Health Literacy Impact on National Healthcare Utilization and Expenditure

Using online health information for unknown symptoms common among young adults: a qualitative analysis of health-related web pages illustrating the need for numeracy skills, the ability to deal with uncertainty, and the risk of ruling out self-care

Young adults experiencing unfamiliar symptoms commonly seek health information online. This study's aim was to explore how health information websites express and communicate health information about symptoms common among young adults and guide readers in regard to health, illness, and care. Symptoms commonly searched for by young adults were used as search terms. The resulting data comprised material from 24 web pages and was analyzed using content analysis. The foremost purpose of online health information is to try to narrow down the user's symptoms and then advise the user on what actions to take. This is done by first forming a foundation of knowledge through descriptions and explanations, then specifying the symptom's time, duration, and location, and finally giving advice on whether to self-manage symptoms or seek additional information about them. However, the uncertainty of the diagnosis may rule out self-care. For readers inexperienced with health care, forming a decisive conclusion about diffuse symptoms on the sole basis of online health information could be challenging. The necessity of numeracy skills and the ability to deal with uncertainty are highlighted. There is a discrepancy between health advice given online and readers' accessibility to health care that needs to be addressed in future policy and research.

The association between health literacy, private health insurance, and medical expenditure in South Korea

BACKGROUND

Health literacy (HL) is crucial for effective healthcare utilization, but its relationship with private health insurance (PHI) enrollment and medical expenditure in South Korea remains unexplored.

OBJECTIVES

This study aimed to examine the associations between HL, PHI enrollment, and annual out-of-pocket (OOP) medical expenditure in South Korea's universal healthcare system.

METHODS

Using data from the 2021 Korea Health Panel Study, we analyzed 5,469 participants aged 19-65. Logistic and multinomial logistic regression models were employed to assess factors influencing PHI enrollment. A Gamma GLM with a log- link function was used to examine the relationship between HL, PHI status, and OOP medical expenditure.

RESULTS

Among participants, 70.05% had indemnity insurance coverage, and 88.02% held at least one PHI policy. Individuals with sufficient HL showed higher indemnity insurance enrollment (71.47%) compared to those with inadequate HL (63.17%). In unadjusted analyses, those with sufficient HL were more likely to have indemnity insurance (OR = 1.46, 95% CI: 1.19-1.80) and PHI policies. However, after adjusting for sociodemographic and health-related factors, these associations became non-significant. Individuals with indemnity insurance spent 36% more on OOP medical expenditure compared to those without (p < 0.01), and OOP medical expenditure increased with the number of insurance policies (39.1%, 71.6%, and 107.5% higher for one, two, and three or more policies, respectively, all p < 0.01). Those with sufficient HL spent 18.9% less on OOP medical expenditure compared to those with inadequate HL (p < 0.01). However, after adjusting for other variables, the coefficients lost statistical significance. After adjusting for other variables, higher education levels were associated with lower OOP medical expenditure.

CONCLUSIONS

While HL initially showed an association with PHI enrollment and reduced OOP medical expenditure, these relationships became non-significant after adjusting for socioeconomic and health-related factors. Higher education levels were associated with lower OOP medical expenditure, suggesting that educational attainment may better explain the observed HL effects. The positive association between PHI and OOP medical expenditure highlights the need for policy attention to ensure sustainable healthcare financing and appropriate medical service utilization in Korea's healthcare system.

[Establishing and implementing the National Action Plan Health Literacy in Germany]

About ten years ago, studies on health literacy in Germany indicated that population health literacy was low. This prompted a group of distinguished experts to initiate the development of a National Action Plan for Health Literacy (NAP-HL) for Germany, modeled after those of other countries. This article explains the origins and development of the plan in Germany, provides an overview of the steps taken during its creation, and summarizes its content. Subsequently, the transfer strategy, including the three steps of diffusion, dissemination, and implementation, is discussed. The concluding assessment evaluates the plan's achieved impacts and critically reflects on the implementation strategy. Overall, numerous impulses were provided for agenda setting and the promotion of health literacy. The challenge remains to develop sustainable interventions for strengthening health literacy, accompanied by systematic research.

Health literacy and its relationship with mental health and quality of life in freshmen students

INTRODUCTION

Health literacy is an effective indicator of people's health level. Therefore, this study aimed to investigate health literacy and its relationship with mental health and quality of life in first-year medical sciences students.

METHODS AND MATERIALS

The cross-sectional study was conducted on freshmen- students of Babol University of Medical Sciences, Iran. 311 students were selected using a multi-stage sampling method. Data was collected by 4 questionnaires including demographic, health literacy questionnaire, General health questionnaire (GHQ-12), and quality of life (short form) (SF-12). Analysis of the data was done using SPSS version 22.

RESULTS

The subjects were 45.5% female and 54.5% male. Almost 60% had adequate/excellent health literacy. A significant relationship between health literacy and the variables of gender and place of residence was found. The results indicated that health literacy, age, educational level, and residential place were predictors of students' mental health. The regression test results showed that the variables of health literacy, age, educational program, and residential place were predictors of students' mental health. The students' mean score of quality of life was 68.81 ± 16.56. The regression test indicated that health literacy, educational level, and residential place were predictors of students' quality of life.

CONCLUSION

This study emphasizes the central role of health literacy in shaping the mental health and quality of life of freshmen students.

Influence of Health Literacy on Physical Activity and Sedentary Behaviors in Older Patients with Coronary Artery Disease

BACKGROUND

Coronary artery disease is a chronic condition that requires continuous adherence to healthy behaviors. Adhering to physical activity and reducing prolonged sedentary behavior are important for the physical health of older patients with coronary artery disease (CAD). Health literacy is increasingly recognized as a key factor in secondary prevention for these patients. However, evidence regarding the associations among health literacy, physical activity, and sedentary behaviors for secondary prevention in older patients with coronary artery disease remains limited.

OBJECTIVES

This study aimed to identify the prevalence of limited health literacy and the influence of health literacy on physical activity and sedentary behaviors in older patients with CAD.

METHODS

This study was a descriptive cross-sectional study conducted from May to December 2022 in South Korea. A total of 186 patients aged 65 and older diagnosed with coronary artery disease participated. Data on health literacy, physical activity, and sedentary behaviors were collected through self-reported questionnaires and electronic medical records.

RESULTS

The prevalence of limited health literacy in older patients was 66.7%. Hierarchical linear regression revealed that health literacy was a significant determinant of physical activity (β = -0.50, P < .001) and sedentary behaviors (β = 0.58, P < .001) after adjusting for confounding variables.

CONCLUSIONS

Our main findings showed that health literacy can facilitate improvements in physical activity and sedentary behaviors. Health literacy can facilitate health decisions for secondary prevention in older patients with CAD. Thus, healthcare professionals should assess patient health literacy and illness severity when designing secondary prevention programs.

Consumer Understanding of Prescription Drug Indications in Direct-to-Consumer Television Advertisements

BACKGROUND

Prescription drugs may be indicated to treat more than one medical condition, and companies may promote more than one indication in the same direct-to-consumer (DTC) ad. This study examined how presenting multiple prescription drug indications in one DTC television ad affects consumers' processing of drug information.

METHODS

We conducted two studies with adults diagnosed with diabetes (Study 1, N = 408) or rheumatoid arthritis (Study 2, N = 411). We randomly assigned participants to view one of three television ads: primary indication only (Study 1: diabetic peripheral neuropathy; Study 2: rheumatoid arthritis), primary plus a similar secondary indication (Study 1: fibromyalgia; Study 2: psoriatic arthritis), or primary plus a dissimilar secondary indication (Study 1: generalized anxiety disorder; Study 2: ulcerative colitis).

RESULTS

Remembering and understanding the primary indication was not significantly affected by the presence of a secondary indication (similar or dissimilar). Higher health literacy participants remembered and understood secondary indications.

CONCLUSIONS

Including a second indication in DTC television ads does not appear to have detrimental effects and can increase awareness of the second indication for some participants. Industry and regulators should continue to ensure DTC promotion is truthful and non-misleading, irrespective of the number of indications presented.

Healthcare utilisation patterns and contributory factors among middle-aged adults: a scoping review

BACKGROUND

Middle-aged adults, defined as individuals between the ages of 45 and 64, represent a significant yet under researched group of healthcare service users. This scoping review aimed to provide a comprehensive overview of the patterns of healthcare utilisation and the factors contributing to them within this demographic.

METHODS

Following PRISMA-ScR guidelines and the framework proposed by Arksey and O'Malley, a systematic literature search was conducted across PubMed, EMBASE, and the Cochrane Library databases from their inception until July 2023. Key search terms such as "healthcare utilisation" and "middle-aged" were used to identify relevant studies. Articles were included if they were original cohort, case-control, or cross-sectional studies published in English. The findings were then synthesised narratively, by identifying recurring concepts and grouping them into broader themes. The themes were categorised according to the Andersen healthcare utilisation model's three factors: predisposing factors, enabling factors, and need-related factors.

RESULTS

After screening 4,810 records, a total of 25 articles were selected for final analysis, comprising 15 from developed countries and 10 from developing countries. Consistent factors influencing healthcare utilisation included multimorbidity, socioeconomic status, and poor health behaviours. Differences emerged across contexts: in developed countries, healthcare utilisation was influenced by lifestyle behaviours and access to private care, while in developing countries, socioeconomic inequalities and limited insurance coverage played more dominant roles. Healthcare system structures likely shaped utilisation patterns.

CONCLUSION

Healthcare utilisation among middle-aged adults is driven by an interplay of medical, social, and economic factors that vary across contexts. Common contributors, such as multimorbidity and poor health behaviours, highlight the need for targeted interventions and policies focusing on primary and preventive care to address the long-term burden of healthcare utilisation. This demographic faces unique challenges in managing healthcare decisions amidst varying systemic and individual-level challenges, which should be further studied.

Factors Affecting Adherence in Allergic Disorders and Strategies for Improvement

Addressing patient adherence is a key element in ensuring positive health outcomes and improving health-related quality of life for patients with atopic and immunologic disorders. Understanding the complex etiologies of patient nonadherence and identifying real-world solutions is important for clinicians, patients, and systems to design and effect change. This review serves as an important resource for defining key issues related to patient nonadherence and outlines solutions, resources, knowledge gaps, and advocacy areas across five domains: health care access, financial considerations, socioenvironmental factors, health literacy, and psychosocial factors. To allow for more easily digestible and usable content, we describe solutions based on three macrolevels of focus: patient, clinician, and system. This review and interactive tool kit serve as an educational resource and call to action to improve equitable distribution of resources, institutional policies, patient-centered care, and practice guidelines for improving health outcomes for all patients with atopic and immunologic disorders.

