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Karakitsiou G, Plakias S, Kedraka K, Arvaniti A, Kokkotis C, Tsiakiri A, Samakouri M. Investigating the Role of Second Chance Schools and COVID-19 Pandemic on the Mental Health and Self-Image of Greek Adult Students. Brain Sci 2023; 13:1203. [PMID: 37626559 PMCID: PMC10452111 DOI: 10.3390/brainsci13081203] [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: 07/21/2023] [Revised: 08/04/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
COVID-19 has globally impacted both physical and mental health. This study aimed to explore the impact of Second Chance Schools (SCS) and the COVID-19 pandemic on the mental health and self-image of Greek SCS students. A total of 251 SCS students from two consecutive study cycles participated, completing the research instruments at the beginning and end of their studies. Participants' anxiety, depressive symptomatology, well-being, self-esteem and self-efficacy were evaluated by means of the GAD-7, PHQ-8, WHO-5 Well-being Index, Rosenberg Self-Esteem Scale and Generalized Self-Efficacy Scale, respectively. The research spanned three years, including a year of universal lockdown, a year with protective measures and a year without anti-COVID-19 measures. Factor analysis, regression analyses and two two-way repeated measures ANOVAs were applied to the collected data. All five psychological dimensions measured by the study's instruments were grouped into two factors, namely mental health and self-image. Well-being positively influenced mental health, while anxiety and depression had a negative impact. On the other hand, self-efficacy and self-esteem positively contributed to self-image. Mental health and self-image were moderately correlated. Pre-SCS values of mental health and self-image predicted a higher percentage of variance in post-SCS values compared to anxiety, depression, well-being, self-efficacy and self-esteem. Moreover, mental health improved after the completion of SCS, but only for participants after the lifting of anti-COVID-19 measures. Conversely, self-image improved for all participants regardless of the presence of anti-COVID-19 measures. Overall, the SCS had a considerable impact on the participants' mental health and self-image, although the effect was influenced by COVID-19.
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Affiliation(s)
- Georgia Karakitsiou
- Department of Psychiatry, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Spyridon Plakias
- Department of Physical Education and Sport Science, University of Thessaly, 38221 Trikala, Greece
| | - Katerina Kedraka
- Department of Molecular Biology and Genetics, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Aikaterini Arvaniti
- Department of Psychiatry, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
- Department of Psychiatry, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece
| | - Christos Kokkotis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece;
| | - Anna Tsiakiri
- Department of Neurology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Maria Samakouri
- Department of Psychiatry, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
- Department of Psychiatry, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece
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Schmiege SJ, Jiang L, Albino J, Johnson RL, Wilson AR, Brega AG. Patterns of Change in Parental Health Literacy in Relation to Children's Oral Health. Health Lit Res Pract 2023; 7:e89-e98. [PMID: 37162254 PMCID: PMC10169466 DOI: 10.3928/24748307-20230419-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Although health literacy (HL) skills may change over time, most research treats HL as a constant, using baseline HL to predict other health-related constructs. Few studies have explored change in HL over time. OBJECTIVE We examined person-level differences in HL trajectories. We identified subgroups (latent classes) based on longitudinal assessments of HL and examined the association of class membership with demographic and oral health variables. METHODS We used four measurement waves of parental HL data, reflecting the risk of limited HL, collected as part of an intervention to reduce dental decay in American Indian children (N = 579 parent-child dyads at baseline). Repeated measures latent class analysis (RMLCA) models were estimated to identify subgroups of HL trajectories over time. We examined class membership in association with baseline demographics and with 36-month assessments of parental oral health knowledge, beliefs, and behaviors as well as pediatric oral health. KEY RESULTS A four-class model best fit the data. The largest class (high HL; 49.7% of the sample) was characterized by high levels of HL at all waves. A second class (improving HL; 17.7%) improved over all waves. The remaining two classes were characterized as moderate HL (20%) and low HL (12.6%) and maintained relatively stable HL levels over time. Higher educational attainment was associated with membership in the high HL and improving HL classes. Older age among this young-adult sample and higher income also were associated with high HL class membership. Parents in the high HL and improving HL classes exhibited more favorable performance on measures of oral health knowledge, beliefs, and behavioral adherence than did those in the other classes. Class membership was not associated with pediatric oral health. CONCLUSIONS RMLCA demonstrated person-level variability in HL trajectories. Longitudinal patterns were associated with baseline demographics and prospectively with parental oral health knowledge, beliefs, and behaviors, but not with pediatric oral health. [HLRP: Health Literacy Research and Practice. 2023;7(2):e89-e98.].
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Health literacy and ophthalmology: A scoping review. Surv Ophthalmol 2023; 68:78-103. [PMID: 35995252 DOI: 10.1016/j.survophthal.2022.08.007] [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: 01/03/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 02/01/2023]
Abstract
As of 2020, it is estimated that 43.3 million people are blind, and an additional 553 million have mild to severe vision impairment.50 At least 1 billion worldwide have a vision impairment that could have been prevented or has yet to be addressed.54 Poor health literacy may be a significant contributor to the prevalence of eye disease. With implications on disease burden, progression, and health outcomes, a greater understanding of the role health literacy plays in ophthalmology is needed. This is the first scoping review to assess the impact of health literacy on eye health outcomes and blindness, including ocular screening rates and/or follow-up rates, treatment adherence, and self-care practices. PubMed, Embase, and CINAHL databases were searched systematically through November 12, 2021, and we evaluated the association between health literacy and ophthalmic outcomes in 4 domains: clinical outcomes, treatment adherence rates, screening and/or follow-up rates, and self-care practices. There is evidence to suggest that health literacy is associated with ophthalmic outcomes in all these domains. To better understand how health literacy impacts eye health, further longitudinal studies examining the effect of health literacy (using standardized health literacy measures) on ophthalmic outcomes are needed. We believe a specific ophthalmic health literacy survey could help achieve this goal and help target interventions to ultimately improve outcomes among ophthalmology patients.
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Shan D, Li S, Xu R, Huang J, Wang Y, Zheng Y, Huang S, Song Y, Han J, Suto S, Dai Z. Low depression literacy exacerbates the development and progression of depressive mood in Chinese adult social media users during COVID-19: A 3-month observational online questionnaire-based study with multiple cross-sectional analyses. Front Public Health 2023; 11:1096903. [PMID: 36875375 PMCID: PMC9978449 DOI: 10.3389/fpubh.2023.1096903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/04/2023] [Indexed: 02/18/2023] Open
Abstract
Background The main purpose of this study was to explore the relationship between depression literacy (D-Lit) and the development and progression of depressive mood. Methods This longitudinal study with multiple cross-sectional analyses used data from a nationwide online questionnaire administered via the Wen Juan Xing survey platform. Eligible participants were 18 years or older and had subjectively experienced mild depressive moods at the time of their initial enrollment in the study. The follow-up time was 3 months. Spearman's rank correlation test was used to analyze the predictive role of D-Lit on the later development of depressive mood. Results We included 488 individuals with mild depressive moods. No statistically significant correlation between D-Lit and Zung Self-rating Depression Scale (SDS) at baseline was observed (adjusted rho = 0.001, p = 0.974). However, after 1 month (adjusted rho = -0.449, p < 0.001) and after 3 months (adjusted rho = -0.759, p < 0.001), D-Lit was significantly and negatively correlated with SDS. Limitations The targeted subjects were limited to the Chinese adult social media users; meanwhile, China's current management policies for COVID-19 differ from most of the other countries, limiting the generalizability of this study. Conclusion Despite the limitations, our study provided novel evidence supporting that low depression literacy may be associated with exacerbated development and progression of depressive mood, which, if not appropriately and promptly controlled, may ultimately lead to depression. In the future, we encourage further research to explore the practical and efficient ways to enhance public depression literacy.
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Affiliation(s)
- Dan Shan
- Department of Biobehavioral Sciences, Columbia University, New York, NY, United States
| | - Shaoyang Li
- Faculty of Science, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Ruichen Xu
- Department of Integrative Biology, University of Wisconsin-Madison, Madison, WI, United States
| | - Jingtao Huang
- School of Basic Medical Science, Capital Medical University, Beijing, China
| | - Yi Wang
- China-Japan Friendship Clinical School, Beijing University of Chinese Medicine, Beijing, China
| | - Yuandian Zheng
- Department of Biobehavioral Sciences, Columbia University, New York, NY, United States
| | - Shanshan Huang
- Department of Medical Imaging, Qujing Second People's Hospital of Yunnan Province, Qujing, China
| | - Yuming Song
- School of Medical Imaging, Hebei Medical University, Shijiazhuang, China
| | - Junchu Han
- Department of Human Development, Columbia University, New York, NY, United States
| | - Sayaka Suto
- Department of Human Development, Columbia University, New York, NY, United States
| | - Zhihao Dai
- School of Medicine, Royal College of Surgeons, Ireland, University of Medicine and Health Sciences, Dublin, Ireland
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Rosenfeld L, Miller A, Garverich S, Guyer M, Steiner R, Lincoln AK. Performing an Organizational Health Literacy Assessment in a Shelter Serving People with Mental Illness. Health Lit Res Pract 2022; 6:e167-e174. [PMID: 35858185 PMCID: PMC9272573 DOI: 10.3928/24748307-20220615-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Health literacy research and practice are constantly evolving. Recent inquiry has highlighted the burdensome literacy demands faced by people with serious mental illness (SMI). Systems, organizational operations, and structures can play a role in decreasing literacy demand, thereby reducing unnecessary challenges for people with SMI. Brief Description of Activity: An organizational health literacy assessment was conducted to explore literacy demands in one mental health shelter and revealed best practice action steps for improving the literacy environment. Implementation: The assessment included an exploration of the shelter environment using The Health Literacy Environment Activity Packet, First Impressions & Walking Interview, and a commonly used shelter document using the Simple Measure of Gobbledygook (SMOG), Suitability Assessment of Materials (SAM), and Centers for Disease Control and Prevention (CDC) Index. Results: The literacy demands of the shelter environment and a frequently used document exceeded the literacy skills of people with SMI. Environment assessment revealed environmental facilitators (e.g., welcoming atmosphere) and barriers (e.g., unclear signage). Document assessment also revealed facilitating factors and barriers. SMOG scores ranged from 11.25 to 11.80 (median: 11.38), meaning 11th to 12th grade-level reading skills are required to understand, use, and take action on the document's content. A SAM score of 50% (adequate) and a CDC Index score of 42.1 (revise and improve) reveal materials contain both facilitating factors (e.g., chunked sections) and barriers (e.g., jargon, mismatched graphics) to use. Lessons Learned: The mismatch between system demands and the literacy skills of people with SMI is more profound than that of the general United States population. Organizational health literacy assessments are achievable and useful for both immediate and long-term action aimed at understanding and improving the organizational health literacy of mental health spaces. Further work is needed to explore the role of behavioral health services in addressing the institutional and programmatic literacy demands that inhibit treatment and recovery. [HLRP: Health Literacy Research and Practice. 2022;6(3):e167–e174.] Plain Language Summary: An organizational health literacy assessment reveals how system demands can be changed to better serve intended users. Engaging in mental health, recovery, and treatment services requires complex literacy skills. Generally, the U.S. adult population does not have the skills to meet such demands, and this is especially true among public mental health service users.
