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Lynch EA, Nolan J, Bulto LN, Mitchell J, McGrath A, Lane S, Harvey G, Cadilhac DA, Harling R, Godecke E. Is learning being supported when information is provided to informal carers during inpatient stroke rehabilitation? A qualitative study. Disabil Rehabil 2023:1-9. [PMID: 37746848 DOI: 10.1080/09638288.2023.2259307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 09/10/2023] [Indexed: 09/26/2023]
Abstract
Purpose: To explore how health professionals provide information to informal carers during inpatient stroke rehabilitation and whether these practices align with adult learning principles.Methods: Informal carers and survivors of stroke who had completed inpatient rehabilitation, and health professionals working in inpatient stroke rehabilitation were interviewed. Directed qualitative content analysis was conducted using an adult learning model, to determine how closely reported practices aligned to adult learning principles.Results: 14 carers, 6 survivors of stroke and 17 health professionals participated. Carers (79% female, 57% spouse/partner) reported having incomplete knowledge during rehabilitation, lacking information about mechanisms of stroke recovery, rehabilitation processes, long-term effects of stroke, and navigating post-discharge services. Health professionals supported carers to address their learning needs related to safety of caring for stroke survivors. Carers indicated they were responsible for their own non-safety related learning. Health professionals tended not to check carers' understanding of information provided nor offer learning opportunities beyond written or verbal information.Conclusions: Health professionals consistently provide certain information to carers during inpatient rehabilitation, but adult learning principles are not routinely applied when information is provided. Fostering adult learning among informal carers may improve preparedness of carers to support stroke survivors after discharge from inpatient rehabilitation.
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Affiliation(s)
- Elizabeth A Lynch
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Jessica Nolan
- School of Health Sciences and Physiotherapy, University of Notre Dame Australia, Fremantle, Australia
- Sir Charles Gairdner and Osborne Park HealthCare Group, Perth, Australia
| | - Lemma N Bulto
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | | | | | | | - Gill Harvey
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Stroke Theme, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Rachel Harling
- Physiotherapy Department, Central Adelaide Local Health Network, Adelaide,Australia
| | - Erin Godecke
- Sir Charles Gairdner and Osborne Park HealthCare Group, Perth, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
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Hughes-Barton D, Chapman J, Flight I, Wilson C. Utilizing RE-AIM to scope potential for feasible immigrant cancer literacy education. Prev Med Rep 2023; 33:102224. [PMID: 37223576 PMCID: PMC10201872 DOI: 10.1016/j.pmedr.2023.102224] [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: 11/10/2022] [Revised: 03/26/2023] [Accepted: 04/27/2023] [Indexed: 05/25/2023] Open
Abstract
Disparities in cancer incidence and mortality exist between settled and newly-arrived immigrant communities in immigrant-nations, such as Australia, Canada and USA. This may be due to differences in the uptake of cancer prevention behaviours and services for early detection, and cultural, language or literacy barriers impacting understanding of mainstream health messages. Blending cancer-literacy with immigrant English language education presents a promising means to reach new immigrants attending language programs. Guided by the RE-AIM framework for translational research, this study explored the feasibility and translation potential of this approach within the Australian context. Focus groups and interviews (N = 22) were held with English-as-a-Second-Language (ESL) teachers and immigrant resource-centre personnel. Thematic Framework Analysis, driven by RE-AIM, identified potential barriers to Reach for immigrants, Adoption by teachers, Implementation into immigrant-language programs and long-term curriculum Maintenance. Responses further highlighted that an Efficacious ESL cancer-literacy resource could be facilitated by developing flexible, culturally-sensitive content to cater for multiple cultures. Interviewees also raised the importance of developing the resource according to national curricula-frameworks, different language levels, and incorporating varied communicative activities and media. This study therefore offers insight into potential barriers and facilitators to developing a resource feasible for inclusion in existing immigrant-language programs, and achieving reach to multiple communities.
