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Ayers BL, Brown CC, Andersen JA, Callaghan-Koru J, McElfish PA. Breastfeeding Intentions among Pregnant Women Enrolled in a Healthy Start Program in Arkansas. Matern Child Health J 2024; 28:1113-1120. [PMID: 38353889 DOI: 10.1007/s10995-024-03902-w] [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] [Accepted: 12/19/2023] [Indexed: 03/03/2024]
Abstract
INTRODUCTION Exclusive breastfeeding is recognized as the optimal source of nutrition for infants. Although exclusive breastfeeding rates have increased overall in the United States, substantial inequities exist in breastfeeding among individuals of different socioeconomic statuses, races, and ethnicities. The purpose of this study was to examine characteristics associated with exclusive breastfeeding intentions among pregnant women in Arkansas enrolled in a Healthy Start program. METHODS The current study included a cross-sectional design, with a sample of 242 pregnant women in Arkansas enrolled in a Healthy Start program. RESULTS The majority of the participants (56.6%) indicated their infant feeding intentions included a combination of breastfeeding and formula feeding. There were substantial differences in breastfeeding intentions among women of different races/ethnicities, with 18.5% of Marshallese women indicating they planned to exclusively breastfeed, compared to 42.1% of White women, 47.6% of Black women, and 31.8% of Hispanic women (p < 0.001). Women over the age of 18 and with higher educational attainment were more likely to intend on exclusively breastfeeding. DISCUSSION This is the first study to examine characteristics associated with exclusive breastfeeding intentions among pregnant women in Arkansas enrolled in a Healthy Start program. The study found that race/ethnicity and age were most strongly associated with breastfeeding intentions. These findings are critical to identifying populations for resource allocation and to developing culturally-tailored interventions to help women in Arkansas achieve their desired infant feeding methods.
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Affiliation(s)
- Britni L Ayers
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR, 72762, USA.
| | - Clare C Brown
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR, 72762, USA
| | - Jennifer Callaghan-Koru
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR, 72762, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR, 72762, USA
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Mols EM, Haak H, Holland M, Schouten B, Ibsen S, Merten H, Christensen EF, Nanayakkara PWB, Nickel CH, Weichert I, Kellett J, Subbe CP, Kremers MNT. Can acutely ill patients predict their outcomes? A scoping review. Emerg Med J 2024; 41:342-349. [PMID: 38238065 DOI: 10.1136/emermed-2022-213000] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 12/20/2023] [Indexed: 05/30/2024]
Abstract
INTRODUCTION The full impact of an acute illness on subsequent health is seldom explicitly discussed with patients. Patients' estimates of their likely prognosis have been explored in chronic care settings and can contribute to the improvement of clinical outcomes and patient satisfaction. This scoping review aimed to identify studies of acutely ill patients' estimates of their outcomes and potential benefits for their care. METHODS A search was conducted in PubMed, Embase, Web of Science and Google Scholar, using terms related to prognostication and acute care. After removal of duplicates, all articles were assessed for relevance by six investigator pairs; disagreements were resolved by a third investigator. Risk of bias was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS Our search identified 3265 articles, of which 10 were included. The methods of assessing self-prognostication were very heterogeneous. Patients seem to be able to predict their need for hospital admission in certain settings, but not their length of stay. The severity of their symptoms and the burden of their disease are often overestimated or underestimated by patients. Patients with severe health conditions and their relatives tend to be overoptimistic about the likely outcome. CONCLUSION The understanding of acutely ill patients of their likely outcomes and benefits of treatment has not been adequately studied and is a major knowledge gap. Limited published literature suggests patients may be able to predict their need for hospital admission. Illness perception may influence help-seeking behaviour, speed of recovery and subsequent quality of life. Knowledge of patients' self-prognosis may enhance communication between patients and their physicians, which improves patient-centred care.
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Affiliation(s)
- Elisabeth Margaretha Mols
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Aging and Long Term Care, Maastricht University, Maastricht, The Netherlands
- Internal Medicine, Maxima Medical Centre Location Veldhoven, Veldhoven, The Netherlands
| | - Harm Haak
- Internal Medicine, Maxima Medical Centre Location Veldhoven, Veldhoven, The Netherlands
- Department of Health Services Research and CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Mark Holland
- Department of Clinical and Biomedical Sciences, University of Bolton, Bolton, UK
- Department of Internal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Bo Schouten
- Department of Public and Occupational Health, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
- Maastricht University Care and Public Health Research Institute, Maastricht, The Netherlands
| | - Stine Ibsen
- Center for Prehospital and Emergency Research, Clinic of Internal and Emergency Medicine, Aalborg Universitetshospital, Aalborg, Denmark
- Physiotherapy, Aalborg University, Aalborg, Denmark
| | - Hanneke Merten
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
- Acute Care Network North-West, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Erika Frischknecht Christensen
- Center for Prehospital and Emergency Research, Clinic of Internal and Emergency Medicine, Aalborg Universitetshospital, Aalborg, Denmark
| | - Prabath W B Nanayakkara
- Section of Acute Medicine, Department of Internal Medicine, Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands
| | | | - Immo Weichert
- Department of Acute Medicine, Ipswich Hospital NHS Trust, Ipswich, UK
| | - John Kellett
- Emergency Medicine, Sydvestjysk Sygehus, Esbjerg, Denmark
| | - Christian Peter Subbe
- Department of Acute Medicine, Ysbyty Gwynedd, Bangor, UK
- School of Medical Sciences, Bangor University, Bangor, UK
| | - Marjolein N T Kremers
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Aging and Long Term Care, Maastricht University, Maastricht, The Netherlands
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Steel A, Foley H, Graham K, Harnett J, Adams J. Patient experiences of information-sharing and patient-centred care across the broad landscape of primary care practice and provision: a nationally representative survey of Australian adults. BMC PRIMARY CARE 2024; 25:151. [PMID: 38704562 PMCID: PMC11070095 DOI: 10.1186/s12875-024-02359-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/01/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Australian government strategies and frameworks have been developed in recent years to encourage the integration and coordination of primary care delivery; including patient-centred approaches to clinical and preventative care, and health promotion. This study aims to explore patient experiences of information-sharing and patient-centred care across various primary care clinical settings, with a particular focus on clinical encounters with GPs, naturopaths, osteopaths and acupuncturists. METHODS Data about healthcare utilisation and experiences from a 63-item cross-sectional survey obtained from a nationally representative sample of Australian adults aged ≥ 18 years were analysed. Chi-square and Kruskal-Wallis H tests were used to explore differences in the experiences of knowledge and information sharing during GP consultations among those who also consulted with a naturopath, osteopath or acupuncturist, compared those who had not. Logistic regression was used to investigate correlations between participants perceptions about GP consultation outcomes, and the GP's information-sharing behaviour or perceived experience of patient-centredness. RESULTS Across 2354 participants, verbal explanation (76.3%) and/or individualised handouts (16.8%) were the most common type of information shared in GP consultations. Individuals who consulted with a GP and a naturopath, an osteopath, or an acupuncturist reported a lower rate of receiving a verbal explanation from their GP but higher rate of receiving other types of information sources including handouts. Over one quarter of study participants who visited a GP did not discuss any of their health information with their GP. Information sharing was lower for individuals who also visited a naturopath, osteopath or acupuncturist. Participants scored their consultations with a GP as patient-centred, but these scores were lower among participants who also consulted with at least one other primary care practitioner type included in the study. CONCLUSIONS Public health and health services researchers, policymakers and leaders of primary care professions have a role and responsibility to ensure practitioners are confident and competent in sharing health information with their patients that considers their health literacy needs, and the importance of patient-centred care. Research focussed on a more in-depth understanding of the differences and relationships observed across the primary care landscape in this study is recommended.
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Affiliation(s)
- Amie Steel
- ARCCIM, School of Public Health, Faculty of Health, University of Technology Sydney, 235-253 Jones St, Ultimo, NSW, Australia.
| | - Hope Foley
- ARCCIM, School of Public Health, Faculty of Health, University of Technology Sydney, 235-253 Jones St, Ultimo, NSW, Australia
| | - Kim Graham
- ARCCIM, School of Public Health, Faculty of Health, University of Technology Sydney, 235-253 Jones St, Ultimo, NSW, Australia
| | - Joanna Harnett
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jon Adams
- ARCCIM, School of Public Health, Faculty of Health, University of Technology Sydney, 235-253 Jones St, Ultimo, NSW, Australia
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Garcia Valencia OA, Thongprayoon C, Miao J, Suppadungsuk S, Krisanapan P, Craici IM, Jadlowiec CC, Mao SA, Mao MA, Leeaphorn N, Budhiraja P, Cheungpasitporn W. Empowering inclusivity: improving readability of living kidney donation information with ChatGPT. Front Digit Health 2024; 6:1366967. [PMID: 38659656 PMCID: PMC11039889 DOI: 10.3389/fdgth.2024.1366967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/01/2024] [Indexed: 04/26/2024] Open
Abstract
Background Addressing disparities in living kidney donation requires making information accessible across literacy levels, especially important given that the average American adult reads at an 8th-grade level. This study evaluated the effectiveness of ChatGPT, an advanced AI language model, in simplifying living kidney donation information to an 8th-grade reading level or below. Methods We used ChatGPT versions 3.5 and 4.0 to modify 27 questions and answers from Donate Life America, a key resource on living kidney donation. We measured the readability of both original and modified texts using the Flesch-Kincaid formula. A paired t-test was conducted to assess changes in readability levels, and a statistical comparison between the two ChatGPT versions was performed. Results Originally, the FAQs had an average reading level of 9.6 ± 1.9. Post-modification, ChatGPT 3.5 achieved an average readability level of 7.72 ± 1.85, while ChatGPT 4.0 reached 4.30 ± 1.71, both with a p-value <0.001 indicating significant reduction. ChatGPT 3.5 made 59.26% of answers readable below 8th-grade level, whereas ChatGPT 4.0 did so for 96.30% of the texts. The grade level range for modified answers was 3.4-11.3 for ChatGPT 3.5 and 1-8.1 for ChatGPT 4.0. Conclusion Both ChatGPT 3.5 and 4.0 effectively lowered the readability grade levels of complex medical information, with ChatGPT 4.0 being more effective. This suggests ChatGPT's potential role in promoting diversity and equity in living kidney donation, indicating scope for further refinement in making medical information more accessible.
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Affiliation(s)
- Oscar A. Garcia Valencia
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Jing Miao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Supawadee Suppadungsuk
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Pajaree Krisanapan
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
- Division of Nephrology, Department of Internal Medicine, Thammasat University Hospital, Pathum Thani, Thailand
| | - Iasmina M. Craici
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Caroline C. Jadlowiec
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ, United States
| | - Shennen A. Mao
- Division of Transplant Surgery, Department of Transplant, Mayo Clinic, Jacksonville, FL, United States
| | - Michael A. Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Napat Leeaphorn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Pooja Budhiraja
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Phoenix, AZ, United States
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
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Dijkman EM, ter Brake WWM, Drossaert CHC, Doggen CJM. Assessment Tools for Measuring Health Literacy and Digital Health Literacy in a Hospital Setting: A Scoping Review. Healthcare (Basel) 2023; 12:11. [PMID: 38200917 PMCID: PMC10778720 DOI: 10.3390/healthcare12010011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
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.
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Affiliation(s)
- Eline M. Dijkman
- Department of Health Technology and Services Research (HTSR), Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (E.M.D.)
- Department of Surgery, Isala Hospital, 8025 AB Zwolle, The Netherlands
| | - Wouter W. M. ter Brake
- Department of Health Technology and Services Research (HTSR), Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (E.M.D.)
| | | | - Carine J. M. Doggen
- Department of Health Technology and Services Research (HTSR), Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (E.M.D.)
- Clinical Research Center, Rijnstate Hospital, 6815 AD Arnhem, The Netherlands
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Daly BM, Kaphingst KA. Variability in conceptualizations and measurement of genetic literacy. PEC INNOVATION 2023; 2:100147. [PMID: 37214533 PMCID: PMC10194132 DOI: 10.1016/j.pecinn.2023.100147] [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: 10/12/2022] [Revised: 03/01/2023] [Accepted: 03/05/2023] [Indexed: 05/24/2023]
Abstract
Objective To examine definitions and measures for genetic literacy in the published literature, and the associations between commonly utilized measures. Methods We completed a systematic review searching eight databases for empirical articles containing quantitative measures of genetic literacy. Articles were assessed for study properties, definitions, and measure characteristics. An online survey was then completed by 531 U.S. adults to examine correlations between frequently used genetic literacy measures. Results 92 articles met inclusion criteria for the systematic review. Articles rarely defined genetic literacy, and existing definitions showed inconsistencies in the knowledge and cognitive domains that comprise genetic literacy. Definitions frequently included objective conceptual knowledge, comprehension, and applied knowledge, however most measures only assessed objective or subjective knowledge. Genetic literacy measures were infrequently assessed for psychometric properties and the content domains assessed by measures varied considerably. Correlation analyses showed weak to moderate relationships between genetic literacy measures. Conclusion A comprehensive and consistent definition of genetic literacy and its cognitive and conceptual domains should be implemented to inform the development of concordant measurement tools and improve research and clinical care in genetics. Innovation We examine and compare definitions and measures of genetic literacy, suggest a more comprehensive definition, and recommendations for research development.
