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Ruksakulpiwat S, Benjasirisan C, Ding K, Phianhasin L, Thorngthip S, Ajibade AD, Thampakkul J, Zhang AY, Voss JG. Utilizing Social Determinants of Health Model to Understand Barriers to Medication Adherence in Patients with Ischemic Stroke: A Systematic Review. Patient Prefer Adherence 2023; 17:2161-2174. [PMID: 37667687 PMCID: PMC10475305 DOI: 10.2147/ppa.s420059] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/11/2023] [Indexed: 09/06/2023] Open
Abstract
Introduction Ischemic strokes and their recurrence create an immense disease burden globally. Therefore, preventing recurrent strokes by promoting medication adherence is crucial to reduce morbidity and mortality. In addition, understanding the barriers to medication adherence related to the social determinants of health (SDoH) could promote equity among persons with ischemic stroke. Objective To explore the barriers to medication adherence among patients with ischemic stroke through the SDoH. Methods This systematic review included studies published between January 2018 and December 2022 identified through PubMed, MEDLINE, Web of Science, and CINAHL Plus Full Text. The descriptions of the studies were systematically summarized and discussed based on the SDoH from the US Healthy People 2030 initiative. Results Eight studies met the inclusion criteria and were included in this review. The most common barrier to adherence was inappropriate medication beliefs, medication side effects, and patient-physician relationship, which relate to the dimensions of healthcare access and quality. Health literacy and health perception, dependent on education access and quality, frequently influenced adherence. Other social determinants, such as financial strain and social and community context, were found to alter adherence behaviors. No study addressed the neighborhood and built environment domain. We found that cognitive impairment is another factor that impacts adherence outcomes among stroke patients. Conclusion Multifaceted approaches are needed to address the SDoH to improve medication adherence among patients with ischemic stroke. This review emphasized strategies, including patient education, provider-patient communication, social support, health literacy, technology, and policy advocacy to enhance adherence.
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Affiliation(s)
- Suebsarn Ruksakulpiwat
- Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | | | - Kedong Ding
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Lalipat Phianhasin
- Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Sutthinee Thorngthip
- Department of Nursing Siriraj Hospital, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Anuoluwapo D Ajibade
- College of Art and Science, Department of Anthropology, Case Western Reserve University, Cleveland, OH, USA
| | - Jai Thampakkul
- Case School of Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Amy Y Zhang
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Joachim G Voss
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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McMillan A, Tregobov N, Shum J, Christie I, Akhtar A, Poureslami I. Exploring chronic airways disease patients' perspectives on self-management topics. PATIENT EDUCATION AND COUNSELING 2022; 105:3540-3549. [PMID: 36100513 DOI: 10.1016/j.pec.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/12/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES In this study, we explored chronic airways disease (CAD) patients' responses to health literacy (HL) communication domain questions within disease self-management scenarios, as part of a larger CAD HL measurement tool development study. METHODS Adult asthma and chronic obstructive pulmonary disease (COPD) patients from specialty care respiratory clinics were initially presented with realistic disease management scenarios and asked to share information they would communicate. Participants' responses were grouped into response categories that were reviewed and verified by key informants. A new cohort of CAD patients then responded to the same scenarios and had their answers placed into the developed response categories by trained interviewers. RESULTS 19 initial stage participants' responses informed response categories for the following self-management topics: Inhaler Use (n = 20); Prednisone Use (n = 30); Flu (Influenza) (n = 35); and Weather Forecasting & Air Quality Index (n = 29). 141 participants' responses were categorised during the second stage. CONCLUSIONS Specialty care CAD patients displayed an understanding of key information to communicate across disease self-management topic. Our two-step, patient-driven approach may interest researchers investigating health-related communication from patients' perspectives. PRACTICE IMPLICATIONS Findings may illuminate potential areas to investigate communication gaps among CAD patients; further investigation is warranted among non-specialty care patients.
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Affiliation(s)
- Austin McMillan
- Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Noah Tregobov
- Respiratory Medicine Division, University of British Columbia, Vancouver, Canada; Vancouver - Fraser Medical Program, University of British Columbia, Vancouver, Canada
| | - Jessica Shum
- Respiratory Medicine Division, University of British Columbia, Vancouver, Canada
| | - Ian Christie
- School of Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Alizeh Akhtar
- School of Medicine, University College Cork, Cork, Ireland
| | - Iraj Poureslami
- Respiratory Medicine Division, University of British Columbia, Vancouver, Canada; Canadian Multicultural Health Promotion Society, Vancouver, Canada.
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Poureslami I, Kopec J, Tregobov N, Shum J, Sawatzky R, Hohn R, FitzGerald JM. An Integrated Framework to Conceptualize and Develop the Vancouver Airways Health Literacy Tool (VAHLT). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168646. [PMID: 34444392 PMCID: PMC8393669 DOI: 10.3390/ijerph18168646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 11/16/2022]
Abstract
There is currently no comprehensive tool to assess the functional health literacy (HL) skills of chronic airway disease (CAD) patients. The purpose of this article is to describe the development of a new HL measure, the Vancouver Airways Health Literacy Tool (VAHLT). The tool was developed through the following phases: (1) Tool conceptualization, consisting of: (A) a systematic review (SR), (B) focus group sessions with CAD patients to understand barriers and facilitators to CAD management, (C) a survey with key-informants to obtain strategies to mitigate self-management barriers and validate patient-derived topics, and (D) respiratory physicians' review of the topics; (2) Scenario and item development; and (3) Tool testing and content validation. The SR identified the lack of a valid HL measurement tool for CAD patients. Patients provided an initial shortlist of disease-related self-care topics. Key-informants helped to finalize topics for inclusion. Respiratory physicians and patients contributed to the development of a scenario-based questionnaire, which was refined during three rounds of testing to develop a 44-item instrument comprising nine self-management passages. We highlight the holistic process of integrating information from the literature with knowledge gained from key stakeholders into our tool framework. Our approach to stakeholder engagement may be of interest to researchers developing similar tools, and could facilitate the development and testing of HL-based interventions to ultimately improve patient outcomes and reduce the burden on the healthcare system.
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Affiliation(s)
- Iraj Poureslami
- Faculty of Medicine, Respiratory Medicine Division, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (I.P.); (N.T.); (J.S.)
| | - Jacek Kopec
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z31Z3, Canada;
| | - Noah Tregobov
- Faculty of Medicine, Respiratory Medicine Division, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (I.P.); (N.T.); (J.S.)
| | - Jessica Shum
- Faculty of Medicine, Respiratory Medicine Division, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (I.P.); (N.T.); (J.S.)
| | - Rick Sawatzky
- School of Nursing, Trinity Western University, Langley, BC V2Y 1Y11Y1, Canada;
| | - Richard Hohn
- Department of Psychology, Simon Fraser University, Burnaby, BC V5A 1S61S6, Canada;
| | - J. Mark FitzGerald
- Faculty of Medicine, Respiratory Medicine Division, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (I.P.); (N.T.); (J.S.)
- Correspondence:
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Salim H, Shariff Ghazali S, Lee PY, Cheong AT, Harrun NH, Mohamed Isa S, Pinnock H. Health literacy levels and its determinants among people with asthma in Malaysian primary healthcare settings: a cross-sectional study. BMC Public Health 2021; 21:1186. [PMID: 34158013 PMCID: PMC8218499 DOI: 10.1186/s12889-021-11194-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 06/03/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Limited health literacy among people with asthma is associated with poor adherence to self-management activities, thus poor clinical outcomes. This study aimed to determine the prevalence of health literacy level and its determinants among people with asthma in the Malaysian primary healthcare settings. METHOD A cross-sectional study was conducted among participants aged > 18 years with asthma who attended five primary health clinics in Malaysia. Systematic random sampling was employed with a final sample of 550 participants. The questionnaires included the validated Malay version of Health Literacy Scale (HLS) and asthma control questionnaire (ACQ). Statistical analysis was done using SPSS version 25. Multiple logistic regression was performed to determine the determinants for limited health literacy. RESULTS The participants mean age of the participants was 48 (SD15.4) years. Most of the participants were women (64%) and of Malay ethnicity (51.1%). Nearly half had a secondary level of education, n = 112, (45.8%). Mean duration of asthma diagnosis is 20.6 (SD 15.9) years. More than half (62.5%) had a family history of asthma. About half (50.9%) had uncontrolled asthma, with 87.3% self-rated themselves as having controlled asthma. About a third (29.1%) received education on of asthma action plan, but only 7.1% of these owned a written version an asthma action plan. Limited health literacy accounts for 60.5% of the participants. The significant determinants for limited health literacy included lower educational attainment (p < 0.001), family history of asthma (p = 0.034), < 20 years duration of asthma diagnosis (p = 0.031) and not receiving asthma action plan education (p < 0.001). CONCLUSION In this study population, more than half of the people living with asthma were found to have limited health literacy, which was associated with not having received self-management education supported by an asthma action plan. Future interventions should include strategies that ensure they meet the needs of people with limited health literacy.
