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Borge CR, Larsen MH, Osborne RH, Aas E, Kolle IT, Reinertsen R, Lein MP, Thörn M, Lind RM, Groth M, Strand O, Andersen MH, Moum T, Engebretsen E, Wahl AK. Impacts of a health literacy-informed intervention in people with chronic obstructive pulmonary disease (COPD) on hospitalization, health literacy, self-management, quality of life, and health costs - A randomized controlled trial. Patient Educ Couns 2024; 123:108220. [PMID: 38458089 DOI: 10.1016/j.pec.2024.108220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE To compare the effect of motivational interviewing (MI) and tailored health literacy (HL) follow-up with usual care on hospitalization, costs, HL, self-management, Quality of life (QOL), and psychological stress in people with chronic obstructive pulmonary disease (COPD). METHODS A RCT was undertaken in Norway between March 2018-December 2020 (n = 127). The control group (CG, n = 63) received usual care. The intervention group (IG, n = 64) received tailored HL follow-up from MI-trained COPD nurses with home visits for eight weeks and phone calls for four months after hospitalization. Primary outcomes were hospitalization at eight weeks, six months, and one year from baseline. The trial was registered with ClinicalTrials.gov (NCT03216603) and analysed per protocol. RESULTS Compared with the IG, the CG had 2.8 higher odds (95% CI [1.3 to 5.8]) of hospitalization and higher hospital health costs (MD=€ -6230, 95% CI [-6510 to -5951]) and lower QALYs (MD=0.1, 95% CI [0.10 to 0.11]) that gives an ICER = - 62,300. The IG reported higher QOL, self-management, and HL (p = 0.02- to <0.01). CONCLUSION MI-trained COPD nurses using tailored HL follow-up is cost-effective, reduces hospitalization, and increases QOL, HL, and self-care in COPD. PRACTICE IMPLICATION Tailored HL follow-up is beneficial for individuals with COPD and the healthcare system.
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Affiliation(s)
- Christine R Borge
- Department of Interdisciplinary Health Sciences, University of Oslo, Norway; Lovisenberg Diaconal Hospital, Oslo, Norway.
| | - Marie H Larsen
- Department of Interdisciplinary Health Sciences, University of Oslo, Norway; Lovisenberg Diaconal University College, Oslo, Norway
| | - Richard H Osborne
- Centre of Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
| | - Eline Aas
- Department of Health Management and Health Economics, University of Oslo, Norway; Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | | | | | | | | | | | | | - Oda Strand
- Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Marit Helen Andersen
- Department of Interdisciplinary Health Sciences, University of Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Torbjørn Moum
- Department of Behavioral Sciences in Medicine, University of Oslo, Norway
| | - Eivind Engebretsen
- Department of Interdisciplinary Health Sciences, University of Oslo, Norway
| | - Astrid K Wahl
- Department of Interdisciplinary Health Sciences, University of Oslo, Norway
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Fry JM, Antoniades J, Temple JB, Osborne RH, Cheng C, Hwang K, Brijnath B. Health literacy and older adults: Findings from a national population-based survey. Health Promot J Austr 2024; 35:487-503. [PMID: 37452578 DOI: 10.1002/hpja.779] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 05/01/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023] Open
Abstract
ISSUE ADDRESSED With an ageing population and growing complexity and fragmentation of health care systems, health literacy is increasingly important in managing health. This study investigated health literacy strengths and challenges reported by older Australians (people aged 65 or over) and identified how socio-demographic and health factors related to their health literacy profiles. METHODS The sample comprised 1578 individuals responding to the Australian Government's 2018 Health Literacy Survey, conducted between January and August. Regression modelling was used to estimate the association between each of nine domains of the Health Literacy Questionnaire (HLQ) and individual socio-demographic and health characteristics. The model allowed for correlation between HLQ scores that was linked to unobserved characteristics of individuals. RESULTS Across the health literacy domains, few individuals received mean scores in the lowest score range. Key individual characteristics associated with higher health literacy were increasing age, English proficiency, higher education levels, better self-assessed health and having certain chronic conditions (cancer, hypertension and arthritis). CONCLUSIONS Our findings suggest that, among those aged 65 or over, being older or living with chronic illnesses were associated with greater confidence in engaging with providers, accessing information and navigating health services compared to individuals aged 65-69 and those older individuals without chronic illness. Lower health literacy was associated with psychological distress and low English proficiency. SO WHAT?: Interventions to improve individual health literacy and organisation health literacy responsiveness to minimise complexity of the Australian health system are required. This may enhance uptake and use of health information and services for the underserviced members of the community.
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Affiliation(s)
- Jane M Fry
- Demography and Ageing Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Jo Antoniades
- National Ageing Research Institute (NARI), Melbourne, Victoria, Australia
| | - Jeromey B Temple
- Demography and Ageing Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Richard H Osborne
- Centre of Global Health and Equity, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Christina Cheng
- Centre of Global Health and Equity, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Kerry Hwang
- National Ageing Research Institute (NARI), Melbourne, Victoria, Australia
| | - Bianca Brijnath
- National Ageing Research Institute (NARI), Melbourne, Victoria, Australia
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Williams V, DeMuro Romano C, Finelli L, Qin S, Saretsky TL, Ma J, Lewis S, Phillips M, Osborne RH, Norquist JM. Psychometric evaluation of the respiratory syncytial virus infection, intensity and impact questionnaire (RSV-iiiQ) in adults. Health Qual Life Outcomes 2024; 22:19. [PMID: 38378572 PMCID: PMC10880342 DOI: 10.1186/s12955-023-02174-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/25/2023] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Despite a number of respiratory syncytial virus (RSV) vaccine candidates being tested in clinical trials, disease-specific, self-reported instruments assessing symptom severity of RSV infection from the perspective of adult patients are still needed. The RSV Infection, Intensity and Impact Questionnaire (RSV-iiiQ) was adapted from the Influenza Intensity and Impact Questionnaire (FluiiQ™). This study evaluated some measurement properties of the RSV-iiiQ. METHODS Data were collected in a web-based survey over two consecutive days. Participants completed the RSV-iiiQ, the Patient Global Impression of Severity, Sheehan Disability Scale, Patient Global Impression of Change, EQ-5D-5L, and a demographic questionnaire. Test-retest reliability, internal consistency, construct validity, and responsiveness of the RSV-iiiQ scales were assessed. RESULTS 111 adults with RSV were enrolled and self-reported a variety of symptoms across the range of disease severity via a web-based platform. The RSV-iiiQ scales demonstrated satisfactory test-retest reliability, construct validity, and discriminating ability. One-factor confirmatory factor analyses confirmed that each of the four scales was sufficiently unidimensional, and internal consistencies indicated that the computation of RSV-iiiQ scale scores was plausible. Correlation-based analyses provided support for the construct validity of the RSV-iiiQ scores, and known groups analyses supported discriminating ability. Estimates of responsiveness of the scale scores were also satisfactory. CONCLUSIONS RSV infection is highly symptomatic and causes significant disease burden, and self-report instruments assessing symptom severity and impact are important for evaluation of new treatments. This study describes the preliminary psychometric properties of the RSV-iiiQ and indicates this tool may be useful for the assessment of the severity of symptoms and impact of acute RSV infection in adults. The findings also indicated two items, Runny nose and Ear pain, may be unnecessary and should be revisited using item response theory analysis with a larger sample size.