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Affiliation(s)
- Brianne M. Daly
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
| | - Kimberly A. Kaphingst
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
- Department of Communication, University of Utah, 255 S. Central Campus Drive, Salt Lake City, UT 84112, USA
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Loeb S, Sanchez Nolasco T, Siu K, Byrne N, Giri VN. Usefulness of podcasts to provide public education on prostate cancer genetics. Prostate Cancer Prostatic Dis 2023; 26:772-777. [PMID: 36681741 DOI: 10.1038/s41391-023-00648-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Podcasts, or episodic digital audio recordings, represent a novel way to reach large audiences for public education. Genetic evaluation has important implications for prostate cancer (PCa) care but is underutilized. We created a series of five podcasts about PCa genetics and tested their usefulness in raising awareness and providing education to lay audiences. METHODS We recruited 157 men and women from the general public and 100 patients with PCa from across the U.S., who listened to a podcast and completed an online survey. The primary outcome was the perceived usefulness of the podcast (score ≥5 on a published 7-point Likert scale). Secondary outcomes were relevance to informational needs, satisfaction and ease of use, as well as genetic knowledge and attitudes toward genetic testing after listening to the podcasts. RESULTS The podcasts were associated with high mean scores for perceived usefulness (5.6/7), relevance to informational needs (5.6/7), satisfaction (5.8/7), and ease of use (5.9/7). After listening to the podcasts, 80-100% correctly answered most key knowledge questions about PCa genetics, and 85% had a positive attitude toward genetic testing. On multivariable analysis, the perceived usefulness of the podcasts was higher among Black/Hispanic adults (p = 0.05) and those with a family history of PCa (p = 0.01). CONCLUSIONS A podcast series on PCa genetics was perceived as useful and associated with high rates of knowledge for patients with PCa and the general public. Podcasts represent a promising new educational tool to raise awareness about PCa genetic evaluation, particularly for high-risk groups.
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Affiliation(s)
- Stacy Loeb
- Department of Urology, New York University, New York, NY, USA.
- Department of Population Health, New York University, New York, NY, USA.
- The Department of Surgery/Urology, Manhattan Veterans Affairs Medical Center, New York, NY, USA.
| | - Tatiana Sanchez Nolasco
- Department of Urology, New York University, New York, NY, USA
- Department of Population Health, New York University, New York, NY, USA
| | - Katherine Siu
- Department of Urology, New York University, New York, NY, USA
- Department of Population Health, New York University, New York, NY, USA
| | - Nataliya Byrne
- Department of Urology, New York University, New York, NY, USA
- Department of Population Health, New York University, New York, NY, USA
| | - Veda N Giri
- The Division of Clinical Cancer Genetics, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA
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Shehadeh-Sheeny A, Baron-Epel O. Prevalence, diagnosis and treatment of ADHD in Arab and Jewish children in Israel, where are the gaps? BMC Psychiatry 2023; 23:586. [PMID: 37568131 PMCID: PMC10416406 DOI: 10.1186/s12888-023-05090-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/08/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder affecting children and causing significant impairment. It is not clear to what extent ADHD differs between population groups. This study aims to assess prevalence, diagnosis and treatment of ADHD among Arab and Jewish children of primary school age in Israel. METHODS Cross-sectional survey, including 517 parents of children ages 7-10 (225 Jewish and 292 Arab) and 60 homeroom teachers of the corresponding children. Both parents and homeroom teachers completed the ADHD Rating Scale-V-RV. ADHD was defined according to DSM-5 ADHD criteria by both parents and teachers, or clinical diagnosis. In addition, parents reported ADHD medication and adherence to medication. RESULTS Prevalence of ADHD was similar for both groups. Yet, seeking diagnosis was lower among Arab Muslim children (9.2%) compared to Jewish children (17.8%). Arab Muslim children received significantly less medication compared to Jewish children. Parental decision to seek diagnosis was associated with education (OR = 6.14, CI 1.74-21.71), not ethnicity. Ethnicity predicted parents' decisions to pharmacologically treat their children with ADHD (OR = 7.61, CI 1.14-50.86) and adherence to medication (OR = 10.19, CI 1.18-88.01). CONCLUSION Education is critical in the help-seeking process, affecting the rate of ADHD diagnosis. Pharmacological treatment and adherence are correlated with ethnicity. Parents with limited education and minorities should be targeted for interventions to increase awareness regarding ADHD and treatment.
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Affiliation(s)
- Amal Shehadeh-Sheeny
- School of Public Health, Faculty of Social Welfare and Health Studies, University of Haifa, Mount Carmel, Haifa, 31905, Israel.
| | - Orna Baron-Epel
- School of Public Health, Faculty of Social Welfare and Health Studies, University of Haifa, Mount Carmel, Haifa, 31905, Israel
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Gagnon KW, Coulter RW, Egan JE, Ho K, Hawk M. Associations Between Sexual History Documentation in Electronic Health Records and Referral to Pre-Exposure Prophylaxis Navigator on Prescription of Pre-Exposure Prophylaxis at a Multi-Site Federally Qualified Health Center. AIDS Patient Care STDS 2023; 37:403-415. [PMID: 37566534 PMCID: PMC10457630 DOI: 10.1089/apc.2023.0068] [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] [Indexed: 08/13/2023] Open
Abstract
This cross-sectional study examined the relationships between sexual history screening (SHS) and referrals to a pre-exposure prophylaxis (PrEP) navigator (non-clinical staff member who assists patients in overcoming structural barriers to PrEP) on the proportion of days covered by PrEP for adult patients at a federally qualified health center. Patients' sociodemographics, PrEP prescriptions, referral to a PrEP navigator, and SHS data were extracted from the electronic health record (EHR). The analytic sample was 214 adult patients who were human immunodeficiency virus (HIV) negative and taking PrEP to prevent infection from January 2016 to December 2019. Mixed-effects negative binomial models were conducted accounting for clustering by patients' primary care providers. Documentation of SHS was associated with a higher proportion of days covered by PrEP (incidence rate ratio = 1.44, 95% confidence interval: 1.17-1.77). There was no significant effect of having a referral to the PrEP navigator on the proportion of days covered by PrEP, nor did having a referral to the PrEP navigator moderate the relationship between having SHS documented in the EHR and the proportion of days covered by PrEP. This study is the first to investigate the relationship between having sexual history documented in the EHR, referrals to a PrEP navigator, and their combined effect on the proportion of days covered by PrEP. Results of this study provide foundational evidence for future studies examining SHS as an opportunity to improve PrEP access and adherence and indicate the need for additional research exploring the value of PrEP navigators as an implementation strategy to overcome social and structural barriers to care.
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Affiliation(s)
- Kelly W. Gagnon
- Division of Infectious Diseases, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Robert W.S. Coulter
- Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James E. Egan
- Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ken Ho
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary Hawk
- Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Loeb S, Ravenell JE, Gomez SL, Borno HT, Siu K, Sanchez Nolasco T, Byrne N, Wilson G, Griffith DM, Crocker R, Sherman R, Washington SL, Langford AT. The Effect of Racial Concordance on Patient Trust in Online Videos About Prostate Cancer: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2324395. [PMID: 37466938 DOI: 10.1001/jamanetworkopen.2023.24395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Importance Black men have a higher risk of prostate cancer compared with White men, but Black adults are underrepresented in online content about prostate cancer. Across racial groups, the internet is a popular source of health information; Black adults are more likely to trust online health information, yet have more medical mistrust than White adults. Objective To evaluate the association between racial representation in online content about prostate cancer and trust in the content and identify factors that influence trust. Design, Setting, and Participants A randomized clinical trial was conducted from August 18, 2021, to January 7, 2022, consisting of a 1-time online survey. Participants included US men and women aged 40 years and older. Data were analyzed from January 2022 to June 2023. Interventions Participants were randomized to watch the same video script about either prostate cancer screening or clinical trials presented by 1 of 4 speakers: a Black physician, a Black patient, a White physician, or a White patient, followed by a questionnaire. Main Outcomes and Measures The primary outcome was a published scale for trust in the information. χ2 tests and multivariable logistic regression were used to compare trust according to the video's speaker and topic. Results Among 2904 participants, 1801 (62%) were men, and the median (IQR) age was 59 (47-69) years. Among 1703 Black adults, a greater proportion had high trust in videos with Black speakers vs White speakers (72.7% vs 64.3%; adjusted odds ratio [aOR], 1.62; 95% CI, 1.28-2.05; P < .001); less trust with patient vs physician presenter (64.6% vs 72.5%; aOR, 0.63; 95% CI, 0.49-0.80; P < .001) and about clinical trials vs screening (66.3% vs 70.7%; aOR, 0.78; 95% CI, 0.62-0.99; P = .04). Among White adults, a lower proportion had high trust in videos featuring a patient vs physician (72.0% vs 78.6%; aOR, 0.71; 95% CI, 0.54-0.95; P = .02) and clinical trials vs screening (71.4% vs 79.1%; aOR, 0.57; 95% CI, 0.42-0.76; P < .001), but no difference for Black vs White presenters (76.8% vs 73.7%; aOR, 1.11; 95% CI, 0.83-1.48; P = .49). Conclusions and Relevance In this randomized clinical trial, prostate cancer information was considered more trustworthy when delivered by a physician, but racial concordance was significantly associated with trust only among Black adults. These results highlight the importance of physician participation and increasing racial diversity in public dissemination of health information and an ongoing need for public education about clinical trials. Trial Registration ClinicalTrials.gov Identifier: NCT05886751.
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Affiliation(s)
- Stacy Loeb
- Department of Urology, New York University Langone Health, New York
- Department of Population Health, New York University Langone Health, New York
- Department of Surgery/Urology, Manhattan Veterans Affairs, New York, New York
| | - Joseph E Ravenell
- Department of Population Health, New York University Langone Health, New York
| | - Scarlett Lin Gomez
- Department of Urology and Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco
| | - Hala T Borno
- Department of Urology and Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco
- Trial Library, Inc., San Francisco, California
| | - Katherine Siu
- Department of Urology, New York University Langone Health, New York
- Department of Population Health, New York University Langone Health, New York
| | - Tatiana Sanchez Nolasco
- Department of Urology, New York University Langone Health, New York
- Department of Population Health, New York University Langone Health, New York
| | - Nataliya Byrne
- Department of Urology, New York University Langone Health, New York
- Department of Population Health, New York University Langone Health, New York
| | | | | | - Rob Crocker
- Stakeholder Advisory Board, New York, New York
| | | | - Samuel L Washington
- Department of Urology and Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco
| | - Aisha T Langford
- Department of Population Health, New York University Langone Health, New York
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11
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Green RK, Nieser KJ, Jacobsohn GC, Cochran AL, Caprio TV, Cushman JT, Kind AJH, Lohmeier M, Shah MN. Differential Effects of an Emergency Department-to-Home Care Transitions Intervention in an Older Adult Population: A Latent Class Analysis. Med Care 2023; 61:400-408. [PMID: 37167559 PMCID: PMC10176501 DOI: 10.1097/mlr.0000000000001848] [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] [Indexed: 05/13/2023]
Abstract
BACKGROUND Older adults frequently return to the emergency department (ED) within 30 days of a visit. High-risk patients can differentially benefit from transitional care interventions. Latent class analysis (LCA) is a model-based method used to segment the population and test intervention effects by subgroup. OBJECTIVES We aimed to identify latent classes within an older adult population from a randomized controlled trial evaluating the effectiveness of an ED-to-home transitional care program and test whether class membership modified the intervention effect. RESEARCH DESIGN Participants were randomized to receive the Care Transitions Intervention or usual care. Study staff collected outcomes data through medical record reviews and surveys. We performed LCA and logistic regression to evaluate the differential effects of the intervention by class membership. SUBJECTS Participants were ED patients (age 60 y and above) discharged to a community residence. MEASURES Indicator variables for the LCA included clinically available and patient-reported data from the initial ED visit. Our primary outcome was ED revisits within 30 days. Secondary outcomes included ED revisits within 14 days, outpatient follow-up within 7 and 30 days, and self-management behaviors. RESULTS We interpreted 6 latent classes in this study population. Classes 1, 4, 5, and 6 showed a reduction in ED revisit rates with the intervention; classes 2 and 3 showed an increase in ED revisit rates. In class 5, we found evidence that the intervention increased outpatient follow-up within 7 and 30 days (odds ratio: 1.81, 95% CI: 1.13-2.91; odds ratio: 2.24, 95% CI: 1.25-4.03). CONCLUSIONS Class membership modified the intervention effect. Population segmentation is an important step in evaluating a transitional care intervention.