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Affiliation(s)
- Lindsay Rosenfeld
- Address correspondence to Lindsay Rosenfeld, ScD, ScM, Brandeis University, The Heller School for Social Policy and Management, Institute for Child, Youth and Family Policy, 415 South Street, Mailstop 035, Waltham, MA 02454-9110;
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Nisarga V, Anupama M, Madhu KN. Social and obstetric risk factors of antenatal depression: A cross-sectional study from South-India. Asian J Psychiatr 2022; 72:103063. [PMID: 35334285 DOI: 10.1016/j.ajp.2022.103063] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/09/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Antenatal depression is as prevalent as postpartum depression and studies on it are very few. It has been relatively neglected leading to adverse effects on the growing child as well as the mother. Hence screening of depression in high risk individuals, planning and adopting important strategies for prevention needs to be undertaken. Our study aimed to assess the modifiable social and obstetric risk factors of antenatal depression. METHODS Third trimester pregnant women of 18-40 years attending obstetric out-patient department and admitted in tertiary hospitals who had no past psychiatric illness were screened using Edinburgh postnatal depression scale after obtaining written consent, socio-demographic and obstetric details. Statistical analysis was calculated using IBM version SPSS 23. RESULTS Among 222 women recruited, 25.6% had antenatal depression. Significant associations were found between lower level of education (p = 0.02,O.R=1.87), urban population (p = 0.04,O.R=5.139), intimate partner violence (p = 0.01,O.R=15.769), daily alcohol use by husband (p < 0.00,O.R=15.281), poor relationship with in-laws (p < 0.000,O.R=21.733) and parents (p < 0.000,O.R=15.281), number of previous pregnancies (p = 0.026,O.R=5.545), parity (p = 0.04,O.R=4.187), previous abortions (p = 0.007,O.R=2.834), fear of labour (p < 0.000,O.R=5.77) and complications during pregnancy (p < 0.000,O.R=3.017) with antenatal depression. Living in urban area (p = 0.023, A.O.R=3.132), fear of labour (p < 0.000, A.O.R=7.398), intimate partner violence (p = 0.026, A.O.R=36.655), poor relationship with in-laws (p = 0.001, A.O.R=36.855) and parents (p = 0.042, A.O.R=8.377) were found to be predictors of antenatal depression. CONCLUSION Antenatal depression is multifactorial in origin and requires a multifactorial approach in prevention and treatment. Routine antenatal screening for depression must be conducted with efforts to build strong family, peer and social support at community level.
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Affiliation(s)
- Vinyas Nisarga
- Department of Psychiatry, J.J.M Medical College, Davangere, Karnataka, India.
| | - M Anupama
- Department of Psychiatry, J.J.M Medical College, Davangere, Karnataka, India.
| | - K N Madhu
- Department of Obstetrics and Gynaecology, J.J.M Medical College, Davangere, Karnataka, India.
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PTSD and Depression 8 Years After the 2004 Tsunami in Sri Lanka. Disaster Med Public Health Prep 2022; 17:e183. [PMID: 35635196 DOI: 10.1017/dmp.2022.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To evaluate prevalence and risk factors of posttraumatic stress disorder (PTSD) and depression among directly exposed (DE) and indirectly or nonexposed (INE) populations in Sri Lanka 8 y after the Indian Ocean Tsunami in 2004. METHODS Population-based structured survey study was conducted among Sri Lankan adults living in 5 coastal districts, Hamboantha, Matara, Galle, Kalutara, and Colombo in 2012-2013. A total of 430 individuals, 325 in DE, 105 in INE, participated in the survey. DE and INE groups were compared for demographics and outcomes. Bivariate and multiple logistic regressions with backward selection were used to identify risk factors for partial PTSD and depression. RESULTS The prevalence of PTSD, partial PTSD and depression were 2.8%, 10.5%, and 18.8% in DE group, respectively. In multivariable analyses tsunami exposure, female gender, subjective physical health before the tsunami, previous trauma, and depression were significantly associated with partial PTSD. Female gender, high frequency of religious activity, previous trauma, social support, and PTSD were significantly associated with depression. CONCLUSIONS The psychological impacts of the tsunami did wane over time, but still present at lower rate even in 8 y. It is important to address these lingering sequelae and expand access to at risk individuals.
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Prevalence and Predictors of Limited Literacy in Public Mental Health Care. Community Ment Health J 2021; 57:1175-1186. [PMID: 33389328 DOI: 10.1007/s10597-020-00750-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
Literacy is an important predictor of health care utilization and outcomes. We examine literacy among people seeking care in a state funded mental health clinic (Site 1) and a safety-net hospital clinic (Site 2). Limited literacy was defined as literacy at or below the 8th grade level. At Site 1, 53% of participants had limited reading literacy and 78% had limited aural literacy. At Site 2, 72% had limited reading and 90% had limited aural literacy. Regression analyses examined associations among limited literacy and psychiatric, neurocognitive and sociodemographic characteristics. Few associations among psychiatric and neurocognitive factors, and literacy were found. At Site 2, black and "other" race participants had higher odds for limited literacy compared to white participants suggesting that limited literacy may be an under-examined mechanism in understanding racial disparities in mental health. Work is needed to understand the relationships among literacy, mental health and mental health care.
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Generalized anxiety symptoms among women attending antenatal clinic in Mwanza Tanzania; a cross-sectional study. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Mwita M, Kasongi D, Bernard E, Gunda D, Mmbaga B. The magnitude and determinants of antepartum depression among women attending antenatal clinic at a tertiary hospital, in Mwanza Tanzania: a cross-sectional study. Pan Afr Med J 2021; 38:258. [PMID: 34104306 PMCID: PMC8164423 DOI: 10.11604/pamj.2021.38.258.27023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/05/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction there is an increased vulnerability for the development of common mental disorders during the peripartum period as evidenced in depressive disorder. Methods a cross sectional study was used to determine the prevalence and risk factors associated with depression among pregnant women attending antenatal clinic (ANC) at Bugando Medical Centre (BMC), a tertiary level hospital in Mwanza Tanzania. A total of 380 pregnant women were recruited and interviewed by using Edinburg Postnatal Depression Scale. The sample size was randomly selected from the clinic. Results the mean age of the participants was 30.35 years, with minimum and maximum age of 20 years and 47 years respectively with 89.74% of the participants being married. Almost half of the participants, 53.68% were on the third trimester, with about two-third of the participants, 76.84% reports to have planned for their current pregnancies. The overall prevalence of depression was 15% with middle age of the partner (31-40 years), been married, high level of education, partner and family support were found to be statistically protective for depression while polygamy and partner violence were statistically risk factor for depression. Conclusion the results showed high prevalence of antepartum depression which emphasizes the importance of earlier screening, detection and intervention to reduce the burden of morbidity and disability.
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Affiliation(s)
- Matiko Mwita
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania.,Bugando Medical Centre, Psychiatry Department, Mwanza, Tanzania
| | - Doreen Kasongi
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Eliya Bernard
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Daniel Gunda
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Blandina Mmbaga
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Vanova M, Aldridge-Waddon L, Jennings B, Puzzo I, Kumari V. Reading skills deficits in people with mental illness: A systematic review and meta-analysis. Eur Psychiatry 2020; 64:e19. [PMID: 33138882 PMCID: PMC8057468 DOI: 10.1192/j.eurpsy.2020.98] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Good reading skills are important for appropriate functioning in everyday life, scholastic performance, and acquiring a higher socioeconomic status. We conducted the first systematic review and meta-analysis to quantify possible deficits in specific reading skills in people with a variety of mental illnesses, including personality disorders (PDs). METHODS We performed a systematic search of multiple databases from inception until February 2020 and conducted random-effects meta-analyses. RESULTS The search yielded 34 studies with standardized assessments of reading skills in people with one or more mental illnesses. Of these, 19 studies provided data for the meta-analysis. Most studies (k = 27; meta-analysis, k = 17) were in people with schizophrenia and revealed large deficits in phonological processing (Hedge's g = -0.88, p < 0.00001), comprehension (Hedge's g = -0.96, p < 0.00001) and reading rate (Hedge's g = -1.22, p = 0.002), relative to healthy controls; the single-word reading was less affected (Hedge's g = -0.70, p < 0.00001). A few studies in affective disorders and nonforensic PDs suggested weaker deficits (for all, Hedge's g < -0.60). In forensic populations with PDs, there was evidence of marked phonological processing (Hedge's g = -0.85, p < 0.0001) and comprehension deficits (Hedge's g = -0.95, p = 0.0003). CONCLUSIONS People with schizophrenia, and possibly forensic PD populations, demonstrate a range of reading skills deficits. Future studies are needed to establish how these deficits directly compare to those seen in developmental or acquired dyslexia and to explore the potential of dyslexia interventions to improve reading skills in these populations.