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Affiliation(s)
- H Salim
- Department of Family Medicine, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia. .,NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, EH89AG, United Kingdom.
| | - S Shariff Ghazali
- Department of Family Medicine, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia.,Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, 43400, Selangor, Malaysia
| | - P Y Lee
- UM eHealth Unit, Faculty of Medicine, University of Malaya, Jalan Universiti, 50603, Petaling Jaya, Kuala Lumpur, Malaysia
| | - A T Cheong
- Department of Family Medicine, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - N H Harrun
- Pandamaran Health Clinic, Ministry of Health, Persiaran Raja Muda Musa, Klang, 42000, Selangor, Malaysia
| | - S Mohamed Isa
- Botanik Health Clinic, Ministry of Health, Jalan Langat, Klang, 41200, Selangor, Malaysia
| | - H Pinnock
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, EH89AG, United Kingdom
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Agarwal P, Lin J, Muellers K, O'Conor R, Wolf M, Federman AD, Wisnivesky JP. A structural equation model of relationships of health literacy, illness and medication beliefs with medication adherence among patients with chronic obstructive pulmonary disease. PATIENT EDUCATION AND COUNSELING 2021; 104:1445-1450. [PMID: 33308880 PMCID: PMC8144232 DOI: 10.1016/j.pec.2020.11.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To determine the relative contributions of health literacy (HL) and illness and medication beliefs to medication adherence among older COPD patients and determine the pathways through which they operate. METHODS The study was conducted using data from a prospective cohort of COPD patients in New York City and Chicago. We used structural equation modeling to examine the pathways linking HL, through medications and illness beliefs, with COPD medication adherence. RESULTS Out of 393 older adults with COPD, 123 (31%) had limited HL and 208 (53%) reported low adherence to daily COPD medications. Those with limited HL were more likely to have low medication adherence (p < 0.0001). Medications concerns (p = 0.001) and medication necessity (p = 0.003) demonstrated a mediational role between HL and adherence. However, in the final multivariate model, HL did not have direct effect on medication adherence (p = 0.12) and illness beliefs (p = 0.16) did not demonstrate a mediational role between HL and adherence. CONCLUSION Our findings suggest that low HL is not a direct predictor of poor medication adherence among COPD patients. PRACTICE IMPLICATIONS Addressing medication concerns and reinforcing the need for daily COPD medications may be a more effective strategy for increasing adherence in this population.
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Affiliation(s)
- Parul Agarwal
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine, New York, NY, USA.
| | - Jenny Lin
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Kimberly Muellers
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Rachel O'Conor
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Michael Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Morrow DG, Lane HC, Rogers WA. A Framework for Design of Conversational Agents to Support Health Self-Care for Older Adults. HUMAN FACTORS 2021; 63:369-378. [PMID: 33090054 PMCID: PMC10680041 DOI: 10.1177/0018720820964085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE We examined the potential of conversational agents (CAs) to support older adults' self-care related to chronic illness in light of lessons learned from decades of pedagogical agent research, which investigates the impact and efficacy of CAs for a wide range of learners. BACKGROUND The role of CAs in education (i.e., pedagogical agents) has been long studied, but their potential for supporting self-care has received less attention, especially for older adults. METHODS We reviewed work on pedagogical agents and considered how it informs the design of CAs for older adults. We propose a framework for designing CAs to support older adult self-care, which organizes a review of work in this area and integration with the pedagogical agent literature. RESULTS Our review of the pedagogical agent literature revealed an evolution from teaching machines to interactive, social systems that influence student motivational as well as learning outcomes. To integrate this review with work on CAs and self-care, we developed a framework that specifies how self-care goals evolve with stages of an illness, communication goals that support self-care at each stage, patient needs, and requirements for CAs to support these needs. The review identified an agenda for future research on CA functions and features that help older adults accept need for self-care, establish self-care, and sustain self-care over time. CONCLUSIONS Integrating insights from the pedagogical agent literature with research on developing CAs for self-care defines an agenda for developing and evaluating CAs to help older adults manage illness.
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Affiliation(s)
| | - H Chad Lane
- 14589 University of Illinois Urbana-Champaign, USA
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Poureslami I, Tregobov N, Shum J, McMillan A, Akhtar A, Kassay S, Starnes K, Mahjoob M, FitzGerald JM. A conceptual model of functional health literacy to improve chronic airway disease outcomes. BMC Public Health 2021; 21:252. [PMID: 33516200 PMCID: PMC7847605 DOI: 10.1186/s12889-021-10313-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 01/21/2021] [Indexed: 11/19/2022] Open
Abstract
Background Current conceptual models of health literacy (HL) illustrate the link between HL and health outcomes. However, these models fail to recognize and integrate certain elements of disease management, health system factors, and socio-demographic factors into their framework. This article outlines the development of Chronic Airway Disease (CAD) Management and Health Literacy (CADMaHL) conceptual model that integrates the aforementioned elements and factors into a single framework. Methods Information obtained during the following stages informed the development of our model: (1) a systematic review of existing CAD HL measurement tools that apply core HL domains; (2) patient-oriented focus group sessions to understand HL barriers to CAD self-management practices; (3) key-informant interviews to obtain potential strategies to mitigate CAD management barriers, and validate disease self-management topics; (4) elicited the perspectives of Canadian respirologist’s on the ideal functional HL skills for asthma and COPD patients. Results Throughout the study process many stakeholders (i.e., patients, key-informants, and an international HL advisory panel) contributed to and reviewed the model. The process enabled us to organize the CADMaHL model into 6 primary modules, including: INPUT, consisting of four HL core components (access, understand, communicate, evaluate,) and numeracy skills; OUTPUT, including application of the obtained information; OUTCOME, covering patient empowerment in performing self-management practices by applying HL skills; ASSESSMENT, consisting of information about functionality and relevancy of CADMaHL; IMPACT, including mediators between HL and health outcomes; CROSSCUTTING FACTORS, consisting of diverse socio-demographics and health-system factors with applicability across the HL domains. Conclusions We developed the CADMaHL model, with input from key-stakeholders, which addresses a knowledge gap by integrating various disease management, health-system and socio-demographic factors absent from previous published frameworks. We anticipate that our model will serve as the backbone for the development of a comprehensive HL measurement tool, which may be utilized for future HL interventions for CAD patients. Trial registration NCT01474928- Date of registration: 11/26/2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10313-x.
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Affiliation(s)
- Iraj Poureslami
- University of British Columbia and VGH Divisions of Respiratory Medicine, Centre for Lung Health, Vancouver Coastal Health Research Institute, Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Noah Tregobov
- University of British Columbia and VGH Divisions of Respiratory Medicine, Centre for Lung Health, Vancouver Coastal Health Research Institute, Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.,Queen's University, 94 University Avenue, Kingston, ON, K7L 3N6, Canada
| | - Jessica Shum
- Respiratory Medicine Division, Department of Medicine, University of British Columbia, Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Austin McMillan
- Queen's University, 94 University Avenue, Kingston, ON, K7L 3N6, Canada
| | - Alizeh Akhtar
- School of Medicine, Brookfield Health Sciences Complex, University College Cork, College Road, T12 AK54, Cork, IE-M, Ireland
| | - Saron Kassay
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Kassandra Starnes
- Faculty of Law, University of Windsor, 401 Sunset Ave, Windsor, ON, N9B 3P4, Canada
| | - Maryam Mahjoob
- University of British Columbia and VGH Divisions of Respiratory Medicine, Centre for Lung Health, Vancouver Coastal Health Research Institute, Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - J Mark FitzGerald
- University of British Columbia and VGH Divisions of Respiratory Medicine, Centre for Lung Health, Vancouver Coastal Health Research Institute, Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
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8
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Emiru YK, Hammeso WW, Adelo ES, Siraj EA, Bizuneh GK, Adamu BA, Yimenu DK. Role of community pharmacists in educating asthmatic patients: A multi-centered cross-sectional study in Ethiopia. Chron Respir Dis 2020; 17:1479973120952679. [PMID: 32856500 PMCID: PMC7457689 DOI: 10.1177/1479973120952679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Effective asthma management requires a multidisciplinary approach that includes; the physician, the patient, and the patient’s family. Objectives: The current study aimed to assess the roles played by community pharmacists toward asthma control together with the barriers hindering their practice and possible strategies to overcome those barriers. Methods: A multi-centered cross-sectional study was conducted. Data was collected using a structured, self-administered questionnaire adapted from previously conducted studies and customized to fit with the current study setup. The collected data was cleaned, coded, and entered into Statistical Package for Social Sciences (SPSS) version 21 for analysis. Descriptive analysis of the collected data was conducted and the results were presented using frequency tables and graphs. Results: A total of 122 community pharmacy professionals; 63 from Gondar, 26 from Bahir Dar, 15 from Debre Markos, 14 from Woldia, and 4 from Debre birhan participated in the study. About 96 (78.7%) of the participants reported that they teach their patients the basic facts about asthma. More than two-thirds of the participants 85 (69.7%) also reported that they were able to identify and manage the triggering factors of asthma for their patients. Lack of pharmacist time was reported by 78 (63.9%) of the study participants as a major reason for the inadequacy of the counseling service provided. Conclusion: It appears evident that there is a need for continuing professional education and pharmacists to receive additional training to improve their ability to go beyond identifying a problem and suggesting therapeutic options.