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Affiliation(s)
- Rebecca K Green
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health
| | - Kenneth J Nieser
- Department of Population Health Sciences, School of Medicine and Public Health
| | - Gwen C Jacobsohn
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health
| | - Amy L Cochran
- Department of Population Health Sciences, School of Medicine and Public Health
- Department of Mathematics, University of Wisconsin-Madison, Madison, WI
| | | | - Jeremy T Cushman
- Department of Public Health Sciences
- Department of Emergency Medicine, University of Rochester Medical Center; Rochester, NY
| | - Amy J H Kind
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison
- Center for Health Disparities Research
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Michael Lohmeier
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health
| | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health
- Department of Population Health Sciences, School of Medicine and Public Health
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison
- Center for Health Disparities Research
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI
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12
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Avila S, Ruiz MJ, Petereit D, Arya R, Callender B, Hasan Y, Kim J, Lee N, McCall A, Son C, Stack K, Asif S, Besecker T, Juneja A, Li Z, Naik P, Ranka T, Saxena P, Siegfried B, Ichikawa T, Golden DW. Communicating the Gynecologic Brachytherapy Experience (CoGBE): Clinician perceived benefits of a graphic narrative discussion guide. Brachytherapy 2023; 22:352-360. [PMID: 36681540 PMCID: PMC10175118 DOI: 10.1016/j.brachy.2022.12.006] [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: 09/03/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Many current radiotherapy patient education materials are not patient-centered. An interprofessional team developed Communicating the Gynecologic Brachytherapy Experience (CoGBE), a graphic narrative discussion guide for cylinder, intracavitary, and interstitial high-dose-rate (HDR) gynecologic brachytherapy. This study assesses perceived clinical benefits, usability, and anxiety-reduction of CoGBE. METHODS AND MATERIALS An electronic survey was sent to members of the American Brachytherapy Society. Participants were assigned to assess one of the three modality-specific CoGBE versions using a modified Systems Usability Scale (SUS), modified state-trait anxiety index (mSTAI), and Likert-type questions. Free response data was analyzed using modified grounded theory. RESULTS Median modified SUS score was 76.3 (interquartile range [IQR], 71.3-82.5) and there were no significant differences between guide types. Median mSTAI was 40 (IQR, 40-43.3) for all guides collectively. The cylinder guide had a significantly higher median mSTAI than the intracavitary and interstitial guides (41.6 vs. 40.0 and 40.0; p = 0.04) suggesting the cylinder guide may have less impact on reducing anxiety. Most respondents reported that CoGBE was helpful (72%), would improve patient understanding (77%) and consultation memorability (82%), and was at least moderately likely to be incorporated into their practice (80%). Qualitative analysis themes included personalization and relatability (positive); generalizability (negative); illustrations (both). CONCLUSIONS Clinicians rate CoGBE as usable with potential to reduce patient anxiety, especially with more invasive treatment modalities including intracavitary or interstitial high-dose-rate. CoGBE has the potential to improve patient-clinician communication for a wider range of patients due to its accessible, adaptable, and patient-centered design.
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Affiliation(s)
- Santiago Avila
- Pritzker School of Medicine, The University of Chicago, Chicago, IL
| | - María J Ruiz
- Pritzker School of Medicine, The University of Chicago, Chicago, IL
| | | | - Ritu Arya
- Texas Oncology Arlington Cancer Center North, Arlington, TX
| | - Brian Callender
- Department of Medicine, The University of Chicago, Chicago, IL
| | - Yasmin Hasan
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - Josephine Kim
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL
| | - Nita Lee
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL
| | - Anne McCall
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - Christina Son
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - Kate Stack
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - Sabah Asif
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - Tyler Besecker
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - Arushi Juneja
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - Zhongyang Li
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - Pinakee Naik
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - Tanvi Ranka
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - Prachi Saxena
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - Brian Siegfried
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - Tomoko Ichikawa
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - Daniel W Golden
- Pritzker School of Medicine, The University of Chicago, Chicago, IL; Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL.
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13
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Guo P, Alajarmeh S, Alarjeh G, Alrjoub W, Al-Essa A, Abusalem L, Giusti A, Mansour AH, Sullivan R, Shamieh O, Harding R. Providing person-centered palliative care in conflict-affected populations in the Middle East: What matters to patients with advanced cancer and families including refugees? Front Oncol 2023; 13:1097471. [PMID: 37051537 PMCID: PMC10083486 DOI: 10.3389/fonc.2023.1097471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
IntroductionUniversal health coverage highlights palliative care as an essential component of health services. However, it is unclear what constitutes person-centered care in populations affected by conflict, as they may have specific concerns in the dimensions of physical, emotional, social, and spiritual wellbeing. This study aimed to identify what matters to patients with advanced cancer and family caregivers in Jordan including refugees, to inform appropriate person-centered assessment and palliative care in conflict-affected populations.MethodsCross-sectional face-to-face, semi-structured interviews were conducted at two sites in Amman. Adult patients with advanced cancer and family caregivers were purposively sampled to maximize diversity and representation. Interviews were digitally audio recorded, anonymized, and transcribed verbatim for thematic analysis.FindingsFour themes were generated from 50 patients (22 refugees; 28 Jordanians) and 20 caregivers (7 refugees; 13 Jordanians) (1). Information, communication, and decision-making. Truth-telling and full disclosure from clinicians was valued, and participants expressed concerns that information was not shared in case patients would disengage with treatment. (2) Priorities and concerns for care and support. Participants’ top priority remained cure and recovery (which was viewed as possible). Other priorities included returning to their “normal” life and their “own” country, and to continue contributing to their family. (3) Role of spirituality and Islam. Most participants had strong faith in God and felt that having faith could comfort them. For refugees whose social network was fractured due to being away from home country, prayer and Quran reading became particularly important. (4) Unmet support needs of family caregivers. Family caregivers were affected physically and emotionally by worrying about and caring for the patients. They needed support and training, but often could not access this.DiscussionTruth-telling is highly valued and essential to achieving person-centered care and informed decision-making. This study also reveals specific concerns in conflict-affected populations, reflecting the experience of prior losses and fracturing of existing social networks and support. The role of religion is crucial in supporting refugee communities, and consideration should be paid to the needs of patients and caregivers when caring for a patient at home without access to their communities of origin and the support they accessed.
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Affiliation(s)
- Ping Guo
- School of Nursing and Midwifery, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, United Kingdom
- *Correspondence: Ping Guo, ; Omar Shamieh,
| | - Sawsan Alajarmeh
- Center for Palliative & Cancer Care in Conflict (CPCCC), King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Ghadeer Alarjeh
- Center for Palliative & Cancer Care in Conflict (CPCCC), King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Waleed Alrjoub
- Center for Palliative & Cancer Care in Conflict (CPCCC), King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Ayman Al-Essa
- Center for Palliative & Cancer Care in Conflict (CPCCC), King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Lana Abusalem
- Center for Palliative & Cancer Care in Conflict (CPCCC), King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Alessandra Giusti
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, United Kingdom
| | - Asem H. Mansour
- Chief Executive Office, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Richard Sullivan
- Institute of Cancer Policy, King’s College London, London, United Kingdom
| | - Omar Shamieh
- Center for Palliative & Cancer Care in Conflict (CPCCC), King Hussein Cancer Center (KHCC), Amman, Jordan
- Department of Palliative Care, King Hussein Cancer Center (KHCC), Amman, Jordan
- Faculty of Medicine, the University of Jordan, Amman, Jordan
- *Correspondence: Ping Guo, ; Omar Shamieh,
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, United Kingdom
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14
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Kostareva U, Pe‘a (Varik) K, Siriwardhana C, Liu M, Qureshi K. Limited English Proficiency, Postoperative Complications, and Interpreter Use in Vascular Surgery Patients in Hawai'i. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2023; 82:39-49. [PMID: 36779005 PMCID: PMC9910193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
A retrospective cohort analysis of inpatient and outpatient vascular surgery cases from 2014 to 2018 was conducted to analyze the relationship between limited English proficiency (LEP) and undesirable postoperative outcomes, and to evaluate interpreter use as part of culturally and linguistically appropriate services (CLAS). Propensity score matching and logistic regression models were used to examine the association of English proficiency with postoperative outcomes and chart review was done to examine CLAS provision. Of the 959 cases, 57 (6%) were LEP and had noticeably worse health status before surgery than non-LEP. The 57 cases include 51 patients who had a single vascular surgery and 3 patients who had 2 vascular surgeries (different medical encounter/visit). There was no statistically significant difference in postoperative outcomes between patients with LEP and without LEP. Males with LEP were significantly less likely than females to receive CLAS (P=.008). On the day of vascular surgery and/or the day informed surgical consent was obtained, 16% of patients with LEP received access to interpreters; 25% had no documentation about interpreter provision, and 59% had mixed language access (family, staff, or interpreter). The provision of interpreters might be influenced by providers' perceived ability to communicate with patients with LEP without an interpreter, ease of obtaining an interpreter, availability of family or ad-hoc interpreters, and patients' preferences. Future research should examine reasons for frequent use of untrained individuals and inform strategies to implement language services in line with national standards.
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Affiliation(s)
- Uliana Kostareva
- Nancy Atmospera-Walch School of Nursing (NAWSON), University of Hawai‘i at Manoa, Honolulu, HI (UK)
| | | | - Chathura Siriwardhana
- Biostatistics Core, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI (CS)
| | - Min Liu
- College of Education, University of Hawai‘i at Manoa, Honolulu, HI (ML)
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15
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Jovelijic J, Shinners LR, Coutts RA. An evaluation of the use of an iPad for hospital orientation in a regional hospital. Collegian 2023. [DOI: 10.1016/j.colegn.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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16
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Agner J, Meyer M, Kaukau TM, Liu M, Nakamura L, Botero A, Sentell T. Health Literacy, Social Networks, and Health Outcomes among Mental Health Clubhouse Members in Hawai'i. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:837. [PMID: 36613158 PMCID: PMC9820034 DOI: 10.3390/ijerph20010837] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
Health literacy is the ability to obtain and utilize health information to make health-related decisions and to navigate health systems. Although health literacy has traditionally been understood as an individual-level construct, current research is revealing the impact that social networks can have on health literacy. To date, no studies have examined associations between health literacy and social networks among people with serious mental illness (PWSMI), who are at high risk of physical illness and premature mortality. To begin to fill this gap, this study explores associations between health literacy, relationships with health discussion partners, and self-reported health outcomes in a racially diverse sample of Clubhouse members in Hawai'i. Clubhouses are community mental health centers that promote recovery from mental illness through destigmatization, meaningful activity, and strong social relationships. Health literacy was assessed using two single-item screeners (SILS). In a sample of 163 members, 56.2% reported adequate ability to understand health-related instructions or pamphlets, and 43.3% reported adequate confidence filling out medical forms independently. This is consistent with other health literacy studies with PWSMI in the United States, and indicates lower health literacy within this group than is reported in national averages. Multivariate logistic regression revealed a larger Clubhouse staff social network and completing high school were significantly associated with requiring less help to read materials. Higher age, male gender, and being Native Hawaiian and/or Pacific Islander were associated with less confidence filling out medical forms, while higher self-efficacy was associated with higher confidence filling out medical forms. This study provides preliminary evidence that relationships fostered within Clubhouses are associated with health literacy among PWSMI, and highlights the need for more research to examine how social networks and health literacy interventions can be leveraged in community mental health settings to improve health outcomes within this vulnerable population.
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Affiliation(s)
- Joy Agner
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA
| | - Monet Meyer
- Department of Psychology, University of Hawai‘i at Mānoa, Honolulu, HI 96822, USA
| | | | - Maileen Liu
- Department of Psychology, University of Hawai‘i at Mānoa, Honolulu, HI 96822, USA
| | - Lisa Nakamura
- Department of Psychology, University of Hawai‘i at Mānoa, Honolulu, HI 96822, USA
| | - Adriana Botero
- Hawai‘i School of Professional Psychology, Chaminade University of Honolulu, Honolulu, HI 96816, USA
| | - Tetine Sentell
- Office of Public Health Studies, Thompson School of Social Work, University of Hawai‘i at Mānoa, Honolulu, HI 96822, USA
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17
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Alzanad F, Feyaza M, Chapanduka ZC. A study of patient-reported pain during bone marrow aspiration and biopsy using local anesthesia alone compared with local anesthesia with intravenous midazolam coadministration at a tertiary academic hospital in South Africa. Health Sci Rep 2022; 5:e902. [PMID: 36324428 PMCID: PMC9621466 DOI: 10.1002/hsr2.902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/04/2022] [Accepted: 10/09/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION During the bone marrow aspiration and biopsy (BMAB) procedure, patients report pain of widely variable intensity. There is limited literature on the factors associated with the pain. The use of local anesthesia (LA) only is still widespread although it does not abolish the pain. Midazolam is the most commonly used benzodiazepine for conscious sedation. Our center introduced universal midazolam sedation unless there is a contraindication to its use, 4 years ago. This study assessed the impact of the universal use of intravenous midazolam for BMAB compared to use of LA only. The factors associated with the pain of BMAB, were analyzed. METHODS A retrospective cross-sectional study was performed on adult patients who had a BMAB procedure from July 1, 2018 to March 30, 2019. A questionnaire incorporating a visual analog pain scale, was used for data collection. RESULTS A total of 182 BMAB procedures were included in the study. Pain was reported in all procedures performed under LA and only in 29.1% of procedures performed with midazolam. Age, sex, race, level of education, body mass index (BMI), indication and diagnosis had no influence on pain. Patients who had previous BMAB experienced less pain. Experience of operator had a significant effect on pain. Midazolam dose showed a negative correlation with pain. CONCLUSION LA only is not enough to abolish pain of BMAB. Midazolam conscious sedation used with LA reduces pain to acceptable levels. Patients with previous experience of BMAB under midazolam premedication reported less pain. Furthermore, the experience of operator reduced the pain significantly.