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Affiliation(s)
- Valerie Williams
- RTI Health Solutions, Box 12194, 3040 East Cornwallis Road Post Office, Research Triangle Park, NC, 27709-2194, USA.
| | - Carla DeMuro Romano
- RTI Health Solutions, Box 12194, 3040 East Cornwallis Road Post Office, Research Triangle Park, NC, 27709-2194, USA
| | | | - Shanshan Qin
- RTI Health Solutions, Box 12194, 3040 East Cornwallis Road Post Office, Research Triangle Park, NC, 27709-2194, USA
| | | | - Jia Ma
- RTI Health Solutions, Box 12194, 3040 East Cornwallis Road Post Office, Research Triangle Park, NC, 27709-2194, USA
| | - Sandy Lewis
- RTI Health Solutions, Box 12194, 3040 East Cornwallis Road Post Office, Research Triangle Park, NC, 27709-2194, USA
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Parker SM, Aslani P, Harris-Roxas B, Wright MC, Barr M, Doolan-Noble F, Javanparast S, Sharma A, Osborne RH, Cullen J, Harris E, Haigh F, Harris M. Community health navigator-assisted transition of care from hospital to community: protocol for a randomised controlled trial. BMJ Open 2024; 14:e077877. [PMID: 38309760 PMCID: PMC10840031 DOI: 10.1136/bmjopen-2023-077877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/12/2024] [Indexed: 02/05/2024] Open
Abstract
INTRODUCTION The objective of this parallel group, randomised controlled trial is to evaluate a community health navigator (CHN) intervention provided to patients aged over 40 years and living with chronic health conditions to transition from hospital inpatient care to their homes. Unplanned hospital readmissions are costly for the health system and negatively impact patients. METHODS AND ANALYSIS Patients are randomised post hospital discharge to the CHN intervention or usual care. A comparison of outcomes between intervention and control groups will use multivariate regression techniques that adjust for age, sex and any independent variables that are significantly different between the two groups, using multiple imputation for missing values. Time-to-event analysis will examine the relationship between seeing a CHN following discharge from the index hospitalisation and reduced rehospitalisations in the subsequent 60 days and 6 months. Secondary outcomes include medication adherence, health literacy, quality of life, experience of healthcare and health service use (including the cost of care). We will also conduct a qualitative assessment of the implementation of the navigator role from the viewpoint of stakeholders including patients, health professionals and the navigators themselves. ETHICS APPROVAL Ethics approval was obtained from the Research Ethics and Governance Office, Sydney Local Health District, on 21 January 2022 (Protocol no. X21-0438 and 2021/ETH12171). The findings of the trial will be disseminated through peer-reviewed journals and national and international conference presentations. Data will be deposited in an institutional data repository at the end of the trial. This is subject to Ethics Committee approval, and the metadata will be made available on request. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN 12622000659707). ARTICLE SUMMARY The objective of this trial is to evaluate a CHN intervention provided to patients aged over 40 years and living with chronic health conditions to transition from hospital inpatient care to their homes.
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Affiliation(s)
- Sharon M Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Parisa Aslani
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Ben Harris-Roxas
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael C Wright
- Health Economics Research and Evaluation, University of Technology, Sydney, New South Wales, Australia
| | - Margo Barr
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - F Doolan-Noble
- General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Sara Javanparast
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Anurag Sharma
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Richard H Osborne
- Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - John Cullen
- Aged Health, Rehabilitation and Chronic Care, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Elizabeth Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona Haigh
- Centre for Health Equity Training, Research and Evaluation, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
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Wahl AK, Hermansen Å, Tschamper MB, Osborne RH, Helseth S, Jacobsen R, Larsen MH. The Parent Health Literacy Questionnaire (HLQ-Parent). Adaptation and validity testing with parents of children with epilepsy. Scand J Public Health 2024; 52:39-47. [PMID: 36214166 PMCID: PMC10845827 DOI: 10.1177/14034948221123436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 06/21/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022]
Abstract
AIMS The aim of this study was to adapt the Health Literacy Questionnaire (HLQ) in English and Norwegian for use with parents. METHODS The research group evaluated all HLQ items and, where relevant, modified them to refocus the attribution of care to that of a child by a parent. Five cognitive interviews with parents were undertaken to gain a detailed depiction of the meanings and processes they used to respond to the HLQ items. Assessment of the psychometric properties of the revised HLQ was undertaken using data from a cross-sectional survey of 254 parents of children with epilepsy. Analysis included internal consistency (Cronbach's alpha) and confirmatory factor analysis (CFA). RESULTS Some 22 out of 44 items and the names of three domains were modified (e.g. attribution changed from 'me' to 'my child'). Cognitive interviews indicated that parents interpreted the HLQ-Parent items in the way intended. All but three factor loadings were high to acceptable. All nine HLQ scales showed satisfactory to good internal consistency (Cronbach's alpha 0.70 to 0.87). When fitting one-factor CFA models, correlated residuals were required for four scales to generate an acceptable fit. One scale, '8. Ability to find good health information', required inclusion of two correlated residuals to generate an acceptable CFA model fit, indicating that further work on this scale is warranted. CONCLUSIONS The results from both the adaptation process and the CFA analysis supported the relevance, understanding and theoretical structure of the instrument in a parental context.