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Affiliation(s)
- Yohannes Kelifa Emiru
- Department of Pharmacognosy, School of Pharmacy, College of medicine and health sciences, 362057University of Gondar, Gondar, Ethiopia
| | | | - Eyerusalem Shello Adelo
- Department of Midwifery, College of Medicine and Health Sciences, 362057University of Gondar, Gondar, Ethiopia
| | - Ebrahim Abdela Siraj
- Department of Pharmacy, College of Medicine and Health Sciences, 247589Bahir Dar University, Bahir Dar, Ethiopia
| | - Gizachew Kassahun Bizuneh
- Department of Pharmacognosy, School of Pharmacy, College of medicine and health sciences, 362057University of Gondar, Gondar, Ethiopia
| | - Betelhem Anteneh Adamu
- Department of Pharmacognosy, School of Pharmacy, College of medicine and health sciences, 362057University of Gondar, Gondar, Ethiopia
| | - Dawit Kumilachew Yimenu
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, 362057University of Gondar, Gondar, Ethiopia
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Weerahandi H, Wisnivesky JP, O'Conor R, Wolf MS, Federman AD. The Relationship of Illness Beliefs with Hospital and Emergency Department Utilization in Chronic Obstructive Pulmonary Disease. J Gen Intern Med 2019; 34:923-928. [PMID: 30847827 PMCID: PMC6544700 DOI: 10.1007/s11606-019-04833-x] [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] [Received: 03/16/2018] [Revised: 11/17/2018] [Accepted: 12/19/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Himali Weerahandi
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU School of Medicine, Brooklyn, NY, USA.
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel O'Conor
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael S Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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10
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Mackey LM, Blake C, Casey MB, Power CK, Victory R, Hearty C, Fullen BM. The impact of health literacy on health outcomes in individuals with chronic pain: a cross-sectional study. Physiotherapy 2019; 105:346-353. [PMID: 30878145 DOI: 10.1016/j.physio.2018.11.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 11/04/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To establish if health literacy (HL) is linked to poorer outcomes and behaviours in patients with chronic pain. DESIGN A prospective cross-sectional observational study. SETTING Multidisciplinary out-patient pain clinics in three university teaching hospitals. PATIENTS New patients (n=131) referred to the pain clinic with a history of chronic pain (>12 weeks). METHODS A questionnaire was distributed to chronic pain patients attending their first appointment. Those eligible for inclusion were newly referred patients who had pain lasting longer than three months. The questionnaire comprised the following sections: demographics, chronic pain status and disease-related knowledge, quality of life (SF-36), beliefs (Beliefs About Pain Control Questionnaire), and a validated HL tool (Newest Vital Sign). RESULTS Of the 131 participants recruited, 54% had inadequate HL. The group was subsequently stratified according to HL level. In bivariate analysis, inadequate HL was associated with older age (p<0.001), being unemployed or retired (p=0.005), less education (p<0.001), lower income, increased comorbidities (p=0.038), being less likely to utilise allied health services (p=0.001), poorer disease-related knowledge (p=0.002), and poorer beliefs about pain (p<0.05). In multivariate analysis, disease-related knowledge (OR 2.5, 95%CI 1.0 to 6.3, p=0.05) and beliefs about pain (B=-2.3, S.E=0.9, p=0.01) remained independently associated with HL. CONCLUSION Inadequate HL is prevalent in chronic pain patients, and may impact on the development of certain characteristics necessary for effective self-management.
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Affiliation(s)
- Laura M Mackey
- School of Public Health, Physiotherapy and Sports Science, University College Dublin 4, Ireland
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, University College Dublin 4, Ireland
| | - Maire-Brid Casey
- Pain Service Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Camillus K Power
- Pain Service, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland
| | - Ray Victory
- Pain Service St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Conor Hearty
- Pain Service Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Brona M Fullen
- School of Public Health, Physiotherapy and Sports Science, University College Dublin 4, Ireland; UCD Centre for Translational Pain Research, University College Dublin, Ireland.
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Abstract
Extensive literature suggests that a solution to the current problems of healthcare sustainability is the active involvement of patients in health management through the empowerment of their abilities. Latest marketing frameworks suggest that patients are important resources for co-creating health value together with operators. This research aims to analyze the effects of patient empowerment on patients’ value co-creation behaviors. An empirical survey was conducted on 250 patients with chronic diseases in Italy. The results, analyzed using the structural equation modeling, showed that their empowerment enhanced value co-creation behaviors. Patients apply their health competencies and resources in their co-creation of health service with operators. It is, therefore, important to empower patients in their transformation from passive to active stakeholders, working with providers for the most optimal health outcomes. This research provides practitioners with suggestions for patient involvement which utilizes their knowledge, capabilities and responsibility to improving healthcare services.
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Chisholm-Burns MA, Spivey CA, Pickett LR. Health literacy in solid-organ transplantation: a model to improve understanding. Patient Prefer Adherence 2018; 12:2325-2338. [PMID: 30464420 PMCID: PMC6229143 DOI: 10.2147/ppa.s183092] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Optimizing wellness and health are the most critical goals for patients post solid-organ transplantation. Low health literacy has important implications for wellness and health, increasing patient risk for negative health outcomes. More than 30% of the general US patient population has low health literacy, and solid-organ transplant recipients (SOTRs) may be especially vulnerable to low health literacy and its adverse impact on health outcomes. A comprehensive literature review was conducted and a model was adapted to better depict factors associated with low health literacy. Based on the Paasche-Orlow and Wolf model of health literacy, the Health Literacy Model in Transplantation (HeaL-T) provides a foundation to visually demonstrate the relationships among variables associated with low health literacy and to develop evidence-based strategies to improve care. The model depicts a number of patient and healthcare level factors associated with health literacy, several of which have bi-directional or reciprocal relationships, including access and utilization of healthcare, provider-patient interaction, and self-management/adherence. The impact of these factors and their relationships to SOTR outcomes are reviewed. The HeaL-T represents an important step in developing holistic understanding of the complexity of health literacy in SOTRs and offers clinicians a base from which to design strategies to mitigate adverse health effects including increased hospitalizations, graft failure, and mortality.
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Affiliation(s)
| | - Christina A Spivey
- University of Tennessee Health Science Center College of Pharmacy, Department of Clinical Pharmacy and Translational Science, Memphis, TN, USA
| | - Logan R Pickett
- University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA,
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Blocker KA, Insel KC, Koerner KM, Rogers WA. Understanding the Medication Adherence Strategies of Older Adults with Hypertension. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/1541931213601498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Many older adults are living with at least one chronic disease and must adhere to prescribed medication to mitigate and control its impact. Hypertension is one chronic disease that affects a significant portion of the world’s population, especially older adults, and is responsible for a high number of annual deaths. It is asymptomatic, meaning that there are no perceptible symptoms and, as such, older adults may struggle with adhering to their prescribed antihypertensive medications. How one internalizes the disease may influence the degree of success in managing the condition. The current study analyzed archival data from a multifaceted prospective memory intervention for older adults with hypertension who were nonadherent to their medication. We coded their responses to self-management interview questions to identify the common themes regarding the knowledge and sense of control the older adults held relevant to managing their illness. Participants’ responses revealed how they internalized hypertension and their medication, as well as the strategies and goals they reportedly used to manage the illness. The association strategy was found to be the most commonly used within participants’ routines. In addition, many participants expressed a general lack of knowledge about the disease or their medication, and their goals regarding hypertension management were general and inexplicit (e.g., “to reduce their blood pressure). This information informs the design of more effective and longer-lasting interventions geared toward significantly improving the medication adherence of older adults diagnosed with hypertension.
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Yin HS, Gupta RS, Mendelsohn AL, Dreyer B, van Schaick L, Brown CR, Encalada K, Sanchez DC, Warren CM, Tomopoulos S. Use of a low-literacy written action plan to improve parent understanding of pediatric asthma management: A randomized controlled study. J Asthma 2017; 54:919-929. [PMID: 28045551 DOI: 10.1080/02770903.2016.1277542] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The objective of the study was to determine whether parents who use a low-literacy, pictogram- and photograph-based written asthma action plan (WAAP) have a better understanding of child asthma management compared to parents using a standard plan. METHODS A randomized controlled study was carried out in 2 urban pediatric outpatient clinics. Inclusion criteria were English- and Spanish-speaking parents of 2- to 12-year-old asthmatic children. Parents were randomized to receive a low-literacy or standard asthma action plan (American Academy of Allergy, Asthma and Immunology) for a hypothetical patient on controller and rescue medications. A structured questionnaire was used to assess whether there was an error in knowledge of (1) medications to give everyday and when sick, (2) need for spacer use, and (3) appropriate emergency response to give albuterol and seek medical help. Multiple logistic regression analyses were performed, adjusting for parent age, health literacy (Newest Vital Sign); child asthma severity, medications; and site. RESULTS 217 parents were randomized (109 intervention and 108 control). Parents who received the low-literacy plan were (1) less likely to make an error in knowledge of medications to take everyday and when sick compared to parents who received the standard plan (63.0 vs. 77.3%, p = 0.03; adjusted odds ratio [AOR] = 0.5[95% confidence interval: 0.2-0.9]) and (2) less likely to make an error regarding spacer use (14.0 vs. 51.1%, p < 0.001; AOR = 0.1 [0.06-0.3]). No difference in error in appropriate emergency response was seen (43.1 vs. 48.1%, p = 0.5). CONCLUSIONS Use of a low-literacy WAAP was associated with better parent understanding of asthma management. Further study is needed to assess whether the use of this action plan improves child asthma outcomes.
