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Eng E, Mowers C, Sachdev D, Yerke-Hansen P, Jackson GR, Knapik DM, Sabesan VJ. Despite an Advanced Readability for the General Population, ChatGPT-3.5 Can Effectively Supplement Patient-Related Information Provided by the Treating Surgeon Regarding Common Questions About Rotator Cuff Repair. Arthroscopy 2024:S0749-8063(24)00369-4. [PMID: 38777000 DOI: 10.1016/j.arthro.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 04/23/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE The purpose of this study was to investigate the accuracy of ChatGPT's responses to frequently asked questions (FAQ) prior to rotator cuff repair surgery. METHODS The ten most common FAQs related to rotator cuff repair were compiled from four institution websites. Questions were then input into ChatGPT-3.5 in one session. The provided ChatGPT-3.5 responses were analyzed by two orthopedic surgeons for reliability, quality, and readability using The Journal of the American Medical Association (JAMA) Benchmark criteria, the DISCERN score, and the Flesch-Kincaid Grade Level. RESULTS The JAMA Benchmark criteria score was 0, indicating the absence of reliable source material citations. The mean Flesch-Kincaid Grade Level was 13.4 (range, 11.2-15.0). The mean DISCERN score was 43.4 (range, 36-51) indicating that the quality of the responses overall was considered fair. All responses cited making final decision-making to be made with the treating physician. CONCLUSION ChatGPT-3.5 provided substandard patient-related information in alignment with recommendations from the treating surgeon regarding common questions around rotator cuff repair surgery. Additionally, the responses lacked reliable source material citations and the readability of the responses was relatively advanced with a complex language style. CLINICAL RELEVANCE The findings of this study suggest that ChatGPT-3.5 may not effectively supplement patient-related information in the context of recommendations provided by the treating surgeon prior to rotator cuff repair surgery.
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Affiliation(s)
- Emma Eng
- Charles E. Schmidt College of Medicine at Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Colton Mowers
- Rush University Medical College, Chicago, IL 60612, USA
| | | | - Payton Yerke-Hansen
- Department of Orthopaedic Surgery, Louisiana State University Health -Shreveport, Shreveport, LA 71103, USA
| | - Garrett R Jackson
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO 65212, USA.
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Washington University and Barnes-Jewish Orthopedic Center, Chesterfield, MO, USA
| | - Vani J Sabesan
- HCA JFK/University of Miami Miller School of Medicine Orthopaedic Residency Program Palm Beach, FL, Lake Worth, FL 33463, USA
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Falade IO, Wilson JC, Mehari ME, Soroudi D, Song S, Kim EA. The complexity of online patient education materials for wound care strategies: A readability analysis. Surgery 2024:S0039-6060(24)00238-1. [PMID: 38769036 DOI: 10.1016/j.surg.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/13/2024] [Accepted: 04/06/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND In the United States, over 6 million people are affected by chronic wounds. Patients often rely on the Internet for treatment information; however, these educational materials typically exceed the average eighth-grade health literacy level. This study aimed to assess the readability and language accessibility of online patient education materials on wound care strategies. METHODS A search was conducted on Google for articles related to wound care strategies. The first 12 unique websites from each search strategy were selected for further analysis. Readability was assessed using 11 tests, with the mean scores calculated for each. RESULTS A total of 66 articles pertaining to wound care strategies were retrieved from 43 websites. All articles had an average reading grade level of 13.5 ± 2.5 and an average reading age of 18.7 ± 2.5 years. Websites were categorized by the following sources: academic (34.9%), reagent/biologic manufacturers (27.9%), wound care (18.6%), news media organizations (14%), and other (4.7%). Flesch Reading Ease Score, graded from 0 for most difficult to 100 for least difficult, was found to be highest for academic websites (44.2, P = .01) and lowest for news media websites (24.9, P = .01). Academic websites were available in the more languages compared to all other website categories (P < .01). CONCLUSION Online materials related to wound care strategies often exceed the National Institute of Health recommended eighth-grade reading level. This study emphasizes the need for healthcare providers to create more accessible educational materials to address the gap in health literacy and optimize patient care.
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Affiliation(s)
- Israel O Falade
- School of Medicine, University of California San Francisco, San Francisco, CA. https://www.twitter.com/israelfal
| | - Jasmin C Wilson
- School of Medicine, University of California San Francisco, San Francisco, CA
| | - Mulki E Mehari
- School of Medicine, University of California San Francisco, San Francisco, CA
| | - Daniel Soroudi
- School of Medicine, University of California San Francisco, San Francisco, CA
| | - Siyou Song
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, CA
| | - Esther A Kim
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, CA.
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Fahy S, Niemann M, Böhm P, Winkler T, Oehme S. Assessment of the Quality and Readability of Information Provided by ChatGPT in Relation to the Use of Platelet-Rich Plasma Therapy for Osteoarthritis. J Pers Med 2024; 14:495. [PMID: 38793077 PMCID: PMC11122161 DOI: 10.3390/jpm14050495] [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: 04/14/2024] [Revised: 04/28/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024] Open
Abstract
Objective: This study aimed to evaluate the quality and readability of information generated by ChatGPT versions 3.5 and 4 concerning platelet-rich plasma (PRP) therapy in the management of knee osteoarthritis (OA), exploring whether large language models (LLMs) could play a significant role in patient education. Design: A total of 23 common patient queries regarding the role of PRP therapy in knee OA management were presented to ChatGPT versions 3.5 and 4. The quality of the responses was assessed using the DISCERN criteria, and readability was evaluated using six established assessment tools. Results: Both ChatGPT versions 3.5 and 4 produced moderate quality information. The quality of information provided by ChatGPT version 4 was significantly better than version 3.5, with mean DISCERN scores of 48.74 and 44.59, respectively. Both models scored highly with respect to response relevance and had a consistent emphasis on the importance of shared decision making. However, both versions produced content significantly above the recommended 8th grade reading level for patient education materials (PEMs), with mean reading grade levels (RGLs) of 17.18 for ChatGPT version 3.5 and 16.36 for ChatGPT version 4, indicating a potential barrier to their utility in patient education. Conclusions: While ChatGPT versions 3.5 and 4 both demonstrated the capability to generate information of moderate quality regarding the role of PRP therapy for knee OA, the readability of the content remains a significant barrier to widespread usage, exceeding the recommended reading levels for PEMs. Although ChatGPT version 4 showed improvements in quality and source citation, future iterations must focus on producing more accessible content to serve as a viable resource in patient education. Collaboration between healthcare providers, patient organizations, and AI developers is crucial to ensure the generation of high quality, peer reviewed, and easily understandable information that supports informed healthcare decisions.
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Affiliation(s)
- Stephen Fahy
- Center for Musculoskeletal Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (S.F.); (M.N.); (T.W.)
| | - Marcel Niemann
- Center for Musculoskeletal Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (S.F.); (M.N.); (T.W.)
| | - Peter Böhm
- Deutsche Rheuma-Liga e.V., 53111 Bonn, Germany;
| | - Tobias Winkler
- Center for Musculoskeletal Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (S.F.); (M.N.); (T.W.)
- Berlin Institute of Health Center for Regenerative Therapies, Berlin Institute of Health at Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Julius Wolff Institute, 13353 Berlin, Germany
| | - Stephan Oehme
- Center for Musculoskeletal Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (S.F.); (M.N.); (T.W.)
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Afessa N, Birhanu D, Negese B, Tefera M. Palliative care service utilization and associated factors among cancer patients at oncology units of public hospitals in Addis Ababa, Ethiopia. PLoS One 2024; 19:e0294230. [PMID: 38483983 PMCID: PMC10939243 DOI: 10.1371/journal.pone.0294230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 10/29/2023] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Palliative care helps patients and their families deal with the hardships that come with a life-threatening illness. However, patients were not fully utilizing the palliative care services provided by healthcare facilities for a number of reasons. In Ethiopia, there hasn't been any research done on the variables that influence the utilization of palliative care services. OBJECTIVE To assess palliative care service utilization & associated factors affecting cancer patients at public hospitals oncology units in Addis Ababa, Ethiopia. METHODS An institution-based cross-sectional study design was carried out. A structured and pre-tested questionnaire was administered to 404 participants at Tikur Anbesa Specialized Hospital and Saint Paul's Hospital Millennium Medical College from July 4 to August 2, 2022. A systematic random sampling technique was used to select the study participants. The data was collected by ODK-Collect version 3.5 software and exported to excel and then to SPSS version 25 for recoding, cleaning, and analysis. Logistic regression model was employed. P-values <0.05 were regarded as statistically significant. RESULT About 404 participants' responded questionnaire giving a 97.6% response rate. The extent of Palliative care service utilization was 35.4% [95% CI: 31.4, 40.3%]. College or university education were 2.3 times more likely and living in a distance of <23 km from PC service centers were 1.8 times more likely to use palliative care services. Factors hindering palliative care service utilization were inability to read & write, treatment side effects, long distance to a health institution, and low satisfaction with the health care service. CONCLUSION AND RECOMMENDATION The extent of palliative care service utilization which was low. Factors to palliative care service utilization were clients' education level, treatment side effects, distance to a health institution, and patients' satisfaction. Interventions to enhance health education and counseling of cancer patients, early detection and management of treatment side effects and accessibility of palliative care services for cancer patients should be emphasized and implemented by all concerned stakeholders.
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Affiliation(s)
- Nigus Afessa
- Department of Nursing, School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Dagmawit Birhanu
- Department of Nursing, School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Belete Negese
- Department of Nursing, School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Mitiku Tefera
- Department of Midwifery, School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
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Roster K, Kann RB, Farabi B, Gronbeck C, Brownstone N, Lipner SR. Readability and Health Literacy Scores for ChatGPT-Generated Dermatology Public Education Materials: Cross-Sectional Analysis of Sunscreen and Melanoma Questions. JMIR DERMATOLOGY 2024; 7:e50163. [PMID: 38446502 PMCID: PMC10955394 DOI: 10.2196/50163] [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: 06/21/2023] [Revised: 01/02/2024] [Accepted: 02/06/2024] [Indexed: 03/07/2024] Open
Affiliation(s)
- Katie Roster
- New York Medical College, New York, NY, United States
| | | | - Banu Farabi
- Dermatology Department, NYC Health + Hospital/Metropolitan, New York, NY, United States
| | - Christian Gronbeck
- Department of Dermatology, University of Connecticut HealthCenter, Framington, CT, United States
| | - Nicholas Brownstone
- Department of Dermatology, Temple University Hospital, Philadelphia, PA, United States
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, NY, United States
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Sathyanarayanan S, Paidisetty P, Wang LKP, Gosman A, Williams S, Chen W. Assessing the Readability of Online English and Spanish Language Patient Education Resources Provided by the American Society of Plastic Surgeons, American Society of Aesthetic Plastic Surgeons, and American Society of Reconstructive Microsurgeons. Ann Plast Surg 2024; 92:263-266. [PMID: 38320007 DOI: 10.1097/sap.0000000000003754] [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: 02/08/2024]
Abstract
INTRODUCTION The National Institutes of Health recommends that patient education materials (PEMs) be written at the sixth grade level. However, PEMs online are still generally difficult to read. The usefulness of online PEMs depends on their comprehensibility. OBJECTIVES This study assessed the readability of PEMs from national Plastic and Reconstructive Surgery (PRS) organization websites. METHODS Patient education materials were collected from 3 prominent PRS organizations-the American Society of Plastic Surgeons (ASPS), American Society of Aesthetic Plastic Surgeons (ASAPS), and the American Society of Reconstructive Microsurgeons (ASRM). ASPS PEMs were organized into reconstructive and cosmetic groups, and then further subdivided into English and Spanish subgroups. ASAPS and ASRM PEMs provided cosmetic and reconstructive comparison groups to ASPS, respectively. Readability scores were generated using the Simple Measure of Gobbledygook (SMOG) and the Spanish SMOG scales. RESULTS Overall, all PEMs failed to meet readability guidelines. Within ASPS, Spanish PEMs were easier to read than English PEMs ( P < 0.001), and cosmetic PEMs were easier to read than reconstructive PEMs ( P < 0.05). There was no significant difference between ASPS cosmetic and ASAPS PEMs ( P = 0.36), nor between ASPS reconstructive and ASRM PEMs ( P = 0.65). ASAPS and ASRM did not have any Spanish PEMs, and 92% of all ASPS PEMs were in English. CONCLUSION Although PRS societies strive to better educate the public on the scope of PRS, PRS ranks lowly in public understanding of its role in patient care. In addition, Spanish language PEMs from the 3 PRS organizations are severely lacking. Addressing these concerns will make online patient resources more equitable for various patient populations.