Applying the Andersen behavioral model to the medication therapy management program: an approach for improving medication safety in older adults

Medication therapy problems (MTPs) are common among older adults and are associated with considerable morbidity, mortality, and healthcare costs. The Medicare Part D Medication Therapy Management (MTM) program, which includes Comprehensive Medication Reviews (CMRs), Targeted Medication Reviews (TMRs), and guidance on safe medication disposal, is designed to optimize therapeutic outcomes and reduce adverse events by addressing MTPs. Although this program has demonstrated success in reducing MTPs, its utilization remains low, with ongoing concerns about service access disparities, patient satisfaction, and long-term health outcomes. This perspective paper applies the Andersen Behavioral Model (ABM) to the Medicare Part D MTM program to enhance understanding of factors influencing service utilization and impact among older adults. The ABM provides a structured framework to examine how macro-and micro-level factors shape health behaviors and outcomes. By applying ABM framework to MTM, this paper highlights essential research directions to generate rigorous evidence for program evaluation, inform policy adjustments, and make targeted recommendations for improving MTM within the U.S. healthcare system. Furthermore, this work has potential implications for global programs aimed at enhancing medication safety by addressing MTPs and optimizing medication use.

Financial Toxicity Among Patients With Traumatic Finger Amputation: A Retrospective Study

BACKGROUND

Patients face increasing financial toxicity (FT), defined as emotional distress due to the cost of medical treatment. However, little is known regarding FT in the context of upper extremity trauma.

METHODS

We surveyed patients who sustained traumatic finger amputation (October 21, 2011-January 1, 2021). We collected patient-reported financial distress using the Comprehensive Score for Financial Toxicity (COST-11), where a lower score indicates worse FT. We also collected data of patients' perceptions regarding the costs of their treatment. We used linear regression to assess patient-level characteristics associated with FT as measured by the COST-11 score.

RESULTS

Of the 191 eligible patients, 46 patients completed the survey (response rate of 24%). A total of 41 respondents (89%) received an initial treatment of revision amputation, with the remaining patients receiving a semi-occlusive dressing. Patients with commercial insurance had significantly lower COST-11 scores (ie, worse FT) than patients with Medicare (β = 7.5, 95% CI: 0.5 to 14.5) and Worker's Compensation (β = 8.7, 95% CI: 1.8 to 15.6). Patients who were single/never married had significantly worse FT (β = -11.3, 95% CI: -18.7 to -3.9). Approximately 35% (n = 16) reported that the costs were higher than expected. More than a third of patients (39%) reported decreasing spending on basic items, such as food, at least once since surgery.

CONCLUSION

Patients face FT when obtaining surgery following traumatic finger amputation. Variation in the FT is associated with type of insurance and marriage status, highlighting how underinsurance and social support likely affect the overall economic well-being of patients.

Readability Metrics in Patient Education: Where Do We Innovate?

The increasing use of digital applications in healthcare has led to a greater need for patient education materials. These materials, often in the form of pamphlets, booklets, and handouts, are designed to supplement physician-patient communication and aim to improve patient outcomes. However, the effectiveness of these materials can be hindered by variations in patient health literacy. Readability, a measure of text comprehension, is a key factor influencing how well patients understand these educational materials. While there has been growing interest in readability assessment in medicine, many studies have demonstrated that digital texts do not frequently meet the recommended sixth-to-eighth grade reading level. The purpose of this opinion article is to review readability from the perspective of studies in pediatric medicine, internal medicine, preventative medicine, and surgery. This article aims to communicate that while readability is important, it tends to not fully capture the complexity of health literacy or effective patient communication. Moreover, a promising avenue to improve readability may be in generative artificial intelligence, as there are currently limited tools with similar effectiveness.

Inadequate health literacy and higher healthcare utilisation among older adults in Switzerland: cross-sectional evidence from a population-based study

BACKGROUND AND AIM

Population ageing in Switzerland poses significant challenges, including for the healthcare system. Inadequate health literacy can hinder individuals' ability to seek appropriate treatments and navigate the healthcare system efficiently. This study explores the associations between health literacy and the number of consultations with general practitioners and healthcare specialists in a population-based sample of adults aged 58+ in Switzerland.

METHODS

We used data from 1424 older adults who participated in Wave 8 (2020) of the Survey of Health, Ageing, and Retirement in Europe (SHARE). The analysis focuses on two outcomes: the reported number of consultations with (1) general practitioners or (2) healthcare specialists in the year prior to the interview. Health literacy, i.e. the ability to find, understand, assess and apply health information, is measured using the short version of the European Health Literacy Survey questionnaire (HLS-EU-Q16). The final health literacy score ranged from 0 to 16 and was categorised into three health literacy levels: inadequate (0-8), problematic (9-12) and sufficient (13-16). Bivariate analyses were conducted using Kruskal-Wallis tests. Partial associations were examined using multivariate generalised Poisson regression models controlling for key sociodemographic, regional and health-related variables.

RESULTS

Overall, 68.5% of the respondents were classified as having sufficient health literacy, while the health literacy level of 23.5% and 7.9% of respondents was classified as problematic or inadequate, respectively. The median number of general practitioner consultations and specialist visits was 2 and 1, respectively, both with an interquartile range of 1. Lower levels of health literacy were statistically significantly associated (p = 0.0011) with a higher number of general practitioner consultations in the year prior to the interview. By contrast, we did not find any significant association between health literacy and the number of specialist consultations.

CONCLUSION

This study finds that lower health literacy is associated with higher healthcare utilisation for older adults in Switzerland. The findings may suggest that general practitioners could have a significant role as advisors for individuals with low levels of health literacy, while a similar pattern is not observed for specialists. This discrepancy might be attributed, at least in part, to the role of general practitioners as intermediaries between patients and specialised care providers. Ensuring accessibility to general practitioners, particularly for individuals with low health literacy, could prove to be a beneficial strategy in addressing the healthcare requirements of this particularly vulnerable patient group. Additionally, improving health literacy in the population may provide further health benefits and lead to resource savings.

Barriers and facilitators of healthcare access for long COVID-19 patients in a universal healthcare system: qualitative evidence from Austria

BACKGROUND

Long COVID-19 challenges health and social systems globally. International research finds major inequalities in prevalence and healthcare utilization as patients describe difficulties with accessing health care. In order to improve long-term outcomes it is vital to understand any underlying access barriers, for which relevant evidence on long COVID-19 is thus far lacking in a universal healthcare system like Austria. This study aims to comprehensively identify access barriers and facilitators faced by long COVID-19 patients in Austria and explore potential socioeconomic and demographic drivers in health and social care access.

METHODS

Applying an exploratory qualitative approach, we conducted semi-structured interviews with 15 experts including medical professionals and senior health officials as well as focus groups with 18 patients with confirmed long COVID-19 diagnosis reflecting varying participant characteristics (age, gender, urbanicity, occupation, education, insurance status) (July-Nov 2023). Data were analysed following a thematic framework approach, drawing on a comprehensive 'access to health care' model.

RESULTS

Based on expert and patient experiences, several access barriers and facilitators emerged along all dimensions of the model. Main themes included scepticism and stigma by medical professionals, difficulties in finding knowledgeable doctors, limited specialist capacities in the ambulatory care sector, long waiting times for specialist care, and limited statutory health insurance coverage of treatments resulting in high out-of-pocket payments. Patients experienced constant self-organization of their patient pathway as stressful, emphasizing the need for multidisciplinary care and centralized coordination. Facilitators included supportive social environments, telemedicine, and informal information provided by a nationwide patient-led support group. Differences in patient experiences emerged, among others, as women and younger patients faced gender- and age-based stigmatization. Complementary health insurance reduced the financial strain, however, did not ease capacity constraints, which were particularly challenging for those living in rural areas.

CONCLUSIONS

The findings of this study indicate a call for action to improve the long COVID-19 situation in Austria by empowering both providers and patients via increased information offerings, strengthened interdisciplinary treatment structures and telemedicine offerings as well as research funding. Our insights on potentially relevant socioeconomic and demographic drivers in access barriers lay the necessary foundation for future quantitative inequality research.

Bridging Gaps in Health Literacy for Cleft Lip and Palate: The Role of Artificial Intelligence and Interactive Educational Materials

OBJECTIVE

Our goal is to address the health literacy gap concerning cleft lip and palate using artificial intelligence (AI), specifically OpenAI's ChatGPT-4, to enhance the readability of patient educational materials (PEMs). Additionally, we aim to explore the integration of interactive educational materials into these resources.

DESIGN

A cross-sectional study.

SETTING

Websites of craniofacial teams approved by the American Cleft Palate-Craniofacial Association (ACPA).

PATIENTS/PARTICIPANTS

PEMs collected from these websites.

INTERVENTIONS

First, we examined the PEMs for interactive educational content such as videos, photos, case examples, and audio clips. Subsequently, we used the WebFX online readability calculator and Grammarly to evaluate the texts' readability and clarity. After that, we used ChatGPT-4 to simplify the PEM texts to a 6th-grade reading level and re-evaluated their readability and clarity.

MAIN OUTCOME MEASURE(S)

Readability levels (grade level) and clarity scores of PEMs before and after AI modification, and the presence of interactive educational content.

RESULTS

Initial evaluations using the Flesch-Kincaid Grade Level formula showed that the texts were written at a median 9th-grade reading level. Modifications using ChatGPT-4 significantly improved readability, achieving a median 6th-grade level and enhanced clarity. Only 27% of the websites featured interactive educational content, indicating a gap in utilizing educational enhancements.

CONCLUSION

The use of AI improved the readability and clarity of patient educational materials, aligning with recommended standards. However, the underutilization of interactive tools suggests a need for broader integration of these resources to optimize patient education and engagement.