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Affiliation(s)
- Donna Hughes-Barton
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University of South Australia, GPO Box 2100, Adelaide, SA 5001, Australia
| | - Janine Chapman
- Appleton Institute for Behavioural Science, Central Queensland University, 44 Greenhill Road, Wayville, SA 5034, Australia
| | - Ingrid Flight
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University of South Australia, GPO Box 2100, Adelaide, SA 5001, Australia
| | - Carlene Wilson
- Olivia Newton John Cancer Wellness and Research Centre, 145 Studley Road, Heidelberg, VIC 3084, Australia
- La Trobe University, Plenty Road, Bundoora, VIC 3083, Australia
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Thomson S, Galletly C, Prener C, Garverich S, Liu D, Lincoln A. Associations between health literacy, cognitive function and general literacy in people with schizophrenia attending community mental health clinics in Australia. BMC Psychiatry 2022; 22:245. [PMID: 35392852 PMCID: PMC8986965 DOI: 10.1186/s12888-022-03901-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/24/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Health literacy (HL) has been defined as the ability of individuals to access, understand, and utilise basic health information. HL is crucial to patient engagement in treatment through supporting patient autonomy, informed consent and collaborative care. In people with physical disorders, poor HL is associated with poor health outcomes, but less is known about HL in people with severe mental illness. This study aimed to assess HL and investigate the associations between education, cognitive function, general literacy, and HL in participants with schizophrenia attending community mental health clinics. METHOD Fifty-two outpatients with schizophrenia attending a public community mental health clinic in Adelaide, Australia completed the Test of Functional Health Literacy in Adults-Short Form (S-TOFHLA) along with tests of cognition, aural and reading literacy and numeracy including Digit Symbol Coding (DSC), verbal fluency, the Wechsler Adult Intelligence Scale (WAIS-IV), Woodcock-Johnson III (Part 4 and 9) and the Lipkus numeracy scale. Sixty-one percent of participants were male. Participants had a mean age of 41.2 (SD 9.9) years and a mean of 11.02 (SD 1.5) years of education. RESULTS The majority of participants had very poor aural and verbal literacy and poorer literacy correlated with fewer years of education. On the S-TOFHLA, 81% of participants had adequate HL; 6% were marginal and 13% were inadequate. There was a positive correlation between education and HL, with those with more years of education scoring higher for HL. There was also a significant association between better HL and better working memory and attention. CONCLUSIONS Consistent with previous research in schizophrenia, our participants had reduced educational attainment, aural and reading literacy and cognitive function compared to population norms. However, HL was better than expected given that previous research has found that people with psychiatric disorders tend to have lower HL, compared to the general population. This may reflect effective case management of our participants whilst attending the community clinics and supports ongoing research and intervention regarding HL in people living with mental illness.
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Affiliation(s)
- Sumana Thomson
- Northern Adelaide Local Health Network, Adelaide, South, Australia. .,Adelaide Medical School, The University of Adelaide, Adelaide, South, Australia.
| | - Cherrie Galletly
- Northern Adelaide Local Health Network, Adelaide, South Australia ,grid.1010.00000 0004 1936 7304Adelaide Medical School, The University of Adelaide, Adelaide, South Australia ,Ramsay Health Care (SA) Mental Health Services, Adelaide, South Australia
| | - Christopher Prener
- grid.262962.b0000 0004 1936 9342 Department of Sociology and Anthropology, Saint Louis University, St. Louis, MO USA
| | - Suzanne Garverich
- grid.261112.70000 0001 2173 3359Institute for Health Equity and Social Justice Research, Northeastern University, Boston, MA USA
| | - Dennis Liu
- Northern Adelaide Local Health Network, Adelaide, South Australia ,grid.1010.00000 0004 1936 7304Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
| | - Alisa Lincoln
- grid.261112.70000 0001 2173 3359Institute for Health Equity and Social Justice Research, Northeastern University, Boston, MA USA
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Ye Q, Asmi F, Anwar MA, Zhou R, Siddiquei AN. Health concerns among waste collectors during pandemic crisis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:6463-6478. [PMID: 34453243 PMCID: PMC8396142 DOI: 10.1007/s11356-021-16071-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
The COVID-19 pandemic has negatively affected the economic, social, and psychological aspects globally. COVID-19 can possibly spread through municipal solid waste (MSW) if it is collected, bagged, transported, and disposed inappropriately. Such situation has posed significant challenges to MSW management (MSWM), which has led waste personnel under massive pressure. This study aims to examine the health-protective behavior of sanitation workers/MSW collectors (MSWCs) during the COVID-19 crisis. Quantitative data were collected by using a self-administered survey from 418 MSWCs working in Mainland China. The study extended the traditional health-belief model and proposed education and training as a facet of the behavioral model. Result showed that education and training were a significant predictor of health-protective behavior. Moreover, the moderating incremental influence of regulative assistance significantly affected the behavioral mapping of MSWCs. This study contributes to the literature by mapping the concerns, risks, and challenges experienced by MSWCs in times of a health crisis. Policymakers should specially consider the safety and hygiene concerns of frontline workforce in the whole chain of waste management (including the outsourced operations of MSWM). Lastly, the adoption of smart communication with the frontline workforce (i.e., MSWCs) is in dire need to maintain trust and avoid rumors and misconceptions during the time of a pandemic situation.