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Affiliation(s)
- Hsiang Shonna Yin
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA.,c Department of Population Health , NYU School of Medicine , New York , NY , USA
| | - Ruchi S Gupta
- b Department of Pediatrics , Northwestern University School of Medicine , Chicago , IL , USA
| | - Alan L Mendelsohn
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA.,c Department of Population Health , NYU School of Medicine , New York , NY , USA
| | - Benard Dreyer
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA
| | - Linda van Schaick
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA
| | - Christina R Brown
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA
| | - Karen Encalada
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA
| | - Dayana C Sanchez
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA
| | - Christopher M Warren
- b Department of Pediatrics , Northwestern University School of Medicine , Chicago , IL , USA
| | - Suzy Tomopoulos
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA
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Bereznicki BJ, Chapman MP, Bereznicki LRE. Factors associated with overestimation of asthma control: A cross-sectional study in Australia. J Asthma 2016; 54:439-446. [PMID: 27603169 DOI: 10.1080/02770903.2016.1226899] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate actual and perceived disease control in Australians with asthma, and identify factors associated with overestimation of asthma control. METHODS This was a cross-sectional study of Australian adults with asthma, who were recruited via Facebook to complete an online survey. The survey included basic demographic questions, and validated tools assessing asthma knowledge, medication adherence, medicine beliefs, illness perception and asthma control. Items that measured symptoms and frequency of reliever medication use were compared to respondents' self-rating of their own asthma control. Predictors of overestimation of asthma control were determined using multivariate logistic regression. RESULTS Of 2971 survey responses, 1950 (65.6%) were complete and eligible for inclusion. Overestimation of control was apparent in 45.9% of respondents. Factors independently associated with overestimation of asthma control included education level (OR = 0.755, 95% CI: 0.612-0.931, P = 0.009), asthma knowledge (OR = 0.942, 95% CI: 0.892-0.994, P = 0.029), total asthma control, (OR = 0.842, 95% CI: 0.818-0.867, P < 0.001), agreement that most medications are addictive (OR = 1.144, 95% CI: 1.017-1.287, P = 0.025), and increased feelings of control over asthma (OR = 1.261, 95% CI: 1.191-1.335), P < 0.001). CONCLUSIONS Overestimation of asthma control remains a significant issue in Australians with asthma. The study highlights the importance of encouraging patients to express their feelings about asthma control and beliefs about medicines, and to be more forthcoming with their asthma symptoms. This would help to reveal any discrepancies between perceived and actual asthma control.
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Affiliation(s)
- Bonnie J Bereznicki
- a Division of Pharmacy, School of Medicine , University of Tasmania , Hobart, Tasmania , Australia
| | | | - Luke R E Bereznicki
- a Division of Pharmacy, School of Medicine , University of Tasmania , Hobart, Tasmania , Australia
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Mackey LM, Doody C, Werner EL, Fullen B. Self-Management Skills in Chronic Disease Management: What Role Does Health Literacy Have? Med Decis Making 2016; 36:741-59. [PMID: 27053527 DOI: 10.1177/0272989x16638330] [Citation(s) in RCA: 177] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 02/01/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Self-management-based interventions can lead to improved health outcomes in people with chronic diseases, and multiple patient characteristics are associated with the development of self-management behaviors. Low health literacy (HL) has been implicated in poorer self-management behaviors and increased costs to health services. However, the mechanisms behind this relationship remain unclear. Therefore, the aim of the current review is to assess the association between HL and patient characteristics related to self-management behaviors (i.e., disease-related knowledge, beliefs, and self-efficacy). METHODS The review comprised 3 phases: 1) database searches, 2) eligibility screening, and 3) study quality assessment and strength of evidence. Inclusion criteria specified that a valid HL screening tool was used, that at least one self-management behavior was assessed, and that patients had a chronic condition. RESULTS An initial search generated a total of 712 articles, of which 31 studies fulfilled the eligibility criteria. A consistent association was found between low HL and poorer disease-related knowledge in respiratory diseases, diabetes, and multiple disease categories. A significant association between low HL and poorer self-efficacy was reported in cardiovascular diseases, diabetes, human immunodeficiency virus, and multiple disease categories. HL was significantly associated with poorer beliefs in respiratory, musculoskeletal, and cardiovascular diseases. DISCUSSION The findings from the current review suggest that low HL may affect behaviors necessary for the development of self-management skills. Given that self-management strategies are core components for effective treatment of a range of chronic diseases, low HL poses a considerable health concern. Further research is needed to understand the mediating influence of HL on disease-related knowledge, self-efficacy, and beliefs. From this, HL-sensitive, self-management interventions ought to be devised and implemented.
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Affiliation(s)
- Laura M Mackey
- University College Dublin, Belfield, Dublin, Ireland (LMM, CD, BMF)
| | - Catherine Doody
- University College Dublin, Belfield, Dublin, Ireland (LMM, CD, BMF)
| | - Erik L Werner
- Department of General Practice, Institute of Health and Society, University of Oslo, Norway (ELW),Research Unit for General Practice, Uni Health, Bergen, Norway (ELW)
| | - Brona Fullen
- University College Dublin, Belfield, Dublin, Ireland (LMM, CD, BMF),UCD Centre for Translational Pain Research, Dublin, Ireland (BMF)
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Sivakumar H, Hanoch Y, Barnes AJ, Federman AD. Cognition, Health Literacy, and Actual and Perceived Medicare Knowledge Among Inner-City Medicare Beneficiaries. JOURNAL OF HEALTH COMMUNICATION 2016; 21:155-163. [PMID: 27676124 DOI: 10.1080/10810730.2016.1193921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Poor Medicare knowledge is associated with worse health outcomes, especially in low-income patients. We examined the association of health literacy and cognition with actual and perceived Medicare knowledge in a sample of inner-city older adults. We conducted a cross-sectional analysis of data on 336 adults ages 65 years and older with Medicare coverage recruited from senior centers and low-income housing facilities in Manhattan, New York. Actual Medicare knowledge was determined by a summary score of 9 true/false questions about the Medicare program and perceived Medicare knowledge with a single item. Validated measures were used to assess health literacy and general cognition. Among respondents, 63.1% had high actual Medicare knowledge, and 36.0% believed that they knew what they needed to know about Medicare. Actual and perceived Medicare knowledge were poorly correlated (r = -.01, p > .05). In multivariable models, low health literacy was significantly associated with actual Medicare knowledge (β = -8.30, SE = 2.71, p < .01) but not perceived Medicare knowledge (β = 0.37, SE = 0.22, p = .09). Individuals with low health literacy were more likely to perceive their Medicare knowledge as adequate when actual Medicare knowledge was low (adjusted odds ratio = 3.30, 95% confidence interval [1.20, 9.05], p < .05). These results show that older adults with low health literacy are more likely to have poor understanding of the Medicare program and yet more likely to believe that their understanding of the program is adequate. This combination of factors may place them at increased risk for poor access to information about the Medicare program and diminish their ability to make fully informed choices.
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Affiliation(s)
- Haran Sivakumar
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , New York , USA
| | - Yaniv Hanoch
- b Department of Healthcare Behavior and Policy , Virginia Commonwealth University School of Medicine , Richmond , Virginia , USA
| | - Andrew J Barnes
- c School of Psychology , Plymouth University , Plymouth , United Kingdom
| | - Alex D Federman
- d Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , New York , USA
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18
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Yin HS, Gupta RS, Tomopoulos S, Mendelsohn AL, Egan M, van Schaick L, Wolf MS, Sanchez DC, Warren C, Encalada K, Dreyer BP. A Low-Literacy Asthma Action Plan to Improve Provider Asthma Counseling: A Randomized Study. Pediatrics 2016; 137:peds.2015-0468. [PMID: 26634774 DOI: 10.1542/peds.2015-0468] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The use of written asthma action plans (WAAPs) has been associated with reduced asthma-related morbidity, but there are concerns about their complexity. We developed a health literacy-informed, pictogram- and photograph-based WAAP and examined whether providers who used it, with no training, would have better asthma counseling quality compared with those who used a standard plan. METHODS Physicians at 2 academic centers randomized to use a low-literacy or standard action plan (American Academy of Allergy, Asthma and Immunology) to counsel the hypothetical parent of child with moderate persistent asthma (regimen: Flovent 110 μg 2 puffs twice daily, Singulair 5 mg daily, Albuterol 2 puffs every 4 hours as needed). Two blinded raters independently reviewed counseling transcriptions. PRIMARY OUTCOME MEASURES medication instructions presented with times of day (eg, morning and night vs number of times per day) and inhaler color; spacer use recommended; need for everyday medications, even when sick, addressed; and explicit symptoms used. RESULTS 119 providers were randomly assigned (61 low literacy, 58 standard). Providers who used the low-literacy plan were more likely to use times of day (eg, Flovent morning and night, 96.7% vs 51.7%, P < .001; odds ratio [OR] = 27.5; 95% confidence interval [CI], 6.1-123.4), recommend spacer use (eg, Albuterol, 83.6% vs 43.1%, P < .001; OR = 6.7; 95% CI, 2.9-15.8), address need for daily medications when sick (93.4% vs 34.5%, P < .001; OR = 27.1; 95% CI, 8.6-85.4), use explicit symptoms (eg, "ribs show when breathing," 54.1% vs 3.4%, P < .001; OR = 33.0; 95% CI, 7.4-147.5). Few mentioned inhaler color. Mean (SD) counseling time was similar (3.9 [2.5] vs 3.8 [2.6] minutes, P = .8). CONCLUSIONS Use of a low-literacy WAAP improves the quality of asthma counseling by helping providers target key issues by using recommended clear communication principles.