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Affiliation(s)
- Martina Vanova
- Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom.,Division of Psychology, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Luke Aldridge-Waddon
- Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom.,Division of Psychology, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Ben Jennings
- Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom.,Division of Psychology, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Ignazio Puzzo
- Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom.,Division of Psychology, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Veena Kumari
- Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom.,Division of Psychology, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom
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Khoshgoo M, Eslami O, Khadem Al-Hosseini M, Shidfar F. The Relationship between Household Food Insecurity and Depressive Symptoms among Pregnant Women: A Cross Sectional Study. IRANIAN JOURNAL OF PSYCHIATRY 2020; 15:126-133. [PMID: 32426008 PMCID: PMC7215255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: There is growing evidence suggesting that household food insecurity (HFI) is associated with adverse outcomes on mental health; however, limited evidence exists for pregnant women. This study was conducted to determine the relationship between HFI and depressive symptoms among a sample of pregnant women. Method : This cross sectional study was performed on 394 pregnant women referring to the health centers located in Qom, Iran, from October 2017 to March 2019. HFI was evaluated using an 18-item US Household Food Security Survey Module. The Beck Depression Inventory-II questionnaire was applied to determine the severity of depressive symptoms. Logistic regression analysis was used to determine the factors associated with elevated depressive symptoms in the study population. Results: The mean (± standard deviation) age of the study population was 28.59 ± 7.28 years. Almost 48% of participants were food insecure, and 37% experienced elevated levels of depressive symptoms during pregnancy. The prevalence of elevated depressive symptoms was significantly higher in food-insecure (P < 0.001) and unemployed (P = 0.02) women, while it was significantly lower in women with higher education levels (P < 0.001). In the adjusted model, it was revealed that HFI was significantly associated with the higher likelihood of having elevated depressive symptoms (OR = 3.31, 95% CI = 2.07, 5.29), while the higher level of education was negatively associated with the levels of depressive symptoms (OR = 0.40, 95% CI = 0.20, 0.79). Conclusion: HFI was positively associated with the severity of depressive symptoms in a sample of pregnant women. Further studies are needed to confirm this finding. Meanwhile, routine screening of HFI for all pregnant women in the community health centers is recommended.
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Affiliation(s)
| | | | | | - Farzad Shidfar
- Corresponding Author: Address: Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran, Postal Code: 1449614535. Tel: 98-2188622755, Fax: 98-2188974462,
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Baird B, Oh KM, Douglas C, Weinstein AA. Health Literacy, Depression Literacy, and Depression among Older Korean Americans. JOURNAL OF HEALTH COMMUNICATION 2019; 24:525-535. [PMID: 31244411 DOI: 10.1080/10810730.2019.1632395] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The purpose of this study was to explore depression and its relationship with background characteristics, health literacy, and depression literacy among Korean Americans (KAs). A cross-sectional survey was conducted among 178 older KAs (age 60≥) in the Washington D.C. metro area in 2016. Three open-ended questions were included to obtain narrative responses for thoughts about depression and its symptoms, and the living situation that might be related to depression. Depression was measured on the Patient Health Questionnaire-9 translated into Korean. The rate of depression was 22.5% among older KAs. No relationship between health literacy and depression was shown. In the regression analysis with covariates, limited English proficiency, less family support, shorter length of U.S. residency, male, and higher depression literacy were significantly associated with higher odds of depression. On narrative questions, only 35% among respondents believed that depression was a mental status. The others described it as environmental or attitude problems such as stress or goals being set too high. Education about depression engaging older KAs immigrants with limited English, and their families are the important health issue in the Korean community.
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Affiliation(s)
- Byung Baird
- a School of Nursing, George Mason University , Fairfax , VA , USA
| | - Kyeung Mi Oh
- a School of Nursing, George Mason University , Fairfax , VA , USA
| | - Charlene Douglas
- a School of Nursing, George Mason University , Fairfax , VA , USA
| | - Ali A Weinstein
- b Department of Global and Community Health, George Mason University , Fairfax , VA , USA
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VanWormer JJ, Tambe SR, Acharya A. Oral Health Literacy and Outcomes in Rural Wisconsin Adults. J Rural Health 2018; 35:12-21. [DOI: 10.1111/jrh.12337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/24/2018] [Accepted: 10/30/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Jeffrey J. VanWormer
- Center for Oral and Systemic Health; Marshfield Clinic Research Institute; Marshfield Wisconsin
| | - Sailee R. Tambe
- School of Public Health; University of Minnesota; Minneapolis Minnesota
| | - Amit Acharya
- Center for Oral and Systemic Health; Marshfield Clinic Research Institute; Marshfield Wisconsin
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Validation of the Arabic version of the MADRS scale among Lebanese patients with depression. Encephale 2018; 45:195-199. [PMID: 30122299 DOI: 10.1016/j.encep.2018.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 05/17/2018] [Accepted: 05/18/2018] [Indexed: 12/26/2022]
Abstract
AIM To use the Arabic version of the MADRS in Lebanese depressed patients, check its validity and reproducibility compared to other versions of the questionnaire and assess risk factors affecting the total MADRS score. METHODS This case-control study, performed between September 2016 and January 2017, included 200 patients (100 patients, 100 controls). The questionnaire included two parts, the first one concerning the socio-demographic characteristics another one that included the Montgomery-Asberg Depression Rating Scale (MADRS) questions, which was translated from English to Arabic through an initial translation and back translation process. RESULTS The MADRS scale items converged over a solution of one factor that had an Eigenvalue over 1, explaining a total of 83.90% of the variance. A Kaiser-Meyer-Olkin measure of sampling adequacy of 0.953 was found, with a significant Bartlett's test of sphericity (P<0.001). A stepwise linear regression, using the total MADRS score as continuous variable, showed that a university level of education would significantly decrease the total MADRS score by 20 points (beta=-20.02, CI: from -26.337 to -13.709, P<0.001). Unemployment was significantly more associated with an increase in the total MADRS score level by 10.23 points (beta=10.23, CI: 3.944-16.526, P=0.002). CONCLUSION This study shows that the Arabic version of the MADRS has promising psychometric properties, and thus it is a good tool to use for the diagnosis of patients with depression. Based on this study, health care professionals and researchers can readily use the MADRS questionnaire to estimate the overall severity of depression among psychiatric patients in Lebanon.
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16
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Abstract
There is a consistent association between education and depressive symptoms, but research on the mechanisms to explain this association remains limited. No study has formally evaluated the extent to which the association between education and depressive symptoms is mediated through a foundational skill such as literacy. Inverse odds ratio weighting (IORW) was used to estimate total, natural direct, and natural indirect effects in examining literacy as a mediator of the association between education and depressive symptoms. Health and Retirement Study participants born in the U.S. between 1900 and 1947 were interviewed biennially for up to 12 years (N = 16,718). Literacy was assessed with a brief vocabulary measure. Depressive symptoms were measured using the 8-item Centers for Epidemiologic Studies-Depression (CES-D) scale. Decomposition estimates were derived using regression analyses of repeated measures of depressive symptoms. Standard errors were obtained using a nonparametric bootstrap with the individual as the independent unit to account for dependence of observations within an individual. In a large cohort of older Americans, a one standard deviation difference in educational attainment (~ 3 years) was associated with a 0.35-point decrement in CES-D score (95% CI: -0.38, -0.32). This decrement represents a 0.22 standard deviation difference in depressive symptoms. Using IORW, the estimated effect of education on depressive symptoms mediated through literacy was -0.10 (95% CI: -0.18, -0.01), which represents 28% of the total effect. Education confers many benefits; as demonstrated by this study for depressive symptoms, one important benefit is literacy.
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Boyle J, Speroff T, Worley K, Cao A, Goggins K, Dittus RS, Kripalani S. Low Health Literacy Is Associated with Increased Transitional Care Needs in Hospitalized Patients. J Hosp Med 2017; 12:918-924. [PMID: 29091980 DOI: 10.12788/jhm.2841] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine the association of health literacy with the number and type of transitional care needs (TCN) among patients being discharged to home. DESIGN, SETTING, PARTICIPANTS A cross-sectional analysis of patients admitted to an academic medical center. MEASUREMENTS Nurses administered the Brief Health Literacy Screen and documented TCNs along 10 domains: caregiver support, transportation, healthcare utilization, high-risk medical comorbidities, medication management, medical devices, functional status, mental health comorbidities, communication, and financial resources. RESULTS Among the 384 patients analyzed, 113 (29%) had inadequate health literacy. Patients with inadequate health literacy had needs in more TCN domains (mean = 5.29 vs 4.36; P < 0 .001). In unadjusted analysis, patients with inadequate health literacy were significantly more likely to have TCNs in 7 out of the 10 domains. In multivariate analyses, inadequate health literacy remained significantly associated with inadequate caregiver support (odds ratio [OR], 2.61; 95% confidence interval [CI], 1.37-4.99) and transportation barriers (OR, 1.69; 95% CI, 1.04-2.76). CONCLUSIONS Among hospitalized patients, inadequate health literacy is prevalent and independently associated with other needs that place patients at a higher risk of adverse outcomes, such as hospital readmission. Screening for inadequate health literacy and associated needs may enable hospitals to address these barriers and improve postdischarge outcomes.
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Affiliation(s)
- Joseph Boyle
- School of Graduate Medical Education, University of Colorado, Aurora, Colorado, USA
| | - Theodore Speroff
- Department of Veterans Affairs, Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center (GRECC), Nashville, Tennessee, USA
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Katherine Worley
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aize Cao
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kathryn Goggins
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert S Dittus
- Department of Veterans Affairs, Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center (GRECC), Nashville, Tennessee, USA
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sunil Kripalani
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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18
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Schapira MM, Swartz S, Ganschow PS, Jacobs EA, Neuner JM, Walker CM, Fletcher KE. Tailoring Educational and Behavioral Interventions to Level of Health Literacy: A Systematic Review. MDM Policy Pract 2017; 2:2381468317714474. [PMID: 30288424 PMCID: PMC6124923 DOI: 10.1177/2381468317714474] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 05/13/2017] [Indexed: 11/15/2022] Open
Abstract
Background: The relative value of universal compared to contingent approaches to communication and behavioral interventions for persons of low health literacy remains unknown. Objective: To examine the effectiveness of interventions that are tailored to individual health literacy level compared to nontailored interventions on health-related outcomes. Design: Systematic review. Data Sources: PubMed and Embase databases. Eligibility Criteria: Studies were eligible if they were in English, used an experimental or observational design, included an intervention that was tailored based on the individual's level of education, health literacy or health numeracy, and had a comparator group in which the intervention was not tailored to individual characteristics. Review Methods: Databases were searched from inception to January 2016, and the retrieved reference lists hand searched. Abstracts that met PICOS criteria underwent dual review for data extraction to assess study details and study quality. A qualitative synthesis was conducted. Results: Of 2,323 unique citations, 458 underwent full review, and 9 met criteria for the systematic review. Five studies were positive and rated as good quality, 3 were negative with 2 of those of good quality, and 1 had mixed results (fair quality). Positive studies were conducted in the clinical domains of hypertension, diabetes, and depression with interventions including educational materials, disease management sessions, literacy training, and physician notification of limited health literacy among patients. Negative studies were conducted in the clinical domains of heart disease, glaucoma, and nutrition with interventions including medication reconciliation and educational materials. Conclusions: Tailoring communication and behavioral interventions to the individual level of health literacy may be an effective strategy to improve knowledge and indicators of disease control in selected clinical settings.
