: The Chinese Medication Literacy Measurement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17196951. [PMID: 32977520 PMCID: PMC7579017 DOI: 10.3390/ijerph17196951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/12/2020] [Accepted: 09/18/2020] [Indexed: 12/26/2022]
Abstract
There is a need for valid and reliable instruments to focus on medication aspects of health literacy and help healthcare professionals address patients’ barriers to medication use. This cross-sectional study describes the conceptualization, development, and psychometric properties of the first Chinese Medication Literacy Measurement (ChMLM) to assess the level of health literacy on medication use. The 17-item ChMLM (ChMLM-17) and its short form, 13-item ChMLM (ChMLM-13), consist of four sections (vocabulary, over-the-counter labels, prescription labels, and advertisements) to cover six domains of medication-related health literacy. Multistage stratified quota sampling was attempted to recruit a representative sample in Taiwan. Receiver operating characteristic curves were used to identify the cut-off point for differentiating high and low medication literacy. Psychometric analyses were performed (n = 1410) to assess the reliability and validity separately on all samples and sociodemographic subgroups. The 17- and 13-item versions both had high construct validity among all patients and patients with low medication literacy. The developed ChMLM-17 and ChMLM-13 is expected to help healthcare providers and researchers to accurately measure medication-related health literacy and improve medication use in the real-world practice.
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11
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Chima CC, Abdelaziz A, Asuzu C, Beech BM. Impact of Health Literacy on Medication Engagement Among Adults With Diabetes in the United States: A Systematic Review. DIABETES EDUCATOR 2020; 46:335-349. [PMID: 32780000 DOI: 10.1177/0145721720932837] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE The purpose of this systematic review is to assess evidence of a relationship between health literacy and medication engagement (formerly referred to as medication adherence) among adults with diabetes mellitus in the United States. METHODS Literature searches were conducted in PubMed, Ovid Medline, CINAHL, Embase, PsycInfo, and Scopus from the inception of each database to April 2020. Studies were included if they met all of the following criteria: (1) conducted in the United States, (2) the population of interest was adults ≥18 years with a diagnosis of type 1 or type 2 diabetes, (3) medication engagement was an outcome variable, (4) a direct and not a mediating relationship between health literacy and medication engagement was assessed, (5) a quantifiable measure of association was reported, and (6) a full-text journal article or dissertation was available. Quality of published evidence was graded according to Joanna Briggs Institute Critical Appraisal Checklists appropriate for the respective study designs identified. RESULTS Thirteen articles from 11 unique studies were retained in the review, most of which used a cross-sectional design. Four out of 11 studies found a direct positive association between health literacy and medication engagement. Two of the 4 studies with positive findings had significant methodological shortcomings. CONCLUSIONS There is some evidence that health literacy is associated with medication engagement among adults with diabetes in the United States. Properly designed and executed longitudinal studies are needed to better elucidate the relationship between health literacy and medication engagement among adults with diabetes.
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Affiliation(s)
- Charles C Chima
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, Mississippi
| | - Aya Abdelaziz
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, Mississippi
| | - Chisom Asuzu
- School of Graduate Studies, Rutgers University, New Brunswick, New Jersey
| | - Bettina M Beech
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, Mississippi
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12
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Walters R, Leslie SJ, Polson R, Cusack T, Gorely T. Establishing the efficacy of interventions to improve health literacy and health behaviours: a systematic review. BMC Public Health 2020; 20:1040. [PMID: 32605608 PMCID: PMC7329558 DOI: 10.1186/s12889-020-08991-0] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/27/2020] [Indexed: 12/29/2022] Open
Abstract
Background The primary aim of this review was to establish whether health literacy interventions, in adults, are effective for improving health literacy. Two secondary aims assessed the impact of health literacy interventions on health behaviours and whether health literacy interventions have been conducted in cardiovascular patients. Methods A systematic review (Prospero registration: CRD42018110772) with no start date running through until April 2020. Eligible studies were conducted in adults and included a pre/post measure of health literacy. Medline, Embase, Eric, PsychINFO, CINAHL, Psychology and Behavioural Science, HMIC, Web of Science, Scopus, Social Care Online, NHS Scotland Journals, Social Policy and Practice, and Global Health were searched. Two thousand one hundred twenty-seven papers were assessed, and 57 full text papers screened to give 22 unique datasets from 23 papers. Risk of bias was assessed regarding randomisation, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting and other biases. Intervention reporting quality was assessed using the TIDieR checklist. Results Twenty-two studies were included reporting on 10,997 participants in nine countries. The majority of studies (14/22) were published in 2018 or later. Eight studies (n = 1268 participants) also reported on behavioural outcomes. Health literacy interventions resulted in improvements in at least some aspect of health literacy in 15/22 studies (n = 10,180 participants) and improved behavioural outcomes in 7/8 studies (n = 1209 participants). Only two studies were conducted with cardiovascular patients. All studies were at risk of bias with 18 judged as high risk. In addition, there was poor reporting of intervention content with little explication of the theoretical basis for the interventions. Conclusions Health literacy interventions can improve health literacy and can also lead to changes in health behaviours. Health literacy interventions offer a way to improve outcomes for populations most at risk of health inequalities. Health literacy is a developing field with very few interventions using clear theoretical frameworks. Closer links between health literacy and behaviour change theories and frameworks could result in higher quality and more effective interventions. Prospero registration Prospero registration: CRD42018110772
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Affiliation(s)
- Ronie Walters
- Centre for Health Science, University of the Highlands and Islands, Old Perth Road, Inverness, IV2 3JH, UK.
| | - Stephen J Leslie
- Centre for Health Science, University of the Highlands and Islands, Old Perth Road, Inverness, IV2 3JH, UK.,NHS Highlands, Cardiology Department, Raigmore Hospital, Old Perth Road, Inverness, IV2 3JH, UK
| | - Rob Polson
- Centre for Health Science, University of the Highlands and Islands, Old Perth Road, Inverness, IV2 3JH, UK
| | - Tara Cusack
- University College Dublin, Health Sciences Building, Bellfield, Dublin, Ireland
| | - Trish Gorely
- Centre for Health Science, University of the Highlands and Islands, Old Perth Road, Inverness, IV2 3JH, UK
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Abstract
International Diabetes Federation estimates that there are more than a half-billion adults ages 20 to 79 years worldwide who have diabetes mellitus (DM) and that the global health care expenditure for adults with DM in 2015 was $673 billion. Nonadherence and nonpersistence to prescribed type 2 DM medications are common and remain a barrier to optimal health outcomes. There is a high prevalence of nonadherence among older adults. Research has focused on prevalence and predictors of adherence, research methodologies, and development of measures of adherence. Improvements hopefully will result in better disease monitoring, medication adherence, and reduced rates of diabetes complications.
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Affiliation(s)
- Khine Swe
- St. Mary's Ascension, CMU College of Medicine, Saginaw, MI, USA; Department of Internal Medicine, CMED 2419, Central Michigan University, Mt. Pleasant, MI 48859, USA
| | - S Sethu K Reddy
- Department of Internal Medicine, CMED 2419, Central Michigan University, Mt. Pleasant, MI 48859, USA.
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Huang YM, Shiyanbola OO, Chan HY, Smith PD. Patient factors associated with diabetes medication adherence at different health literacy levels: a cross-sectional study at a family medicine clinic. Postgrad Med 2020; 132:328-336. [PMID: 32233892 DOI: 10.1080/00325481.2020.1749499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Type 2 diabetes (T2D) incurs tremendous health costs associated with various complications due to poor diabetes control. Medication adherence, which is correlated with patients' health literacy, should be consistently practiced achieving optimal diabetes control. A deeper understanding of the specific communication and psychosocial factors related to medication-taking behaviors across different levels of health literacy among people with T2D will guide the development of effective interventions and strategies to enhance medication adherence. OBJECTIVES This cross-sectional study aimed to identify salient patient factors associated with diabetes medication adherence across different levels of health literacy. METHODS A questionnaire was administered via a face-to-face approach with 205 participants at a family medicine clinic. Study participants were all above 20 years of age with T2D, were prescribed at least one oral diabetes medication, and understood English. The questionnaire assessed participants' health literacy, self-efficacy for medication use, beliefs in medicines, patient-provider communication, perceived barriers to medication adherence, and self-reported medication adherence. Separate analysis of covariance was used to compare the mean scores of patient factors related to medication adherence across people with different health literacy levels. RESULTS The mean age of participants was 61 years old, and the majority of the participants were female (57%), White (75%), and college educated (62%). Thirty-three percent of the participants had adequate health literacy, but only 43% of them reported high adherence to their diabetes medications. Analysis of covariance showed that having stronger self-efficacy (P < 0.001), lower concern beliefs about medication (P = 0.047), and fewer perceived barriers to medication-taking (P < 0.001), are necessary for better medication adherence. CONCLUSION Findings suggest that practitioners should address concern beliefs among low-adherent patients with low health literacy, help improve self-efficacy, and address perceived barriers to medication adherence among all low-adherent patients to optimally support patients' diabetes care.