Factors associated with low health literacy in unpaid caregivers of older people: a systematic review

Health literacy is a public health issue. Unpaid caregivers of older people with low health literacy may have difficulties providing care, exerting a negative impact on the care process. The aim of the present study was to perform a systematic review of the literature on factors associated with low health literacy in unpaid caregivers of older people. Searches for relevant articles were conducted in the Cochrane Library, Embase, LILACS, PubMed and Web of Science databases. A total of 1440 articles were identified, nine of which met the eligibility criteria and were included in the systematic review, which was registered in PROSPERO (CRD42024522986). A total of 2209 unpaid caregivers participated in the studies selected for this review. Most were women (67.2%). The average frequency of inadequate health literacy was 27.1%. Sociodemographic characteristics (i.e. advanced age, low educational level, the female sex), factors related to the care process (i.e. low acculturation, low empowerment, poor ability to read medication package inserts, lower care capacity, greater disease severity, hospitalization of care recipients), cognitive factors and factors related to quality of life/well-being (i.e. less social support, poorer quality of life, greater cognitive impairment, higher levels of burden) were associated with low health literacy. In conclusion, low health literacy in unpaid caregivers of older people is associated with sociodemographic, care-related and cognitive factors as well as factors related to quality of life/well-being. Low health literacy may exert a negative impact on the health of caregivers and, consequently, the quality of care provided to older people.

Parental knowledge and attitudes toward food allergies: a cross-sectional study on determinants and educational needs

BACKGROUND

Food allergy (FA) may often lead to fatal consequences if it is treated promptly. Parents of children with FA should have adequate knowledge to improve health outcomes and reduce the associated burden. This study aimed to examine the knowledge and attitudes regarding FA among parents of children with FA.

METHODS

This was a cross-sectional study conducted among parents attending a primary healthcare center using convenience sampling. The minimum sample size of 280 was calculated using an equation based on the local prevalence of FA among children, and was increased to account for missing data. The data were collected using a four-section questionnaire that collected data about the parents and their children and included questions about knowledge and attitudes regarding FA. The knowledge score was calculated by summing the number of correct answers, with a maximum of 15 points. The Mann-Whitney and Kruskal-Wallis tests were used to examine the associations between the knowledge score and other variables. Spearman's correlation was employed to test the correlations between the knowledge score and other variables.

RESULTS

A total of 381 parents completed the questionnaires, of whom 71.9% were mothers and 28.1% were fathers. The prevalence of food allergies was 14.22%. Almost one-third had children who had one or more types of FA (32.8%). Most of those patients had received a professional diagnosis of FA (75.3%). The median knowledge score was 7.0 (IQR = 6-8), with variable proportions of correct answers across and within topics. A higher knowledge score was significantly associated with parenting a child with FA (p = 0.006), comorbid asthma or eczema (p = 0.012), the preference to acquire information from professional health agencies (p < 0.001), and higher educational (p = 0.002) and income (p = 0.001) levels. Moreover, the number of discussions held with a healthcare professional regarding FA was significantly correlated with the knowledge score (r = 0.210, p = 0.019). Online resources were the most commonly reported source of information (65.4%). Parents believed that having a child with FA can cause stress in the family (76.1%) and impact siblings' daily lives (66.7%), while only a minority viewed FA as stigmatizing. Additionally, the majority encouraged governmental spending on FA research (92.9%).

CONCLUSIONS

Parenting a child with FA, comorbid asthma or eczema, number of discussions held with healthcare professionals, and education and income levels were significantly associated with a higher knowledge score. Educational interventions targeting parents should blend emotional regulation, medical information, and management skills to increase knowledge about FA and alleviate associated stress.

Online Patient Education in Obstructive Sleep Apnea: ChatGPT versus Google Search

The widespread implementation of artificial intelligence technologies provides an appealing alternative to traditional search engines for online patient healthcare education. This study assessed ChatGPT-3.5's capabilities as a source of obstructive sleep apnea (OSA) information, using Google Search as a comparison. Ten frequently searched questions related to OSA were entered into Google Search and ChatGPT-3.5. The responses were assessed by two independent researchers using the Global Quality Score (GQS), Patient Education Materials Assessment Tool (PEMAT), DISCERN instrument, CLEAR tool, and readability scores (Flesch Reading Ease and Flesch-Kincaid Grade Level). ChatGPT-3.5 significantly outperformed Google Search in terms of GQS (5.00 vs. 2.50, p < 0.0001), DISCERN reliability (35.00 vs. 29.50, p = 0.001), and quality (11.50 vs. 7.00, p = 0.02). The CLEAR tool scores indicated that ChatGPT-3.5 provided excellent content (25.00 vs. 15.50, p < 0.001). PEMAT scores showed higher understandability (60-91% vs. 44-80%) and actionability for ChatGPT-3.5 (0-40% vs. 0%). Readability analysis revealed that Google Search responses were easier to read (FRE: 56.05 vs. 22.00; FKGL: 9.00 vs. 14.00, p < 0.0001). ChatGPT-3.5 delivers higher quality and more comprehensive OSA information compared to Google Search, although its responses are less readable. This suggests that while ChatGPT-3.5 can be a valuable tool for patient education, efforts to improve readability are necessary to ensure accessibility and utility for all patients. Healthcare providers should be aware of the strengths and weaknesses of various healthcare information resources and emphasize the importance of critically evaluating online health information, advising patients on its reliability and relevance.

Evaluating ChatGPT's Performance in Answering Questions About Allergic Rhinitis and Chronic Rhinosinusitis

OBJECTIVE

This study aims to evaluate the accuracy of ChatGPT in answering allergic rhinitis (AR) and chronic rhinosinusitis (CRS) related questions.

STUDY DESIGN

This is a cross-sectional study.

SETTING

Each question was inputted as a separate, independent prompt.

METHODS

Responses to AR (n = 189) and CRS (n = 242) related questions, generated by GPT-3.5 and GPT-4, were independently graded for accuracy by 2 senior rhinology professors, with disagreements adjudicated by a third reviewer.

RESULTS

Overall, ChatGPT demonstrated a satisfactory performance, accurately answering over 80% of questions across all categories. Specifically, GPT-4.0's accuracy in responding to AR-related questions significantly exceeded that of GPT-3.5, but distinction not evident in CRS-related questions. Patient-originated questions had a significantly higher accuracy compared to doctor-originated questions when utilizing GPT-4.0 to respond to AR-related questions. This discrepancy was not observed with GPT-3.5 or in the context of CRS-related questions. Across different types of content, ChatGPT excelled in covering basic knowledge, prevention, and emotion for AR and CRS. However, it experienced challenges when addressing questions about recent advancements, a trend consistent across both GPT-3.5 and GPT-4.0 iterations. Importantly, the accuracy of responses remained unaffected when questions were posed in Chinese.

CONCLUSION

Our findings suggest ChatGPT's capability to convey accurate information for AR and CRS patients, and offer insights into its performance across various domains, guiding its utilization and improvement.

Health literacy profiles of medical students in an Australian Doctor of Medicine programme: A cross-sectional study using the Health Literacy Questionnaire

ISSUE ADDRESSED

With the emerging focus on designing health-literate organisations and health care systems, it is essential to understand the health literacy profiles of the medical workforce including medical students, as medical professionals play a key role in within these systems. Medical professionals contribute to good patient health outcomes through enabling access to appropriate health care, provision of quality health information and collaborative shared decision-making, which are fundamental health literacy competencies. The aim of this study is to identify health literacy strengths and weaknesses of medical students enrolled in an Australian Doctor of Medicine programme.

METHODS

Students from all 4 years of an Australian Doctor of Medicine programme were invited to complete an anonymous, online survey in January 2021. Health literacy profiles were identified using the 9-domain, 44-item multi-dimensional Health Literacy Questionnaire, a validated tool which comprehensively evaluates health literacy strengths and weaknesses from diverse perspectives. Demographic characteristics and social attributes were also recorded. The results were compared with Australian Bureau of Statistics data.

RESULTS

Eighty-six participants completed the survey. Most participants were female students (57%) who spoke English at home (88%) with tertiary-educated fathers (60%) and resided in locations associated with high socioeconomic status during adolescence (61%). Males scored significantly higher in three domains which explored health information access and appraisal, and ability to actively engage with health care providers. Students' scores were significantly lower than the Australian general population in Domain 6 (Ability to actively engage with health care providers) and Domain 7 (Navigating the health care system).

CONCLUSIONS

Medical students' health literacy profiles indicate areas of weakness in their ability to engage with health care providers and to navigate the health system. Medical educators will need to create opportunities to address these weaknesses within medical curricula. Gender differences identified in self-rated ability to access and appraise health information requires further exploration. SO WHAT?: Further understanding of health literacy profiles of medical students may influence design of medical school curricula.

Assessment of health literacy in a French emergency department

BACKGROUND

Health literacy (HL) has become a subject of major interest in public health worldwide. It is known to be linked to self-efficacy in care use and to global health status, and a non-negligible frequency of problematic or inadequate levels of HL in populations worldwide is reported. As this has yet to be evaluated in France, the present study aimed to evaluate the HL level of patients in a French emergency department (ED).

METHODS

We conducted a descriptive, cross-sectional observational, single center study in the ED of the Lyon Sud hospital (Hospices civils de Lyon, Lyon, France). The primary endpoint was the HL level of the patients determined according to the score obtained using the 16-item European Health Literacy Survey Questionnaire. The secondary endpoint was the identification of sociodemographic factors associated with the HL level.

RESULTS

A total of 189 patients were included for analysis. 10% (95% CI [3%; 17%]) of the patients had an inadequate HL, 38% (95% CI [31%; 45%]) had a problematic HL, and 53% (95% CI [46%; 61%] had an adequate HL. In multivariate analysis, age and perceived health status were independent predictors of the HL level; OR =0.82 (95% CI [0.69; 0.97]; p=0.026) for a 10-year increase in age, and OR =1.84 (95% CI [1.22; 2.82]; p=0.004]).

CONCLUSIONS

The HL level of the patients in the ED studied herein was similar to that found in the population of France and other European countries and was influenced by age and perceived health status, which are both associated with care needs. It may be therefore interesting to explore in future studies how taking into consideration HL in the general population may lead to a better self-efficacy in care and optimize the use of the healthcare system.

Socioeconomic Disparities Associated with Access to Oculofacial Plastic Surgeons: A Cross-Sectional Analysis of US County Demographics

PURPOSE

To compare population demographics with the geographic distribution of oculofacial plastic surgeons (OPSs) in the United States.

DESIGN

A cross-sectional study design was used to investigate demographic differences between counties with 1 or more OPSs and counties with zero OPSs.

