Health literacy and transplant patients and practitioners

eHealth literacy and web-based patient portal usage among kidney and liver transplant recipients

Patient portals promote self-management, but require skills with electronic health information which can be measured by a patient's eHealth literacy. We aimed to describe eHealth literacy among a population of kidney transplant (KT) and liver transplant (LT) recipients and to investigate the relationship between eHealth literacy and Web-based patient portal utilization. We conducted phone surveys (August 2016-March 2017) among 178 KT and 110 LT recipients at two large transplant centers, including the eHealth Literacy Scale (eHEALS) and items assessing routine portal usage. Portal users were defined as routine if usage was every day, weekly, or monthly. The mean eHEALS score was 30.9 (SD: 5.4), and 45.4% routinely used the patient portal more than a few times per month. Routine users had higher eHealth literacy than non-routine users and non-users (31.97 vs. 29.97 vs. 28.20, p < .001). Routine users had higher eHealth literacy scores compared with non-users after adjusting for transplant organ type, age, educational level, employment status, mobile Internet access, and transplant center (OR: 1.10, 95% CI: 1.03-1.17). KT and LT recipients who routinely use patient portals have high eHealth literacy compared with other diseased populations, which should be leveraged by encouraging routine usage to improve post-transplant health and medication adherence.

IUHPE Position Statement on Health Literacy: a practical vision for a health literate world

The International Union for Health Promotion and Education (IUHPE) Position Statement on Health Literacy provides an overview of existing evidence and continuing debate on health literacy. Developed by the IUHPE Global Working Group on Health Literacy, including experts from around the globe, the Statement provides a basis for discussion and advocacy, by and with IUHPE, both within the health promotion community, and among stakeholders and partners in health promotion. The Statement offers a detailed introduction to the concept of health literacy, calling for global action to improve health literacy in populations. It positions health literacy as an important and modifiable social determinant of health, that plays a significant role in broadly-based strategies for health promotion. The Statement emphasises the necessity of a systems approach to health literacy, underpinned by global, national, regional and local policies. It summarises key evidence to guide practice and policy development, recognising the importance of continued investment in intervention research, in professional and consumer capacity building, and in the transfer of research findings into frontline health promotion practice. In summary, health literacy is understood as an important cross-cutting issue in health promotion throughout the lifespan, which has practical application in guiding clinical practice, public health interventions and public policy for the advancement of global health.

Health literacy in solid-organ transplantation: a model to improve understanding

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.

A New Measure of Health Numeracy: Brief Medical Numbers Test (BMNT)

BACKGROUND

Approximately half of Americans have inadequate health literacy, which leads to poorer health outcomes. Health numeracy is an important component of literacy, which reflects one's ability to understand and manipulate numbers. This is especially important for transplant candidates, as adherence to medical recommendations is essential for posttransplant care. Although validated measures of numeracy exist, they can be inconvenient and time consuming to administer.

OBJECTIVE

The Brief Medical Numbers Test (BMNT) was created in 2011 to quickly assess the health numeracy of a patient during presurgical psychiatric transplant evaluations. The purpose of this study was to evaluate the reliability and validity of the BMNT for this use via retrospective chart review.

METHODS

There were 293 patients referred over a 2-year period for a presurgical psychiatric evaluation. The evaluation consisted of a semistructured interview and completion of several measures, including the BMNT, a measure of health literacy, and a brief test of cognitive functioning.

RESULTS

The BMNT had acceptable internal consistency (α = .71), convergent validity with health literacy and cognitive functioning, and predictive validity with surgical outcomes.

CONCLUSIONS

Preliminary data suggests the BMNT is a reliable and valid measure of health numeracy in patients being evaluated for transplant.

