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Meyers N, Costich M, Abrams MA, Friedman S, Gupta A, Morrison A, Wood M, Solano J. Prioritizing Health Literacy Educational Objectives for Pediatric Residents - A Delphi Study. Acad Pediatr 2024:S1876-2859(24)00234-1. [PMID: 38959997 DOI: 10.1016/j.acap.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/04/2024] [Accepted: 06/21/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE Children of caregivers with limited health literacy are at risk of poorer health outcomes. Thus, health literacy-informed communication tools are critical to achieving a more equitable health system. However, there is no agreement on the health literacy skills pediatric residents should attain. We used Delphi methodology to establish consensus on health literacy objectives to inform development of a pediatric resident curriculum. METHODS Our Delphi panel participated in 3 rounds of anonymous surveys to rank the importance of health literacy objectives in pediatric resident education. Consensus was defined as ≥70% of panelists identifying an objective as essential or 100% agreeing an objective was recommended or essential. RESULTS Thirteen pediatric health literacy experts comprised a racially, geographically, and professionally-diverse panel. After 3 survey rounds, 27 of the initial 65 objectives met consensus. All final objectives aligned with Accreditation Council for Graduate Medical Education (ACGME) core competencies. CONCLUSIONS A panel of pediatric health literacy experts established consensus on health literacy objectives specific to pediatric resident training. These prioritized objectives align with ACGME core competencies, as well as evidence-based strategies like teach-back, and newer considerations like addressing organizational health literacy. They should inform future health literacy curricula and assessment within pediatric residency programs.
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Affiliation(s)
- Nicole Meyers
- NewYork-Presbyterian/Columbia University Irving Medical Center, Department of Pediatrics, 622 West 168th Street, New York, NY 10032, United States.
| | - Marguerite Costich
- Columbia University Irving Medical Center, Department of Pediatrics, 622 West 168th Street, New York, NY 10032, United States.
| | - Mary Ann Abrams
- The Ohio State University College of Medicine, Department of Pediatrics, Nationwide Children's Hospital, 700 Childrens Drive, Columbus, OH 43205, United States.
| | - Suzanne Friedman
- Columbia University Irving Medical Center, Department of Pediatrics, 622 West 168th Street, New York, NY 10032, United States.
| | - Aditi Gupta
- Baylor College of Medicine, Department of Pediatrics, 1 Baylor Plaza, Houston, TX 77030, United States.
| | - Andrea Morrison
- CommunicateMD, 361 Falls Rd #71177, Grafton, WI 53024, North Valley Emergency Specialists, 1200 Harger Rd #408, Oak Brook, IL 60523, United States.
| | - Margaret Wood
- Baylor College of Medicine, Department of Pediatrics, 1 Baylor Plaza, Houston, TX 77030, United States.
| | - Joy Solano
- Children's Mercy Kansas City, Department of Pediatrics, 2401 Gillham Road, Kansas City, MO 64108, United States.
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Melhado C, Kao E, Evans L, Stephens CQ, Lee H, Jensen AR. Evaluating Health Literacy in Families of Injured Children: A Prospective Observational Cohort Study at a Level One Pediatric Trauma Center. J Pediatr Surg 2024; 59:1315-1318. [PMID: 38614949 DOI: 10.1016/j.jpedsurg.2024.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/05/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Low health literacy (HL) has been associated with poor health outcomes in children. Optimal recovery after pediatric injury requires caregiver participation in complicated rehabilitative and medical aftercare. We aimed to quantify HL among guardians of injured children and identify factors associated with low HL of guardians. METHODS A prospective observational cohort study was conducted to evaluate the HL using the Newest Vital Sign™ of guardians of injured children (≤18 years) admitted to a level 1 pediatric trauma center. Patient and guardian characteristics were compared across levels of HL using univariate statistics. We conducted multivariable logistic regression to identify factors independently-associated with low HL. RESULTS A sample of 95 guardian-child dyads were enrolled. The majority of guardians had low HL (n = 52, 55%), followed by moderate HL (n = 36, 38%) and high HL (n = 7, 7%). Many families received public benefits (n = 47, 49%) and 12 guardians (13%) had both housing and employment insecurity. Guardians with low HL were significantly more likely to have insecure housing and not have completed any college. CONCLUSION The majority of injured children had a primary guardian with low HL. Pediatric trauma centers should consider screening for low HL to ensure that families have adequate post-discharge support. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Caroline Melhado
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, UCSF Benioff Children's Hospitals, San Francisco, CA, USA.
| | - Emily Kao
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, UCSF Benioff Children's Hospitals, San Francisco, CA, USA
| | - Lauren Evans
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, UCSF Benioff Children's Hospitals, San Francisco, CA, USA
| | - Caroline Q Stephens
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, UCSF Benioff Children's Hospitals, San Francisco, CA, USA
| | - Hanmin Lee
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, UCSF Benioff Children's Hospitals, San Francisco, CA, USA
| | - Aaron R Jensen
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, UCSF Benioff Children's Hospitals, San Francisco, CA, USA
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Coffin A, Elder B, Luercio M, Ahuja N, Barber R, DeCamp LR, Encalada K, Fan AL, Farkas JS, Jain P, Johnson TM, Mallick N, Wilder JL, Yang TJ, Yin HS, Lion KC, Khan A. Creating Culturally Adapted Multilingual Materials for Research. Pediatrics 2024; 154:e2023063988. [PMID: 38860305 DOI: 10.1542/peds.2023-063988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 06/12/2024] Open
Abstract
Patients who speak languages other than English are frequently excluded from research. This exclusion exacerbates inequities, biases results, and may violate federal regulations and research ethics. Language justice is the right to communicate in an individual's preferred language to address power imbalances and promote equity. To promote language justice in research, we propose a method to translate and culturally-adapt multifaceted research materials into multiple languages simultaneously. Our method involves a multistep approach, including professional translation, review by bilingual expert panels to refine and reach consensus, and piloting or cognitive interviews with patients and families. Key differences from other translation approaches (eg, the World Health Organization) include omitting back-translation, given its limited utility in identifying translation challenges, and limiting expert panelist and piloting-participant numbers for feasibility. We detail a step-by-step approach to operationalizing this method and outline key considerations learned after utilizing this method to translate materials into 8 languages other than English for an ongoing multicenter pediatric research study on family safety-reporting. Materials included family brochures, surveys, and intervention materials. This approach took ∼6 months overall at a cost of <$2000 per language (not including study personnel costs). Key themes across the project included (1) tailor scope to timeline, budget, and resources, (2) thoughtfully design English source materials, (3) identify and apply guiding principles throughout the translation and editing process, and (4) carefully review content and formatting to account for nuances across multiple languages. This method balances feasibility and rigor in translating participant-facing materials into multiple languages simultaneously, advancing language justice in research.
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Affiliation(s)
- Alyssa Coffin
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Brynn Elder
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Marcella Luercio
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Namrata Ahuja
- Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Rebecca Barber
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California
| | - Lisa Ross DeCamp
- Department of Pediatrics, University of Colorado School of Medicine Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado
- Adult and Child Center for Outcomes Research and Delivery Science, Aurora, Colorado
- Latino Research and Policy Center, Anschutz Medical Campus, Aurora, Colorado
| | - Karen Encalada
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York
| | - Angela L Fan
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Jonathan S Farkas
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York
- Department of Pediatrics, New York University Langone Health and Bellevue Hospital Center, New York, New York
| | - Pia Jain
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Tyler M Johnson
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Nandini Mallick
- Family Advisory Council, Boston Children's Hospital, Boston, Massachusetts
| | - Jayme L Wilder
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Tracy J Yang
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - H Shonna Yin
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - K Casey Lion
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
- Department of Pediatrics, University of Washington School of Medicine, Seattle Washington
| | - Alisa Khan
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Han YY, Gutwein A, Apter A, Celedón JC. Health literacy and asthma: An update. J Allergy Clin Immunol 2024; 153:1241-1251. [PMID: 38135010 PMCID: PMC11070295 DOI: 10.1016/j.jaci.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/09/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Abstract
The US Department of Health and Human Services has defined health literacy (HL) as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Structural and social determinants of health lead to low HL in approximately 36% of adults in the United States, where this condition is most prevalent in racial and ethnic minorities, economically disadvantaged communities, and immigrants with limited English proficiency. In turn, low HL can worsen asthma outcomes through direct effects (eg, nonadherence to or incorrect use of medications) and indirect effects (eg, an unhealthy diet leading to obesity, a risk factor for asthma morbidity). The purpose of this update is to examine evidence from studies on low HL and health and asthma outcomes published in the last 12 years, identify approaches to improve HL and reduce health disparities in asthma, and discuss future directions for research in this area under the conceptual framework of a socioecological model that illustrates the multifactorial and interconnected complexity of this public health issue at different levels.
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Affiliation(s)
- Yueh-Ying Han
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
| | - Amanda Gutwein
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
| | - Andrea Apter
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pa
| | - Juan C Celedón
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa.
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Baranwal P, Sathe M, Lobritto SJ, Vittorio J. The impact of health literacy on adolescent and young adult pediatric liver transplant recipients. Liver Transpl 2024; 30:386-394. [PMID: 37812071 DOI: 10.1097/lvt.0000000000000283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023]
Abstract
Pediatric liver transplant recipients have increased rates of morbidity and mortality following transfer to adult health care providers. The role of health literacy (HL) has not been adequately assessed in this population and may be an unrecognized barrier to successful health care transition. We sought to determine the impact of HL for patients and their caregivers on measures of transition readiness (TR), adherence, health-related quality of life, and medical outcomes following pediatric liver transplant. This is a single-center study of pediatric liver transplant recipients transplanted between the ages of 12 and 26 from October 2016 through August 2020. Patients and caregivers completed 4 surveys to evaluate TR, health-related quality of life, and HL. Clinical outcomes were stratified based on the presence or absence of adequate HL. Limited HL was identified in 57.0% of recipients and 47.4% of caregivers. Patients with limited HL were more likely to be younger in age ( p = 0.004), Hispanic ( p = 0.003), and less likely to have obtained a high school diploma or equivalent ( p < 0.001). Patients with adequate HL demonstrated significantly higher levels of TR ( p < 0.001). Patient HL did not impact health-related quality of life, adherence, or medical outcomes. Caregiver HL did not impact patient outcomes or adherence, though higher levels of caregiver education were associated with adequate patient HL ( p = 0.049). This study demonstrates that limited HL is associated with decreased measures of TR. Inadequate HL may be an unrecognized barrier to a successful health care transition. Regular assessment of HL may provide an opportunity for intervention prior to transfer of care. Future studies should investigate the impact of these interventions on long-term medical outcomes.