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Affiliation(s)
- Qing Ye
- University of Science and Technology of China, Hefei, Anhui, China
- Fuyang Normal University, Fuyang, China
- Key Laboratory of Immersive Media Technology (Wanxin Media), Ministry of Culture and Tourism, Hefei, Anhui, China
| | - Fahad Asmi
- University of Science and Technology of China, Hefei, Anhui, China.
| | - Muhammad Azfar Anwar
- Shenzhen University, Shenzhen, China.
- COMSATS University Islamabad, Vehari, Pakistan.
| | - Rongting Zhou
- University of Science and Technology of China, Hefei, Anhui, China
- Key Laboratory of Immersive Media Technology (Wanxin Media), Ministry of Culture and Tourism, Hefei, Anhui, China
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Gomes da Silva J, Silva CS, Alexandre B, Morgado P. Education as a Predictor Factor for Knowledge of COVID-19 in Portugal. Front Public Health 2021; 9:680726. [PMID: 34660506 PMCID: PMC8516069 DOI: 10.3389/fpubh.2021.680726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/25/2021] [Indexed: 01/11/2023] Open
Abstract
Introduction/Objective: Pandemic of COVID-19 is a major public health problem. At the time of development of this study, no specific medication/vaccine for this disease was approved. Therefore, preventive measures were the main key to control this pandemic. Health literacy (HL) is the ability to obtain, understand and use the information to make free and informed decisions about the health of an individual and to promote community empowerment. Thus, the HL of COVID-19 is important for community empowerment and the adoption of preventive measures. This article aims to understand possible predictors of HL of COVID-19, functional domain. Material and Methods: A cross-sectional study was designed, applying the Questionnaire of COVID-19 (previously designed and submitted to a preliminary pilot testing) through an online platform from April 23 to June 23, 2020. An Index of Health Knowledge of COVID-19 Questionnaire (IHK-COV19) was constructed. Associations between independent variables (“Gender,” “Age,” “Education,” and “Risk Factor” for COVID-19 codified by ICPC-2) and HL were assessed using multivariate analyses (mixed effects models). The level of significance was set at p < 0.05. Results: Our sample includes 864 subjects (median age, 44.33 years), mostly women (n = 619; 71.76%), undergraduate (n = 392; 45.37%) and with at least one risk factor for COVID-19 (n = 266; 30.79%). Univariate and multivariate analyses demonstrated “Age” as a negative predictor of IHK-COV19 and “Education” and “Risk Factor” as positive predictors of IHK-COV19. Conclusions: Health knowledge regarding COVID-19 is associated with the level of education. Future interventions should consider including HL mechanisms in interventions designed to improve communication.
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Affiliation(s)
- Joana Gomes da Silva
- Unidade de Cuidados de Saúde Personalizados Mirandela II, Unidade Local de Saúde Do Nordeste, Mirandela, Portugal
| | - Carla Sofia Silva
- Alumni Department of Mathematics, University of Minho, Braga, Portugal
| | - Bárbara Alexandre
- Unidade de Cuidados de Saúde Personalizados Mirandela II, Unidade Local de Saúde Do Nordeste, Mirandela, Portugal
| | - Pedro Morgado
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal
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Serbim A, Paskulin L, Nutbeam D. Improving health literacy among older people through primary health care units in Brazil: feasibility study. Health Promot Int 2021; 35:1256-1266. [PMID: 31821454 DOI: 10.1093/heapro/daz121] [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] [Indexed: 11/12/2022] Open
Abstract
There are only a small number of reported intervention studies to improve health literacy among older populations. This paper reports on a study designed to investigate the feasibility and potential impact on health literacy and health practices of embedding an intervention programme to improve health literacy with older people through established primary health care units (PHCUs) in a disadvantaged urban community in Brazil. This investigation utilized a quasi-experimental design, with 42 participants recruited for the intervention group and comparison group. The Alfa-Health Program was offered by a nurse in a PHCU as part of the public universal health system over a period of 5 months, and was compared for its impact on a range of health literacy and self-reported health outcomes with routine health care available for older people. The intervention achieved relatively high levels of participation, and positive feedback from participants. Some improvements in vaccination rates, health literacy and reported health behaviours related to food choices and physical activity were observed. The intervention made good use of existing facilities; the content and methods were well received by the participants. However, there were some difficulties in recruitment and in retention of participants. The study has demonstrated the practical feasibility of delivering a comprehensive health education programme designed to improve health literacy in a PHCU in Brazil.