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Affiliation(s)
- H Shonna Yin
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York; Department of Population Health, New York University School of Medicine, New York, New York;
| | - Ruchi S Gupta
- Center for Community Health, and Smith Child Health Research Program, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; and
| | - Suzy Tomopoulos
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York
| | - Alan L Mendelsohn
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York; Department of Population Health, New York University School of Medicine, New York, New York
| | - Maureen Egan
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Linda van Schaick
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York
| | - Michael S Wolf
- Health Literacy and Learning Program, Center for Communication in Healthcare, Division of General Internal Medicine, and Institute for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dayana C Sanchez
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York
| | | | - Karen Encalada
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York
| | - Benard P Dreyer
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York
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Broadbent E, Wilkes C, Koschwanez H, Weinman J, Norton S, Petrie KJ. A systematic review and meta-analysis of the Brief Illness Perception Questionnaire. Psychol Health 2015; 30:1361-85. [DOI: 10.1080/08870446.2015.1070851] [Citation(s) in RCA: 282] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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20
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Federman AD, Martynenko M, O'Conor R, Kannry J, Karp A, Lurio J, Hoy-Rosas J, Lopez R, Obiapi R, Young E, Wolf MS, Wisnivesky JP. Rationale and design of a comparative effectiveness trial of home- and clinic-based self-management support coaching for older adults with asthma. Contemp Clin Trials 2015; 44:103-111. [PMID: 26238181 DOI: 10.1016/j.cct.2015.07.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 07/23/2015] [Accepted: 07/25/2015] [Indexed: 01/01/2023]
Abstract
Older adults with asthma face numerous barriers to effective self-management and asthma control, and experience worse outcomes than younger asthmatics. Yet, there have been no controlled trials of interventions specifically designed to improve their care and outcomes. Through a multi-stakeholder collaboration (patients, academia, community-based organizations, a state department of health, and an advocacy organization) we developed a multi-component asthma self-management support intervention to address the myriad psychosocial, functional, health status, and cognitive barriers to effective asthma self-management in adults ages 60 and older. We are recruiting 425 New Yorkers in Manhattan and the Bronx for a pragmatic randomized controlled trial with 3 arms: the intervention delivered in primary care settings or in their home, or usual care. In the intervention, care coaches use a novel screening tool to identify the specific barriers to asthma control and self-management they experience. Once identified, the coach and patient choose from a menu of actions to address it. The intervention emphasizes efficiency, flexibility, shared decision making and goal setting, communication strategies appropriate for individuals with limited cognition and literacy skills, and ongoing reinforcement and support. Additionally, we introduced asthma-specific enhancements to the electronic health records of all participating clinical practices, including an asthma severity assessment, clinical decision support, and a patient-tailored asthma action plan. Patients will be followed for 12months and interviewed at baseline, 3, 6, and 12months and data on emergency department visits and hospitalizations will be obtained through the New York State Statewide Planning and Research Cooperative System.
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Affiliation(s)
- Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Melissa Martynenko
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Rachel O'Conor
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Joseph Kannry
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Adam Karp
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Joseph Lurio
- Institute for Family Health, New York, NY, United States
| | | | - Ray Lopez
- Little Sisters of the Assumption Family Health Service, New York, NY, United States
| | - Rosemary Obiapi
- St. Luke's Hospital, Mount Sinai Healthcare System, New York, NY, United States
| | - Edwin Young
- Union Settlement, New York, NY, United States
| | - Michael S Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Kale MS, Federman AD, Krauskopf K, Wolf M, O’Conor R, Martynenko M, Leventhal H, Wisnivesky JP. The Association of Health Literacy with Illness and Medication Beliefs among Patients with Chronic Obstructive Pulmonary Disease. PLoS One 2015; 10:e0123937. [PMID: 25915420 PMCID: PMC4411058 DOI: 10.1371/journal.pone.0123937] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 03/09/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Low health literacy is associated with low adherence to self-management in many chronic diseases. Additionally, health beliefs are thought to be determinants of self-management behaviors. In this study we sought to determine the association, if any, of health literacy and health beliefs among elderly individuals with COPD. METHODS We enrolled a cohort of patients with COPD from two academic urban settings in New York, NY and Chicago, IL. Health literacy was measured using the Short Test of Functional Health Literacy in Adults. Using the framework of the Self-Regulation Model, illness and medication beliefs were measured with the Brief Illness Perception Questionnaire (B-IPQ) and Beliefs about Medications Questionnaire (BMQ). Unadjusted analyses, with corresponding Cohen's d effect sizes, and multiple logistic regression were used to assess the relationships between HL and illness and medication beliefs. RESULTS We enrolled 235 participants, 29% of whom had low health literacy. Patients with low health literacy were more likely to belong to a racial minority group (p<0.001), not be married (p = 0.006), and to have lower income (p<0.001) or education (p<0.001). In unadjusted analyses, patients with low health literacy were less likely to believe they will always have COPD (p = 0.003, Cohen's d = 0.42), and were more likely to be concerned about their illness ((p = 0.04, Cohen's d = 0.17). In analyses adjusted for sociodemographic factors and other health beliefs, patients with low health literacy were less likely to believe that they will always have COPD (odds ratio [OR]: 0.78, 95% confidence interval [CI]: 0.65-0.94). In addition, the association of low health literacy with expressed concern about medications remained significant (OR: 1.20, 95% CI: 1.05-1.37) though the association of low health literacy with belief in the necessity of medications was no longer significant (OR: 0.92, 95% CI: 0.82-1.04). CONCLUSIONS In this cohort of urban individuals with COPD, low health literacy was prevalent, and associated with illness beliefs that predict decreased adherence. Our results suggest that targeted strategies to address low health literacy and related illness and medications beliefs might improve COPD medication adherence and other self-management behaviors.
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Affiliation(s)
- Minal S. Kale
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Alex D. Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Katherine Krauskopf
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Michael Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Rachel O’Conor
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Melissa Martynenko
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Howard Leventhal
- Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, United States of America
| | - Juan P. Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
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Strategies used by older adults with asthma for adherence to inhaled corticosteroids. J Gen Intern Med 2014; 29:1506-12. [PMID: 25092003 PMCID: PMC4238202 DOI: 10.1007/s11606-014-2940-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 05/16/2014] [Accepted: 06/09/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Older adults with asthma have low levels of adherence to their prescribed inhaled corticosteroids (ICS). While prior research has identified demographic and cognitive factors associated with ICS adherence among elderly asthmatics, little is known about the strategies that older adults use to achieve daily use of their medications. Identifying such strategies could provide clinicians with useful advice for patients when counseling their patients about ICS adherence. OBJECTIVE To identify medication use strategies associated with good ICS adherence in older adults. PARTICIPANTS English-speaking and Spanish-speaking adults ages 60 years and older with moderate or severe asthma were recruited from primary care and pulmonary practices in New York City, NY, and Chicago, IL. Patients with chronic obstructive pulmonary disease, other chronic lung diseases or a smoking history of greater than 10 pack-years were excluded. MAIN MEASURES Medication adherence was assessed with the Medication Adherence Rating Scale (MARS). Medication use strategies were assessed via open-ended questioning. "Good adherence" was defined as a mean MARS score of 4.5 or greater. KEY RESULTS The rate of good adherence to ICS was 37 %. We identified six general categories of medication adherence strategies: keeping the medication in a usual location (44.2 %), integrating medication use with a daily routine (32.6 %), taking the medication at a specific time (21.7 %), taking the medication with other medications (13.4 %), using the medication only when needed (13.4 %), and using other reminders (11.9 %). The good adherence rate was greater among individuals who kept their ICS medication in the bathroom (adjusted odds ration [AOR] 3.05, 95 % CI 1.03-9.02, p = 0.04) or integrated its use into a daily routine (AOR 3.77, 95 % CI: 1.62-8.77, p = 0.002). CONCLUSIONS Keeping ICS medications in the bathroom and integrating them into daily routines are strategies associated with good ICS adherence. Clinicians concerned with adherence should consider recommending these strategies to their older asthmatic patients, although additional research is needed to determine whether such advice would improve adherence behaviors.