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Affiliation(s)
- Prerana Baranwal
- Division of Pediatric Gastroenterology, Nutrition, and Liver Diseases, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mihika Sathe
- Departments of Internal Medicine and Pediatrics, Inova Health, Annandale, Virginia, USA
| | - Steven J Lobritto
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Columbia University Irving Medical Center, New York, New York, USA
| | - Jennifer Vittorio
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, New York University (NYU) Langone Health, New York University School of Medicine, New York, New York, USA
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Cheng JW, Christakis DA, Kieran K, Niessen BA, Fernandez N, Merguerian PA, Chang EK, Shnorhavorian M. Association between YouTube® videos and health literacy with postoperative healthcare utilization following pediatric urologic surgery: A randomized trial. J Pediatr Urol 2024; 20:226.e1-226.e9. [PMID: 38071113 DOI: 10.1016/j.jpurol.2023.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/07/2023] [Accepted: 11/21/2023] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Limited caregiver health literacy has been associated with poorer health outcomes in pediatric patients and may limit caregiver understanding of printed education resources. Postoperative healthcare utilization may be related to confusion about instructions or complications. OBJECTIVE To correlate caregiver health literacy and educational video intervention with postoperative healthcare utilization following ambulatory pediatric urologic surgery. STUDY DESIGN From July through December 2021, a randomized double-blinded trial assessed postoperative healthcare utilization following pediatric urologic surgery. Caregivers were randomized to receive standardized postoperative counseling and printed instructions (control) or access to English-language educational YouTube® videos with standardized postoperative counseling and printed instructions (intervention). Medical record abstraction was completed 30 days following surgery to identify postoperative healthcare utilization with calls, messages, add-on clinic visits, or presentation for urgent or emergent care, and postoperative complications. RESULTS Target enrollment was achieved with 400 caregivers with 204 in the intervention and 196 in the control groups. There was a 32.5 % overall rate of postoperative healthcare utilization. Health literacy was inversely associated with total postoperative healthcare utilization (p < 0.001). There was no difference in the incidence of postoperative healthcare utilization between the control and intervention groups (p = 0.623). However, on sub-analysis of caregivers with postoperative healthcare utilization (Summary Figure), there were fewer total occurrences in the intervention group (intervention median 1, IQR 1,2.3; control median 2, IQR 1,3; p < 0.001). For caregivers with limited health literacy, there was a greater associated reduction in median calls from 2 (IQR 0,2) to 0 (IQR 0,0.5) with video intervention (p = 0.016). On multivariate analysis, total postoperative healthcare utilization was significantly associated with limited caregiver health literacy (OR 1.08; p = 0.004), English as preferred language (OR 0.68; p = 0.018), and older patient age (OR 0.95; p = 0.001). DISCUSSION Current resources for postoperative education are limited as resources can be written above recommended reading levels and families can have difficulty recalling information discussed during postoperative counseling. Video intervention is an underutilized resource that can provide an additional resource to families with visual and auditory aids and be accessed as needed. CONCLUSION Caregiver health literacy was inversely associated with postoperative healthcare utilization. There was no difference in the incidence of postoperative healthcare utilization with video intervention. However, on subgroup analysis, supplemental videos were associated with fewer occurrences of postoperative healthcare utilization, especially in caregivers with limited health literacy. On multivariate regression, health literacy, preferred language, and patient age were significantly associated with total postoperative healthcare utilization.
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Affiliation(s)
- Julie W Cheng
- Seattle Children's Hospital, Division of Urology, United States; University of Washington, Department of Urology, United States; Oregon Health and Science University, Department of Urology, United States.
| | | | - Kathleen Kieran
- Seattle Children's Hospital, Division of Urology, United States; University of Washington, Department of Urology, United States.
| | - Brett A Niessen
- Seattle Children's Hospital, Patient and Family Education and Communication, United States.
| | - Nicolas Fernandez
- Seattle Children's Hospital, Division of Urology, United States; University of Washington, Department of Urology, United States.
| | - Paul A Merguerian
- Seattle Children's Hospital, Division of Urology, United States; University of Washington, Department of Urology, United States.
| | - Edward K Chang
- University of Washington, Department of Urology, United States.
| | - Margarett Shnorhavorian
- Seattle Children's Hospital, Division of Urology, United States; University of Washington, Department of Urology, United States.
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Howe CJ, Lewis B, Edmondson S. Barriers and Facilitators to Implementing Health Literacy Practices in a Pediatric ENT Clinic: A Mixed-Methods Study. J Nurs Care Qual 2024; 39:106-113. [PMID: 37729004 DOI: 10.1097/ncq.0000000000000744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
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.
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Affiliation(s)
- Carol J Howe
- Author Affiliations: Harris College of Nursing & Health Sciences, Texas Christian University, Fort Worth (Dr Howe); Department of Nursing, Children's Health, Dallas, Texas (Dr Lewis); and Medical School, The University of Texas Southwestern Medical Center, Dallas (Ms Edmondson)
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Bayne M, Chirico I, Wei L, Galanter C. Impact of Illness Severity Tools on Adolescent Psychiatric Managed Care in California. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:162-171. [PMID: 38051430 DOI: 10.1007/s10488-023-01323-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 12/07/2023]
Abstract
Youth with mental illness struggle to receive essential behavioral health care. One obstacle is denial of coverage by insurance. In California, managed care consumers may apply for independent medical review (IMR) which potentially overturns an insurance denial through the California Department of Managed Healthcare (CDMHC). The authors aim to analyze IMR appeals for psychiatric treatment among adolescents and elucidate factors associated with obtaining coverage of care. We performed an analysis to identify factors that are associated with depression and substance use disorder (SUD) treatment claim denials in 11-20-year-olds from 2001 to 2022 using CDMHC data. Logistic regression modeling was used to identify specific factors related to claim characteristics and medical society instruments that are significantly associated with overturning a denial by IMR. Behavioral health IMRs are overturned at a higher rate than non-behavioral health claims. 54.5% of those with depression and 36.3% of those with SUD initially denied care coverage were overturned by IMR. For those seeking depression treatment, we found a significantly greater odds of overturn by IMR if there was a reference of CALOCUS [1.64, 95%CI (1.06-2.5)]. The odds of a SUD treatment denial being overturned was significantly greater if referencing CALOCUS [3.85 (1.54-9.62)] or ASAM [2.47, [4.3 (1.77-10.47)]. After the standardized implementation of illness severity tools in IMRs, the odds of a medically necessary claim being overturned was 2.5 times higher than before the standards. With a high percentage of claims being overturned after IMR, the findings suggest that health plans inappropriately deny medically necessary behavioral health treatment. The use of medical society instruments was associated with higher odds of overturning a denial. The recent decision of CDMHC to implement standard use of CALOCUS and similar illness severity criteria is supported by our findings and may facilitate more equitable care.
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Affiliation(s)
- Mitchell Bayne
- State University of New York (SUNY) Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, 11203, USA.
| | - Isabella Chirico
- Mount Sinai Morningside West, 1090 Amsterdam Ave, New York, NY, 10025, USA
| | - Lulu Wei
- State University of New York (SUNY) Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - Cathryn Galanter
- State University of New York (SUNY) Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
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Selzer A, Eibensteiner F, Kaltenegger L, Hana M, Laml-Wallner G, Geist MB, Mandler C, Valent I, Arbeiter K, Mueller-Sacherer T, Herle M, Aufricht C, Boehm M. Parents' understanding of medication at discharge and potential harm in children with medical complexity. Arch Dis Child 2024; 109:215-221. [PMID: 38041681 DOI: 10.1136/archdischild-2022-325119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Children with medical complexity (CMC) are among the most vulnerable patient groups. This study aimed to evaluate their prevalence and risk factors for medication misunderstanding and potential harm (PH) at discharge. DESIGN AND SETTING Cross-sectional study at a tertiary care centre. STUDY POPULATION CMC admitted at Medical University of Vienna between May 2018 and January 2019. INTERVENTION CMC and caregivers underwent a structured interview at discharge; medication understanding and PH for adverse events were assessed by a hybrid approach. MAIN OUTCOME MEASURES Medication misunderstanding rate; PH. RESULTS For 106 included children (median age 9.6 years), a median number of 5.0 (IQR 3.0-8.0) different medications were prescribed. 83 CMC (78.3%) demonstrated at least one misunderstanding, in 33 CMC (31.1%), potential harm was detected, 5 of them severe. Misunderstandings were associated with more medications (r=0.24, p=0.013), new prescriptions (r=0.23, p=0.019), quality of medication-related communication (r=-0.21, p=0.032), low level of education (p=0.013), low language skills (p=0.002) and migratory background (p=0.001). Relative risk of PH was 2.27 times increased (95% CI 1.23 to 4.22) with new medications, 2.14 times increased (95% CI 1.10 to 4.17) with migratory background. CONCLUSION Despite continuous care at a tertiary care centre and high level of subjective satisfaction, high prevalence of medication misunderstanding with relevant risk for PH was discovered in CMC and their caregivers. This demonstrates the need of interventions to improve patient safety, with stratification of medication-related communication for high-risk groups and a restructured discharge process focusing on detection of misunderstandings ('unknown unknowns').
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Affiliation(s)
- Axana Selzer
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria
| | - Fabian Eibensteiner
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria
| | - Lukas Kaltenegger
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria
| | - Michelle Hana
- Drug Information and Clinical Pharmacy, Institutional Pharmacy, University Hospital Vienna, Vienna, Austria
| | - Gerda Laml-Wallner
- Drug Information and Clinical Pharmacy, Institutional Pharmacy, University Hospital Vienna, Vienna, Austria
| | - Matthias Benjamin Geist
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria
| | - Christopher Mandler
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria
| | - Isabella Valent
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria
| | - Klaus Arbeiter
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria
| | - Thomas Mueller-Sacherer
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria
| | - Marion Herle
- Drug Information and Clinical Pharmacy, Institutional Pharmacy, University Hospital Vienna, Vienna, Austria
| | - Christoph Aufricht
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria
| | - Michael Boehm
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria
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Donelle L, Hiebert B, Hall J. An investigation of mHealth and digital health literacy among new parents during COVID-19. Front Digit Health 2024; 5:1212694. [PMID: 38333052 PMCID: PMC10850289 DOI: 10.3389/fdgth.2023.1212694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 12/29/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction Especially during the COVID-19 pandemic, parents were expected to understand increasingly sophisticated information about health issues and healthcare systems and access online resources as a part of their caregiving role. Yet little is known about parents' online digital technology use and digital health literacy skill. This study aimed to investigate parents' digital technology use, their self-reported digital health literacy skill, and demographic information as potential factors influencing their use of digital technologies. Methods An online survey utilizing convenience sampling was administered to new parents during the COVID-19 pandemic that inquired about their demographic information, digital technology use, and digital health literacy skills within Ontario, Canada. Results A total of 151 individuals responded to the survey; these were primarily mothers (80%) who self-reported as white (72%), well-educated 86%), heterosexual (86%) females (85%) with incomes over $100,00 per year (48%). Participants reported consistent and persistent online activity related to their parenting role and mostly via mobile smartphone devices (92%). Participants had moderate to high digital health literacy skills, greater than the Canadian national average. Almost half of participants reported negative health and well-being consequences from their digital online behaviours. There were no significant relationships between technology use, digital health literacy skill, and demographic variables. Discussion The COVID-19 pandemic has reinforced the need for and importance of effective and equitable digital health services. Important opportunities exist within clinical practice and among parenting groups to proactively address the physical and mental health implications of digital parenting practices. Equally important are opportunities to insert into clinical workflow the inquiry into parents' online information-seeking behaviours, and to include digital health literacy as part of prenatal/postnatal health education initiatives.
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Affiliation(s)
- Lorie Donelle
- College of Nursing, University of South Carolina, Columbia, SC, United States
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Brad Hiebert
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Jodi Hall
- School of Nursing, Fanshawe College, London, ON, Canada
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Tiong K, Palmer GM, Jaaniste T. Attrition from Face-to-Face Pediatric Outpatient Chronic Pain Interventions: A Narrative Review and Theoretical Model. CHILDREN (BASEL, SWITZERLAND) 2024; 11:126. [PMID: 38275436 PMCID: PMC10814025 DOI: 10.3390/children11010126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Abstract
There is limited understanding of attrition (premature treatment withdrawal and non-completion) from pediatric chronic pain services. This narrative review aimed to summarize attrition prevalence from face-to-face pediatric outpatient chronic pain interventions, identify associated factors and develop a theoretical model to account for attrition in this setting. A comprehensive search of the published literature revealed massive variability (0-100%) in the reported attrition rates from pediatric chronic pain interventions that varied in type and format (individual vs. group, single discipline vs. interdisciplinary, psychological only vs. multiple combined interventions, of different durations). The factors associated with attrition from pediatric chronic pain programs varied between the studies: some have assessed patient sex, psychological and other comorbidities, avoidance strategies, missed schooling, family composition/tensions, caregiver catastrophizing, scheduling, caregiver leave and clinic access. A theoretical model is presented depicting youth, caregiver and service factors that may impact attrition from pediatric chronic pain interventions. Where available, literature is drawn from the pediatric chronic pain context, but also from adult chronic pain and pediatric weight management fields. The implications for research and clinical practice are discussed, including improved reporting, patient screening and targeted supports to promote intervention completion. This review contributes to a better understanding of attrition, which is crucial for optimizing pediatric chronic pain service outcomes.