Opportunities for Engaging Patients in Kidney Research

Purpose:

The purpose of this review is to provide a summary of the rationale for engaging patients in research as well as to review the established and envisioned advantages and strategies for patient-researcher partnerships. The authors of this article, which include a patient and 4 researchers in kidney disease, discuss the expected benefits and opportunities for patient engagement in their respective research programs. The 4 research programs span the spectrum of kidney disease and focus on enhancing bone health, increasing living donor kidney transplants, improving medication adherence, and preventing kidney transplant rejection.

Sources of Information:

The sources of information for this review include published studies on the topics of patient engagement and the 4 research programs of the new investigators.

Key Findings:

(1) Patient, health care provider, and researcher partnerships can contribute useful insights capable of enhancing research in kidney disease. (2) Regardless of the research program, there are various strategies and opportunities for engagement of patients with lived experience across the various stages of research in kidney disease. (3) Envisioned advantages of patient-researcher partnerships include: targeting patient-identified research priorities, integrating patients’ experiential knowledge, improving study design and feasibility through patient-researcher input, facilitating dissemination of research findings to other patients, effectively responding to patient concerns about studies, and inspiring researchers to conduct their research.

Limitations:

The limitations of the current review include the relative scarcity of literature on patient engagement within the field of kidney disease.

Implications:

The findings of the current review suggest that it will be important for future studies to identify optimal strategies for patient engagement in setting research priorities, study design, participant recruitment, execution of research projects, and knowledge dissemination and translation.

An observational study of health literacy and medication adherence in adult kidney transplant recipients

BACKGROUND

There is a high prevalence of non-adherence to immunosuppressants in kidney transplant recipients. Although limited health literacy is common in kidney recipients and is linked to adverse outcomes in other medical populations, its effect on medication adherence in kidney transplant recipients remains poorly understood. The objective was to investigate the effect of lower health literacy on immunosuppressant adherence.

METHODS

Kidney recipients who were at least 6 months post-transplant and outpatients of Vancouver General Hospital in B.C., Canada were recruited through invitation letters. A total of 96 recipients completed the Health Literacy Questionnaire, which provides a multifactorial profile of self-reported health literacy and the Transplant Effects Questionnaire-Adherence subscale measuring self-reported immunosuppressant adherence. Hierarchical linear regression was used to analyze the association between health literacy and adherence after controlling for identified risk factors of non-adherence.

RESULTS

Our sample was on average 53 years old, 56% male and 9 years post-transplant. Kidney recipients reported low levels of health literacy on scales measuring active health management and critical appraisal of information and 75% reported non-perfect adherence. Worse adherence was associated with poorer overall health literacy (ΔR2 = 0.08, P = 0.004) and lower scores on six of nine of the health literacy factors.

CONCLUSIONS

Poorer health literacy is associated with lower immunosuppressant adherence in adult kidney transplant recipients suggesting the importance of considering a recipient's level of health literacy in research and clinical contexts. Medication adherence interventions can target the six factors of health literacy identified as being risk factors for lower medication adherence.

Relationship between Health Literacy and Kidney Function

AIM

Low health literacy (HL) may contribute to poor self-management of chronic kidney disease (CKD) and poor kidney function. This study aimed to assess the relationship between HL and estimated glomerular filtration rate (eGFR).

METHODS

A cross-sectional observational study was conducted among consecutive eligible adult patients with CKD stages 1-4 attending an outpatient nephrology clinic. HL was assessed using Newest Vital Sign (NVS). eGFR was estimated using the Modification of Diet in Renal Disease equation. CKD self-management behaviour knowledge was assessed using a study instrument (CKD self-management knowledge (SMKT)).

RESULTS

One hundred fifty patients participated in the study (83% participation rate). The prevalence of high likelihood of limited HL was 32.7%. Participants' eGFRs ranged from 17 to 152 mL/min / 1.73 m(2) , with over 80% of the eGFRs below 60 mL/min / 1.73 m(2) . HL was associated with eGFR after controlling for all demographics except age, race and gender (which are included in eGFR equation) (P = 0.05). Every unit increase in NVS score was associated with a 1.9% increase (95% confidence interval = 0 to 3.86%) in eGFR (model R square = 0.23, P = 0.002), which remained significant after controlling for CKD-SMKT (P = 0.05; model R square = 0.28, P < 0.001). The relationship was non-significant after controlling for age, although it remained significant after controlling for other demographics including gender and race.