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Affiliation(s)
- Fatima Alzanad
- Division of Hematological Pathology, Department of PathologyStellenbosch University Faculty of Medicine and Health SciencesCape TownSouth Africa,National Health Laboratory Service Tygerberg HospitalCape TownSouth Africa
| | - Merga Feyaza
- Division of Epidemiology, Department of Global HealthStellenbosch University Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Zivanai C. Chapanduka
- Division of Hematological Pathology, Department of PathologyStellenbosch University Faculty of Medicine and Health SciencesCape TownSouth Africa,National Health Laboratory Service Tygerberg HospitalCape TownSouth Africa
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18
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Ansah EW, Menyanu EK. Factors Influencing Drug Use Information Received at Primary Healthcare Centre Pharmacies in Ghana. Health Serv Insights 2022; 15:11786329221127140. [PMID: 36186736 PMCID: PMC9516421 DOI: 10.1177/11786329221127140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/31/2022] [Indexed: 11/15/2022] Open
Abstract
Background Health literacy addresses environmental, political, and social factors that determine health. Drug dispensers play a major role in educating patients on drug use to increase effective and efficient drug utilisation, thereby promoting positive healthcare outcomes. From the patients' perspective, this study examined the communication quality between patients and drug dispensers at primary healthcare centres in the Cape Coast Metropolis of Ghana. Method We conveniently surveyed 269 patients seeking health care at primary healthcare facilities using a researcher-constructed 13-item instrument. In SPSS version 21 software, we analysed the data using percentages, chi-square analysis, and logistic regression. Results Almost half of the participants (n = 132) reported low health literacy, with 81% (n = 218) reporting that drug side effects were not discussed with them at the pharmacies. The findings further indicated that health literacy and educational level predicted general communication quality between participants and drug dispensers; participants with secondary education were about 3 times more likely to report not being told of the side effects of prescribed drugs as compared with those who had completed only basic education. Conclusions There is still a high level of low health literacy among patients seeking healthcare at primary healthcare centres and a very high percentage of patients did not receive any education on side effects of dispensed drugs. Drug use directives from dispensers at primary healthcare facilities can make a difference between any 2 patients.
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Affiliation(s)
- Edward Wilson Ansah
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Elias Kweshievi Menyanu
- Faculty of Health and Behavioural Sciences, University of Wollongong, Wollongong, NSW, Australia
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Puello SDCP, Silva-Júnior MF, de Sousa MDLR, Batista MJ. Criterion validity of 14-item Health Literacy Scale (HLS-14) questionnaire in Brazilian adults and older people. Health Promot Int 2022; 37:6749054. [DOI: 10.1093/heapro/daac142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Summary
The objective of this study was to evaluate the criterion validity of the 14-item Health Literacy Scale (HLS-14) in Brazilian adults and older adults. The cross-sectional study performed in an oral health (OH) prospective cohort was conducted in 2017 in Piracicaba, Brazil. The HLS-14 questionnaire was applied to evaluate Health Literacy (HL) by dimensions: Functional literacy (FunL), Communicative literacy (ComL) and Critical literacy (CriL). An evaluation protocol (EP) was proposed to evaluate the criterion validity of HLS-14 considering HL dimensions (FunL: reading of the drug information leaflets; ComL: reading of the medical prescription and CriL: identification of OH conditions). HL (total) was dichotomized by the median in high (≥35 point) or low (<35 point) HL. Kendall’s rank correlation coefficient (p < 0.05) and chi-squared test (p < 0.05) were applied. There was agreement between EP and HLS-14 for FunL (p < 0.01). There was association between high HL, measured through the HLS-14 questionnaire, assessing the reading of the drug information leaflets (p < 0.01) and the need for help to read them (p < 0.01). EP showed association between high HL and being able to read the drug information leaflet (p < 0.01), not needing help to read (p < 0.01), having found in the prescription all the information to take the medicine (p < 0.01) and knowing two or more health and OH information in the educational material (p < 0.01). The HSL-14 questionnaire showed criterion validity to measure FunL, and for some items of ComL and CriL evaluation. HL evaluation in a practical and multidimensional way could have an effect on the communication between health professional and patient, motivation and health outcomes.
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Affiliation(s)
- Sthefanie del Carmen Perez Puello
- Department of Health Sciences and Pediatric Dentistry of the Piracicaba Dental School, State University of Campinas , Piracicaba, São Paulo , Brazil
- Department of Research, Faculty of Dentistry, Universidad de Cartagena , Cartagena, Bolívar , Colombia
| | | | - Maria da Luz Rosário de Sousa
- Department of Health Sciences and Pediatric Dentistry of the Piracicaba Dental School, State University of Campinas , Piracicaba, São Paulo , Brazil
| | - Marília Jesus Batista
- Department of Health Sciences and Pediatric Dentistry of the Piracicaba Dental School, State University of Campinas , Piracicaba, São Paulo , Brazil
- Department of Community Health, Medical School of Jundiaí , Jundiaí, São Paulo , Brazil
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Boonstra MD, Abma FI, Wilming L, Ståhl C, Karlsson E, Brouwer S. Social Insurance Literacy of Dutch Workers Receiving Disability Benefits and its Associations with Socio-Economic Characteristics. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:494-504. [PMID: 34985681 PMCID: PMC9576638 DOI: 10.1007/s10926-021-10018-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
Purpose This study explores the concept social insurance literacy (SIL) and corresponding questionnaire (SILQ) among workers receiving disability benefits and the comprehensibility of the social security institute (SSI), and examines associations with socio-economic characteristics. Methods 1753 panel members of the Dutch SSI were approached to complete the SILQ-NL37. This measure was based on the original SILQ. The SILQ-NL37 contains domains for obtaining, understanding and acting upon information for both individual SIL and system comprehensibility. A higher score means better SIL or comprehensibility. Data on age, gender, education, living situation, Dutch skills and time receiving disability benefits were also collected. With k-means clustering, groups with adequate and limited SIL were created. Associations with socio-economic characteristics were examined with independent t-tests and linear regression analyses for both the total scores and within domain scores. Cronbach α and Spearman rho's indicated measurement properties were good to acceptable for the SILQ-NL37. Results Thirty-five percent of the 567 participants were in the group with limited SIL. Higher individual SILQ-NL37 scores were associated with having a partner (p = 0.018) and northeastern living region (p = 0.031). Higher scores for obtaining (p = 0.041) and understanding (p = 0.049) information were associated with female sex, and for acting on information with younger age (p = 0.020). People with limited Dutch skills (p = 0.063) and a partner (p = 0.085) rated system comprehensibility higher. Conclusions According to the SILQ-NL37 scores, about 35% of the panel members have limited ability to obtain, understand and act upon social insurance systems information. Limited SIL is associated with several socio-economic factors. Future researches should study the concept in a more representative sample, and in different countries and social insurance contexts.
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Affiliation(s)
- M D Boonstra
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, Groningen, The Netherlands.
| | - F I Abma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, Groningen, The Netherlands
- Research Center for Insurance Medicine, Amsterdam, The Netherlands
| | - L Wilming
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, Groningen, The Netherlands
- Research Center for Insurance Medicine, Amsterdam, The Netherlands
| | - C Ståhl
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- HELIX Competence Center, Linköping University, Linköping, Sweden
| | - E Karlsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - S Brouwer
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, Groningen, The Netherlands
- Research Center for Insurance Medicine, Amsterdam, The Netherlands
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21
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Ahn S, Lee CJ, Ko Y. Network social capital and health information acquisition. PATIENT EDUCATION AND COUNSELING 2022; 105:2923-2933. [PMID: 35637049 DOI: 10.1016/j.pec.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/17/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study examines the associations of network social capital with obtaining health information from health care professionals, the media, and laypeople. We also investigate whether and how the relationship between social capital and health information acquisition differs by personal health literacy. We used a position generator to measure network social capital. METHODS We conducted a survey with a nationally representative sample (N = 626) in the United States in April 2014. RESULTS Network social capital was positively associated with obtaining health information from health professionals, the media, and laypeople. Also, the associations of social capital with health information acquisition from health professionals were enhanced among those with adequate personal health literacy. However, health literacy did not moderate the relationship between social capital and health information acquisition from the media and laypeople. CONCLUSION Social capital may encourage individuals to utilize health information sources. Also, health literacy might reinforce the linkage between social capital and acquiring health information from health professionals. PRACTICE IMPLICATIONS Social capital interventions may promote health information acquisition. Also, health professionals should communicate with patients in a patient-centered way so that low-literate individuals easily understand health information. Moreover, a universal precaution approach should be employed.
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Affiliation(s)
- Suhwoo Ahn
- Department of Communication, Michigan State University, 404 Wilson Rd., Room 456, East Lansing, MI 48823, USA.
| | - Chul-Joo Lee
- Department of Communication, Seoul National University, Seoul, Republic of Korea
| | - Yena Ko
- Department of Communication, Seoul National University, Seoul, Republic of Korea
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Costa Jacobsohn G, Maru AP, Green RK, Gifford AN, Lukasik MD, Bandara T, Caprio TV, Cochran AL, Cushman JT, Jones CMC, Kind AJH, Lohmeier M, Shah MN. Multimethod Process Evaluation of a Community Paramedic Delivered Care Transitions Intervention for Older Emergency Department Patients. PREHOSP EMERG CARE 2022; 27:841-850. [PMID: 35748597 PMCID: PMC9839887 DOI: 10.1080/10903127.2022.2094514] [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: 04/19/2022] [Revised: 06/16/2022] [Accepted: 06/22/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE We assessed fidelity of delivery and participant engagement in the implementation of a community paramedic coach-led Care Transitions Intervention (CTI) program adapted for use following emergency department (ED) visits. METHODS The adapted CTI for ED-to-home transitions was implemented at three university-affiliated hospitals in two cities from 2016 to 2019. Participants were aged ≥60 years old and discharged from the ED within 24 hours of arrival. In the current analysis, participants had to have received the CTI. Community paramedic coaches collected data on program delivery and participant characteristics at each transition contact via inventories and assessments. Participants provided commentary on the acceptability of the adapted CTI. Using a multimethod approach, the CTI implementation was assessed quantitatively for site- and coach-level differences. Qualitatively, barriers to implementation and participant satisfaction with the CTI were thematically analyzed. RESULTS Of the 863 patient participants, 726 (84.1%) completed their home visits. Cancellations were usually patient-generated (94.9%). Most planned follow-up visits were successfully completed (94.6%). Content on the planning for red flags and post-discharge goal setting was discussed with high rates of fidelity overall (95% and greater), while content on outpatient follow-up was lower overall (75%). Differences in service delivery between the two sites existed for the in-person visit and the first phone follow-up, but the differences narrowed as the study progressed. Participants showed a 24.6% increase in patient activation (i.e., behavioral adoption) over the 30-day study period (p < 0.001).Overall, participants reported that the program was beneficial for managing their health, the quality of coaching was high, and that the program should continue. Not all participants felt that they needed the program. Community paramedic coaches reported barriers to CTI delivery due to patient medical problems and difficulties with phone visit coordination. Coaches also noted refusal to communicate or engage with the intervention as an implementation barrier. CONCLUSIONS Community paramedic coaches delivered the adapted CTI with high fidelity across geographically distant sites and successfully facilitated participant engagement, highlighting community paramedics as an effective resource for implementing such patient-centered interventions.
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Affiliation(s)
- Gwen Costa Jacobsohn
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Apoorva P Maru
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Rebecca K Green
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Angela N Gifford
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Matthew D Lukasik
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Tikiri Bandara
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Thomas V Caprio
- Department of Medicine, Division of Geriatrics, University of Rochester Medical Center, Rochester, New York
| | - Amy L Cochran
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Department of Mathematics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jeremy T Cushman
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - Courtney M C Jones
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - Amy J H Kind
- Department of Medicine (Geriatrics and Gerontology), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Michael Lohmeier
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Department of Medicine (Geriatrics and Gerontology), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Gaffney HJ, Hamiduzzaman M. Factors that influence older patients’ participation in clinical communication within developed country hospitals and GP clinics: A systematic review of current literature. PLoS One 2022; 17:e0269840. [PMID: 35759474 PMCID: PMC9236261 DOI: 10.1371/journal.pone.0269840] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 05/28/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Engaging older adults in clinical communication is an essential aspect of high-quality elder care, patient safety and satisfaction in hospitals and GP clinics. However, the factors that influence older adults’ participation during their appointments with health professionals from the older patient’s perspective remain under-investigated.
Objectives
We aimed to fill this knowledge gap by reviewing research articles that have examined older patients’ involvement in clinical communication. In doing so, we hope to assist healthcare professionals and institutions in developing new strategies to improve older patients’ participation and engagement in clinical communication.