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Affiliation(s)
- Marilyn M. Schapira
- Marilyn M. Schapira, University of
Pennsylvania, 1110 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104,
USA; telephone: 215-898-2022; e-mail:
| | - Sheila Swartz
- University of Pennsylvania, Philadelphia,
Pennsylvania (MMS)
- Crescenz VA Medical Center, Philadelphia,
Pennsylvania (MMS)
- Medical College of Wisconsin, Milwaukee, Wisconsin
(SS, JMN, KEF)
- Rush University Medical Center, Chicago, Illinois
(PSG)
- University of Wisconsin, Madison, Wisconsin
(EAJ)
- Duquensne University, Pittsburgh, Pennsylvania
(CMW)
- Milwaukee VA Medical Center, Milwaukee, Wisconsin
(KEF)
| | - Pamela S. Ganschow
- University of Pennsylvania, Philadelphia,
Pennsylvania (MMS)
- Crescenz VA Medical Center, Philadelphia,
Pennsylvania (MMS)
- Medical College of Wisconsin, Milwaukee, Wisconsin
(SS, JMN, KEF)
- Rush University Medical Center, Chicago, Illinois
(PSG)
- University of Wisconsin, Madison, Wisconsin
(EAJ)
- Duquensne University, Pittsburgh, Pennsylvania
(CMW)
- Milwaukee VA Medical Center, Milwaukee, Wisconsin
(KEF)
| | - Elizabeth A. Jacobs
- University of Pennsylvania, Philadelphia,
Pennsylvania (MMS)
- Crescenz VA Medical Center, Philadelphia,
Pennsylvania (MMS)
- Medical College of Wisconsin, Milwaukee, Wisconsin
(SS, JMN, KEF)
- Rush University Medical Center, Chicago, Illinois
(PSG)
- University of Wisconsin, Madison, Wisconsin
(EAJ)
- Duquensne University, Pittsburgh, Pennsylvania
(CMW)
- Milwaukee VA Medical Center, Milwaukee, Wisconsin
(KEF)
| | - Joan M. Neuner
- University of Pennsylvania, Philadelphia,
Pennsylvania (MMS)
- Crescenz VA Medical Center, Philadelphia,
Pennsylvania (MMS)
- Medical College of Wisconsin, Milwaukee, Wisconsin
(SS, JMN, KEF)
- Rush University Medical Center, Chicago, Illinois
(PSG)
- University of Wisconsin, Madison, Wisconsin
(EAJ)
- Duquensne University, Pittsburgh, Pennsylvania
(CMW)
- Milwaukee VA Medical Center, Milwaukee, Wisconsin
(KEF)
| | - Cindy M. Walker
- University of Pennsylvania, Philadelphia,
Pennsylvania (MMS)
- Crescenz VA Medical Center, Philadelphia,
Pennsylvania (MMS)
- Medical College of Wisconsin, Milwaukee, Wisconsin
(SS, JMN, KEF)
- Rush University Medical Center, Chicago, Illinois
(PSG)
- University of Wisconsin, Madison, Wisconsin
(EAJ)
- Duquensne University, Pittsburgh, Pennsylvania
(CMW)
- Milwaukee VA Medical Center, Milwaukee, Wisconsin
(KEF)
| | - Kathlyn E. Fletcher
- University of Pennsylvania, Philadelphia,
Pennsylvania (MMS)
- Crescenz VA Medical Center, Philadelphia,
Pennsylvania (MMS)
- Medical College of Wisconsin, Milwaukee, Wisconsin
(SS, JMN, KEF)
- Rush University Medical Center, Chicago, Illinois
(PSG)
- University of Wisconsin, Madison, Wisconsin
(EAJ)
- Duquensne University, Pittsburgh, Pennsylvania
(CMW)
- Milwaukee VA Medical Center, Milwaukee, Wisconsin
(KEF)
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Sensitivity and Specificity in Three Measures of Depression Among Mexican American Women. J Immigr Minor Health 2016; 19:562-571. [PMID: 27757694 DOI: 10.1007/s10903-016-0512-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This paper examined the prevalence of depressive symptomotology among women of Mexican ancestry (N = 205), over the age of 18, of diverse incomes and nativity. We examined differences in rates of diagnosis by Spanish/English preference and the sensitivity and specificity of three common measures: the Patient Health Questionnaire (PHQ9), the Kessler Psychological Distress Scale (K-10), and depression questions from the Composite International Diagnostic Interview, Short Form (MDD CIDI-SF); PHQ9 was used as the "gold standard" measure. Results indicated 18-32 % of participants met criteria for depression with higher rates found among Spanish preference participants. The K-10 had significantly higher sensitivity (0.81) but lower specificity (0.79) than the MDD CIDI-SF items (0.57 and 0.89, respectively). This study suggests that the K-10 and MDD CIDI-SF measures are complementary to each other for screening of depressive symptomatology. Implications for cultural and linguistic assessment of depression are further discussed.
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Cheng ER, Bauer NS, Downs SM, Sanders LM. Parent Health Literacy, Depression, and Risk for Pediatric Injury. Pediatrics 2016; 138:peds.2016-0025. [PMID: 27273749 DOI: 10.1542/peds.2016-0025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Population-wide research on the impact of parent health literacy to children's health outcomes is limited. We assessed the relationship of low parent health literacy to a range of pediatric health risks within a large cohort of primary care patients. METHODS Data were from 17 845 English- and Spanish-speaking parents of children aged ≤7 years presenting for well-child care. We used a 3-item screener to measure health literacy. Outcomes included secondhand smoke exposure, asthma treatment nonadherence, parent depression, child-rearing practices, injury prevention, and parent first-aid knowledge. We summarized study variables with descriptive statistics and then performed multivariable logistic regression to identify associations between low parent literacy and our dependent measures. RESULTS Mean child age was 4.8 years (SD 3.7); 36.5% of parent respondents had low health literacy. In models adjusted for child gender, race/ethnicity, insurance, age, and parent language preference, low parent health literacy was related to a range of pediatric health risks, including parent depression (adjusted odds ratio [AOR] 1.32; 95% confidence interval 1.18-1.48), firearm access (AOR 1.68; 1.49-1.89), not having a working smoke detector (AOR 3.54; 2.74-4.58), and lack of first-aid knowledge about choking (AOR 1.67; 1.44-1.93) and burns (AOR 1.45; 1.29-1.63). Children of parents with low health literacy were also more likely to watch >2 hours of television per day (AOR 1.27; 1.17-1.36). CONCLUSIONS Low parent health literacy is independently and significantly related to parent depression, child television viewing, and at-risk family behaviors associated with child injury. Use of low-literacy approaches to health-behavior interventions may be essential to address common child morbidities.
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Affiliation(s)
- Erika R Cheng
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana;
| | - Nerissa S Bauer
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; Regenstrief Institute, Inc., Indianapolis, Indiana; and
| | - Stephen M Downs
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; Regenstrief Institute, Inc., Indianapolis, Indiana; and
| | - Lee M Sanders
- Division of General Pediatrics, Center for Policy, Outcomes, and Prevention, Stanford University, Stanford, California
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Reprint of: Health literacy in Canada and the ophthalmology patient. Can J Ophthalmol 2015; 50 Suppl 1:S40-6. [PMID: 26049890 DOI: 10.1016/j.jcjo.2015.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 09/05/2011] [Accepted: 10/04/2011] [Indexed: 01/04/2023]
Abstract
Health literacy represents the cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand, and use information in ways that promote and maintain good health.(1) According to the 2003 International Adult Literacy and Life Skills Survey (IALSS), over 12 million (60%) adult Canadians lack the capacity to obtain, understand, and act on health information and services, as well as make appropriate health decisions on their own.(2,3) Of these 12 million Canadians, the elderly are the most health illiterate age group in Canada. What this suggests for Canadian physicians is that to improve the CanMEDS roles of communicator and health advocate,(4) physicians need to recognize health literacy as a modifiable contributor of poor health outcomes and work to remove literacy-related barriers.(5) This is particularly important for ophthalmologists who manage chronic illnesses in elderly patients.(2,6,7) The objective of this review is 2-fold. The first objective is to describe health literacy in Canada and provide a summary on the current state of health literacy research, both generally in medicine and specifically to Ophthalmology. The second objective is to propose a 3-step approach of evidence based techniques for managing low health literate patients in clinic.
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22
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Kim S. An exploratory study of inactive health information seekers. Int J Med Inform 2014; 84:119-33. [PMID: 25453277 DOI: 10.1016/j.ijmedinf.2014.10.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 09/24/2014] [Accepted: 10/03/2014] [Indexed: 11/15/2022]
Abstract
PURPOSE This study aims to identify people who do not actively seek out health information and the demographic characteristics of Inactive Seekers. The possible determinants of inactive seeking behaviors are also explored. DESIGN AND MEASUREMENTS A total of 14,420 survey respondents were drawn from the 2009 Annenberg National Health Communication Survey (ANHCS) data. K-means clustering was used to discriminate Inactive Seekers from Active Seekers. The inactive information seeker group was formed based on their experience with health information seeking. The potential determinants that were tested to predict inactive seeking included the following: health condition, health service use, health media exposure, and computer/Internet activities. RESULTS Within this national survey data, the respondents were more likely to be included in the Inactive Seekers (N=8312, 58.5%) compared to Active Seekers (N=5908, 41.5%). The demographic characteristics indicated that the Inactive Seekers were identified as younger, male, highly educated, White, and high household income people. The binary logistic regression results from the study model indicated that healthier people were less likely to seek out health information than their counterparts. In addition, those who were exposed to various media were almost 1.6 times more likely to seek out health information than those who were not exposed to such media. Within this study data, the statistically significant determinants identified were health condition and health media exposure while computer/Internet activities did not show strong indications in predicting inactive seeking behavior. CONCLUSION The development of more generalizable measures for health literacy or behavioral patterns will bolster advanced study on inactive seeking relating to knowledge of technology and health context. Further study should be directed at estimating the negative aspects of information seeking such as information ignorance or information avoidance.