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Affiliation(s)
| | - Praneet Paidisetty
- From the University of Texas Health Science Center Houston at McGovern Medical School Houston
| | - Leonard Kuan-Pei Wang
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX
| | - Amanda Gosman
- Division of Plastic Surgery, UC San Diego School of Medicine, San Diego
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Fahy S, Oehme S, Milinkovic D, Jung T, Bartek B. Assessment of Quality and Readability of Information Provided by ChatGPT in Relation to Anterior Cruciate Ligament Injury. J Pers Med 2024; 14:104. [PMID: 38248805 PMCID: PMC10817257 DOI: 10.3390/jpm14010104] [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: 11/03/2023] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
The aim of our study was to evaluate the potential role of Artificial Intelligence tools like ChatGPT in patient education. To do this, we assessed both the quality and readability of information provided by ChatGPT 3.5 and 4 in relation to Anterior Cruciate Ligament (ACL) injury and treatment. ChatGPT 3.5 and 4 were used to answer common patient queries relating to ACL injuries and treatment. The quality of the information was assessed using the DISCERN criteria. Readability was assessed with the use of seven readability formulae: the Flesch-Kincaid Reading Grade Level, the Flesch Reading Ease Score, the Raygor Estimate, the SMOG, the Fry, the FORCAST, and the Gunning Fog. The mean reading grade level (RGL) was compared with the recommended 8th-grade reading level, the mean RGL among adults in America. The perceived quality and mean RGL of answers given by both ChatGPT 3.5 and 4 was also compared. Both ChatGPT 3.5 and 4 yielded DISCERN scores suggesting "good" quality of information, with ChatGPT 4 slightly outperforming 3.5. However, readability levels for both versions significantly exceeded the average 8th-grade reading level for American patients. ChatGPT 3.5 had a mean RGL of 18.08, while the mean RGL of ChatGPT 4 was 17.9, exceeding the average American reading grade level by 10.08 grade levels and 9.09 grade levels, respectively. While ChatGPT can provide both reliable and good quality information on ACL injuries and treatment options, the readability of the content may limit its utility. Additionally, the consistent lack of source citation represents a significant area of concern for patients and clinicians alike. If AI is to play a role in patient education, it must reliably produce information which is accurate, easily comprehensible, and clearly sourced.
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Affiliation(s)
- Stephen Fahy
- Centrum für Muskuloskeletale Chirurgie, Charité Universitätsmedizin, 10117 Berlin, Germany; (S.O.); (T.J.); (B.B.)
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Tran AX, Barriera P, Xiong D, Knackstedt T. Racial-Ethnic, Education, and Socioeconomic Differences in the Treatment of Head and Neck Melanoma in situ: A Surveillance Epidemiology and End Results Population-Based Analysis. Dermatol Surg 2023; 49:1134-1138. [PMID: 37962949 DOI: 10.1097/dss.0000000000004005] [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: 11/16/2023]
Abstract
BACKGROUND Incidence and treatment disparities for cutaneous melanomas have been documented among racial and sociodemographic minorities. However, the association between treatment types, race, and socioeconomic status remains unknown. OBJECTIVE To characterize treatment differences for head and neck melanoma in situ (MIS) and lentigo maligna (LM) based on race and sociodemographic variables. MATERIALS AND METHODS A population-based retrospective cohort study of the Surveillance Epidemiology and End Results database (1998-2016) was performed. Univariate and multivariate logistic regression modeling evaluated the association of race and US census-reported sociodemographic factors with Mohs micrographic surgery (MMS) utilization. RESULTS A total of 76,328 adult patients with head and neck MIS/LM were included. MMS accounted for 11.8% of total cases, with increased utilization observed since 1998-2002. Compared with areas with greater percentages of individuals completing high school (first quartile), patients living in the second (Odds ratio [OR] 0.71; 95% confidence interval [CI] 0.64-0.80; p < .001), third (OR 0.74; 95% CI 0.63-0.86; p < .001), and fourth quartiles (OR 0.44; 95% CI 0.35-0.55; p < .001) were less likely to undergo MMS for their MIS/LM. CONCLUSION Educational efforts and awareness can bridge the knowledge gaps of appropriate treatment in patients with head and neck MIS/LM.
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Affiliation(s)
- Andrew X Tran
- Department of Dermatology, MetroHealth System, Cleveland, Ohio
| | - Paola Barriera
- Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - David Xiong
- Department of Dermatology, University Hospitals, Cleveland, Ohio
| | - Thomas Knackstedt
- Department of Dermatology, Case Western Reserve School of Medicine, Cleveland, Ohio
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- Pinehurst Dermatology & Mohs Surgery Center, Pinehurst, North Carolina
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Müller F, Munagala A, Arnetz JE, Achtyes ED, Alshaarawy O, Holman HT. Racial disparities in emergency department utilization among patients with newly diagnosed depression. Gen Hosp Psychiatry 2023; 85:163-170. [PMID: 37926052 DOI: 10.1016/j.genhosppsych.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/25/2023] [Accepted: 10/28/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To test the hypothesis that racial and ethnic minorities have increased emergency department visit rates, despite being established with a primary care provider. METHODS In this retrospective cohort study, ED visits without hospital admission in a 12-month period among patients with a new primary care provider-issued diagnosis of depression were assessed. Electronic medical record (EMR) data was obtained from 47 family medicine clinics in a large Michigan-based healthcare system. General linear regression models with Poisson distribution were used to predict frequency of ED visits. RESULTS A total of 4159 patients were included in the analyses. In multivariable analyses, Black / African American race was associated with an additional 0.90 (95% CI 0.64, 1.16) ED visits and American Indian or Alaska Native race was associated with an additional 1.39 (95% CI 0.92, 1.87) ED visits compared to White or Caucasians (null value 0). These risks were only exceeded by patients who received a prescription for a typical antipsychotic drug agent. CONCLUSION Despite being established patients at primary care providers and having follow-up encounters, Black / African American and American Indian or Alaska Native patients with depression were considerably more likely to seek ED treatment compared to White/Caucasian patients with depression.
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Affiliation(s)
- Frank Müller
- Department of Family Medicine, Michigan State University, Grand Rapids, MI, USA; Corewell Health Family Medicine Residency Clinic, Grand Rapids, MI, USA; Department of General Practice, University Medical Center Göttingen, Göttingen, Germany.
| | - Akhilesh Munagala
- Department of Family Medicine, Michigan State University, Grand Rapids, MI, USA.
| | - Judith E Arnetz
- Department of Family Medicine, Michigan State University, Grand Rapids, MI, USA.
| | - Eric D Achtyes
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA.
| | - Omayma Alshaarawy
- Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA.
| | - Harland T Holman
- Department of Family Medicine, Michigan State University, Grand Rapids, MI, USA; Corewell Health Family Medicine Residency Clinic, Grand Rapids, MI, USA.
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Gulbrandsen MT, O’Reilly OC, Gao B, Cannon D, Jesurajan J, Gulbrandsen TR, Phipatanakul WP. Health literacy in rotator cuff repair: a quantitative assessment of the understandability of online patient education material. JSES Int 2023; 7:2344-2348. [PMID: 37969518 PMCID: PMC10638567 DOI: 10.1016/j.jseint.2023.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background The American Medical Association and National Institutes of Health recommend online health information be written at a 6th grade or lower reading level for clear understanding. While syntax reading grade level has previously been utilized, those analyses do not determine whether readers are processing key information (understandability) or identifying available actions to take (actionability). The Patient Education Materials Assessment Tool (PEMAT-P) is a method to measure the understandability and actionability of online patient education materials. The purpose of this study was to evaluate online resources regarding rotator cuff repair utilizing measures of readability, understandability, and actionability. Methods The search term "rotator cuff surgery" was used in two independent online searches to obtain the top 50 search results. The readability of included resources was quantified using valid objective algorithms: Flesch-Kincaid Grade-Level, Simple Measure of Gobbledygook grade, Coleman-Liau Index, and Gunning Fog Index. The PEMAT-P form was used to assess actionability and understandability. Results A total of 49 unique websites were identified to meet our inclusion criteria and were included in our analysis. The mean Flesch-Kincaid Grade Level graded materials at a 10.6 (approximately a 10th grade reading level), with only two websites offering materials at a 6th grade reading level or below. The remaining readability studies graded the mean reading level at high school or greater, with the Gunning Fog Index scoring at a collegiate reading level. Mean understandability and actionability scores were 64.6% and 29.5%, respectively, falling below the 70% PEMAT score threshold for both scales. Fourteen (28.6%) websites were above the threshold for understandability, while no website (0%) scored above the 70% threshold for actionability. When comparing source categories, commercial health publishers provided websites that scored higher in understandability (P < .05), while private practice materials scored higher in actionability (P < .05). Resources published by academic institutions or organizations scored lower in both understandability and actionability than private practice and commercial health publishers (P < .05). No readability, understandability, or actionability score was significantly associated with search result rank. Conclusion Overall, online patient education materials related to rotator cuff surgery scored poorly with respect to readability, understandability, and actionability. Only two (4.1%) of the patient education websites scored at the American Medical Association and National Institutes of Health recommended reading level. Fourteen (28.6%) scored above the 70% PEMAT score for understandability; however, no website met the threshold for actionability.