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Affiliation(s)
- Andreivna Serbim
- Nursing School, Federal University of Alagoas (UFAL), Arapiraca Campus, Brazil
| | - Lisiane Paskulin
- Nursing School, Nursing Graduate Program, Federal University of Rio Grande do Sul (UFRGS), Brazil
| | - Don Nutbeam
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
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Holst C, Sukums F, Ngowi B, Diep LM, Kebede TA, Noll J, Winkler AS. Digital Health Intervention to Increase Health Knowledge Related to Diseases of High Public Health Concern in Iringa, Tanzania: Protocol for a Mixed Methods Study. JMIR Res Protoc 2021; 10:e25128. [PMID: 33885369 PMCID: PMC8103301 DOI: 10.2196/25128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/28/2021] [Accepted: 03/17/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Traditionally, health promotion and health education have been provided to communities in the global south in the form of leaflets or orally by health care workers. Digital health interventions (DHIs) such as digital health messages accessed by smartphones have the potential to reach more people at a lower cost and to contribute to strengthening of health care systems. The DHI in this study focuses on disseminating digital health education regarding 3 disease complexes of high public health concern: HIV/AIDS, tuberculosis, and Taenia solium (neuro)cysticercosis or taeniasis, a parasitic zoonotic disease that requires a One Health approach. The DHI presents the participants with animated health videos (animations) and provides access to information spots (InfoSpots) with a free-of-charge digital health platform containing messages about health to rural Tanzanian communities. OBJECTIVE The objective of this study is to measure the effect of the DHI on health knowledge uptake and retention over time in the rural communities. METHODS This is a mixed methods study including a nonrandomized controlled trial and qualitative interviews conducted in rural Tanzania. A health platform containing digital health messages for the communities was developed prior to the study. The health messages consist of text, pictures, quizzes, and animations of everyday stories, aimed at disease prevention and early treatment. The baseline and immediate postintervention assessments were completed in Iringa, Tanzania in May 2019. The participants were interviewed by enumerators and completed questionnaires regarding health knowledge. Participants in the intervention group were exposed to 3 different health animations once on a tablet device. The participants' health knowledge was assessed again immediately after the exposure. The first follow-up survey was undertaken in August 2019. The InfoSpots with the digital health platform were thereafter launched in the intervention villages in November 2019. Qualitative interviews were undertaken in February 2020. The second follow-up was completed in June 2020. RESULTS A total of 600 participants have been enrolled in the trial. We will assess (1) the difference in knowledge scores between baseline and the immediate postintervention assessments in the intervention group and (2) the difference in knowledge scores between the intervention and control groups at baseline, 3 and 6 months post-DHI rollout. Since a randomized design did not prove feasible, potential confounders (eg, age, gender, education, and time of exposure) may be introduced, and results will be adjusted. Data analysis for the 35 qualitative interviews is currently ongoing, and perspectives and experiences related to use and nonuse of the InfoSpots are being explored. CONCLUSIONS The data have been collected, and the analysis is ongoing in this digital health study, aimed at evaluating the effects of a DHI based on relevant health messages. The publications of results can be expected this year. TRIAL REGISTRATION ClinicalTrials.gov NCT03808597; https://clinicaltrials.gov/ct2/show/NCT03808597. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/25128.
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Affiliation(s)
- Christine Holst
- Centre for Global Health, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Felix Sukums
- Directorate of ICT, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Bernard Ngowi
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, United Republic of Tanzania
- Mbeya College of Health and Allied Sciences, University of Dar es Salaam, Mbeya, United Republic of Tanzania
| | - Lien My Diep
- Oslo Centre for Biostatistics & Epidemiology, Oslo University Hospital, Oslo, Norway
| | | | - Josef Noll
- Basic Internet Foundation, Kjeller, Norway
- Department of Technology Systems, University of Oslo, Oslo, Norway
| | - Andrea Sylvia Winkler
- Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
- Center for Global Health, Department of Neurology, Technical University of Munich, Munich, Germany
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Davergne T, Rakotozafiarison A, Servy H, Gossec L. Wearable Activity Trackers in the Management of Rheumatic Diseases: Where Are We in 2020? SENSORS (BASEL, SWITZERLAND) 2020; 20:E4797. [PMID: 32854412 PMCID: PMC7506912 DOI: 10.3390/s20174797] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/14/2020] [Accepted: 08/24/2020] [Indexed: 12/26/2022]
Abstract
In healthcare, physical activity can be monitored in two ways: self-monitoring by the patient himself or external monitoring by health professionals. Regarding self-monitoring, wearable activity trackers allow automated passive data collection that educate and motivate patients. Wearing an activity tracker can improve walking time by around 1500 steps per day. However, there are concerns about measurement accuracy (e.g., lack of a common validation protocol or measurement discrepancies between different devices). For external monitoring, many innovative electronic tools are currently used in rheumatology to help support physician time management, to reduce the burden on clinic time, and to prioritize patients who may need further attention. In inflammatory arthritis, such as rheumatoid arthritis, regular monitoring of patients to detect disease flares improves outcomes. In a pilot study applying machine learning to activity tracker steps, we showed that physical activity was strongly linked to disease flares and that patterns of physical activity could be used to predict flares with great accuracy, with a sensitivity and specificity above 95%. Thus, automatic monitoring of steps may lead to improved disease control through potential early identification of disease flares. However, activity trackers have some limitations when applied to rheumatic patients, such as tracker adherence, lack of clarity on long-term effectiveness, or the potential multiplicity of trackers.
