1
|
Xiao Y, Fulda KG, Young RA, Hendrix ZN, Daniel KM, Chen KY, Zhou Y, Roye JL, Kosmari L, Wilson J, Espinoza AM, Sutcliffe KM, Pitts SI, Arbaje AI, Chui MA, Blair S, Sloan D, Jackson M, Gurses AP. Patient Partnership Tools to Support Medication Safety in Community-Dwelling Older Adults: Protocol for a Nonrandomized Stepped Wedge Clinical Trial. JMIR Res Protoc 2024; 13:e57878. [PMID: 38684080 PMCID: PMC11091807 DOI: 10.2196/57878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/20/2024] [Accepted: 03/23/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Preventable harms from medications are significant threats to patient safety in community settings, especially among ambulatory older adults on multiple prescription medications. Patients may partner with primary care professionals by taking on active roles in decisions, learning the basics of medication self-management, and working with community resources. OBJECTIVE This study aims to assess the impact of a set of patient partnership tools that redesign primary care encounters to encourage and empower patients to make more effective use of those encounters to improve medication safety. METHODS The study is a nonrandomized, cross-sectional stepped wedge cluster-controlled trial with 1 private family medicine clinic and 2 public safety-net primary care clinics each composing their own cluster. There are 2 intervention sequences with 1 cluster per sequence and 1 control sequence with 1 cluster. Cross-sectional surveys will be taken immediately at the conclusion of visits to the clinics during 6 time periods of 6 weeks each, with a transition period of no data collection during intervention implementation. The number of visits to be surveyed will vary by period and cluster. We plan to recruit patients and professionals for surveys during 405 visits. In the experimental periods, visits will be conducted with two partnership tools and associated clinic process changes: (1) a 1-page visit preparation guide given to relevant patients by clinic staff before seeing the provider, with the intention to improve communication and shared decision-making, and (2) a library of short educational videos that clinic staff encourage patients to watch on medication safety. In the control periods, visits will be conducted with usual care. The primary outcome will be patients' self-efficacy in medication use. The secondary outcomes are medication-related issues such as duplicate therapies identified by primary care providers and assessment of collaborative work during visits. RESULTS The study was funded in September 2019. Data collection started in April 2023 and ended in December 2023. Data was collected for 405 primary care encounters during that period. As of February 15, 2024, initial descriptive statistics were calculated. Full data analysis is expected to be completed and published in the summer of 2024. CONCLUSIONS This study will assess the impact of patient partnership tools and associated process changes in primary care on medication use self-efficacy and medication-related issues. The study is powered to identify types of patients who may benefit most from patient engagement tools in primary care visits. TRIAL REGISTRATION ClinicalTrials.gov NCT05880368; https://clinicaltrials.gov/study/NCT05880368. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/57878.
Collapse
Affiliation(s)
- Yan Xiao
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
- College of Engineering, University of Texas at Arlington, Arlington, TX, United States
| | - Kimberley G Fulda
- Department of Family Medicine and Osteopathic Manipulative Medicine and North Texas Primary Care Practice-Based Research Network (NorTex), University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Richard A Young
- Family Medicine Residency Program, John Peter Smith Health Network, Fort Worth, TX, United States
| | - Z Noah Hendrix
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
| | - Kathryn M Daniel
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
| | - Kay Yut Chen
- College of Business, University of Texas at Arlington, Arlington, TX, United States
| | - Yuan Zhou
- College of Engineering, University of Texas at Arlington, Arlington, TX, United States
| | - Jennifer L Roye
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
| | - Ludmila Kosmari
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
| | - Joshua Wilson
- College of Liberal Arts, University of Texas at Arlington, Arlington, TX, United States
| | - Anna M Espinoza
- Department of Family Medicine and Osteopathic Manipulative Medicine and North Texas Primary Care Practice-Based Research Network (NorTex), University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Kathleen M Sutcliffe
- Carey Business School, Johns Hopkins University, Baltimore, MD, United States