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Affiliation(s)
- Yen-Ming Huang
- College of Pharmacy and Allied Health Professions, South Dakota State University , Brookings, SD, USA.,Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University , Taipei City, Taiwan
| | - Olayinka O Shiyanbola
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison , Madison, WI, USA
| | - Hsun-Yu Chan
- Department of Psychology and Special Education, Texas A&M University , Commerce, TX, USA
| | - Paul D Smith
- Department of Family Medicine and Community Health, University of Wisconsin-Madison , Madison, WI, USA
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15
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Persell SD, Karmali KN, Lee JY, Lazar D, Brown T, Friesema EM, Wolf MS. Associations Between Health Literacy and Medication Self-Management Among Community Health Center Patients with Uncontrolled Hypertension. Patient Prefer Adherence 2020; 14:87-95. [PMID: 32021120 PMCID: PMC6970267 DOI: 10.2147/ppa.s226619] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 12/13/2019] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Examine associations between health literacy and several medication self-management constructs among a population of adults with uncontrolled hypertension. PATIENTS AND METHODS Cross-sectional study of health center patients from the Chicago area with uncontrolled hypertension enrolled between April 2012 and February 2015. Medication self-management constructs-applied to hypertension medications, chronic condition medications and all medications-included: 1) medication reconciliation, 2) knowledge of drug indications, 3) understanding instructions and dosing, and 4) self-reported adherence over 4 days (no missed doses). We determined associations between health literacy and self-management outcomes using multivariable generalized linear regression. RESULTS There were 1460 patients who completed screening interviews; 62.9% enrolled and had complete baseline data collected, and were included in the analysis. Of 919 participants, 47.4% had likely limited (low), 33.2% possibly limited, and 19.4% likely adequate health literacy. Compared to participants with likely adequate health literacy, participants with low health literacy were less likely to have chronic medications reconciled (18.0% versus 29.6%, p=0.007), know indications for chronic medications (64.1% versus 83.1%, p<0.001), and demonstrate understanding of instructions and dosing (68.1% versus 82.9%, p=0.001). Self-reported adherence to hypertension medications was higher among the low health literacy group (65.6% versus 56.0%, p=0.010). In multivariable models, health literacy was strongly associated with knowledge of drug indications, and understanding of instructions and dosing. CONCLUSION Low health literacy was associated with worse medication self-management in several domains. However, non-adherence was greatest in the most health literate in unadjusted analysis. Among a population of patients with uncontrolled hypertension, the drivers of poor control may vary by health literacy.
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Affiliation(s)
- Stephen D Persell
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Center for Primary Care Innovation, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Correspondence: Stephen D Persell Division of General Internal Medicine and Geriatrics, Department of MedicineFeinberg School of Medicine, Northwestern University, 750 North Lake Shore Drive, 10th Floor, Chicago, IL60611, USATel +1 312 503 6464Fax +1 312 503 2755 Email
| | - Kunal N Karmali
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ji Young Lee
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Danielle Lazar
- Access Community Health Network and the ACCESS Center for Discovery and Learning, Chicago, IL, USA
| | - Tiffany Brown
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Elisha M Friesema
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Center for Primary Care Innovation, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Carlson School of Management, University of Minnesota, Minneapolis, MN, USA
| | - Michael S Wolf
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Roles for Physical Therapists to Address Health Literacy as a Social Determinant of Cardiovascular Disease: A Clinical Perspective. Cardiopulm Phys Ther J 2020. [DOI: 10.1097/cpt.0000000000000132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Fernández-González L, Bravo-Valenzuela P. Effective interventions to improve the health literacy of cancer patients. Ecancermedicalscience 2019; 13:966. [PMID: 31921337 PMCID: PMC6834381 DOI: 10.3332/ecancer.2019.966] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Indexed: 12/04/2022] Open
Abstract
Health literacy (HL) refers to the cognitive and social abilities that are determinants in the motivation and capacity of the individual to access, understand and use information for the care of one’s own health. In oncology, increased survival, navigation of the healthcare system, the many different forms of treatment and the management of adverse effects/outcomes make HL a critical factor in patient care. The objective of this study is to identify the structure, content and effectiveness of interventions to improve HL in cancer patients.
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Affiliation(s)
- Loreto Fernández-González
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada
| | - Paulina Bravo-Valenzuela
- Nursing School, Pontificia Universidad Catolica de Chile, Santiago 7820436, Chile.,School of Social Sciences, Cardiff University, Cardiff CF10 3NN, UK
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18
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O'Meara L, Williams SL, Ames K, Lawson C, Saluja S, Vandelanotte C. Low Health Literacy Is Associated With Risk of Developing Type 2 Diabetes in a Nonclinical Population. DIABETES EDUCATOR 2019; 45:431-441. [PMID: 31226913 DOI: 10.1177/0145721719857548] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to examine associations among risk of type 2 diabetes (T2D), health literacy levels, and sociodemographic characteristics in a nonclinical adult population to assist in the development of effective T2D prevention programs. METHODS The Health Literacy Questionnaire and Australian Type 2 Diabetes Risk Assessment Tool were included in an online survey. Participants were a random sample of adults residing in each Australian state and territory. Data were analyzed with descriptive statistics and multinomial logistic regression. RESULTS A total of 1279 Australian adults participated (52% female; mean ± SD age, 61 ± 12 years). Most were at medium (42.4%) or high (46.9%) risk of developing T2D. The lowest health literacy scores were found for the domains "critical appraisal of health information" and "navigating the health care system." After controlling for covariates, participants at the highest risk of developing T2D were significantly more likely to be unemployed, have ≥1 chronic conditions, or have a mental health condition. Furthermore, they were significantly more likely to develop T2D if they scored low in 1 of the following health literacy domains: critical appraisal of health information, navigating the health care system, actively managing health, social support, and health care provider support. CONCLUSIONS Health literacy was associated with increased risk for developing T2D and should therefore be part of diabetes prevention initiatives. Specifically, new health promotion initiatives need to help people develop skills required to critically appraise health information and navigate the health care system. Health practitioners and educators should ensure that health information developed for consumers is uncomplicated and easily understood.
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Affiliation(s)
- Lydia O'Meara
- School of Health, Medical and Applied Sciences, CQUniversity, Cairns, Australia
| | - Susan L Williams
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Australia
| | - Kate Ames
- School of Education and the Arts, CQUniversity, Rockhampton, Australia
| | - Celeste Lawson
- School of Education and the Arts, CQUniversity, Rockhampton, Australia
| | - Sonia Saluja
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Australia
| | - Corneel Vandelanotte
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Australia
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19
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Shiyanbola OO, Walbrandt Pigarelli DL, Unni EJ, Smith PD, Maurer MA, Huang YM. Design and rationale of a mixed methods randomized control trial: ADdressing Health literacy, bEliefs, adheRence and self-Efficacy (ADHERE) program to improve diabetes outcomes. Contemp Clin Trials Commun 2019; 14:100326. [PMID: 30705995 PMCID: PMC6348197 DOI: 10.1016/j.conctc.2019.100326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/09/2019] [Accepted: 01/12/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Improving medication adherence is one of the most effective approaches to improving the health outcomes of patients with diabetes. To date, enhancing diabetes medication adherence has occurred by improving diabetes-related knowledge. Unfortunately, behavior change often does not follow knowledge change. Enhancing communication between patients and healthcare professionals through addressing health literacy-related psychosocial attributes is critical. OBJECTIVE Examine whether a patient-centered intervention augmenting usual care with a health literacy-psychosocial support intervention will improve medication adherence for patients with diabetes, compared to usual care. METHODS This study is a randomized controlled trial with an intervention mixed methods design. Fifty participants being enrolled are English-speaking, 18-80 years old with diagnosed diabetes, take at least one diabetes medication, have low diabetes medication adherence (proportion of days covered less than 80% or based on clinical notes), and have poor diabetes control (hemoglobin A1c of ≥8%). Participants will be allocated to either a control group receiving usual care (n = 25) or an intervention group (n = 25) receiving usual care and a 6-session intervention focusing on the modifiable psychosocial factors that may influence medication adherence. A questionnaire will be administered at baseline and at the end of the intervention to all participants to assess the effectiveness of the intervention. Fifteen participants from the intervention group will be interviewed to explore participants' experiences and perceptions of the intervention processes and outcomes. CONCLUSIONS The trial will examine if a patient-centered intervention that addresses patients' health literacy and focuses on modifiable psychosocial factors will improve medication adherence among patients with diabetes.
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Affiliation(s)
- Olayinka O. Shiyanbola
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, WI, USA
| | | | - Elizabeth J. Unni
- Department of Pharmaceutical Sciences, College of Pharmacy, Roseman University of Health Sciences, Utah, USA
| | - Paul D. Smith
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, WI, USA
| | - Martha A. Maurer
- Sonderegger Research Center, School of Pharmacy, University of Wisconsin-Madison, WI, USA
| | - Yen-Ming Huang
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, WI, USA
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20
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Leslie KH, McCowan C, Pell JP. Adherence to cardiovascular medication: a review of systematic reviews. J Public Health (Oxf) 2019; 41:e84-e94. [PMID: 29850883 PMCID: PMC6459362 DOI: 10.1093/pubmed/fdy088] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 03/21/2018] [Accepted: 05/03/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Use of cardiovascular medication has increased over time, especially for primary and secondary prevention, with polypharmacy common. METHODS Review of published systematic reviews of the factors and outcomes associated with adherence to cardiovascular medication using MEDLINE, Embase, CINAHL and PsycINFO databases. Quality was assessed using the AMSTAR tool. RESULTS Of 789 systematic reviews identified, 45 met the inclusion criteria and passed the quality assessment; 34 focused on factors associated with adherence, and 11 on outcomes. High heterogeneity, both between and within reviews, precluded meta-analysis and so a pooled estimate of adherence levels could not be derived. Adherence was associated with disease factors, therapy factors, healthcare factors, patient factors and social factors, though with some inconsistencies. In total, 91% of reviews addressing outcomes reported that low adherence was associated with poorer clinical and economic endpoints. CONCLUSIONS Factors from across five key domains relate to non-adherence to cardiovascular medications, and may contribute to poorer clinical outcomes. Interventions to improve adherence should be developed to address modifiable factors and targeted at those at highest risk of non-adherence. Adherence research is highly heterogeneous to-date and efforts to standardize this should be implemented to improve comparability.
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Affiliation(s)
- K H Leslie
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, UK
| | - C McCowan
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Boyd Orr Building, Glasgow, UK
| | - J P Pell
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, UK
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21
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Huang YM, Shiyanbola OO, Chan HY. A path model linking health literacy, medication self-efficacy, medication adherence, and glycemic control. PATIENT EDUCATION AND COUNSELING 2018; 101:1906-1913. [PMID: 29935739 DOI: 10.1016/j.pec.2018.06.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 06/04/2018] [Accepted: 06/15/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate whether medication self-efficacy moderates or mediates the relationship between health literacy and medication adherence. To propose a path model that illustrates the interrelated relationship between health literacy, medication self-efficacy, medication adherence, and hemoglobin A1c (HbA1c). METHODS This cross-sectional study was performed via a face-to-face survey. Factors that may influence medication adherence and HbA1c were identified from the literature review. One hundred and seventy-four participants included were ≥20 years old with diagnosed type 2 diabetes, understood English, and were prescribed at least one oral diabetes medicine. During clinic visits, a questionnaire was administered to evaluate health literacy, medication self-efficacy, and medication adherence. HbA1c values were obtained from electronic medical records. Path analyses were conducted for data analysis. RESULTS Medication self-efficacy mediated but did not moderate the relationship between numeracy and diabetes medication adherence. Participants with higher numeracy skills may develop a greater level of medication self-efficacy, which in turn may result in a higher level of diabetes medication adherence and a lower level of HbA1c. CONCLUSION Enhancing patients' medication self-efficacy and numeracy skills may be imperative in intervention programs to improve diabetes medication adherence. PRACTICE IMPLICATIONS An improvement in numeracy skills and medication self-efficacy is recommended to enhance diabetes medication adherence.