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Affiliation(s)
- Kristen Tiong
- School of Clinical Medicine, University of New South Wales, Kensington, NSW 2052, Australia;
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Greta M. Palmer
- Children’s Pain Management Service, Department of Anaesthesia and Pain Management, Royal Children’s Hospital, Melbourne, VIC 3052, Australia;
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
| | - Tiina Jaaniste
- School of Clinical Medicine, University of New South Wales, Kensington, NSW 2052, Australia;
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
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12
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Carroll AR, Johnson JA, Stassun JC, Greevy RA, Mixon AS, Williams DJ. Health Literacy-Informed Communication to Reduce Discharge Medication Errors in Hospitalized Children: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2350969. [PMID: 38227315 DOI: 10.1001/jamanetworkopen.2023.50969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
Abstract
Importance Inadequate communication between caregivers and clinicians at hospital discharge contributes to medication dosing errors in children. Health literacy-informed communication strategies during medication counseling can reduce dosing errors but have not been tested in the pediatric hospital setting. Objective To test a health literacy-informed communication intervention to decrease liquid medication dosing errors compared with standard counseling in hospitalized children. Design, Setting, and Participants This parallel, randomized clinical trial was performed from June 22, 2021, to August 20, 2022, at a tertiary care, US children's hospital. English- and Spanish-speaking caregivers of hospitalized children 6 years or younger prescribed a new, scheduled liquid medication at discharge were included in the analysis. Interventions Permuted block (n = 4) randomization (1:1) to a health literacy-informed discharge medication communication bundle (n = 99) compared with standard counseling (n = 99). A study team member delivered the intervention consisting of a written, pictogram-based medication instruction sheet, teach back (caregivers state information taught), and demonstration of dosing with show back (caregivers show how they would draw the liquid medication in the syringe). Main Outcome and Measures Observed dosing errors, assessed using a caregiver-submitted photograph of their child's medication-filled syringe and expressed as the percentage difference from the prescribed dose. Secondary outcomes included caregiver-reported medication knowledge. Outcome measurements were blinded to participant group assignment. Results Among 198 caregivers randomized (mean [SD] age, 31.4 [6.5] years; 186 women [93.9%]; 36 [18.2%] Hispanic or Latino and 158 [79.8%] White), the primary outcome was available for 151 (76.3%). The observed mean (SD) percentage dosing error was 1.0% (2.2 percentage points) among the intervention group and 3.3% (5.1 percentage points) among the standard counseling group (absolute difference, 2.3 [95% CI, 1.0-3.6] percentage points; P < .001). Twenty-four of 79 caregivers in the intervention group (30.4%) measured an incorrect dose compared with 39 of 72 (54.2%) in the standard counseling group (P = .003). The intervention enhanced caregiver-reported medication knowledge compared with the standard counseling group for medication dose (71 of 76 [93.4%] vs 55 of 69 [79.7%]; P = .03), duration of administration (65 of 76 [85.5%] vs 49 of 69 [71.0%]; P = .04), and correct reporting of 2 or more medication adverse effects (60 of 76 [78.9%] vs 13 of 69 [18.8%]; P < .001). There were no differences in knowledge of medication name, indication, frequency, or storage. Conclusions and Relevance A health literacy-informed discharge medication communication bundle reduced home liquid medication administration errors and enhanced caregiver medication knowledge compared with standard counseling. Routine use of these standardized strategies can promote patient safety following hospital discharge. Trial Registration ClinicalTrials.gov Identifier: NCT05143047.
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Affiliation(s)
- Alison R Carroll
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jakobi A Johnson
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Justine C Stassun
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Robert A Greevy
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Amanda S Mixon
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Internal Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Derek J Williams
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
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13
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Reddy AR, Doshi AK, Mak A, Shea JA, Fardad JT, Moon J, Hu P, Garcia-Marcinkiewicz AG. Assessing the health literacy of caregivers in the pediatric intensive care unit: a mixed-methods study. Front Pediatr 2023; 11:1308673. [PMID: 38188919 PMCID: PMC10771288 DOI: 10.3389/fped.2023.1308673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/01/2023] [Indexed: 01/09/2024] Open
Abstract
Background Limited health literacy is associated with increased hospitalizations, emergency visits, health care costs, and mortality. The health literacy levels of caregivers of critically ill children are unknown. This mixed-methods study aims to quantitatively assess the health literacy of caregivers of children admitted to the pediatric intensive care unit (PICU) and qualitatively describe facilitators and barriers to implementing health literacy screening from the provider perspective. Methods Caregivers of patients admitted to our large, academic PICU (between August 12, 2022 and March 31, 2023) were approached to complete a survey with the Newest Vital Sign (NVS), which is a validated health literacy screener offered in English and Spanish. We additionally conducted focus groups of interdisciplinary PICU providers to identify factors which may influence implementation of health literacy screening using the Consolidated Framework for Implementation Research (CFIR) framework. Results Among 48 surveyed caregivers, 79% demonstrated adequate health literacy using the Newest Vital Sign screener. The majority of caregivers spoke English (96%), were mothers (85%), and identified as White (75%). 83% of caregivers were able to attend rounds at least once and 98% believed attending rounds was helpful. Within the PICU provider focus groups, there were 11 participants (3 attendings, 3 fellows, 2 nurse practitioners, 1 hospitalist, 2 research assistants). Focus group participants described facilitators and barriers to implementation, which were mapped to CFIR domains. Timing of screening and person administering screening were identified as modifiable factors to improve future implementation. Conclusion We found the health literacy levels of PICU caregivers in our setting is similar to prior assessments of parental health literacy. Participation in morning rounds was helpful for developing understanding of their child's illness, regardless of health literacy status. Qualitative feedback from providers identified barriers across all CFIR domains, with timing of screening and person administering screening as modifiable factors to improve future implementation.
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Affiliation(s)
- Anireddy R. Reddy
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
| | - Anushree K. Doshi
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Allison Mak
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
- Department of General Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Judy A. Shea
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
- Department of Medicine, Perelman School of Medicine and University of Pennsylvania, Philadelphia, PA, United States
| | - Joana T. Fardad
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Jiwon Moon
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Paula Hu
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Annery G. Garcia-Marcinkiewicz
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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Sescu D, Chansiriwongs A, Minta KJ, Vasudevan J, Kaliaperumal C. Early Preventive Strategies and CNS Meningioma - Is This Feasible? A Comprehensive Review of the Literature. World Neurosurg 2023; 180:123-133. [PMID: 37774783 DOI: 10.1016/j.wneu.2023.09.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Meningiomas are one of the most common benign primary brain tumors; however, there is a paucity of literature on potential preventability. This comprehensive review aimed to explore the existing evidence for the potential risk factors that may contribute to meningioma development and to discuss early prevention strategies. METHODS Literature search was conducted via MEDLINE, Embase, Web of Science, and Cochrane Database to retrieve existing literature on various environmental exposures and lifestyle behaviors that are potential risk factors for the development of meningiomas. RESULTS Significant risk factors included exposure to ionizing radiation and certain environmental chemicals. Notably, this study also identified that cigarette smoking and obesity are associated with the development of meningiomas. To date, wireless phone usage, hormonal exposures, dietary factors, and traumatic brain injury remain inconclusive. Early prevention strategies should primarily be family-driven, community-based, and public health-endorsed strategies. Targeting unhealthy behaviors through healthcare organizations could execute a pivotal role in the maintenance of an optimum lifestyle, reducing the development of risk factors pertinent to meningiomas. CONCLUSIONS To our knowledge, this is the first study that offers a perspective on prevention of meningiomas. A causal relationship of risk factors in developing meningiomas cannot be directly established with the current evidence. We are aware of the limitations of the hypothesis, but we believe that this study will raise more awareness and our findings could potentially be endorsed by organizations promoting health across the globe. Further prospective and retrospective studies will shed more light on this topic and help establish a definitive relationship.
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Affiliation(s)
- Daniel Sescu
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom.
| | - Aminta Chansiriwongs
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Katarzyna Julia Minta
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Jyothi Vasudevan
- Department of Community Medicine, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Bahour, Puducherry, India
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15
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Gosliner W, Ritchie LD. Bold Action Needed for Equitable Access to Nutrition Assistance by All. Am J Public Health 2023; 113:S202-S205. [PMID: 38118095 PMCID: PMC10733885 DOI: 10.2105/ajph.2023.307483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 12/22/2023]
Affiliation(s)
- Wendi Gosliner
- Wendi Gosliner and Lorrene D. Ritchie are with the Nutrition Policy Institute, University of California Agriculture and Natural Resources, Oakland, CA
| | - Lorrene D Ritchie
- Wendi Gosliner and Lorrene D. Ritchie are with the Nutrition Policy Institute, University of California Agriculture and Natural Resources, Oakland, CA
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16
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Glick AF, Farkas JS, Gadhavi J, Mendelsohn AL, Schulick N, Yin HS. Pediatric Resident Communication of Hospital Discharge Instructions. Health Lit Res Pract 2023; 7:e178-e186. [PMID: 37812910 PMCID: PMC10561625 DOI: 10.3928/24748307-20230918-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/18/2023] [Indexed: 10/11/2023] Open
Abstract
OBJECTIVE Suboptimal provider-parent communication contributes to poor parent comprehension of pediatric discharge instructions, which can lead to adverse outcomes. Residency is a critical window to acquire and learn to utilize key communication skills, potentially supported by formal training programs or visual reminders. Few studies have examined resident counseling practices or predictors of counseling quality. Our objectives were to (1) examine pediatric resident counseling practices and (2) determine how formal training and presence of discharge templates with domain-specific prompts are associated with counseling. METHODS We conducted a cross-sectional survey of a convenience sample of residents in the American Academy of Pediatrics Section on Pediatric Trainees. Outcomes included resident self-report of frequency of (1) counseling in domains of care and (2) use of health literacy-informed counseling strategies (pictures, demonstration, Teach Back, Show Back) (6-point scales; frequent = often/usually/always). Predictor variables were (1) formal discharge-related training (e.g., lectures) and (2) hospital discharge instruction template with space for individual domains. Logistic regression analyses, utilizing generalized estimating equations when appropriate to account for multiple domains (adjusting for resident gender, postgraduate year), were performed. KEY RESULTS Few residents (N = 317) (13.9%) reported formal training. Over 25% of residents infrequently counsel on side effects, diagnosis, and restrictions. Resident reported use of communication strategies was infrequent: drawing pictures (24.1%), demonstration (15.8%), Teach Back (36.8%), Show Back (11.4%). Designated spaces in instruction templates for individual domains were associated with frequent domain-specific counseling (adjusted odds ratio [aOR] 4.1 [95% confidence interval: 3.5-4.8]). Formal training was associated with frequent Teach Back (aOR 2.6 [1.4-5.1]) and Show Back (aOR 2.7 [1.2-6.2]). CONCLUSIONS Lack of formal training and designated space for domain-specific instructions are associated with suboptimal counseling at discharge by pediatric residents. Future research should focus on determining the best mechanisms for teaching trainees communication skills and optimizing written instruction templates to support verbal counseling. [HLRP: Health Literacy Research and Practice. 2023;7(4):e178-e186.].