Methods
A systematic review of nine databases was conducted for studies reporting identified influences on older patients’ participation in clinical communication published from 2010. These studies were then subjected to thematic analysis for stratification.
Results
Twenty-one articles with a total of 36,797 participants were included and highlighted three major themes that influenced older patients’ participation in the clinical communication. The first theme identified includes accessibility to appointments, support, health information and person-centred care, highlighting that access to appointments, person centred care and health information significantly influences clinical communication participation. Relevant and understandable healthcare information identified that communication factors [i.e. tailored health information, health literacy and patient language barriers, and communication impairments] influences older patients’ participation. Older Patient perceptions of HCP credibility and trustworthiness highlighted how patient’s perceptions of health professionals influence their willingness to participate in clinical communications.
Conclusions and implications
This review demonstrates that there are several factors that contribute to insufficient or no participation of older patients in clinical communication in hospitals and GP clinics. These include accessibility to relevant and understandable health information, and the perceived health professional credibility and trustworthiness. Identifying ways to address these factors may improve patient participation, doctor-patient collaboration and overall health outcomes for older patients.
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Affiliation(s)
- Harry James Gaffney
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- * E-mail:
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Coombs NC, Campbell DG, Caringi J. A qualitative study of rural healthcare providers’ views of social, cultural, and programmatic barriers to healthcare access. BMC Health Serv Res 2022; 22:438. [PMID: 35366860 PMCID: PMC8976509 DOI: 10.1186/s12913-022-07829-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/21/2022] [Indexed: 11/24/2022] Open
Abstract
Background Ensuring access to healthcare is a complex, multi-dimensional health challenge. Since the inception of the coronavirus pandemic, this challenge is more pressing. Some dimensions of access are difficult to quantify, namely characteristics that influence healthcare services to be both acceptable and appropriate. These link to a patient’s acceptance of services that they are to receive and ensuring appropriate fit between services and a patient’s specific healthcare needs. These dimensions of access are particularly evident in rural health systems where additional structural barriers make accessing healthcare more difficult. Thus, it is important to examine healthcare access barriers in rural-specific areas to understand their origin and implications for resolution. Methods We used qualitative methods and a convenience sample of healthcare providers who currently practice in the rural US state of Montana. Our sample included 12 healthcare providers from diverse training backgrounds and specialties. All were decision-makers in the development or revision of patients’ treatment plans. Semi-structured interviews and content analysis were used to explore barriers–appropriateness and acceptability–to healthcare access in their patient populations. Our analysis was both deductive and inductive and focused on three analytic domains: cultural considerations, patient-provider communication, and provider-provider communication. Member checks ensured credibility and trustworthiness of our findings. Results Five key themes emerged from analysis: 1) a friction exists between aspects of patients’ rural identities and healthcare systems; 2) facilitating access to healthcare requires application of and respect for cultural differences; 3) communication between healthcare providers is systematically fragmented; 4) time and resource constraints disproportionately harm rural health systems; and 5) profits are prioritized over addressing barriers to healthcare access in the US. Conclusions Inadequate access to healthcare is an issue in the US, particularly in rural areas. Rural healthcare consumers compose a hard-to-reach patient population. Too few providers exist to meet population health needs, and fragmented communication impairs rural health systems’ ability to function. These issues exacerbate the difficulty of ensuring acceptable and appropriate delivery of healthcare services, which compound all other barriers to healthcare access for rural residents. Each dimension of access must be monitored to improve patient experiences and outcomes for rural Americans.
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Shah MN, Jacobsohn GC, Jones CMC, Green RK, Caprio TV, Cochran AL, Cushman JT, Lohmeier M, Kind AJ. Care transitions intervention reduces ED revisits in cognitively impaired patients. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12261. [PMID: 35310533 PMCID: PMC8919246 DOI: 10.1002/trc2.12261] [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: 08/26/2021] [Revised: 12/13/2021] [Accepted: 01/11/2022] [Indexed: 01/25/2023]
Abstract
Introduction About half of older adults with impaired cognition who are discharged home from the emergency department (ED) return for further care within 30 days. We tested the effect of an adapted Care Transitions Intervention (CTI) at reducing ED revisits in this vulnerable population. Methods We conducted a pre-planned subgroup analysis of community-dwelling, cognitively impaired older (age ≥60 years) participants from a randomized controlled trial testing the effectiveness of the CTI adapted for ED-to-home transitions. The parent study recruited ED patients from three university-affiliated hospitals from 2016 to 2019. Subjects eligible for this sub-analysis had to: (1) have a primary care provider within these health systems; (2) be discharged to a community residence; (3) not receive care management or hospice services; and (4) be cognitively impaired in the ED, as determined by a score >10 on the Blessed Orientation Memory Concentration Test. The primary outcome, ED revisits within 30 days of discharge, was abstracted from medical records and evaluated using logistic regression. Results Of our sub-sample (N = 81, 36 control, 45 treatment), 57% were female and the mean age was 78 years. Multivariate analysis, adjusted for the presence of moderate to severe depression and inadequate health literacy, found that the CTI significantly reduced the odds of a repeat ED visit within 30 days (odds ratio [OR] 0.25, 95% confidence interval [CI] 0.07 to 0.90) but not 14 days (OR 1.01, 95% CI 0.26 to 3.93). Multivariate analysis of outpatient follow-up found no significant effects. Discussion Community-dwelling older adults with cognitive impairment receiving the CTI following ED discharge experienced fewer ED revisits within 30 days compared to usual care. Further studies must confirm and expand upon this finding, identifying features with greatest benefit to patients and caregivers.
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Affiliation(s)
- Manish N. Shah
- BerbeeWalsh Department of Emergency MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Department of Medicine (Geriatrics and Gerontology)University of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Department of Population Health SciencesUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Center for Health Disparities ResearchUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Gwen C. Jacobsohn
- BerbeeWalsh Department of Emergency MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Courtney MC Jones
- Department of Emergency MedicineUniversity of Rochester Medical CenterRochesterNew YorkUSA,Department of Public Health SciencesUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Rebecca K. Green
- BerbeeWalsh Department of Emergency MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Thomas V. Caprio
- Department of Medicine, Division of GeriatricsUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Amy L. Cochran
- Department of Population Health SciencesUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Department of MathematicsUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Jeremy T. Cushman
- Department of Emergency MedicineUniversity of Rochester Medical CenterRochesterNew YorkUSA,Department of Public Health SciencesUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Michael Lohmeier
- BerbeeWalsh Department of Emergency MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Amy J.H. Kind
- Department of Medicine (Geriatrics and Gerontology)University of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Center for Health Disparities ResearchUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,William S. Middleton VA Geriatrics Research Education and Clinical Center (GRECC)MadisonWisconsinUSA
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Attributes of Organizational Health Literacy in Health Care Centers in Iran: A Qualitative Content Analysis Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042310. [PMID: 35206492 PMCID: PMC8872005 DOI: 10.3390/ijerph19042310] [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: 12/25/2021] [Revised: 01/29/2022] [Accepted: 02/10/2022] [Indexed: 11/17/2022]
Abstract
Organizational Health Literacy (OHL) is described as a new concept to remote health organizations to implement practices, policies, and systems that make it easier for patients to use, understand, and navigate health information to take care their own health. In Iran, there is no consensus on the attributes of OHL, and its practical implications and scope have not been evaluated. This manuscript is one of the first attempts to explain the attributes of the OHL in health care centers in Iran. This study is a content analysis survey, which was guided by the attributes of the OHL provided by Brach et al. and 26 semi-structured interviews were conducted with Iranian health professionals and employees of healthcare organizations from June 2020 to January 2021. A data analysis was performed using the MAXQDA 10 software. Across the study, ten sub-themes, 21 subcategories, and 67 codes emerged. The 10 main attributes of OHL were management, integration of health literacy in the organization, workforce, participation, range of HL skills, HL strategies, access, media variety, the role of the organization in crisis, and costs. These attributes may guide the planning of health care centers improvements and have the potential to promote health service reforms and public health policy.
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Jacobsohn GC, Jones CMC, Green RK, Cochran AL, Caprio TV, Cushman JT, Kind AJH, Lohmeier M, Mi R, Shah MN. Effectiveness of a care transitions intervention for older adults discharged home from the emergency department: A randomized controlled trial. Acad Emerg Med 2022; 29:51-63. [PMID: 34310796 PMCID: PMC8766871 DOI: 10.1111/acem.14357] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/06/2021] [Accepted: 07/20/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Improving care transitions following emergency department (ED) visits may reduce post-ED adverse events among older adults (e.g., ED revisits, decreased function). The Care Transitions Intervention (CTI) improves hospital-to-home transitions; however, its effectiveness at improving post-ED outcomes is unknown. We tested the effectiveness of the CTI with community-dwelling older adult ED patients, hypothesizing that it would reduce revisits and increase performance of self-management behaviors during the 30 days following discharge. METHODS We conducted a randomized controlled trial among patients age ≥ 60 discharged home from one of three EDs in two states. Intervention participants received a minimally modified CTI, with a home visit 24 to 72 h postdischarge and one to three phone calls over 28 days. We collected demographic, health status, and psychosocial data at the initial ED visit. Medication adherence and knowledge of red flag symptoms were assessed via phone survey. Care use and comorbidities were abstracted from medical records. We performed multivariate regressions for intention-to-treat and per-protocol (PP) analyses. RESULTS Participant characteristics (N = 1,756) were similar across groups: mean age 72.4 ± 8.6 years and 53% female. Of those randomized to the intervention, 84% completed the home visit. Overall, 12.4% of participants returned to the ED within 30 days. The CTI did not significantly affect odds of 30-day ED revisits (adjusted odds ratio [AOR] = 0.97, 95% confidence interval [CI] = 0.72 to 1.30) or medication adherence (AOR = 0.89, 95% CI = 0.60 to 1.32). Participants receiving the CTI (PP) had increased odds of in-person follow-up with outpatient clinicians during the week following discharge (AOR = 1.24, 95% CI = 1.01 to 1.51) and recalling at least one red flag from ED discharge instructions (AOR = 1.34 95% CI = 1.05 to 1.71). CONCLUSIONS The CTI did not reduce 30-day ED revisits but did significantly increase key care transition behaviors (outpatient follow-up, red flag knowledge). Additional research is needed to explore if patients with different conditions benefit more from the CTI and whether decreasing ED revisits is the most appropriate outcome for all older adults.
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Affiliation(s)
- Gwen C Jacobsohn
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Courtney M C Jones
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Rebecca K Green
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Amy L Cochran
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Thomas V Caprio
- Division of Geriatrics, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Jeremy T Cushman
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Amy J H Kind
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
- William S. Middleton Veterans Affairs Geriatrics Research, Education, and Clinical Center, Madison, Wisconsin, USA
| | - Michael Lohmeier
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Ranran Mi
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
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Boonstra MD, Reijneveld SA, Navis G, Westerhuis R, de Winter AF. Co-Creation of a Multi-Component Health Literacy Intervention Targeting Both Patients with Mild to Severe Chronic Kidney Disease and Health Care Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413354. [PMID: 34948960 PMCID: PMC8704507 DOI: 10.3390/ijerph182413354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/30/2022]
Abstract
Limited health literacy (LHL) is common in chronic kidney disease (CKD) patients and frequently associated with worse self-management. Multi-component interventions targeted at patients and healthcare professionals (HCPs) are recommended, but evidence is limited. Therefore, this study aims to determine the objectives and strategies of such an intervention, and to develop, produce and evaluate it. For this purpose, we included CKD patients with LHL (n = 19), HCPs (n = 15), educators (n = 3) and students (n = 4) from general practices, nephrology clinics and universities in an Intervention Mapping (IM) process. The determined intervention objectives especially address the patients’ competences in maintaining self-management in the long term, and communication competences of patients and HCPs. Patients preferred visual strategies and strategies supporting discussion of needs and barriers during consultations to written and digital strategies. Moreover, they preferred an individual approach to group meetings. We produced a four-component intervention, consisting of a visually attractive website and topic-based brochures, consultation cards for patients, and training on LHL for HCPs. Evaluation revealed that the intervention was useful, comprehensible and fitting for patients’ needs. Healthcare organizations need to use visual strategies more in patient education, be careful with digitalization and group meetings, and train HCPs to improve care for patients with LHL. Large-scale research on the effectiveness of similar HL interventions is needed.
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Affiliation(s)
- Marco D. Boonstra
- Department of Health Sciences, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (S.A.R.); (A.F.d.W.)
- Correspondence: ; Tel.: +31653243985
| | - Sijmen A. Reijneveld
- Department of Health Sciences, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (S.A.R.); (A.F.d.W.)
| | - Gerjan Navis
- Department of Nephrology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (G.N.); (R.W.)
| | - Ralf Westerhuis
- Department of Nephrology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (G.N.); (R.W.)
| | - Andrea F. de Winter
- Department of Health Sciences, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (S.A.R.); (A.F.d.W.)