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Affiliation(s)
- Astrid K. Wahl
- Faculty of Medicine, Institute of Health and Society, Department of Interdisciplinary Health Sciences, University of Oslo, Norway
| | - Åsmund Hermansen
- Faculty of Social Sciences, Oslo Metropolitan University, Norway
| | - Merete B. Tschamper
- Faculty of Medicine, Institute of Health and Society, Department of Interdisciplinary Health Sciences, University of Oslo, Norway
| | - Richard H. Osborne
- Centre of Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
| | - Sølvi Helseth
- Faculty of Health Sciences, Oslo Metropolitan University, Norway
| | - Rita Jacobsen
- Lovisenberg Diaconal University College, Oslo, Norway
| | - Marie H. Larsen
- Faculty of Medicine, Institute of Health and Society, Department of Interdisciplinary Health Sciences, University of Oslo, Norway
- Lovisenberg Diaconal University College, Oslo, Norway
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Ramjee S, Mohamedthani H, Patel AU, Goiriz R, Harwood CA, Osborne RH, Cheng C, Hasan ZU. The Effect of Remote Digital Services on Health Care Inequalities Among People Under Long-Term Dermatology Follow-Up: Cross-Sectional Questionnaire Study. JMIR Dermatol 2023; 6:e48981. [PMID: 38064259 PMCID: PMC10746975 DOI: 10.2196/48981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/13/2023] [Accepted: 11/07/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Given the expansion of remote digital dermatology services from the National Health Service, particularly during the COVID-19 pandemic, there is a need for methods that identify patients at risk of digital exclusion to guide equitable representation in service co-design processes and tailor remote services to the needs of their patient population. OBJECTIVE This quality improvement project aims to inform the redesign of remote services to optimally support the ongoing needs of patients with chronic skin diseases, ensuring that the services are tailored to patients' digital health literacy requirements. METHODS We profiled the digital health literacy of 123 people with chronic skin conditions who require long-term surveillance in 2 specialist clinics (London, United Kingdom) using the Multidimensional Readiness and Enablement Index for Health Technology (READHY) questionnaire alongside the Optimizing Health Literacy and Access (Ophelia) process for hierarchical cluster analysis. RESULTS The cluster analysis of READHY dimensions in responding participants (n=116) revealed 7 groups with distinct digital and health literacy characteristics. High READHY scores in groups 1 (n=22, 19%) and 2 (n=20, 17.2%) represent those who are confident with managing their health and using technology, whereas the lower-scoring groups, 6 (n=4, 3.4%) and 7 (n=12, 10.3%), depended on traditional services. Groups 3 (n=27, 23.3%), 4 (n=23, 19.8%), and 5 (n=8, 6.9%) had varying digital skills, access, and engagement, highlighting a population that may benefit from a co-designed dermatology service. CONCLUSIONS By identifying patient groups with distinguishable patterns of digital access and health literacy, our method demonstrates that 63.8% (n=74) of people attending specialist clinics in our center require support in order to optimize remote follow-up or need an alternative approach. Future efforts should streamline the READHY question profile to improve its practicality and use focus groups to elicit strategies for engaging patients with digital services.
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Affiliation(s)
- Serena Ramjee
- Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, United Kingdom
| | - Hanen Mohamedthani
- Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, United Kingdom
| | - Aditya Umeshkumar Patel
- Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, United Kingdom
| | - Rebeca Goiriz
- Dermatology Department, Barts Health NHS Trust, London, United Kingdom
| | - Catherine A Harwood
- Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, United Kingdom
- Dermatology Department, Barts Health NHS Trust, London, United Kingdom
| | - Richard H Osborne
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christina Cheng
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
| | - Zeeshaan-Ul Hasan
- Dermatology Department, Barts Health NHS Trust, London, United Kingdom
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Elbrink SH, Elmer SL, Osborne RH. Understanding needs and expectations to start effective communities of practice. BMC Health Serv Res 2023; 23:1230. [PMID: 37946189 PMCID: PMC10637013 DOI: 10.1186/s12913-023-10241-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Communities of practice (CoPs) are frequently used in health settings to enhance knowledge and support action around public health issues. Yet, most are ineffective and often at risk of not delivering on this promise. To prevent loss of time and resources by organisations, facilitators, and members, this paper argues for a reliable assessment of the needs of people who intend to join and to set realistic expectations to assure effective communities of practice. This research proposes a valid and reliable needs assessment and analysis tool for starting communities of practice, by presenting the results of using such a tool. METHODS Inception needs assessments were developed, tested and administered to 246 respondents entering five communities of practice that focused on one of three public health issues: health literacy, mental health literacy and trauma-informed care. One community of practice had a global audience, four were based in Australia. Data from the needs assessments were analysed qualitatively and supplemented with descriptive statistics. Results were used to develop an analysis tool to support future communities of practice. RESULTS The short-term expectations of respondents included seeking to increase their knowledge and getting to know other members of the community of practice. Long-term expectations shifted towards undertaking action, collaborating and improving health outcomes. While respondents learning expectations included a wide range of topics, they articulated very specific knowledge they expected to share with others. There were high expectations of receiving practical support from the facilitator and a strong preference for meetings with synchronous interaction. Most respondents who planned to join focused initially on the direct and individual benefits and participation they expected from others, whereas they indicated limited intention to actively contribute to the learning needs of other community members. Respondents appeared to need to take time to build self-confidence and trust, and frequently applied a wait-and-see attitude. CONCLUSIONS The findings of this study suggest that an inception needs assessment allows members to express their needs and expectations, which directly informs the direction and structure of a community of practice, gives voice to members, and supports facilitators in managing expectations.