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Affiliation(s)
- Matthew T. Gulbrandsen
- Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Olivia C. O’Reilly
- Department of Orthopedic Surgery, University of Iowa Hospital, Iowa City, IA, USA
| | - Burke Gao
- Department of Orthopedic Surgery, University of Iowa Hospital, Iowa City, IA, USA
| | - Damion Cannon
- Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Jose Jesurajan
- Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | | | - Wesley P. Phipatanakul
- Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
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Szilágyiné Lakatos T, Lukács B, Nagy AC, Jenei Z, Veres-Balajti I. Efficiency of Printed Patient Information Leaflets Written for Total Knee and Hip Arthroplasty Patients to Reduce Their Fear of Surgery. Geriatrics (Basel) 2023; 8:89. [PMID: 37736889 PMCID: PMC10514843 DOI: 10.3390/geriatrics8050089] [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: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/23/2023] Open
Abstract
Background: Patient education plays a key role in health care. In our study, we created a new information guide for patients waiting for total knee (TKA) or hip (THA) arthroplasty. The goal of our study was to create patient education material that would reduce patients' fear of surgery and improve their postoperative lifestyle. Methods: Patients in the intervention group (n = 44) received newly developed paper-based patient education material before surgery. The surgical fear questionnaire (SFQ) was used to assess fear reduction. A self-designed assessment questionnaire was used to measure the effectiveness of the leaflet among the intervention group patients. Results: The SFQ scores decreased significantly both in patients with TKA (median 37.50 IQR 30.00-40.00 vs. median 20.00 IQR 16.00-24.00) and THA (median 34.50 IQR 28.00-42.00 vs. median 20.00 IQR 16.00-22.00). A control group with TKA (median 37.50 IQR 30.00-40.00 vs. median 64.50 IQR 54.00-82.00) and THA (median 34.50 IQR 28.00-42.00 vs. median 73.00 IQR 56.00-81.00) was also included. An assessment of the content, usability, and clarity of the new leaflet showed that patients rated the new leaflet as almost entirely usable (median score 12.00-10.00). Conclusions: Our results suggest that new printed patient education material may reduce the fear of surgery.
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Affiliation(s)
- Tünde Szilágyiné Lakatos
- Department of Medical Rehabilitation and Physical Medicine, Faculty of Medicine, University of Debrecen, 4031 Debrecen, Hungary;
| | - Balázs Lukács
- Department of Physiotherapy, Faculty of Health Sciences, Institute of Health Sciences, University of Debrecen, 4028 Debrecen, Hungary; (B.L.); (I.V.-B.)
| | - Attila Csaba Nagy
- Department of Health Informatics, Faculty of Health Sciences, Institute of Health Sciences, University of Debrecen, 4028 Debrecen, Hungary;
| | - Zoltán Jenei
- Department of Medical Rehabilitation and Physical Medicine, Faculty of Medicine, University of Debrecen, 4031 Debrecen, Hungary;
| | - Ilona Veres-Balajti
- Department of Physiotherapy, Faculty of Health Sciences, Institute of Health Sciences, University of Debrecen, 4028 Debrecen, Hungary; (B.L.); (I.V.-B.)
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Simion L, Rotaru V, Cirimbei C, Gales L, Stefan DC, Ionescu SO, Luca D, Doran H, Chitoran E. Inequities in Screening and HPV Vaccination Programs and Their Impact on Cervical Cancer Statistics in Romania. Diagnostics (Basel) 2023; 13:2776. [PMID: 37685314 PMCID: PMC10486539 DOI: 10.3390/diagnostics13172776] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
(1) Introduction: A Romanian woman is diagnosed with cervical cancer every two hours; the country ranks second in Europe in terms of the mortality and incidence rate of this disease. This paper aims to identify the main reasons that have led to this situation, focusing on the measures taken by the Romanian Ministry of Health for the prevention of this type of cancer-national programs for cervical cancer screening and HPV vaccination. (2) Materials and methods: We performed a study based on the available secondary data from the National Statistics Institute, World Health Organization and Bucharest Institute of Oncology in order to assess the burden associated with cervical cancer and place it in the context of known global and European incidence and mortality rates, thus evaluating the importance of this health issue in Romania. The second component of our study was a cross-sectional study. Here, we used a 14-question questionnaire applied to the women participating in the National Screening Program for Cervical Cancer and aimed to evaluate the women's level of knowledge about screening and HPV vaccination and their access cervical-cancer-specific healthcare services. (3) Results: The results of this research show that a high percentage of women postpone routine checks due to a lack of time and financial resources and indicate that a low level of knowledge about the disease and the specific preventive methods determines the low participation in screening and HPV vaccination programs implemented in Romania, contributing to the country's cervical cancer situation. (4) Conclusions: The national programs have complicated procedures, are underfunded and do not motivate healthcare workers enough. This, combined with the lack of information for the eligible population, adds up to an extremely low number of women screened and vaccinated. Our conclusion is that the Romanian Ministry of Health must take immediate action by conducting major awareness campaigns, implementing measures to make the programs functional and ensuring coherent funding.
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Affiliation(s)
- Laurentiu Simion
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (L.S.); (L.G.); (D.-C.S.); (D.L.); (H.D.); (E.C.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Vlad Rotaru
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (L.S.); (L.G.); (D.-C.S.); (D.L.); (H.D.); (E.C.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Ciprian Cirimbei
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (L.S.); (L.G.); (D.-C.S.); (D.L.); (H.D.); (E.C.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Laurentia Gales
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (L.S.); (L.G.); (D.-C.S.); (D.L.); (H.D.); (E.C.)
- Medical Oncology Department, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Daniela-Cristina Stefan
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (L.S.); (L.G.); (D.-C.S.); (D.L.); (H.D.); (E.C.)
| | - Sinziana-Octavia Ionescu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (L.S.); (L.G.); (D.-C.S.); (D.L.); (H.D.); (E.C.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Dan Luca
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (L.S.); (L.G.); (D.-C.S.); (D.L.); (H.D.); (E.C.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Horia Doran
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (L.S.); (L.G.); (D.-C.S.); (D.L.); (H.D.); (E.C.)
- Surgical Clinic I, Clinical Hospital Dr. I. Cantacuzino Bucharest, 030167 Bucharest, Romania
| | - Elena Chitoran
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (L.S.); (L.G.); (D.-C.S.); (D.L.); (H.D.); (E.C.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
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Rosenbaum AJ, Marinescu AG, Levine D, Ellis SJ. Republication of "Cross-Sectional Assessment of Orthopedic Foot and Ankle Patient Knowledge". FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231188095. [PMID: 37506106 PMCID: PMC10369091 DOI: 10.1177/24730114231188095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Abstract
Background Individuals with limited health literacy often struggle in effectively communicating with their physicians and may lack the skills needed to make informed health decisions. It is therefore important that providers have insight into patients' baseline medical knowledge, as this can help physicians customize their approach to, and conversations with, each patient. As such, this study evaluated the foot and ankle-specific knowledge of patients seeking care for various foot and ankle ailments. Methods An unvalidated survey developed by our study group was distributed to 206 patients, assessing their knowledge of foot and ankle anatomy, terminology, conditions, treatment, and perioperative issues. Performance was evaluated as a function of participants' demographic factors. Results Participants performed significantly worse on the conditions and treatment questions as compared to the anatomy, terminology, and perioperative considerations subsections. Significantly better performance correlated with education (≥college), visit type (preoperative evaluation), a current or previous health care occupation, and prior orthopedic surgeon evaluation. Conclusions Patients' knowledge of foot and ankle anatomy, terminology, conditions, treatment, and perioperative issues correlates with certain patient characteristics and demographics. With enhanced insight into the risk factors for limited knowledge, education campaigns can be designed to target those most in need.
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Muacevic A, Adler JR, Mamilly A, Saad Aldine A, De Alba L, Arevalo O, Ahuja C, Cuellar HH. The Complexity of Online Patient Education Materials About Interventional Neuroradiology Procedures Published by Major Academic Institutions. Cureus 2023; 15:e34233. [PMID: 36852354 PMCID: PMC9962712 DOI: 10.7759/cureus.34233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 01/27/2023] Open
Abstract
Introduction Health literacy is an independent predictor of population health status and is directly related to the readability of available patient education material. The National Institutes of Health (NIH) and the American Medical Association have recommended that patient education materials (PEMs) be written between a fourth- and a sixth-grade education level. The authors assessed the readability of online PEMs about neurointerventional procedures that have been published by several academic institutions across the US. Methods Online PEMs regarding five common neurointerventional procedures, including mechanical thrombectomy for large vessel occlusion, cerebral diagnostic angiography, carotid artery stenting, endovascular aneurysm embolization, and epidural steroid injection collected from the websites of 20 top institutions in Neurology and Neurosurgery. The materials were assessed via five readability scales and then were statistically analyzed and compared to non-institutional education websites (Wikipedia.com and WebMD.com). Results None of the PEMs were written at or below the NIH's recommended 6th-grade reading level. The average educational level required to comprehend the texts across all institutions, as assessed by the readability scales, was 10-11th grade level. Some materials required a college-level education or higher. Material from non-institutional websites had significantly lower readability scores compared to the 20 institutions. Conclusions Current PEMs related to neurointerventional procedures are not written at or below the NIH's recommended fourth- to sixth-grade education level. Given the complexity of those procedures, significant attention should be pointed toward an improvement in the available online materials.
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Amdani S, Conway J, Kleinmahon J, Auerbach S, Hsu D, Cousino MK, Kaufman B, Alejos J, Cruz JH, Lee HY, Rudraraju R, Kirklin JK, Asante-Korang A. Race and Socioeconomic Bias in Pediatric Cardiac Transplantation. JACC. HEART FAILURE 2023; 11:19-26. [PMID: 36599545 DOI: 10.1016/j.jchf.2022.08.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND To date, no studies evaluated implicit bias among clinicians caring for children with advanced heart failure. OBJECTIVES This study aims to evaluate implicit racial and socioeconomic bias among pediatric heart transplant clinicians. METHODS A cross-sectional survey of transplant clinicians from the Pediatric Heart Transplant Society was conducted between June and August 2021. The survey consisted of demographic questions along with explicit and validated race and socioeconomic status (SES) implicit association tests (IATs). Implicit and explicit biases among survey group members were studied and associations were tested between implicit and explicit measures. RESULTS Of 500 members, 91 (18.2%) individuals completed the race IAT and 70 (14%) completed the SES IAT. Race IAT scores indicated moderate levels of implicit bias (mean = 0.33, d = 0.76; P < 0.001; ie, preference for White individuals). SES IAT scores indicated strong implicit bias (mean = 0.52, d = 1.53; P < 0.001; ie, preference for people from upper SES). There were weak levels of explicit race and wealth bias. There was a strong level of explicit education bias (mean = 5.22, d = 1.19; P < 0.001; ie, preference for educated people). There were nonsignificant correlations between the race and the SES IAT and explicit measures (P > 0.05 for all). CONCLUSIONS As observed across other health care disciplines, among a group of pediatric heart transplant clinicians, there is an implicit preference for individuals who are White and from higher SES, and an explicit preference for educated people. Future studies should evaluate how implicit biases affect clinician behavior and assess the impact of efforts to reduce such biases.