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Federman AD, Wolf MS, Sofianou A, Martynenko M, O’Connor R, Halm EA, Leventhal H, Wisnivesky JP. Self-management behaviors in older adults with asthma: associations with health literacy. J Am Geriatr Soc 2014; 62:872-9. [PMID: 24779482 PMCID: PMC4024064 DOI: 10.1111/jgs.12797] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine self-management behaviors, including medication adherence and inhaler technique, in older adults with asthma and their association with health literacy. DESIGN Observational cohort study. SETTING Primary care and pulmonary specialty practices in two tertiary academic medical centers and three federally qualified health centers in New York, New York, and Chicago, Illinois. PARTICIPANTS Adults with moderate or severe persistent asthma aged 60 and older (N = 433). MEASUREMENTS Outcomes were adherence to asthma controller medications, metered dose inhaler (MDI) and dry powder inhaler (DPI) techniques, having a usual asthma physician, and avoidance of four common triggers. Health literacy was assessed using the Short Test of Functional Health Literacy in Adults. RESULTS The mean age was 67, and 36% of participants had marginal or low health literacy. Adherence was low (38%) overall and worse in individuals with low health literacy (22%) than in those with adequate literacy (47%, P < .001) and after adjusting for demographic factors and health status (odds ratio (OR) = 0.48, 95% confidence interval (CI) = 0.31-0.73). Similarly, inhaler technique was poor; only 38% and 54% had good MDI and DPI technique, respectively. Technique was worse in those with low health literacy (MDI technique: OR = 0.57, 95% CI = 0.38-0.85; DPI technique: OR = 0.42, 95% CI = 0.25-0.71). Asthma self-monitoring and avoidance of triggers occurred infrequently but were less consistently associated with low health literacy. CONCLUSION Adherence to medications and inhaler technique are poor in older adults with asthma and worse in those with low health literacy. Clinicians should routinely assess controller medication adherence and inhaler technique and use low-literacy communication strategies to support self-management in older adults with asthma.
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Affiliation(s)
- Alex D. Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai
| | - Michael S. Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University
| | - Anastasia Sofianou
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai
| | - Melissa Martynenko
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai
| | - Rachel O’Connor
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University
| | - Ethan A. Halm
- Division of General Internal Medicine, University of Texas Southwestern Medical Center
| | - Howard Leventhal
- Institute of Health, Health Care Policy and Aging Research, Rutgers University
| | - Juan P. Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai
- Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai School of Medicine
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Wang KY, Chu NF, Lin SH, Chiang IC, Perng WC, Lai HR. Examining the causal model linking health literacy to health outcomes of asthma patients. J Clin Nurs 2013; 23:2031-42. [PMID: 24329740 DOI: 10.1111/jocn.12434] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2013] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore health literacy status in asthma patients and to examine the causal model linking health literacy to health outcome-related factors via mediator and moderator variables. BACKGROUND Understanding how low health literacy may influence health outcomes is important. DESIGN This is a cross-sectional survey study. METHODS A total of 326 asthma patients aged 20 years and older (average: 51 ± 18·3 years) were recruited by purposive sampling from pulmonary medicine outpatient departments at three medical centres and a regional teaching hospital in northern Taiwan. Data were collected via structured questionnaires, including measures of socio-demographic and disease characteristics; medical decision-making; asthma knowledge, attitudes and self-efficacy; healthcare experience and health outcome-related factors (metered-dose inhaler/dry-powder inhaler usage proficiency, medical use, self-management behaviour). Three hundred patients who met the inclusion criteria and completed the questionnaire survey were analysed. RESULTS Overall, 217 subjects (72·3%) had adequate functional health literacy, 42 (14%) had inadequate functional health literacy, and 41 (13·7%) had marginal functional health literacy. Subjects' average asthma knowledge, attitudes and self-efficacy scores were 7·23 ± 2·69, 51·46 ± 6·18 and 58·31 ± 8·10, respectively. Health literacy correlated positively with asthma knowledge (r = 0·605), attitudes (r = 0·192) and medical decision-making (r = 0·413). CONCLUSIONS Health literacy is positively associated with proficiency in metered-dose inhaler usage, asthma knowledge, attitudes and medical decision-making, but is not significantly associated with medical care use and self-management behaviour. Health literacy had an indirect effect on self-management behaviour through the mediation effect of asthma attitudes. No moderator was found for the effect of health literacy on health outcome-related factors. RELEVANCE TO CLINICAL PRACTICE Results of this study may help to develop adequate intervention strategies to improve the health outcomes of asthma patients.
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Affiliation(s)
- Kwua-Yun Wang
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan; School of Nursing, National Defense Medical Center, Taipei, Taiwan
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Federman AD, Wolf MS, Sofianou A, O'Conor R, Martynenko M, Halm EA, Leventhal H, Wisnivesky JP. Asthma outcomes are poor among older adults with low health literacy. J Asthma 2013; 51:162-7. [PMID: 24102556 DOI: 10.3109/02770903.2013.852202] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To examine the association of health literacy (HL) with asthma outcomes among older asthmatics. METHODS The study included adults ages ≥60 with moderate to severe asthma in New York City and Chicago. We assessed asthma control with the Asthma Control Questionnaire (ACQ) and the percent predicted forced expiratory volume at 1 s (FEV1) by spirometry, hospitalizations and emergency department (ED) visits in the past 6 months, and quality of life. HL was assessed with the Short Test of Functional Health Literacy in Adults (S-TOFHLA). Multivariate logistic regression models controlled for age, sex, race, income, general health and years with asthma. RESULTS Among 433 individuals, 36% had low HL, 55% were over age 65, 38% were Hispanic and 22% were black. Poor asthma control was reported by 40% and 32% had FEV1 <70% of predicted; 9% had a hospital stay, 23% had an ED and 38% had poor quality of life. In multivariable analysis, individuals with low HL were more likely to have FEV1 <70% predicted (odds ratio [OR] 2.34, 95% confidence interval [CI] 1.39-3.94, p = 0.001), hospitalizations (OR 2.53, 95% CI 1.17-5.49, p = 0.02) and ED visits for asthma (OR 1.81, 95% CI 1.05-3.10, p = 0.03). There were no differences in self-reported asthma control and quality of life. CONCLUSIONS Low HL is associated with poor asthma control by objective measure, and greater likelihood of ED visits and hospitalization. HL is a modifiable target for interventions to improve asthma outcomes in the elderly.
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Affiliation(s)
- Alex D Federman
- Division of General Internal Medicine, Mount Sinai School of Medicine , New York, NY , USA
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Speck AL, Nelson B, Jefferson SO, Baptist AP. Young, African American adults with asthma: what matters to them? Ann Allergy Asthma Immunol 2013; 112:35-9. [PMID: 24331391 DOI: 10.1016/j.anai.2013.10.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 10/09/2013] [Accepted: 10/21/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Asthma is a common chronic condition that shows significant health disparities among minority populations. Little research has focused on the management needs and preferences of young African American adults with asthma, a population undergoing dramatic life changes as they transition from adolescence to adulthood. OBJECTIVE To understand the experiences and perspectives of young African American adults managing their asthma. METHODS Focus groups were conducted with African American adults (n = 34) 18 to 30 years old with a physician diagnosis of asthma. Focus group sessions were audiotaped, transcribed verbatim, and coded using constant comparative analysis. RESULTS Six major domains were identified and some of the salient themes included changes in asthma management needs with the onset of adulthood, career limitations owing to asthma, childcare interference with asthma regimen adherence, and difficulties with medication cost owing to lapses in insurance coverage. Participants also reported feeling discouraged when interacting with physicians as it related to their asthma care; yet ageism and racism were not perceived. Despite poor medication regimen compliance, participants were overwhelmingly interested in participating in asthma self-management programs and had strong preferences that such programs be tailored specifically to young adults with special consideration of the cultural experience of young African Americans with asthma. CONCLUSION Young African American adults have specific barriers to optimal asthma care and distinctive ideas for self-management programs. It is important for the asthma care provider to identify and address these population- and age-specific barriers to improve asthma outcomes and decrease health care disparities.