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Affiliation(s)
- Alexander F. Glick
- Address correspondence to Alexander F. Glick, MD, MS, Department of Pediatrics, NYU Grossman School of Medicine/Bellevue Hospital Center, 462 First Avenue, New York, NY 10016;
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17
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Kaplan C, Kranidis A, Saint-Fleur AL, Christophides A, Kier C. Bridging the Gap from Acute to Chronic Care: Partnerships and Tools for Pediatric Asthma. Pediatr Rev 2023; 44:578-584. [PMID: 37777653 DOI: 10.1542/pir.2022-005599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Affiliation(s)
- Carl Kaplan
- Stony Brook Children's Hospital, Stony Brook, NY
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18
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Stewart TA, Perrin EM, Yin HS. Addressing Health Literacy in Pediatric Practice: A Health Equity Lens. Pediatr Clin North Am 2023; 70:745-760. [PMID: 37422312 DOI: 10.1016/j.pcl.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
Low health literacy has been linked to worse child health-related knowledge, behaviors, and outcomes across multiple health domains. As low health literacy is highly prevalent and an important mediator of income- and race/ethnicity-associated disparities, provider adoption of health literacy best practices advances health equity. A multidisciplinary effort involving all providers engaged in communication with families should include a universal precautions approach, with clear communication strategies employed with all patients, and advocacy for health system change.
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Affiliation(s)
- Tiffany A Stewart
- Department of Pediatrics, New York University Grossman School of Medicine / Bellevue Hospital Center, 550 First Avenue, NBV 8S4-11, New York, NY 10016, USA
| | - Eliana M Perrin
- Department of Pediatrics, Johns Hopkins School of Medicine / School of Nursing, 200 North Wolfe Street, Rubenstein Building 2071, Baltimore, MD 21287, USA
| | - Hsiang Shonna Yin
- Department of Pediatrics, New York University Grossman School of Medicine / Bellevue Hospital Center, 550 First Avenue, NBV 8S4-11, New York, NY 10016, USA; Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
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19
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Keith KE, Wadhwa A, York J, Fazeli PL, Bhatia S, Landier W. Health Literacy in Parents of Children Newly Diagnosed With Cancer and Comprehension of Key Concepts Related to Their Child's Care. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2023; 40:235-244. [PMID: 37063061 DOI: 10.1177/27527530221140076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Background: There is a paucity of literature regarding health literacy in pediatric oncology. We sought to understand the relationship between health literacy and comprehension of key new diagnosis education concepts in parents of children newly diagnosed with cancer. Methods: Using data from a study evaluating a structured new diagnosis discharge teaching intervention, we performed a secondary analysis to understand the relationship between parental health literacy (Brief Health Literacy Screener: BHLS) and comprehension of six key concepts (child's diagnosis, primary oncologist, and treatment plan; seeking emergent care; fever definition; re-dosing medication). We also evaluated the association between parents self-reported sociodemographic characteristics, preferred learning style (one-item ordinal assessment) and health literacy. We tested relationships using Fisher's exact tests, independent samples t-tests, and Pearson correlations. Results: Fifty parents participated (age 35.4 ± 8.2 years [M ± SD]; 86% female; 60% non-Hispanic white; 24% with ≤high school education); nine parents (18%) scored in the BHLS low literacy range; 80% correctly responded to all six items on the key concepts questionnaire (100% comprehension). Health literacy was not significantly related to 100% comprehension or to individual key concept responses, with the exception of "child's treatment plan" (correct responses: 55.6% in low vs. 100% in adequate literacy groups; p < .001). Parental sociodemographic characteristics and preferred learning styles were not significantly related to health literacy. Discussion:Despite variability in health literacy levels, 80% of the parents comprehended all key concepts, suggesting that the intervention was effective for most parents, regardless of health literacy level.
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Affiliation(s)
- K Elizabeth Keith
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Aman Wadhwa
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jocelyn York
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Wendy Landier
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Hansen DA, Stevenson EL, Johnson R, Teague M. Incorporating a Patient Education Video With Provider Consultation to Improve Patient Satisfaction and Reduce Consultation Time Among New Patients Seeking Cosmetic Injections. PLASTIC AND AESTHETIC NURSING 2023; 43:79-83. [PMID: 37001002 DOI: 10.1097/psn.0000000000000492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
The field of aesthetics is expanding more rapidly than ever before, bringing with it an influx of new-to-aesthetics patients who lack industry knowledge. We investigated ways to bridge this gap in knowledge and provide patients with important procedural information and also increase their satisfaction and confidence. We implemented this project to improve the delivery of preprocedural patient education via the implementation of an educational video. We collected data over a 16-week period and analyzed the results of the pre- and post-video implementation. We found that implementing the educational video decreased the average time the provider spent consulting with new patients considering injectable neuromodulators or dermal fillers. We also found that using the video increased the patient's preprocedural confidence and postprocedural satisfaction. Based on the results of our quality improvement project, we concluded that implementing a patient education video before performing cosmetic injectable procedures improved patient confidence and satisfaction and decreased provider consultation times.
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Carroll AR, Schlundt D, Bonnet K, Mixon AS, Williams DJ. Caregiver and Clinician Perspectives on Discharge Medication Counseling: A Qualitative Study. Hosp Pediatr 2023; 13:325-342. [PMID: 36987806 PMCID: PMC10071429 DOI: 10.1542/hpeds.2022-006937] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
OBJECTIVES Children are at increased risk for medication errors and the transition from hospital-to-home is a vulnerable time for errors to occur. This study aimed to explore the perspectives of multidisciplinary clinicians and caregivers regarding discharge medication counseling and to develop a conceptual model to inform intervention efforts to reduce discharge medication dosing errors. METHODS We conducted semistructured interviews with clinicians and caregivers of children <4 years old discharged from the hospital on a liquid medication. A hierarchical coding system was developed using the interview guide and several transcripts. Qualitative analysis employed an iterative inductive-deductive approach to identify domains and subthemes and inform a conceptual framework. RESULTS We conducted focus groups and individual interviews with 17 caregivers and 16 clinicians. Using the Donabedian structure-process-outcomes model of quality evaluation, domains and subthemes included: (1) infrastructure of healthcare delivery, including supplies for counseling, content and organization of discharge instructions, clinician training and education, roles and responsibilities of team members, and hospital pharmacy delivery and counseling program; (2) processes of healthcare delivery, including medication reconciliation, counseling content, counseling techniques, and language barriers and health literacy; and (3) measurable outcomes, including medication dosing accuracy and caregiver understanding and adherence to discharge instructions. CONCLUSIONS The conceptual model resulting from this analysis can be applied to the development and evaluation of interventions to reduce discharge medication dosing errors following a hospitalization. Interventions should use a health literacy universal precautions approach-written materials with plain language and pictures and verbal counseling with teach-back and show-back.
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Affiliation(s)
- Alison R. Carroll
- Divisions of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt
| | - David Schlundt
- Department of Psychology (College of Arts and Science), Vanderbilt University, Nashville, Tennessee
| | - Kemberlee Bonnet
- Vanderbilt Center for Health Services Research, Qualitative Research Core, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Amanda S. Mixon
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Internal Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Derek J. Williams
- Divisions of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt
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Rennane S, Dick A. Effects of Medicaid Automatic Enrollment on Disparities in Insurance Coverage and Caregiver Burden for Children with Special Health Care Needs. Med Care Res Rev 2023; 80:65-78. [PMID: 35788159 DOI: 10.1177/10775587221106116] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We analyze how Medicaid automatic enrollment policies for children with special health care needs (CSHCN) who are enrolled in Supplemental Security Income (SSI) reduce disparities in health insurance coverage and caregiving burden. Using the 2009-2010 National Survey of Children with Special Health Care Needs, we implement a difference-in-differences regression model comparing insurance enrollment rates between CSHCN receiving SSI and CSHCN not receiving SSI, in states with and without automatic enrollment policies. We find that Medicaid automatic enrollment has a meaningful impact on insurance enrollment for low-income CSHCN who participate in SSI and can be an effective method for mitigating disparities in insurance coverage (reducing uninsurance by 38%). Medicaid automatic enrollment also reduces caregiver burden among socioeconomically disadvantaged families with CSHCN. The effects of these policies are largest families who might be on the margin of eligibility or who face high administrative burden.
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Chen A, Demaestri S, Schweiberger K, Sidani J, Wolynn R, Chaves-Gnecco D, Hernandez R, Rothenberger S, Mickievicz E, Cowden JD, Ragavan M. Inclusion of Non-English-Speaking Participants in Pediatric Health Research: A Review. JAMA Pediatr 2023; 177:81-88. [PMID: 36315130 PMCID: PMC10854994 DOI: 10.1001/jamapediatrics.2022.3828] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Importance The inclusion of non-English-speaking (NES) participants in pediatric research is an essential step to improving health equity for these populations. Although some studies have shown lack of progress in NES research participation in the past decade, few have examined NES inclusivity in pediatric research or details about the practices that researchers have used to communicate with NES participants. Objective To assess how frequently NES families were included in pediatric research, how rates of inclusion changed over time, what languages were included, and methodological details about oral and written communication with NES participants. Evidence Review In this review, all original investigation articles published in JAMA Pediatrics, Pediatrics, and The Journal of Pediatrics between January 2012 and November 2021 were screened. Eligible articles, which included those based in the US and with human participants, were reviewed to determine whether they included or excluded NES participants or whether or not there was specific mention of language. A second-round review was conducted on the subset of articles that included NES participants to determine methodological details (eg, languages included, type of study, region where the study was located, and oral and written communication practices with NES participants). Findings Of the 8142 articles screened, 5008 (62%) met inclusion criteria; of these, 469 (9%) included NES participants. The most common language was Spanish (350 [75%]); 145 articles (31%) reported non-English or other language without specification. A total of 230 articles (49%) reported the number of NES participants, and 61 (13%) specified the methods used to determine whether participants preferred a language other than English. In all, 101 (22%) and 136 (29%) articles specified how oral and written communication occurred with NES participants, respectively. Conclusions and Relevance This review of 3 pediatric journals provides preliminary evidence suggesting exclusion of NES communities from pediatric research from 2012 to 2021 and highlights an opportunity to provide more methodological detail about communication with NES participants. Best practices for improving inclusivity of NES participants are needed to guide researchers toward improved methods and more relevant results.
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Affiliation(s)
- Annie Chen
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Kelsey Schweiberger
- Division of General Academic Pediatrics; University of Pittsburgh, Pittsburgh, PA
| | - Jaime Sidani
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, PA
| | - Riley Wolynn
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, PA
| | - Diego Chaves-Gnecco
- Division of General Academic Pediatrics; University of Pittsburgh, Pittsburgh, PA
| | - Raquel Hernandez
- Johns Hopkins All Children’s Hospital Institute for Clinical and Translational Research, St. Petersburg, FL
| | - Scott Rothenberger
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Erin Mickievicz
- Division of General Academic Pediatrics; University of Pittsburgh, Pittsburgh, PA
| | - John D. Cowden
- Kansas City University; Kansas City, MO
- Division of General Academic Pediatrics, Children’s Mercy Kansas City, Kansas City, MO
| | - Maya Ragavan
- Division of General Academic Pediatrics; University of Pittsburgh, Pittsburgh, PA
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24
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Batool SH, Safdar M, Eman S. Relationship between parents' health literacy and child health: systematic review. LIBRARY HI TECH 2022. [DOI: 10.1108/lht-11-2021-0398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeParents' health literacy is an important element to ensure the sound health of children. One of the major purposes of this study was to systematically collect and review the literature that identified the relationship between two variables: parents' health literacy and their child's health.Design/methodology/approachTo meet the purpose, the authors searched four well-reputed research databases such as Web of Science, Scopus, Google Scholar and LISTA (Library, Information Science and Technology Abstracts) comprehensively to collect the relevant research on the topic. Except for books, various types of content from different years were used for this review. The investigators used Preferred Items for Systematic Reviews and Meta-analysis guidelines to select eligible studies for this review. The authors also assessed the quality of the reviewed research in the light of well-reputed quality guidelines shared by Boynton and Greenhalgh (2004).FindingsThe majority of the reviewed studies found a statistically significant relationship between parents' health literacy and the health of their children. Findings also identified that the majority of the reviewed literature scored from 9 to 12 on the quality assessment criteria. Results also highlighted that the majority of the reviewed research on parents' health literacy and child health has been conducted in the USA and utilized quantitative methods to conduct research on the topic under this study.Research limitations/implicationsThis systematic review has multiple theoretical and practical implications for parents, policymakers and researchers.Originality/valueThis is the first systematically collected and reviewed paper on the relationship between parents' health literacy and child health.