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Affiliation(s)
- Sujin Kim
- 230G, Multidisciplinary Science Building, Division of Biomedical Informatics, College of Public Health & School of Library and Information Science, College of Communication and Information University of Kentucky, Lexington, KY 40536-0082, USA.
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Abstract
BACKGROUND In many countries, illiteracy rates among aged people are quite high. However, only few studies have specifically investigated the impact of illiteracy on depression. METHODS Data for 1,890 elderly individuals (aged ≥65 years) were obtained from a nationwide dementia epidemiological study conducted in South Korea. Based on their reading ability, the participants were divided into three groups: totally illiterate, partially illiterate, and literate. The Korean version of the Geriatric Depression Scale - Short Form (SGDS-K) was used to detect depression (cut-off score = 8). Multivariate logistic regression analyses were used to assess the association between illiteracy and depression. To explore clinical features of depression in illiterate people, we performed logistic regression to calculate odds ratios of positive responses (or negative responses to reverse-coded items) for each SGDS-K item using literate individuals as the reference group. RESULTS Totally illiterate participants had 2.41 times the odds and partially illiterate individuals had 1.59 times the odds of being depressed compared with literate participants after controlling for other variables. Compared with literate individuals, illiterate elderly persons were at increased odds for responding negatively to the majority of SGDS-K items, including "having memory problems," "others are better off than me," and "feeling worthless" even after controlling for various demographic and clinical factors. CONCLUSIONS Illiteracy in elderly individuals was associated with a higher rate and increased severity of depression. Illiteracy negatively affected depression symptomatology, especially factors associated with self-esteem. Therefore, clinicians should carefully monitor for the presence of depression in illiterate elderly adults.
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Mobley SC, Thomas SD, Sutherland DE, Hudgins J, Ange BL, Johnson MH. Maternal health literacy progression among rural perinatal women. Matern Child Health J 2014; 18:1881-92. [PMID: 24469358 PMCID: PMC4164840 DOI: 10.1007/s10995-014-1432-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This research examined changes in maternal health literacy progression among 106 low income, high risk, rural perinatal African American and White women who received home visits by Registered Nurse Case Managers through the Enterprise Community Healthy Start Program. Maternal health literacy progression would enable women to better address intermediate factors in their lives that impacted birth outcomes, and ultimately infant mortality (Lu and Halfon in Mater Child Health J 7(1):13-30, 2003; Sharma et al. in J Natl Med Assoc 86(11):857-860, 1994). The Life Skills Progression Instrument (LSP) (Wollesen and Peifer, in Life skills progression. An outcome and intervention planning instrument for use with families at risk. Paul H. Brookes Publishing Co., Baltimore, 2006) measured changes in behaviors that represented intermediate factors in birth outcomes. Maternal Health Care Literacy (LSP/M-HCL) was a woman's use of information, critical thinking and health care services; Maternal Self Care Literacy (LSP/M-SCL) was a woman's management of personal and child health at home (Smith and Moore in Health literacy and depression in the context of home visitation. Mater Child Health J, 2011). Adequacy was set at a score of (≥4). Among 106 women in the study initial scores were inadequate (<4) on LSP/M-HCL (83 %), and on LSP/M-SCL (30 %). Significant positive changes were noted in maternal health literacy progression from the initial prenatal assessment to the first (p < .01) postpartum assessment and to the final (p < .01) postpartum assessment using McNemar's test of gain scores. Numeric comparison of first and last gain scores indicated women's scores progressed (LSP/M-HCL; p < .0001) and (LSP/M-SCL; p < .0001). Elevated depression scores were most frequent among women with <4 LSP/M-HCL and/or <4 LSP/M-SCL. Visit notes indicated lack or loss of relationship with the father of the baby and intimate partner discord contributed to higher depression scores.
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Affiliation(s)
- Sandra C. Mobley
- Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, GA USA
- SW Campus, Medical College of Georgia, Georgia Regents University, Augusta, GA USA
- Enterprise Community Healthy Start, Department of Ambulatory Care, Georgia Regents University, Augusta, GA 30912 USA
| | | | - Donald E. Sutherland
- Enterprise Community Healthy Start, Department of Ambulatory Care, Georgia Regents University, Augusta, GA 30912 USA
| | - Jodi Hudgins
- Enterprise Community Healthy Start, Department of Ambulatory Care, Georgia Regents University, Augusta, GA 30912 USA
| | - Brittany L. Ange
- Evaluation Services, Medical College of Georgia, Georgia Regents University, Augusta, GA 30912 USA
| | - Maribeth H. Johnson
- Department of Biostatistics and Epidemiology, Medical College of Georgia, Georgia Regents University, Augusta, GA 30912-4900 USA
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Barton JL, Trupin L, Tonner C, Imboden J, Katz P, Schillinger D, Yelin EH. English language proficiency, health literacy, and trust in physician are associated with shared decision making in rheumatoid arthritis. J Rheumatol 2014; 41:1290-7. [PMID: 24931952 PMCID: PMC4286372 DOI: 10.3899/jrheum.131350] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Treat-to-target guidelines promote shared decision making (SDM) in rheumatoid arthritis (RA). Also, because of high cost and potential toxicity of therapies, SDM is central to patient safety. Our objective was to examine patterns of perceived communication around decision making in 2 cohorts of adults with RA. METHODS Data were derived from patients enrolled in 1 of 2 longitudinal, observational cohorts [University of California, San Francisco (UCSF) RA Cohort and RA Panel Cohort]. Subjects completed a telephone interview in their preferred language that included a measure of patient-provider communication, including items about decision making. Measures of trust in physician, education, and language proficiency were also asked. Logistic regression was performed to identify correlates of suboptimal SDM communication. Analyses were performed on each sample separately. RESULTS Of 509 patients across 2 cohorts, 30% and 32% reported suboptimal SDM communication. Low trust in physician was independently associated with suboptimal SDM communication in both cohorts. Older age and limited English proficiency were independently associated with suboptimal SDM in the UCSF RA Cohort, as was limited health literacy in the RA Panel Cohort. CONCLUSION This study of over 500 adults with RA from 2 demographically distinct cohorts found that nearly one-third of subjects report suboptimal SDM communication with their clinicians, regardless of cohort. Lower trust in physician was independently associated with suboptimal SDM communication in both cohorts, as was limited English language proficiency and older age in the UCSF RA Cohort and limited health literacy in the RA Panel Cohort. These findings underscore the need to examine the influence of SDM on health outcomes in RA.
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Affiliation(s)
| | | | | | | | | | - Dean Schillinger
- University of California, San Francisco
- UCSF Center for Vulnerable Populations, San Francisco General Hospital
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26
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Poor marital support associate with anxiety and worries during pregnancy in Greek pregnant women. Midwifery 2014; 30:628-35. [DOI: 10.1016/j.midw.2013.10.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 10/08/2013] [Accepted: 10/13/2013] [Indexed: 01/21/2023]
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Ell K, Oh H, Lee PJ, Guterman J. Collaborative health literate depression care among predominantly Hispanic patients with coronary heart disease in safety net care. PSYCHOSOMATICS 2014; 55:555-65. [PMID: 25262042 DOI: 10.1016/j.psym.2014.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 03/20/2014] [Accepted: 03/23/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether evidence-based socioculturally health literate-adapted collaborative depression care improves depression care, depressive symptoms, and quality of life among predominantly Hispanic patients with coronary heart disease. METHODS The 12-month trial included 97 patients with coronary heart disease (79% of eligible patients) who met the depression criteria assessed by the Patient Health Questionnaire-9. Patients were recruited from 3 safety net clinics and offered depression team care by a bilingual clinical social worker and community patient navigator, a consulting psychiatrist, and a primary care physician. The team provided problem-solving therapy (PST) or pharmacotherapy or both, telephone symptom monitoring and behavioral activation, and patient resource navigation support. Recruited patients were given patient and family member health literacy-adapted educational and community resource materials in Spanish or English. RESULTS Overall, depression treatment was 74% (PST, 55%; PST plus antidepressant medications, 18%; and antidepressant medications alone, 2%). Nearly half of the patients showed a 50% reduction of the Symptom Checklist-20 (49% at 6 mo and 48% at 12 mo) and of Patient Health Questionnaire-9 score with 47% of patients at 6 months and 43% at 12 months. The 50% improvement in Patient Health Questionnaire and Symptom Checklist-20 score reduction did not vary significantly between patients who received PST or antidepressant only or those who received PST plus antidepressant. The quality of life Short-Form Health Survey SF-12, the Minnesota Living with Heart Failure questionnaire, and the Sheehan Disability Scale outcomes also improved significantly. CONCLUSIONS Socioculturally literacy-adapted collaborative depression care was accepted by patients with coronary heart disease and improved depression care and symptoms, quality of life, and functional outcomes among predominantly Hispanic patients with heart disease.
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Affiliation(s)
- Kathleen Ell
- School of Social Work, University of Southern California, Los Angeles, CA (KE, HO, P-JL).
| | - Hyunsung Oh
- School of Social Work, University of Southern California, Los Angeles, CA (KE, HO, P-JL)
| | - Pey-Jiuan Lee
- School of Social Work, University of Southern California, Los Angeles, CA (KE, HO, P-JL)
| | - Jeffrey Guterman
- David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Health Services, Los Angeles County, Los Angeles, CA (JG)
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Sadeghi S, Brooks D, Stagg-Peterson S, Goldstein R. Growing awareness of the importance of health literacy in individuals with COPD. COPD 2013; 10:72-8. [PMID: 23413895 DOI: 10.3109/15412555.2012.727919] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Good communication will impact clinical practice by assisting patients in understanding health information as well as medical recommendations. Health literacy is important for communication between healthcare professionals and patients with Chronic Obstructive Lung Disease (COPD). In this article we review the concepts, definitions and measurement tools used to evaluate health literacy and recommend ways in which this information may be integrated into clinical practice. Increased awareness of health literacy will assist clinicians to improve patients' knowledge of their disease and adherence to healthcare recommendations.
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Affiliation(s)
- Shiva Sadeghi
- Department of Respiratory Medicine, University of Toronto, Toronto, Ontario, Canada
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Abstract
Low health literacy is common among adults and is related to adverse health outcomes. It also impacts health management and one’s ability to control his or her chronic illness. The current study examined the association of health literacy and diabetes management self-efficacy with employment among 126 individuals with diabetes. No relationship was found between health literacy and employment. Diabetes-management self-efficacy was not directly related to employment but it was indirectly linked to it through physical health and lack of interference of diabetes with activities of daily living. This research suggests that strategies to improve self-efficacy may contribute to improved health and employment outcomes. Implications for rehabilitation counseling practice and research are discussed.