PARTICIPANTS

The number of OPSs were identified in each US county using online public databases: American Society of Ophthalmic Plastic and Reconstructive Surgeons and American Academy of Ophthalmology. Counties were categorized into 2 groups: 1 or more OPSs and zero OPSs. Demographic characteristics at the county level were obtained from the 2021 US Census Bureau Population Estimates and the American Community Survey. Cost of living was collected from the 2022 Economic Policy Institute Family Budget Calculator.

MAIN OUTCOME MEASURES

Socioeconomic demographics of the US population as related to geographic OPS distribution.

RESULTS

A total of 1238 OPSs were identified. States with the most OPSs per million were Hawaii (6.2), D.C. (6.0), Connecticut (5.8), Utah (5.1), and Maryland (5.0). Among 3143 counties, 2725 (86.7%) had zero OPSs and 418 (13.3%) had 1 or more OPSs. Counties with 1 or more OPSs had a higher median (standard deviation) household income versus counties with zero OPSs ($72 471 [$19 152] vs. $56 152 [$13 675]; difference $16 319; 95% confidence interval [CI], $14 300-$18 338; P < 0.001). The annual cost of living per person (standard deviation) was higher in counties with 1 or more OPSs versus counties with zero OPSs ($39 238 [$6992] vs. $36 227 [$3516]; difference $3011; 95% CI, $2328-$3694; P < 0.001). Counties with zero OPSs versus counties with 1 or more OPSs had higher proportions of persons with only Medicaid (15.6% vs. 13.6%; difference 2.0%; 95% CI, 1.4%-2.5%; P < 0.001), no health insurance (9.9% vs. 8.0%; difference 1.9%; 95% CI, 1.5%-2.4%; P < 0.001), no household internet access (17.2% vs. 9.6%; difference 7.6%; 95% CI, 7.1%-8.0%; P < 0.001), and higher proportions of persons aged 65 years or older (20.0% vs. 17.0%; difference 3.0%; 95% CI, 2.5%-3.5%; P < 0.001).

CONCLUSIONS

This cross-sectional analysis of all US counties revealed socioeconomic disparities associated with access to OPSs.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

School Nurses Practices Promoting Self-Management and Healthcare Transition Skills for Adolescents with Chronic Conditions in Urban Public Schools: A Mixed Methods Study

Background: Adolescents and young adults (AYA) with chronic conditions should acquire self-management skills as part of their healthcare transition (HCT) from pediatric to adult-focused care. HCT/self-management skills have the potential to help mitigate health disparities among minority AYA with chronic conditions. This study investigated school nurses' practices promoting HCT/self-management skills in urban public schools. Methods: Seventy-nine nurses from three urban school districts in Massachusetts completed a survey of 32 Likert-type questions on HCT/self-management skills, eight demographic questions, and five open-ended practice questions assessing how often they have asked students with chronic conditions about HCT/self-management skills, based on the UNC TRxANSITION IndexTM. Results: Among the 79 school nurses who participated (response rate 76%), 67% never or rarely assessed students' knowledge of HCT/self-management, and 90% would use a tool that promotes/measures HCT/self-management skills. Conclusion: In our study sample, most school nurses acknowledged the importance of assessing HCT/self-management skills. The majority favored using a tool to promote these skills.

Exploring the potential of Chat-GPT as a supportive tool for sialendoscopy clinical decision making and patient information support

INTRODUCTION

Sialendoscopy has emerged in the last decades as a groundbreaking technique, offering a minimally invasive approach for exploring and managing salivary gland disorders. More recently, the advent of chatbots, powered by advanced natural processing language and artificial intelligence algorithms, has revolutionized the way healthcare professionals and patients access and analyze medical information and potentially will support soon the clinical decision-making process.

MATERIALS AND METHODS

A prospective, cross-sectional study was designed to assess the level of agreement between Chat-GPT and 10 expert sialendoscopists aiming the capabilities of Chat-GPT to further improve the management of salivary gland disorders.

RESULTS

The mean level of agreement was 3.4 (SD: 0.69; Min: 2, Max: 4) for Chat-GPT's answers while it was 4.1 (SD: 0.56; Min: 3, Max: 5) for the group of EESS (p < 0.015). The overall Wilcoxon signed-rank test yielded a significance level of p < 0.026 when comparing the level of agreement between Chat-GPT and EESS. The mean number of therapeutic alternatives suggested by Chat-GPT was 3.33 (SD: 1.2; Min: 2, Max: 5), while it was 2.6 (SD: 0.51; Min: 2, Max: 3) for the group of EESS; p = 0.286 (95% CI - 0.385 to 1.320).

CONCLUSION

Chat-GPT represents a promising tool in the clinical decision-making process within the salivary gland clinic, particularly for patients who are candidates for sialendoscopy treatment. Additionally, it serves as a valuable source of information for patients. However, further development is necessary to enhance the reliability of these tools and ensure their safety and optimal use in the clinical setting.

Barriers and Facilitators to Implementing Health Literacy Practices in a Pediatric ENT Clinic: A Mixed-Methods Study

BACKGROUND

Despite strong evidence of improved patient outcomes, clinicians have been slow to adopt health literacy practices.

PURPOSE

To identify facilitators and barriers to implementing health literacy practices into clinical care.

METHODS

Stakeholders (N = 40) completed surveys of acceptability, appropriateness, feasibility, conviction, and confidence with teach-back practices. Using the Consolidated Framework for Implementation Research (CFIR), interviews (n = 12) were conducted and analyzed.

RESULTS

Most reported high acceptability, appropriateness, and feasibility, but low confidence in using teach-back. Facilitators included leadership engagement and relative advantage. Barriers were related to compatibility due to time and workflow constraints. The CFIR-ERIC (Expert Recommendations for Implementing Change) Implementation Strategy Matching Tool was applied to select implementation strategies.

CONCLUSIONS

The CFIR framework along with the CFIR-ERIC Matching Strategy Tool helped the research team select strategies likely to yield successful implementation and sustained use of health literacy practices.

Changing society, changing research: integrating gender to better understand physical and psychological treatments use in chronic pain management

ABSTRACT

Treatment of chronic pain should be multimodal and include pharmacological, physical, and psychological treatments. However, because various barriers to physical and psychological treatments (PPTs) exist, a better understanding of biopsychosocial factors leading to their use is relevant. This study aimed to explore the association between gender identity, gender-stereotyped personality traits, and the use of PPTs in chronic pain management. The ChrOnic Pain trEatment cohort, a self-reported data infrastructure resulting from a web-based recruitment of 1935 people living with chronic pain (Quebec, Canada) was analyzed. Gender identity was operationalized as women, men, and nonbinary. Gender-stereotyped personality traits were measured using the Bem Sex-Role Inventory (feminine, masculine, androgynous, undifferentiated). A checklist of 31 types of PPTs that can be used for chronic pain management was presented to participants (yes/no). From the 1433 participants, 85.5% reported using at least one PPT. Hot-cold therapies (43.4%), exercise (41.9%), and meditation (35.2%) were the most frequently used PPTs, but most popular PPTs were not the same among women and men. Women reported a significantly higher use of PPTs in general (87.2% vs 77.2%; P < 0.001). Multivariable and interaction analyses showed that identifying as a man decreased the odds of reporting the use of PPTs (odds ratio: 0.32, 95% confidence interval: 0.11-0.92) but only among participants who scored high on both masculine and feminine personality traits (those classified as androgynous). The high prevalence of PPTs use found in our study is positive. Our results are relevant for a more personalized promotion of PPTs for chronic pain management.

Modifiable prognostic factors of high societal costs among people on sick leave due to musculoskeletal disorders: findings from an occupational cohort study

OBJECTIVES

The objective was to identify modifiable prognostic factors of high societal costs among people on sick leave due to musculoskeletal disorders, and to identify modifiable prognostic factors of high costs related to separately healthcare utilisation and productivity loss.

DESIGN

A prospective cohort study with a 1-year follow-up.

PARTICIPANTS AND SETTING

A total of 549 participants (aged 18-67 years) on sick leave (≥ 4 weeks) due to musculoskeletal disorders in Norway were included.

OUTCOME MEASURES AND METHOD

The primary outcome was societal costs aggregated for 1 year of follow-up and dichotomised as high or low, defined by the top 25th percentile. Secondary outcomes were high costs related to separately healthcare utilisation and productivity loss aggregated for 1 year of follow-up. Healthcare utilisation was collected from public records and included primary, secondary and tertiary healthcare use. Productivity loss was collected from public records and included absenteeism, work assessment allowance and disability pension. Nine modifiable prognostic factors were selected based on previous literature. Univariable and multivariable binary logistic regression analyses were performed to identify associations (crude and adjusted for selected covariates) between each modifiable prognostic factor and having high costs.

RESULTS

Adjusted for selected covariates, six modifiable prognostic factors associated with high societal costs were identified: pain severity, disability, self-perceived health, sleep quality, return to work expectation and long-lasting disorder expectation. Depressive symptoms, work satisfaction and health literacy showed no prognostic value. More or less similar results were observed when high costs were related to separately healthcare utilisation and productivity loss.

CONCLUSION

Factors identified in this study are potential target areas for interventions which could reduce high societal costs among people on sick leave due to musculoskeletal disorders. However, future research aimed at replicating these findings is warranted.

TRIAL REGISTRATION NUMBER

NCT04196634, 12 December 2019.

[Professional health literacy among nurses in Germany: Results of a quantitative, cross-sectional survey]

Professional health literacy among nurses in Germany: Results of a quantitative, cross-sectional survey Abstract. Background: Little is known about the professional health literacy (HL) of nurses, i.e., how well they are able to promote patients' HL. Existing studies have focused on personal HL, which does not entirely align with professional HL. Therefore, a new concept and questionnaire for professional HL have been developed and implemented for the first time. The results obtained for nurses in Germany are analysed with this article. Research question: It is asked how professional health literacy (HL) is distributed among nurses and which factors are associated with it. Methods: Data were collected through an online survey where nurses were asked about the difficulties they encounter in managing tasks in four dimensions: (1) information and knowledge management, (2) explaining and conveying information, (3) patient-centered communication, and (4) professional digital health literacy. Descriptive and multivariate, linear regression methods were used for analysis. Results: The 624 respondents rated the fourth dimension as the most difficult. The first and second dimensions were rated as similarly difficult, while the third dimension was considered least difficult. Higher professional HL is linked to better self-assessed training and framework conditions. Conclusion: Despite a relatively positive self-assessment, the results indicate areas that require improvement and should be addressed urgently.