CONCLUSIONS

There is a small but significant association between HL and eGFR. Providers should use HL-tailored communication strategies in CKD patients. Larger multicentre studies are needed to substantiate this relationship.

Health literacy and kidney transplant outcomes

CONTEXT

Kidney disease is a common disease that is best treated through kidney transplant. The kidney transplant process is complex and can be difficult to navigate and most likely requires an adequate amount of health literacy.

OBJECTIVE

To assess the relationship between health literacy and transplant outcomes, including whether a patient was listed for or received a transplant.

DESIGN

A cross-sectional study measuring patients' health literacy and transplant outcomes.

SETTING AND PARTICIPANTS

Participants from a single transplant center were invited to participate if they were referred to the center for transplant and spoke English. Of the 92 patients, 30 (33%) were in the vascular access clinic, 31 (34%) were posttransplant, and 31 (34%) were pretransplant.

INTERVENTION

Health literacy was measured by using 3 tools: Rapid Estimate of Adult Literacy of Medicine-Transplant (REALM-T), Newest Vital Sign (NVS), and Decision-Making Capacity Assessment Tool (DMCAT).

MAIN OUTCOME MEASURE

Two dichotomous variables: whether the patient was listed for transplant and/or received a transplant. Descriptive and univariate statistics were calculated. Six logistic regression models were used to test for a correlation between each of the tools and patients' likelihood to be listed for and/or receive a transplant.

RESULTS

Fifty-three patients (58%) were formally listed for a transplant, and 36 (39%) received a transplant. The REALM-T, NVS, and DMCAT each significantly predicted whether or not a patient was listed for transplant (odds ratios, 1.044, 1.672, and 1.408). The NVS and DMCAT significantly predicted whether a patient received a transplant (odds ratios, 1.667 and 1.256). Health literacy is a positive and significant predictor of transplant outcomes. Clinicians should take assessments of health literacy into account when speaking to patients about kidney transplant.

Response Across the Health-Literacy Spectrum of Kidney Transplant Recipients to a Sun-Protection Education Program Delivered on Tablet Computers: Randomized Controlled Trial

BACKGROUND

Sun protection can reduce skin cancer development in kidney transplant recipients, who have a greater risk of developing squamous cell carcinoma than the general population.

OBJECTIVE

A culturally sensitive sun-protection program (SunProtect) was created in English and Spanish with the option of choosing audio narration provided by the tablet computer (Samsung Galaxy Tab 2 10.1). The intervention, which showed skin cancer on patients with various skin tones, explained the following scenarios: skin cancer risk, the ability of sun protection to reduce this risk, as well as offered sun-protection choices. The length of the intervention was limited to the time usually spent waiting during a visit to the nephrologist.

METHODS

The development of this culturally sensitive, electronic, interactive sun-protection educational program, SunProtect, was guided by the "transtheoretical model," which focuses on decision making influenced by perceptions of personal risk or vulnerability to a health threat, importance (severity) of the disease, and benefit of sun-protection behavior. Transportation theory, which holds that narratives can have uniquely persuasive effects in overcoming preconceived beliefs and cognitive biases because people transported into a narrative world will alter their beliefs based on information, claims, or events depicted, guided the use of testimonials. Participant tablet use was self-directed. Self-reported responses to surveys were entered into the database through the tablet. Usability was tested through interviews. A randomized controlled pilot trial with 170 kidney transplant recipients was conducted, where the educational program (SunProtect) was delivered through a touch-screen tablet to 84 participants.