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Morris NS, Maclean CD, Littenberg B. Change in health literacy over 2 years in older adults with diabetes. DIABETES EDUCATOR 2013; 39:638-46. [PMID: 23963099 DOI: 10.1177/0145721713496871] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the stability of health literacy in adults with diabetes over time. Understanding the dynamic nature of health literacy is important when tailoring health messages, especially those targeted at the management of chronic health conditions. METHOD This was a descriptive longitudinal study of 751 adults with diabetes randomly selected from primary care practices in the Vermont Diabetes Information System study between July 2003 and December 2007. Participants were interviewed and completed questionnaires upon entrance into the study and again 24 months later. Health literacy was measured with the Short Test for Functional Health Literacy of Adults. Participants also completed the SF-12 and the Self-Administered Comorbidity Questionnaire and self-reported their sex, income, education, marital status, race/ethnicity, health insurance, duration of diabetes, and problems with vision. RESULTS A significant decrease in health literacy was noted over 24 months. The largest decrease was in adults ≥65 years of age and those with higher physical function at baseline. Smaller declines were noted for women and participants who were white, higher educated, poly-pharmacy users, and with fair to excellent vision. CONCLUSIONS Health literacy exhibits decline with increasing age among adults with diabetes. Individual variability in health literacy has implications for the best timing and approach to provide self-management education and support.
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Affiliation(s)
- Nancy S Morris
- University of Massachusetts, Worcester, Massachusetts (Dr Morris)
| | - Charles D Maclean
- University of Vermont, Burlington, Vermont (Dr MacLean, Dr Littenberg)
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Abstract
We explored health literacy in parents as an underlying construct that develops through social interaction and reflection and involves an array of skills that enable a parent to manage personal and child health and healthcare. We hypothesized that depression impairs health literacy and impedes efforts to promote health literacy through home visitation. We analyzed an AHRQ/NIH database of 2,572 parent/child dyads compiled in a 2006–2008 quasi-experimental six-site nationwide study using multiple waves of measurement and a matched comparison group. Cohort families participated in home visitation programs augmented to develop parents’ reflective skills. Visitors monitored depression, health- and healthcare-related practices, and surrounding family conditions at baseline and 6-month intervals for up to 36 months using the Life Skills Progression instrument. We examined differences in initial depression ratings for demographic subgroups and explored patterns of change in health literacy among depressed versus not-depressed parents. Correlation analysis showed that at each of four assessments better depression scores were consistently and positively correlated with use of information and services (r = 21–22, P < .001) and with self-management of personal and child health (r = 42–49, P < .001). Overall, parents made significant improvements in health literacy (P < .001). As expected, depressed parents demonstrated lower baseline health literacy scores than not-depressed parents; however, they achieved greater gains (P < .001). While depression is linked with lower parental health literacy, after 1 year of enhanced home visitation, vulnerable parents were better able to manage personal and family health and healthcare, especially if depressed. Enhanced home visitation could be an effective channel to develop health literacy as a life skill, and to improve depression.
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Affiliation(s)
- Sandra A Smith
- Department of Health Services, University of Washington, Seattle, WA, USA.
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Edison K, Staiculescu I, Hudson S. Educate your patients and improve outcomes: health literacy for the dermatologist. Clin Dermatol 2012; 30:459-63. [PMID: 22682199 DOI: 10.1016/j.clindermatol.2011.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Karen Edison
- Department of Dermatology, School of Medicine, University of Missouri, One Hospital Drive, Columbia, MO 65212, USA.
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Ali NS, Azam IS, Ali BS, Tabbusum G, Moin SS. Frequency and associated factors for anxiety and depression in pregnant women: a hospital-based cross-sectional study. ScientificWorldJournal 2012; 2012:653098. [PMID: 22629180 PMCID: PMC3354685 DOI: 10.1100/2012/653098] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 01/24/2012] [Indexed: 12/17/2022] Open
Abstract
Antepartum anxiety and/or depression is a major public health problem globally. The aim of this study was to estimate the frequency of antepartum anxiety and/or depression among pregnant women. This was a cross-sectional study conducted in a tertiary care hospital among pregnant women. A total of 165 pregnant women were interviewed by a clinical psychologist using HADS for assessing anxiety and/or depression and also collected information regarding sociodemographic, obstetric, family relationships, and home environment. Out of the total of 165 pregnant women about 70 percent of them were either anxious and/or depressed. The increasing age of women (P-value = 0.073), not having any live birth (P-value = 0.036), adverse pregnancy outcome in past including death of a child, stillbirth or abortion (P-value = 0.013), participant's role in household decision making (P-value = 0.013), and domestic violence (verbal or physical abuse towards mother or children by any family member) (P-value = 0.123). Our study highlights that anxiety and/or depression is quite common among pregnant women. Therefore, there is a need to incorporate screening for anxiety and depression in the existing antenatal programs and development of strategies to provide practical support to those identified.
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Affiliation(s)
- Niloufer S. Ali
- Department of Family Medicine, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
| | - Iqbal S. Azam
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
| | - Badar S. Ali
- Department of Family Medicine, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
| | - Ghurnata Tabbusum
- Department of Peadiatrics and Child Health, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
| | - Sana S. Moin
- Department of Rheumatology, Waikato Hospital, Pembroke Street, Hamilton 3204, New Zealand
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Park JH, Kim KW, Kim MH, Kim MD, Kim BJ, Kim SK, Kim JL, Moon SW, Bae JN, Woo JI, Ryu SH, Yoon JC, Lee NJ, Lee DY, Lee DW, Lee SB, Lee JJ, Lee JY, Lee CU, Chang SM, Jhoo JH, Cho MJ. A nationwide survey on the prevalence and risk factors of late life depression in South Korea. J Affect Disord 2012; 138:34-40. [PMID: 22284016 DOI: 10.1016/j.jad.2011.12.038] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 11/15/2011] [Accepted: 12/14/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study aimed to estimate prevalence rates and risk factors of LLD among a large nationwide sample of Korean elders in South Korea. METHOD Of 8199 randomly sampled Koreans aged 65 years or more, 6018 participated (response rate=73.4%). Using the Korean version of the short form Geriatric Depression Scale (SGDS-K), we classified individual scoring 8 or 9 as having possible depression and those scoring ≥ 10 as having probable depression. RESULTS The age-, gender-, education-, and urbanicity-standardized prevalences were 10.1% (95% CI=9.3-10.8) for possible depression, 17.8% (95% CI=16.8-8.7) for probable depression, and 27.8% (95% CI=26.7-29.0) for overall depression. Poverty, living alone, low education, illiteracy, smoking, history of head trauma, and low Mini Mental Status Examination score were associated with greater risk of depression, while mild alcohol use and moderate to heavy exercise were associated with lower risk of depression. However gender difference in the risk of depression was not found. CONCLUSION LLD is decidedly common in South Korea. It was associated with various sociodemographic and clinical factors, some of which are amendable through policy actions. This study was limited by use of the SGDS-K rather than a standardized clinical interview.
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Affiliation(s)
- Joon Hyuk Park
- Department of Psychiatry, Jeju National University School of Medicine and Jeju National University Hospital, Jejudo, Republic of Korea
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Visscher KL, Hutnik CM. Health literacy in Canada and the ophthalmology patient. Can J Ophthalmol 2012; 47:72-8. [DOI: 10.1016/j.jcjo.2011.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 09/05/2011] [Accepted: 10/04/2011] [Indexed: 11/29/2022]
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Bhat AA, DeWalt DA, Zimmer CR, Fried BJ, Rangachari P, Seol YH, Callahan LF. Associations between low literacy and health status measures: cross-sectional analyses of two physical activity trials. JOURNAL OF HEALTH COMMUNICATION 2011; 17:230-245. [PMID: 22059652 DOI: 10.1080/10810730.2011.585688] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Arthritis researchers have thoroughly documented a powerful relationship between years of education and health outcomes, but they have not documented the role of literacy. The authors examined the associations between literacy and arthritis health status measures. Participants were recruited from southeastern urban and rural areas. Rapid Estimate of Adult Literacy in Medicine, which provides an estimate of reading level in less than 3 minutes, was administered to 447 participants at baseline in 2 community-based randomized controlled trials of lifestyle interventions designed for aging sedentary adults with arthritis. Those who read below ninth grade were considered to have low literacy. Among the 447 study participants, the median sample age was 69 years. A majority of the participants were women (86%), Caucasian (80%), overweight or obese (72%). Of all participants, 20% had low literacy. Significantly more African Americans (54%) than Caucasians (12%) had low literacy levels (p < .001). Individuals with low literacy did not have significantly worse disability or arthritis symptoms than individuals with adequate literacy (all ps > .05). Among our study participants, 1 in 5 had low literacy, but literacy was not associated with health status in this population.
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Affiliation(s)
- Anita A Bhat
- Medical College of Georgia, 1120 15th Street, EB 1011, Augusta, GA 30912, USA.
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Nasreen HE, Kabir ZN, Forsell Y, Edhborg M. Prevalence and associated factors of depressive and anxiety symptoms during pregnancy: a population based study in rural Bangladesh. BMC WOMENS HEALTH 2011; 11:22. [PMID: 21635722 PMCID: PMC3117808 DOI: 10.1186/1472-6874-11-22] [Citation(s) in RCA: 150] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 06/02/2011] [Indexed: 01/07/2023]
Abstract
Background Few studies have examined the associated factors of antepartum depressive and anxiety symptoms (ADS and AAS) in low-income countries, yet the World Health Organization identifies depressive disorders as the second leading cause of global disease burden by 2020. There is a paucity of research on mental disorders and their predictors among pregnant women in Bangladesh. This study aims to estimate the prevalence of depressive and anxiety symptoms and explore the associated factors in a cross-section of rural Bangladeshi pregnant women. Methods The study used cross-sectional data originating from a rural community-based prospective cohort study of 720 randomly selected women in their third trimester of pregnancy from a district of Bangladesh. The validated Bangla version of the Edinburgh Postnatal Depression Scale was used to measure ADS, and a trait anxiety inventory to assess general anxiety symptoms. Background information was collected using a structured questionnaire at the respondents' homes. Results Prevalence of ADS was 18% and AAS 29%. Women's literacy (OR 0.59, 95% CI 0.37-0.95), poor partner relationship (OR 2.23, 95% CI 3.37-3.62), forced sex (OR 1.95, 95% CI 1.01-3.75), physical violence by spouse (OR 1.69, 95% CI 1.02-2.80), and previous depression (OR 4.62 95% CI 2.72-7.85) were found to be associated with ADS. The associated factors of AAS were illiteracy, poor household economy, lack of practical support, physical partner violence, violence during pregnancy, and interaction between poor household economy and poor partner relationship. Conclusion Depressive and anxiety symptoms are found to occur commonly during pregnancy in Bangladesh, drawing attention to a need to screen for depression and anxiety during antenatal care. Policies aimed at encouraging practical support during pregnancy, reducing gender-based violence, supporting women with poor partner relationships, and identifying previous depression may ameliorate the potentially harmful consequences of antepartum depression and anxiety for the women and their family, particularly children.