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Affiliation(s)
- Shahnawaz Amdani
- Department of Pediatric Cardiology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA.
| | - Jennifer Conway
- Department of Cardiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Jake Kleinmahon
- Department of Cardiology, Ochsner Hospital for Children, New Orleans, Louisiana, USA
| | - Scott Auerbach
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Daphne Hsu
- Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, New York, USA
| | - Melissa K Cousino
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Beth Kaufman
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Stanford, California, USA
| | - Juan Alejos
- Division of Pediatric Cardiology, UCLA Mattel Children's Hospital, Los Angeles, California, USA
| | - Jason Hopper Cruz
- Department of Cardiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Hannah Y Lee
- Department of Pediatrics, Program for Pediatric Cardiomyopathy, Heart Failure and Transplantation, Columbia University Irving Medical Center, New York, New York, USA
| | - Ramaraju Rudraraju
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James K Kirklin
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Alfred Asante-Korang
- Division of Pediatric Cardiology, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
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How readable are orthognathic surgery consent forms? Int Orthod 2022; 20:100689. [PMID: 36117084 DOI: 10.1016/j.ortho.2022.100689] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/19/2022] [Accepted: 08/20/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND/OBJECTIVE The valid consent process for medical intervention requires the disclosure of information in a format that is easily understandable by the patient. The aim of this investigation was to assess the readability of orthognathic surgery informed consent forms (OSICFs). METHODS An online search methodology was conducted to identify OSICFs for analysis. The forms that satisfied inclusion/exclusion criteria were evaluated according to a standardised protocol. The readability of the content was assessed using three validated tools: the Simple Measure of Gobbledegook (SMOG) score, Flesch-Kincaid Grade-Level (FKGL) score and Flesch Reading Ease (FRE) score. RESULTS Most of the 26 evaluated OSICFs were sourced from websites within the United States (69.2%) and from oral and maxillo-facial surgery practices (76.9%). Two of the assessed forms were template OSICFs available from oral and maxillo-facial professional societies to its members. The scores from the three tools found that the content of 84.6% to 92.3% of the forms were "difficult" to read. The mean (SD) SMOG score for all evaluated OSICFs was 12.31(2.22) [95% CI: 11.42 to 13.21]. The SMOG and FKGL scores were closely correlated (r=0.99, P < 0.0001; 95% CI: 0.9864 to 0.9973). There was no association between SMOG scores and the number of words contained within each consent form (r=-0.047;95% CI: -0.44 to 0.36). CONCLUSIONS The OSICFs surveyed in this investigation failed to meet recommended readability levels. A significant number of patients are not likely to understand the information contained within the forms. Orthodontists are advised that poor literacy skills of their patients may preclude them from validly consenting to orthognathic surgery treatment procedures.
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Docimo S, Seeras K, Acho R, Pryor A, Spaniolas K. Academic and community hernia center websites in the United States fail to meet healthcare literacy standards of readability. Hernia 2022; 26:779-786. [PMID: 35344107 DOI: 10.1007/s10029-022-02584-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 02/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Health literacy is considered the single best predictor of health status. Organizations including the American Medical Association (AMA) and the National Institutes of Health (NIH) have recommended that the readability of patient education materials not exceed the sixth-grade level. Our study focuses on the readability of self-designated hernia centers websites at both academic and community organizations across the United States to determine their ability to dispense patient information at an appropriate reading level. METHODS A search was conducted utilizing the Google search engine. The key words "Hernia Center" and "University Hernia Center" were used to identify links to surgical programs within the United States. The following readability tests were conducted via the program: Flesch-Kincaid Grade Level (FKGL), Gunning Fox Index (GFI), Coleman-Liau Index (CLI), Simple Measure of Gobbledygook (SMOG), and Flesch Reading Ease (FRE) score. RESULTS Of 96 websites, zero (0%) had fulfilled the recommended reading level in all four tests. The mean test scores for all non-academic centers (n = 50) were as follows: FKGL (11.14 ± 2.68), GFI (14.39 ± 3.07), CLI (9.29 ± 2.48) and SMOG (13.38 ± 2.03). The mean test scores [SK1] for all academic programs (n = 46) were as follows: FKGL (11.7 ± 2.66), GFI (15.01 ± 2.99), CLI (9.34 ± 1.91) and SMOG (13.71 ± 2.02). A one-sample t test was performed to compare the FKGL, GFI, CLI, and SMOG scores for each hernia center to a value of 6.9 (6.9 or less is considered an acceptable reading level) and a p value of 0.001 for all four tests were noted demonstrating statistical significance. The Academic and Community readability scores for both groups were compared to each other with a two-sample t test with a p value of > 0.05 for all four tests and there were no statistically significant differences. CONCLUSION Neither Academic nor Community hernia centers met the appropriate reading level of sixth-grade or less. Steps moving forward to improve patient comprehension and/or involving with their care should include appropriate reading level material, identification of a patient with a low literacy level with intervention or additional counseling when appropriate, and the addition of adjunct learning materials such as videos.
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Affiliation(s)
- S Docimo
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Renaissance School, Medicine at Stony Brook University, Stony Brook, NY, USA.
| | - K Seeras
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Renaissance School, Medicine at Stony Brook University, Stony Brook, NY, USA
| | - R Acho
- Henry Ford Macomb, Detroit, MI, USA
| | - A Pryor
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Renaissance School, Medicine at Stony Brook University, Stony Brook, NY, USA
| | - K Spaniolas
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Renaissance School, Medicine at Stony Brook University, Stony Brook, NY, USA
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Chang IA, Wells MW, Zheng DX, Mulligan KM, Wong C, Scott JF, Zins JE. A Multimetric Readability Analysis of Online Patient Educational Materials for Submental Fat Reduction. Aesthetic Plast Surg 2022; 46:712-718. [PMID: 35037081 PMCID: PMC8761512 DOI: 10.1007/s00266-021-02675-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 11/07/2021] [Indexed: 11/24/2022]
Abstract
Background Patients often utilize the Internet to seek information related to their care. This study assesses the readability of online patient educational materials for submental fat reduction. Methods Patient educational materials from the 12 most popular websites related to submental fat reduction were downloaded and assessed for readability grade level using 10 unique scales. Results Analysis of the 12 most popular websites (and corresponding 47 articles) revealed that patient educational materials were written, on average, at an 11th grade reading level. The Flesch Reading Ease score was 48.9 (range 39.8–59.2), representing a “difficult” level of reading. Mean readability grade levels (range 9–13th grade for individual websites) were as follows: Coleman-Liau, 11.1; Flesch-Kincaid, 10.8; FORCAST, 10.8; Fry Graph, 10.1; Gunning Fog, 12.7; New Dale-Chall, 10.1; New Fog Count, 11.8; Simple Measure of Gobbledygook, 11.7; Raygor, 6.7. No website was at the 6th grade reading level for patient educational materials recommended by the American Medical Association and National Institutes of Health. Conclusions Online patient educational materials for submental fat reduction are written well above the recommended reading level. Recognition of disparities in health literacy is necessary to enable patients to make informed decisions and become active participants in their own care. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266
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Hanly SD, Kanagaretnam H, Katti S, Sivapalan G, Wong TLH, Bailey J. Colorectal cancer screening: A pilot study investigating participation in and barriers to screening in rural New South Wales. Aust J Rural Health 2021; 30:291-297. [PMID: 34939716 DOI: 10.1111/ajr.12825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/20/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Sean Denis Hanly
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Harsan Kanagaretnam
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Shobhana Katti
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Gajanth Sivapalan
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Timothy Lung Hon Wong
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Jannine Bailey
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
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Rooney MK, Santiago G, Perni S, Horowitz DP, McCall AR, Einstein AJ, Jagsi R, Golden DW. Readability of Patient Education Materials From High-Impact Medical Journals: A 20-Year Analysis. J Patient Exp 2021; 8:2374373521998847. [PMID: 34179407 PMCID: PMC8205335 DOI: 10.1177/2374373521998847] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Comprehensive patient education is necessary for shared decision-making. While patient–provider conversations primarily drive patient education, patients also use published materials to enhance their understanding. In this investigation, we evaluated the readability of 2585 patient education materials published in high-impact medical journals from 1998 to 2018 and compared our findings to readability recommendations from national groups. For all materials, mean readability grade levels ranged from 11.2 to 13.8 by various metrics. Fifty-four (2.1%) materials met the American Medical Association recommendation of sixth grade reading level, and 215 (8.2%) met the National Institutes of Health recommendation of eighth grade level. When stratified by journal and material type, general medical education materials from Annals of Internal Medicine were the most readable (P < .001), with 79.8% meeting the eighth grade level. Readability did not differ significantly over time. Efforts to standardize publication practice with the incorporation of readability evaluation during the review process may improve patients’ understanding of their disease processes and treatment options.
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Affiliation(s)
- Michael K Rooney
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gaia Santiago
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Subha Perni
- Harvard Radiation Oncology Program, Boston, MA, USA
| | - David P Horowitz
- Department of Radiation Oncology and Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Anne R McCall
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine and Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Reshma Jagsi
- Department of Radiation Oncology and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Daniel W Golden
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
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Gutiontov SI, Golden DW, McCloskey S, Shumway D, Sullivan DR, Wall TJ, Gunderson LL, Jagsi R. Informed Consent in Radiation Oncology. Int J Radiat Oncol Biol Phys 2021; 109:29-35. [PMID: 32911020 DOI: 10.1016/j.ijrobp.2020.08.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/10/2020] [Accepted: 08/31/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Stanley I Gutiontov
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Daniel W Golden
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Susan McCloskey
- Ronald Reagan UCLA Medical Center Department of Radiation Oncology, Los Angeles, California
| | - Dean Shumway
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Donald R Sullivan
- Department of Pulmonary and Critical Medicine, Oregon Health & Science University, Portland, Oregon
| | | | | | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
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Wasserburg JR, Sayegh F, Sanati-Mehrizy P, Graziano FD, Taub PJ. Cleft Care Readability: Can Patients Access Helpful Online Resources? Cleft Palate Craniofac J 2020; 58:1287-1293. [PMID: 33325255 DOI: 10.1177/1055665620980244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The present study identifies and analyzes online patient resources for cleft lip with or without cleft palate to survey the online educational landscape relative to the recommended difficulty set by the National Institutes of Health (NIH) and American Medical Association (AMA). METHODS An internet search of "cleft palate," "cleft lip," and 12 similar inputs were entered into a search engine. The first 50 links for each search term were identified, collected, and reviewed individually for relevance and accessibility. The content of the websites was analyzed with Readability Studio Version 2019.1. The following readability metrics were utilized in this study: (1) Coleman-Liau (grade levels), (2) New Dale-Chall, (3) Flesch-Kincaid, (4) Flesch Reading Ease, (5) FORCAST, (6) Fry, (7) Gunning Fog, (8) New Fog Count, (9) Raygor Readability Estimate, and (10) Simple Measure of Gobbledygook. RESULTS In no combination of search terms did any collection of links provide information within the mid-seventh grade levels recommended by the NIH. The analysis of 143 unique websites in the "Cleft Palate" group showed a readability level appropriate to high school students. The analysis of 144 unique websites in the "Cleft Lip" group showed a readability level appropriate for eighth grade students with 6 months of class complete. CONCLUSIONS The information presented to patients on cleft care is too complex and well above the recommended 7th-grade reading level target set forth by the NIH and AMA, which hinders functional health literacy.