RESULTS

The study involved 62 non-Hispanic white, 60 non-Hispanic black, and 48 Hispanic/Latino kidney transplant recipients. The demographic survey data showed no significant mean differences between the intervention and control groups in age, sex, income, or time since transplantation. The mean duration of program use varied by the ethnic/racial group, with non-Hispanic whites having the shortest use (23 minutes) and Hispanic/Latinos having the longest use (42 minutes). Knowledge, awareness of skin cancer risk, willingness to change sun protection, and use of sun protection increased from baseline to 2 weeks after the program in participants from all ethnic/racial groups in comparison with controls (P<.05). Kidney transplant recipients with inadequate (47/170, 28%) and marginal functional health literacy (59/170, 35%) listened to either Spanish or English audio narration accompanying the text and graphics. After completion of the program, Hispanic/Latino patients with initially inadequate health literacy increased their knowledge more than non-Hispanic white and black patients with adequate health literacy (P<.05). Sun protection implemented 2 weeks after education varied by the ethnic/racial group. Outdoor activities were reduced by Hispanics/Latinos, non-Hispanic blacks sought shade, Hispanic/Latinos and non-Hispanic blacks wore clothing, and non-Hispanic whites wore sunscreen (P<.05).

CONCLUSION

Educational program with a tablet computer during the kidney transplant recipients' 6- or 12-month follow-up visits to the transplant nephrologist improved sun protection in all racial/ethnic groups. Tablets may be used to provide patient education and reduce the physician's burden of educating and training patients.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01646099; https://clinicaltrials.gov/ct2/show/NCT01646099.

Health literacy of living kidney donors and kidney transplant recipients

BACKGROUND

Health literacy (HL) may be a mediator for known socioeconomic and racial disparities in living kidney donation.

METHODS

We evaluated the associations of patient and demographic characteristics with HL in living kidney donors (LD), living donor kidney transplant recipients (LDR), and deceased donor recipients (DDR) in a single-center retrospective review of patients undergoing kidney donation or transplantation from September 2010 to July 2012. HL and demographic data were collected. HL was assessed via the Short Literacy Survey (SLS) comprising three self-reported screening questions scored using the five-point Likert scale (low, moderate, high). Chi-square and logistic regression were used to test factors associated with lower HL.

RESULTS

The sample included 360 adults (105 LD, 103 LDR, and 152 DDR; 46±14 years; 70% white; 56% male; 14±3 years of education). HL scores were skewed (49% high, 41% moderate, and 10% low). The distribution of HL categories differed significantly among groups (P=0.019). After controlling for age, race, sex, education, and a race-education interaction term, DDR was more likely to have moderate or low HL than LDR (OR, 1.911; 95% CI, 1.096-3.332; P=0.022).

CONCLUSION

Overall, living donors had high HL. The distribution of low, moderate, and high HL differed significantly between LD, DDR, and LDR. DDR had a higher likelihood of having low HL than LDR. Screening kidney transplant candidates and donors for lower HL may identify barriers to living donation. Future interventions addressing HL may be important to increase living donation and reduce disparities.

Development and Testing of a Disease-Specific Health Literacy Measure in Kidney Transplant Patients

Context

Health literacy affects a patient's ability to navigate through the system of care for late-stage kidney disease, including evaluation, waiting, and recovering from kidney transplant.

Objectives

To develop and provide a preliminary evaluation of a knowledge and decision-making capacity tool, which is a component of health literacy.

Design

Cross-sectional design with purposive sampling.

Setting

Vascular access, dialysis, and outpatient transplant clinics.

Methods

A Decision-Making Capacity Assessment Tool (DMCAT) was developed and administered to 127 adults at different stages in the kidney care process.

Results

The DMCAT tool is positively and significantly correlated to the other 2 previously validated instruments and accounts for more variance than the other 2 tools in the regression models. We found significant differences in patients' health literacy and decision-making capacity related to their stage of care. Decision-making capacity appeared to be an important component of health literacy and should be considered as health care providers tailor care to meet patients' needs.

