Health literacy in chronic kidney disease patients: association with self-reported presence of acquaintance with kidney disease, disease burden and frequent contact with health care provider

Factors associated with self-care behavior in patients with chronic kidney disease: a systematic review

BACKGROUND

Chronic kidney disease (CKD) is a significant global health issue associated with cardiovascular risk, elevated morbidity and mortality rates, reduced quality of life, and high medical costs. Self-care behavior (SCB) is an effective strategy for mitigating the negative impacts of CKD. Identifying factors that influence SCB in CKD patients is essential for improving clinical outcomes. This study analyzes the factors affecting self-care behavior in patients with CKD.

METHODS

A structured search was conducted on PubMed and EBSCO up to June 10th, 2024. This review was not limited by publication year, published in English, and only full-text articles were included.

RESULTS

A total of 510 articles were identified from both databases. After removing 109 duplicates, 401 articles remained. Sixteen articles met the inclusion criteria. The results showed that several factors were associated with SCB, including health literacy (HL), social support, disease knowledge (DK), age, occupation, income, marital status, place of residence, gender, education, comorbidities, smoking habits, body mass index, participation in CKD programs, duration since CKD diagnosis, CKD stage, psychological factors, therapy compliance, self-efficacy, and laboratory results (triglyceride, PCR urine, hemoglobin, phosphor, and albumin levels).

CONCLUSIONS

The findings indicated that multiple factors can influence SCB in patients with CKD. The most factors that showed a significant association with SCB were age and education in 5 studies, respectively. These findings underscore the importance of addressing patient-specific factors to improve patient SBC through education and counseling from healthcare providers.

Unravelling the role of health literacy among individuals with multimorbidity: a systematic review and meta-analysis

OBJECTIVE

To examine existing literature regarding health literacy levels and their association with multimorbidity and the potential underlying mechanisms behind the said association.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

The databases MEDLINE, EMBASE, CINAHL and Science Direct were searched for articles published between 1 January 2000 and 31 October 2023 using a systematic search strategy.

ELIGIBILITY CRITERIA

Included were all primary studies conducted in people over 18 years old with data on health literacy levels and the presence of multimorbidity. No language restrictions were used.

DATA EXTRACTION AND SYNTHESIS

Two authors independently extracted data and assessed the bias using the Joanna Briggs Institute critical appraisal tools.

RESULTS

We included a total of 39 studies (36 quantitative, two qualitative and one mixed-method), representing 154 337 participants. We found a 32% proportion of limited health literacy among individuals with multimorbidity. Analysis of three articles using the Health Literacy Questionnaire tool (n=31 228) (Pooled OR 2.88 (95% CI 1.92 to 4.31)) and three articles using the Health Literacy Survey Questionnaire-European Union tool (n=35 358) (OR 1.16 (95% CI 1.07 to 1.25)) indicated that people with limited health literacy were likely to have multiple conditions. One of three articles studying underlying mechanisms reported that self-efficacy mediates the association between health literacy and multimorbidity. Additionally, substantial literature identified education and income as the most consistent determinants of health literacy among individuals with multimorbidity. Of the only two articles studying the effectiveness of health literacy-related interventions, both reported an improvement in clinical outcomes after the intervention.

CONCLUSIONS

Our review demonstrated a consistent association between health literacy and multimorbidity, indicating that people with lower health literacy levels are more likely to have multimorbidity. More evidence is needed regarding the effect of health literacy interventions on multimorbidity.

PROSPERO REGISTRATION NUMBER

CRD42022301369.

Health literacy in older adults receiving hemodialysis in Turkey: A cross-sectional study

INTRODUCTION

This study aimed to determine the health literacy level and related factors of older adults receiving hemodialysis treatment.

METHODS

A cross-sectional study was conducted at the five dialysis centers, using the information form and Turkish Health Literacy Survey-32 (THLS-32). A total of 336 older adults receiving hemodialysis treatment participated.

RESULTS

The general health literacy score was found to be 25.69 ± 14.47. Based on the health literacy assessment scores, 62.5% of the participants were in the category of inadequate and limited level of health literacy. The lower level of education, perceived health status, income, and getting help in reading and writing were statistically significant predictors of the health literacy score.

CONCLUSION

The health literacy of older adults receiving hemodialysis treatment was inadequate and limited. Findings of this study emphasize the importance of integrating health literacy assessment in clinical care settings and supporting the health literacy of older adults receiving hemodialysis treatment.

Profiles of health literacy and digital health literacy in clusters of hospitalised patients: a single-centre, cross-sectional study

OBJECTIVE

To investigate health literacy (HL) and digital health literacy (eHL) among patients hospitalised in surgical and medical wards using a cluster analysis approach.

DESIGN

Cross-sectional study using Ward's hierarchical clustering method to measure cluster adequacy by evaluating distances between cluster centroids (a measure of cohesion). Different distances produced different cluster solutions.

SETTING AND PARTICIPANTS

The study was conducted at a Norwegian university hospital. A total of 260 hospitalised patients were enrolled between 24 May and 6 June 2021.

DATA COLLECTION

All data were collected by self-reported questionnaires. Data on HL and eHL were collected by the Health Literacy Questionnaire (HLQ) and the eHealth Literacy Questionnaire (eHLQ). We also collected data on background characteristics, health status and patient diagnosis.

RESULTS

We found six HLQ clusters to be the best solution of the sample, identifying substantial diversity in HL strengths and challenges. Two clusters, representing 21% of the total sample, reported the lowest HLQ scores in eight of nine HLQ domains. Compared with the other clusters, these two contained the highest number of women, as well as the patients with the highest mean age, a low level of education and the lowest proportion of being employed. One of these clusters also represented patients with the lowest health status score. We identified six eHL clusters, two of which represented 31% of the total sample with the lowest eHLQ scores in five of seven eHLQ domains, with background characteristics comparable to patients in the low-scoring HLQ clusters.

CONCLUSIONS

This study provides new, nuanced knowledge about HL and eHL profiles in different clusters of patients hospitalised in surgical and medical wards. With such data, healthcare professionals can take into account vulnerable patients' HL needs and tailor information and communication accordingly.

Assessment Tools for Measuring Health Literacy and Digital Health Literacy in a Hospital Setting: A Scoping Review

Assessment of (digital) health literacy in the hospital can raise staff awareness and facilitate tailored communication, leading to improved health outcomes. Assessment tools should ideally address multiple domains of health literacy, fit to the complex hospital context and have a short administration time, to enable routine assessment. This review aims to create an overview of tools for measuring (digital) health literacy in hospitals. A search in Scopus, PubMed, WoS and CINAHL, following PRISMA guidelines, generated 7252 hits; 251 studies were included in which 44 assessment tools were used. Most tools (57%) were self-reported and 27% reported an administration time of <5 min. Almost all tools addressed the domain 'understanding' (98%), followed by 'access' (52%), 'apply' (50%), 'appraise' (32%), 'numeracy' (18%), and 'digital' (18%). Only four tools were frequently used: the Newest Vital Sign (NVS), the Short Test of Functional Health Literacy for Adults ((S)TOFHLA), the Brief Health Literacy Screener (BHLS), and the Health Literacy Questionnaire (HLQ). While the NVS and BHLS have a low administration time, they cover only two domains. HLQ covers the most domains: access, understanding, appraise, and apply. None of these four most frequently used tools measured digital skills. This review can guide health professionals in choosing an instrument that is feasible in their daily practice, and measures the required domains.