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Affiliation(s)
- J Roscoe Wasserburg
- Division of Plastic and Reconstructive Surgery, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Farah Sayegh
- Division of Plastic and Reconstructive Surgery, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paymon Sanati-Mehrizy
- Division of Plastic and Reconstructive Surgery, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Francis D Graziano
- Division of Plastic and Reconstructive Surgery, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter J Taub
- Division of Plastic and Reconstructive Surgery, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Dunphy E, Gardner EC. Telerehabilitation to Address the Rehabilitation Gap in Anterior Cruciate Ligament Care: Survey of Patients. JMIR Form Res 2020; 4:e19296. [PMID: 32945776 PMCID: PMC7532455 DOI: 10.2196/19296] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/15/2020] [Accepted: 07/26/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Evidence shows that after anterior cruciate ligament (ACL) reconstruction, patients may have varied access to physical therapy. In particular, physical therapy input may end many months before patients reach full recovery. Telerehabilitation may provide an opportunity to address this rehabilitation gap and improve access to evidence-based rehabilitation alongside physical therapy at all stages of care. OBJECTIVE This study aims to understand the opinions of patients who have undergone ACL surgery and rehabilitation on the use of telerehabilitation as part of ACL care and define the population and explore their experiences and views on the acceptability of telerehabilitation after ACL reconstruction. METHODS This study was a cross-sectional, voluntary, web-based survey combining both closed and open questions. Ethical approval was obtained from the Yale School of Medicine Institutional Review Board. Participants were aged 16 years or older at the time of recruitment and had undergone ACL reconstruction within the past 5 years. A 26-item survey was developed using the Qualtrics survey platform. No items were mandatory. Responses were multiple choice, binary, and qualitative. The CHERRIES (Checklist for Reporting Results of Internet E-Surveys) was used to ensure the quality of reporting of surveys in the medical literature. Data were analyzed using Stata version 15. Qualitative data were analyzed using NVivo 11. The theoretical framework for this analysis is based on the Capability, Opportunity, and Motivation-Behavior model of behavior change. RESULTS A total of 100 participants opened the survey. All completers were unique. The participation and completion rates were each 96% (96/100). Patients reported their physical therapy care ended at an average of 6.4 months and that they felt fully recovered at an average of 13.2 months. Only 26% (25/96) of patients felt fully recovered at the end of physical therapy. Of these 96 patients, 54 (60%) were younger than 30 years, 71 (74%) were recreational athletes, 24 (24%) were competitive athletes, 72 (75%) had private insurance, 74 (77%) were not familiar at all with telerehabilitation, and 89% (85/96) felt capable. They preferred to use telerehabilitation at different stages of care. Reported benefits included resource saving, improved access to care, improved learning, and greater engagement. Concerns included incorrect performance of exercises or unmanaged pain being missed and less access to manual therapy, motivation, and opportunities to ask questions. Participants' priorities for a future telerehabilitation intervention included its use as an adjunct to physical therapy rather than a replacement, with content available for each stage of care, especially return to sports. Participants stressed that the intervention should be personalized to them and include measures of progress. CONCLUSIONS These findings helped understand and define the ACL reconstruction population. Participants found telerehabilitation acceptable in principle and highlighted the key user requirements and scope of future interventions.
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Affiliation(s)
- Emma Dunphy
- eHealth Unit, Department of Primary Care and Population Health, University College London, Rowland Hill Street, United Kingdom
| | - Elizabeth C Gardner
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College St, New Haven, CT, United States
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Enhancing Trauma Patient Experience Through Education and Engagement: Development of a Mobile Application. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:JAAOSGlobal-D-20-00025. [PMID: 32440637 PMCID: PMC7209794 DOI: 10.5435/jaaosglobal-d-20-00025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 01/07/2023]
Abstract
The purpose was to determine the utility of an open access mobile device application (App: http://bit.ly/traumaapp) to improve patient education and engagement.
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Nguyen DL, Ambinder EB, Jones MK, Hill G, Harvey SC. Improving Patient Comprehension of Screening Mammography Recall Lay Letters. J Am Coll Radiol 2019; 16:1669-1676. [DOI: 10.1016/j.jacr.2019.05.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/17/2019] [Accepted: 05/17/2019] [Indexed: 10/26/2022]
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Santos PJF, Daar DA, Badeau A, Leis A. Readability of online materials for Dupuytren's contracture. J Hand Ther 2019; 31:472-479. [PMID: 28843342 DOI: 10.1016/j.jht.2017.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Descriptive. BACKGROUND Dupuytren's contracture is a common disorder involving fibrosis of the palmar fascia. As patients are increasingly using online materials to gather health care information, it is imperative to assess the readability and appropriateness of this content. The recommended grade level for patient educational materials is seventh to eighth grade according to the National Institutes of Health. This study aims to assess the readability and content of online patient resources for Dupuytren's contracture. PURPOSE OF THE STUDY Evaluate readability of online patient education materials for Dupuytren's contracture. METHODS The largest public search engine, Google, was queried using the term "Dupuytren's contracture surgery" on February 26, 2016. Location filters were disabled, and sponsored results were excluded to avoid any inadvertent search bias. The 10 most popular Web sites were identified, and all relevant patient-directed information within 1 click from the original site was downloaded and saved as plain text. Readability was analyzed using 6 established analyses (Readable.io, Added Bytes, Ltd, UK). RESULTS Analysis of 10 Web sites demonstrates an average grade level of at least 11th grade (Flesch-Kincaid grade level, 10.2; Gunning-Fog grade level, 13.1; Coleman-Liau grade level, 14.4; Simple Measure of Gobbledygook grade level, 10.0; automated readability grade level, 9.7; and average grade level, 11.5). Overall Flesch-Kincaid reading ease index was 46.4, which is difficult. No single article was at the recommended reading level. CONCLUSIONS Online materials available for treatment of Dupuytren's contracture are above recommended reading levels and do not include a comprehensive explanation of treatment options, which may negatively impact decision making in patients seeking treatment for this condition. Surgeons and hand therapists alike should be cognizant of available online patient materials and make efforts to develop and provide more appropriate materials. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Pauline Joy F Santos
- Department of Plastic Surgery, University of California Irvine, Orange, CA, USA.
| | - David A Daar
- Department of Plastic Surgery, University of California Irvine, Orange, CA, USA
| | - Austin Badeau
- Department of Plastic Surgery, University of California Irvine, Orange, CA, USA
| | - Amber Leis
- Department of Plastic Surgery, University of California Irvine, Orange, CA, USA
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Perni S, Rooney MK, Horowitz DP, Golden DW, McCall AR, Einstein AJ, Jagsi R. Assessment of Use, Specificity, and Readability of Written Clinical Informed Consent Forms for Patients With Cancer Undergoing Radiotherapy. JAMA Oncol 2019; 5:e190260. [PMID: 31046122 DOI: 10.1001/jamaoncol.2019.0260] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Importance Appropriate informed consent processes are crucial to preservation of patient autonomy and shared decision making. Although half of patients with cancer receive radiotherapy, it is unknown whether current consent practices are comprehensible for patients. Objective To characterize use, specificity, and readability of clinical informed consent forms for radiotherapy, hypothesizing that forms would be higher than the recommended sixth- to eighth-grade readability level. Design, Setting, and Participants This nationwide cross-sectional survey study and readability analysis was conducted from 2016 to 2018 and included 89 academic radiation oncology departments that were part of the 2016 Electronic Residency Application Service. Department leaders (clinical directors, chairs, and personal contacts of study authors) at academic radiation oncology departments were contacted via email. Main Outcomes and Measures Readability levels were measured by 7 validated readability indices, including the Ford, Caylor, Sticht (FORCAST) index for nonnarrative texts. Difficult words were identified using The Living Word Vocabulary, which describes the readability grade levels of 40 000 common words. Results Of 89 departments, 67 (75%) responded to questions and 57 (64%) provided 113 forms for analysis. Departments providing forms did not differ substantially from others in terms of region, residency size, research output, rural vs urban location, or public vs private institution status. All departments obtained patient written informed consent before radiotherapy; 38 (57%) used body site-specific forms. Using the most conservative (low-score) estimate, mean form readability ranged from grade level 10.6 to 14.2. By 7 distinct indices, only 9 (8%) of 113 forms met the recommended eighth-grade readability level, and 4 (4%) forms met a sixth-grade level. Not a single form met either recommendation based on the FORCAST index. Forms used an average of 7.2 difficult words. Body site-specific forms had considerably better readability than general consent forms. Conclusions and Relevance This nationwide study of informed consent practices for cancer treatment with radiotherapy demonstrates that while all US academic radiotherapy departments use written consent forms, it is rare for templates to meet the recommended readability levels for patient materials. These data suggest the need for reevaluation and modification of the approach to radiotherapy consent, ideally with guidance and templates designed by national professional organizations.
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Affiliation(s)
- Subha Perni
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York.,Harvard Radiation Oncology Program, Boston, Massachusetts
| | | | - David P Horowitz
- Department of Radiation Oncology and Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York
| | - Daniel W Golden
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Anne R McCall
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York.,Department of Radiology and Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York
| | - Reshma Jagsi
- Department of Radiation Oncology and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor
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Mertz K, Burn MB, Eppler SL, Kamal RN. The Reading Level of Surgical Consent Forms in Hand Surgery. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2019. [DOI: 10.1016/j.jhsg.2019.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Reid M, Nel M, Janse van Rensburg-Bonthuyzen E. Development of a Sesotho health literacy test in a South African context. Afr J Prim Health Care Fam Med 2019; 11:e1-e13. [PMID: 31038342 PMCID: PMC6495000 DOI: 10.4102/phcfm.v11i1.1853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/19/2018] [Accepted: 11/19/2018] [Indexed: 11/05/2022] Open
Abstract
Background Research shows that poor health literacy (HL) can be a threat to health and health care. Health literacy is under-researched and poorly understood in developing countries, including South Africa, because of the absence of language and context-specific HL tests. Aim The researchers aimed to develop an appropriate HL test for use among South African public health service users with Sesotho as their first language. Setting The test was developed in the Free State Province of South Africa, for use among Sesotho speakers. Methods Mixed methods were employed to develop the Sesotho Health Literacy Test (SHLT). The process of developing the test was carried out in distinctive methodological steps. Results The stepwise process set out by identifying abstracts (n = 206) referring to HL tests. Sourcing of HL tests followed a tapered process resulting in the use of 17 HL tests. Elements within a conceptual framework guided HL test item selection (n = 47). Two Delphi sessions assisted in reaching consensus regarding final HL test items (n = 40). The readability testing of the SHLT tested 4.19 on the Coleman–Liau Index score. A context-suitable and comprehensive SHLT ensued from this work. Conclusion The SHLT assessment instrument development creates a platform for HL testing among Sesotho first language speakers in South Africa. The context-sensitive methodology is entrenched in a theoretical framework, distributing HL test items between identified competencies and related skill dimensions and domains. The methodology can be applied to the development of HL tests for other languages and population groups in developing countries. Keywords health literacy assessment; primary health care; South Africa; developing countries; public health service; context-sensitive assessment.
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Affiliation(s)
- Marianne Reid
- School of Nursing, Faculty of Health Sciences, University of the Free State, Bloemfontein.