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Affiliation(s)
- Yen-Ming Huang
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, WI, 53705, USA.
| | - Olayinka O Shiyanbola
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, WI, 53705, USA.
| | - Hsun-Yu Chan
- Department of Psychology and Special Education, Texas A&M University-Commerce, TX, 75429, USA.
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22
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Roh YH, Noh JH, Gong HS, Baek GH. Comparative adherence to weekly oral and quarterly intravenous bisphosphonates among patients with limited heath literacy who sustained distal radius fractures. J Bone Miner Metab 2018; 36:589-595. [PMID: 28983705 DOI: 10.1007/s00774-017-0867-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 08/27/2017] [Indexed: 10/18/2022]
Abstract
Individuals with limited health literacy (HL) are less likely to obtain preventive care. We designed a study to compare adherence to weekly oral and quarterly intravenous bisphosphonates among patients with low HL. The study enrolled a total of 432 female patients who presented with a distal radius fracture caused by low-energy trauma. Participant HL was measured using the Newest Vital Sign tool, and patients were randomized to weekly oral or quarterly intravenous bisphosphonate groups. Subjects in the intravenous bisphosphonate group received intravenous injections of 3 mg ibandronate every 3 months, and those in the oral bisphosphonate group self-administered 70 mg alendronate orally once each week for 12 months. The adherence to weekly oral or quarterly intravenous bisphosphonates was analyzed by HL level. The rate of adherence to quarterly intravenous bisphosphonates was significantly higher than that for weekly oral bisphosphonates in patients with inadequate HL (73 vs. 46%, p = 0.001), whereas no significant differences were observed between HL groups in adherence to intravenous bisphosphonate. Conversely, the rate of adherence to orally administered bisphosphonates was significantly lower in patients with inadequate HL than in those with appropriate HL (46 vs. 65%, p = 0.005). After controlling for confounding variables, inadequate HL, the presence of comorbidities, and weekly oral bisphosphonates were associated with a higher likelihood of nonadherence to osteoporosis treatment. Thus patients with limited health literacy can achieve rates of adherence to quarterly intravenous bisphosphonates, as opposed to weekly oral bisphosphonates, similar to rates among patients with appropriate literacy.
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Affiliation(s)
- Young Hak Roh
- Department of Orthopaedic Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jung Ho Noh
- Department of Orthopaedic Surgery, Kangwon National University Hospital, 156 Baengnyeong-ro, Chuncheon, Gangwon-do, 200-722, Korea.
| | - Hyun Sik Gong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Goo Hyun Baek
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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Korhonen MJ, Ilomäki J, Sluggett JK, Brookhart MA, Visvanathan R, Cooper T, Robson L, Bell JS. Selective prescribing of statins and the risk of mortality, hospitalizations, and falls in aged care services. J Clin Lipidol 2018; 12:652-661. [PMID: 29574073 DOI: 10.1016/j.jacl.2018.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/26/2018] [Accepted: 02/20/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Compared to randomized controlled trials, nonexperimental studies often report larger survival benefits but higher rates of adverse events for statin use vs nonuse. OBJECTIVE We compared characteristics of statin users and nonusers living in aged care services and evaluated the relationships between statin use and all-cause mortality, all-cause and fall-related hospitalizations, and number of falls during a 12-month follow-up. METHODS A prospective cohort study of 383 residents aged ≥65 years was conducted in six Australian aged care services. Data were obtained from electronic medical records and medication charts and through a series of validated assessments. RESULTS The greatest differences between statin users and nonusers were observed in activities of daily living, frailty, and medication use (absolute standardized difference >0.40), with users being less dependent and less frail but using a higher number of medications. Statin use was associated with a decreased risk of all-cause mortality (adjusted hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.37-0.93) and hospitalizations (HR 0.67, 95% CI 0.46-0.98). After exclusion of residents unable to sit or stand, statin use was associated with a nonsignificant increase in the risk of fall-related hospitalizations (HR 1.47, 95% CI 0.80-2.68) but with a lower incidence of falls (incidence rate ratio 0.67, 95% CI 0.47-0.96). CONCLUSIONS The observed associations between statin use and the outcomes may be largely explained by selective prescribing and deprescribing of statins and variation in likelihood of hospitalization based on consideration of each resident's clinical and frailty status. Randomized deprescribing trials are needed to guide statin prescribing in this setting.
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Affiliation(s)
- Maarit J Korhonen
- NHMRC Centre for Research Excellence in Frailty and Healthy Ageing, Adelaide, South Australia, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia; Institute of Biomedicine, University of Turku, Turku, Finland.
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Janet K Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - M Alan Brookhart
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Renuka Visvanathan
- NHMRC Centre for Research Excellence in Frailty and Healthy Ageing, Adelaide, South Australia, Australia; School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - Tina Cooper
- Resthaven Incorporated, Adelaide, South Australia, Australia
| | - Leonie Robson
- Resthaven Incorporated, Adelaide, South Australia, Australia
| | - J Simon Bell
- NHMRC Centre for Research Excellence in Frailty and Healthy Ageing, Adelaide, South Australia, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Sansom Institute, University of South Australia, Adelaide, South Australia, Australia
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24
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Soto Mas F, Schmitt CL, Jacobson HE, Myers OB. A Cardiovascular Health Intervention for Spanish Speakers: The Health Literacy and ESL Curriculum. J Community Health 2018; 43:717-724. [PMID: 29428986 DOI: 10.1007/s10900-018-0475-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Spanish speakers in the United States are in need of effective interventions that address both cardiovascular disease (CVD) and health literacy. However, the literature lacks interventions that have used and evaluated a strategies that focus on both, particularly at the community level. The aim of this study was to explore the effect of a health literacy curriculum on cardiovascular health behavior among Spanish speaking adults. It used a randomized controlled pre-posttest design. Participants included Hispanic adults with a low-to-intermediate level of English proficiency. The intervention group received the health literacy and English as a second language (ESL) Curriculum with CVD specific content, while the control group received a conventional ESL curriculum. Tools included the Spanish Cardiovascular Health Questionnaire (CSC), the test of functional health literacy in adults (TOFHLA), and the Combined English Language Skills Assessment. Analysis of change scores included independent sample t test and multiple linear regression. A total of 155 participants completed the study. There was a significant greater improvement for the intervention group in change of CSC score from pretest to posttest (P = 0.049) compared to controls. The study also found significantly improved TOFHLA (P = 0.011), however it did not find a relationship between changes in CVD behavior and health literacy or English proficiency. The Health Literacy and ESL Curriculum constitutes a valuable resource for addressing the cardiovascular health, literacy, and language needs of Spanish-speaking adults. Interventions that take a multilevel education and health approach may be more effective in addressing the needs of immigrants. Research should further explore the interactions between CVD behavior, health literacy, and English proficiency.
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Affiliation(s)
- Francisco Soto Mas
- College of Population Health MSC09 5070, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA.
| | - Cheryl L Schmitt
- School of Medicine, Family & Community Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Holly E Jacobson
- Department of Linguistics, University of New Mexico, Albuquerque, NM, USA
| | - Orrin B Myers
- School of Medicine, Family & Community Medicine, University of New Mexico, Albuquerque, NM, USA
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25
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N’Goran AA, Pasquier J, Deruaz-Luyet A, Burnand B, Haller DM, Neuner-Jehle S, Zeller A, Streit S, Herzig L, Bodenmann P. Factors associated with health literacy in multimorbid patients in primary care: a cross-sectional study in Switzerland. BMJ Open 2018; 8:e018281. [PMID: 29440210 PMCID: PMC5829773 DOI: 10.1136/bmjopen-2017-018281] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To identify factors associated with health literacy in multimorbid patients. DESIGN A nationwide cross-sectional study in Switzerland. Univariate and multivariate linear regressions were calculated to identify variables associated with health literacy. A multiple imputation approach was used to deal with missing values. PARTICIPANTS Multimorbid patients recruited in primary care settings (n=888), above 18 years old and suffering from at least 3 of 75 chronic conditions on a predefined list based on the International Classification of Primary Care 2. MAIN MEASURES Health literacy was assessed using the European Health Literacy Survey project questionnaire (HLS-EU 6). This comprises six items scored from 1 to 4 (very difficult=1, fairly difficult=2, fairly easy=3, very easy=4), and the total health literacy score is computed as their mean. As we wished to understand the determinants associated with lower health literacy, the HLS-EU 6 score was the only dependent variable; all other covariates were considered independent. RESULTS The mean health literacy score (SD) was 2.9 (0.5). Multivariate analyses found significant associations between low health literacy scores and treatment burden scores (β=-0.004, 95% CI -0.006 to 0.002); marital status, predominantly the divorced group (β=0.136, 95% CI 0.012 to 0.260); dimensions of the EuroQuol 5 Dimension 3 Level (EQ5D3L) quality of life assessment, that is, for moderate problems with mobility (β=-0.086, 95% CI -0.157 to 0.016); and with moderate problems (β=-0.129, 95% CI -0.198 to 0.060) and severe problems with anxiety/depression (β=-0.343, 95% CI -0.500 to 0.186). CONCLUSIONS Multimorbid patients with a high treatment burden, altered quality of life by problems with mobility, anxiety or depression, often also have low levels of health literacy. Primary care practitioners should therefore pay particular attention to these patients in their daily practice.