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Affiliation(s)
- Thomas Davergne
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (UMRS 1136), 75013 Paris, France;
| | | | - Hervé Servy
- E-Health Services Sanoïa, 13420 Gémenos, France;
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (UMRS 1136), 75013 Paris, France;
- APHP, Rheumatology Department, Pitié Salpêtrière Hospital, 75013 Paris, France;
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Gibney S, Bruton L, Ryan C, Doyle G, Rowlands G. Increasing Health Literacy May Reduce Health Inequalities: Evidence from a National Population Survey in Ireland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5891. [PMID: 32823744 PMCID: PMC7459493 DOI: 10.3390/ijerph17165891] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/30/2020] [Accepted: 08/05/2020] [Indexed: 11/16/2022]
Abstract
Background. Health literacy has been separately associated with socio-economic status and worse health status and outcomes. However, the magnitude of the associations between health literacy and health status and outcomes may not be evenly distributed across society. This study aims to estimate and compare the associations between health status, health behaviours, and healthcare utilisation within different levels of social status in the Irish population. Materials and methods. Data from Ireland collected as part of the 2011 European Health Literacy Survey were analysed. General health literacy was measured on a 0-50 scale, low to high. There were four binary outcomes: long-standing health conditions, smoking, hospital visits in the last 12 months, and self-rated health status. Logistic regression analysis was conducted to estimate the likelihood of each health outcome. Health literacy was treated as the main independent variable. Marginal effects were calculated using the delta method to demonstrate the change in likelihood of each outcome associated with a 5-point increase in health literacy score. The sample was grouped into tertiles based on self-reported social status, and models were replicated and compared for each tertile. Models were adjusted for known correlates of health literacy and health: age, gender, and education. Analysis was conducted using Stata V14. Results. Higher health literacy scores were associated with a lower probability of having a limiting illness within the low social status group only. Higher health literacy scores were associated with a lower probability of three or more hospital visits in the past 12 months in the low and middle social status groups. For people in the low and middle social status groups, higher health literacy levels were associated with a lower probability of being a current smoker. The associations between health literacy and self-rated health status were similar in each social status group. Conclusions: Improvement in population health literacy may reduce the prevalence of long-term chronic health conditions, reduce smoking levels, and result in fewer hospital visits. Whilst improved health literacy should improve behaviours and outcomes in all groups, it should have a more marked impact in lower social status groups, and hence contribute to reducing the observed social disparities in these health outcomes.
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Affiliation(s)
- Sarah Gibney
- Department of Health, Dublin 2, DO2 XW14, Ireland; (S.G.); (L.B.); (C.R.)
| | - Lucy Bruton
- Department of Health, Dublin 2, DO2 XW14, Ireland; (S.G.); (L.B.); (C.R.)
| | - Catherine Ryan
- Department of Health, Dublin 2, DO2 XW14, Ireland; (S.G.); (L.B.); (C.R.)
| | - Gerardine Doyle
- UCD College of Business, University College Dublin, Dublin 4, D04 V1W8, Ireland;
- UCD Geary Institute for Public Policy, University College Dublin, Dublin 4, D04 V1W8, Ireland
| | - Gillian Rowlands
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
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Bellamy K, Ostini R, Martini N, Kairuz T. Insights from the coalface: barriers to accessing medicines and pharmacy services for resettled refugees from Africa. Aust J Prim Health 2019; 25:118-124. [PMID: 30721646 DOI: 10.1071/py18092] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 12/03/2018] [Indexed: 11/23/2022]
Abstract
Resettled refugees in Australia have been shown to exhibit a high prevalence of limited health literacy and are at greater risk of mismanaging their medication and not being able to access the healthcare services they need. The aim of the current study is to explore the barriers to accessing medicines and pharmacy services in Queensland, Australia, among resettled refugees from Africa; this research was conducted from the perspectives of healthcare professionals and people who help the refugees to resettle in their adopted country (resettlement workers). A 'generic qualitative' approach was used in this study. In-depth interviews were conducted among healthcare professionals (two GPs, nine pharmacists and three nurse practitioners) and resettlement workers. Participants were recruited via a purposive snowball sampling method in the cities of Brisbane and Townsville, Queensland, Australia. Twenty-four in-depth interviews were conducted; 14 with healthcare professionals. Three key themes emerged from the data: (1) Communication Barriers; (2) Navigating the Health System; and (3) Belief Systems and Culture. Perceptions of those 'at the coalface' - healthcare professionals and people who are responsible for assisting refugees to resettle in Australia - provide insight into the language and cultural challenges experienced by resettled refugees from Africa regarding access to the Australian health system, including medicines and pharmacy services.