Health literacy: emerging evidence and applications in kidney disease care

Health literacy represents the communication among patients, their social networks, providers, and health systems to promote patients' understanding and engagement in their care. This is particularly relevant in kidney disease, in which the complexity of the medical condition and the extent of the health-care team require strategies to overcome health-literacy-related barriers. Limited literacy is common in patients with all stages of kidney disease and is associated with important outcomes, including reduced knowledge, less adherence, hospitalization, and death. A growing understanding and characterization of the health system, or organizational health literacy, may further our understanding of this dynamic relationship. Although various valid methods exist, assessment of health literacy within individuals or systematically within care settings has not been routinely performed. This may be in part due to the limited research in kidney-specific strategies to address limited health literacy. Future research to understand the mechanisms of health literacy will permit targeted, efficient interventions to bridge gaps and improve outcomes even in patients with complex kidney disease.

Progression of CKD in Hispanics: potential roles of health literacy, acculturation, and social support

Hispanics are the fastest growing minority group in the United States, and compared with non-Hispanic whites, they have a higher incidence of end-stage renal disease. Examining novel factors that may explain this disparity in progression of chronic kidney disease (CKD) in Hispanics is urgently needed. Interpersonal and patient-centered characteristics, including health literacy, acculturation, and social support, have been shown to affect health outcomes in patients with other chronic diseases. However, these characteristics have not been well studied in the context of CKD, particularly in relation to disease knowledge, attitudes, and behaviors. In this report, we examine the potential roles of these factors for CKD progression in Hispanics and propose targeted therapeutic interventions.

Skin cancer prevention education for kidney transplant recipients: a systematic evaluation of Internet sites

CONTEXT

Repeated patient education about skin cancer prevention is important to self-care after transplant.

OBJECTIVE

Examine educational materials for kidney transplant recipients available on the Internet that address sun protection and skin self-examination for early detection of squamous cell carcinoma.

DESIGN

Systematic review of Web sites for kidney transplant recipients endorsed by transplant physicians and dermatologists.

PARTICIPANTS

An expert panel of 8 dermatologists providing care for kidney transplant recipients and 1 research medical anthropologist.

MAIN OUTCOME MEASURES

Reading grade level, inclusion of people with skin of color, sufficient content to support effective sun protection, and description of 4 sun-protection strategies and skin self-examination. Results-Of the 40 sites identified, 11 contained information about sun protection or increased risk of any type of cancer. The Web sites had a ninth-grade median reading level (range, seventh grade to college senior). Interrater reliability for the 25-item assessment tool was assessed by Fleiss' kappa (kappa = 0.87). Skin cancer risk was presented as relevant to those with fair skin. Sites recommended regular use of sunscreen with sun-protection factor of 15 or greater (n=3) to reduce the risk of skin cancer (n=4). Few sites recommended using protective clothing (n=5), seeking shade (n=4), and avoiding deliberate tanning with indoor or outdoor light (n=1). Five sites recommended skin self-examination.

CONCLUSION

Because many patients seek self-management information from the Internet, Web sites must provide more thorough educational information about skin cancer prevention and health promotion at a lower reading grade level.

Skin Cancer Prevention Education for Kidney Transplant Recipients: A Systematic Evaluation of Internet Sites

Context

Repeated patient education about skin cancer prevention is important to self-care after transplant.

Objective

Examine educational materials for kidney transplant recipients available on the Internet that address sun protection and skin self-examination for early detection of squamous cell carcinoma.

Design

Systematic review of Web sites for kidney transplant recipients endorsed by transplant physicians and dermatologists.

Participants

An expert panel of 8 dermatologists providing care for kidney transplant recipients and 1 research medical anthropologist.

Main Outcome Measures

Reading grade level, inclusion of people with skin of color, sufficient content to support effective sun protection, and description of 4 sun-protection strategies and skin self-examination.