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Lin JA, Im CJ, O'Sullivan P, Kirkwood KS, Cook AC. The surgical resident experience in serious illness communication: A qualitative needs assessment with proposed solutions. Am J Surg 2021; 222:1126-1130. [PMID: 34565516 PMCID: PMC9365675 DOI: 10.1016/j.amjsurg.2021.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/04/2021] [Accepted: 09/13/2021] [Indexed: 11/21/2022]
Abstract
Background: Serious illness communication skills are important tools for surgeons, but training in residency is limited. Methods: Thirteen senior surgical residents at an academic center were interviewed about their experiences with serious illness communication. Conventional content analysis was performed using established communication frameworks and inductive development of themes. Results: Residents had frequent conversations and employed known communication strategies. Three themes highlighted challenges they face. Illness severity included factors attributed to the illness that made serious illness communication more challenging: symptoms, poor prognosis, and urgency. Knowledge and feelings included the factual understanding and emotional experience of residents, patients, and families. Academic structure included hierarchy and the residents’ dual role as learners and teachers. On reflection, residents identified needing greater experiential practice, analogous to learning procedural skills. Conclusions: Surgical residents regularly face serious illness conversations with little training beyond observation of role models. Dedicated training may help meet this need.
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Affiliation(s)
- Joseph A Lin
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA; Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Cecilia J Im
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Patricia O'Sullivan
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Kimberly S Kirkwood
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Allyson C Cook
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA; Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Critical Care Medicine, University of California San Francisco, San Francisco, CA, USA
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Agrawal P, Chen TA, McNeill LH, Acquati C, Connors SK, Nitturi V, Robinson AS, Martinez Leal I, Reitzel LR. Factors Associated with Breast Cancer Screening Adherence among Church-Going African American Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168494. [PMID: 34444241 PMCID: PMC8392666 DOI: 10.3390/ijerph18168494] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 11/16/2022]
Abstract
Relative to White women, African American/Black women are at an increased risk of breast cancer mortality. Early detection of breast cancer through mammography screening can mitigate mortality risks; however, screening rates are not ideal. Consequently, there is a need to better understand factors associated with adherence to breast cancer screening guidelines to inform interventions to increase mammography use, particularly for groups at elevated mortality risk. This study used the Andersen Behavioral Model of Health Services Use to examine factors associated with adherence to National Comprehensive Cancer Network breast cancer screening guidelines amongst 919 African American, church-going women from Houston, Texas. Logistic regression analyses measured associations between breast cancer screening adherence over the preceding 12 months (adherent or non-adherent) and predisposing (i.e., age, education, and partner status), enabling (i.e., health insurance status, annual household income, employment status, patient-provider communication, and social support), and need (i.e., personal diagnosis of cancer, family history of cancer, and risk perception) factors, separately and conjointly. Older age (predisposing: OR = 1.015 (1.007-1.023)), having health insurance and ideal patient-provider communication (enabling: OR = 2.388 (1.597-3.570) and OR = 1.485 (1.080-2.041)), and having a personal diagnosis of cancer (need: OR = 2.244 (1.058-4.758)) were each associated with greater odds of screening adherence. Only having health insurance and ideal patient-provider communication remained significantly associated with screening adherence in a conjoint model; cancer survivorship did not moderate associations between predisposing/enabling factors and screening adherence. Overall, results suggest that interventions which are designed to improve mammography screening rates amongst African American women might focus on broadening health insurance coverage and working to improve patient-provider communication. Implications for multi-level intervention approaches, including the role of churches in their dissemination, are proposed.
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Affiliation(s)
- Pooja Agrawal
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (P.A.); (T.A.C.); (S.K.C.); (V.N.); (I.M.L.)
- School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Tzuan A. Chen
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (P.A.); (T.A.C.); (S.K.C.); (V.N.); (I.M.L.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
| | - Lorna H. McNeill
- MD Anderson Cancer Center, Department of Health Disparities Research, Houston, TX 77230, USA; (L.H.M.); (C.A.)
| | - Chiara Acquati
- MD Anderson Cancer Center, Department of Health Disparities Research, Houston, TX 77230, USA; (L.H.M.); (C.A.)
- Graduate College of Social Work, University of Houston, Houston, TX 77204, USA
| | - Shahnjayla K. Connors
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (P.A.); (T.A.C.); (S.K.C.); (V.N.); (I.M.L.)
- Department of Social Sciences, University of Houston-Downtown, Houston, TX 77002, USA
| | - Vijay Nitturi
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (P.A.); (T.A.C.); (S.K.C.); (V.N.); (I.M.L.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
| | - Angelica S. Robinson
- Department of Radiology, University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Isabel Martinez Leal
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (P.A.); (T.A.C.); (S.K.C.); (V.N.); (I.M.L.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
| | - Lorraine R. Reitzel
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (P.A.); (T.A.C.); (S.K.C.); (V.N.); (I.M.L.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
- Correspondence: ; Tel.: +1-713-743-6679
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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.
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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
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Physician Communication in Injectable Opioid Agonist Treatment: Collecting Patient Ratings With the Communication Assessment Tool. J Addict Med 2021; 14:480-488. [PMID: 32032213 DOI: 10.1097/adm.0000000000000631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Patient ratings of physician communication in the setting of daily injectable opioid agonist treatment are reported. Associations between communication items and demographic, health, drug use, and treatment characteristics are explored. METHODS Participants (n = 121) were patients receiving treatment for opioid use disorder with hydromorphone (an opioid analgesic) or diacetylmorphine (medical grade heroin). Ratings of physician communication were collected using the 14-item Communication Assessment Tool. Items were dichotomized and associations were explored using univariate and multivariable logistic regression models for each of the 14 items. RESULTS Ratings of physician communication were lower than reported in other populations. In nearly all of the 14 multivariable models, participants with more physical health problems and with lower scores for treatment drug liking had lower odds of rating physician communication as excellent. CONCLUSIONS In physician interactions with patients with opioid use disorder, there is a critical need to address comorbid physical health problems and account for patient medication preferences. PRACTICE IMPLICATIONS Findings reinforce the role physicians can play in communicating with patients about their comorbid conditions and about medication preferences. In the patient-physician interaction efforts to meet patients' evolving treatment needs and preferences can be made by offering patients access to all available evidence-based treatments.
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王 晓, 陈 美, 云 青, 孙 思, 王 熙, 史 宇, 纪 颖, 管 仲, 常 春. [Impact of health literacy on patient experience of outpatients in China and its mechanism]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53:560-565. [PMID: 34145861 PMCID: PMC8220056 DOI: 10.19723/j.issn.1671-167x.2021.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To understand the relationship between health literacy and patient experience of outpatients in China, and to explore its mechanism. METHODS The conceptual framework was developed based on Andersen's behavioral model of health services use and health literacy skills framework. An online cross-sectional survey was conducted with snowball sampling method, while the health literacy was measured by self-designed patient health literacy scale, and the patient experience was measured by the Chinese patient experience questionnaire for ambulatory care developed by Peking Union Medical College. And a structural equation model was built to explore the relationship between them and test the mechanism of health literacy influencing patient experience. RESULTS A total of 2 773 subjects were investigated. The average score of health literacy was (90.72±12.90) points, accounting for 78.89% of the full score, and the dimension of seeking social support had the lowest score. The average score of overall rating of patient experience was (3.71±0.74) points, and the scores of each dimension of patient experience were between 3.56 and 3.80. The model fit indices of structural equation model for overall rating of patient experience among the outpatients were χ2/df=9.29 (χ2=4 107.27, df=442), root mean square error of approximation (RMSEA)=0.055 (< 0.06), comparative fit index (CFI)=0.926 (>0.90), Tucker-Lewis index (TLI)=0.918 (>0.90), standardized root mean square residual (SRMR)=0.061 (< 0.08), the model was acceptable. The variance in patient experience explained by the model was 0.108. The structural equation model analysis results showed that the overall rating of outpatient experience was directly affected by health literacy (β=0.263, P < 0.001), also indirectly affected by health literacy (β=0.012, P < 0.001). In other words, the overall rating increased by 0.275 units for each standard deviation increase of health literacy. Self-evaluated health status mediated the relationship between health literacy and the overall rating of outpatient experience. In terms of diffe-rent dimensions of patient experience, the standardized path coefficient of the total effect of health literacy on patient experience was as follows: Information guidance 0.337, humanistic care 0.319, communication with doctors 0.294, service efficiency 0.240, and hospital environment 0.173. CONCLUSION The patients with higher level of health literacy were more likely to have a better outpatient experience in China, and the information guidance experience and humanistic care experience were most affected by health literacy. And the communication and information utilization ability had the greatest influence on patient experience.
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Affiliation(s)
- 晓琪 王
- 北京大学公共卫生学院社会医学与健康教育学系,北京 100191Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China
| | - 美君 陈
- 北京大学公共卫生学院社会医学与健康教育学系,北京 100191Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China
| | - 青萍 云
- 北京大学公共卫生学院社会医学与健康教育学系,北京 100191Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China
| | - 思伟 孙
- 北京大学公共卫生学院社会医学与健康教育学系,北京 100191Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China
- 北京大学第六医院,北京 100191Peking University Sixth Hospital, Beijing 100191, China
| | - 熙凯 王
- 首都医科大学卫生管理与教育学院,北京 100069School of Health Management and Education, Capital Medical University, Beijing 100069, China
| | - 宇晖 史
- 北京大学公共卫生学院社会医学与健康教育学系,北京 100191Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China
| | - 颖 纪
- 北京大学公共卫生学院社会医学与健康教育学系,北京 100191Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China
| | - 仲军 管
- 首都医科大学卫生管理与教育学院,北京 100069School of Health Management and Education, Capital Medical University, Beijing 100069, China
| | - 春 常
- 北京大学公共卫生学院社会医学与健康教育学系,北京 100191Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China
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Lowe SM, Nobriga CV. Head and Neck Cancer in a Rural U.S. Population: Quality of Life, Coping, Health Care Literacy, and Access to Services. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1116-1133. [PMID: 33970685 DOI: 10.1044/2021_ajslp-20-00223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The aim of this study was to explore the beliefs, access, and motivations of individuals with head and neck cancer (HNC) living in a rural community in the United States, regarding their speech and swallowing deficits. Method A convenience sample of nine patient participants with HNC and nine caregiver participants completed in-depth, semistructured interviews regarding their experiences with HNC diagnosis and treatment. The researchers utilized a thematic networks approach to analyze the qualitative data obtained. Results Primary results of the study were a set of common themes emerging from 735 units for analysis, arranged into 34 basic themes, nine organizing themes, and four global themes. The resulting networks centered around quality of life impact, coping, health literacy, and access. Direct quotes from the participants are utilized to illustrate response categories. Conclusions Individuals with HNC and their caregivers living in rural communities in the United States appear to represent a unique subset of the HNC population. While they present similarly in most areas, they display unique tendencies in the areas of psychological coping, health literacy, and access. Provision of practical, pertinent information that can be accessed by patients and caregivers alike outside the hospital is suggested to better serve this community.
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Affiliation(s)
- Shawn M Lowe
- Department of Communication Sciences and Disorders, Loma Linda University, CA
| | - Christina V Nobriga
- Department of Communication Sciences and Disorders, Loma Linda University, CA
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Mengiste M, Ahmed MH, Bogale A, Yilma T. Information-Seeking Behavior and Its Associated Factors Among Patients with Diabetes in a Resource-Limited Country: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2021; 14:2155-2166. [PMID: 34040402 PMCID: PMC8139726 DOI: 10.2147/dmso.s289905] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 04/14/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Diabetes mellitus is one of the most common chronic diseases in the world. The burden of diabetes mellitus is increasing rapidly in developing countries, including Ethiopia. Diabetes information seeking is essential for patients with diabetes to better manage and control their diabetes. However, information seeking about disease prevention and treatment is low in developing countries. OBJECTIVE This study aims to assess the diabetes information-seeking behavior and its associated factors among patients with diabetes in Debre Markos Referral Hospital, Amhara Region, Northwest Ethiopia. METHODS An institution-based cross-sectional quantitative study supplemented with a qualitative study was conducted among 423 subjects from March to April 2019. A structured questionnaire and in-depth interview were used to collect the required data from the study subjects. The data were entered using Epi Info version 7.2.2. Data processing and analysis were conducted using SPSS version 23. Descriptive statistics and a binary logistic regression model were used for the quantitative study, and thematic content analysis was used for the qualitative study. The significance test cut-off value for bivariate analysis was P<0.2 and the cut-off value for multivariate analysis was P<0.05. Adjusted odds ratios with 95% confidence intervals were used to interpret the results. RESULTS Out of 423 study participants, only 41.6% of patients with diabetes were diabetes information seekers. After adjusting all other factors in the final model, educational status, place of residence, comorbidity and health literacy were significantly associated with diabetes information seeking. CONCLUSION This study result indicates that the overall prevalence of information seeking among patients with diabetes toward diabetes was low. Having higher educational status, urban place of residence, the presence of comorbidity and adequate health literacy level increased the likelihood of diabetes information-seeking behavior among patients with diabetes.