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25
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Westphaln KK, Fry-Bowers EK, Birchfield JW, Lee E, Ronis SD. Examining the Relationship of Family Social Capital and Use of Pediatric Primary Health Care Services in the 2016-19 National Survey of Children's Health. J Pediatr Health Care 2022; 36:347-357. [PMID: 34996680 DOI: 10.1016/j.pedhc.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 12/19/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study examined the relationship of family social capital (FSC) and pediatric primary health care services (PHCU) among young children aged 0-5 years in the United States. FSC involves the interrelated contexts of child health and family characteristics. Understanding how this impacts PHCU may reveal important considerations for supporting access and use of essential health care services. METHOD Using data from the 2016-19 National Survey of Children's Health (weighted N = 21,496,634), we conducted descriptive statistics and logistic regression to ascertain the relationship between FSC and PHCU. RESULTS Statistically significant contributions included FSC (odds ratio [OR] = 1.2; confidence interval [CI] = 1.08-1.40), high school (OR = 0.49; CI = 2.65-5.39), and some college (OR = 0.72; CI = 0.62-0.85) DISCUSSION: Findings support that FSC and parent academic achievement impact PHCU. Interventions that foster family connection and parent adult health literacy may enhance PHCU.
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Affiliation(s)
- Kristi K Westphaln
- Assistant Professor, School of Nursing, University of California Los Angeles, Los Angeles, CA; University Hospitals Center for Child Health and Policy, and Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH.
| | - Eileen K Fry-Bowers
- Professor and Associate Provost, Hahn School of Nursing and Health Science, University of San Diego, San Diego, CA
| | - Jesse W Birchfield
- Doctoral Student, Department of Biostatistics, University of California Los Angeles, Los Angeles, CA
| | - Eunice Lee
- Lecturer, Jack, Joseph, and Morton Mandel School of Applied Social Science, Case Western Reserve University, Cleveland, OH
| | - Sarah D Ronis
- Director, University Hospitals Center for Child Health and Policy, and Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
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26
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Ji X, Sohn H, Sil S, Castellino SM. Moving Beyond Patient-Level Drivers of Racial/Ethnic Disparities in Childhood Cancer. Cancer Epidemiol Biomarkers Prev 2022; 31:1154-1158. [PMID: 35642393 PMCID: PMC9203027 DOI: 10.1158/1055-9965.epi-21-1068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/24/2021] [Accepted: 03/03/2022] [Indexed: 01/11/2023] Open
Abstract
Racial/ethnic disparities in childhood cancer survival persist despite advances in cancer biology and treatment. Survival rates are consistently lower among non-Hispanic Black and Hispanic children as compared with non-Hispanic White children across a range of hematologic cancers and solid tumors. We provide a framework for considering complex systems and social determinants of health in research examining the drivers of racial/ethnic disparities in childhood cancer survival, given that pediatric patients' interactions with the healthcare system are filtered through their caregiver, family, and societal structure. Dismantling the multi-level (patient, family, healthcare system, and structural) barriers into modifiable drivers is critical to developing policies and interventions toward equitable health outcomes. This commentary highlights areas at the family, healthcare system, and society levels that merit closer examination and proposes actions and interventions to support improvements across these levels. See recently published article in the November issue of CEBP, Racial/Ethnic Disparities in Childhood Cancer Survival in the United States p. 2010.
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Affiliation(s)
- Xu Ji
- Department of Pediatrics, Emory University School of
Medicine, Atlanta, Georgia.,Aflac Cancer & Blood Disorders Center,
Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Heeju Sohn
- Department of Sociology, Emory University, Atlanta,
Georgia
| | - Soumitri Sil
- Department of Pediatrics, Emory University School of
Medicine, Atlanta, Georgia.,Aflac Cancer & Blood Disorders Center,
Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Sharon M. Castellino
- Department of Pediatrics, Emory University School of
Medicine, Atlanta, Georgia.,Aflac Cancer & Blood Disorders Center,
Children’s Healthcare of Atlanta, Atlanta, Georgia
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27
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Burns J, Higgins C, Ganigara M, Kalivas B, Basken A. Health literacy in CHD. Cardiol Young 2022; 32:1-4. [PMID: 35611812 DOI: 10.1017/s1047951122001020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Joseph Burns
- Cohen Children's Medical Center, Queens, NY 11040, USA
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Bhatt P, Parmar N, Ayensu M, Umscheid J, Vasudeva R, Donda K, Doshi H, Dapaah-Siakwan F. Trends and Resource Use for Kernicterus Hospitalizations in the United States. Hosp Pediatr 2022; 12:e185-e190. [PMID: 35578911 DOI: 10.1542/hpeds.2021-006502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the trends in hospitalization for kernicterus in the United States from 2006 through 2016. METHOD Repeated, cross-sectional analysis of the 2006 to 2016 editions of the Kids' Inpatient Database. All neonatal hospitalizations with an International Classification of Diseases, Ninth or Tenth Revision, Clinical Modification code for kernicterus and admitted at age ≤28 days were included. RESULTS Among 16 094 653 neonatal hospitalizations from 2006 to 2016, 20.5% were diagnosed with jaundice with overall incidence of kernicterus 0.5 per 100 000. The rate of kernicterus (per 100 000) was higher among males (0.59), Asian or Pacific Islanders (1.04), and urban teaching hospitals (0.72). Between 2006 and 2016, the incidence of kernicterus decreased from 0.7 to 0.2 per 100 000 (P-trend = .03). The overall median length of stay for kernicterus was 5 days (interquartile range [IQR], 3-8 days). The overall median inflation-adjusted cost of hospitalization was $5470 (IQR, $1609-$19 989). CONCLUSIONS Although the incidence of kernicterus decreased between 2006 and 2016, its continued occurrence at a higher rate among Asian or Pacific Islander and Black race or ethnicity in the United States require further probing. Multipronged approach including designating kernicterus as a reportable event, strengthening newborn hyperbilirubinemia care practices and bilirubin surveillance, parental empowerment, and removing barriers to care can potentially decrease the rate of kernicterus further.
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Affiliation(s)
- Parth Bhatt
- Department of Pediatrics, United Hospital Center, Bridgeport, West Virginia
| | - Narendrasinh Parmar
- Department of Pediatrics, Brookdale University Hospital and Medical Center, Brooklyn, New York
| | - Marian Ayensu
- Outpatient Department, The Trust Hospital, Accra, Ghana
| | - Jacob Umscheid
- Department of Pediatrics, University of Kansas School of Medicine, Wichita, Kansas
| | - Rhythm Vasudeva
- Department of Pediatrics, University of Kansas School of Medicine, Wichita, Kansas
| | - Keyur Donda
- Section of Neonatology, Department of Pediatrics, University of South Florida, Tampa, Florida
| | - Harshit Doshi
- Neonatal Intensive Care Unit, Golisano Children's hospital of Southwest Florida, Fort Myers, Florida
| | - Fredrick Dapaah-Siakwan
- Neonatal Intensive Care Unit, Department of Medicine, Valley Children's Hospital, Madera, California
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Umaretiya PJ, Vinci RJ, Bona K. A Structural Racism Framework to Guide Health Equity Interventions in Pediatric Oncology. Pediatrics 2022; 149:186711. [PMID: 35490282 DOI: 10.1542/peds.2021-054634] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Puja J Umaretiya
- Department of Pediatric Oncology.,Division of Population Sciences.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Robert J Vinci
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.,Boston University School of Medicine Boston, Massachusetts
| | - Kira Bona
- Department of Pediatric Oncology.,Division of Population Sciences.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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30
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Leslie CJ, Donelan K, Nicholas P, Buglione M, Smith DL. Health Literacy Profiles of Early Intervention Providers: Use of the Health Literacy Questionnaire. Health Lit Res Pract 2022; 6:e128-e136. [PMID: 35680120 PMCID: PMC9179036 DOI: 10.3928/24748307-20220523-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Early intervention (EI) providers work with parents of children with or who have risk factors of developmental delay or disability through Part C of the Individuals with Disabilities Education Act. Many parents in the United States have low health literacy; therefore, EI providers should be aware of and address families' health literacy needs. EI providers need to be health literate themselves to implement evidence-based recommended practices. Objective: This study aimed to measure health literacy levels of interdisciplinary EI providers and investigate associations between health literacy levels and demographic variables. Methods: A survey containing the Health Literacy Questionnaire (HLQ) was completed by EI providers working at 10 EI centers in Massachusetts. Scale scores were calculated and compared across demographic variables, including EI job role, age, years of EI experience, and highest education level. Key Results: Of 715 EI providers invited to participate, 376 surveys were completed (52.6% response rate). Most participants were women (92.6%, n = 348), reported race as White (85.4%, n = 321), had a mean age of 43.1 years (standard deviation [SD] 12.9) ranging from 20 to 74 years, and English as their primary language (89.6%, n = 337). EI providers scored the lowest on HLQ Scale 5 “Appraisal of health information” (mean [M] = 2.99 (SD 0.50) [confidence interval (CI) 2.93, 3.04]), and Scale 7 “Navigating the healthcare system” (M = 3.83 (SD 0.58) [CI 3.77, 3.89]). EI providers having stronger health literacy profiles were generally older, with a higher education level, were licensed providers, or had more years of EI work experience. Conclusions: EI providers require adequate health literacy to manage their health needs and to effectively provide services to EI families. Study results may inform future targeted professional development to support improvement of EI providers' health literacy skills, including appraisal of health information and navigation of the health care system. [HLRP: Health Literacy Research and Practice. 2022;6(2):e128–e136.] Plain Language Summary: EI providers' health literacy profiles have not been previously investigated. Study results reveal EI providers struggled with health literacy skills of appraising health information and navigating the health care system, which are vital for EI practice. Health Literacy Questionnaire results can inform targeted professional development to improve EI providers' health literacy levels and their clinical practice.