Results

Of the 40 sites identified, 11 contained information about sun protection or increased risk of any type of cancer. The Web sites had a ninth-grade median reading level (range, seventh grade to college senior). Interrater reliability for the 25-item assessment tool was assessed by Fleiss' kappa (κ = 0.87). Skin cancer risk was presented as relevant to those with fair skin. Sites recommended regular use of sunscreen with sun-protection factor of 15 or greater (n=3) to reduce the risk of skin cancer (n= 4). Few sites recommended using protective clothing (n = 5), seeking shade (n=4), and avoiding deliberate tanning with indoor or outdoor light (n = 1). Five sites recommended skin self-examination

Conclusion

Because many patients seek self-management information from the Internet, Web sites must provide more thorough educational information about skin cancer prevention and health promotion at a lower reading grade level.

Numeracy skills in CKD: correlates and outcomes

BACKGROUND AND OBJECTIVES

Healthcare providers communicate the risks and benefits of treatments using frequencies, percentages, or proportions. However, many patients lack the numerical skills needed to interpret this information accurately to make informed choices.

DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS

We assessed numeracy, the capacity to use and comprehend numbers, in a prospective cohort study of 187 patients with stage 4 to 5 chronic kidney disease or ESRD. Patients completed a three-item numeracy test and were assessed for global mental status, cognitive function, type of hemodialysis access, and kidney transplant use. We examined the association of numeracy with healthcare use and other cognitive and sociodemographic variables.

RESULTS

Over 50% of patients answered one or fewer numeracy questions correctly. Although African Americans (P = 0.0001), women (P = 0.05), and the unemployed (P = 0.0004) demonstrated lower numeracy skills, numeracy deficits were prevalent in every subgroup. In analyses adjusted for demographics and length of follow-up, higher numeracy was significantly associated with receipt of a transplant or active waiting list status. Numeracy was not associated with dialysis modality or hemodialysis vascular access.

CONCLUSION

Similar to prior findings in the general population, these findings indicate that poor numeracy skills are very common in patients with advanced chronic kidney disease and end-stage renal disease. Additional research is needed to further explore whether poor numeracy is a barrier to receipt of a kidney transplant. Clinicians caring for patients with kidney disease should consider using tools to enhance communication and overcome limited numeracy skills.

Health literacy skills of kidney transplant recipients

CONTEXT

Although low health literacy can affect patients' treatment decision making, comprehension of health information, and medication adherence, little is known about health literacy skills of kidney transplant recipients.

OBJECTIVE

To examine the relationship among kidney transplant recipients' health literacy levels, transplant knowledge, and graft function.

DESIGN

Cross-sectional study of 124 adult kidney transplant recipients.

MAIN OUTCOME MEASURES

Health literacy was assessed via the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the Rapid Estimate of Adult Literacy in Medicine-Transplantation (REALM-T). Data on recipients' transplant numeracy, knowledge needs, and demographics were collected via semistructured interviews. Multivariable linear regressions were used to assess the relationship between health literacy and graft function.

RESULTS

Most kidney recipients (91%) had adequate health literacy (S-TOFHLA); however, 81% were unfamiliar with at least 1 kidney transplant-related term (REALM-T). The 5 least familiar terms were sensitization (50%), urethra (45%), trough level (41%), blood urea nitrogen (32%), and toxicity (31%). Numeracy levels varied: 21% knew the likelihood of 1-year graft survival; 29% knew that half of kidney recipients have problems with the transplant in the first 6 months; 68% were aware of the risk of death within the first year after transplantation; and 86% knew the normal range for creatinine in kidney recipients. Patients with lower health literacy (REALM-T) had higher creatinine levels.

CONCLUSIONS

Transplant providers should intervene with better patient education materials to improve patients' health literacy, which may improve patients' medication adherence or transplant outcomes.