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Affiliation(s)
- Sanne H Elbrink
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, John Street, Hawthorn, Victoria, 3122, Australia.
| | - Shandell L Elmer
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, John Street, Hawthorn, Victoria, 3122, Australia
| | - Richard H Osborne
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, John Street, Hawthorn, Victoria, 3122, Australia
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Arsenović S, Oyewole O, Trajković G, Osborne RH, Wiltshire-Fletcher M, Gazibara T, Kisić Tepavčević D, Pekmezović T, Gazibara T. Linguistic adaptation and psychometric properties of the health literacy questionnaire in serbian language among people with chronic diseases. Chronic Illn 2023; 19:605-624. [PMID: 35581691 DOI: 10.1177/17423953221102630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To translate the Health Literacy Questionnaire (HLQ) to Serbian language and examine its psychometric characteristics. METHODS This cross-sectional study was conducted among 295 people with chronic diseases from the Foča region (Republic of Srpska, Bosnia and Herzegovina). The HLQ was translated according to the translation integrity procedure. Construct validity was tested using confirmatory factor analysis (CFA) using the maximum likelihood estimator and reliability was estimated using the α and ω coefficients. RESULTS Minor linguistic differences in 17 items were observed between the original and the initial forward translation and were corrected. The parameters of one-factor CFA on domains 3 and 8 fitted well. The parameters of the CFA for domains 1, 2, 4, 5, 6, 7 and 9 were acceptable after modification using residuals' correlation. The α and ω coefficients for all domains were good to excellent (>0.80). CONCLUSION Each domain of the HLQ in Serbian has acceptable construct validity and overall good reliability. This study adds to the growing evidence that the HLQ is a useful tool to provide in-depth multidimensional information on health literacy to improve researchers and policymakers understanding of the health literacy strengths, needs and preferences across cultures and languages.
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Affiliation(s)
- Sladjana Arsenović
- Public Health Institute of Republic of Srpska, Regional Center Foča, Foča, Republic of Srpska (Bosnia and Herzegovina)
| | - Olufemi Oyewole
- Department of Physiotherapy, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - Goran Trajković
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Richard H Osborne
- Faculty of Health, Arts and Design, Centre for Global Health and Equity, Swinburne University of Technology, Hawthorn, Australia
| | | | | | | | - Tatjana Pekmezović
- Faculty of Medicine, Institute of Epidemiology, University of Belgrade, Belgrade, Serbia
| | - Tatjana Gazibara
- Faculty of Medicine, Institute of Epidemiology, University of Belgrade, Belgrade, Serbia
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Osborne RH, Nelson LM, Fehnel S, Williams N, Bender RH, Ziemiecki R, Gymnopoulou E, De Paepe E, Vandendijck Y, Norcross L, Heijnen E, Ispas G, Comeaux C, Callendret B, Chan EKH, Scott JA. Evaluation of symptoms in respiratory syncytial virus infection in adults: psychometric evaluation of the Respiratory Infection Intensity and Impact Questionnaire™ symptom scores. J Patient Rep Outcomes 2023; 7:51. [PMID: 37261682 DOI: 10.1186/s41687-023-00593-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/18/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND The Respiratory Infection Intensity and Impact Questionnaire (RiiQ™) is a patient-reported outcome measure designed to assess symptoms and impacts of respiratory syncytial virus (RSV) infection. This study evaluated the construct validity, reliability, and responsiveness of the RiiQ™ Respiratory and Systemic Symptoms Scale scores. METHODS Prospective data were analyzed from a total of 1795 participants, including from non-hospitalized patients with acute respiratory infection (ARI) and no coinfections enrolled in a Phase 2b RSV vaccine study (RSV-positive: n = 60; RSV-negative: n = 1615), and two observational studies of patients hospitalized with RSV (n = 20; n = 100). Descriptive statistics, confirmatory factor analysis (CFA), test-retest intraclass correlation coefficients (ICCs), construct validity correlations (between a clinician-assessed clinical questionnaire and the RiiQ™ symptoms scale), known-groups validity, and responsiveness (correlations of change scores) were evaluated. RESULTS Mean patient age ranged from 66.5 to 71.5 years and the majority of patients were female. Initial assessments in the vaccine trial (ARI Day 1) were suggestive of less severe illness than in the observational studies with hospitalized patients. CFA loadings (> 0.40) supported summary scores. ICCs exceeding the recommended threshold of 0.70 supported test-retest reliability for Respiratory and Systemic Symptoms, except in the small observational study. At the scale level, correlations were moderate to strong (|r| ≥ 0.3) and positive between the Respiratory Symptoms Scale and the related clinical questionnaire scores, reflecting measurement of similar symptoms in support of convergent validity. Correlations with change in Patient Global Impression of Severity > 0.30 supported responsiveness. CONCLUSIONS Psychometric tests applied to the RiiQ™ Symptoms scales provide evidence of its reliability, construct validity, discriminating ability, and responsiveness for use in clinical studies to assess the onset and severity of RSV symptoms.
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Affiliation(s)
- Richard H Osborne
- Measured Solutions for Health, P.O. Box 5127, Alphington, VIC, 3079, Australia.