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Affiliation(s)
- Kim Bellamy
- School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, Qld 4102, Australia; and Corresponding author.
| | - Remo Ostini
- Rural Clinical School, The University of Queensland, Toowoomba, Qld 4350, Australia
| | - Nataly Martini
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Grafton, Auckland 1023, New Zealand
| | - Therese Kairuz
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW 2308, Australia
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McCaffery KJ, Morony S, Muscat DM, Hayen A, Shepherd HL, Dhillon HM, Smith SK, Cvejic E, Meshreky W, Luxford K, Nutbeam D. Evaluation of an Australian Health Literacy Program Delivered in Adult Education Settings. Health Lit Res Pract 2019; 3:S42-S57. [PMID: 31687657 PMCID: PMC6826892 DOI: 10.3928/24748307-20190402-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/05/2019] [Indexed: 01/07/2023] Open
Abstract
Background: Adult education targeting health literacy (HL) may bring added value in the form of improved health. Objective: This study evaluated the effects of a HL program as part of an adult education curriculum for adults with low literacy and numeracy. Methods: This was a partial-cluster randomized controlled trial among 308 adults enrolled in basic education programs in Australia. Of the 308 participants, 141 (46%) were randomized to either the standard program (language, literacy, and numeracy [LLN]), or the HL intervention (LLN with embedded health content); the remainder (n = 167) were allocated to standard intervention programs by the education provider at the class level. The main outcomes were functional HL, self-reported confidence, patient activation, generic HL (ie, HLQ, health knowledge, and self-reported health behavior). Data were collected at baseline, immediately after, and at 6 months post-intervention. Key Results: Of the 308 participants, 71% had limited literacy and 60% spoke a language other than English at home. Both interventions benefited participants, with improvements from baseline to immediate follow up on individual-level functional HL (e.g., reading a thermometer; HL group 18.4% vs. standard group 7.2%; p = .001), confidence (HL group 0.34 vs. standard group 0.06; p = .014) and health literacy questionnaire (HLQ) subscales. At 6 months, improvements in confidence (p < .001) and some HLQ measures were retained. A consistent pattern of increased improvement in the HL program was observed compared to the standard program, although only some measures reached statistical significance: reading a food label (HL group 6.03/10 correct vs. standard group 5.49/10 correct; p = .022); confidence (p = .008); ability to actively manage health (HLQ) (p = .017), and health knowledge at 6 months (HL group 68% vs. standard group 60% correct, p = .052). HL participants reported being more likely to share course information and rated the program more useful to understand their health. Conclusions: Improving language, literacy, and numeracy generally has potential public health benefits that are retained at 6 months. Integrating health content adds further value to adult basic learning, is feasible, and potentially scalable. [HLRP: Health Literacy Research and Practice. 2019;3(Suppl.):S42–S57.] Plain Language Summary: We compared the effect of an adult education-based health literacy (HL) program versus a standard language, literacy, and numeracy program on students' HL skills and psychosocial outcomes. Although students in both trial arms improved their skills, students in the HL program had better outcomes with higher HL, greater confidence, and higher health knowledge scores at 6 months.