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Affiliation(s)
- Aimee L Speck
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Michigan.
| | - Belinda Nelson
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - S Olivia Jefferson
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Alan P Baptist
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Michigan; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
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Mitzner TL, McBride SE, Barg-Walkow LH, Rogers WA. Self-Management of Wellness and Illness in an Aging Population. ACTA ACUST UNITED AC 2013. [DOI: 10.1177/1557234x13492979] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this chapter, we review the last 10 years of literature on self-management of illnesses (acute/episodic and chronic) and wellness (e.g., health promotion). We focus on health self-management in the context of an aging population, wherein middle-aged adults are more likely to be managing wellness activities and older adults are often managing both maintenance of health and chronic illnesses. The critical issues related to self-management of health are discussed, including those imposed by health care demands and those stemming from individual differences in general abilities (e.g., motor, perception, cognition) and socioemotional characteristics. The dynamic relationship between theory and practice is highlighted. Health care demands reflect the nature of the illness or wellness activity and include managing comorbidities, symptoms, and medications; engaging in health promotion activities (e.g., exercise, diet); the required use of health technologies; the need for health-related information; and coordination of the care network. Individual differences in motor, perceptual, and cognitive abilities, as well as in the severity and complexity of the illness and the consequent demands, also impact how a person self-manages health. Cognitive abilities, such as decision making, knowledge, literacy (i.e., general, health, and e-health literacy), and numeracy are particularly implicated in the process of managing one’s own health and are especially important in the context of an aging population; therefore we give these cognitive abilities special attention in this chapter. Socioemotional characteristics, and attitudes and beliefs about one’s health, impact an individual’s self-management of health as well, impacting his or her motivation and goal-setting behaviors. Moreover, we discuss literature on interventions that have been used to improve self-management of health, and we examine the potential for technology. We conclude with guidelines for technology design and instruction, and discuss emerging themes.
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Abstract
Many asthma-related hospitalizations are preventable with appropriate access to care as well as adherence to lifestyle modifications and medical treatment, yet as many as half of all patients with asthma fail to adhere to treatment as prescribed. Identifying the specific barriers affecting a patient and engaging with the patient in active planning to overcome adherence barriers is a practical strategy for achieving and sustaining adherence to long-term therapy.
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Federman AD, Wolf M, Sofianou A, Wilson EAH, Martynenko M, Halm EA, Leventhal H, Wisnivesky JP. The association of health literacy with illness and medication beliefs among older adults with asthma. PATIENT EDUCATION AND COUNSELING 2013; 92:273-8. [PMID: 23523196 PMCID: PMC3720706 DOI: 10.1016/j.pec.2013.02.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 02/05/2013] [Accepted: 02/27/2013] [Indexed: 05/22/2023]
Abstract
OBJECTIVE Suboptimal health literacy (HL) and asthma beliefs are associated with poor asthma self-management and outcomes. We tested the hypothesis that low HL is associated with inaccurate beliefs. METHODS Asthmatics ≥60 were recruited from hospital and community practices in New York, NY and Chicago, IL (n=420). HL was measured with the Short Test of Functional Health Literacy in Adults; validated instruments derived from the self regulation model were used to assess beliefs. The association of beliefs with HL was evaluated with multivariate models. RESULTS Thirty-six percent of patients had low HL; 54% believed they only have asthma when symptoms are present, 29% believed they will not always have asthma and 20% believed that their doctor can cure asthma. HL was associated with beliefs of not having asthma all the time and that asthma can be cured (OR: 1.84, 95% CI: 1.2-2.82; OR: 2.22, 95% CI: 1.29-3.82, respectively). Patients with low HL were also more likely to be concerned about medication use (β=0.92, p=.05), despite recognizing their necessity (β=-1.36, p=.01). CONCLUSIONS Older asthmatics with low HL endorse erroneous asthma beliefs. PRACTICE IMPLICATIONS Health communications for improving self-management behaviors in asthma should employ both health literacy-appropriate strategies and messages to counter illness-related misconceptions.
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Affiliation(s)
- Alex D Federman
- Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Morrow DG, Conner-Garcia T. Improving Comprehension of Medication Information: Implications for Nurse–Patient Communication. J Gerontol Nurs 2013; 39:22-9. [DOI: 10.3928/00989134-20130220-03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 01/18/2013] [Indexed: 11/20/2022]
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Chesser AK, Keene Woods N, Wipperman J, Wilson R, Dong F. Health Literacy Assessment of the STOFHLA: Paper versus electronic administration continuation study. HEALTH EDUCATION & BEHAVIOR 2013; 41:19-24. [PMID: 23444322 DOI: 10.1177/1090198113477422] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Low health literacy is associated with poor health outcomes. Research is needed to understand the mechanisms and pathways of its effects. Computer-based assessment tools may improve efficiency and cost-effectiveness of health literacy research. The objective of this preliminary study was to assess if administration of the Short Test of Functional Health Literacy in Adults (STOFHLA) through a computer-based medium was comparable to the paper-based test in terms of accuracy and time to completion. A randomized, crossover design was used to compare computer versus paper format of the STOFHLA at a Midwestern family medicine residency program. Eighty participants were initially randomized to either computer (n = 42) or paper (n = 38) format of the STOFHLA. After a 30-day washout period, participants returned to complete the other version of the STOFHLA. Data analysis revealed no significant difference between paper- and computer-based surveys (p = .9401; N = 57). The majority of participants showed "adequate" health literacy via paper- and computer-based surveys (100% and 97% of participants, respectively). Electronic administration of STOFHLA results were equivalent to the paper administration results for evaluation of adult health literacy. Future investigations should focus on expanded populations in multiple health care settings and validation of other health literacy screening tools in a clinical setting.
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Affiliation(s)
- Amy K Chesser
- 1University of Kansas School of Medicine-Wichita, Wichita, KS, USA
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Quinlan P, Price KO, Magid SK, Lyman S, Mandl LA, Stone PW. The relationship among health literacy, health knowledge, and adherence to treatment in patients with rheumatoid arthritis. HSS J 2013; 9:42-9. [PMID: 24426844 PMCID: PMC3640723 DOI: 10.1007/s11420-012-9308-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 08/10/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with poor health literacy often lack the knowledge needed to manage their treatment. OBJECTIVE The aim of this cross-sectional study is to determine whether health literacy is a predictor of health knowledge and/or adherence to medication treatment in patients with rheumatoid arthritis. METHOD The study was completed in an urban, outpatient rheumatology setting. Health literacy was measured using the Test of Functional Health Literacy in Adults. The Arthritis Knowledge Questionnaire was modified to measure medication specific health knowledge, and the Morisky Medication Adherence scale was used to measure adherence. Researchers used regression analyses to determine if health literacy was a predicator of knowledge and/or adherence. RESULTS Participants (N = 125) had high mean health literacy scores. The average medication knowledge score was 0.73. Adherence to medication regimen was 0.84. Controlling for patient covariates, health literacy was positively associated with education, race, and age. In adjusted analyses, health literacy was a significant predictor of health knowledge but not adherence. Race, neighborhood income, and confidence with contacting provider about medications were predictors of adherence. CONCLUSION Study findings indicate that health literacy is independently associated with medication knowledge but not medication adherence in patients with rheumatoid arthritis. These results provide useful information for planning initiatives to support individuals with disease self-management.
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Affiliation(s)
- Patricia Quinlan
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Kwanza O. Price
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Steven K. Magid
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ,Weill Cornell University Medical College, New York, NY USA
| | - Stephen Lyman
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Lisa A. Mandl
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ,Weill Cornell University Medical College, New York, NY USA
| | - Patricia W. Stone
- Center for Health Policy, Columbia University School of Nursing, New York, NY USA
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Krauskopf KA, Sofianou A, Goel MS, Wolf MS, Wilson EAH, Martynenko ME, Halm EA, Leventhal H, Feldman JM, Federman AD, Wisnivesky JP. Depressive symptoms, low adherence, and poor asthma outcomes in the elderly. J Asthma 2013; 50:260-6. [PMID: 23294120 DOI: 10.3109/02770903.2012.757779] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine the impact of depressive symptoms on asthma outcomes and medication adherence in inner-city elderly patients with asthma. METHODS Cohort study of elderly asthmatics receiving primary care at three clinics in New York City and Chicago from 1 January 2010 to 1 January 2012. Depressive symptoms were ascertained with the Patient Health Questionnaire (PHQ-9). Outcomes included asthma control (Asthma Control Questionnaire, ACQ), asthma-related quality of life (Asthma Quality of Life Questionnaire, AQLQ), and acute resource utilization (inpatient and outpatient visits). Asthma medication adherence was evaluated using the Medication Adherence Reporting Scale (MARS). RESULTS Three hundred and seventeen participants ≥60 years were included in the study (83% women, 30% Hispanic, and 31% Black). In unadjusted analyses, participants with depressive symptoms were more likely to report poor asthma control (p < .001), worse AQLQ scores (p < .001), and higher rates of inpatient asthma-related visits (odds ratio [OR]: 2.03, 95% confidence interval [CI]: 1.04-3.99). Those with depressive symptoms also reported lower medication adherence (OR: 0.23, 95%CI: 0.10-0.54). Similar results were obtained in analyses adjusting for age, sex, race/ethnicity, income, asthma medication prescription, years with asthma, intubation history, comorbidities, and health literacy. CONCLUSION In this cohort of elderly inner-city participants, depressive symptoms were associated with poorer asthma control and quality of life, as well as with lower rates of adherence to controller medications. Future work exploring possible mediators, including adherence, might elucidate the relationship between depression and poorer asthma outcomes in this population.