- Centre of Global Health and Equity, Swinburne University of Technology, Hawthorn, VIC, Australia.
| | | | - Sheri Fehnel
- RTI Health Solutions, Research Triangle Park, NC, USA
| | | | | | | | | | - Els De Paepe
- Janssen Infectious Diseases, Beerse, Antwerp, Belgium
| | | | | | | | | | | | | | | | - Jane A Scott
- Janssen Global Services, High Wycombe, Buckinghamshire, UK
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Poot CC, Meijer E, Fokkema M, Chavannes NH, Osborne RH, Kayser L. Translation, cultural adaptation and validity assessment of the Dutch version of the eHealth Literacy Questionnaire: a mixed-method approach. BMC Public Health 2023; 23:1006. [PMID: 37254148 DOI: 10.1186/s12889-023-15869-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 05/10/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND The digitalization of healthcare requires users to have sufficient competence in using digital health technologies. In the Netherlands, as well as in other countries, there is a need for a comprehensive, person-centered assessment of eHealth literacy to understand and address eHealth literacy related needs, to improve equitable uptake and use of digital health technologies. OBJECTIVE We aimed to translate and culturally adapt the original eHealth Literacy Questionnaire (eHLQ) to Dutch and to collect initial validity evidence. METHODS The eHLQ was translated using a systematic approach with forward translation, an item intent matrix, back translation, and consensus meetings with the developer. A validity-driven and multi-study approach was used to collect validity evidence on 1) test content, 2) response processes and 3) internal structure. Cognitive interviews (n = 14) were held to assess test content and response processes (Study 1). A pre-final eHLQ version was completed by 1650 people participating in an eHealth study (Study 2). A seven-factor Confirmatory Factor Analysis (CFA) model was fitted to the data to assess the internal structure of the eHLQ. Invariance testing was performed across gender, age, education and current diagnosis. RESULTS Cognitive interviews showed some problems in wording, phrasing and resonance with individual's world views. CFA demonstrated an equivalent internal structure to the hypothesized (original) eHLQ with acceptable fit indices. All items loaded substantially on their corresponding latent factors (range 0.51-0.81). The model was partially metric invariant across all subgroups. Comparison of scores between groups showed that people who were younger, higher educated and who had a current diagnosis generally scored higher across domains, however effect sizes were small. Data from both studies were triangulated, resulting in minor refinements to eight items and recommendations on use, score interpretation and reporting. CONCLUSION The Dutch version of the eHLQ showed strong properties for assessing eHealth literacy in the Dutch context. While ongoing collection of validity evidence is recommended, the evidence presented indicate that the eHLQ can be used by researchers, eHealth developers and policy makers to identify eHealth literacy needs and inform the development of eHealth interventions to ensure that people with limited digital access and skills are not left behind.
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Affiliation(s)
- Charlotte C Poot
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands.
- National eHealth Living Lab (NeLL), Leiden University Medical Centre, The Netherlands, Leiden, The Netherlands.
| | - Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
- National eHealth Living Lab (NeLL), Leiden University Medical Centre, The Netherlands, Leiden, The Netherlands
| | - Marjolein Fokkema
- Methodology and Statistics Research Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
- National eHealth Living Lab (NeLL), Leiden University Medical Centre, The Netherlands, Leiden, The Netherlands
| | - Richard H Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, VIC, Australia
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lars Kayser
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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11
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Jawahar Z, Elmer S, Hawkins M, Osborne RH. Application of the optimizing health literacy and access (Ophelia) process in partnership with a refugee community in Australia: Study protocol. Front Public Health 2023; 11:1112538. [PMID: 36895685 PMCID: PMC9989023 DOI: 10.3389/fpubh.2023.1112538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/03/2023] [Indexed: 02/23/2023] Open
Abstract
Refugees experience health inequities resulting from multiple barriers and difficulties in accessing and engaging with services. A health literacy development approach can be used to understand health literacy strengths, needs, and preferences to build equitable access to services and information. This protocol details an adaptation of the Ophelia (Optimizing Health Literacy and Access) process to ensure authentic engagement of all stakeholders to generate culturally appropriate, needed, wanted and implementable multisectoral solutions among a former refugee community in Melbourne, Australia. The Health Literacy Questionnaire (HLQ), widely applied around the world in different population groups, including refugees, is usually the quantitative needs assessment tool of the Ophelia process. This protocol outlines an approach tailored to the context, literacy, and health literacy needs of former refugees. This project will engage a refugee settlement agency and a former refugee community (Karen people origin from Myanmar also formerly knowns as Burma) in codesign from inception. A needs assessment will identify health literacy strengths, needs, and preferences, basic demographic data and service engagement of the Karen community. This community will be engaged and interviewed using a semi-structured interview based on the Conversational Health Literacy and Assessment Tool (CHAT) will cover supportive professional and personal relationships, health behaviors, access to health information, use of health services, and health promotion barriers and support. Using the needs assessment data, vignettes portraying typical individuals from this community will be developed. Stakeholders will be invited to participate in ideas generation and prioritization workshops for in-depth discussion on what works well and not well for the community. Contextually and culturally appropriate and meaningful action ideas will be co-designed to respond to identified health literacy strengths, needs, and preferences of the community. This protocol will develop and test new and improved methods that are likely to be useful for community-based organizations and health services to systematically understand and improve communication, services and outcomes among disadvantaged groups, particularly migrants and refugees.
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Affiliation(s)
- Zaman Jawahar
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Shandell Elmer
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Melanie Hawkins
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Richard H Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, VIC, Australia
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12
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Passi R, Kaur M, Lakshmi PVM, Cheng C, Hawkins M, Osborne RH. Health literacy strengths and challenges among residents of a resource-poor village in rural India: Epidemiological and cluster analyses. PLOS Glob Public Health 2023; 3:e0001595. [PMID: 36963029 PMCID: PMC10022012 DOI: 10.1371/journal.pgph.0001595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/28/2022] [Indexed: 02/19/2023]
Abstract
Cluster analysis can complement and extend the information learned through epidemiological analysis. The aim of this study was to determine the relative merits of these two data analysis methods for describing the multidimensional health literacy strengths and challenges in a resource poor rural community in northern India. A cross-sectional survey (N = 510) using the Health Literacy Questionnaire (HLQ) was undertaken. Descriptive epidemiology included mean scores and effect sizes among sociodemographic characteristics. Cluster analysis was based on the nine HLQ scales to determine different health literacy profiles within the population. Participants reported highest mean scores for Scale 4. Social support for health (2.88) and Scale 6. Ability to actively engage with healthcare professionals (3.66). Lower scores were reported for Scale 3. Actively managing my health (1.81) and Scale 8. Ability to find good health information (2.65). Younger people (<35 years) had much higher scores than older people (ES >1.0) for social support. Eight clusters were identified. In Cluster A, educated younger men (mean age 27 years) reported higher scores on all scales except one (Scale 1. Feeling understood and supported by a healthcare professional) and were the cluster with the highest number (43%) of new hypertension diagnoses. In contrast, Cluster H also had young participants (mean age 30 years) but with low education (72% illiterate) who scored lowest across all nine scales. While epidemiological analysis provided overall health literacy scores and associations between health literacy and other characteristics, cluster analysis provided nuanced health literacy profiles with the potential to inform development of solutions tailored to the needs of specific population subgroups.