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Affiliation(s)
- Catherine J. Leslie
- Address correspondence to Catherine J. Leslie, PhD, MOT, OTR/L, CEIS, PO Box 290007, Boston, MA 02129;
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Costich M, Bisono G, Meyers N, Lane M, Meyer D, Friedman S. A Pediatric Resident Curriculum for the Use of Health Literacy Communication Tools. Health Lit Res Pract 2022; 6:e121-e127. [PMID: 35680125 PMCID: PMC9179039 DOI: 10.3928/24748307-20220517-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Objective: Methods: Key Results: Conclusions: Plain Language Summary:
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Affiliation(s)
| | | | | | | | | | - Suzanne Friedman
- Address correspondence to Suzanne Friedman, MD, Department of Pediatrics, Columbia University Irving Medical Center, 622 W. 168th Street, VC417, New York, NY 10032;
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Gibson C, Smith D, Morrison AK. Improving Health Literacy Knowledge, Behaviors, and Confidence with Interactive Training. Health Lit Res Pract 2022; 6:e113-e120. [PMID: 35522855 PMCID: PMC9126053 DOI: 10.3928/24748307-20220420-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 06/16/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Ensuring that health care professionals are knowledgeable about the influence limited health literacy has on health outcomes and how to apply health literate strategies is crucial to transform quality and safety in care settings. Although many organizational efforts to address health literacy have focused on hospital settings, few have focused on primary care. The designation of a patient-centered medical home requires the need to address integrating health literacy and the training needs of primary care settings. Brief description of activity: An interactive health literacy training intervention was developed, implemented, and evaluated for 25 primary care clinics. This included an online educational module, in-person application activities, and a sustainability plan to continue skill building, reinforce behaviors, and support practice. IMPLEMENTATION Using a descriptive pre- and post-training design, three survey measures were used to rate health literacy knowledge, behaviors, and confidence levels of more than 475 primary care staff. A pre-training survey was completed prior to completion of an interactive online health literacy module and attendance at an in-person training session which followed. A post-training survey was then completed. Sustainment activities, including lunch and learns, and reinforcement activities by clinic leaders, were initiated to promote use of the strategies in practice. A 1-year follow-up survey was then administered to measure sustainability. RESULTS The interactive training intervention improved primary care staff's knowledge, behaviors, and confidence in using health literacy strategies with patients and families. Common barriers and facilitators around the use of these strategies were also identified. LESSONS LEARNED Careful consideration should be taken when developing health literacy training to ensure it will be effective, efficient, and sustainable. Using elements that facilitate the transfer of training to practice will help improve success. Addressing barriers and promoting facilitators, as well as integrating and connecting health literacy strategies with existing organizational goals and initiatives offer additional ways to reinforce and sustain the practice change. [HLRP: Health Literacy Research and Practice. 2022;6(2):e113-e120.] Plain Language Summary: Clinic staff can improve how they provide information and education to children and families. Interactive training about health literacy led clinic staff to (1) know more about health literacy, (2) use health literacy strategies more, and (3) feel more confident using health literacy strategies. Training over time, supporting staff, and connecting to organizational goals are important for sustainment.
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Affiliation(s)
- Cori Gibson
- Address correspondence to Cori Gibson, MSN, RN, CNL, Children's Wisconsin Corporate Center, Suite 650, 999 N. 92nd Street, Milwaukee, WI 53226;
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Novel Way to Improve Satisfaction, Comprehension, and Anxiety in Caregivers: A Randomized Trial Exploring the Use of Comprehensive, Illustrated Children's Books for Pediatric Surgical Populations. J Am Coll Surg 2022; 234:263-273. [PMID: 35213488 DOI: 10.1097/xcs.0000000000000057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgery generates anxiety and stress, which can negatively impact informed consent and postoperative outcomes. This study assessed whether educational, illustrated children's books improve comprehension, satisfaction, and anxiety of caregivers in pediatric surgical populations. METHODS A prospective randomized trial was initiated at a tertiary care children's hospital. All patients ≤ 18 years old with caregiver and diagnosis of 1) uncomplicated appendicitis (English or Spanish speaking); 2) ruptured appendicitis; 3) pyloric stenosis; 4) need for gastrostomy tube; or 5) umbilical hernia were eligible. Conventional consent was obtained followed by completion of 17 validated survey questions addressing apprehension, satisfaction, and comprehension. Randomization (2:1) occurred after consent and before operative intervention with the experimental group (EG) receiving an illustrated comprehensive children's book outlining anatomy, pathophysiology, hospital course, and postoperative care. A second identical survey was completed before discharge. Primary outcomes were caregiver apprehension, satisfaction, and comprehension. RESULTS Eighty caregivers were included (55: EG, 25: control group [CG]). There were no significant differences in patient or caregiver demographics between groups. The baseline survey demonstrated no difference in comprehension, satisfaction, or apprehension between groups (all p values NS). After intervention, EG had significant improvement in 14 of 17 questions compared with CG (all p < 0.05). When tabulated by content, there was significant improvement in comprehension (p = 0.0009), satisfaction (p < 0.0001), and apprehension (p < 0.0001). CONCLUSION The use of illustrated educational children's books to explain pathophysiology and surgical care is a novel method to improve comprehension, satisfaction, and anxiety of caregivers. This could benefit informed consent, understanding, and postoperative outcomes.
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What if children with psychiatric problems disagree with their clinicians on the need for care? Factors explaining discordance and clinical directions. Child Adolesc Psychiatry Ment Health 2022; 16:10. [PMID: 35164814 PMCID: PMC8845355 DOI: 10.1186/s13034-022-00448-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/03/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Children and adolescents in mental healthcare often perceive their care needs and necessary treatment differently from their clinicians. As such discordance between young patients and clinicians may obstruct treatment adherence and compromise treatment outcomes, it is important to understand the factors associated with it. We therefore investigated the factors associated with patient-clinician discordance with regard to care needs in various areas of functioning. METHODS A cross-sectional study involving 244 children/adolescents aged 6-18 participating with their clinicians in treatment at a specialized mental healthcare center. As a previous study conducted by our research group had found the greatest patient-clinician discordance in three CANSAS care needs-"mental health problems," "information regarding diagnosis and/or treatment," and "making and/or keeping friends"-we used univariable and multivariable statistics to investigate the factors associated with discordance regarding these three care needs. RESULTS patient-clinician discordance on the three CANSAS items was associated with child, parent, and family/social-context factors. Three variables were significant in each of the three final multivariable models: dangerous behavior towards self (child level); severity of psychiatric problems of the parent (parent level); and growing up in a single-parent household (family/social-context level). CONCLUSIONS To deliver treatment most effectively and to prevent drop-out, it is important during diagnostic assessment and treatment planning to address the patient's care needs at all three levels: child, parent and family/social context.
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Griffeth E, Sharif I, Caldwell A, Townsend Cooper M, Tyrrell H, Dunlap M. Health Literacy Perceptions and Knowledge in Pediatric Continuity Practices. Health Lit Res Pract 2022; 6:e51-e60. [PMID: 35263233 PMCID: PMC8919674 DOI: 10.3928/24748307-20220208-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Low health literacy affects one-third of adults in the United States and can have a negative effect on health behavior and outcomes. Objective: The goal of this study was to examine attitudes and knowledge of health literacy among pediatric residents and faculty in pediatric resident continuity clinics across the country. Methods: An online mixed-methods survey was distributed to pediatric faculty and residents through the Academic Pediatric Association's Continuity Research Network. The 20-question survey included questions about the participants' health literacy knowledge and health literacy practices in continuity clinics, such as use of universal health literacy precautions. Categorical answer choices were dichotomized into positive and negative groupings and resident and faculty responses were compared using the Chi-squared test (significance p < .05). Qualitative data were analyzed using emergent coding and grounded theory to determine themes. Key Results: Responses were received from 402 individuals at 24 pediatric residency programs. Most participants agreed or strongly agreed that they could correctly identify participants with low health literacy (76% residents vs. 53% faculty). Only 19% of residents and 26% of faculty were familiar with universal health literacy precautions. Many residents and faculty had received no training in health literacy (37% residents vs. 38% faculty). Barriers and challenges around health literacy included time, language, limited training or resources, low literacy, disease mismanagement, and fixed misconceptions. Conclusion: Despite ample evidence in the literature to the contrary, most respondents believed they could correctly identify individuals with low health literacy. Additionally, most participants had not heard of universal health literacy precautions and were unaware of their usage in their practice setting. This is not consistent with current expert recommendations. These findings are troubling as they are from academic residency programs, indicating an educational deficit. These findings point toward a next step in health literacy education for pediatric residents. [HLRP: Health Literacy Research and Practice. 2022;6(1):e51–e60.] Plain Language Summary: Pediatric residents and faculty in continuity clinics were surveyed about their opinions, health literacy knowledge, ability, and practices in continuity clinics. Despite evidence to the contrary, most respondents believed they could correctly identify individuals with low health literacy and had not heard of universal health literacy precautions. These findings highlight the need for more health literacy education for pediatric residents.
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Affiliation(s)
| | | | | | | | | | - Marny Dunlap
- Address correspondence to Marny Dunlap, MD, University of Oklahoma Health Sciences Center, 1200 Children's Avenue, Suite 12400, Oklahoma City, OK 73104;
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A First Look at Applied Behavior Analysis Service Delivery to Latino American Families Raising a Child With Autism Spectrum Disorder. Behav Anal Pract 2021; 14:974-983. [PMID: 34868810 DOI: 10.1007/s40617-021-00572-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2021] [Indexed: 12/25/2022] Open
Abstract
Recent statistics indicate children of Latino background are diagnosed with autism spectrum disorder (ASD) at a much later age than their non-Latino White counterparts. Once a diagnosis is made, it is critically important that families get access to evidence-based interventions, including applied behavior analysis (ABA) services. However, disadvantaging factors such as a lack of awareness of available services, poor health care access and health literacy, and language barriers may impact these families' ability to access and maintain ABA services. The purpose of this pilot study was to obtain preliminary information on the experiences of accessing and maintaining ABA services for a sample of Latino American families living in Massachusetts. We conducted structured interviews with 28 families that had a child with ASD aged 8 years or younger. Questions in the interview were related to the background and diagnostic experiences of the child; difficulties in accessing ABA services; and for those children receiving ABA services, parents' perceptions of the services. Results of the interviews are summarized, and implications for future research and service delivery are discussed.
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Yin HS, Neuspiel DR, Paul IM, Franklin W, Tieder JS, Adirim T, Alvarez F, Brown JM, Bundy DG, Ferguson LE, Gleeson SP, Leu M, Mueller BU, Connor Phillips S, Quinonez RA, Rea C, Rinke ML, Shaikh U, Shiffman RN, Vickers Saarel E, Spencer Cockerham SP, Mack Walsh K, Jones B, Adler AC, Foster JH, Green TP, Houck CS, Laughon MM, Neville K, Reigart JR, Shenoi R, Sullivan JE, Van Den Anker JN, Verhoef PA. Preventing Home Medication Administration Errors. Pediatrics 2021; 148:183379. [PMID: 34851406 DOI: 10.1542/peds.2021-054666] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Medication administration errors that take place in the home are common, especially when liquid preparations are used and complex medication schedules with multiple medications are involved; children with chronic conditions are disproportionately affected. Parents and other caregivers with low health literacy and/or limited English proficiency are at higher risk for making errors in administering medications to children in their care. Recommended strategies to reduce home medication errors relate to provider prescribing practices; health literacy-informed verbal counseling strategies (eg, teachback and showback) and written patient education materials (eg, pictographic information) for patients and/or caregivers across settings (inpatient, outpatient, emergency care, pharmacy); dosing-tool provision for liquid medication measurement; review of medication lists with patients and/or caregivers (medication reconciliation) that includes prescription and over-the-counter medications, as well as vitamins and supplements; leveraging the medical home; engaging adolescents and their adult caregivers; training of providers; safe disposal of medications; regulations related to medication dosing tools, labeling, packaging, and informational materials; use of electronic health records and other technologies; and research to identify novel ways to support safe home medication administration.