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Affiliation(s)
- Hashima E Nasreen
- Research and Evaluation Division, BRAC, 75 Mohakhali, Dhaka 1212, Bangladesh. Hashima-E-
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Peterson PN, Shetterly SM, Clarke CL, Bekelman DB, Chan PS, Allen LA, Matlock DD, Magid DJ, Masoudi FA. Health literacy and outcomes among patients with heart failure. JAMA 2011; 305:1695-701. [PMID: 21521851 PMCID: PMC4540335 DOI: 10.1001/jama.2011.512] [Citation(s) in RCA: 302] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Little is known about the effects of low health literacy among patients with heart failure, a condition that requires self-management and frequent interactions with the health care system. OBJECTIVE To evaluate the association between low health literacy and all-cause mortality and hospitalization among outpatients with heart failure. DESIGN, SETTING, AND PATIENTS Retrospective cohort study conducted at Kaiser Permanente Colorado, an integrated managed care organization. Outpatients with heart failure were identified between January 2001 and May 2008, were surveyed by mail, and underwent follow-up for a median of 1.2 years. Health literacy was assessed using 3 established screening questions and categorized as adequate or low. Responders were excluded if they did not complete at least 1 health literacy question or if they did not have at least 1 year of enrollment prior to the survey date. MAIN OUTCOME MEASURES All-cause mortality and all-cause hospitalization. RESULTS Of the 2156 patients surveyed, 1547 responded (72% response rate). Of 1494 included responders, 262 (17.5%) had low health literacy. Patients with low health literacy were older, of lower socioeconomic status, less likely to have at least a high school education, and had higher rates of coexisting illnesses. In multivariable Cox regression, low health literacy was independently associated with higher mortality (unadjusted rate, 17.6% vs 6.3%; adjusted hazard ratio, 1.97 [95% confidence interval, 1.3-2.97]; P = .001) but not hospitalization (unadjusted rate, 30.5% vs 23.2%; adjusted hazard ratio, 1.05 [95% confidence interval, 0.8-1.37]; P = .73). CONCLUSION Among patients with heart failure in an integrated managed care organization, low health literacy was significantly associated with higher all-cause mortality.
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Affiliation(s)
- Pamela N Peterson
- Division of Cardiology, Denver Health Medical Center, Mail Code 0960, 777 Bannock St, Denver, CO 80204, USA.
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Allen K, Zoellner J, Motley M, Estabrooks PA. Understanding the internal and external validity of health literacy interventions: a systematic literature review using the RE-AIM framework. JOURNAL OF HEALTH COMMUNICATION 2011; 16 Suppl 3:55-72. [PMID: 21951243 PMCID: PMC6214368 DOI: 10.1080/10810730.2011.604381] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We conducted a systematic literature review, using the RE-AIM framework, with the goal of determining what information is available to inform research to practice translation of health promotion interventions developed to address health literacy. Thirty-one articles reflecting 25 trials published between 2000 and 2010 met inclusion criteria. Two researchers coded each article, using a validated RE-AIM (reach, effectiveness/efficacy, adoption, implementation, maintenance) data extraction tool, and group meetings were used to gain consensus on discrepancies. Across all studies (14 randomized controlled trials, 11 quasi-experimental; 24 clinic-based, 1 community-based), the mean level of reporting RE-AIM indicators varied by dimension (reach = 69%; efficacy/ effectiveness = 58%; adoption = 36%; implementation = 35%; maintenance = 11%). Among participants enrolled in the 25 interventions, approximately 38% were identified as low health literate. Only eight of the studies examined health literacy status as a moderator of intervention effectiveness. This review suggests that the current research on health promotion for participants with low health literacy provides insufficient information to conclude whether interventions for health literacy can attract the target population, achieve an effect that is sustainable, or be generalized outside of clinical settings. Recommendations for enhancing the design and reporting of these trials are provided.
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Affiliation(s)
- Kacie Allen
- Department of Human Nutrition, Foods and Exercise, Virginia Polytechnic Institute and State University, Roanoke, Virginia 24016, USA.
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Bickmore TW, Mitchell SE, Jack BW, Paasche-Orlow MK, Pfeifer LM, ODonnell J. Response to a Relational Agent by Hospital Patients with Depressive Symptoms. INTERACTING WITH COMPUTERS 2010; 22:289-298. [PMID: 20628581 PMCID: PMC2901553 DOI: 10.1016/j.intcom.2009.12.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Depression affects approximately 15% of the US population, and is recognized as an important risk factor for poor outcomes among patients with various illnesses. Automated health education and behavior change programs have the potential to help address many of the shortcomings in health care. However, the role of these systems in the care of patients with depression has been insufficiently examined. In the current study, we sought to evaluate how hospitalized medical patients would respond to a computer animated conversational agent that has been developed to provide information in an empathic fashion about a patient's hospital discharge plan. In particular, we sought to examine how patients who have a high level of depressive symptoms respond to this system. Therapeutic alliance-the trust and belief that a patient and provider have in working together to achieve a desired therapeutic outcome- was used as the primary outcome measure, since it has been shown to be important in predicting outcomes across a wide range of health problems, including depression. In an evaluation of 139 hospital patients who interacted with the agent at the time of discharge, all patients, regardless of depressive symptoms, rated the agent very high on measures of satisfaction and ease of use, and most preferred receiving their discharge information from the agent compared to their doctors or nurses in the hospital. In addition, we found that patients with symptoms indicative of major depression rated the agent significantly higher on therapeutic alliance compared to patients who did not have major depressive symptoms. We conclude that empathic agents represent a promising technology for patient assessment, education and counseling for those most in need of comfort and caring in the inpatient setting.
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Affiliation(s)
- Timothy W. Bickmore
- College of Computer and Information Science, Northeastern University 360 Huntington Ave, WVH202, Boston, MA 02115 USA
| | - Suzanne E. Mitchell
- Boston University School of Medicine / Boston Medical Center 850 Harrison Ave, 2nd Floor, Boston, MA 02118 USA
| | - Brian W. Jack
- Boston University School of Medicine / Boston Medical Center 850 Harrison Ave, 2nd Floor, Boston, MA 02118 USA
| | - Michael K. Paasche-Orlow
- Boston University School of Medicine / Boston Medical Center 850 Harrison Ave, 2nd Floor, Boston, MA 02118 USA
| | - Laura M. Pfeifer
- College of Computer and Information Science, Northeastern University 360 Huntington Ave, WVH202, Boston, MA 02115 USA
| | - Julie ODonnell
- Boston University School of Medicine / Boston Medical Center 850 Harrison Ave, 2nd Floor, Boston, MA 02118 USA
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Rothman RL, Yin HS, Mulvaney S, Co JPT, Homer C, Lannon C. Health literacy and quality: focus on chronic illness care and patient safety. Pediatrics 2009; 124 Suppl 3:S315-26. [PMID: 19861486 DOI: 10.1542/peds.2009-1163h] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Despite a heightened focus on improving quality, recent studies have suggested that children only receive half of the indicated preventive, acute, or chronic care. Two major areas in need of improvement are chronic illness care and prevention of medical errors. Recently, health literacy has been identified as an important and potentially ameliorable factor for improving quality of care. Studies of adults have documented that lower health literacy is independently associated with poorer understanding of prescriptions and other medical information and worse chronic disease knowledge, self-management behaviors, and clinical outcomes. There is also growing evidence to suggest that health literacy is important in pediatric safety and chronic illness care. Adult studies have suggested that addressing literacy can lead to improved patient knowledge, behaviors, and outcomes. Early studies in the field of pediatrics have shown similar promise. There are significant opportunities to evaluate and demonstrate the importance of health literacy in improving pediatric quality of care. Efforts to address health literacy should be made to apply the 6 Institute of Medicine aims for quality-care that is safe, effective, patient centered, timely, efficient, and equitable. Efforts should also be made to consider the distinct nature of pediatric care and address the "4 D's" unique to child health: the developmental change of children over time; dependency on parents or adults; differential epidemiology of child health; and the different demographic patterns of children and their families.
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Affiliation(s)
- Russell L Rothman
- Vanderbilt University Medical Center, Vanderbilt Center for Health Services Research, Internal Medicine and Pediatrics, Suite 6000 Medical Center East, Nashville, TN 37232-8300, USA.
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Sanders LM, Shaw JS, Guez G, Baur C, Rudd R. Health literacy and child health promotion: implications for research, clinical care, and public policy. Pediatrics 2009; 124 Suppl 3:S306-14. [PMID: 19861485 DOI: 10.1542/peds.2009-1162g] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The nation's leading sources of morbidity and health disparities (eg, preterm birth, obesity, chronic lung disease, cardiovascular disease, type 2 diabetes, mental health disorders, and cancer) require an evidence-based approach to the delivery of effective preventive care across the life course (eg, prenatal care, primary preventive care, immunizations, physical activity, nutrition, smoking cessation, and early diagnostic screening). Health literacy may be a critical and modifiable factor for improving preventive care and reducing health disparities. Recent studies among adults have established an independent association between lower health literacy and poorer understanding of preventive care information and poor access to preventive care services. Children of parents with higher literacy skills are more likely to have better outcomes in child health promotion and disease prevention. Adult studies in disease prevention have suggested that addressing health literacy would be an efficacious strategy for reducing health disparities. Future initiatives to reduce child health inequities should include health-promotion strategies that meet the health literacy needs of children, adolescents, and their caregivers.