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Affiliation(s)
- Katherine A Krauskopf
- Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Sofianou A, Martynenko M, Wolf MS, Wisnivesky JP, Krauskopf K, Wilson EAH, Goel MS, Leventhal H, Halm EA, Federman AD. Asthma beliefs are associated with medication adherence in older asthmatics. J Gen Intern Med 2013; 28:67-73. [PMID: 22878848 PMCID: PMC3539042 DOI: 10.1007/s11606-012-2160-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 06/04/2012] [Accepted: 06/12/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Empirical research and health policies on asthma have focused on children and young adults, even though asthma morbidity and mortality are higher among older asthmatics. OBJECTIVE To explore the relationship of asthma-related beliefs and self-reported controller medication adherence in older asthmatics. DESIGN An observational study of asthma beliefs and self-management among older adults. PARTICIPANTS Asthmatics ages ≥ 60 years (N = 324, mean age 67.4 ± 6.8, 28 % white, 32 % black, 30 % Hispanic) were recruited from primary care practices in New York City and Chicago. MAIN MEASURES Self-reported controller medication adherence was assessed using the Medication Adherence Report Scale. Based on the Common Sense Model of Self-Regulation, patients were asked if they believe they only have asthma with symptoms, their physician can cure their asthma, and if their asthma will persist. Beliefs on the benefit, necessity and concerns of treatment use were also assessed. Multivariate logistic regression was used to examine the association of beliefs with self-reported medication adherence. KEY RESULTS The majority (57.0 %) of patients reported poor adherence. Poor self-reported adherence was more common among those with erroneous beliefs about asthma illness and treatments, including the "no symptoms, no asthma" belief (58.7 % vs. 31.7 %, respectively, p < 0.001), "will not always have asthma" belief (34.8 % vs. 12.5 %, p < 0.001), and the "MD can cure asthma" belief (21.7 % vs. 9.6 %, p = 0.01). Adjusting for illness beliefs, treatment beliefs and demographics, patients with a "no symptoms, no asthma" belief had lower odds of having good self-reported adherence (odds ratio [OR] 0.45, 95 % confidence interval [CI] 0.23-0.86), as did those with negative beliefs about the benefits (OR 0.73, 95 % CI 0.57-0.94) and necessity (OR 0.89, 95 % CI 0.83-0.96) of treatment. CONCLUSIONS Illness and treatment beliefs have a strong influence on self-reported medication adherence in older asthmatics. Interventions to improve medication adherence in older asthmatics by modifying illness and treatment beliefs warrant study.
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Affiliation(s)
- Anastasia Sofianou
- Division of General Internal Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1087, New York, NY 10029, USA
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Abstract
Exacerbations occur frequently in severe asthma. They result in significant morbidity and can lead to hospitalization and death. Severe exacerbations can also lead to an accelerated decline in lung function. Phenotyping severe asthma can aid with both prognostication of exacerbation risk and maintenance treatment selection to minimize future risks of exacerbations in severe asthma. The rate of exacerbations differs by phenotype, and is most frequent in refractory eosinophilic asthma and early onset allergic asthma. Phenotype specific therapy can reduce exacerbations in both these forms of severe asthma. Exacerbations are multi-component events. Each exacerbation represents an opportunity to assess and target treatment to the domains of airway pharmacotherapy, self-management behaviour, risk factors, and relevant co-morbidities.
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Affiliation(s)
- V M McDonald
- School of Nursing and Midwifery, The University of Newcastle, Newcastle, Australia
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Wisnivesky JP, Krauskopf K, Wolf MS, Wilson EAH, Sofianou A, Martynenko M, Halm EA, Leventhal H, Federman AD. The association between language proficiency and outcomes of elderly patients with asthma. Ann Allergy Asthma Immunol 2012; 109:179-84. [PMID: 22920072 DOI: 10.1016/j.anai.2012.06.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 06/15/2012] [Accepted: 06/25/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Asthma is a growing cause of morbidity for elderly Americans and is highly prevalent among Hispanic people in the United States. The inability to speak English poses a barrier to patient-provider communication. OBJECTIVE To evaluate associations between limited English proficiency, asthma self-management, and outcomes in elderly Hispanic patients. METHOD Elderly patients with asthma receiving primary care at clinics in New York City and Chicago were studied. RESULTS Of 268 patients in the study, 68% were non-Hispanic, 18% English-proficient Hispanic, and 14% Hispanic with limited English proficiency. Unadjusted analyses showed that Hispanic persons with limited English proficiency had worse asthma control (P = .0007), increased likelihood of inpatient visits (P = .002), and poorer quality of life (P < .0001). We also found significant associations between limited English proficiency and poorer medication adherence (P = .006). Similar results were obtained in multiple regression analyses adjusting for demographics, asthma history, comorbidities, depression, and health literacy. CONCLUSION Limited English proficiency was associated with poorer self-management and worse outcomes among elderly patients with asthma. Further understanding of mechanisms underlying this relationship is necessary to develop interventions that improve asthma outcomes in this vulnerable population.
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Affiliation(s)
- Juan P Wisnivesky
- Division of General Internal Medicine, Mount Sinai School of Medicine, New York, New York, USA.
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Health literacy and asthma. J Allergy Clin Immunol 2012; 129:935-42. [PMID: 22326486 DOI: 10.1016/j.jaci.2012.01.040] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 01/05/2012] [Accepted: 01/12/2012] [Indexed: 11/20/2022]
Abstract
The report "Healthy people" from the US Department of Health and Human Services defines health literacy (HL) as follows: "The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions." The same report identifies asthma as a public health problem of high priority. Unfortunately, impaired HL is prevalent in our society, and patients with low HL and asthma face multiple challenges as they attempt to manage their disease. Indeed, the National Asthma Education and Prevention Program's current guidelines require patients to have considerable HL and self-management skills. Numerous studies have linked inadequate literacy with poor health outcomes. Unlike many sociodemographic variables, HL can potentially be addressed in the health care setting. The purpose of this review is to raise awareness of the problem, summarize the current evidence linking HL and asthma, and offer strategies to strengthen the communication between patients and health care providers to decrease asthma health disparities. In addition, we discuss potential future directions for research in this field.
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Armour CL, Lemay K, Saini B, Reddel HK, Bosnic-Anticevich SZ, Smith LD, Burton D, Song YJC, Alles MC, Stewart K, Emmerton L, Krass I. Using the community pharmacy to identify patients at risk of poor asthma control and factors which contribute to this poor control. J Asthma 2011; 48:914-22. [PMID: 21942306 DOI: 10.3109/02770903.2011.615431] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although asthma can be well controlled by appropriate medication delivered in an appropriate way at an appropriate time, there is evidence that management is often suboptimal. This results in poor asthma control, poor quality of life, and significant morbidity. METHODS The objective of this study was to describe a population recruited in community pharmacy identified by trained community pharmacists as being at risk for poor asthma outcomes and to identify factors associated with poor asthma control. It used a cross-sectional design in 96 pharmacies in metropolitan and regional New South Wales, Victoria, Queensland, and Australian Capital Territory in Australia. Community pharmacists with specialized asthma training enrolled 570 patients aged ≥18 years with doctor-diagnosed asthma who were considered at risk of poor asthma outcomes and then conducted a comprehensive asthma assessment. In this assessment, asthma control was classified using a symptom and activity tool based on self-reported frequency of symptoms during the previous month and categorized as poor, fair, or good. Asthma history was discussed, and lung function and inhaler technique were also assessed by the pharmacist. Medication use/adherence was recorded from both pharmacy records and the Brief Medication Questionnaire (BMQ). RESULTS The symptom and activity tool identified that 437 (77%) recruited patients had poor asthma control. Of the 570 patients, 117 (21%) smoked, 108 (19%) had an action plan, 372 (69%) used combination of inhaled corticosteroid (ICS)/long-acting β(2)-agonist (LABA) medications, and only 17-28% (depending on device) used their inhaler device correctly. In terms of adherence, 90% had their ICS or ICS/LABA dispensed <6 times in the previous 6 months, which is inconsistent with regular use; this low adherence was confirmed from the BMQ scores. A logistic regression model showed that patients who smoked had incorrect inhaler technique or low adherence (assessed by either dispensing history or BMQ) and were more likely to have poor control. CONCLUSION Community pharmacists were able to identify patients with asthma at risk of suboptimal control, and factors that contributed to this were elicited. This poorly controlled group that was identified may not be visible or accessible to other health-care professionals. There is an opportunity within pharmacies to target poorly controlled asthma and provide timely and tailored interventions.
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Affiliation(s)
- Carol L Armour
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia.
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Redman BK. Ethics of patient education and how do we make it everyone's ethics. Nurs Clin North Am 2011; 46:283-9, v. [PMID: 21791263 DOI: 10.1016/j.cnur.2011.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Patient education has long been central to nursing's philosophy of practice, and, because of this commitment, nurses in all practice settings have been deeply distressed with the careless and generally incomplete manner in which it is practiced in the health care system. This article examines the ethical underpinning of this distress and of this neglect in patient education and what actions nurses can take to correct this situation.
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Affiliation(s)
- Barbara K Redman
- Wayne State University, College of Nursing, 5557 Cass Avenue, Detroit, MI 48202, USA.
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