Field based research in the era of the pandemic in resource limited settings: challenges and lessons for the future

The coronavirus pandemic that began in December 2019, has had an unprecedented impact on the global economy, health systems and infrastructure, in addition to being responsible for significant mortality and morbidity worldwide. The "new normal" has brought along, unforeseen challenges for the scientific community, owing to obstructions in conducting field-based research in lieu of minimizing exposure through in-person contact. This has had greater ramifications for the LMICs, adding to the already existing concerns. As a response to COVID-19 related movement restrictions, public health researchers across countries had to switch to remote data collections methods. However, impediments like lack of awareness and skepticism among participants, dependence on paper-based prescriptions, dearth of digitized patient records, gaps in connectivity, reliance on smart phones, concerns with participant privacy at home and greater loss to follow-up act as hurdles to carrying out a research study virtually, especially in resource-limited settings. Promoting health literacy through science communication, ensuring digitization of health records in hospitals, and employing measures to encourage research participation among the general public are some steps to tackle barriers to remote research in the long term. COVID-19 may not be a health emergency anymore, but we are not immune to future pandemics. A more holistic approach to research by turning obstacles into opportunities will not just ensure a more comprehensive public health response in the coming time, but also bolster the existing infrastructure for a stronger healthcare system for countries.

Relative predictive value of sociodemographic factors for chronic diseases among All of Us participants: a descriptive analysis

BACKGROUND

Although sociodemographic characteristics are associated with health disparities, the relative predictive value of different social and demographic factors remains largely unknown. This study aimed to describe the sociodemographic characteristics of All of Us participants and evaluate the predictive value of each factor for chronic diseases associated with high morbidity and mortality.

METHODS

We performed a cross-sectional analysis using de-identified survey data from the All of Us Research Program, which has collected social, demographic, and health information from adults living in the United States since May 2018. Sociodemographic data included self-reported age, sex, gender, sexual orientation, race/ethnicity, income, education, health insurance, primary care provider (PCP) status, and health literacy scores. We analyzed the self-reported prevalence of hypertension, coronary artery disease, any cancer, skin cancer, lung disease, diabetes, obesity, and chronic kidney disease. Finally, we assessed the relative importance of each sociodemographic factor for predicting each chronic disease using the adequacy index for each predictor from logistic regression.

RESULTS

Among the 372,050 participants in this analysis, the median age was 53 years, 59.8% reported female sex, and the most common racial/ethnic categories were White (54.0%), Black (19.9%), and Hispanic/Latino (16.7%). Participants who identified as Asian, Middle Eastern/North African, and White were the most likely to report annual incomes greater than $200,000, advanced degrees, and employer or union insurance, while participants who identified as Black, Hispanic, and Native Hawaiian/Pacific Islander were the most likely to report annual incomes less than $10,000, less than a high school education, and Medicaid insurance. We found that age was most predictive of hypertension, coronary artery disease, any cancer, skin cancer, diabetes, obesity, and chronic kidney disease. Insurance type was most predictive of lung disease. Notably, no two health conditions had the same order of importance for sociodemographic factors.

CONCLUSIONS

Age was the best predictor for the assessed chronic diseases, but the relative predictive value of income, education, health insurance, PCP status, race/ethnicity, and sexual orientation was highly variable across health conditions. Identifying the sociodemographic groups with the largest disparities in a specific disease can guide future interventions to promote health equity.

Dietary behaviors of rural residents in northeastern China: implications for designing intervention information and targeting high-risk population

Background

Dietary behavior is a pivotal modifiable determinant in reducing the occurrence of obesity/overweight and chronic non-communicable diseases. Improving the dietary behavior of rural residents in China is imminent due to the poor performance of their dietary behavior. Nutrition knowledge and health literacy are considered as elements that are linked intimately to healthy dietary behaviors but lack research in the Chinese setting.

Purpose

The study is designed to explore the relationship between nutritional knowledge, health literacy and dietary behaviors and to analyze the performance under different demographic characteristics.

Methods

A face-to-face survey of 400 rural residents on their nutrition knowledge, functional health literacy and dietary intake of five food categories consisting of 32 items was conducted based on a validated questionnaire. Descriptive analysis, difference test including ANOVA, t-test and non-parametric test, and multivariate linear regression were used for data analysis.

Results

The results indicate that declarative nutrition knowledge, individuals' information application capacity, and dietary behaviors, especially the intake of fruits, dairy and beans, and vegetable are not ideal and requires improvement. Male, elder, low-income, unmarried, and low-education populations performed significantly worse and were the high-risk group. Procedural nutrition knowledge, information access capacity, information understanding capacity, and information application capacity have remarkable effects on better dietary behavior.

Conclusion

This study provides evidence-based guidance for prioritizing information and populations for healthy dietary interventions.

Online artificial intelligence platforms and their applicability to gastrointestinal surgical operations

BACKGROUND

The internet is a common source of health information for patients. Interactive online artificial intelligence (AI) may be a more reliable source of health-related information than traditional search engines. This study aimed to assess the quality and perceived utility of chat-based AI responses related to 3 common gastrointestinal (GI) surgical procedures.

METHODS

A survey of 24 questions covering general perioperative information on cholecystectomy, pancreaticoduodenectomy (PD), and colectomy was created. Each question was posed to Chat Generative Pre-trained Transformer (ChatGPT) in June 2023, and the generated responses were recorded. The quality and perceived utility of responses were independently and subjectively graded by expert respondents specific to each surgical field. Grades were classified as "poor," "fair," "good," "very good," or "excellent."

RESULTS

Among the 45 respondents (general surgeon [n = 13], surgical oncologist [n = 18], colorectal surgeon [n = 13], and transplant surgeon [n = 1]), most practiced at an academic facility (95.6%). Respondents had been in practice for a mean of 12.3 years (general surgeon, 14.5 ± 7.2; surgical oncologist, 12.1 ± 8.2; colorectal surgeon, 10.2 ± 8.0) and performed a mean 53 index operations annually (cholecystectomy, 47 ± 28; PD, 28 ± 27; colectomy, 81 ± 44). Overall, the most commonly assigned quality grade was "fair" or "good" for most responses (n = 622/1080, 57.6%). Most of the 1080 total utility grades were "fair" (n = 279, 25.8%) or "good" (n = 344, 31.9%), whereas only 129 utility grades (11.9%) were "poor." Of note, ChatGPT responses related to cholecystectomy (45.3% ["very good"/"excellent"] vs 18.1% ["poor"/"fair"]) were deemed to be better quality than AI responses about PD (18.9% ["very good"/"excellent"] vs 46.9% ["poor"/"fair"]) or colectomy (31.4% ["very good"/"excellent"] vs 38.3% ["poor"/"fair"]). Overall, only 20.0% of the experts deemed ChatGPT to be an accurate source of information, whereas 15.6% of the experts found it unreliable. Moreover, 1 in 3 surgeons deemed ChatGPT responses as not likely to reduce patient-physician correspondence (31.1%) or not comparable to in-person surgeon responses (35.6%).

CONCLUSIONS

Although a potential resource for patient education, ChatGPT responses to common GI perioperative questions were deemed to be of only modest quality and utility to patients. In addition, the relative quality of AI responses varied markedly on the basis of procedure type.

Medical Doctors Approaches and Understanding of Health Literacy: A Systematic Literature Review

A physician's role is critical in fostering patient health literacy (HL) and influencing various aspects, including patient-physician communication and treatment effectiveness. The purpose of this systematic literature review is to analyze physicians' perspectives, comprehension, and management of HL. The focus of this review is on physicians' views, opinions, experiences, and strategies related to HL. We conducted comprehensive searches across seven databases, including PubMed, Scopus, ProQuest, Science Direct, Web of Science, The Cochrane Library, and Google Scholar. Original research articles published between January 1, 2009, and July 31, 2020, were considered for inclusion. This literature review incorporates qualitative studies and mixed-methods studies, with a focus on extracting qualitative data. Among the 22 articles included in our review, we employed the method of inductive thematic analysis for data analysis. A detailed description of the review methodology can be found in a previously published protocol available through PROSPERO (CRD42020212599). The themes that emerged from the thematic analysis include: (a) physicians' perception and management of HL; and (b) barriers. The results of the systematic review reveal that healthcare professionals exhibit varying perceptions of patients' HL levels and ascribe different meanings to it. However, none of them employ a specific measuring tool. While there appears to be no uniform approach to managing patients with low HL, some prioritize certain communication strategies, such as repetition, simplified language, and providing written instructions, among others. Most physicians cited multiple barriers that impede the development of patients' HL, including dysfunctions within the healthcare system, staff shortages, managing a large number of patients, limited time, work-related stress, cultural and socio-economic barriers, medical jargon, and language barriers. Considering the pivotal role of physicians in fostering patient HL, it is crucial to enhance medical education in addressing and managing HL, both within academic curricula and through continuing education seminars. Furthermore, there is a pressing need to improve healthcare professionals' working conditions, ensuring that each physician can allocate the necessary time to each patient based on their individual needs, without being hindered by stress-inducing work environments.

Health Literacy Analytics of Accessible Patient Resources in Cardiovascular Medicine: What are Patients Wanting to Know?

Introduction

There remains an increasing utilization of internet-based resources as a first line of medical knowledge. Among patients with cardiovascular disease, these resources often are relied upon for numerous diagnostic and therapeutic modalities. However, the reliability of this information is not fully understood. The aim of this study was to provide a descriptive profile on the literacy quality, readability, and transparency of publicly available educational resources in cardiology.

Methods

The frequently asked questions and associated online educational articles on common cardiovascular diagnostic and therapeutic interventions were investigated using publicly available data from the Google RankBrain machine learning algorithm after applying inclusion and exclusion criteria. Independent raters evaluated questions for Rothwell's Classification and readability calculations.

Results

Collectively, 520 questions and articles were evaluated across 13 cardiac interventions, resulting in 3,120 readability scores. The sources of articles were most frequently from academic institutions followed by commercial sources. Most questions were classified as "Fact" at 76.0% (n = 395), and questions regarding "Technical Details" of each intervention were the most common subclassification at 56.3% (n = 293).

Conclusions

Our data show that patients most often are using online search query programs to seek information regarding specific knowledge of each cardiovascular intervention rather than form an evaluation of the intervention. Additionally, these online patient educational resources continue to not meet grade-level reading recommendations.