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Samantha I Pitts
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Alicia I Arbaje
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Michelle A Chui
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, United States
| | - Somer Blair
- Office of Clinical Research, John Peter Smith Health Network, Fort Worth, TX, United States
| | - Dawn Sloan
- Family Medicine Residency Program, John Peter Smith Health Network, Fort Worth, TX, United States
| | - Masheika Jackson
- Family Medicine Residency Program, John Peter Smith Health Network, Fort Worth, TX, United States
| | - Ayse P Gurses
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, United States
| |
Collapse
|
2
|
Raghu Subramanian C, Yang DA, Khanna R. Enhancing Health Care Communication With Large Language Models-The Role, Challenges, and Future Directions. JAMA Netw Open 2024; 7:e240347. [PMID: 38466311 DOI: 10.1001/jamanetworkopen.2024.0347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Affiliation(s)
| | | | - Raman Khanna
- Division of Clinical Informatics and Digital Transformation, University of California, San Francisco
| |
Collapse
|
3
|
Smith G, Lui SF, Kalantar-Zadeh K, Bonner A. The Shift from Individual to Organizational Health Literacy: Implications for Kidney Healthcare Leaders and Clinicians. Nephron Clin Pract 2023; 148:349-356. [PMID: 38109858 DOI: 10.1159/000534073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/23/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND As a social determinant of health, health literacy has a vital role in the management of chronic disease management, including chronic kidney disease (CKD). SUMMARY To be able to manage their condition, patients with CKD need to be able to assess, comprehend, appraise, and utilize complex health-related information. Those patients are much more likely to understand and use health information appropriately, if it addresses their personal needs related to language, culture, educational background, and socioeconomic status. One aspect of health literacy, organizational health literacy (OHL), relates to the degree with which health organizations justifiably empower patients to locate, understand, and utilize health information and facilities to inform their decision-making and health behaviours. With increasing evidence-based about OHL as a way to improve healthcare, it is a new concept for kidney clinicians. KEY MESSAGES As producers of health-related information, the multidisciplinary kidney healthcare team have a responsibility to meet the needs of those in their care, as such, priority should be given to implementation of OHL initiatives. Through enhancing the clarity of information, OHL initiatives may provide a game plan for person-centred care for those with CKD.
Collapse
Affiliation(s)
- Graeme Smith
- School of Health Sciences, Caritas Institute of Higher Education, Hong Kong, Hong Kong, China
| | - Siu-Fai Lui
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong, China
| | | | - Ann Bonner
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia,
| |
Collapse
|
4
|
Hadian SA, Yarmohammadian MH, Shaarbafchizadeh N. The organizational health components for small-sized health-care organizations: A systematic review. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:37. [PMID: 37034860 PMCID: PMC10079190 DOI: 10.4103/jehp.jehp_1307_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/29/2021] [Indexed: 06/19/2023]
Abstract
BACKGROUND Organizational health (OH) is an organizational aspect in which staff is encouraged to be clearly involved and participate in decision-making, problem solving, and collaborating to improve organizational climate and culture. Multilevel staff involvement facilitates strengthened relationships, open communication, trust, and organizational commitment. The purpose of this study was to find components of OH for small-sized health-care organizations. METHODS A systematic review across three key databases by using an extensive list of keywords components and interventions was conducted. This survey included studies that explored various OH elements, components and interventions. RESULTS It comprises 34 full-text studies from 221 received studies. Afterward, the OH elements were classified into three main categories (OH elements, organizational health literacy, and organizational health interventions). Then, according to the reviewed data, 23 dimensions were defined similarly for all groups of studies and relevant explanations related to them were reported. CONCLUSION The OH encompasses multiple dimensions. Empirical research is required for designing a questionnaire according to the final extracted components and measuring its validation in small-sized health organizations.