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Affiliation(s)
| | - Jérôme Pasquier
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Anouk Deruaz-Luyet
- Institute of Family Medicine, University of Lausanne, Lausanne, Switzerland
| | - Bernard Burnand
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Dagmar M Haller
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Lilli Herzig
- Institute of Family Medicine, University of Lausanne, Lausanne, Switzerland
| | - Patrick Bodenmann
- Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, Lausanne, Switzerland
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Crengle S, Luke JN, Lambert M, Smylie JK, Reid S, Harré-Hindmarsh J, Kelaher M. Effect of a health literacy intervention trial on knowledge about cardiovascular disease medications among Indigenous peoples in Australia, Canada and New Zealand. BMJ Open 2018; 8:e018569. [PMID: 29371275 PMCID: PMC5786120 DOI: 10.1136/bmjopen-2017-018569] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 11/14/2017] [Accepted: 11/28/2017] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To assess the effect of a customised, structured cardiovascular disease (CVD) medication health literacy programme on medication knowledge among Indigenous people with, or at high risk of, CVD. DESIGN Intervention trial with premeasures and postmeasures at multiple time points. SETTING Indigenous primary care services in Australia, Canada and New Zealand. PARTICIPANTS 171 Indigenous people aged ≥20 years of age who had at least one clinical diagnosis of a CVD event, or in Canada and Australia had a 5-year CVD risk ≥15%, and were prescribed at least two of the following CVD medication classes: statin, aspirin, ACE inhibitors and beta blockers. INTERVENTION An education session delivered on three occasions over 1 month by registered nurses or health educators who had received training in health literacy and principles of adult education. An interactive tablet application was used during each session and an information booklet and pill card provided to participants. PRIMARY OUTCOME MEASURES Knowledge about the CVD medications assessed before and after each session. RESULTS Knowledge at baseline (presession 1) was low, with the mean per cent correct answers highest for statins (34.0% correct answers), 29.4% for aspirin, 26.0% for beta blockers and 22.7% for ACE inhibitors. Adjusted analyses showed highly significant (P<0.001) increases in knowledge scores between preassessments and postassessments at all three time points for all medication classes. For the four medications, the absolute increases in adjusted per cent correct items from presession 1 to postsession 3 assessments were 60.1% for statins, 76.8% for aspirin, 71.4% for ACE inhibitor and 69.5% for beta blocker. CONCLUSIONS The intervention was highly effective in contextually diverse Indigenous primary healthcare services in Australia, Canada and New Zealand. The findings from this study have important implications for health services working with populations with low health literacy more generally. TRIAL REGISTRATION NUMBER ACTRN12612001309875.
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Affiliation(s)
- Sue Crengle
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Joanne N Luke
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Michelle Lambert
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Janet K Smylie
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Susan Reid
- Health Literacy NZ, Auckland, New Zealand
| | | | - Margaret Kelaher
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Caruso R, Magon A, Baroni I, Dellafiore F, Arrigoni C, Pittella F, Ausili D. Health literacy in type 2 diabetes patients: a systematic review of systematic reviews. Acta Diabetol 2018; 55:1-12. [PMID: 29129000 DOI: 10.1007/s00592-017-1071-1] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/03/2017] [Indexed: 01/08/2023]
Abstract
Aim To summarize, critically review, and interpret the evidence related to the systematic reviews on health literacy (HL) amongst type 2 diabetes mellitus (T2DM). Methods The methodology for this study consisted of a systematic review of systematic reviews, using the PRISMA statement and flowchart to select studies, and searching on PubMed, CINAHL, Scopus, and Cochrane. The search covered the period between January 2006 and June 2016. Results From the 115 identified record by the queries, only six systematic reviews were included, following a quality evaluation using AMSTAR. The included systematic reviews content was analyzed by the independent work of two authors, using a narrative synthesis approach. The findings of this study (i.e., main themes) are areas of consensus and gaps in knowledge. Areas of consensus are HL definition, HL measurement tools, and the relationship between T2DM patient knowledge (or literacy) and his/her HL. The gaps in knowledge were the assessment of the relations between HL and health outcomes and self-efficacy, the gender differences, the effectiveness of interventions to improve HL, the cost-effectiveness study of interventions to improve HL, and the understanding of the influence of organizational environment on HL. Conclusion This review provides a current state of knowledge to address clinical practice and research proposals. HL could be useful to personalize patients' follow-up and it should be routinely assessed in its three dimensions (i.e. functional, interactive and critical) to enhance patients' ability to cope with clinical recommendations. Future research should be mainly aimed to test the effectiveness of evidence-based interventions to improve HL amongst T2DM patients.
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Affiliation(s)
- Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato University Hospital, San Donato Milanese, MI, Italy
| | - Arianna Magon
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato University Hospital, San Donato Milanese, MI, Italy
| | - Irene Baroni
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato University Hospital, San Donato Milanese, MI, Italy
| | - Federica Dellafiore
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato University Hospital, San Donato Milanese, MI, Italy
| | - Cristina Arrigoni
- Hygiene Section, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Francesco Pittella
- Nursing Degree Course, University of Milan, Section of IRCCS Policlinico San Donato University Hospital, San Donato Milanese, MI, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy.
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Huang YM, Shiyanbola OO, Smith PD. Association of health literacy and medication self-efficacy with medication adherence and diabetes control. Patient Prefer Adherence 2018; 12:793-802. [PMID: 29785094 PMCID: PMC5953319 DOI: 10.2147/ppa.s153312] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION The exact pathway linking health literacy, self-efficacy, medication adherence, and glycemic control for type 2 diabetes remains unclear. Understanding the relationship between patient factors, medication adherence, and lower glycated hemoglobin (HbA1c) may help patients better manage their disease. This study examined the association of health literacy and medication self-efficacy with self-reported diabetes medication adherence, and the association of health literacy, medication self-efficacy, and self-reported diabetes medication adherence with HbA1c of patients with type 2 diabetes. METHODS This cross-sectional study utilized a face-to-face questionnaire at two family medicine clinics in a Midwestern state among 174 patients; subjects enrolled were at least 20 years old with diagnosed type 2 diabetes, prescribed at least one oral diabetes medicine, and understood English. Questionnaires were administered to assess the participants': health literacy, using the Newest Vital Sign six-item questionnaire (NVS); self-efficacy for medication use, using the 13-item Self-Efficacy for Appropriate Medication Use Scale; and self-report medication adherence, using the eight-item Morisky Medication Adherence Scale. HbA1c values were obtained from participants' electronic medical records. Multiple linear regressions were used to explore the association of health literacy and medication self-efficacy with both medication adherence and HbA1c level after controlling for all other covariates. RESULTS Self-reported health status (β = 0.17, p = 0.015) and medication self-efficacy (β = 0.53, p < 0.001) were positively associated with diabetes medication adherence. Health literacy was neither associated with diabetes medication adherence (β = -0.04, p = 0.586) nor HbA1c (β = -0.06, p = 0.542). Lower diabetes medication adherence (β = -0.26, p = 0.008) and higher number of prescribed medications (β = 0.28, p = 0.009) were correlated with higher HbA1c. CONCLUSION Health literacy, as measured by the NVS, does not correlate with medication adherence or glycemic control among patients with type 2 diabetes. Interventions to improve patients' self-efficacy of medication use may improve diabetes medication adherence.
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Affiliation(s)
- Yen-Ming Huang
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
- Correspondence: Yen-Ming Huang, Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, 777 Highland Avenue, Madison, WI 53705, USA, Email
| | - Olayinka O Shiyanbola
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Paul D Smith
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI, USA
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Roh YH, Koh YD, Noh JH, Gong HS, Baek GH. Effect of health literacy on adherence to osteoporosis treatment among patients with distal radius fracture. Arch Osteoporos 2017; 12:42. [PMID: 28421547 DOI: 10.1007/s11657-017-0337-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/10/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED Patients with inadequate health literacy, those with medical comorbidities, or those with a previous history of adverse drug events have a higher likelihood of non-adherence to osteoporosis treatment after sustaining a distal radius fracture. INTRODUCTION Patients with a distal radial fracture (DRF) have a higher risk of subsequent fractures, which provides an important opportunity to begin treatment for osteoporosis. This study assessed the effect that health literacy of patients suffering from a DRF has on the subsequent adherence to osteoporosis treatment. METHODS A total of 116 patients (female, over 50 years of age) presenting a DRF caused by low-energy trauma were enrolled. Their health literacy was measured using the Newest Vital Sign (NVS). Alendronate (70 mg, orally, once weekly) was prescribed to all patients for 1 year, and adherence was defined as taking at least 80% of the tablets for 12 months and returning for the visit on month 12. Multivariable analyses were conducted to determine whether the patients' clinical, demographic, and health literacy factors influenced their adherence to osteoporosis treatment. RESULTS About half (52%) of the participants who sustained a DRF exhibited an inadequate health literacy, and the rate of non-adherence to osteoporosis treatment was 38%. The rate of non-adherence for patients with inadequate literacy was significantly higher than for those with appropriate literacy (47 vs. 29%, p = 0.04). The results of the regression analysis indicate that limited health literacy, the presence of comorbidities, and prior history of adverse drug events are associated with a higher likelihood of non-adherence to osteoporosis treatment after sustaining a DRF. CONCLUSIONS Patients with inadequate health literacy, adverse drug events, or medical comorbidities had higher rates of non-adherence with alendronate treatment after sustaining a DRF. Further research is needed to show whether improvements in patient comprehension via informational intervention in patients with a DRF will improve adherence to osteoporosis treatment.