Factors Influencing Telehealth Service Use and Health Outcomes in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis: Cross-Sectional Study

BACKGROUND

Several studies have demonstrated the efficacy and user acceptance of telehealth in managing patients with chronic conditions, including continuous ambulatory peritoneal dialysis (CAPD). However, the rates of telehealth service use in various patient groups have been low and have declined over time, which may affect important health outcomes. Telehealth service use in patients undergoing CAPD has been recognized as a key challenge that needs to be examined further.

OBJECTIVE

This study aimed to explore the rates of telehealth service use over 4 months, identify factors influencing its use, and examine the relationship between telehealth service use and health outcomes in Thai people undergoing CAPD.

METHODS

This cross-sectional study, which was a part of a pragmatic randomized controlled trial study, was conducted at a dialysis center in Bangkok, Thailand. The study included patients who were undergoing CAPD. These patients were randomly enrolled in the intervention group to receive telehealth service and additional standard care for 4 months. Data were collected using self-reported questionnaires, including a demographic form, Functional, Communicative, and Critical Health Literacy Scale, Perceived Usefulness Questionnaire, Brief Illness Perception Questionnaire, Patient-Doctor Relationship Questionnaire, and Kidney Disease Quality of Life 36 Questionnaire. Additionally, Google Analytics was used to obtain data on the actual use of the telehealth service. These data were analyzed using descriptive statistics, repeated-measures ANOVA, and regression analyses.

RESULTS

A total of 159 patients were included in this study. The mean rate of telehealth service use throughout the period of 4 months was 62.06 (SD 49.71) times. The rate of telehealth service use was the highest in the first month (mean 23.48, SD 16.28 times) and the lowest in the third month (mean 11.09, SD 11.48 times). Independent variables explained 27.6% of the sample variances in telehealth service use. Older age (β=.221; P=.002), higher perceived usefulness (β=.414; P<.001), unemployment (β=-.155; P=.03), and positive illness perception (β=-.205; P=.004) were associated with a significantly higher rate of telehealth service use. Regarding the relationship between telehealth service use and health outcomes, higher rates of telehealth service use were linked to better quality of life (β=.241; P=.002) and lower peritonitis (odds ratio 0.980, 95% CI 0.962-0.997; P=.03).

CONCLUSIONS

This study provides valuable insights into factors impacting telehealth service use, which in turn affect health outcomes in patients undergoing CAPD.

Interventions for improving health literacy in migrants

BACKGROUND

Health literacy (HL) is a determinant of health and important for autonomous decision-making. Migrants are at high risk for limited HL. Improving HL is important for equitable promotion of migrants' health.

OBJECTIVES

To assess the effectiveness of interventions for improving HL in migrants. To assess whether female or male migrants respond differently to the identified interventions.

SEARCH METHODS

We ran electronic searches to 2 February 2022 in CENTRAL, MEDLINE, Embase, PsycInfo and CINAHL. We also searched trial registries. We used a study filter for randomised controlled trials (RCTs) (RCT classifier).

SELECTION CRITERIA

We included RCTs and cluster-RCTs addressing HL either as a concept or its components (access, understand, appraise, apply health information).

DATA COLLECTION AND ANALYSIS

We used the methodological procedures recommended by Cochrane and followed the PRISMA-E guidelines. Outcome categories were: a) HL, b) quality of life (QoL), c) knowledge, d) health outcomes, e) health behaviour, f) self-efficacy, g) health service use and h) adverse events. We conducted meta-analysis where possible, and reported the remaining results as a narrative synthesis.

MAIN RESULTS

We included 28 RCTs and six cluster-RCTs (8249 participants), all conducted in high-income countries. Participants were migrants with a wide range of conditions. All interventions were adapted to culture, language and literacy. We did not find evidence that HL interventions cause harm, but only two studies assessed adverse events (e.g. anxiety). Many studies reported results for short-term assessments (less than six weeks after total programme completion), reported here. For several comparisons, there were also findings at later time points, which are presented in the review text. Compared with no HL intervention (standard care/no intervention) or an unrelated HL intervention (similar intervention but different information topic) Self-management programmes (SMP) probably improve self-efficacy slightly (standardised mean difference (SMD) 0.28, 95% confidence interval (CI) 0.06 to 0.50; 2 studies, 333 participants; moderate certainty). SMP may improve HIV-related HL (understanding (mean difference (MD) 4.25, 95% CI 1.32 to 7.18); recognition of HIV terms (MD 3.32, 95% CI 1.28 to 5.36)) (1 study, 69 participants). SMP may slightly improve health behaviours (3 studies, 514 participants), but may have little or no effect on knowledge (2 studies, 321 participants) or subjective health status (MD 0.38, 95% CI -0.13 to 0.89; 1 study, 69 participants) (low certainty). We are uncertain of the effects of SMP on QoL, health service use or adverse events due to a lack of evidence. HL skills building courses (HLSBC) may improve knowledge (MD 10.87, 95% CI 5.69 to 16.06; 2 studies, 111 participants) and any generic HL (SMD 0.48, 95% CI 0.20 to 0.75; 2 studies, 229 participants), but may have little or no effect on depression literacy (MD 0.17, 95% CI -1.28 to 1.62) or any health behaviour (2 studies, 229 participants) (low certainty). We are uncertain if HLSBC improve QoL, health outcomes, health service use, self-efficacy or adverse events, due to very low-certainty or a lack of evidence. Audio-/visual education without personal feedback (AVE) probably improves depression literacy (MD 8.62, 95% CI 7.51 to 9.73; 1 study, 202 participants) and health service use (MD -0.59, 95% CI -1.11 to -0.07; 1 study, 157 participants), but probably has little or no effect on health behaviour (risk ratio (RR) 1.07, 95% CI 0.91 to 1.25; 1 study, 135 participants) (moderate certainty). AVE may improve self-efficacy (MD 3.51, 95% CI 2.53 to 4.49; 1 study, 133 participants) and may slightly improve knowledge (MD 8.44, 95% CI -2.56 to 19.44; 2 studies, 293 participants) and intention to seek depression treatment (MD 1.8, 95% CI 0.43 to 3.17), with little or no effect on depression (SMD -0.15, 95% CI -0.40 to 0.10) (low certainty). No evidence was found for QoL and adverse events. Adapted medical instruction may improve understanding of health information (3 studies, 478 participants), with little or no effect on medication adherence (MD 0.5, 95% CI -0.1 to 1.1; 1 study, 200 participants) (low certainty). No evidence was found for QoL, health outcomes, knowledge, health service use, self-efficacy or adverse events. Compared with written information on the same topic SMP probably improves health numeracy slightly (MD 0.7, 95% CI 0.15 to 1.25) and probably improves print literacy (MD 9, 95% CI 2.9 to 15.1; 1 study, 209 participants) and self-efficacy (SMD 0.47, 95% CI 0.3 to 0.64; 4 studies, 552 participants) (moderate certainty). SMP may improve any disease-specific HL (SMD 0.67, 95% CI 0.27 to 1.07; 4 studies, 955 participants), knowledge (MD 11.45, 95% CI 4.75 to 18.15; 6 studies, 1101 participants) and some health behaviours (4 studies, 797 participants), with little or no effect on health information appraisal (MD 1.15, 95% CI -0.23 to 2.53; 1 study, 329 participants) (low certainty). We are uncertain whether SMP improves QoL, health outcomes, health service use or adverse events, due to a lack of evidence or low/very low-certainty evidence. AVE probably has little or no effect on diabetes HL (MD 2, 95% CI -0.15 to 4.15; 1 study, 240 participants), but probably improves information appraisal (MD -9.88, 95% CI -12.87 to -6.89) and application (RR 1.51, 95% CI 1.29 to 1.77) (1 study, 608 participants; moderate certainty). AVE may slightly improve knowledge (MD 8.35, 95% CI -0.32 to 17.02; low certainty). No short-term evidence was found for QoL, depression, health behaviour, self-efficacy, health service use or adverse events. AVE compared with another AVE We are uncertain whether narrative videos are superior to factual knowledge videos as the evidence is of very low certainty. Gender differences Female migrants' diabetes HL may improve slightly more than that of males, when receiving AVE (MD 5.00, 95% CI 0.62 to 9.38; 1 study, 118 participants), but we do not know whether female or male migrants benefit differently from other interventions due to very low-certainty or a lack of evidence.

AUTHORS' CONCLUSIONS

Adequately powered studies measuring long-term effects (more than six months) of HL interventions in female and male migrants are needed, using well-validated tools and representing various healthcare systems.

Evaluating health claim assessment skills of parents with preschool children: A cross-sectional study using Informed Health Choices Claim Evaluation Tool

Background

Health literacy is a global problem and is particularly relevant when making health care decisions about small children. We analysed how parents of preschool children assess health claims and explored the predictors of their assessment skill.

Methods

We conducted a survey with questions from the Claim Evaluation Tools (CET) database, part of the Informed Health Choices (IHC) project, in ten paediatric primary care practices of the Split-Dalmatia County Health Center, Split, Croatia, from 1 February to 31 March 2023. Eligible participants were parents accompanying preschool-aged children for check-ups. We also collected data on parents' and children's demographic and health characteristics (including the presence of any chronic illness in the child), visits to paediatric emergency service, hospitalisations, vaccination status, the presence of chronic illness of parents or relatives, and whether parents had to made treatment decisions for themselves and/or their family member.

Results

Overall, 402 parents of preschool children (median age 35 years (interquartile range (IQR) = 31.0-38.3)) had a median IHC CET test score of 10.0 (IQR = 8.0-11.0) out of 12 questions. The multiple regression analysis showed that female gender, higher level of education, being employed, and having a history of a visit to paediatric emergency service were significant predictors of the test score, explaining 21.9% of the variance.

Conclusions

Parents of preschool children have a very good ability for critical assessment of health-related statements in a complex health care system and an environment of generally unsatisfactory health literacy. Further studies should explore how parents understand health claims in different geographical, socio-economic and cultural setting, and explore educational interventions to increase critical thinking abilities and informed decision-making, especially among fathers, unemployed parents and those with lower levels of education.