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Kim H, Goldsmith JV, Sengupta S, Mahmood A, Powell MP, Bhatt J, Chang CF, Bhuyan SS. Mobile Health Application and e-Health Literacy: Opportunities and Concerns for Cancer Patients and Caregivers. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:3-8. [PMID: 29139070 DOI: 10.1007/s13187-017-1293-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Health literacy is critical for cancer patients as they must understand complex procedures or treatment options. Caregivers' health literacy also plays a crucial role in caring for cancer patients. Low health literacy is associated with low adherence to medications, poor health status, and increased health care costs. There is a growing interest in the use of mobile health applications (apps) to improve health literacy. Mobile health apps can empower underserved cancer patients and their caregivers by providing features or functionalities to enhance interactive patient-provider communication and to understand medical information more readily. Despite the potentiality of improving health literacy through mobile health apps, there exist several related concerns: no equal access to mobile technology, no familiarity or knowledge of using mobile health apps, and privacy and security concerns. These elements should be taken into account for health policy making and mobile apps design and development. Importantly, mobile apps should be developed with the goal of achieving a high range of user access by considering all health literacy level and various cultural and linguistic needs.
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Affiliation(s)
- Hyunmin Kim
- Division of Health Systems Management and Policy, University of Memphis School of Public Health, Memphis, TN, 38152, USA
| | - Joy V Goldsmith
- Department of Communication, The University of Memphis, Memphis, TN, 38152, USA
| | - Soham Sengupta
- Department of Business Information and Technology, The Fogelman College of Business and Economics, The University of Memphis, Memphis, TN, 38152, USA
| | - Asos Mahmood
- Division of Health Systems Management and Policy, University of Memphis School of Public Health, Memphis, TN, 38152, USA
| | - M Paige Powell
- Division of Health Systems Management and Policy, University of Memphis School of Public Health, Memphis, TN, 38152, USA
| | - Jay Bhatt
- Health Research & Educational Trust, American Hospital Association, Chicago, IL, 60606, USA
| | - Cyril F Chang
- Department of Economics, The Fogelman College of Business and Economics, The University of Memphis, Memphis, TN, 38152, USA
- The Methodist and Le Bonheur Center for Healthcare Economics, Memphis, TN, 38152, USA
| | - Soumitra S Bhuyan
- Division of Health Systems Management and Policy, University of Memphis School of Public Health, Memphis, TN, 38152, USA.
- Health Research & Educational Trust, American Hospital Association, Chicago, IL, 60606, USA.
- The Methodist and Le Bonheur Center for Healthcare Economics, Memphis, TN, 38152, USA.
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Hadden KB, Prince LY, Bushmiaer MK, Watson JC, Barnes CL. Health literacy and surgery expectations in total hip and knee arthroplasty patients. PATIENT EDUCATION AND COUNSELING 2018; 101:1823-1827. [PMID: 29880403 DOI: 10.1016/j.pec.2018.05.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/09/2018] [Accepted: 05/26/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES This study assessed patients' health literacy and expectations for total hip (THA) and total knee (TKA) replacement surgery, and compared health literacy levels of patients and their caregivers. METHODS A convenience sample of 200 THA/TKA participants, patients and their caregivers, participated in this study. RESULTS Results demonstrated no statistical difference in health literacy between patients and their caregivers. However, patients with lower health literacy had significantly lower expectations for walking after surgery. CONCLUSIONS Practices should be aware that caregivers may not be any better equipped to consume and use complicated patient education materials than the patient they are assisting. Additionally, lower health literacy, rather than or in addition to race or social factors, may contribute to disparities in opting for THA/TKA because of lower expectations for walking after surgery. PRACTICE IMPLICATIONS Healthcare practices should develop patient educational materials that are easy for all patients and caregivers to understand, especially those with low health literacy. Additional patient education and counseling may help patients with low health literacy realistically align their expectations and mitigate barriers to consenting to surgery due to low expectations.
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Affiliation(s)
- Kristie B Hadden
- University of Arkansas for Medical Sciences, Center for Health Literacy, Little Rock, AR 72205, USA.
| | - Latrina Y Prince
- University of Arkansas for Medical Sciences, Center for Health Literacy, Little Rock, AR 72205, USA.
| | - Marty K Bushmiaer
- University of Arkansas for Medical Sciences, Department of Orthpaedic Surgery, Little Rock, AR 72205, USA.
| | - Jamie C Watson
- University of Arkansas for Medical Sciences, Division of Medical Humanities, Little Rock, AR 72205, USA.
| | - C Lowry Barnes
- University of Arkansas for Medical Sciences, Department of Orthpaedic Surgery, Little Rock, AR 72205, USA.
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Avci G, Kordovski VM, Woods SP. A Preliminary Study of Health Literacy in an Ethnically Diverse University Sample. J Racial Ethn Health Disparities 2018; 6:182-188. [PMID: 29980990 DOI: 10.1007/s40615-018-0512-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 06/21/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Abstract
There is a considerable body of research on health literacy in adult healthcare settings, mostly among at-risk clinical populations. However, much less is known about health literacy among youth transitioning to adulthood, including college students. Despite the protective effects of higher levels of education, some college students might have other risk factors for low health literacy (i.e., minority status). Hence, the purpose of the present study was to explore health literacy in an ethnically diverse public urban university. Although a majority of the students performed within the adequate range, we observed a subset of Hispanic and foreign students with lower health literacy, particularly in the domain of numeracy. Our preliminary results suggest that, contrary to common belief, there exists a vulnerable subpopulation of college students that have difficulty understanding and using health-related information. Health professionals should be alert to possible low health literacy among college students that may interfere with communication of vital health-related information and decision-making.
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Affiliation(s)
- Gunes Avci
- Department of Psychology, University of Houston, 3695 Cullen Boulevard Room 126, Houston, TX, 77204-5022, USA.
| | - Victoria M Kordovski
- Department of Psychology, University of Houston, 3695 Cullen Boulevard Room 126, Houston, TX, 77204-5022, USA
| | - Steven P Woods
- Department of Psychology, University of Houston, 3695 Cullen Boulevard Room 126, Houston, TX, 77204-5022, USA
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Health Literacy Demands of Patient-Reported Evaluation Tools in Orthopedics: A Mixed-Methods Case Study. Qual Manag Health Care 2018; 27:98-103. [PMID: 29596271 DOI: 10.1097/qmh.0000000000000165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In response to an assessment of organizational health literacy practices at a major academic health center, this case study evaluated the health literacy demands of patient-reported outcome measures commonly used in orthopedic surgery practices to identify areas for improvement. METHODS A mixed-methods approach was used to analyze the readability and patient feedback of orthopedic patient-reported outcome materials. Qualitative results were derived from focus group notes, observations, recordings, and consensus documents. Results were combined to formulate recommendations for quality improvement. RESULTS Readability results indicated that narrative portions of sample patient outcome tools were written within or below the recommended eighth-grade reading level (= 5.9). However, document literacy results were higher than the recommended reading level (= 9.8). Focus group results revealed that participants had consensus on 8 of 12 plain language best practices, including use of bullet lists and jargon or technical words in both instruments. CONCLUSIONS Although the typical readability of both instruments was not exceedingly high, appropriate readability formula and assessment methods gave a more comprehensive assessment of true readability. In addition, participant feedback revealed the need to reduce jargon and improve formatting to lessen the health literacy demands on patients. As clinicians turn more toward patient-reported measures to assess health care quality, it is important to consider the health literacy demands that are inherent in the instruments they are given in our health systems.
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Riba LA, Gruner RA, Fleishman A, James TA. Surgical Risk Factors for the Delayed Initiation of Adjuvant Chemotherapy in Breast Cancer. Ann Surg Oncol 2018; 25:1904-1911. [DOI: 10.1245/s10434-018-6351-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Indexed: 12/25/2022]
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Arafat SMY, Majumder MAA, Kabir R, Papadopoulos K, Uddin MS. Health Literacy in School. OPTIMIZING HEALTH LITERACY FOR IMPROVED CLINICAL PRACTICES 2018. [DOI: 10.4018/978-1-5225-4074-8.ch010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Health literacy is a core element of patient-centered healthcare. Poor health literacy is a silent epidemic across the globe as it affects every aspect of health. Schools bear an important role in increasing health literacy. Improving health literacy in adolescence is supposed to improve the later life as adolescents are used to carry their modified behavior lifelong. Various school-based interventions covering physical and mental health have been studied and found to be effective. International bodies recommend incorporation of health-related tasks into school lessons and considered that teaching the young people will be a good investment for future. Multisectoral collaborations and locally proved effective strategies are the practical challenges. This chapter aims to focus on health literacy, global scenario of health literacy, measurement tools, role of school, interventions, limitations, and challenges of health literacy.
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Palumbo R. Examining the impacts of health literacy on healthcare costs. An evidence synthesis. Health Serv Manage Res 2017; 30:197-212. [PMID: 29034727 DOI: 10.1177/0951484817733366] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Scholars and practitioners share a significant concern about rising healthcare costs. Health literacy is widely presented as a solution to this momentous issue, paving the way for a more appropriate access to care and therefore, for cost savings. However, to date little is still known about the ultimate effects of better health literacy on healthcare costs. Drawing from the findings of a systematic literature review which ultimately involved 29 papers retrieved from Scopus-Elsevier and PubMed. This manuscript is aimed at shedding light on the relationship between health literacy and healthcare costs. The inadequate ability of patients to understand health information and to navigate the healthcare system was found to be an important predictor of inappropriateness in the access to health care. In addition, people living with problematic health literacy are discouraged to be engaged in the provision of health services and are expected to show poor self-efficacy in dealing with their health-related conditions. From this point of view, poor health literate patients are assumed to be at high risk of exacerbation of their health problems, which in turn contributes in rising healthcare costs. In spite of these findings, both policy makers and practitioners seem to overlook the importance of health literacy. Eventually, the joint intervention on laws, policies, organizational strategies, and practices is crucial to handle the challenges related to limited health literacy.
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Wu Y, Wang L, Cai Z, Bao L, Ai P, Ai Z. Prevalence and Risk Factors of Low Health Literacy: A Community-Based Study in Shanghai, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E628. [PMID: 28604645 PMCID: PMC5486314 DOI: 10.3390/ijerph14060628] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/02/2017] [Accepted: 06/08/2017] [Indexed: 11/16/2022]
Abstract
Background: Health literacy is an increasingly important public health concern. However, little is known about the health literacy of general public in China. The aim of this study was to evaluate the prevalence of low health literacy and demographic associations in Shanghai, China. Methods: This study was a community-based cross-sectional health survey utilizing a multi-stage random sampling design. The sample consisted of 1360 individuals aged 15-69 years with the total community-dwelling Chinese as the sample frame. Health literacy was measured by a questionnaire developed on the basis of a national health literacy manual released by the Chinese Ministry of Health. Multiple logistic regression models were used to identify whether common socio-demographic features were associated with health literacy level. Results: The prevalence of low health literacy was 84.49% (95% CI, 82.56% to 86.41%). The prevalence of low health literacy was negatively associated with the level of education, occupation, and annual household income, but was not associated with gender, age, or the presence of non-communicable chronic disease. Conclusions: Simplifying health services, enhancing health education, and promoting interventions to improve health literacy in high-risk populations should be considered as part of the strategies in the making of health policy in China.