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Affiliation(s)
- H Shonna Yin
- Departments of Pediatrics and Population Health, Grossman School of Medicine, New York University, New York, New York
| | | | - Ian M Paul
- Departments of Pediatrics and Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
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Pawellek M, Kopf FM, Egger N, Dresch C, Matterne U, Brandstetter S. Pathways linking parental health literacy with health behaviours directed at the child: a scoping review. Health Promot Int 2021; 37:6403923. [PMID: 34668013 DOI: 10.1093/heapro/daab154] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Health literacy (HL) is thought to be crucial for the management of the manifold demands relating to child health which parents are faced with. Albeit many studies have investigated parental HL and health behaviours (HBs) directed at the child, knowledge about the pathways which link parental HL with HB is scarce. The aim of this scoping review was to identify and comprehensively describe the variety of pathways linking parental HL with HBs directed at the child which were empirically analysed in previous studies. Following established scoping review methods database searches were conducted in MEDLINE, EMBASE, PsycINFO and WebofScience on 5 March 2020. Eligibility criteria included primary, empirical studies assessing parental HL and HB directed at the child in the general parent population. Titles and abstracts were screened independently by six reviewers for potentially relevant publications and data were extracted using standardized data extraction forms. The search identified 6916 articles for title and abstract screening. After full-text review, 50 studies were included in this review. Most studies (N = 24) assumed a direct association between HL and HBs and only few studies (N = 4) used more complex models investigating different pathways or mediation and/or moderation models. Overall, the evidence on the underlying pathways linking parental HL and HBs directed at the child is mixed and fairly limited. Therefore, hypothesis-driven research and integration of results into theoretical frameworks is needed for advancing both the research on HL and public health practice.
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Affiliation(s)
- Maja Pawellek
- University Children's Hospital Regensburg (KUNO), University of Regensburg, Klinik St. Hedwig, Steinmetzstr. 1-3, Regensburg 93049, Germany.,Member of the Research and Development Campus Regensburg (WECARE), Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Felicitas Maria Kopf
- University Children's Hospital Regensburg (KUNO), University of Regensburg, Klinik St. Hedwig, Steinmetzstr. 1-3, Regensburg 93049, Germany
| | - Nina Egger
- Department of Public Health and Health Education, Freiburg University of Education, Kunzenweg 21, Freiburg 79117, Germany
| | - Carolin Dresch
- Department of Research Methods, Freiburg University of Education, Kunzenweg 21, Freiburg 79117, Germany
| | - Uwe Matterne
- Medical Faculty, Institute of Social Medicine and Health Systems Research, Otto von Guericke University, Leipziger Str. 44, Magdeburg 39120, Germany
| | - Susanne Brandstetter
- University Children's Hospital Regensburg (KUNO), University of Regensburg, Klinik St. Hedwig, Steinmetzstr. 1-3, Regensburg 93049, Germany.,Member of the Research and Development Campus Regensburg (WECARE), Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
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Bhavsar D, Hohman C, Stinson HE, Wallace LS. Child Dehydration Management: A Health Literacy-Focused Resource Analysis. AMERICAN JOURNAL OF HEALTH EDUCATION 2021. [DOI: 10.1080/19325037.2021.1973618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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40
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"I Don't Do Much Without Researching Things Myself": A Mixed Methods Study Exploring the Role of Parent Health Literacy in Autism Services Use for Young Children. J Autism Dev Disord 2021; 52:3598-3611. [PMID: 34435270 DOI: 10.1007/s10803-021-05240-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
Little is known about how parent health literacy contributes to health-related outcomes for children with autism. This mixed-methods study included 82 U.S. parents of a child with autism 2-5 years-old and sought to describe (1) health literacy dimensions, (2) how health literacy influences services use, and (3) health literacy improvement strategies. Results showed: autism information was accessed from multiple sources; understanding autism information involved "doing your own research"; autism information empowered decision-making; health literacy facilitated behavioral services use; health literacy influenced medication use; family and system characteristics also affected services use; autism education remains needed; services information is needed across the diagnostic odyssey; and greater scientific information accessibility would increase uptake. Findings demonstrate how parent health literacy affects services use.
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Gharpure R, Marsh ZA, Tack DM, Collier SA, Strysko J, Ray L, Payne DC, Garcia-Williams AG. Disparities in Incidence and Severity of Shigella Infections Among Children-Foodborne Diseases Active Surveillance Network (FoodNet), 2009-2018. J Pediatric Infect Dis Soc 2021; 10:782-788. [PMID: 34145878 PMCID: PMC8744073 DOI: 10.1093/jpids/piab045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/25/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Shigella infections are an important cause of diarrhea in young children and can result in severe complications. Disparities in Shigella infections are well documented among US adults. Our objective was to characterize disparities in incidence and severity of Shigella infections among US children. METHODS We analyzed laboratory-diagnosed Shigella infections reported to FoodNet, an active, population-based surveillance system in 10 US sites, among children during 2009-2018. We calculated the incidence rate stratified by sex, age, race/ethnicity, Shigella species, and disease severity. Criteria for severe classification were hospitalization, bacteremia, or death. The odds of severe infection were calculated using logistic regression. RESULTS During 2009-2018, 10 537 Shigella infections were reported in children and 1472 (14.0%) were severe. The incidence rate was 9.5 infections per 100 000 child-years and the incidence rate of severe infections was 1.3 per 100 000 child-years. Incidence was highest among children aged 1-4 years (19.5) and lowest among children aged 13-17 years (2.3); however, children aged 13-17 years had the greatest proportion of severe infections (21.2%). Incidence was highest among Black (16.2 total; 2.3 severe), Hispanic (13.1 total; 2.3 severe), and American Indian/Alaska Native (15.2 total; 2.5 severe) children. Infections caused by non-sonnei species had higher odds of severity than infections caused by Shigella sonnei (adjusted odds ratio 2.58; 95% confidence interval 2.12-3.14). CONCLUSIONS The incidence and severity of Shigella infections among US children vary by age, race/ethnicity, and Shigella species, warranting investigation of unique risk factors among pediatric subpopulations.
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Affiliation(s)
- Radhika Gharpure
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA,Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Zachary A. Marsh
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Danielle M. Tack
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah A. Collier
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonathan Strysko
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA,Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Logan Ray
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Daniel C. Payne
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amanda G. Garcia-Williams
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Abstract
This article synthesizes what is known about the relationship between social disadvantage and measures of health literacy (HL), and reviews the research examining whether low HL is an explanatory factor connecting social disadvantage, health outcomes, and health disparities. Written from a United States perspective, this article offers a novel conceptual framework that presents how the social determinants of health might interact with HL to result in health disparities. The framework articulates relationships that reflect public health pathways and health care pathways, which include their related health literacies. The article continues with several cautionary statements based on the inherent limitations of current HL research, including problems and concerns specific to the attribution of HL as an explanatory factor for extant socioeconomic and racial/ethnic health disparities. The article closes with recommendations regarding future research directions. [HLRP: Health Literacy Research and Practice. 2021;5(3):e233–e243.]
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Affiliation(s)
- Dean Schillinger
- Address correspondence to Dean Schillinger, MD, Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Box 1364, San Francisco, CA 94143;
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43
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Hutton JS, Huang G, Wiley C, DeWitt T, Ittenbach RF. Randomized Trial of a Mobile App Introduced During Well-Visits to Enhance Guidance for Reading With Young Children. Acad Pediatr 2021; 21:977-987. [PMID: 34020099 DOI: 10.1016/j.acap.2021.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/28/2021] [Accepted: 05/12/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To estimate feasibility, usability and efficacy of a mobile parenting app (Rx for Success; RxS) to enhance reading guidance provided to parents of young children during well-visits. METHODS This trial was conducted at a clinic serving primarily families of Hispanic ethnicity and low-socioeconomic status (SES) where Reach Out and Read (ROR) is standard practice. It involved 252 parent-child dyads in 2 age groups (~6-months old, ~18-months old) randomized during well-visits to receive RxS or a children's book modeling alternatives to screen time (Control) by research coordinators. RxS involves videos, activities and "push" messages. Follow-up assessments were conducted approximately 6 months later, including impression and use, shared reading behaviors, child language and screen time. RESULTS A total of 217 dyads completed both visits (110 RxS, 107 Control). Time to introduce RxS was under 3 minutes and 32% of parents experienced largely minor performance issues. Parent impression of RxS was favorable for both age groups at baseline and follow-up, though use was infrequent, attributable to a desire for more relevant and updated content. Significant findings favoring RxS included shared reading as a favorite activity, more frequent shared reading reported at 12 months and higher language scores at 24 months. Screen time was equivalent between cohorts, exceeding American Academy of Pediatrics guidelines. CONCLUSIONS A mobile app introduced to parents of young children from low-SES backgrounds was feasible during well-visits, rated as helpful, and effective to enhance shared reading at younger and language at older ages. While a potentially impactful enhancement to ROR, features needing improvement were identified.
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Affiliation(s)
- John S Hutton
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center (JS Hutton and T DeWitt), Cincinnati, Ohio; Reading and Literacy Discovery Center, Cincinnati Children's Hospital Medical Center (JS Hutton and T DeWitt), Cincinnati, Ohio.
| | - Guixia Huang
- Division of Biostatistics and Epidemiology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center (G Huang and RF Ittenbach), Cincinnati, Ohio
| | - Catherine Wiley
- Community Health Center at Connecticut Children's Hospital (C Wiley), Hartford, Conn
| | - Thomas DeWitt
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center (JS Hutton and T DeWitt), Cincinnati, Ohio; Reading and Literacy Discovery Center, Cincinnati Children's Hospital Medical Center (JS Hutton and T DeWitt), Cincinnati, Ohio
| | - Richard F Ittenbach
- Division of Biostatistics and Epidemiology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center (G Huang and RF Ittenbach), Cincinnati, Ohio
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Woelber JP, Lessing C, Oesterreich D. [Oral health competence and its communication in "talking dentistry"]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:986-992. [PMID: 34226945 DOI: 10.1007/s00103-021-03370-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/03/2021] [Indexed: 11/30/2022]
Abstract
The concept of health literacy has received much attention in recent years. Essential approaches are the provision of health information, teaching through educational programs, and transfer via communication techniques. From a dental point of view, the individual discussion between patient and dentist is of particular importance ("talking dentistry").The aim of our article is to present the current state of knowledge on the relationship between oral health literacy and talking dentistry, to present existing concepts for teaching communicative competencies, and to identify the further need for action from the point of view of the German Dental Association. Several health psychology models emphasize a positive relationship between oral health literacy, oral health behavior, and oral health. Further determinants seem to be the patient's self-efficacy beliefs and the individual interaction with the dentist. Therefore, it seems purposeful to intervene in an occasion-related manner in the sense of talking dentistry. The personal conversation between dentist and patient can cover counselling, education, motivation, and practical guidance and can lead to participatory decision-making.Offers for learning and deepening communication techniques represent important aids for the practice. Some are presented in this article as examples. However, in order to establish talking dentistry on a broad level, more far-reaching offers and incentives are needed. Through our suggestions, we would like to show ways in which talking dentistry can be further promoted and consolidated as an integral part of dental care.