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Affiliation(s)
- Reetu Passi
- Department of Community Medicine and School of Public Health, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manmeet Kaur
- Department of Community Medicine and School of Public Health, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Christina Cheng
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Melanie Hawkins
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Richard H Osborne
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
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13
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Bakker MM, Putrik P, Dikovec C, Rademakers J, Vonkeman HE, Kok MR, Voorneveld-Nieuwenhuis H, Ramiro S, de Wit M, Buchbinder R, Batterham R, Osborne RH, Boonen A. Exploring discordance between Health Literacy Questionnaire scores of people with RMDs and assessment by treating health professionals. Rheumatology (Oxford) 2022; 62:52-64. [PMID: 35438147 PMCID: PMC9788830 DOI: 10.1093/rheumatology/keac248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/21/2022] [Accepted: 03/02/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES We studied discordance between health literacy of people with rheumatic and musculoskeletal diseases (RMDs) and assessment of health literacy by their treating health professionals, and explored whether discordance is associated with the patients' socioeconomic background. METHODS Patients with RA, spondyloarthritis (SpA) or gout from three Dutch outpatient rheumatology clinics completed the nine-domain Health Literacy Questionnaire (HLQ). Treating health professionals assessed their patients on each HLQ domain. Discordance per domain was defined as a ≥2-point difference on a 0-10 scale (except if both scores were below three or above seven), leading to three categories: 'negative discordance' (i.e. professional scored lower), 'probably the same' or 'positive discordance' (i.e. professional scored higher). We used multivariable multilevel multinomial regression models with patients clustered by health professionals to test associations with socioeconomic factors (age, gender, education level, migration background, employment, disability for work, living alone). RESULTS We observed considerable discordance (21-40% of patients) across HLQ domains. Most discordance occurred for 'Critically appraising information' (40.5%, domain 5). Comparatively, positive discordance occurred more frequently. Negative discordance was more frequently and strongly associated with socioeconomic factors, specifically lower education level and non-Western migration background (for five HLQ domains). Associations between socioeconomic factors and positive discordance were less consistent. CONCLUSION Frequent discordance between patients' scores and professionals' estimations indicates there may be hidden challenges in communication and care, which differ between socioeconomic groups. Successfully addressing patients' health literacy needs cannot solely depend on health professionals' estimations but will require measurement and dialogue. VIDEO ABSTRACT A video abstract of this article can be found at https://www.youtube.com/watch?v=ggnB1rATdQ4.
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Affiliation(s)
- Mark M Bakker
- Department of Internal Medicine, Division of Rheumatology, Maastricht UMC.,CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht
| | - Polina Putrik
- Department of Internal Medicine, Division of Rheumatology, Maastricht UMC.,CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht
| | - Cédric Dikovec
- Department of Internal Medicine, Division of Rheumatology, Maastricht UMC
| | - Jany Rademakers
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht.,Nivel Netherlands Institute for Health Services Research, Utrecht
| | - Harald E Vonkeman
- Department of Psychology, Health and Technology, University of Twente, Enschede.,Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Arthritis Center Twente, Enschede
| | - Marc R Kok
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam
| | | | - Sofia Ramiro
- Department of Rheumatology, Leiden UMC, Leiden.,Department of Rheumatology, Zuyderland Medical Center, Heerlen
| | - Maarten de Wit
- Tools2Use Patient Association, Amsterdam, The Netherlands
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University.,Monash Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Australia
| | - Roy Batterham
- Faculty of Public Health, Thammasat University, Bangkok, Thailand
| | - Richard H Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Australia
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht UMC.,CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht
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14
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Osborne RH, Elmer S, Hawkins M, Cheng CC, Batterham RW, Dias S, Good S, Monteiro MG, Mikkelsen B, Nadarajah RG, Fones G. Health literacy development is central to the prevention and control of non-communicable diseases. BMJ Glob Health 2022; 7:bmjgh-2022-010362. [PMID: 36460323 PMCID: PMC9723891 DOI: 10.1136/bmjgh-2022-010362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/19/2022] [Indexed: 12/04/2022] Open
Abstract
The WHO's report Health literacy development for the prevention and control of non-communicable diseases (NCDs) delivers practical what-to-do how-to-do guidance for health literacy development to build, at scale, contextually-relevant public health actions to reduce inequity and the burden of NCDs on individuals, health systems and economies. The key premise for health literacy development is that people's health awareness and behaviours are linked to lifelong experiences and social practices, which may be multilayered, hidden and beyond their control. Meaningful community engagement, local ownership and locally driven actions are needed to identify health literacy strengths, challenges and preferences to build locally fit-for-purpose and implementable actions. Health literacy development needs to underpin local and national policy, laws and regulations to create enabling environments that reduce community exposures to NCD risk factors. Deficit approaches and siloed health system and policy responses need to be avoided, focusing instead on integrating community-based solutions through co-design, cognisant of people's daily experiences and social practices.