Toward Shared Decision-Making in Degenerative Cervical Myelopathy: Protocol for a Mixed Methods Study

BACKGROUND

Health care decisions are a critical determinant in the evolution of chronic illness. In shared decision-making (SDM), patients and clinicians work collaboratively to reach evidence-based health decisions that align with individual circumstances, values, and preferences. This personalized approach to clinical care likely has substantial benefits in the oversight of degenerative cervical myelopathy (DCM), a type of nontraumatic spinal cord injury. Its chronicity, heterogeneous clinical presentation, complex management, and variable disease course engenders an imperative for a patient-centric approach that accounts for each patient's unique needs and priorities. Inadequate patient knowledge about the condition and an incomplete understanding of the critical decision points that arise during the course of care currently hinder the fruitful participation of health care providers and patients in SDM. This study protocol presents the rationale for deploying SDM for DCM and delineates the groundwork required to achieve this.

OBJECTIVE

The study's primary outcome is the development of a comprehensive checklist to be implemented upon diagnosis that provides patients with essential information necessary to support their informed decision-making. This is known as a core information set (CIS). The secondary outcome is the creation of a detailed process map that provides a diagrammatic representation of the global care workflows and cognitive processes involved in DCM care. Characterizing the critical decision points along a patient's journey will allow for an effective exploration of SDM tools for routine clinical practice to enhance patient-centered care and improve clinical outcomes.

METHODS

Both CISs and process maps are coproduced iteratively through a collaborative process involving the input and consensus of key stakeholders. This will be facilitated by Myelopathy.org, a global DCM charity, through its Research Objectives and Common Data Elements for Degenerative Cervical Myelopathy community. To develop the CIS, a 3-round, web-based Delphi process will be used, starting with a baseline list of information items derived from a recent scoping review of educational materials in DCM, patient interviews, and a qualitative survey of professionals. A priori criteria for achieving consensus are specified. The process map will be developed iteratively using semistructured interviews with patients and professionals and validated by key stakeholders.

RESULTS

Recruitment for the Delphi consensus study began in April 2023. The pilot-testing of process map interview participants started simultaneously, with the formulation of an initial baseline map underway.

CONCLUSIONS

This protocol marks the first attempt to provide a starting point for investigating SDM in DCM. The primary work centers on developing an educational tool for use in diagnosis to enable enhanced onward decision-making. The wider objective is to aid stakeholders in developing SDM tools by identifying critical decision junctures in DCM care. Through these approaches, we aim to provide an exhaustive launchpad for formulating SDM tools in the wider DCM community.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/46809.

Neighborhood context and children's health care utilization and health outcomes: a comprehensive descriptive analysis of national survey data

While child health and health care disparities arising from unequal distribution of resources are well documented, a nationally representative inventory of health and well-being for children across the spectrum of opportunity is lacking. Using the nationally representative sample of children from pooled 2013-2017 Medical Expenditure Panel Survey data linked to the census-tract-level Child Opportunity Index 2.0, a composite measure of neighborhood health, education, and socioeconomic conditions, we describe US children's socioeconomic characteristics, health care utilization and expenditures across the spectrum of child neighborhood opportunity levels. We found that neighborhood level of child opportunity was associated with almost all of children's health status, health care utilization, expenditures, access to care, and satisfaction with care outcomes. Children living in lower-opportunity neighborhoods had the highest rates of poor physical and mental health status and fewest ambulatory care visits but accounted for the highest share of emergency department visits. Their parents were also least likely to report having positive experiences with health care, good communication with providers, and easy access to care. Our findings underscore the myriad harms to children of gaps in health, education, and financial resources at the community level and provide targets for public investments to improve child-focused outcomes.

Efficacy of AI Chats to Determine an Emergency: A Comparison Between OpenAI's ChatGPT, Google Bard, and Microsoft Bing AI Chat

Background The escalating overload and saturation of emergency services, primarily caused by non-urgent cases overwhelming the system, have spurred a critical necessity for innovative solutions that can effectively differentiate genuine emergencies from situations that could be managed through alternative means, such as using AI chatbots. This study aims to evaluate and compare the accuracy in differentiating between a medical emergency and a non-emergency of three of the most popular AI chatbots at the moment. Methods In this study, patient questions from the online forum r/AskDocs on Reddit were collected to determine whether their clinical cases were emergencies. A total of 176 questions were reviewed by the authors, with 75 deemed emergencies and 101 non-emergencies. These questions were then posed to AI chatbots, including ChatGPT, Google Bard, and Microsoft Bing AI, with their responses evaluated against each other and the authors' responses. A criteria-based system categorized the AI chatbot answers as "yes," "no," or "cannot determine." The performance of each AI chatbot was compared in both emergency and non-emergency cases, and statistical analysis was conducted to assess the significance of differences in their performance. Results In general, AI chatbots considered around 12-15% more cases to be an emergency than reviewers, while they considered a very low number of cases as non-emergency compared to reviewers (around 35% fewer cases). Google Bard detected the most true emergency cases (87%) and true non-emergency cases (36%). However, no real difference in performance between the three AI chatbots was found in detecting true emergencies (p-value = 0.35) and non-emergency cases (p-value = 0.16).  Conclusions These AI systems require further refinement to identify emergency situations accurately, but they could potentially be an innovative tool for emergency care and improving patient outcomes. The integration of AI chatbots like ChatGPT, Google Bard, and Microsoft Bing Chat offers a promising avenue to mitigate ED strain and enhance emergency management.

Sex and gender differences in healthcare utilisation trajectories: a cohort study among Quebec workers living with chronic pain

OBJECTIVES

Chronic pain (CP) is a poorly recognised and frequently inadequately treated condition affecting one in five adults. Reflecting on sociodemographic disparities as barriers to CP care in Canada was recently established as a federal priority. The objective of this study was to assess sex and gender differences in healthcare utilisation trajectories among workers living with CP.

DESIGN

Retrospective cohort study.

PARTICIPANTS

This study was conducted using the TorSaDE Cohort which links the 2007-2016 Canadian Community Health Surveys and Quebec administrative databases (longitudinal claims). Among 2955 workers living with CP, the annual number of healthcare contacts was computed during the 3 years after survey completion.

OUTCOME

Group-based trajectory modelling was used to identify subgroups of individuals with similar patterns of healthcare utilisation over time (healthcare utilisation trajectories).

RESULTS

Across the study population, three distinct 3-year healthcare utilisation trajectories were found: (1) low healthcare users (59.9%), (2) moderate healthcare users (33.6%) and (3) heavy healthcare users (6.4%). Sex and gender differences were found in the number of distinct trajectories and the stability of the number of healthcare contacts over time. Multivariable analysis revealed that independent of other sociodemographic characteristics and severity of health condition, sex-but not gender-was associated with the heavy healthcare utilisation longitudinal trajectory (with females showing a greater likelihood; OR 2.6, 95% CI 1.6 to 4.1).

CONCLUSIONS

Our results underline the importance of assessing sex-based disparities in help-seeking behaviours, access to healthcare and resource utilisation among persons living with CP.

Forecasting User Interests Through Topic Tag Predictions in Online Health Communities

The increasing reliance on online communities for healthcare information by patients and caregivers has led to the increase in the spread of misinformation, or subjective, anecdotal and inaccurate or non-specific recommendations, which, if acted on, could cause serious harm to the patients. Hence, there is an urgent need to connect users with accurate and tailored health information in a timely manner to prevent such harm. This article proposes an innovative approach to suggesting reliable information to participants in online communities as they move through different stages in their disease or treatment. We hypothesize that patients with similar histories of disease progression or course of treatment would have similar information needs at comparable stages. Specifically, we pose the problem of predicting topic tags or keywords that describe the future information needs of users based on their profiles, traces of their online interactions within the community (past posts, replies) and the profiles and traces of online interactions of other users with similar profiles and similar traces of past interaction with the target users. The result is a variant of the collaborative information filtering or recommendation system tailored to the needs of users of online health communities. We report results of our experiments on two unique datasets from two different social media platforms which demonstrates the superiority of the proposed approach over the state of the art baselines with respect to accurate and timely prediction of topic tags (and hence information sources of interest).

Comparing Physician and Artificial Intelligence Chatbot Responses to Patient Questions Posted to a Public Social Media Forum

Importance

The rapid expansion of virtual health care has caused a surge in patient messages concomitant with more work and burnout among health care professionals. Artificial intelligence (AI) assistants could potentially aid in creating answers to patient questions by drafting responses that could be reviewed by clinicians.

Objective

To evaluate the ability of an AI chatbot assistant (ChatGPT), released in November 2022, to provide quality and empathetic responses to patient questions.

Design, Setting, and Participants

In this cross-sectional study, a public and nonidentifiable database of questions from a public social media forum (Reddit's r/AskDocs) was used to randomly draw 195 exchanges from October 2022 where a verified physician responded to a public question. Chatbot responses were generated by entering the original question into a fresh session (without prior questions having been asked in the session) on December 22 and 23, 2022. The original question along with anonymized and randomly ordered physician and chatbot responses were evaluated in triplicate by a team of licensed health care professionals. Evaluators chose "which response was better" and judged both "the quality of information provided" (very poor, poor, acceptable, good, or very good) and "the empathy or bedside manner provided" (not empathetic, slightly empathetic, moderately empathetic, empathetic, and very empathetic). Mean outcomes were ordered on a 1 to 5 scale and compared between chatbot and physicians.

Results

Of the 195 questions and responses, evaluators preferred chatbot responses to physician responses in 78.6% (95% CI, 75.0%-81.8%) of the 585 evaluations. Mean (IQR) physician responses were significantly shorter than chatbot responses (52 [17-62] words vs 211 [168-245] words; t = 25.4; P < .001). Chatbot responses were rated of significantly higher quality than physician responses (t = 13.3; P < .001). The proportion of responses rated as good or very good quality (≥ 4), for instance, was higher for chatbot than physicians (chatbot: 78.5%, 95% CI, 72.3%-84.1%; physicians: 22.1%, 95% CI, 16.4%-28.2%;). This amounted to 3.6 times higher prevalence of good or very good quality responses for the chatbot. Chatbot responses were also rated significantly more empathetic than physician responses (t = 18.9; P < .001). The proportion of responses rated empathetic or very empathetic (≥4) was higher for chatbot than for physicians (physicians: 4.6%, 95% CI, 2.1%-7.7%; chatbot: 45.1%, 95% CI, 38.5%-51.8%; physicians: 4.6%, 95% CI, 2.1%-7.7%). This amounted to 9.8 times higher prevalence of empathetic or very empathetic responses for the chatbot.