Collapse
Affiliation(s)
- Shirin Alsadat Hadian
- Student Research Committee, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hossein Yarmohammadian
- Health Management and Economics Research Center, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasrin Shaarbafchizadeh
- Health Management and Economics Research Center, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
5
|
Feinberg I, Tighe EL, Ogrodnick MM. Strengthening the Case for Universal Health Literacy: The Dispersion of Health Literacy Experiences Across a Southern U.S. State. Health Lit Res Pract 2022; 6:e182-e190. [PMID: 35858187 PMCID: PMC9272571 DOI: 10.3928/24748307-20220620-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: How individuals perceive their health literacy may differ based on demographic and individual characteristics. Objective: The purpose of this study was to understand the dispersion of health literacy across demographics in the state of Georgia in 2021 and to determine which factors influence health literacy. Methods: Study participants were age 18 years and older and completed an on-line Health Literacy Questionnaire (N = 520). The participant pool was stratified to mirror state-wide demographics of geography and race. Results were further collapsed into composite scales reflecting basic, communicative, and critical health literacy. Descriptive statistics, bivariate Pearson's correlations, and multiple regression analyses were used. A two-step cluster analysis was performed with the nine health literacy scales. Key Results: Rural county and no health insurance were negatively related to all three composite scales (rs = .093-.254, ps < .05). Demographic predictors accounted for 6.7% of the variance in basic (F[6, 439] = 5.287, p < .001), 10% in communicative (F[6, 438] = 8.154, p < .001), and 6% for critical (F[6, 439] = 4.675, p < .0010. In all scales, health insurance status was the strongest primary unique predictor (βs = .236, .295, .181, ps <.05, respectively). In a two-step cluster analysis only health insurance status differentiated the health literacy level clusters (X2(3) = 9.43, 34.51, ps = 024, <.001 respectively). Conclusion: Lacking health insurance is the most consistent and largest contributor to low health literacy across the state of Georgia; population demographics are not. Health literacy policies and practices should be developed for universal application and not focus on specific populations. [HLRP: Health Literacy Research and Practice. 2022;6(3):e182–e190.] Plain Language Summary: In this study, demographics that are usually associated with low health literacy like age, sex, race, educational attainment, and type of county (rural or urban) were not associated with; the only significant factor was lack of health insurance. This relationship strengthens the case for universal health literacy precautions that go beyond population demographics.
Collapse
Affiliation(s)
- Iris Feinberg
- Address correspondence to Iris Feinberg, PhD, Adult Literacy Research Center, Department of Learning Sciences, College of Education and Human Development, Georgia State University, P.O. Box 3978, Atlanta, GA 30302;
| | | | | |
Collapse
|
6
|
Rosenfeld L, Miller A, Garverich S, Guyer M, Steiner R, Lincoln AK. Performing an Organizational Health Literacy Assessment in a Shelter Serving People with Mental Illness. Health Lit Res Pract 2022; 6:e167-e174. [PMID: 35858185 PMCID: PMC9272573 DOI: 10.3928/24748307-20220615-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Health literacy research and practice are constantly evolving. Recent inquiry has highlighted the burdensome literacy demands faced by people with serious mental illness (SMI). Systems, organizational operations, and structures can play a role in decreasing literacy demand, thereby reducing unnecessary challenges for people with SMI. Brief Description of Activity: An organizational health literacy assessment was conducted to explore literacy demands in one mental health shelter and revealed best practice action steps for improving the literacy environment. Implementation: The assessment included an exploration of the shelter environment using The Health Literacy Environment Activity Packet, First Impressions & Walking Interview, and a commonly used shelter document using the Simple Measure of Gobbledygook (SMOG), Suitability Assessment of Materials (SAM), and Centers for Disease Control and Prevention (CDC) Index. Results: The literacy demands of the shelter environment and a frequently used document exceeded the literacy skills of people with SMI. Environment assessment revealed environmental facilitators (e.g., welcoming atmosphere) and barriers (e.g., unclear signage). Document assessment also revealed facilitating factors and barriers. SMOG scores ranged from 11.25 to 11.80 (median: 11.38), meaning 11th to 12th grade-level reading skills are required to understand, use, and take action on the document's content. A SAM score of 50% (adequate) and a CDC Index score of 42.1 (revise and improve) reveal materials contain both facilitating factors (e.g., chunked sections) and barriers (e.g., jargon, mismatched graphics) to use. Lessons Learned: The mismatch between system demands and the literacy skills of people with SMI is more profound than that of the general United States population. Organizational health literacy assessments are achievable and useful for both immediate and long-term action aimed at understanding and improving the organizational health literacy of mental health spaces. Further work is needed to explore the role of behavioral health services in addressing the institutional and programmatic literacy demands that inhibit treatment and recovery. [HLRP: Health Literacy Research and Practice. 2022;6(3):e167–e174.] Plain Language Summary: An organizational health literacy assessment reveals how system demands can be changed to better serve intended users. Engaging in mental health, recovery, and treatment services requires complex literacy skills. Generally, the U.S. adult population does not have the skills to meet such demands, and this is especially true among public mental health service users.