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Affiliation(s)
- Richard H Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Victoria, Australia .,Section of Health Services Research, University of Copenhagen, Kobenhavn, Denmark
| | - Shandell Elmer
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Melanie Hawkins
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Christina C Cheng
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Roy W Batterham
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Victoria, Australia,Faculty of Public Health, Thammasat University, Bangkok, Thailand
| | - Sónia Dias
- National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, NOVA University of Lisbon, Lisbon, Portugal
| | - Suvajee Good
- Department of Universal Health Coverage/Family Health, Gender, and Life Course, World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - Maristela G Monteiro
- Noncommunicable Diseases and Mental Health Department, Pan American Health Organization, Washington, District of Columbia, USA
| | - Bente Mikkelsen
- Division for Universal Health Coverage/Communicable Diseases and Noncommunicable Diseases, WHO, Geneve, Switzerland
| | - Ranjit Gajendra Nadarajah
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Guy Fones
- Global Noncommunicable Diseases Platform, World Health Organization, Geneve, Switzerland
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15
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Borge CR, Larsen MH, Osborne RH, Engebretsen E, Andersen MH, Holter IA, Wahl AK. How to co-design a health literacy-informed intervention based on a needs assessment study in chronic obstructive pulmonary disease. BMJ Open 2022; 12:e063022. [PMID: 36302571 PMCID: PMC9621159 DOI: 10.1136/bmjopen-2022-063022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To develop a co-designed health literacy (HL)-informed intervention for people with chronic obstructive pulmonary disease (COPD) that enables them to find, understand, remember, use and communicate the health information needed to promote and maintain good health. DESIGN This study used a co-design approach informed by the programme logic of the Ophelia (Optimising Health Literacy and Access) process. The co-design included workshops where possible solutions for an HL-informed intervention were discussed based on an HL needs assessment study. SETTINGS Five workshops were performed in a local community setting in the specialist and municipality healthcare services in Oslo, Norway. PARTICIPANTS People with COPD, multidisciplinary healthcare professionals (HCPs) from the municipality and specialist healthcare services, and researchers (n=19) participated in the workshops. The co-designed HL-informed intervention was based on seven focus groups with people with COPD (n=14) and HCPs (n=21), and a cross-sectional study of people with COPD using the Health Literacy Questionnaire (n=69). RESULTS The workshop co-design process identified 45 action points and 51 description points for possible intervention solutions to meet the HL needs of people with COPD. The final recommendation for an HL-informed intervention focused on tailored follow-up after hospitalisation, which uses motivational interviewing techniques, is based on the individual's HL, self-management and quality of life needs and is implemented in cooperation with HCPs in both the specialist and municipality healthcare services. CONCLUSION During the codesign process, the workshop group generated several ideas for how to help patients find, understand, remember, use and communicate health information in order to promote and maintain good health. People with COPD need tailored follow-up based on their individual HL needs by HCPs that have knowledge of COPD and are able to motivate them for self-management tasks and help them to improve their quality of life (QOL) and decrease hospitalisation.
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Affiliation(s)
- Christine Råheim Borge
- Department of Interdisciplinary Health Sciences, University of Oslo Faculty of Medicine, Oslo, Norway
- Research Department, Lovisenberg Diakonale Hospital, Oslo, Norway
| | | | - Richard H Osborne
- Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Eivind Engebretsen
- Department of Interdisciplinary Health Sciences, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Marit Helen Andersen
- Department of Interdisciplinary Health Sciences, University of Oslo Faculty of Medicine, Oslo, Norway
- Division of Cancer Medicine, Surgery and Transplantation, Oslo Universitetssykehus, Oslo, Norway
| | | | - Astrid K Wahl
- Department of Interdisciplinary Health Sciences, University of Oslo Faculty of Medicine, Oslo, Norway
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16
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Elsworth GR, Nolte S, Cheng C, Hawkins M, Osborne RH. Modelling variance in the multidimensional Health Literacy Questionnaire: Does a General Health Literacy factor account for observed interscale correlations? SAGE Open Med 2022; 10:20503121221124771. [PMID: 36172568 PMCID: PMC9511310 DOI: 10.1177/20503121221124771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/17/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives Self-report measures of health literacy frequently encompass a group of conceptually distinct but related domains scored as either a single scale or separately for each domain. Psychometric studies of the 44-item Health Literacy Questionnaire, scored as nine separate scales, typically report the results of correlated factors confirmatory factor analyses as validity evidence. However, some scales are quite strongly correlated, raising the question of whether there is sufficient discriminant validity to warrant separate scoring. This psychometric study aims to contrast the results of fitting higher-order and bifactor models as alternative options to illuminate the issue. Methods Correlated factors, higher-order and bifactor confirmatory factor analysis models were fitted to an Australian sample of responses to the Health Literacy Questionnaire (N = 813) using Bayesian confirmatory factor analysis methods. Results All models representing a nine-factor structure for the Health Literacy Questionnaire fitted well. The correlated factors model replicated previous findings, showing inter-factor correlations between 0.19 and 0.93. A higher-order model showed relatively high loadings of all nine first-order factors on the second-order factor with particularly high loadings (⩾0.97) for three. Two bifactor models showed that the majority of Health Literacy Questionnaire items were multifactorial, each containing systematic variance from both a General Health Literacy factor and a domain-specific factor. Seven items from four scales were identified as strongly associated with the General Health Literacy factor, with item content suggesting that this factor indexes a broad sense of agency and efficacy in interacting with health-related information and healthcare providers. Conclusion Contrasting correlated factors, higher-order and bifactor models fitted to the Health Literacy Questionnaire suggest that constituent items in self-report health literacy questionnaires might be anticipated to represent at least two sources of reliable and substantive common factor variance: variance associated with General Health Literacy and variance associated with a more specific domain, suggesting that items may be 'irreducibly' heterogeneous. Implications for test development and validation practice are discussed.
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Affiliation(s)
- Gerald R Elsworth
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
- Gerald R Elsworth, Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC 3122, Australia.
| | - Sandra Nolte
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
- Medical Clinic, Department of Psychosomatic Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Christina Cheng
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Melanie Hawkins
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Richard H Osborne
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
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17
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Cheng C, Gearon E, Hawkins M, McPhee C, Hanna L, Batterham R, Osborne RH. Digital Health Literacy as a Predictor of Awareness, Engagement, and Use of a National Web-Based Personal Health Record: Population-Based Survey Study. J Med Internet Res 2022; 24:e35772. [PMID: 36112404 PMCID: PMC9526109 DOI: 10.2196/35772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/16/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Web-based personal health records (PHRs) have the potential to improve the quality, accuracy, and timeliness of health care. However, the international uptake of web-based PHRs has been slow. Populations experiencing disadvantages are less likely to use web-based PHRs, potentially widening health inequities within and among countries.