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Affiliation(s)
- Johan Peter Woelber
- Klinik für Zahnerhaltungskunde und Parodontologie, Department für Zahn‑, Mund- und Kieferheilkunde, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Constanze Lessing
- Abteilung Versorgung und Qualität, Bundeszahnärztekammer, Arbeitsgemeinschaft der Deutschen Zahnärztekammern e. V., Chausseestraße 13, 10115, Berlin, Deutschland.
| | - Dietmar Oesterreich
- Abteilung Versorgung und Qualität, Bundeszahnärztekammer, Arbeitsgemeinschaft der Deutschen Zahnärztekammern e. V., Chausseestraße 13, 10115, Berlin, Deutschland
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Ayalew B, Dawson-Hahn E, Cholera R, Falusi O, Haro TM, Montoya-Williams D, Linton JM. The Health of Children in Immigrant Families: Key Drivers and Research Gaps Through an Equity Lens. Acad Pediatr 2021; 21:777-792. [PMID: 33529739 DOI: 10.1016/j.acap.2021.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/13/2021] [Accepted: 01/24/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The United States benefits economically and socially from the diverse skill-set and innovative contributions of immigrants. By applying a socioecological framework with an equity lens, we aim to provide an overview of the health of children in immigrant families (CIF) in the United States, identify gaps in related research, and suggest future areas of focus to advance health equity. METHODS The literature review consisted of identifying academic and gray literature using a MeSH Database, Clinical Queries, and relevant keywords in 3 electronic databases (PubMed, Web of Science, and BrowZine). Search terms were selected with goals of: 1) conceptualizing a model of key drivers of health for CIF; 2) describing and classifying key drivers of health for CIF; and 3) identifying knowledge gaps. RESULTS The initial search produced 1120 results which were screened for relevance using a meta-narrative approach. Of these, 224 papers were selected, categorized by topic, and reviewed in collaboration with the authors. Key topic areas included patient and family outcomes, institutional and community environments, the impact of public policy, and opportunities for research. Key inequities were identified in health outcomes; access to quality health care, housing, education, employment opportunities; immigration policies; and inclusion in and funding for research. Important resiliency factors for CIF included strong family connections and social networks. CONCLUSIONS Broad structural inequities contribute to poor health outcomes among immigrant families. While resiliency factors exist, research on the impact of certain important drivers of health, such as structural and cultural racism, is missing regarding this population. More work is needed to inform the development and optimization of programs and policies aimed at improving outcomes for CIF. However, research should incorporate expertise from within immigrant communities. Finally, interventions to improve outcomes for CIF should be considered in the context of the socioecological model which informs the upstream and downstream drivers of health outcomes.
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Affiliation(s)
- Betlihem Ayalew
- UofSC School of Medicine Greenville (B Ayalew and JM Linton), Greenville, SC
| | - Elizabeth Dawson-Hahn
- University of Washington, Seattle Children's Research Institute, Harborview Medical Center (E Dawson-Hahn), Seattle, Wash
| | - Rushina Cholera
- Department of Pediatrics, National Clinician Scholars Program, Duke School of Medicine and the Margolis Center for Health Policy, Duke University (R Cholera), Durham NC
| | - Olanrewaju Falusi
- Child Health Advocacy Institute and Division of General and Community Pediatrics, The George Washington University School of Medicine and Health Sciences, Children's National Hospital (O Falusi), Washington, DC
| | - Tamar Magarik Haro
- Federal and State Advocacy, American Academy of Pediatrics (TM Haro), North Washington, DC
| | - Diana Montoya-Williams
- Division of Neonatology, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research 2714 (D Montoya-Williams), Philadelphia, Pa
| | - Julie M Linton
- UofSC School of Medicine Greenville (B Ayalew and JM Linton), Greenville, SC; Prisma Health Children's Hospital (JM Linton), Greenville, SC.
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46
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Faus A, Schlaier J. Health Literacy of Youth with Co-Occurring Behavioral and Physical Health Care Needs: A Preliminary Report. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2021. [DOI: 10.1080/15398285.2021.1901053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Amy Faus
- Bergen’s Promise, Inc., Hackensack, New Jersey, USA
| | - Jan Schlaier
- Bergen’s Promise, Inc., Hackensack, New Jersey, USA
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Aristizabal P, Winestone LE, Umaretiya P, Bona K. Disparities in Pediatric Oncology: The 21st Century Opportunity to Improve Outcomes for Children and Adolescents With Cancer. Am Soc Clin Oncol Educ Book 2021; 41:e315-e326. [PMID: 34061564 PMCID: PMC9126642 DOI: 10.1200/edbk_320499] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Adult cancer disparities have been documented for decades and continue to persist despite clinical advancements in cancer prevention, detection, and treatment. Pediatric cancer survival has improved significantly in the United States for the past 5 decades to over 80%; however, disparate outcomes among children and adolescents with cancer still affect many populations in the United States and globally, including racial and ethnic minorities, populations with low socioeconomic status, and residents of underserved areas. To achieve equitable outcomes for all children and adolescents with cancer, it is imperative that concerted multilevel approaches be carried out to understand and address health disparities and to ensure access to high-quality cancer care. Addressing social determinants of health, such as removing barriers to health care access and ensuring access to social supports, can reduce pediatric cancer disparities. Nevertheless, public health policy, health system interventions, and innovative delivery of evidence-based services are critically needed. Partnerships among patients, caregivers, and health care providers, and among health care, academic, and governmental institutions, have a pivotal role in reducing cancer disparities and improving outcomes in the 21st century.
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Affiliation(s)
- Paula Aristizabal
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of California San Diego/Peckham Center for Cancer and Blood Disorders, Rady Children’s Hospital San Diego, San Diego, CA
- Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla, CA
| | - Lena E. Winestone
- Department of Pediatrics, Division of Allergy, Immunology, and Blood & Marrow Transplantation, University of California San Francisco Benioff Children’s Hospitals, San Francisco, CA
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Puja Umaretiya
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kira Bona
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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48
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Tambling RR, D’Aniello C, Russell BS. Health Insurance Literacy among Caregivers of Substance Using Young Adults. ALCOHOLISM TREATMENT QUARTERLY 2021. [DOI: 10.1080/07347324.2021.1927926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Rachel R. Tambling
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Carissa D’Aniello
- Department of Community, Family, and Addiction Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Beth S. Russell
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
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Aristizabal P, Ma AK, Kumar NV, Perdomo BP, Thornburg CD, Martinez ME, Nodora J. Assessment of Factors Associated With Parental Perceptions of Voluntary Decisions About Child Participation in Leukemia Clinical Trials. JAMA Netw Open 2021; 4:e219038. [PMID: 33944924 PMCID: PMC8097494 DOI: 10.1001/jamanetworkopen.2021.9038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
IMPORTANCE Obtaining voluntary informed consent prior to enrollment in clinical trials is a fundamental ethical requirement. OBJECTIVE To assess whether health literacy, contextual factors, or sociodemographic characteristics are associated with perception of voluntariness among parents who had consented for their child's participation in a leukemia therapeutic clinical trial. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study prospectively enrolled 97 parents of children diagnosed as having leukemia at Rady Children's Hospital San Diego, a large tertiary academic center in California, from 2014 to 2017. Health literacy, contextual factors (acculturation, decisional regret, and satisfaction with informed consent), sociodemographic characteristics, and perception of voluntariness after consenting for a therapeutic clinical trial were measured. Univariable and multivariable regression were used to determine significant associations. The analyses for the present study were conducted from May 2019 to May 2020. EXPOSURES Informed consent for a therapeutic leukemia clinical trial. MAIN OUTCOMES AND MEASURES The primary outcome of interest was perception of voluntariness and its associations with health literacy and other contextual factors (acculturation, decisional regret, and satisfaction with informed consent) and sociodemographic characteristics, including age, race/ethnicity, parental language, educational level, insurance type, marital status, and socioeconomic status. RESULTS Of 97 parents included, the majority were women (65 [67%]), married (71 [73%]), and of self-reported Hispanic ethnicity (50 [52%]). Lower perception of voluntariness was significantly associated with lower health literacy (r = 0.30; 95% CI, 0.11-0.47; P = .004), Spanish language (x̅ = -4.50, P = .05), lower acculturation if of Hispanic ethnicity (r = 0.30; 95% CI, 0.02-0.54; P = .05), greater decisional regret (r = -0.54; 95% CI, -0.67 to -0.38; P < .001), and lower satisfaction with informed consent (r = 0.39; 95% CI, 0.21-0.54; P < .001) in univariable analysis. Lower health literacy remained significantly associated with lower perception of voluntariness in multivariable analysis after adjustment for contextual factors and sociodemographic characteristics (β = 4.06; 95% CI, 1.60-6.53; P = .001). Lower health literacy was significantly associated with Hispanic ethnicity (mean, 4.16; 95% CI, 3.75-4.57; P < .001), Spanish language spoken at home (mean, 3.17; 95% CI, 1.94-4.40; P < .001), high school or less educational level (mean, 3.41; 95% CI, 2.83-3.99; P < .001), public insurance (mean, 4.00; 95% CI, 3.55-4.45; P < .001), and unmarried status (mean, 3.71; 95% CI, 2.91-4.51; P = .03). CONCLUSIONS AND RELEVANCE Among parents of children with newly diagnosed leukemia who had consented for their child's participation in a therapeutic clinical trial, lower perception of voluntariness was significantly associated with lower health literacy. These results suggest that parents with low health literacy may perceive external influences in their decision for their child's participation in clinical trials. This finding highlights the potential role of recruitment interventions tailored to the participant's health literacy level to improve voluntary informed consent in underserved populations.
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Affiliation(s)
- Paula Aristizabal
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California San Diego, La Jolla
- Peckham Center for Cancer and Blood Disorders, Rady Children’s Hospital San Diego, San Diego
- Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla
| | - Arissa K. Ma
- School of Medicine, University of California San Diego, La Jolla
- Now with MemorialCare Health System, Fountain Valley, California
| | - Nikhil V. Kumar
- School of Medicine, University of California San Diego, La Jolla
| | - Bianca P. Perdomo
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California San Diego, La Jolla
- Peckham Center for Cancer and Blood Disorders, Rady Children’s Hospital San Diego, San Diego
- Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla
| | - Courtney D. Thornburg
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California San Diego, La Jolla
- Peckham Center for Cancer and Blood Disorders, Rady Children’s Hospital San Diego, San Diego
| | - Maria Elena Martinez
- Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - Jesse Nodora
- Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
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50
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Kampouroglou G, Velonaki VS, Pavlopoulou ID, Kosmopoulos M, Kouvas N, Drakou E, Skoutelis N, Spinos D, Tsagkaris S, Tsoumakas K. Health literacy of parents/caregivers of paediatric surgical patients: A study on 1000 individuals. Afr J Paediatr Surg 2021; 18:85-89. [PMID: 33642404 PMCID: PMC8232355 DOI: 10.4103/ajps.ajps_42_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE There is a paucity of studies concerning health literacy (HL) of parents/guardians of patients in paediatric surgery. The purpose of our study is to measure HL levels of parents/guardians of paediatric surgery patients and to explore the determinants of low HL levels in this population. MATERIALS AND METHODS We conducted a cross-sectional study from December 2016 to July 2018 through in-person interviews of parents/guardians of paediatric surgical patients. Sociodemographic and clinical data were recorded, and HL levels were calculated using a validated tool (HLS-EU-Q16). In order to examine the impact of various sociodemographic variables and clinical data on HL, a multivariate regression model was run. RESULTS A total of 1000 participants were recruited (recruitment rate 93.5%). Slightly less than half (44.2%) presented problematic or inadequate HL levels. The results of the regression analysis showed that nationality other than Greek (β = -2.180, P < 0.001) and lower health insurance status (β = -0.461, P < 0.05) were associated with lower HL levels. HL was found positively associated with the educational level of the parent (β = -0.775, P < 0.001) and being a health professional (β = 1.791, P < 0.001). CONCLUSION The prevalence of low HL levels in the parents/guardians of paediatric surgical patients is high and should not be neglected both in the pre-operative and post-operative setting. Communication should be tailored to the specific needs of each individual to achieve better engagement and quality of care.
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Affiliation(s)
| | - Venetia-Sofia Velonaki
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna D Pavlopoulou
- Department of Nursing, Pediatric Clinic, 'P. and A. Kyriakou' Children's Hospital, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Marinos Kosmopoulos
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikos Kouvas
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Drakou
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Skoutelis
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Spinos
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavros Tsagkaris
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Tsoumakas
- Department of Nursing, Pediatric Clinic, 'P. and A. Kyriakou' Children's Hospital, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
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