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Affiliation(s)
- Kirsten J. McCaffery
- Address correspondence to Kirsten J. McCaffery, PhD, Sydney School of Public Health, Room 128B Edward Ford Building, The University of Sydney, NSW 2006, Australia;
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Greenberg KL, Leiter E, Donchin M, Agbaria N, Karjawally M, Zwas DR. Cardiovascular health literacy and patient-physician communication intervention in women from disadvantaged communities. Eur J Prev Cardiol 2019; 26:1762-1770. [PMID: 31189377 DOI: 10.1177/2047487319853900] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND For many women in low socioeconomic status communities, limited health literacy is an obstacle to following medical guidance and engaging in health-promoting behaviours. Low health literacy skills are also associated with an increased risk of cardiovascular disease. DESIGN A health literacy intervention was designed through focus groups with women in low socioeconomic status communities. The primary health literacy issue identified was communication challenges at doctors' visits. A unique intervention tailored to the participants' preferences was designed consisting of three workshops conducted in community women's groups in low socioeconomic status Jerusalem communities. The intervention aimed to increase patient-physician communication skills through doctor visit preparation and better visit management, improve perceived efficacy in patient-physician interaction and expand cardiovascular disease knowledge. METHODS Questionnaires were completed before and 3 months after the intervention, assessing knowledge of cardiovascular disease risk factors and symptoms, self-report of behaviours in preparations for a doctor's visit, and perceived efficacy in patient-physician interaction. RESULTS A total of 407 women from low socioeconomic status communities completed questionnaires. Post-intervention, the percentage of women that reported preparing for doctors' visits increased significantly. Women with initially low levels of perceived efficacy in patient-physician interaction showed a significant increase in perceived efficacy, while initially higher perceived efficacy in patient-physician interaction participants showed a decrease. Participants also demonstrated an increase in knowledge of several risk factors for cardiovascular disease and heart attack symptoms. CONCLUSIONS A community-based cardiovascular health literacy intervention improved cardiovascular knowledge and reported doctor visit preparation in low socioeconomic status women as well as increased perceived efficacy in patient-physician interaction among participants with low baseline perceived efficacy in patient-physician interaction. This may lead to improved health care utilisation, preventing chronic illness. Registered at ClinicalTrials.gov, https://www.clinicaltrials.gov , registration number: NCT03203018.
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Affiliation(s)
- Keren L Greenberg
- The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, Israel
| | - Elisheva Leiter
- The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, Israel
| | - Milka Donchin
- The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, Israel.,The Braun School of Public Health and Community Medicine, Hebrew University and Hadassah University Medical Center, Israel
| | - Nisreen Agbaria
- The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, Israel
| | - Mayada Karjawally
- The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, Israel
| | - Donna R Zwas
- The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, Israel
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Morony S, Weir KR, Bell KJL, Biggs J, Duncan G, Nutbeam D, McCaffery KJ. A stepped wedge cluster randomised trial of nurse-delivered Teach-Back in a consumer telehealth service. PLoS One 2018; 13:e0206473. [PMID: 30379942 PMCID: PMC6209310 DOI: 10.1371/journal.pone.0206473] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/12/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the impact of Teach-Back on communication quality in a national telephone-based telehealth service, for callers varying in health literacy. DESIGN Cross-sectional stepped wedge cluster randomised trial with continuous recruitment, short (fixed) exposure and blinded outcome assessors. Nurses were stratified by hours worked and randomised into training groups using a computer generated sequence. SETTING An Australian national pregnancy and parenting telephone helpline. INTERVENTION Complex intervention involving a single 2-hour group Teach-Back training session, combined with ongoing nurse self-reflection on their communication following each call and each shift. PARTICIPANTS Participants were 637 callers to the telephone helpline aged 18-75 (87% female), of whom 127 (13%) had inadequate health literacy (measured with the Single Item Literacy Screener); and 15 maternal and child health nurses with 15 years' experience on average. MEASURES Primary outcome was a modified subscale of the Health Literacy Questionnaire, 'having sufficient information to manage health'. Secondary caller outcomes included caller confidence, perceived actionability of information and nurse effort to listen and understand. Nurse outcomes were perceptions of their communication effectiveness. RESULTS Over a 7 week period, 376 surveyed callers received usual care and 261 Teach-Back. Ratings on the primary outcome increased over time (OR 1.17, CI 1.01 to 1.32, p = 0.03) but no independent Teach-Back effect was observed. A consistent pattern suggests that, compared with usual care, Teach-Back helps callers with inadequate health literacy feel listened to (OR 2.3, CI 0.98 to 5.42, p = 0.06), confident to act (OR 2.44, CI 1.00 to 5.98, p = 0.06), and know what steps to take (OR 2.68, CI 1.00 to 7.17, p = 0.06). Nurse perceptions of both their own communication effectiveness (OR = 2.31; CI 1.38 to 3.86, p<0.0001), and caller understanding (OR = 2.56; CI 1.52 to 4.30, p<0.001) both increased with Teach-Back. No harms were reported. CONCLUSIONS Teach-Back appears to benefit telephone health service users with inadequate health literacy, but the extent of this is unclear due to smaller numbers of lower literacy participants. Improving caller ratings over time are likely due to increasing nurse communication competence.