Collapse
Affiliation(s)
- Lindsay Rosenfeld
- Address correspondence to Lindsay Rosenfeld, ScD, ScM, Brandeis University, The Heller School for Social Policy and Management, Institute for Child, Youth and Family Policy, 415 South Street, Mailstop 035, Waltham, MA 02454-9110;
| | | | | | | | | | | |
Collapse
|
7
|
Sørensen K, Levin-Zamir D, Duong TV, Okan O, Brasil VV, Nutbeam D. Building health literacy system capacity: a framework for health literate systems. Health Promot Int 2021; 36:i13-i23. [PMID: 34897445 PMCID: PMC8672927 DOI: 10.1093/heapro/daab153] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The human and social implications of poor health literacy are substantial and wide-ranging. Health literacy represents the personal competencies and organizational structures, resources and commitment that enable people to access, understand, appraise and use information and services in ways that promote and maintain good health. A large-scale societal improvement of health literacy will require political buy-in and a systematic approach to the development of health literacy capacity at all levels. This article builds the case for enhancing health literacy system capacity and presents a framework with eight action areas to accommodate the structural transformation needed at micro, meso and macro levels, including a health literate workforce, health literate organization, health literacy data governance, people-centred services and environments based on user engagement, health literacy leadership, health literacy investments and financial resources, health literacy-informed technology and innovation, and partnerships and inter-sectoral collaboration. Investment in the health literacy system capacity ensures an imperative and systemic effort and transformation which can be multiplied and sustained over time and is resilient towards external trends and events, rather than relying on organizational and individual behavioural change alone. Nevertheless, challenges still remain, e.g. to specify the economic benefits more in detail, develop and integrate data governance systems and go beyond healthcare to engage in health literacy system capacity within a wider societal context.
Collapse
Affiliation(s)
| | - Diane Levin-Zamir
- Department of Health Education and Promotion,
Clalit, Tel Aviv and School of Public Health, University of Haifa,
Haifa, Israel
| | - Tuyen V Duong
- School of Nutrition and Health Sciences, Taipei
Medical University, Taipei, Taiwan
| | - Orkan Okan
- Interdisciplinary Centre for Health Literacy
Research, Bielefeld University, Germany
| | | | - Don Nutbeam
- Sydney School of Public Health, University of
Sydney, Sydney, Australia
| |
Collapse
|
8
|
Chu-Ko F, Chong ML, Chung CJ, Chang CC, Liu HY, Huang LC. Exploring the factors related to adolescent health literacy, health-promoting lifestyle profile, and health status. BMC Public Health 2021; 21:2196. [PMID: 34852793 PMCID: PMC8635084 DOI: 10.1186/s12889-021-12239-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health literacy has been concerned a key factor for determining the use of health information and promoting health. The study aimed to explore adolescent health literacy, health-promoting lifestyle profile, and health status and related factors. METHODS A cross-sectional study design was used; 918 first year junior college students were recruited in Taiwan. The measurements were the Chinese Health Literacy Survey Questionnaire (HLS-C-Q), the Chinese Health-Promoting Lifestyle Profile (HPLP-S), and the Health Status Questionnaire. RESULTS The mean score for health literacy was 36.15 (±6.21), with 30.17% of the participants having insufficient or problematic health literacy. Further, 19.9% of participants were obese and 11.2% experienced emotional instability. Health literacy and health-promoting lifestyle profile showed significant positive and negative correlations with perceived health status and depression, respectively (p < 0.05). An exercise frequency of ≥3 times/week was a predictor of health literacy, health-promoting lifestyle profile, and emotional stability. CONCLUSIONS Adolescent health literacy, health-promoting lifestyle profile, and health status require careful consideration. In adolescents, developing regular exercise may increase health literacy, thereby developing healthy lifestyle profiles and ameliorating obesity and depression-related issues.