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Affiliation(s)
- Young Hak Roh
- Department of Orthopaedic Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Young Do Koh
- Department of Orthopaedic Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Jung Ho Noh
- Department of Orthopaedic Surgery, Kangwon National University Hospital, 156 Baengnyeong-ro, Chuncheon-si, Gangwon-do, 200-722, South Korea.
| | - Hyun Sik Gong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Goo Hyun Baek
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Jaam M, Awaisu A, Ibrahim MI, Kheir N. Synthesizing and Appraising the Quality of the Evidence on Factors Associated with Medication Adherence in Diabetes: A Systematic Review of Systematic Reviews. Value Health Reg Issues 2017; 13:82-91. [PMID: 29073997 DOI: 10.1016/j.vhri.2017.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Nonadherence to medications is a common phenomenon in patients with diabetes. Several studies and systematic reviews have investigated the barriers to medication adherence in diabetes. However, no study has evaluated the quality of the existing literature and synthesized the plethora of evidence with a goal to design holistic conceptual frameworks and interventions. OBJECTIVES The aims of this review were to systematically evaluate existing systematic reviews focusing on factors associated with medication adherence in diabetes in an effort to synthesize the evidence, determine their methodological quality, and identify the gaps in the current literature. METHODS Fourteen databases and gray literature sources were systematically searched through June 2016. Systematic reviews reporting factors associated with medication adherence (barriers and facilitators) in patients with diabetes were selected on the basis of predetermined criteria. Studies were appraised for quality using AMSTAR (A Measurement Tool to Assess Systematic Reviews). RESULTS Seventeen systematic reviews including 542 primary studies, most of which were cross-sectional quantitative studies, were included. All the reviews were rated as moderate to low quality and exhibited common methodological pitfalls. Factors influencing medication adherence identified were categorized as patient-, medication-, disease-, health care provider-, health care system-, and social-related factors. CONCLUSIONS Factors influencing medication adherence are multifactorial with remarkably consistent findings across the existing reviews; yet, most reviews were judged to be of low to moderate quality. Further comprehensive and well-conducted original studies and systematic reviews on this topic shall be conducted taking into consideration the drawbacks of existing ones.
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Affiliation(s)
- Myriam Jaam
- College of Pharmacy, Qatar University, Doha, Qatar
| | - Ahmed Awaisu
- College of Pharmacy, Qatar University, Doha, Qatar.
| | | | - Nadir Kheir
- College of Pharmacy, Qatar University, Doha, Qatar; School of Pharmacy, the University of Auckland, Auckland, New Zealand
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Galura G, Pai AB. Health Literacy and Medication Management in Chronic Kidney Disease. Health Lit Res Pract 2017; 1:e109-e115. [PMID: 31294256 PMCID: PMC6607792 DOI: 10.3928/24748307-20170607-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/05/2017] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Amy Barton Pai
- Address correspondence to Amy Barton Pai, PharmD, BCPS, FASN, FCCP, FNKF, Department of Clinical Pharmacy, University of Michigan College of Pharmacy, 428 Church Street, Ann Arbor, MI 48109;
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Rodgers JE, Thudium EM, Beyhaghi H, Sueta CA, Alburikan KA, Kucharska-Newton AM, Chang PP, Stearns SC. Predictors of Medication Adherence in the Elderly: The Role of Mental Health. Med Care Res Rev 2017; 75:746-761. [PMID: 29148336 DOI: 10.1177/1077558717696992] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aging population routinely has comorbid conditions requiring complicated medication regimens, yet nonadherence can preclude optimal outcomes. This study explored the association of adherence in the elderly with demographic, socioeconomic, and disease burden measures. Data were from the fifth visit (2011-2013) for 6,538 participants in the Atherosclerosis Risk in Communities Study, conducted in four communities. The Morisky-Green-Levine Scale measured self-reported adherence. Forty percent of respondents indicated some nonadherence, primarily due to poor memory. Logit regression showed, surprisingly, that persons with low reading ability were more likely to report being adherent. Better self-reported physical or mental health both predicted better adherence, but the magnitude of the association was greater for mental than for physical health. Compared with persons with normal or severely impaired cognition, mild cognitive impairment was associated with lower adherence. Attention to mental health measures in clinical settings could provide opportunities for improving medication adherence.
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Affiliation(s)
- Jo E Rodgers
- 1 Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, NC, USA
| | - Emily M Thudium
- 1 Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, NC, USA
| | - Hadi Beyhaghi
- 2 Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, NC, USA
| | - Carla A Sueta
- 3 School of Medicine, The University of North Carolina at Chapel Hill, NC, USA
| | - Khalid A Alburikan
- 4 College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Anna M Kucharska-Newton
- 2 Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, NC, USA
| | - Patricia P Chang
- 3 School of Medicine, The University of North Carolina at Chapel Hill, NC, USA
| | - Sally C Stearns
- 2 Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, NC, USA
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van Schaik TM, Jørstad HT, Twickler TB, Peters RJG, Tijssen JPG, Essink-Bot ML, Fransen MP. Cardiovascular disease risk and secondary prevention of cardiovascular disease among patients with low health literacy. Neth Heart J 2017; 25:446-454. [PMID: 28247247 PMCID: PMC5513995 DOI: 10.1007/s12471-017-0963-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To explore the association between health literacy and the risk of cardiovascular disease (CVD), and to assess the differential effects by health literacy level of a nurse-coordinated secondary prevention program (NCPP) in patients with coronary artery disease (CAD). METHODS Data were collected in two medical centres participating in the RESPONSE trial (Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists). CVD risk profiles were assessed at baseline and 12-month follow-up using the Systematic Coronary Risk Evaluation (SCORE). Health literacy was assessed by the short Rapid Estimate of Adult Literacy in Medicine (REALM-D) and the Newest Vital Sign (NVS-D); self-reported health literacy was evaluated by the Set of Brief Screening Questions (SBSQ-D). RESULTS Among 201 CAD patients, 18% exhibited reading difficulties, 52% had difficulty understanding and applying written information, and 5% scored low on self-reported health literacy. Patients with low NVS-D scores had a higher CVD risk [mean SCORE 5.2 (SD 4.8) versus 3.3 (SD 4.1), p < 0.01]. Nurse-coordinated care seemed to reduce CVD risk irrespective of health literacy levels without significant differences. CONCLUSION Inadequate health literacy is prevalent in CAD patients in the Netherlands, and is associated with less favourable CVD risk profiles. Where many other forms of CVD prevention fail, nurse-coordinated care seems to be effective among patients with inadequate health literacy.
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Affiliation(s)
- T M van Schaik
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - H T Jørstad
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - T B Twickler
- Department of Endocrinology, Diabetology and Metabolic Diseases, University Hospital, Antwerp, Belgium.,Department of Endocrinology, Diabetology and Metabolic Diseases, AZ Monica Hospital, Deurne/Antwerp, Belgium
| | - R J G Peters
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J P G Tijssen
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - M L Essink-Bot
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - M P Fransen
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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The impact of inadequate health literacy on patient satisfaction, healthcare utilization, and expenditures among older adults. Geriatr Nurs 2017; 38:334-341. [PMID: 28089217 DOI: 10.1016/j.gerinurse.2016.12.003] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/09/2016] [Accepted: 12/12/2016] [Indexed: 11/22/2022]
Abstract
Inadequate health literacy (HL) is associated with impaired healthcare choices leading to poor quality-of-care. Our primary purpose was to estimate the prevalence of inadequate HL among two populations of AARP® Medicare Supplement insureds: sicker and healthier populations; to identify characteristics of inadequate HL; and to describe the impact on patient satisfaction, preventive services, healthcare utilization, and expenditures. Surveys were mailed to insureds in 10 states. Multivariate regression models were used to identify characteristics and adjust outcomes. Among respondents (N = 7334), 23% and 16% of sicker and healthier insureds, respectively, indicated inadequate HL. Characteristics of inadequate HL included male gender, older age, more comorbidities, and lower education. Inadequate HL was associated with lower patient satisfaction, lower preventive service compliance, higher healthcare utilization and expenditures. Inadequate HL is more common among older adults in poorer health, further compromising their health outcomes; thus they may benefit from expanded educational or additional care coordination interventions.
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Jones J, Rosaasen N, Taylor J, Mainra R, Shoker A, Blackburn D, Wilson J, Mansell H. Health Literacy, Knowledge, and Patient Satisfaction Before Kidney Transplantation. Transplant Proc 2016; 48:2608-2614. [DOI: 10.1016/j.transproceed.2016.07.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/26/2016] [Indexed: 10/20/2022]
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Brainard J, Wilsher SH, Salter C, Loke YK. Methodological review: quality of randomized controlled trials in health literacy. BMC Health Serv Res 2016; 16:246. [PMID: 27402048 PMCID: PMC4940982 DOI: 10.1186/s12913-016-1479-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 06/20/2016] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND The growing move towards patient-centred care has led to substantial research into improving the health literacy skills of patients and members of the public. Hence, there is a pressing need to assess the methodology used in contemporary randomized controlled trials (RCTs) of interventions directed at health literacy, in particular the quality (risk of bias), and the types of outcomes reported. METHODS We conducted a systematic database search for RCTs involving interventions directed at health literacy in adults, published from 2009 to 2014. The Cochrane Risk of Bias tool was used to assess quality of RCT implementation. We also checked the sample size calculation for primary outcomes. Reported evidence of efficacy (statistical significance) was extracted for intervention outcomes in any of three domains of effect: knowledge, behaviour, health status. Demographics of intervention participants were also extracted, including socioeconomic status. RESULTS We found areas of methodological strength (good randomization and allocation concealment), but areas of weakness regarding blinding of participants, people delivering the intervention and outcomes assessors. Substantial attrition (losses by monitoring time point) was seen in a third of RCTs, potentially leading to insufficient power to obtain precise estimates of intervention effect on primary outcomes. Most RCTs showed that the health literacy interventions had some beneficial effect on knowledge outcomes, but this was typically for less than 3 months after intervention end. There were far fewer reports of significant improvements in substantive patient-oriented outcomes, such as beneficial effects on behavioural change or health (clinical) status. Most RCTs featured participants from vulnerable populations. CONCLUSIONS Our evaluation shows that health literacy trial design, conduct and reporting could be considerably improved, particularly by reducing attrition and obtaining longer follow-up. More meaningful RCTs would also result if health literacy trials were designed with public and patient involvement to focus on clinically important patient-oriented outcomes, rather than just knowledge, behaviour or skills in isolation.