Conclusions

In this cross-sectional study, a chatbot generated quality and empathetic responses to patient questions posed in an online forum. Further exploration of this technology is warranted in clinical settings, such as using chatbot to draft responses that physicians could then edit. Randomized trials could assess further if using AI assistants might improve responses, lower clinician burnout, and improve patient outcomes.

Scoping review of outpatient health services utilization among women

BACKGROUND

Health services utilization, as one of the mechanisms of the health system, guarantees a healthy life and improves well-being for everyone.

AIMS

The aim of this study was to identify factors affecting the use of outpatient health services among women.

METHODS/DESIGNS

This scoping review examined the studies related to outpatient health services utilization (OHSU) and its determinants among women. This review was conducted on English language studies published between 2010 and 2023 (All searches were conducted on 20 January 2023). Studies available in databases such as Web of Science, MEDLINE (PubMed), Scopus, Wiley library, Proquest, and Google Scholar were searched manually. Selected keywords and their equivalents were used to search for related articles in each database.

RESULTS

A total of 18 795 articles were identified, of which 37 met the inclusion criteria. Findings showed that age, marital status, level of education, employment status, income level, socioeconomic status, rape experience, health insurance, health status, ethnicity, living in rural areas, quality of services, area of residence, having a purpose in life and access to health services affect OHSU among women.

CONCLUSIONS

The results of the present review showed that in order to achieve the universal goals of health services coverage and health service utilization, it is necessary for countries to provide insurance coverage to the maximum number of people. Also, policies should change in favor of the elderly, poor and low-income, low-educated, rural, ethnic minority, and chronically ill women and provide them with free preventive health services.

Shifts in Diabetes Health Literacy Policy and Practice in Australia-Promoting Organisational Health Literacy

Improving organisational health literacy ensures people can navigate, understand and use essential health information and services. However, systematic reviews have identified limited evidence for practical approaches to implementing such organisational change, particularly at a national level. This study aimed to (a) investigate the approach taken by an Australian national diabetes organisation-Diabetes Australia, as the administrator of the National Diabetes Services Scheme (NDSS)-to improve organisational health literacy over a 15-year-period and (b) examine the impact of organisational changes on the health literacy demands of health information. We performed an environmental scan, examining the websites of the NDSS, Diabetes Australia and the Australian government for reports and position statements describing organisational health literacy policies and practices between 2006 and 2021. The Patient Education Materials Assessment Tool (PEMAT) was applied to consecutively published NDSS diabetes self-care fact sheets (n = 20) to assess changes in the health literacy demands (understandability and actionability) of these fact sheets over the same period. We identified nine policies resulting in 24 health literacy practice changes or projects between 2006 and 2021, applied using a streamlined incremental approach and group reflexivity. The incremental approach focused on (1) increasing audience reach, (2) consistency and branding, (3) person-centred language and (4) the understandability and actionability of health information. The PEMAT scores of fact sheets improved between 2006 and 2021 for understandability (53% to 79%) and actionability (43% to 82%). Diabetes Australia's information development process leveraging national policies, employing an incremental approach and group reflexivity has improved the health literacy demands of diabetes information and serves as a template for other organisations seeking to improve their organisational health literacy.

Wound healing and healing process in patients with diabetic foot ulcers: A survival analysis study

AIMS

This study aimed to identify demographic, clinical, and psychological contributors to DFU healing and favorable healing process.

METHODS

Patients with a chronic DFU were evaluated at baseline (T0; n = 153), two months later (T1; n = 108), and six months later (T2; n = 71). Patients were evaluated on health literacy, perceived stress, anxiety, depression, and illness perceptions. Cox proportional hazard models were built to analyze the predictors of DFU healing and favorable healing process (wound area reduction), including the assessment of time to achieve those outcomes.

RESULTS

More than half of patients had their DFU healed (56.1%) or showed a favorable healing process (83.6%). Median time for healing was 112 days, while for favorable process was 30 days. Illness perceptions were the only predictor of wound healing. Being female , with adequate health literacy, and a first DFU predicted a favorable healing process.

CONCLUSIONS

This is the first study showing that beliefs about DFU are significant predictors of DFU healing, and that health literacy is a significant predictor of a favorable healing process. Brief, comprehensive interventions should be implemented, at the treatment initial stage, in order to change misperceptions and to promote DFU literacy and better health outcomes.

Health Literacy in Orthopaedics

Health literacy is a dynamic, multifaceted skill set that relies on patients, healthcare providers, and the healthcare system. In addition, health literacy assessment provides an avenue for evaluating patient understanding and offers insights into their health management capabilities. Inadequate health literacy results in poor patient outcomes and compromised care by considerably hindering successful communication and comprehension of relevant health information between the patient and the provider. In this narrative review, we explore why limited health literacy poses serious implications for orthopaedic patient health and safety, expectations, treatment outcomes, and healthcare costs. Furthermore, we elaborate on the complexity of health literacy, provide an overview of key concepts, and offer recommendations for clinical practice and research investigations.

Developing a Health Literacy Scale for adults in Hong Kong: A modified e-Delphi study with healthcare consumers and providers

INTRODUCTION

Health literacy (HL) refers to individuals' abilities to process and use health information to promote health. This study aimed to develop the first HL measurement tool for the Chinese Hong Kong population.

METHODS

A two-phase methodology was adopted. In Phase I, evidence synthesis with a deductive method was conducted to formulate the item list from the literature. In Phase II, a modified e-Delphi survey was conducted among stakeholders (i.e., healthcare providers and healthcare consumers) to confirm the content validity of the item list. The stakeholders were invited to rate the relevance of each draft item on a 4-point scale and provide suggestions for revisions, removal or adding new items.

RESULTS

In Phase I, a total of 34 items covering functional, interactive and critical HL were generated. In Phase II, to obtain a balanced view from experts and laypeople, healthcare professionals (n = 12) and consumers (n = 12) were invited to participate in the Delphi panel. The response rates of the three rounds were 100%. After the third round, the consensus was reached for 31 items, and no further comments for adding or revising items were received. All items exhibited excellent content validity (item content validity index: 0.79-1.00; K*: 0.74-1.00).

CONCLUSIONS

A Health Literacy Scale for Hong Kong was developed. Compared with existing HL scales, the scale fully operationalized the skills involved in functional, interactive and critical HL. The Delphi study shows evidence supporting the high content validity of all items in the scale. In future studies, these items should undergo rigorous testing to examine their psychometric properties in our target population groups. By illuminating the details in the development process, this paper provides a deeper understanding of the scale's scope and limitations for others who are interested in using this tool.

PATIENT OR PUBLIC CONTRIBUTION

Public as healthcare consumers, in addition to healthcare providers, were involved in developing a new HL scale for this study. The input from the public contributed to examining the scale's content validity by judging whether all items reflected the skills that they need to find and use health-related information in their daily life.

Health Literacy in Orthopedic Surgery: A Systematic Review

Background: Limited health literacy has been associated with adverse health outcomes. Undergoing orthopedic surgery often requires patients to make complex decisions and adhere to complicated instructions, suggesting that health literacy skills might have a profound impact on orthopedic surgery outcomes. Purpose: We sought to review the literature for studies investigating the level of health literacy in patients undergoing orthopedic surgery and also to assess how those studies report factors affecting health equity. Methods: We conducted a systematic search of PubMed, Embase, and Cochrane Library for all health literacy studies published in the orthopedic surgery literature up to February 8, 2022. Search terms included synonyms for health literacy and for all orthopedic surgery subspecialties. Two reviewers independently extracted study data in addition to indicators of equity reporting using the PROGRESS+ checklist (Place of Residence, Race/Ethnicity, Occupation, Gender/sex, Religion, Education, Social capital, Socioeconomic status, plus age, disability, and sexual orientation). Results: The search resulted in 616 studies; 9 studies remained after exclusion criteria were applied. Most studies were of arthroplasty (4/9; 44%) or trauma (3/9; 33%) patients. Validated health literacy assessments were used in 4 of the included studies, and only 3 studies reported the rate of limited health literacy in the patients studied, which ranged between 34% and 38.5%. At least one PROGRESS+ item was reported in 88% (8/9) of the studies. Conclusions: We found a paucity of appropriately designed studies that used validated measures of health literacy in the field of orthopedic surgery. The potential impact of health literacy on orthopedic patients and their outcomes has yet to be elucidated. Thoughtful, high-quality trials across diverse demographics and geographies are warranted.

Association of Health Literacy and Health Care Utilization Among Glaucoma Patients

PRCIS

Among 7846 adults with self-reported glaucoma, low health literacy (LHL) was associated with fewer outpatient ophthalmological follow-up visits, utilization of a greater number of ocular hypotensive medication classes, and higher costs for glaucoma medications.

PURPOSE

Previous studies found LHL is associated with increased difficulty with treatment adherence among adults with glaucoma, which can lead to poor outcomes. This study examined patterns of glaucoma health care utilization associated with LHL.

METHODS

We analyzed 7846 adults with self-reported glaucoma enrolled in the 1996-2017 Medical Expenditure Panel Survey. Adult glaucoma patients with LHL (defined by National Assessment of Adult Literacy score <226) were the compared with those with high health literacy. Multivariable regression models were constructed to examine the association of LHL with number of outpatient glaucoma visits, prescription medications, polypharmacy (≥2 ocular hypotensive classes prescribed), and associated costs.

RESULTS

Self-reported glaucoma diagnosis was associated with higher rates of LHL [23.9% vs. 9.7%, odds ratio (95% CI): 2.43 (2.25-2.62), P <0.0001]. Among those with glaucoma, LHL was associated with fewer glaucoma outpatient visits [risk ratio: 0.94 (0.89-0.99), P =0.02] and the use of a greater number of ocular hypotensive medications [1.06 (1.01-1.12), P =0.03]. Moreover, those with LHL had higher health care spending on prescription medications [mean: $556.40 vs. $471.87, β (95% CI): $57.05 ($30.22-$83.87)]. Adult glaucoma patients with LHL were also more likely to have polypharmacy [odds ratio (95% CI): 1.26 (1.01-1.59)].

CONCLUSION

LHL was more prevalent in patients with glaucoma, compared with those without. Glaucoma patients with LHL were prescribed more medications and had higher medication costs, however, they had fewer outpatient glaucoma visits. Improved glaucoma patient education to address LHL is needed, in addition to studies to understand the impact of these findings on treatment outcomes.