Collapse
Affiliation(s)
- Fen Chu-Ko
- Nursing Department, Jenteh Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Meng-Ling Chong
- Department of Nursing, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan
| | - Chi-Jung Chung
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chun-Chi Chang
- Nursing Department, Jenteh Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan
| | - Hsin-Yi Liu
- Nursing Department, Jenteh Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan
| | - Li-Chi Huang
- School of Nursing, China Medical University; Adjunct Supervisor, Department of Nursing, China Medical University Children Hospital, Taichung, Taiwan
| |
Collapse
|
9
|
Xie H, Li Y, Theodoropoulos N, Wang Q. Mammography Screening Disparities in Asian American Women: Findings From the California Health Interview Survey 2015-2016. Am J Health Promot 2021; 36:248-258. [PMID: 34814756 DOI: 10.1177/08901171211048136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To identify mammography screening prevalence and predictors in Asian American women, focusing on the potential disparities in race and its influence on screening behaviors. DESIGN A secondary analysis utilized the California Health Interview Survey (CHIS) 2015-2016. SETTING California, U.S. SAMPLE Cisgender women who were non-Hispanic (NH) White, Chinese, Filipino, Vietnamese, Japanese, Korean, or "other Asian", aged 40 or above (unweighted N=13 451). MEASURES Socioeconomics, chronic health conditions, and preventive care utilization were mesuared as potential risk factors, where up-to-date mammography screening as the outcome variable. ANALYSIS Multivariable adjusted logistic regressions were generalized to identify the up-to-date mammography screening behaviors in relation to potential factors, stratified by race and ethnicity. RESULTS The prevalence for up-to-date mammography screening in NH-White and Asian American women were 68.06% and 65.97%, respectively. In NH-White women, receiving an up-to-date mammogram was associated with age, birthplace, smoking status, diabetes, hypertension, health insurance coverage, and a preventive care visit in the past 12 months, whereas only age and a preventive care visit were significant predictors in Asian women. CONCLUSIONS The findings indicate that utilization disparities exist in mammogram in relation to socioeconomics, chronic health conditions, preventive care utilization, when comparing between race and ethnicity. Asian American women with borderline hypertension and no preventive care visits may require more public health outreach and cancer education.
Collapse
Affiliation(s)
- Hui Xie
- Joseph J. Zilber School of Public Health, 14751University of Wisconsin-Milwaukee Milwaukee, WI, USA
| | - Yannan Li
- Dapartment of Medicine, 5925Icahn School of Medicine at Mount Sinai Morningside and West, New York, NY, USA
| | - Nickolas Theodoropoulos
- Dapartment of Medicine, 5925Icahn School of Medicine at Mount Sinai Morningside and West, New York, NY, USA
| | - Qian Wang
- Division of Hematology and Medical Oncology, Department of Medicine, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
10
|
Patient Satisfaction Determinants of Inpatient Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111337. [PMID: 34769856 PMCID: PMC8582779 DOI: 10.3390/ijerph182111337] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/26/2021] [Accepted: 10/12/2021] [Indexed: 12/19/2022]
Abstract
The aim of the study was to analyse and evaluate the determinants influencing the overall satisfaction of patients with inpatient healthcare in the conditions of the Czech Republic. A total of the 1425 patients, who experienced hospitalisation and agreed to participate, were questioned in the study. A research questionnaire was used to obtain data on satisfaction with hospitalisation. The subject of the research consisted of the indicators related to the following factors: (i) satisfaction with the hospital, clinic, room and meals; (ii) satisfaction with medical staff-nurses, physician expertise and other staff; (iii) the quality of the treatment provided; (iv) satisfaction with leaving the hospital. The formulated statistical hypotheses were evaluated through structural equation modelling. The results of the analyses brought interesting findings. Satisfaction with medical staff is the most significant factor which has a positive effect on satisfaction with hospitalisation. Physician expertise (with trust and good communication skills) is more important for patients than satisfaction with nurses or other staff. The results obtained from the study represent valuable information for policymakers, regional healthcare plans, as well as for managers of hospitals.
Collapse
|
11
|
Implementation, Mechanisms and Context of the MAMAACT Intervention to Reduce Ethnic and Social Disparity in Stillbirth and Infant Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168583. [PMID: 34444335 PMCID: PMC8391863 DOI: 10.3390/ijerph18168583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/25/2022]
Abstract
The MAMAACT intervention aimed to address ethnic and social disparity in stillbirth and infant health by improving management of pregnancy complications. This process evaluation of the intervention was guided by the British Medical Research Council’s framework. We examined implementation through dose, reach, and fidelity, important mechanisms and the influence of contextual factors. The intervention included a six-hour training session for antenatal care (ANC) midwives in intercultural communication and cultural competence, two follow-up dialogue meetings, and health education materials (leaflet and app) on warning signs of severe pregnancy complications and how to respond for pregnant women. A mixed-methods approach was applied. Cross-sectional survey data and administrative data were used to assess intervention reach and dose. Qualitative data (records from dialogue meetings with midwives, participant observations and field notes from ANC visits, focus group interviews with midwives, and individual interviews with non-Western immigrant women) evaluated intervention fidelity, mechanisms, and contextual barriers. More than 80% of women received the MAMAACT leaflet and many found the content useful. The app was used more selectively. Midwives described being more aware and reflective in their communication with women from various cultural backgrounds. Organizational factors in ANC (time pressure, lack of flexibility in visits, poor interpreter services), barriers in women’s everyday life (lack of social network, previous negative experiences/lack of trust and domestic responsibilities), and habitual interaction patterns among midwives served as contextual barriers. The reach of the intervention was high and it was evaluated positively by both pregnant women and midwives. Organizational factors hindered changes towards more needs-based communication in ANC potentially hindering the intended mechanisms of the intervention. When interpreting the intervention effects, attention should be drawn to both organizational and interpersonal factors in the clinic as well as the pregnant women’s life situations.