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Affiliation(s)
- Ying Wu
- Postdoctoral Research Station of Medicine, School of Medicine, Tongji University, Shanghai 200092, China.
| | - Lu Wang
- Baoshan Center for Disease Control and Prevention of Shanghai, Baoshan 201900, China.
| | - Zhongyuan Cai
- Baoshan Center for Disease Control and Prevention of Shanghai, Baoshan 201900, China.
| | - Luqi Bao
- Baoshan Center for Disease Control and Prevention of Shanghai, Baoshan 201900, China.
| | - Pu Ai
- Department of Clinic Medicine, Anhui Medical University, Hefei 230022, China.
| | - Zisheng Ai
- Department of Medical Statistics, School of Medicine, Tongji University, 1239 Siping Road, Yangpu District, Shanghai 200092, China.
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Hansberry DR, Agarwal N, John ES, John AM, Agarwal P, Reynolds JC, Baker SR. Evaluation of internet-based patient education materials from internal medicine subspecialty organizations: will patients understand them? Intern Emerg Med 2017; 12:535-543. [PMID: 28138915 DOI: 10.1007/s11739-017-1611-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 01/18/2017] [Indexed: 11/26/2022]
Abstract
The majority of Americans use the Internet daily, if not more often, and many search online for health information to better understand a diagnosis they have been given or to research treatment options. The average American reads at an eighth-grade level. The purpose of this study is to evaluate the readability of online patient education materials on the websites of 14 professional organizations representing the major internal medicine subspecialties. We used ten well-established quantitative readability scales to assess written text from patient education materials published on the websites of the major professional organizations representing the following subspecialty groups: allergy and immunology, cardiology, endocrinology, gastroenterology, geriatrics, hematology, hospice and palliative care, infectious disease, nephrology, oncology, pulmonology and critical care, rheumatology, sleep medicine, and sports medicine. Collectively the 540 articles analyzed were written at an 11th-grade level (SD 1.4 grade levels). The sleep medicine and nephrology websites had the most readable materials, written at an academic grade level of 8.5 ± 1.5 and 9.0 ± 0.2, respectively. Material at the infectious disease site was written at the most difficult level, with average readability corresponding to grades 13.9 ± 0.3. None of the patient education materials we reviewed conformed to the American Medical Association (AMA) and the National Institutes of Health (NIH) guidelines requiring that patient education articles be written at a third- to seventh-grade reading level. If these online resources were rewritten, it is likely that more patients would derive benefit from reading them.
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Affiliation(s)
- David R Hansberry
- Department of Radiology, Thomas Jefferson University Hospitals, 132 South 10th Street, Philadelphia, PA, 19107, USA.
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Elizabeth S John
- Department of Medicine, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Ann M John
- Department of Medicine, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Prateek Agarwal
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - James C Reynolds
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen R Baker
- Department of Radiology, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
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Vargas CR, Ricci JA, Lee M, Tobias AM, Medalie DA, Lee BT. The accessibility, readability, and quality of online resources for gender affirming surgery. J Surg Res 2017; 217:198-206. [PMID: 28587891 DOI: 10.1016/j.jss.2017.05.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/15/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The transgender population is disproportionally affected by health disparities related to access to care. In many communities, transgender specialists are geographically distant and locally available medical professionals may be unfamiliar with unique needs of transgender patients. As a result, use of Internet resources for information about gender affirming surgery is particularly important. This study simulates a patient search for online educational material about gender affirming surgery and evaluates the accessibility, readability, and quality of the information. METHODS An Internet search for the term "transgender surgery" was performed, and the first 10 relevant hits were identified. Readability was assessed using 10 established tests: Coleman-Liau, Flesch-Kincaid, FORCAST, Fry, Gunning Fog, New Dale-Chall, New Fog Count, Raygor Estimate, Simple Measure of Gobbledygook, and Flesch Reading Ease. Quality was assessed using Journal of the American Medical Association criteria and the DISCERN instrument. RESULTS Review of 69 results was required to identify 10 sites with relevant patient information. There were 97 articles collected; overall mean reading level was 14.7. Individual Web site reading levels ranged from 12.0 to 17.5. All articles and Web sites exceeded the recommended sixth grade level. Quality ranged from 0 to 4 (Journal of the American Medical Association) and 35 to 79 (DISCERN) across Web sites. CONCLUSIONS Web sites with relevant patient information about gender affirming surgery were difficult to identify from search results. The content of these sites universally exceeded the recommended reading level. A wide range of Web site quality was noted, and this may further complicate successful navigation. Barriers in access to appropriately written patient information on the Internet may contribute to disparities in referral, involvement, satisfaction, and outcomes.
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Affiliation(s)
- Christina R Vargas
- Department of Plastic Surgery, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Joseph A Ricci
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Michelle Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Adam M Tobias
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Daniel A Medalie
- Division of Plastic and Reconstructive Surgery, Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Bernard T Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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Schapira MM, Mozal C, Shofer FS, Gonzalez R, Apter AJ. Alignment of Patient Health Numeracy with Asthma Care Instructions in the Patient Portal. Health Lit Res Pract 2017; 1:e1-e10. [PMID: 31294245 PMCID: PMC6607833 DOI: 10.3928/24748307-20170307-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 01/23/2017] [Indexed: 11/20/2022] Open
Abstract
Background After Visit Summary (AVS) instructions provided through the patient portal of the electronic medical record can support asthma self-management if patients have the skills to interpret and apply the health information provided. Print literacy demands of patient materials are often higher than the reading ability of patients. However, less is known regarding the numeric demand of patient education materials and how well it aligns with patient health numeracy. Objectives This study (1) developed measures of numeric demand for use in the AVS, (2) described the health numeracy demand of AVS instructions for asthma care, and (3) evaluated the association between numeracy demand of materials and patient health numeracy. Methods We reviewed personalized AVS instructions for an index visit from 74 adults with moderate or severe asthma recruited from clinics serving low-income urban communities. Using measures of numeric complexity and density developed for this study, numeracy demand of the AVS was compared to the numeracy skills of patients using the validated Asthma Numeracy Questionnaire. Key Results The numeric complexity and density scales demonstrated content and face validity. The median (range) of the numeric complexity score for AVS instructions was 2.5 (0-46), and density of numeric information was 8% (0%-33%). The median (range) of the Asthma Numeracy Questionnaire was 2 (0-4). There was no association between patient asthma-related health numeracy and the complexity (p = .29) or density (p = .81) of numeric information. Conclusions Patient instructions regarding medications and self-management often include numeric information. Lack of alignment of the numeracy demand of materials with health numeracy skill may be a barrier to communication, particularly among patients of lower health numeracy. [Health Literacy Research and Practice. 2017;1(1):e1-e10.]. Plain Language Summary This study developed a way to measure the frequency and complexity of numeric information in instructions given to patients with asthma. No association was found between the difficulty of numeric information provided and the numeracy level of patients. This poses a potential barrier to communication, especially for patients with low health numeracy.
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Affiliation(s)
- Marilyn M. Schapira
- Address correspondence to Marilyn M. Schapira, MD, MPH, 1110 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104;
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Powell CK, Hill EG, Clancy DE. The Relationship Between Health Literacy and Diabetes Knowledge and Readiness to Take Health Actions. DIABETES EDUCATOR 2017; 33:144-51. [PMID: 17272800 DOI: 10.1177/0145721706297452] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to explore the relationship among health literacy, patients' readiness to take health actions, and diabetes knowledge among individuals with type 2 diabetes. METHODS Sixty-eight patients with type 2 diabetes receiving care in an academic general internal medicine clinic were administered the Rapid Estimate of Adult Literacy in Medicine (REALM) literacy instrument prior to completing the Diabetes Health Belief Model (DHBM) scale and Diabetes Knowledge Test (DKT). Multivariable linear regression was used to assess the association between REALM literacy level, DKT score, DHBM scale score, and most recent hemoglobin A1C level while controlling for other covariates of interest. RESULTS After controlling for other covariates of interest, no significant association between DHBM scale score and REALM literacy level was found (P = .29). However, both DKT score and most recent hemoglobin A1Clevel were found to be significantly associated with patient literacy (P = .004 and P = .02, respectively). Based on the multivariable model, patients with less than a fourth-grade literacy level had 13% lower DKT scores (95% confidence interval [CI], -28% to -2%; P = .08) and 1.36% higher most recent hemoglobin A1Clevels (95% CI, 1.06% to 1.73%; P = .02) relative to those with a high school literacy level. CONCLUSIONS Low health literacy is a problem faced by many patients that affects their ability to navigate the health care system and manage their chronic illnesses. While low health literacy was significantly associated with worse glycemic control and poorer disease knowledge in patients with type 2 diabetes, there was no significant relationship with their readiness to take action in disease management.
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Affiliation(s)
- Caroline K Powell
- The Department of Medicine, Medical University of South Carolina, Charleston (Dr Powell, Dr Clancy)
| | - Elizabeth G Hill
- The Department of Biostatistics, Bioinformatics and Epidemiology, Medical University of South Carolina, Charleston (Dr Hill)
| | - Dawn E Clancy
- The Department of Medicine, Medical University of South Carolina, Charleston (Dr Powell, Dr Clancy)
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Barrett TW, Rising KL, Bellolio MF, Hall MK, Brody A, Dodd KW, Grieser M, Levy PD, Raja AS, Self WH, Weingarten G, Hess EP, Hollander JE. The 2016 Academic Emergency Medicine Consensus Conference, "Shared Decision Making in the Emergency Department: Development of a Policy-relevant Patient-centered Research Agenda" Diagnostic Testing Breakout Session Report. Acad Emerg Med 2016; 23:1354-1361. [PMID: 27404959 DOI: 10.1111/acem.13050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 06/28/2016] [Accepted: 07/07/2016] [Indexed: 12/15/2022]
Abstract
Diagnostic testing is an integral component of patient evaluation in the emergency department (ED). Emergency clinicians frequently use diagnostic testing to more confidently exclude "worst-case" diagnoses rather than to determine the most likely etiology for a presenting complaint. Increased utilization of diagnostic testing has not been associated with reductions in disease-related mortality but has led to increased overall healthcare costs and other unintended consequences (e.g., incidental findings requiring further workup, unnecessary exposure to ionizing radiation or potentially nephrotoxic contrast). Shared decision making (SDM) presents an opportunity for clinicians to discuss the benefits and harms associated with diagnostic testing with patients to more closely tailor testing to patient risk. This article introduces the challenges and opportunities associated with incorporating SDM into emergency care by summarizing the conclusions of the diagnostic testing group at the 2016 Academic Emergency Medicine Consensus Conference on SDM. Three primary domains emerged: 1) characteristics of a condition or test appropriate for SDM, 2) critical elements of and potential barriers to SDM discussions on diagnostic testing, and 3) financial aspects of SDM applied to diagnostic testing. The most critical research questions to improve engagement of patients in their acute care diagnostic decisions were determined by consensus.