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Affiliation(s)
- Julii Brainard
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ UK
| | | | - Charlotte Salter
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ UK
| | - Yoon Kong Loke
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ UK
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Trinh-Duc A, Painbeni T, Byzcko A, Fort PA. Le dossier pharmaceutique dans un service d’accueil des urgences : évaluation de son accessibilité et de son impact sur le niveau de connaissance du traitement du patient. ANNALES PHARMACEUTIQUES FRANÇAISES 2016; 74:288-95. [DOI: 10.1016/j.pharma.2015.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 11/03/2015] [Accepted: 11/04/2015] [Indexed: 10/22/2022]
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Owen-Smith AA, Smith DH, Rand CS, Tom JO, Laws R, Waterbury A, Williams A, Vollmer WM. Difference in Effectiveness of Medication Adherence Intervention by Health Literacy Level. Perm J 2016; 20:15-200. [PMID: 27352409 DOI: 10.7812/tpp/15-200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
CONTEXT There is little research investigating whether health information technologies, such as interactive voice recognition, are effective ways to deliver information to individuals with lower health literacy. OBJECTIVE Determine the extent to which the impact of an interactive voice recognition-based intervention to improve medication adherence appeared to vary by participants' health literacy level. DESIGN Promoting Adherence to Improve Effectiveness of Cardiovascular Disease Therapies (PATIENT) was a randomized clinical trial designed to test the impact, compared with usual care, of 2 technology-based interventions that leveraged interactive voice recognition to promote medication adherence. A 14% subset of participants was sent a survey that included questions on health literacy. This exploratory analysis was limited to the 833 individuals who responded to the survey and provided data on health literacy. MAIN OUTCOME MEASURES Adherence to statins and/or angiotensin-converting enzyme inhibitors and/or angiotensin II receptor blockers. RESULTS Although intervention effects did not differ significantly by level of health literacy, the data were suggestive of differential intervention effects by health literacy level. CONCLUSIONS The differences in intervention effects for high vs low health literacy in this exploratory analysis are consistent with the hypothesis that individuals with lower health literacy may derive greater benefit from this type of intervention compared with individuals with higher health literacy. Additional studies are needed to further explore this finding.
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Affiliation(s)
- Ashli A Owen-Smith
- Assistant Professor of Health Management and Policy at the Georgia State University School of Public Health in Atlanta.
| | - David H Smith
- Senior Investigator at The Kaiser Permanente Center for Health Research in Portland, OR.
| | - Cynthia S Rand
- Professor of Medicine in the Department of Medicine at the Johns Hopkins School of Medicine in Baltimore, MD.
| | - Jeffrey O Tom
- Assistant Clinical Professor in the Department of Pediatrics at the University of Hawaii John A Burns School of Medicine in Honolulu.
| | - Reesa Laws
- Research and Data Analytics Center Manager and Technical Research Program Manager at The Kaiser Permanente Center for Health Research in Portland, OR.
| | - Amy Waterbury
- Research Program Manager at The Kaiser Permanente Center for Health Research in Portland, OR.
| | - Andrew Williams
- Faculty Scientist in the Center for Outcomes Research and Evaluation at the Maine Medical Center Research Institute in Scarborough.
| | - William M Vollmer
- Senior Investigator at The Kaiser Permanente Center for Health Research in Portland, OR.
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Fan JH, Lyons SA, Goodman MS, Blanchard MS, Kaphingst KA. Relationship Between Health Literacy and Unintentional and Intentional Medication Nonadherence in Medically Underserved Patients With Type 2 Diabetes. THE DIABETES EDUCATOR 2016; 42:199-208. [PMID: 26763625 PMCID: PMC5546794 DOI: 10.1177/0145721715624969] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to investigate the relationship between health literacy and overall medication nonadherence, unintentional nonadherence, and intentional nonadherence. Limited health literacy may be associated with worse diabetes outcomes, but the literature shows mixed results, and mechanisms remain unclear. Medication adherence is associated with diabetes outcomes and may be a mediating factor. Distinguishing between unintentional and intentional nonadherence may elucidate the relationship between health literacy and nonadherence in patients with type 2 diabetes. METHODS Cross-sectional study of 208 patients with type 2 diabetes recruited from a primary care clinic in St. Louis, Missouri. Information was obtained from written questionnaire and patient medical records. Bivariate and multivariable regression were used to examine predictors of medication nonadherence. RESULTS The majority of patients in the study were low income, publicly insured, and African American, with limited health literacy and a high school/GED education or less. In multivariable models, limited health literacy was significantly associated with increased unintentional nonadherence but not intentional nonadherence. CONCLUSIONS Results suggest differences in factors affecting intentional and unintentional nonadherence. The findings also suggest interventions are needed to decrease unintentional nonadherence among patients with type 2 diabetes and limited health literacy. Efforts to address unintentional medication nonadherence among patients with type 2 diabetes with limited health literacy may improve patient health.
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Affiliation(s)
- Jessica H Fan
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri (Ms Fan, Ms Lyons, Dr Goodman, Dr Kaphingst)
| | - Sarah A Lyons
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri (Ms Fan, Ms Lyons, Dr Goodman, Dr Kaphingst)
| | - Melody S Goodman
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri (Ms Fan, Ms Lyons, Dr Goodman, Dr Kaphingst)
| | - Melvin S Blanchard
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri (Dr Blanchard)
| | - Kimberly A Kaphingst
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri (Ms Fan, Ms Lyons, Dr Goodman, Dr Kaphingst)
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Sansom-Daly UM, Lin M, Robertson EG, Wakefield CE, McGill BC, Girgis A, Cohn RJ. Health Literacy in Adolescents and Young Adults: An Updated Review. J Adolesc Young Adult Oncol 2016; 5:106-18. [PMID: 26859721 DOI: 10.1089/jayao.2015.0059] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Health literacy is important for health outcomes in adults. However, little is known about the health literacy of adolescents and young adults (AYAs). The purpose of this study was to provide an updated systematic review examining health literacy among AYAs with and without chronic illness. Specifically, the review considered (1) what sources of health information AYAs use; (2) how well AYAs are able to understand, communicate, and critically evaluate health-related information; and (3) whether health literacy is associated with health behaviors and outcomes. METHODS A systematic search was conducted for literature published in peer-reviewed journals using Medline, Embase, and PsycINFO databases. RESULTS Of 603 articles reviewed, 14 studies met the inclusion criteria, six of which examined health literacy in a chronic illness population. Studies reported high usage for information sources, though no clear links between source type and health literacy emerged. Adequate health literacy was reported in at least 60% of participants, though poor functional literacy was reported. Few studies explored communicative or critical health literacy; those that did indicated that AYAs experience challenges in these domains. Poorer health literacy was associated with some adverse health outcomes, such as obesity and smoking. For AYAs with a chronic illness, there were mixed findings between health literacy and medication adherence. CONCLUSION Understanding the challenges AYAs face with regards to complex developing communicative and critical health literacy skills is crucial. Due to the paucity of research in this field, addressing health literacy across all AYAs will provide a valuable step in guiding research in AYAs with cancer.
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Affiliation(s)
- Ursula M Sansom-Daly
- 1 Kids Cancer Centre, Sydney Children's Hospital , Randwick, Australia .,2 Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales , Australia .,3 Sydney Youth Cancer Service, Prince of Wales/Sydney Children's Hospital , Randwick, Australia
| | - Merry Lin
- 1 Kids Cancer Centre, Sydney Children's Hospital , Randwick, Australia .,2 Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales , Australia
| | - Eden G Robertson
- 1 Kids Cancer Centre, Sydney Children's Hospital , Randwick, Australia .,2 Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales , Australia
| | - Claire E Wakefield
- 1 Kids Cancer Centre, Sydney Children's Hospital , Randwick, Australia .,2 Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales , Australia
| | - Brittany C McGill
- 1 Kids Cancer Centre, Sydney Children's Hospital , Randwick, Australia .,2 Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales , Australia
| | - Afaf Girgis
- 4 Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Medicine, University of New South Wales , Kensington, Australia
| | - Richard J Cohn
- 1 Kids Cancer Centre, Sydney Children's Hospital , Randwick, Australia .,2 Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales , Australia
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Abstract
BACKGROUND Little is known about the functional health literacy (FHL) associated with medication adherence in elderly patients. The aim of this study was to examine the FHL among older adults and identify influencing factors that can predict medication adherence. METHODS This was a cross-sectional survey. Participants (n=160) aged 65 years and older were selected from outpatient clinics of 3 tertiary care hospitals, 6 community pharmacies, and 2 senior centers between November 1 and 30, 2014. The participants' FHL was measured using the Korean Functional Health Literacy Test, which consists of 15 items including 8 numeracy and 7 reading comprehension items. Medication adherence was measured by the Adherence to Refills and Medication Scale. Descriptive statistics, chi-square or Fisher's exact test, and multiple regression analyses were used to analyze the data. RESULTS The mean score of the total FHL was 7.72±3.51 (range 0-15). The percentage of the total number of correct answers for the reading comprehension subtest and numeracy subtest were 48.1% and 54.4%, respectively. Among 160 participants, 52.5% showed low adherence to medication. The factors affecting medication adherence included the patient's degree of satisfaction with the service (β=-0.215, P=0.022), sufficient explanation of medication counseling (β=-0.335, P=0.000), education level (β=-0.153, P=0.045), health-related problems (β=-0.239, P=0.004), and dosing frequency (β=0.189, P=0.018). CONCLUSION In this study, we found medication adherence of elderly patients was associated with education level, health-related problems, dosing frequency, satisfaction with patient counseling, and explanation of medication, but no association was found with FHL. Pharmacists should consider elderly patients' individual characteristics such as educational background and specific patient-related health problems, provide sufficient information and explanation of medication, and ensure patient satisfaction with the counseling.