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Affiliation(s)
- Muluken Mengiste
- Department of Health Informatics, Institute of Public Health, Mettu University, Metu Zuria, Ethiopia
| | - Mohammedjud Hassen Ahmed
- Department of Health Informatics, Institute of Public Health, Mettu University, Metu Zuria, Ethiopia
| | - Adina Bogale
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Tesfahun Yilma
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Zakkar MA, Meyer SB, Janes CR. Evidence and politics of patient experience in Ontario: The perspective of healthcare providers and administrators. Int J Health Plann Manage 2021; 36:1189-1206. [PMID: 33829549 DOI: 10.1002/hpm.3153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/22/2020] [Accepted: 03/01/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Patient experience has a direct impact on patients' engagement in healthcare, their commitment to treatment plans, and their relationship with their healthcare providers, all of which can impact their health outcomes. The complexity of the healthcare system, the increasing health needs of the population, and the priority and knowledge differences among healthcare stakeholders impact how they conceptualize and seek to achieve the ideal patient experience and the weights that they give to different elements of this experience. AIMS This study sought to understand the perspectives of healthcare providers and administrators in Ontario regarding the factors affecting the patient experience. MATERIALS & METHODS Qualitative data were collected between April 2018 and May 2019. Twenty-one semi-structured interviews were conducted. Interviewees included physicians, nurses, optometrists, dietitians, quality managers, and policymakers. Thematic analysis was used to analyse the data, utilizing and extending a previously developed patient experience framework. RESULTS Several themes emerged in the data, and they represent two perspectives on patient experience: the biomedical perspective, which prioritizes health outcomes and gives high weights to healthcare experience factors that can be controlled by healthcare providers, while ignoring other factors, and the sociopolitical perspective, which recognizes the impacts of healthcare politics and the social context of health on patient experience in Ontario. CONCLUSION The study is timely in light of the current changes in the Ontario healthcare system and the healthcare reform started by the new government, as it sheds light on the possible negative impact of healthcare policy and politics on patient experience.
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Affiliation(s)
- Moutasem A Zakkar
- The School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Samantha B Meyer
- The School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Craig R Janes
- The School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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Davaris MT, Bunzli S, Dowsey MM, Choong PF. Gamifying health literacy: how can digital technology optimize patient outcomes in surgery? ANZ J Surg 2021; 91:2008-2013. [PMID: 33825300 DOI: 10.1111/ans.16753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 02/22/2021] [Accepted: 03/07/2021] [Indexed: 01/22/2023]
Abstract
The digital age is entrenched in our society, with constant innovation driving change in the way clinicians and patients manage their health concerns. Health literacy is emerging as an important modifiable factor that can affect clinical and patient outcomes, yet traditional forms of patient education have shown mixed results. Digital media and technologies, the concept of gamification as a means to improve patient health literacy, and its potential for misuse will be explored in this review, in the context of a digital, gamified tool that could support patients along their surgical journey.
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Affiliation(s)
- Myles T Davaris
- Department of Surgery, University of Melbourne, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Samantha Bunzli
- Department of Surgery, University of Melbourne, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Michelle M Dowsey
- Department of Surgery, University of Melbourne, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Peter F Choong
- Department of Surgery, University of Melbourne, St Vincent's Hospital, Fitzroy, Victoria, Australia
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Leveraging Organizational Health Literacy to Enhance Health Promotion and Risk Prevention: A Narrative and Interpretive Literature Review. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2021; 94:115-128. [PMID: 33795988 PMCID: PMC7995945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Organizational health literacy involves the health care organizations' ability to establish an empowering and co-creating relationship with patients, engaging them in the design and delivery of health services in collaboration with health professionals. Although scholars agree that organizational health literacy contributes to health promotion and risk prevention via patient empowerment, literature is not consistent in depicting the interplay between organizational health literacy and preventive medicine. The article intends to shed light into this issue, summarizing current knowledge about this topic and advancing avenues for further development. A narrative literature review was performed through a systematic search on PubMed®, Scopus®, and Web of Science™. The review focused on 50 relevant contributions. Organizational health literacy triggers the transition towards a patient-centered approach to care. It complements individual health literacy, enabling patients to actively participate in health promotion and risk prevention as co-producers of health services and co-creators of value. However, many obstacles - including lack of time and limited resources available - prevent the transition towards health literate health care organizations. Two initiatives are required to overcome extant barriers. On the one hand, a health literate workforce should be prepared to increase the institutional ability of health care organizations to empower and engage patients in health co-creation. On the other hand, increased efforts should be made to assess organizational health literacy and to make its contribution to preventive medicine explicit.
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Safari-Moradabadi A, Rakhshanderou S, Ramezankhani A, Ghaffari M. Explaining the concept of oral health literacy: Findings from an exploratory study. Community Dent Oral Epidemiol 2021; 50:106-114. [PMID: 33760244 DOI: 10.1111/cdoe.12637] [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] [Received: 11/11/2020] [Revised: 02/16/2021] [Accepted: 03/02/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Identifying those with inadequate oral health literacy is difficult because little is known about its various multiple dimensions. Accordingly, the present research investigated dimensions of the concept using a qualitative approach. METHOD Participants (n = 15) who met inclusion criteria (Including having expertise in the fields of general dental, social dental, and health education and health promotion and having at least 5 years of relevant working experience) were recruited by purposive sampling via the public health and dentistry faculty in Tehran between December 2018 and October 2019. Thematic analysis was used to assess the data. RESULTS A total of 15 specialists (ranging in age from 28 to 61, mean 44) were included in the study. Their working experience averaged 15.5 years (SD = 7.7, Min = 6, Max = 30). Independent analysis of qualitative data by three researchers led to identification of seven themes and 18 sub-categories, including need perception (feeling the need and paying attention to meeting the need), emotional literacy (valuation of oral health, formation of personality and taking care of oral health), planning literacy (planning and goal-orientation), communicative literacy (choice in decision-making, interpersonal communication skill and claiming), behavioural literacy (self-care), cognitive literacy (knowledge, information comprehension, information use, and information analysis) and media literacy (the ability to use up-to-date technologies, the ability to search for and acquire the information, and judgment). CONCLUSIONS Our findings provide insights into the dimensions of oral health literacy. It is hoped that these findings can be used to guide the development of interventions on OHL and that aspects of the concept can help to enhance levels of OHL and help to promote health at societal level.
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Affiliation(s)
- Ali Safari-Moradabadi
- Department of public health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sakineh Rakhshanderou
- Department of public health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Ramezankhani
- Department of public health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohtasham Ghaffari
- Department of public health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Rooney MK, Santiago G, Perni S, Horowitz DP, McCall AR, Einstein AJ, Jagsi R, Golden DW. Readability of Patient Education Materials From High-Impact Medical Journals: A 20-Year Analysis. J Patient Exp 2021; 8:2374373521998847. [PMID: 34179407 PMCID: PMC8205335 DOI: 10.1177/2374373521998847] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Comprehensive patient education is necessary for shared decision-making. While patient–provider conversations primarily drive patient education, patients also use published materials to enhance their understanding. In this investigation, we evaluated the readability of 2585 patient education materials published in high-impact medical journals from 1998 to 2018 and compared our findings to readability recommendations from national groups. For all materials, mean readability grade levels ranged from 11.2 to 13.8 by various metrics. Fifty-four (2.1%) materials met the American Medical Association recommendation of sixth grade reading level, and 215 (8.2%) met the National Institutes of Health recommendation of eighth grade level. When stratified by journal and material type, general medical education materials from Annals of Internal Medicine were the most readable (P < .001), with 79.8% meeting the eighth grade level. Readability did not differ significantly over time. Efforts to standardize publication practice with the incorporation of readability evaluation during the review process may improve patients’ understanding of their disease processes and treatment options.
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Affiliation(s)
- Michael K Rooney
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gaia Santiago
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Subha Perni
- Harvard Radiation Oncology Program, Boston, MA, USA
| | - David P Horowitz
- Department of Radiation Oncology and Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Anne R McCall
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine and Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Reshma Jagsi
- Department of Radiation Oncology and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Daniel W Golden
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
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Cayenne NA, Jacobsohn GC, Jones CMC, DuGoff EH, Cochran AL, Caprio TV, Cushman JT, Green RK, Kind AJH, Lohmeier M, Mi R, Shah MN. Association between social isolation and outpatient follow-up in older adults following emergency department discharge. Arch Gerontol Geriatr 2021; 93:104298. [PMID: 33307444 PMCID: PMC7887021 DOI: 10.1016/j.archger.2020.104298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/01/2020] [Accepted: 11/15/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Follow-up with outpatient clinicians after discharge from the emergency department (ED) reduces adverse outcomes among older adults, but rates are suboptimal. Social isolation, a common factor associated with poor health outcomes, may help explain these low rates. This study evaluates social isolation as a predictor of outpatient follow-up after discharge from the ED. MATERIALS AND METHODS This cohort study uses the control group from a randomized-controlled trial investigating a community paramedic-delivered Care Transitions Intervention with older patients (age≥60 years) at three EDs in mid-sized cities. Social Isolation scores were measured at baseline using the PROMIS 4-item social isolation questionnaire, grouped into tertiles for analysis. Chart abstraction was conducted to identify follow-up with outpatient primary or specialty healthcare providers and method of contact within 7 and 30 days of discharge. RESULTS Of 642 patients, highly socially-isolated adults reported significantly worse overall health, as well as increased anxiety, depressive symptoms, functional limitations, and co-morbid conditions compared to those less socially-isolated (p<0.01). We found no effect of social isolation on 30-day follow-up. Patients with high social isolation, however, were 37% less likely to follow-up with a provider in-person within 7 days of ED discharge compared to low social isolation (OR:0.63, 95% CI:0.42-0.96). CONCLUSION This study adds to our understanding of how and when socially-isolated older adults seek outpatient care following ED discharge. Increased social isolation was not significantly associated with all-contact follow-up rates after ED discharge. However, patients reporting higher social isolation had lower rates of in-person follow-up in the week following ED discharge.
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Affiliation(s)
- Nia A Cayenne
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - Gwen Costa Jacobsohn
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States.
| | - Courtney M C Jones
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, United States; Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Eva H DuGoff
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD, United States; Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States; Berkeley Research Group, Washington, DC, United States
| | - Amy L Cochran
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Thomas V Caprio
- Division of Geriatrics, Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Jeremy T Cushman
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, United States; Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Rebecca K Green
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - Amy J H Kind
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States; William S. Middleton Veterans Affairs Geriatrics Research, Education, and Clinical Center, Madison, WI, United States
| | - Michael Lohmeier
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - Ranran Mi
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States; Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States; Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
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Sharif A, Haque N, Jogezai S, Rahim H, Ghilzai D, Iqbal Q, Haider S, Sadaf N, Anwar M, Saleem F. A cross-sectional assessment of patient satisfaction with pharmacy performance attending a public healthcare institute of Quetta city, Pakistan. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-019-01100-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Benjenk I, DuGoff EH, Jacobsohn GC, Cayenne N, Jones CMC, Caprio TV, Cushman JT, Green RK, Kind AJH, Lohmeier M, Mi R, Shah MN. Predictors of Older Adult Adherence With Emergency Department Discharge Instructions. Acad Emerg Med 2021; 28:215-225. [PMID: 32767696 DOI: 10.1111/acem.14105] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/13/2020] [Accepted: 07/27/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Older adults discharged from the emergency department (ED) are at high risk for adverse outcomes. Adherence to ED discharge instructions is necessary to reduce those risks. The objective of this study is to determine the individual-level factors associated with adherence with ED discharge instructions among older adult ED outpatients. METHODS We performed a secondary analysis of data from the control group of a randomized controlled trial testing a care transitions intervention among older adults (age ≥ 60 years) discharged home from the ED in two states. Taking data from patient surveys and chart reviews, we used multivariable logistic regression to identify patient characteristics associated with adherence to printed discharge instructions. Outcomes were patient-reported medication adherence, provider follow-up visit adherence, and knowledge of "red flags" (signs of worsening health requiring further medical attention). RESULTS A total 824 patients were potentially eligible, and 699 had data in at least one pillar. A total of 35% adhered to medication instructions, 76% adhered to follow-up instructions, and 35% recalled at least one red flag. In the multivariate analysis, no factors were significantly associated with failure to adhere to medications. Participants with poor health status (adjusted odds ratio [AOR] = 0.55, 95% confidence interval [CI] = 0.31 to 0.98) were less likely to adhere to follow-up instructions. Participants who were older (AORs trended downward as age category increased) or depressed (AOR = 0.39, 95% CI = 0.17 to 0.85) or had one or more functional limitations (AOR = 0.62, 95% CI = 0.41 to 0.94) were less likely to recall red flags. CONCLUSION Older adults discharged home from the ED have mixed rates of adherence to discharge instructions. Although it is thought that some subgroups may be higher risk than others, given the opportunity to improve ED-to-home transitions, EDs and health systems should consider providing additional care transition support to all older adults discharged home from the ED.