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Affiliation(s)
- Tyler W. Barrett
- Department of Emergency Medicine; Vanderbilt University Medical Center; Nashville TN
| | - Kristin L. Rising
- Department of Emergency Medicine; Thomas Jefferson University Hospital; Philadelphia PA
| | | | - M. Kennedy Hall
- Division of Emergency Medicine; University of Washington; Seattle WA
| | - Aaron Brody
- Department of Emergency Medicine; Wayne State University; Detroit MI
| | - Kenneth W. Dodd
- Department of Emergency Medicine; Hennepin County Medical Center; Minneapolis MN
| | - Mira Grieser
- Program Officer, Addressing Disparities; Patient-Centered Outcomes Research Institute; Washington DC
| | - Phillip D. Levy
- Department of Emergency Medicine; Wayne State University; Detroit MI
| | - Ali S. Raja
- Department of Emergency Medicine; Massachusetts General Hospital and Harvard Medical School; Boston MA
| | - Wesley H. Self
- Department of Emergency Medicine; Vanderbilt University Medical Center; Nashville TN
| | | | - Erik P. Hess
- Department of Emergency Medicine; Mayo Clinic; Rochester MN
| | - Judd E. Hollander
- Department of Emergency Medicine; Thomas Jefferson University Hospital; Philadelphia PA
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Hadden K, Prince LY, Schnaekel A, Couch CG, Stephenson JM, Wyrick TO. Readability of Patient Education Materials in Hand Surgery and Health Literacy Best Practices for Improvement. J Hand Surg Am 2016; 41:825-32. [PMID: 27291416 DOI: 10.1016/j.jhsa.2016.05.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/03/2016] [Accepted: 05/16/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to update a portion of a 2008 study of patient education materials from the American Society for Surgery of the Hand Web site with new readability results, to compare the results to health literacy best practices, and to make recommendations to the field for improvement. METHODS A sample of 77 patient education documents were downloaded from the American Society for Surgery of the Hand Web site, handcare.org, and assessed for readability using 4 readability tools. Mean readability grade-level scores were derived. Best practices for plain language for written health materials were compiled from 3 government agency sources. RESULTS The mean readability of the 77 patient education documents in the study was 9.3 grade level. This reading level is reduced from the previous study in 2008 in which the overall mean was 10.6; however, the current sample grade level still exceeds recommended readability according to best practices. CONCLUSIONS Despite a small body of literature on the readability of patient education materials related to hand surgery and other orthopedic issues over the last 7 years, readability was not dramatically improved in our current sample. Using health literacy as a framework, improvements in hand surgery patient education may result in better understanding and better outcomes for patients seeing hand surgeons. CLINICAL RELEVANCE Improved understanding of patient education materials related to hand surgery may improve preventable negative outcomes that are clinically significant as well as contribute to improved quality of life for patients.
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Affiliation(s)
- Kristie Hadden
- University of Arkansas for Medical Sciences, Little Rock, AR.
| | | | - Asa Schnaekel
- University of Arkansas for Medical Sciences, Little Rock, AR
| | - Cory G Couch
- University of Arkansas for Medical Sciences, Little Rock, AR
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Rosenbaum AJ, Marinescu AG, Levine D, Ellis SJ. Cross-Sectional Assessment of Orthopedic Foot and Ankle Patient Knowledge. FOOT & ANKLE ORTHOPAEDICS 2016. [DOI: 10.1177/2473011416674727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Individuals with limited health literacy often struggle in effectively communicating with their physicians and may lack the skills needed to make informed health decisions. It is therefore important that providers have insight into patients’ baseline medical knowledge, as this can help physicians customize their approach to, and conversations with, each patient. As such, this study evaluated the foot and ankle–specific knowledge of patients seeking care for various foot and ankle ailments. Methods: An unvalidated survey developed by our study group was distributed to 206 patients, assessing their knowledge of foot and ankle anatomy, terminology, conditions, treatment, and perioperative issues. Performance was evaluated as a function of participants’ demographic factors. Results: Participants performed significantly worse on the conditions and treatment questions as compared to the anatomy, terminology, and perioperative considerations subsections. Significantly better performance correlated with education (≥college), visit type (preoperative evaluation), a current or previous health care occupation, and prior orthopedic surgeon evaluation. Conclusions: Patients’ knowledge of foot and ankle anatomy, terminology, conditions, treatment, and perioperative issues correlates with certain patient characteristics and demographics. With enhanced insight into the risk factors for limited knowledge, education campaigns can be designed to target those most in need.
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Readability analysis of online resources related to lung cancer. J Surg Res 2016; 206:90-97. [PMID: 27916381 DOI: 10.1016/j.jss.2016.07.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/12/2016] [Accepted: 07/08/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients seeking health information commonly use the Internet as the first source for material. Studies show that well-informed patients have increased involvement, satisfaction, and healthcare outcomes. As one-third of Americans have only basic or below basic health literacy, the National Institutes of Health and American Medical Association recommend patient-directed health resources be written at a sixth-grade reading level. This study evaluates the readability of commonly accessed online resources on lung cancer. METHODS A search for "lung cancer" was performed using Google and Bing, and the top 10 websites were identified. Location services were disabled, and sponsored sites were excluded. Relevant articles (n = 109) with patient-directed content available directly from the main sites were downloaded. Readability was assessed using 10 established methods and analyzed with articles grouped by parent website. RESULTS The average reading grade level across all sites was 11.2, with a range from 8.8 (New Fog Count) to 12.2 (Simple Measure of Gobbledygook). The average Flesch Reading Ease score was 52, corresponding with fairly difficult to read text. The readability varied when compared by individual website, ranging in grade level from 9.2 to 15.2. Only 10 articles (9%) were written below a sixth-grade level and these tended to discuss simpler topics. CONCLUSIONS Patient-directed online information about lung cancer exceeds the recommended sixth-grade reading level. Readability varies between individual websites, allowing physicians to direct patients according to level of health literacy. Modifications to existing materials can significantly improve readability while maintaining content for patients with low health literacy.
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Davidhizar RE, Brownson K. Literacy, Cultural Diversity, and Client Education. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2016. [DOI: 10.1177/108482230001200208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Client education offers many challenges to health care professionals. There is a mismatch between the reading level of most clients and the reading level of printed materials used in health education. Social and cultural factors also influence how our clients are able to learn about their health. These problems can lead to noncompliance with treatments, missed appointments, wrong dosages of medication, and undue fear among our clients. There are things that health care professionals can do to make written materials more user-friendly and culturally more acceptable.
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Owen-Smith AA, Smith DH, Rand CS, Tom JO, Laws R, Waterbury A, Williams A, Vollmer WM. Difference in Effectiveness of Medication Adherence Intervention by Health Literacy Level. Perm J 2016; 20:15-200. [PMID: 27352409 DOI: 10.7812/tpp/15-200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
CONTEXT There is little research investigating whether health information technologies, such as interactive voice recognition, are effective ways to deliver information to individuals with lower health literacy. OBJECTIVE Determine the extent to which the impact of an interactive voice recognition-based intervention to improve medication adherence appeared to vary by participants' health literacy level. DESIGN Promoting Adherence to Improve Effectiveness of Cardiovascular Disease Therapies (PATIENT) was a randomized clinical trial designed to test the impact, compared with usual care, of 2 technology-based interventions that leveraged interactive voice recognition to promote medication adherence. A 14% subset of participants was sent a survey that included questions on health literacy. This exploratory analysis was limited to the 833 individuals who responded to the survey and provided data on health literacy. MAIN OUTCOME MEASURES Adherence to statins and/or angiotensin-converting enzyme inhibitors and/or angiotensin II receptor blockers. RESULTS Although intervention effects did not differ significantly by level of health literacy, the data were suggestive of differential intervention effects by health literacy level. CONCLUSIONS The differences in intervention effects for high vs low health literacy in this exploratory analysis are consistent with the hypothesis that individuals with lower health literacy may derive greater benefit from this type of intervention compared with individuals with higher health literacy. Additional studies are needed to further explore this finding.
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Affiliation(s)
- Ashli A Owen-Smith
- Assistant Professor of Health Management and Policy at the Georgia State University School of Public Health in Atlanta.
| | - David H Smith
- Senior Investigator at The Kaiser Permanente Center for Health Research in Portland, OR.
| | - Cynthia S Rand
- Professor of Medicine in the Department of Medicine at the Johns Hopkins School of Medicine in Baltimore, MD.
| | - Jeffrey O Tom
- Assistant Clinical Professor in the Department of Pediatrics at the University of Hawaii John A Burns School of Medicine in Honolulu.
| | - Reesa Laws
- Research and Data Analytics Center Manager and Technical Research Program Manager at The Kaiser Permanente Center for Health Research in Portland, OR.
| | - Amy Waterbury
- Research Program Manager at The Kaiser Permanente Center for Health Research in Portland, OR.
| | - Andrew Williams
- Faculty Scientist in the Center for Outcomes Research and Evaluation at the Maine Medical Center Research Institute in Scarborough.
| | - William M Vollmer
- Senior Investigator at The Kaiser Permanente Center for Health Research in Portland, OR.
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Barnett T, Hoang H, Furlan A. An analysis of the readability characteristics of oral health information literature available to the public in Tasmania, Australia. BMC Oral Health 2016; 16:35. [PMID: 26984514 PMCID: PMC4794850 DOI: 10.1186/s12903-016-0196-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/11/2016] [Indexed: 11/10/2022] Open
Abstract
Background The effectiveness of print-based health promotion materials is dependent on their readability. This study aimed to assess the characteristics of print-based oral health information literature publically available in Tasmania, Australia. Methods Oral health education brochures were collected from 11 dental clinics across Tasmania and assessed for structure and format, content and readability. Reading level was calculated using three widely-used measures: Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease, and Simple Measure of Gobbledygook (SMOG) reading grade level. Results The FKGL of the 67 brochures sampled ranged from grade 3 to 13. The grade level for government health department brochures (n = 14) ranged from grade 4 to 11 (5.6 ± 1.8). Reading levels for materials produced by commercial sources (n = 22) ranged from 3 to 13 (8.3 ± 2.1), those from professional associations (n = 22) ranged from grade 7 to 11 (8.9 ± 0.9) and brochures produced by other sources (n = 9) ranged from 5 to 10 (7.6 ± 1.5). The SMOG test was positively correlated with the FKGL (rs = 0.92, p < 0.001) though consistently rated materials 2-3 grades higher. The reading level required to comprehend brochures published by government sources were, on average, lower than those from commercial, professional and other sources. Government materials were also more likely to contain fewer words and professional jargon terms than brochures from the other sources. Conclusion A range of oral health information brochures were publically available for patients in both public and private dental clinics. However, their readability characteristics differed. Many brochures required a reading skill level higher than that suited to a large proportion of the Tasmanian population. Readability and other characteristics of oral health education materials should be assessed to ensure their suitability for use with patients, especially those suspected of having low literacy skills.
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Affiliation(s)
- Tony Barnett
- Centre for Rural Health, University of Tasmania, Locked Bag 1322, Launceston, TAS, 7250, Australia.
| | - Ha Hoang
- Centre for Rural Health, University of Tasmania, Locked Bag 1322, Launceston, TAS, 7250, Australia
| | - Ashlea Furlan
- Northern Dental Centre, Oral Health Services Tasmania, 2 Kelham St, Launceston, TAS, 7250, Australia
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Multiple-domain Versus Single-domain Measurements of Socioeconomic Status (SES) for Predicting Nonadherence to Statin Medications. Med Care 2016; 54:195-204. [DOI: 10.1097/mlr.0000000000000468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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