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Affiliation(s)
- Suzanne Morony
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Kristie R. Weir
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Health Literacy Lab, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Katy J. L. Bell
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | | | - Gregory Duncan
- Eastern Health Clinical School, Monash University, Box Hill, Australia
| | - Don Nutbeam
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Health Literacy Lab, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Kirsten J. McCaffery
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Health Literacy Lab, Sydney School of Public Health, The University of Sydney, Sydney, Australia
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Champlin S, Hoover DS, Mackert M. Health Literacy in Adult Education Centers: Exploring Educator and Staff Needs. Health Promot Pract 2018; 21:198-208. [PMID: 30070148 DOI: 10.1177/1524839918789690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective. Incorporating health content into adult education courses is promising for increasing health literacy skills among "hard-to-reach" populations. The purpose of this study was to gain previously untapped knowledge of adult education personnel (i.e., educators, staff) about the strategies and programs that would be beneficial for helping students learn about health. Method. Personnel (N = 53) from three literacy coalitions completed an online survey that assessed interest and preferences for developing a health literacy curriculum. Results. Personnel indicated general concepts such as health services and insurance as those of greatest priority. Additionally, tools designed for general use (completion of forms) were favored. Personnel preferred programs that focused on general skills over those designed to address specific health topics, χ2(1) = 11.52, p = .001. Conclusions. Adult education personnel find greatest value in health literacy programs aimed at increasing general skills rather than disease-/topic-specific content. There were several mismatches in topics noted as a "priority" and those for which personnel felt comfortable teaching. A focus on fostering general health skills will help all students-not just those with specific health concerns such as diabetes and asthma. Teaching health literacy through general skill development could make health programs exciting, engaging, and accessible for students.
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Muscat DM, Morony S, Smith SK, Shepherd HL, Dhillon HM, Hayen A, Trevena L, Luxford K, Nutbeam D, McCaffery KJ. Qualitative insights into the experience of teaching shared decision making within adult education health literacy programmes for lower-literacy learners. Health Expect 2017; 20:1393-1400. [PMID: 28678433 PMCID: PMC5689229 DOI: 10.1111/hex.12580] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2017] [Indexed: 11/28/2022] Open
Abstract
Background Enhancing health literacy can play a major role in improving healthcare and health across the globe. To build higher‐order (communicative/critical) health literacy skills among socially disadvantaged Australians, we developed a novel shared decision making (SDM) training programme for adults with lower literacy. The programme was delivered by trained educators within an adult basic education health literacy course. Objective To explore the experience of teaching SDM within a health literacy programme and investigate whether communicative/critical health literacy content meets learner needs and teaching and institutional objectives. Design and participants Qualitative interview study with 11 educators who delivered the SDM programme. Transcripts were analysed using the Framework approach; a matrix‐based method of thematic analysis. Results Teachers noted congruence in SDM content and the institutional commitment to learner empowerment in adult education. The SDM programme was seen to offer learners an alternative to their usual passive approach to healthcare decision making by raising awareness of the right to ask questions and consider alternative test/treatment options. Teachers valued a structured approach to training building on foundational skills, with language reinforcement and take‐home resources, but many noted the need for additional time to develop learner understanding and cover all aspects of SDM. Challenges for adult learners included SDM terminology, computational numerical risk tasks and understanding probability concepts. Discussion and conclusions SDM programmes can be designed in a way that both supports teachers to deliver novel health literacy content and empowers learners. Collaboration between adult education and healthcare sectors can build health literacy capacity of those most in need.
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Affiliation(s)
- Danielle M Muscat
- University of Sydney, School of Public Health, Sydney, NSW, Australia.,University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney, NSW, Australia
| | - Suzanne Morony
- University of Sydney, School of Public Health, Sydney, NSW, Australia.,University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney, NSW, Australia
| | - Sian K Smith
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Heather L Shepherd
- University of Sydney, School of Public Health, Sydney, NSW, Australia.,University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney, NSW, Australia.,University of Sydney, Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Sydney, NSW, Australia
| | - Haryana M Dhillon
- University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney, NSW, Australia.,University of Sydney, School of Psychology, Sydney, NSW, Australia
| | - Andrew Hayen
- University of Technology Sydney, Faculty of Health, Sydney, NSW, Australia
| | - Lyndal Trevena
- University of Sydney, School of Public Health, Sydney, NSW, Australia.,University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney, NSW, Australia
| | - Karen Luxford
- Clinical Excellence Commission, Sydney, NSW, Australia
| | - Don Nutbeam
- University of Sydney, School of Public Health, Sydney, NSW, Australia
| | - Kirsten J McCaffery
- University of Sydney, School of Public Health, Sydney, NSW, Australia.,University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney, NSW, Australia
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