Collapse
|
12
|
Villani J, Trivedi N. Health Literacy Research Funded by the NIH for Disease Prevention. Health Lit Res Pract 2021; 4:e212-e223. [PMID: 33170287 PMCID: PMC8330440 DOI: 10.3928/24748307-20200928-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 11/11/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Advancing health literacy is a fundamental step toward achieving population health. To that end, the National Institutes of Health (NIH) funded research to increase scientific understanding of how health literacy can reduce disparities and enhance the health of the United States. Objective: This study identified and evaluated NIH-funded health literacy research focusing on disease prevention. Methods: New R01, R03, and R21 research project grants awarded from fiscal year (FY) 2004 to FY 2017 studying health literacy and disease prevention were identified. Study characteristics, including the role of health literacy, how health literacy was measured, populations studied, and study design, were coded for each grant. Administrative grant data were obtained from the NIH's internal database. Research impact was assessed using the relative citation ratio (RCR). Key Results: There were 192 grants studying health literacy and disease prevention awarded by 18 NIH institutes and centers from FY 2004 to FY 2017, covering a wide variety of health conditions including cancer (26.0%), infectious diseases (13.5%), nutrition (8.3%), drug/alcohol use (7.8%), and cardiovascular disease (6.3%). Most grants studied the health literacy skills of patients (88%), with a few studies assessing the health literacy practices of health care providers (2.1%) or systems (1%). There was good representation of populations with traditionally low levels of health literacy, including Black/African American participants (30.2%), Hispanic/Latinx participants (28.6%), older adults (37%), and people with low income (20.8%). The scientific articles generated by these grants were more than twice (RCR = 2.18) as influential on the field as similar articles. Conclusions: The NIH provided support for a wide array of prevention-focused health literacy research. The value of this research is highlighted by the number of funding institutes and centers, the diversity of populations and health conditions studied, and the effect these grants had on the field. Future research should move beyond patient-level health literacy to health literacy practices of health care systems and providers. [HLRP: Health Literacy Research and Practice. 2020, 4(4):e212–e223.] Plain Language Summary: This study describes health literacy research funded by the National Institutes of Health that focused on disease prevention. These grants sought to prevent a variety of health conditions, but health literacy research over the past 14 years continued to concentrate on the capacity of patients despite increased attention on the health literacy practices of health care providers and systems.
Collapse
Affiliation(s)
- Jennifer Villani
- Address correspondence to Jennifer Villani, PhD, MPH, Office of Disease Prevention, NIH, 6100 Executive Boulevard, Suite 2B03, Rockville, MD 20892;
| | | |
Collapse
|
13
|
Bremer D, Klockmann I, Jaß L, Härter M, von dem Knesebeck O, Lüdecke D. Which criteria characterize a health literate health care organization? - a scoping review on organizational health literacy. BMC Health Serv Res 2021; 21:664. [PMID: 34229685 PMCID: PMC8259028 DOI: 10.1186/s12913-021-06604-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/02/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Organizational health literacy (OHL) aims to respond to the health literacy needs of patients by improving health information and services and making them easier to understand, access, and apply. This scoping review primarily maps criteria characterizing health literate health care organizations. Secondary outcomes are the concepts and terminologies underlying these criteria as well as instruments to measure them. METHODS The review was carried out following the JBI Manual on scoping reviews. The databases CINAHL, Cochrane Library, JSTOR, PsycINFO, PubMed, Web of Science Core Collection, and Wiley Online Library were searched in July 2020. Three researchers screened the records and extracted the data. The results were synthesized systematically and descriptively. RESULTS The literature search resulted in 639 records. After removing duplicates, screening by title and abstract, and assessing full-texts for eligibility, the scoping review included 60 publications. Criteria for OHL were extracted and assigned to six main categories (with 25 subcategories). The most prevalent topic of organizational health literacy refers to communication with service users. Exemplary criteria regarding this main category are the education and information of service users, work on easy-to-understand written materials as well as oral exchange, and verifying understanding. The six main categories were defined as 1) communication with service users; 2) easy access & navigation; 3) integration & prioritization of OHL; 4) assessments & organizational development; 5) engagement & support of service users, and 6) information & qualification of staff. The criteria were based on various concepts and terminologies. Terminologies were categorized into four conceptual clusters: 1) health literacy in various social contexts; 2) health literate health care organization; 3) organizational behavior, and 4) communication in health care. 17 different assessment tools and instruments were identified. Only some of the toolkits and instruments were validated or tested in feasibility studies. CONCLUSIONS Organizational health literacy includes a significant number of distinct organizational criteria. The terminologies used in the OHL literature are heterogeneous based on a variety of concepts. A comprehensive, consensus-based conceptual framework on OHL is missing.