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Affiliation(s)
- Lee M Sanders
- University of Miami, Miller School of Medicine, Jay Weiss Center for Social Medicine and Health Equity, Department of Pediatrics, 1601 NW 12th Ave, Suite 4063, Miami, FL 33136, USA.
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Driscoll A, Davidson P, Clark R, Huang N, Aho Z. Tailoring consumer resources to enhance self-care in chronic heart failure. Aust Crit Care 2009; 22:133-40. [PMID: 19581110 DOI: 10.1016/j.aucc.2009.05.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 04/09/2009] [Accepted: 05/08/2009] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Chronic heart failure (CHF) is associated with high hospitalisation and mortality rates and debilitating symptoms. In an effort to reduce hospitalisations and improve symptoms individuals must be supported in managing their condition. Patients who can effectively self-manage their symptoms through lifestyle modification and adherence to complex medication regimens will experience less hospitalisations and other adverse events. AIM The purpose of this paper is to explain how providing evidence-based information, using patient education resources, can support self-care. DISCUSSION Self-care relates to the activities that individuals engage in relation to health seeking behaviours. Supporting self-care practices through tailored and relevant information can provide patients with resources and advice on strategies to manage their condition. Evidence-based approaches to improve adherence to self-care practices in patients with heart failure are not often reported. Low health literacy can result in poor understanding of the information about CHF and is related to adverse health outcomes. Also a lack of knowledge can lead to non-adherence with self-care practices such as following fluid restriction, low sodium diet and daily weighing routines. However these issues need to be addressed to improve self-management skills. OUTCOME Recently the Heart Foundation CHF consumer resource was updated based on evidence-based national clinical guidelines. The aim of this resource is to help consumers improve understanding of the disease, reduce uncertainty and anxiety about what to do when symptoms appear, encourage discussions with local doctors, and build confidence in self-care management. CONCLUSION Evidence-based CHF patient education resources promote self-care practices and early detection of symptom change that may reduce hospitalisations and improve the quality of life for people with CHF.
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Affiliation(s)
- Andrea Driscoll
- Dept of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
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Clement S, Ibrahim S, Crichton N, Wolf M, Rowlands G. Complex interventions to improve the health of people with limited literacy: A systematic review. PATIENT EDUCATION AND COUNSELING 2009; 75:340-351. [PMID: 19261426 DOI: 10.1016/j.pec.2009.01.008] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Revised: 12/23/2008] [Accepted: 01/08/2009] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate the published literature on the effects of complex (multi-faceted) interventions intended to improve the health-related outcomes of individuals with limited literacy or numeracy. METHODS We undertook a systematic review of randomized and quasi-randomized controlled trials with a narrative synthesis. The search strategy included searching eight databases from start date to 2007, reference checking and contacting expert informants. After the initial screen, two reviewers independently assessed eligibility, extracted data and evaluated study quality. RESULTS The searches yielded 2734 non-duplicate items, which were reduced to 15 trials. Two interventions were directed at health professionals, one intervention was literacy education, and 12 were health education/management interventions. The quality of the trials was mixed, 13/15 trials were conducted in North America, and all focused on literacy rather than numeracy. 13/15 trials reported at least one significant difference in primary outcome, all favoring the intervention group. Only 8/15 trials measured direct clinical outcomes. Knowledge and self-efficacy were the class of outcome most likely to improve. CONCLUSION A wide variety of complex interventions for adults with limited literacy are able to improve some health-related outcomes. PRACTICE IMPLICATIONS This review supports the wider introduction of interventions for people with limited literacy, particularly within an evaluation context.
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Affiliation(s)
- Sarah Clement
- Health Service and Population Research Department (PO29), David Goldberg Centre, Institute of Psychiatry, London, UK.
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Lee ACK, Tang SW, Leung SSK, Yu GKK, Cheung RTF. Depression literacy among Chinese stroke survivors. Aging Ment Health 2009; 13:349-56. [PMID: 19484598 DOI: 10.1080/13607860802636230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Mental health literacy is fundamental to the pursuit of health. Little is known about patients' literacy levels regarding depression even though it is common among elderly stroke survivors. This paper will report the level of mental health literacy and thematic constructs of depression interpreted by a group of stroke survivors. METHOD Qualitative data on patients' understanding of 'depression' in Chinese were translated and analyzed by an academic and a researcher separately to identify emerging constructs using a thematic approach. Out of 214 ischemic stroke older adults, aged 50+, 85 were able to explain the term in their own words after their first stroke attack. RESULTS The majority of stroke patients (60%, 129 out of 214) had never heard of depression and only four referred to it as a medical disease. Only a third would like to learn more about depression. Older Chinese adults depicted depression mainly by using words in the cognitive and affective domains, but the descriptors used were mostly non-specific and might not match the diagnostic criteria for depression or the commonly used screening tools. CONCLUSION Low mental health literacy among older patients indicated that much more work needs to be done in health promotion and education on depression literacy.
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Affiliation(s)
- A C K Lee
- Department of Nursing Studies, The University of Hong Kong, Hong Kong SAR, China.
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Sudore RL, Schillinger D. Interventions to Improve Care for Patients with Limited Health Literacy. JOURNAL OF CLINICAL OUTCOMES MANAGEMENT : JCOM 2009; 16:20-29. [PMID: 20046798 PMCID: PMC2799039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE: To propose a framework and describe best practices for improving care for patients with limited health literacy (LHL). METHODS: Review of the literature. RESULTS: Approximately half of the U.S. adult population has LHL. Because LHL is associated with poor health outcomes and contributes to health disparities, the adoption of evidence-based best practices is imperative. Feasible interventions at the clinician-patient level (eg, patient-centered communication, clear communication techniques, teach-to-goal methods, and reinforcement), at the system-patient level (eg, clear health education materials, visual aids, clear medication labeling, self-management support programs, and shame-free clinical environments), and at the community-patient level (eg, adult education referrals, lay health educators, and harnessing the mass media) can improve health outcomes for patients with LHL. CONCLUSION: Because LHL is prevalent, and because the recommended communication strategies can benefit patients of all literacy levels, clinicians, health system planners, and health policy leaders should promote the uptake of these strategies into routine care.
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Affiliation(s)
- Rebecca L Sudore
- Division of Geriatrics (Dr. Sudore), and the Division of General Internal Medicine (Dr. Schillinger), University of California, San Francisco, CA
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Sher L, Stanley BH, Cooper TB, Malone KM, Mann JJ, Oquendo MA. Serotonergic responses in depressed patients with or without a history of alcohol use disorders and healthy controls. Eur Neuropsychopharmacol 2008; 18:692-9. [PMID: 18590952 PMCID: PMC3785085 DOI: 10.1016/j.euroneuro.2008.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Revised: 05/13/2008] [Accepted: 05/19/2008] [Indexed: 01/21/2023]
Abstract
Dysfunction of serotonergic neurotransmission has been implicated in the etiopathogenesis of major depression (MDD) and alcohol use disorders (AUD). To compare serotonin function in MDD with co-occurring AUD (MDD/AUD), MDD without co-occurring AUD (MDD only) and healthy controls (HC) we sought to study differences in prolactin responses to fenfluramine administration in patients with MDD/AUD, patients with MDD only and HC. In all, 169 subjects (62 MDD/AUD, 75 MDD only, and 32 HC) were entered into the study. Controlling for gender, prolactin responses were lower in the MDD/AUD group compared to the MDD only or the HC group. Controlling for gender and aggression, prolactin responses in the MDD/AUD group remained significantly lower compared to the HC group but the difference between the MDD/AUD and the MDD only groups disappeared. The difference in prolactin responses between MDD/AUD and MDD only could be attributed to higher aggression scores in the MDD/AUD group compared to the MDD group.
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Affiliation(s)
- Leo Sher
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY 10032, USA.
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Ginde AA, Clark S, Goldstein JN, Camargo CA. Demographic disparities in numeracy among emergency department patients: evidence from two multicenter studies. PATIENT EDUCATION AND COUNSELING 2008; 72:350-356. [PMID: 18462915 DOI: 10.1016/j.pec.2008.03.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 02/22/2008] [Accepted: 03/09/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To estimate the prevalence and demographic disparities in limited numeracy among emergency department (ED) patients. METHODS We performed two cross-sectional studies of ED patients with sub-critical illness in 2000-2001 and 2006. We enrolled 959 adult patients from 28 EDs in 17 US states and measured numeracy based on four validated questions. RESULTS Rates of correct responses for individual numeracy questions ranged from 15% to 68%; only 11% of participants answered all questions correctly. Several demographic characteristics were independently associated with frequency of correct answers, including age (OR 0.92 [95% confidence interval (CI), 0.87-0.97] per (upward arrow) 5 years), race/ethnicity (compared to whites: OR 0.35 for blacks [95%CI, 0.20-0.63]; and OR 0.36 for Hispanics [95%CI, 0.19-0.69]), education (OR 4.74 [95%CI, 2.01-11.14] for high school graduates vs. not), health insurance (OR 1.70 [95%CI, 1.06-2.71] for those with private insurance vs. not), and income (OR 1.13 [95%CI, 1.05-1.22] per (upward arrow) $10,000). CONCLUSION We found a higher prevalence of limited numeracy among ED patients compared to the general population. Significant demographic disparities are consistent with previous observations for general health literacy. PRACTICE IMPLICATIONS Greater understanding of the high prevalence of limited numeracy may guide healthcare providers to simplify messages and communicate health information more effectively.
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Affiliation(s)
- Adit A Ginde
- Division of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, CO 80045, USA.
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Paasche-Orlow MK, Wolf MS. Evidence does not support clinical screening of literacy. J Gen Intern Med 2008; 23:100-2. [PMID: 17992564 PMCID: PMC2173929 DOI: 10.1007/s11606-007-0447-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Revised: 10/18/2007] [Accepted: 10/24/2007] [Indexed: 10/22/2022]
Abstract
Limited health literacy is a significant risk factor for adverse health outcomes. Despite controversy, many health care professionals have called for routine clinical screening of patients' literacy skills. Whereas brief literacy screening tools exist that with further evaluation could potentially be used to detect limited literacy in clinical settings, no screening program for limited literacy has been shown to be effective. Yet there is a noted potential for harm, in the form of shame and alienation, which might be induced through clinical screening. There is fair evidence to suggest that possible harm outweighs any current benefits; therefore, clinical screening for literacy should not be recommended at this time.
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Affiliation(s)
- Michael K Paasche-Orlow
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA.
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