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Affiliation(s)
- Ivy Benjenk
- From the Department of Health Policy and Management School of Public Health University of Maryland College Park MDUSA
| | - Eva H. DuGoff
- From the Department of Health Policy and Management School of Public Health University of Maryland College Park MDUSA
- the Department of Population Health Sciences School of Medicine and Public HealthUniversity of Wisconsin MadisonWIUSA
- the Berkeley Research Group Washington DCUSA
| | - Gwen C. Jacobsohn
- and the Department of Emergency Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
| | - Nia Cayenne
- and the Department of Emergency Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
| | - Courtney M. C. Jones
- the Department of Emergency MedicineUniversity of Rochester Medical Center RochesterNYUSA
| | - Thomas V. Caprio
- the Department of Public Health SciencesUniversity of Rochester Medical Center RochesterNYUSA
- the Department of Medicine Division of Geriatrics University of Rochester Medical Center Rochester NYUSA
| | - Jeremy T. Cushman
- the Department of Emergency MedicineUniversity of Rochester Medical Center RochesterNYUSA
- the Department of Public Health SciencesUniversity of Rochester Medical Center RochesterNYUSA
| | - Rebecca K. Green
- and the Department of Emergency Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
| | - Amy J. H. Kind
- the Division of Geriatrics and Gerontology Department of Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
- and the William S. Middleton Veterans Affairs Geriatrics Research, Education, and Clinical Center Madison WIUSA
| | - Michael Lohmeier
- and the Department of Emergency Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
| | - Ranran Mi
- and the Department of Emergency Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
| | - Manish N. Shah
- the Department of Population Health Sciences School of Medicine and Public HealthUniversity of Wisconsin MadisonWIUSA
- and the Department of Emergency Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
- the Division of Geriatrics and Gerontology Department of Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
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Sentell T, Foss-Durant A, Patil U, Taira D, Paasche-Orlow MK, Trinacty CM. Organizational Health Literacy: Opportunities for Patient-Centered Care in the Wake of COVID-19. Qual Manag Health Care 2021; 30:49-60. [PMID: 33229999 DOI: 10.1097/qmh.0000000000000279] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND OBJECTIVES The coronavirus disease-2019 (COVID-19) pandemic is transforming the health care sector. As health care organizations move from crisis mobilization to a new landscape of health and social needs, organizational health literacy offers practical building blocks to provide high-quality, efficient, and meaningful care to patients and their families. Organizational health literacy is defined by the Institute of Medicine as "the degree to which an organization implements policies, practices, and systems that make it easier for people to navigate, understand, and use information and services to take care of their health." METHODS This article synthesizes insights from organizational health literacy in the context of current major health care challenges and toward the goal of innovation in patient-centered care. We first provide a brief overview of the origins and outlines of organizational health literacy research and practice. Second, using an established patient-centered innovation framework, we show how the existing work on organizational health literacy can offer a menu of effective, patient-centered innovative options for care delivery systems to improve systems and outcomes. Finally, we consider the high value of management focusing on organizational health literacy efforts, specifically for patients in health care transitions and in the rapid transformation of care into myriad distance modalities. RESULTS This article provides practical guidance for systems and informs decisions around resource allocation and organizational priorities to best meet the needs of patient populations even in the face of financial and workforce disruption. CONCLUSIONS Organizational health literacy principles and guidelines provide a road map for promoting patient-centered care even in this time of crisis, change, and transformation. Health system leaders seeking innovative approaches can have access to well-established tool kits, guiding models, and materials toward many organizational health literacy goals across treatment, diagnosis, prevention, education, research, and outreach.
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Affiliation(s)
- Tetine Sentell
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, Hawaii (Dr Sentell and Mr Patil); Arizona State University Edson College of Nursing and Healthcare Innovations, Phoenix (Ms Foss-Durant); The Daniel K. Inouye College of Pharmacy, Hilo, Hawaii (Dr Taira); Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts (Dr Paasche-Orlow); and Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Dr Trinacty)
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Review of Organizational Health Literacy Practice at Health Care Centers: Outcomes, Barriers and Facilitators. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207544. [PMID: 33081335 PMCID: PMC7589923 DOI: 10.3390/ijerph17207544] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 12/29/2022]
Abstract
The term organizational health literacy (OHL) is a new concept that emerged to address the challenge of predominantly in patients with limited health literacy (HL). There is no consensus on how OHL can improve HL activities and health outcomes in healthcare organizations. In this study, a systematic review of the literature was conducted to understand the evidence for the effectiveness of OHL and its health outcome, and the facilitators and barriers that influence the implementation of OHL. A literature search was done using six databases, the gray literature method and reference hand searches. Thirteen potentially articles with data on 1254 health organizations were included. Eight self-assessment tools and ten OHL attributes have been identified. Eleven quality-improvement characteristics and 15 key barriers were reviewed. Evidence on the effectiveness of HL tools provides best practices and recommendations to enhance OHL capacities. Results indicated that shifting to a comprehensive OHL would likely be a complex process because HL is not usually integrated into the healthcare organization’s vision and strategic planning. Further development of OHL requires radical, simultaneous, and multiple changes. Thus, there is a need for the healthcare system to consider HL as an organizational priority, that is, be responsive.
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Finlay S, Meggetto E, Robinson A, Davis C. Health literacy education for rural health professionals: shifting perspectives. AUST HEALTH REV 2020; 43:404-407. [PMID: 30032741 DOI: 10.1071/ah18019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/15/2018] [Indexed: 11/23/2022]
Abstract
Health literacy is a major issue for improving health outcomes of clients. In rural Victoria, Australia, the Gippsland Health Literacy Project (GHLP) educated local health services staff about health literacy and provided tools and techniques for health literacy implementation in services. This paper reports the outcomes of this project. Participants' change in knowledge was measured through pre- and post-project surveys and interviews. Descriptive analysis of survey data and analysis of interviews using qualitative description enabled exploration of individual and organisational shifts in health literacy perspectives. Healthcare professionals' knowledge of health literacy has improved as a result of the health literacy education. Health service organisations are also taking greater responsibility for health literacy responsiveness in their services. Systematic changes to policy and procedures that support health literacy are required. Although health literacy education provides more accessible health care for consumers, where projects had executive-level support the changes implemented were more likely to be successful and sustainable.
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Affiliation(s)
- Sarah Finlay
- Monash University, School of Rural Health, Department of Rural and Indigenous Health, 3 Ollerton Ave, Newborough Vic. 3825, Australia.
| | - Elizabeth Meggetto
- Central West Gippsland Primary Care Partnership, PO Box 62, Moe, Vic. 3825, Australia. Email
| | - Anske Robinson
- Monash University, School of Rural Health, Department of Rural and Indigenous Health, 3 Ollerton Ave, Newborough Vic. 3825, Australia.
| | - Claire Davis
- Central West Gippsland Primary Care Partnership, PO Box 62, Moe, Vic. 3825, Australia. Email
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Yen PY, Lehmann LS, Snyder J, Schnock K, Couture B, Smith A, Pearl N, Gershanik E, Martinez W, Dykes PC, Bates DW, Rossetti SC. Development and Validation of WeCares, a Survey Instrument to Assess Hospitalized Patients’ and Family Members’ “Willingness to Engage in Your Care and Safety”. Jt Comm J Qual Patient Saf 2020; 46:565-572. [DOI: 10.1016/j.jcjq.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 01/21/2023]
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Poureslami I, Shum J, Goldstein R, Gupta S, Aaron SD, Lavoie KL, Poirier C, Kassay S, Starnes K, Akhtar A, FitzGerald JM. Asthma and COPD patients' perceived link between health literacy core domains and self-management of their condition. PATIENT EDUCATION AND COUNSELING 2020; 103:1415-1421. [PMID: 32087989 DOI: 10.1016/j.pec.2020.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/23/2020] [Accepted: 02/07/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Health literacy (HL) is a person's ability to practically apply a wide range of cognitive and non-cognitive skills, to make health-related decisions. Currently, no tool applies all HL core domains to capture necessary data to measures HL in adult asthma and COPD patients. We endeavored to develop a comprehensive, function-based tool that adequately and accurately measures HL skills of this patient population. We explored the perspectives of patients related to each core HL domain, with an emphasis on self-management practices. METHODS Sixteen focus groups were conducted (n = 93; 40 asthma and 53 COPD) across Canada. Data was analyzed using NVivo12. RESULTS Thirteen subthemes were identified within five HL domains: (a) access: active access; passive access; lack of access; (b) understanding: how to improve understanding; (c) trustworthiness; relevancy and validity of information: pre- and post- application of information; (d) communication: barriers to proper communication; (e) application of information: making health decisions. CONCLUSIONS Participants provided valuable insight in terms of disease management topics and corresponding items to include in our HL tool. PRACTICE IMPLICATIONS Involvement of patients from initial stage allowed us to develop a tool that will serve as a first ever developed HL tool for asthma and COPD patient group.
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Affiliation(s)
- Iraj Poureslami
- Division of Respiratory Medicine, Department of Medicine, Institute for Heart and Lung Health, The University of British Columbia, Vancouver, BC, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Jessica Shum
- Division of Respiratory Medicine, Department of Medicine, Institute for Heart and Lung Health, The University of British Columbia, Vancouver, BC, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Roger Goldstein
- West Park's Respiratory Rehabilitation Service Toronto, West Park Hospital, University of Toronto, Toronto, ON, Canada
| | - Samir Gupta
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Shawn D Aaron
- Division of Respirology in Department of Medicine U-Ottawa, Ottawa, ON, Canada
| | - Kim L Lavoie
- Department of Psychology, University of Quebec at Montreal (UQAM), Montreal, QC, Canada
| | - Claude Poirier
- Centre Hospital, University of Montreal (CHUM), Montreal, QC, Canada
| | - Saron Kassay
- Division of Respiratory Medicine, Department of Medicine, Institute for Heart and Lung Health, The University of British Columbia, Vancouver, BC, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Kassie Starnes
- Division of Respiratory Medicine, Department of Medicine, Institute for Heart and Lung Health, The University of British Columbia, Vancouver, BC, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Alizeh Akhtar
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, BC, Canada
| | - J Mark FitzGerald
- Division of Respiratory Medicine, Department of Medicine, Institute for Heart and Lung Health, The University of British Columbia, Vancouver, BC, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, BC, Canada.
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Seixas A, Connors C, Chung A, Donley T, Jean-Louis G. A Pantheoretical Framework to Optimize Adherence to Healthy Lifestyle Behaviors and Medication Adherence: The Use of Personalized Approaches to Overcome Barriers and Optimize Facilitators to Achieve Adherence. JMIR Mhealth Uhealth 2020; 8:e16429. [PMID: 32579121 PMCID: PMC7381082 DOI: 10.2196/16429] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/16/2020] [Accepted: 01/29/2020] [Indexed: 12/26/2022] Open
Abstract
Patient nonadherence to healthy lifestyle behaviors and medical treatments (like medication adherence) accounts for a significant portion of chronic disease burden. Despite the plethora of behavioral interventions to overcome key modifiable/nonmodifiable barriers and enable facilitators to adherence, short- and long-term adherence to healthy lifestyle behaviors and medical treatments is still poor. To optimize adherence, we aimed to provide a novel mobile health solution steeped in precision and personalized population health and a pantheoretical approach that increases the likelihood of adherence. We have described the stages of a pantheoretical approach utilizing tailoring, clustering/profiling, personalizing, and optimizing interventions/strategies to obtain adherence and highlight the minimal engineering needed to build such a solution.
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Affiliation(s)
- Azizi Seixas
- NYU Grossman School of Medicine, New York, NY, United States
| | | | - Alicia Chung
- NYU Grossman School of Medicine, New York, NY, United States
| | - Tiffany Donley
- NYU Grossman School of Medicine, New York, NY, United States
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Head KJ, Johnson NL, Scott SF, Zimet GD. Communicating Cervical Cancer Screening Results in Light of New Guidelines: Clinical Practices at Federally Qualified Health Centers. HEALTH COMMUNICATION 2020; 35:815-821. [PMID: 30945950 DOI: 10.1080/10410236.2019.1593079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
New guidelines for cervical cancer screening (CCS) incorporate both HPV and Pap tests, and there is a need to understand communication of these cotesting results to patients, especially in at-risk populations disproportionally affected by cervical cancer. This study used computer-assisted telephone interviews in 2017 at 51 federally qualified health centers (FQHCs) in Indiana to evaluate the characteristics of clinical communication CCS results to women. Results revealed that clinical communication practices varied on channel, timing, and content. Almost half of the clinics (n = 23, 45%) communicate results to patients by phone. Most clinics (n = 47, 92%) notify patients of results in two weeks or less. For cotesting, 70% (n = 36) always communicate Pap/HPV results at the same time. The majority of clinics (n = 42, 82%) explain the type of abnormal Pap test, while only 43% (n = 22) discuss the cervical cancer risk as indicated by the HPV test result. Even though 98% (n = 48) of participants rated their communication strategy as effective, qualitatively participants acknowledged difficulties in communicating cotesting results with their often transient and low health literate patients populations. These results indicate considerable variation and potential deficits in clinical communication of cotesting results in FQHCs, but several promising communication strategies were identified that may inform improved screening communication for other clinics.
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Affiliation(s)
- Katharine J Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis
| | - Nicole L Johnson
- Department of Communication Studies, Indiana University-Purdue University Indianapolis
| | - Susanna Foxworthy Scott
- Department of Communication Studies, Indiana University-Purdue University Indianapolis
- Division of Clinical Pharmacology, Indiana University School of Medicine
| | - Gregory D Zimet
- Division of Adolescent Medicine, Indiana University School of Medicine
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