Health literacy and kidney disease: toward a new line of research

Health literacy has been recognized as an important public health issue over the past decade. Low health literacy is a widespread problem in the general population, affecting over 90 million Americans. A growing body of research has demonstrated the association between low health literacy and worse health outcomes in a variety of chronic conditions. Despite the increasing prevalence of chronic kidney disease (CKD) and the considerable interest in health literacy, there has been limited research examining the role of health literacy in individuals at all stages of CKD. This article examines the role of health literacy in kidney disease by reviewing early research on the topic, providing a conceptual model of the relationship between health literacy and health outcomes, and highlighting potential areas for future research on health literacy in CKD.

Health Literacy Skills of Kidney Transplant Recipients

Context

Although low health literacy can affect patients' treatment decision making, comprehension of health information, and medication adherence, little is known about health literacy skills of kidney transplant recipients.

Objective

To examine the relationship among kidney transplant recipients' health literacy levels, transplant knowledge, and graft function.

Design

Cross-sectional study of 124 adult kidney transplant recipients.

Main Outcome Measures

Health literacy was assessed via the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the Rapid Estimate of Adult Literacy in Medicine-Transplantation (REALM-T). Data on recipients' transplant numeracy, knowledge needs, and demographics were collected via semistructured interviews. Multivariable linear regressions were used to assess the relationship between health literacy and graft function.

Results

Most kidney recipients (91%) had adequate health literacy (S-TOFHLA); however, 81% were unfamiliar with at least 1 kidney transplant–related term (REALM-T). The 5 least familiar terms were sensitization (50%), urethra (45%), trough level (41%), blood urea nitrogen (32%), and toxicity (31%). Numeracy levels varied: 21% knew the likelihood of 1-year graft survival; 29% knew that half of kidney recipients have problems with the transplant in the first 6 months; 68% were aware of the risk of death within the first year after transplantation; and 86% knew the normal range for creatinine in kidney recipients. Patients with lower health literacy (REALM-T) had higher creatinine levels.

Conclusions

Transplant providers should intervene with better patient education materials to improve patients' health literacy, which may improve patients' medication adherence or transplant outcomes.

Patient education on mobile devices: an e-health intervention for low health literate audiences

Providing health information to low health literate audiences remains a challenge. Beyond message design, realistic delivery models are needed for delivering information to a traditionally hard-to-reach audience. This study investigated two e-health interventions to provide health information on mobile devices — one providing diabetes information and one offering childcare information. Both were well-received, and most of the subjects' usability issues related to the translation of these interventions to the mobile device's smaller screen. The diabetes website was effective in providing information to study participants (as measured by pre- and post-tests of knowledge), while the childcare website was not. Continued work in this area could explore improved design strategies for mobile devices — a delivery model that could be used in doctors' offices, for example. Effective delivery of health information to low health literate audiences is an important issue, and this research highlights a critical element by targeting another potential delivery model.

Patients' Willingness to Talk to others about Living Kidney Donation

Background

Living donor kidney transplantation has several advantages for patients with end-stage renal disease. However, many patients are reluctant to pursue this treatment option, preferring instead to wait for a deceased donor organ.

Objective

To examine predictors of patients' willingness to talk to others about living kidney donation.

Methods

One hundred thirty-two adult patients awaiting kidney transplantation who were enrolled in a randomized trial examining the effectiveness of education on rates of live donor kidney transplantation completed a baseline rating of their willingness to talk to others about living kidney donation. Also, patients completed measures of knowledge and concerns about living donation and a rating of perceived health.

Results

Slightly more than half the patients (56.1%) had low willingness to talk to others about living donation. The following variables were associated with higher willingness to talk to others: white race (odds ratio, 3.31; confidence interval, 1.7–7.4), college education (odds ratio, 3.43, confidence interval, 2.0–5.6), fewer concerns about living donor kidney transplantation (odds ratio, 0.31; confidence interval, 0.2–0.6), and less favorable perceptions of their current health status (odds ratio, 4.31; confidence interval, 2.6–7.6).

Conclusion

White race, more education, less concern about living donor kidney transplantation, and poorer perceived health are associated with greater willingness to talk to others about living kidney donation. These findings have important implications for educating patients about living donor kidney transplantation.