Collapse
Affiliation(s)
- Daniel Bremer
- Department of Medical Psychology, Center for Health Care Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Izumi Klockmann
- Department of Medical Sociology, Center for Health Care Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Leonie Jaß
- Department of Medical Sociology, Center for Health Care Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, Center for Health Care Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Olaf von dem Knesebeck
- Department of Medical Sociology, Center for Health Care Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Daniel Lüdecke
- Department of Medical Sociology, Center for Health Care Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| |
Collapse
|
14
|
Mehlis A, Locher V, Hornberg C. Barriers to Organizational Health Literacy at Public Health Departments in Germany. Health Lit Res Pract 2021; 5:e264-e271. [PMID: 34533395 PMCID: PMC8447847 DOI: 10.3928/24748307-20210809-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 10/20/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Strengthening individual health literacy and knowledge about health challenges are important preventive approaches in public health to improve health equality. Health care organizations have come into focus in this regard. They need to raise their organizational health literacy (OHL) to help users to access and navigate information and services. OBJECTIVE In Germany, public health departments (PHDs) are responsible for public and environmental health at the population level. This study breaks new ground as it is the first to investigate the OHL of these health care organizations. The study attempts to answer what barriers keep them from raising their OHL and how can these be overcome? METHODS In this explorative study, 10 guideline-oriented interviews with experts from PHDs were conducted in two states in Germany. Qualitative content analysis was used to extract the results from the experts´ statements. KEY RESULTS Eleven barriers to raising OHL were identified. Obstacles were found in leadership and organizational culture, design and implementation of information, and in human resources. False expectations due to negative preconceptions about public service were identified as a new barrier that had not been elucidated in prior literature. The same applies to lack of cooperation on cross-sectoral topics as well as lack of accessibility. Clear communication of tasks and clear jurisdictional authority are some of the recommendations for lowering these barriers. Other examples include identifying and using synergies and involvement of target groups. CONCLUSIONS Overcoming these obstacles could improve the OHL of German PHDs. This, in turn, could improve the health of the general population and thus contribute significantly to overall public health. Extrapolating to the whole of Germany and other countries could further strengthen research on OHL. [HLRP: Health Literacy Research and Practice. 2021;5(3):e264-e271.] Plain Language Summary: Public health departments (PHDs) must be able to help their users access, understand, and use health information and services. This competence is called organizational health literacy (OHL). Ten experts from German PHDs were interviewed about barriers to raising OHL. This article reports the barriers identified and recommendations for lowering them, as well as three previously unknown obstacles.