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Affiliation(s)
| | - Yeonhee Kim
- Center for Excellence in Teaching & Learning
| | - Sandy Jeong Rhie
- College of Pharmacy
- Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
- Correspondence: Sandy Jeong Rhie, College of Pharmacy, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Republic of Korea, Tel +82 2 3277 3023, Fax +82 2 3277 2851, Email
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Geboers B, Brainard JS, Loke YK, Jansen CJM, Salter C, Reijneveld SA, de Winter AF, deWinter AF. The association of health literacy with adherence in older adults, and its role in interventions: a systematic meta-review. BMC Public Health 2015; 15:903. [PMID: 26377316 PMCID: PMC4573285 DOI: 10.1186/s12889-015-2251-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/08/2015] [Indexed: 12/14/2022] Open
Abstract
Background Low health literacy is a common problem among older adults. It is often suggested to be associated with poor adherence. This suggested association implies a need for effective adherence interventions in low health literate people. However, previous reviews show mixed results on the association between low health literacy and poor adherence. A systematic meta-review of systematic reviews was conducted to study the association between health literacy and adherence in adults above the age of 50. Evidence for the effectiveness of adherence interventions among adults in this age group with low health literacy was also explored. Methods Eight electronic databases (MEDLINE, ERIC, EMBASE, PsycINFO, CINAHL, DARE, the Cochrane Library, and Web of Knowledge) were searched using a variety of keywords regarding health literacy and adherence. Additionally, references of identified articles were checked. Systematic reviews were included if they assessed the association between health literacy and adherence or evaluated the effectiveness of interventions to improve adherence in older adults with low health literacy. The AMSTAR tool was used to assess the quality of the included reviews. The selection procedure, data-extraction, and quality assessment were performed by two independent reviewers. Seventeen reviews were selected for inclusion. Results Reviews varied widely in quality. Both reviews of high and low quality found only weak or mixed associations between health literacy and adherence among older adults. Reviews report on seven studies that assess the effectiveness of adherence interventions among low health literate older adults. The results suggest that some adherence interventions are effective for this group. The interventions described in the reviews focused mainly on education and on lowering the health literacy demands of adherence instructions. No conclusions could be drawn about which type of intervention could be most beneficial for this population. Conclusions Evidence on the association between health literacy and adherence in older adults is relatively weak. Adherence interventions are potentially effective for the vulnerable population of older adults with low levels of health literacy, but the evidence on this topic is limited. Further research is needed on the association between health literacy and general health behavior, and on the effectiveness of interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2251-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bas Geboers
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, FA10, PO Box 196, , 9700 AD, Groningen, The Netherlands.
| | - Julii S Brainard
- Norwich Medical School, Faculty of Medicine & Health Sciences, University of East Anglia, Norwich, UK.
| | - Yoon K Loke
- Norwich Medical School, Faculty of Medicine & Health Sciences, University of East Anglia, Norwich, UK.
| | - Carel J M Jansen
- Department of Communication and Information Studies, Faculty of Arts, University of Groningen, Groningen, The Netherlands.
| | - Charlotte Salter
- Norwich Medical School, Faculty of Medicine & Health Sciences, University of East Anglia, Norwich, UK.
| | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, FA10, PO Box 196, , 9700 AD, Groningen, The Netherlands.
| | - Andrea F de Winter
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, FA10, PO Box 196, , 9700 AD, Groningen, The Netherlands.
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Palumbo R. Discussing the Effects of Poor Health Literacy on Patients Facing HIV: A Narrative Literature Review. Int J Health Policy Manag 2015; 4:417-30. [PMID: 26188806 PMCID: PMC4493582 DOI: 10.15171/ijhpm.2015.95] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/09/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Scholars describe poor health literacy as a "silent epidemic," which is challenging the functioning of healthcare systems all over the world. Health literacy is mainly meant as an individual trait which concerns the ability to obtain, process, and understand basic health information in order to effectively navigate the health system. Low health literate patients perceive poor self-efficacy dealing with their health conditions, are not willing to be involved in the provision of care, show larger risks of hospitalization and mortality, and are not aware about the determinants of well-being. Hence, limited health literacy has been associated with inadequate management of long-term conditions; nonetheless, several authors argue that health literacy has been an overlooked factor dealing with HIV. METHODS This study is aimed at discussing the effects of poor health literacy on people living with HIV, drawing from the findings of a narrative literature review which involved 41 papers retrieved from the databases "Scopus-Elsevier" and "PubMed." RESULTS The scientific literature is not consistent dealing with the relationship between health literacy and HIV treatment. For example, health literate patients seem to better understand their health conditions; on the other hand, people living with poor health literacy are likely to report higher compliance with providers' prescriptions, blindly trusting healthcare professionals. CONCLUSION Poor health literacy is a social barrier to access healthcare services and to appropriate health treatment among patients living with HIV. Tailored interventions should be aimed at enhancing the health skills of patients affected by HIV infection to improve their ability to navigate the health system.
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Affiliation(s)
- Rocco Palumbo
- Department of Management and Information Technology, University of Salerno, Salerno, Italy
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Thurston MM, Bourg CA, Phillips BB, Huston SA. Impact of health literacy level on aspects of medication nonadherence reported by underserved patients with type 2 diabetes. Diabetes Technol Ther 2015; 17:187-93. [PMID: 25531555 DOI: 10.1089/dia.2014.0220] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Medication adherence can be affected by many factors, including health literacy. The purpose of this study is to determine (1) if a relationship exists between health literacy and self-reported or objectively measured medication adherence and (2) which aspect or aspects of medication nonadherence are most associated with health literacy. SUBJECTS AND METHODS This is a multicenter, cross-sectional survey study of adult patients with type 2 diabetes mellitus (T2DM), taking one or more antidiabetes medication for ≥6 months with a hemoglobin A1c (HbA1c) measure on record. Data collected included patient demographics (age, gender, race, language, highest level of education, injectable diabetes medication use, last HbA1c, and diabetes medication refill history) and two survey instruments (the Morisky eight-item Medication Adherence Scale [MMAS-8] and the short-form Test of Functional Health Literacy in Adults [s-TOFHLA]). Descriptive statistics and bivariate correlations were assessed, along with linear and logistic regression. RESULTS One hundred ninety-two patients with an average HbA1c level of 8.1% were included. Of these subjects, 32.8% had limited health literacy as measured by the s-TOFHLA, 58.9% had low adherence as measured by MMAS-8, and 65.1% were nonadherent based on cumulative medication gap (CMG) analysis. Age was associated with s-TOFHLA (-0.411; P<0.01) and MMAS-8 (0.157; P<0.05) scores. HbA1c was associated with MMAS-8 (-0.209; P<0.01) and CMG (0.152; P<0.05) scores. There was no significant association between s-TOFHLA and MMAS-8 or CMG. However, s-TOFHLA was positively related to MMAS-8 question 8, assessing difficulty remembering to take medications (P=0.017). CONCLUSIONS Health literacy level is not associated with self-reported or objectively measured medication adherence in underserved patients with T2DM. Lower health literacy scores are associated with a patient experiencing difficulty remembering to take medications.
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Affiliation(s)
- Maria Miller Thurston
- 1 Department of Pharmacy Practice, Mercer University College of Pharmacy , Atlanta, Georgia
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Kripalani S, Goggins K, Nwosu S, Schildcrout J, Mixon AS, McNaughton C, McDougald Scott AM, Wallston KA. Medication Nonadherence Before Hospitalization for Acute Cardiac Events. JOURNAL OF HEALTH COMMUNICATION 2015; 20 Suppl 2:34-42. [PMID: 26513029 PMCID: PMC4705844 DOI: 10.1080/10810730.2015.1080331] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Medication nonadherence increases the risk of hospitalization and poor outcomes, particularly among patients with cardiovascular disease. The purpose of this study was to examine characteristics associated with medication nonadherence among adults hospitalized for cardiovascular disease. Patients in the Vanderbilt Inpatient Cohort Study who were admitted for acute coronary syndrome or heart failure completed validated assessments of self-reported medication adherence (the Adherence to Refills and Medications Scale), demographic characteristics, health literacy, numeracy, social support, depressive symptoms, and health competence. We modeled the independent predictors of nonadherence before hospitalization, standardizing estimated effects by each predictor's interquartile range. Among 1,967 patients studied, 70.7% indicated at least some degree of medication nonadherence leading up to their hospitalization. Adherence was significantly lower among patients with lower health literacy (0.18-point change in adherence score per interquartile range change in health literacy), lower numeracy (0.28), lower health competence (0.30), and more depressive symptoms (0.52) and those of younger age, of non-White race, of male gender, or with less social support. Medication nonadherence in the period before hospitalization is more prevalent among patients with lower health literacy, numeracy, or other intervenable psychosocial factors. Addressing these factors in a coordinated care model may reduce hospitalization rates.
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Affiliation(s)
- Sunil Kripalani
- a Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- b Center for Clinical Quality and Implementation Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- c Center for Health Services Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Kathryn Goggins
- b Center for Clinical Quality and Implementation Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- c Center for Health Services Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Sam Nwosu
- d Department of Biostatistics , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Jonathan Schildcrout
- d Department of Biostatistics , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Amanda S Mixon
- a Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- b Center for Clinical Quality and Implementation Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- c Center for Health Services Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- e Department of Veterans Affairs , Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center , Nashville , Tennessee , USA
| | - Candace McNaughton
- f Department of Emergency Medicine , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Amanda M McDougald Scott
- c Center for Health Services Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- f Department of Emergency Medicine , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- g Department of Biomedical Informatics , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Kenneth A Wallston
- h School of Nursing , Vanderbilt University Medical Center , Nashville , Tennessee , USA
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Sörberg Wallin A, Falkstedt D, Allebeck P, Melin B, Janszky I, Hemmingsson T. Does high intelligence improve prognosis? The association of intelligence with recurrence and mortality among Swedish men with coronary heart disease. J Epidemiol Community Health 2014; 69:347-53. [PMID: 25488976 PMCID: PMC4392213 DOI: 10.1136/jech-2014-204958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Lower intelligence early in life is associated with increased risks for coronary heart disease (CHD) and mortality. Intelligence level might affect compliance to treatment but its prognostic importance in patients with CHD is unknown. METHODS A cohort of 1923 Swedish men with a measure of intelligence from mandatory military conscription in 1969-1970 at age 18-20, who were diagnosed with CHD 1991-2007, were followed to the end of 2008. PRIMARY OUTCOME recurrent CHD event. Secondary outcome: case fatality from the first event, cardiovascular and all-cause mortality. National registers provided information on CHD events, comorbidity, mortality and socioeconomic factors. RESULTS The fully adjusted HRs for recurrent CHD for medium and low intelligence, compared with high intelligence, were 0.98, (95% CIs 0.83 to 1.16) and 1.09 (0.89 to 1.34), respectively. The risks were increased for cardiovascular and all-cause mortality with lower intelligence, but were attenuated in the fully adjusted models (fully adjusted HRs for cardiovascular mortality 1.92 (0.94 to 3.94) and 1.98 (0.89 to 4.37), respectively; for all-cause mortality 1.63 (1.00 to 2.65) and 1.62 (0.94 to 2.78), respectively). There was no increased risk for case-fatality at the first event (fully adjusted ORs 1.06 (0.73 to 1.55) and 0.97 (0.62 to 1.50), respectively). CONCLUSIONS Although we found lower intelligence to be associated with increased mortality in middle-aged men with CHD, there was no evidence for its possible effect on recurrence in CHD.