Collapse
Affiliation(s)
- Anika Mehlis
- Address correspondence to Anika Mehlis, Annenstrasse 54, 08523 Plauen, Germany;
| | | | | |
Collapse
|
15
|
Brorsen E, Rasmussen TD, Ekstrøm CT, Osborne RH, Villadsen SF. Health literacy responsiveness: a cross-sectional study among pregnant women in Denmark. Scand J Public Health 2021; 50:507-515. [PMID: 33863261 DOI: 10.1177/14034948211004320] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: Communication barriers in healthcare encounters contribute to ethnic inequality in health outcomes. This study aimed to examine, in a large national Danish sample of women, whether ethnicity was associated with pregnant women's Active engagement with healthcare providers. Methods: A cross-sectional survey of 1898 pregnant women attending 19 Danish maternity wards. The key variable of interest was maternal ethnicity among ethnic Danish, European, African and Asian immigrant women and their descendants. Syrian immigrant women were studied as a subgroup. The outcome was the health literacy questionnaire domain Ability to engage actively with healthcare providers (five-item domain scored from 'cannot do/always difficult' (1) to 'always easy' (5)) which is a reflection of a respondent's lived experiences of engaging with healthcare providers. Adjusted mixed effect multivariate linear regression was used to compare Active engagement across groups expressed as the mean difference (95% confidence interval). Results: Lower means of Active engagement were reported for immigrant women compared to ethnic Danish women in all models. When adjusting for age, parity, complications and occupation, the difference between ethnic Danish women's Active engagement and other groups was smallest among European -0.15 (-0.26 to -0.05), slightly larger in African -0.19 (-0.40 to 0.02), and largest in Asian immigrant women -0.31 (-0.41 to -0.21). Syrian immigrant women had the largest difference -0.42 (-0.58 to -0.27). Conclusions: Pregnant immigrant women reported lower means of Active engagement than ethnic Danish women did. Increased health literacy responsiveness in maternity care is required to mitigate the potential for differential care and health inequity.
Collapse
Affiliation(s)
- Eva Brorsen
- Section of Social Medicine, University of Copenhagen, Denmark
| | | | | | - Richard H Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Australia
| | | |
Collapse
|
16
|
BRACH C, BORSKY A. How the U.S. Agency for Healthcare Research and Quality Promotes Health Literate Health Care. Stud Health Technol Inform 2020; 269:313-323. [PMID: 32594006 PMCID: PMC7413323 DOI: 10.3233/shti200046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This report traces the U.S. Agency for Healthcare Research and Quality's (AHRQ) strategic approach to promote health literate health care delivery systems. For almost 15 years, the AHRQ Health Literacy Action Plan has served as the framework for the Agency's efforts to: 1) Develop Measures; 2) Improve the Evidence Base and Create Implementation Tools; 3) Create and Support Change; 4) Disseminate and Transfer Knowledge and Tools; and 5) Practice What We Preach. Drawing upon its core competencies in data and measurement, practice improvement, and health services research, AHRQ accelerated the uptake of evidence-based health literacy strategies by health care organizations.
Collapse
Affiliation(s)
- Cindy BRACH
- Center for Evidence and Practice Improvement Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services
| | - Amanda BORSKY
- Center for Evidence and Practice Improvement Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services
| |
Collapse
|
17
|
Polek C, Hardie T. Cancer Screening and Prevention in Lesbian, Gay, Bisexual, and Transgendered Community and Asian Lesbian, Gay, Bisexual, and Transgendered Members. Asia Pac J Oncol Nurs 2019; 7:6-11. [PMID: 31879678 PMCID: PMC6927152 DOI: 10.4103/apjon.apjon_46_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 09/06/2019] [Indexed: 11/17/2022] Open
Abstract
Participation in cancer screening and prevention (cessation of or reduction in modifiable health risk behaviors) are the most effective methods of reducing cancer morbidity and mortality. Some members of the lesbian, gay, bisexual, and transgendered (LGBT) communities have not participated in screening for a variety of reasons which have been explored in the literature. Common and unique behavioral risks are also reviewed. Knowledge about Asian members of the LGBT community participation in cancer screening and prevention is limited. This paper reviews the current literature on participation and barriers to cancer screening and prevention for the LGBT community and provides some insights for the Asian LGBT subcommunity. Potential interventions that have been demonstrated to be effective are presented for potential implementation within nursing practice and practice settings. Suggestions for future research are also provided to enhance the care of the LGBT community.
Collapse
Affiliation(s)
- Carolee Polek
- School of Nursing, University of Delaware, Newark, DE, USA
| | - Thomas Hardie
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
18
|
Santos MG, Paasche-Orlow MK. Special Supplement: Health Literacy and Adult Basic Education. Health Lit Res Pract 2019; 3:S88-S90. [PMID: 31773087 PMCID: PMC6857768 DOI: 10.3928/24748307-20190909-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Maricel G. Santos
- Address correspondence to Maricel G. Santos, EdD, Department of English, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA 94132;
| | | |
Collapse
|