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Affiliation(s)
- Alma Sörberg Wallin
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Falkstedt
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden Division of Psychology, Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - Peter Allebeck
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Bo Melin
- Division of Psychology, Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - Imre Janszky
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden Department of Public Health and General Practice, NTNU, Trondheim, Norway
| | - Tomas Hemmingsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
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Salter C, Brainard J, McDaid L, Loke Y. Challenges and opportunities: what can we learn from patients living with chronic musculoskeletal conditions, health professionals and carers about the concept of health literacy using qualitative methods of inquiry? PLoS One 2014; 9:e112041. [PMID: 25375767 PMCID: PMC4222964 DOI: 10.1371/journal.pone.0112041] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 10/12/2014] [Indexed: 11/18/2022] Open
Abstract
The field of health literacy continues to evolve and concern public health researchers and yet remains a largely overlooked concept elsewhere in the healthcare system. We conducted focus group discussions in England UK, about the concept of health literacy with older patients with chronic musculoskeletal conditions (mean age = 73.4 years), carers and health professionals. Our research posed methodological, intellectual and practical challenges. Gaps in conceptualisation and expectations were revealed, reiterating deficiencies in predominant models for understanding health literacy and methodological shortcomings of using focus groups in qualitative research for this topic. Building on this unique insight into what the concept of health literacy meant to participants, we present analysis of our findings on factors perceived to foster and inhibit health literacy and on the issue of responsibility in health literacy. Patients saw health literacy as a result of an inconsistent interactive process and the implications as wide ranging; healthcare professionals had more heterogeneous views. All focus group discussants agreed that health literacy most benefited from good inter-personal communication and partnership. By proposing a needs-based approach to health literacy we offer an alternative way of conceptualising health literacy to help improve the health of older people with chronic conditions.
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Affiliation(s)
- Charlotte Salter
- Norwich Medical School, Faculty of Medicine & Health Sciences, University of East Anglia, Norwich, NR4 7TJ, United Kingdom
| | - Julii Brainard
- Norwich Medical School, Faculty of Medicine & Health Sciences, University of East Anglia, Norwich, NR4 7TJ, United Kingdom
| | - Lisa McDaid
- Norwich Medical School, Faculty of Medicine & Health Sciences, University of East Anglia, Norwich, NR4 7TJ, United Kingdom
| | - Yoon Loke
- Norwich Medical School, Faculty of Medicine & Health Sciences, University of East Anglia, Norwich, NR4 7TJ, United Kingdom
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Kim KB, Han HR, Huh B, Nguyen T, Lee H, Kim MT. The effect of a community-based self-help multimodal behavioral intervention in Korean American seniors with high blood pressure. Am J Hypertens 2014; 27:1199-208. [PMID: 24671049 DOI: 10.1093/ajh/hpu041] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Great strides have been made in improving heart health in the United States during the last 2 decades, yet these strides have not encompassed many ethnic minority populations. There are significant health disparity gaps stemming from both a paucity of valid research and a lack of culturally sensitive interventions. In particular, many Korean Americans with chronic illnesses encounter difficulty navigating the healthcare system because of limited health literacy. METHODS The effect of a multimodal Self-Help Intervention Program on the Control of High Blood Pressure (HBP) was tested in a community-based clinical trial for Korean American seniors. Of 440 seniors enrolled, 369 completed the study (184 in the intervention group and 185 in the control group; mean age = 70.9±5.3 years). The intervention group received 6 weekly educational sessions on HBP management skill building, including health literacy training, followed by telephone counseling and home blood pressure (BP) monitoring for 12 months. RESULTS Findings support that the Self-Help Intervention Program on the Control of HBP was effective in controlling BP in this ethnic/linguistic minority population. The BP control rates for the intervention and control groups were 49.5% vs. 43.2% at baseline, 58.5% vs. 42.4% at 6 months, 67.9% vs. 52.5% at 12 months, and 54.3% vs. 53.0% at 18 months. Significant changes were observed over time in some psychobehavioral outcomes, including self-efficacy for BP control, medication adherence behavior, HBP knowledge, and depression. CONCLUSIONS The study findings suggest that the multimodal Self-Help Intervention Program on the Control of HBP is effective at promoting optimal HBP control for this ethnic/linguistic minority population. CLINICAL TRIALS REGISTRY NCT00406614.
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Affiliation(s)
- Kim B Kim
- Korean Resource Center, Ellicott City, Maryland
| | - Hae-Ra Han
- School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Boyun Huh
- School of Nursing, University of California at San Francisco, San Francisco, California
| | - Tam Nguyen
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
| | - Hochang Lee
- School of Medicine, Yale University, New Haven, Connecticut
| | - Miyong T Kim
- School of Nursing, University of Texas at Austin, Austin, Texas.
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Mixon AS, Myers AP, Leak CL, Lou Jacobsen JM, Cawthon C, Goggins KM, Nwosu S, Schildcrout JS, Schnelle JF, Speroff T, Kripalani S. Characteristics associated with postdischarge medication errors. Mayo Clin Proc 2014; 89:1042-51. [PMID: 24998906 PMCID: PMC4126191 DOI: 10.1016/j.mayocp.2014.04.023] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 04/07/2014] [Accepted: 04/14/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the association of patient- and medication-related factors with postdischarge medication errors. PATIENTS AND METHODS The Vanderbilt Inpatient Cohort Study includes adults hospitalized with acute coronary syndromes and/or acute decompensated heart failure. We measured health literacy, subjective numeracy, marital status, cognition, social support, educational attainment, income, depression, global health status, and medication adherence in patients enrolled from October 1, 2011, through August 31, 2012. We used binomial logistic regression to determine predictors of discordance between the discharge medication list and the patient-reported list during postdischarge medication review. RESULTS Among 471 patients (mean age, 59 years), the mean total number of medications reported was 12, and 79 patients (16.8%) had inadequate or marginal health literacy. A total of 242 patients (51.4%) were taking 1 or more discordant medication (ie, appeared on either the discharge list or patient-reported list but not both), 129 (27.4%) failed to report a medication on their discharge list, and 168 (35.7%) reported a medication not on their discharge list. In addition, 279 participants (59.2%) had a misunderstanding in indication, dose, or frequency in a cardiac medication. In multivariable analyses, higher subjective numeracy (odds ratio [OR], 0.81; 95% CI, 0.67-0.98) was associated with lower odds of having discordant medications. For cardiac medications, participants with higher health literacy (OR, 0.84; 95% CI, 0.74-0.95), with higher subjective numeracy (OR, 0.77; 95% CI, 0.63-0.95), and who were female (OR, 0.60; 95% CI, 0.46-0.78) had lower odds of misunderstandings in indication, dose, or frequency. CONCLUSION Medication errors are present in approximately half of patients after hospital discharge and are more common among patients with lower numeracy or health literacy.
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Affiliation(s)
- Amanda S Mixon
- Department of Veterans Affairs, Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center, Nashville, Tennessee; Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, Tennessee; Center for Health Services Research, Vanderbilt University, Nashville, Tennessee.
| | - Amy P Myers
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cardella L Leak
- Center for Health Services Research, Vanderbilt University, Nashville, Tennessee
| | - J Mary Lou Jacobsen
- Center for Health Services Research, Vanderbilt University, Nashville, Tennessee; Center for Quality Aging, Vanderbilt University, Nashville, Tennessee
| | - Courtney Cawthon
- Center for Health Services Research, Vanderbilt University, Nashville, Tennessee
| | - Kathryn M Goggins
- Center for Health Services Research, Vanderbilt University, Nashville, Tennessee
| | - Samuel Nwosu
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | | | - John F Schnelle
- Department of Veterans Affairs, Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center, Nashville, Tennessee; Center for Quality Aging, Vanderbilt University, Nashville, Tennessee
| | - Theodore Speroff
- Department of Veterans Affairs, Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center, Nashville, Tennessee; Center for Health Services Research, Vanderbilt University, Nashville, Tennessee; Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - Sunil Kripalani
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, Tennessee; Center for Health Services Research, Vanderbilt University, Nashville, Tennessee; Center for Clinical Quality and Implementation Research, Vanderbilt University, Nashville, Tennessee
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Lyles A, Culver N, Ivester J, Potter T. Effects of health literacy and polypharmacy on medication adherence. ACTA ACUST UNITED AC 2014; 28:793-9. [PMID: 24322963 DOI: 10.4140/tcp.n.2013.793] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine if health literacy has an effect on medication adherence in patients taking fewer than five prescriptions (no polypharmacy), and those taking five or more prescriptions (polypharmacy). DESIGN Retrospective cohort. SETTING The Primary Care Residents' Clinic at Virginia Commonwealth University Health System (VCUHS). PATIENTS Those who received a Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R) assessment at the clinic between June 1, 2009, and June 30, 2010, and utilized the VCUHS outpatient pharmacies to fill their prescriptions. A total of 648 individuals were identified. INTERVENTIONS The degree of health literacy and level of medication adherence were analyzed per patient by accessing the clinic's electronic health records. The number of medications each patient filled was determined using VCUHS outpatient pharmacy databases. MAIN OUTCOME MEASURE To determine if there are any associations among the degree of health literacy, the level of medication adherence, and the amount of medications a patient is taking. RESULTS There was a significant association found between the level of medication adherence and the degree of polypharmacy. We found no association between the degree of health literacy and the level of adherence to a prescribed medication regimen. Additionally, there was no relationship between the degree of polypharmacy and health literacy. Those patients with more medications were also found to have lower levels of medication adherence and vice versa. CONCLUSION Our study does not show an association between health literacy and medication adherence nor between health literacy and polypharmacy. Thus, potential changes to improving health literacy may not have a significant effect on adherence.
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Affiliation(s)
- Adraine Lyles
- Virginia Commonwealth University Health System-Department of Pharmacy, Richmond, Virginia
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