Objective
With limited understanding of the predictors of community uptake and use of web-based PHR, the aim of this study was to identify the predictors of awareness, engagement, and use of the Australian national web-based PHR, My Health Record (MyHR).
Methods
A population-based survey of adult participants residing in regional Victoria, Australia, was conducted in 2018 using telephone interviews. Logistic regression, adjusted for age, was used to assess the relationship among digital health literacy, health literacy, and demographic characteristics, and the 3 dependent variables of MyHR: awareness, engagement, and use. Digital health literacy and health literacy were measured using multidimensional tools, using all 7 scales of the eHealth Literacy Questionnaire and 4 out of the 9 scales of the Health Literacy Questionnaire.
Results
A total of 998 responses were analyzed. Many elements of digital health literacy were strongly associated with MyHR awareness, engagement, and use. A 1-unit increase in each of the 7 eHealth Literacy Questionnaire scales was associated with a 2- to 4-fold increase in the odds of using MyHR: using technology to process health information (odds ratio [OR] 4.14, 95% CI 2.34-7.31), understanding of health concepts and language (OR 2.25, 95% CI 1.08-4.69), ability to actively engage with digital services (OR 4.44, 95% CI 2.55-7.75), feel safe and in control (OR 2.36, 95% CI 1.43-3.88), motivated to engage with digital services (OR 4.24, 95% CI 2.36-7.61), access to digital services that work (OR 2.49, 95% CI 1.32-4.69), and digital services that suit individual needs (OR 3.48, 95% CI 1.97-6.15). The Health Literacy Questionnaire scales of health care support, actively managing health, and social support were also associated with a 1- to 2-fold increase in the odds of using MyHR. Using the internet to search for health information was another strong predictor; however, older people and those with less education were less likely to use MyHR.
Conclusions
This study revealed strong and consistent patterns of association between digital health literacy and the use of a web-based PHR. The results indicate potential actions for promoting PHR uptake, including improving digital technology and skill experiences that may improve digital health literacy and willingness to engage in web-based PHR. Uptake may also be improved through more responsive digital services, strengthened health care, and better social support. A holistic approach, including targeted solutions, is needed to ensure that web-based PHR can realize its full potential to help reduce health inequities.
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Affiliation(s)
- Christina Cheng
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
| | - Emma Gearon
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Melanie Hawkins
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
| | | | - Lisa Hanna
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Roy Batterham
- Faculty of Public Health, Thammasat University, Bangkok, Thailand
| | - Richard H Osborne
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
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18
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Borge CR, Larsen MH, Osborne RH, Engebretsen E, Andersen MH, Holter IA, Leine M, Wahl AK. Exploring patients' and health professionals' perspectives on health literacy needs in the context of chronic obstructive pulmonary disease. Chronic Illn 2022; 18:549-561. [PMID: 33705224 DOI: 10.1177/1742395321999441] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Persons with chronic obstructive pulmonary disease (COPD) require complex follow-up by healthcare professionals (HCPs) and may experience several health literacy (HL) needs. This study aimed to explore such needs in people with COPD and the HCPs who care for them. METHODS From October 2016 to August 2017 a qualitative study with four focus groups (FG) were performed in people with COPD (n = 14) and three in multidisciplinary HCPs (n = 21). An inductive thematic analysis was used to investigate HL needs. RESULTS Four HL needs emerged: 1) strengthening the feeling of security; 2) combating the burden of insufficient knowledge on COPD and lack of informational flow; 3) supporting motivation for endurance and self-management; and 4) strengthening dignity. DISCUSSION This study highlights a gap between people with COPD who express important HL needs and HCPs' capabilities to care for these needs. For HCPs to increase HL in such cases, HCPs need to improve their own HL. It is essential to find solutions on how to improve HL in HCPs who care for people with COPD and to increase the availability of interventions that increase HL in COPD. Education programs, health organizations, and governments should be aware of HL needs in such situations.
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Affiliation(s)
- Christine R Borge
- Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway.,Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Marie H Larsen
- Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway.,Lovisenberg Diaconal University College, Oslo, Norway
| | - Richard H Osborne
- Centre of Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia
| | - Eivind Engebretsen
- Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Marit H Andersen
- Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway.,Oslo University Hospital, Oslo, Norway
| | | | | | - Astrid K Wahl
- Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
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Osborne RH, Cheng CC, Nolte S, Elmer S, Besancon S, Budhathoki SS, Debussche X, Dias S, Kolarčik P, Loureiro MI, Maindal H, Nascimento do O D, Smith JA, Wahl A, Elsworth GR, Hawkins M. Health literacy measurement: embracing diversity in a strengths-based approach to promote health and equity, and avoid epistemic injustice. BMJ Glob Health 2022. [PMCID: PMC9462086 DOI: 10.1136/bmjgh-2022-009623] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Definitions of health literacy have evolved from notions of health-related literacy to a multidimensional concept that incorporates the importance of social and cultural knowledge, practices and contexts. This evolution is evident in the development of instruments that seek to measure health literacy in different ways. Health literacy measurement is important for global health because diverse stakeholders, including the WHO, use these data to inform health practice and policy, and to understand sources of inequity. In this Practice paper, we explore the potential for negative consequences, bias and epistemic injustice to occur when health literacy instruments are used across settings without due regard for the lived experiences of people in various contexts from whom data are collected. A health literacy measurement approach that is emic-sensitive, strengths based and solution oriented is needed to minimise biased data interpretation and use and to avoid epistemic injustice.
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Affiliation(s)
- Richard H Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
| | - Christina C Cheng
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Victoria, Australia
| | | | - Shandell Elmer
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Stephane Besancon
- Santé Diabète Headquarter, Grenoble, France
- Santé Diabète delegation of Mali, Bamako, Mali
| | - Shyam Sundar Budhathoki
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, St. Mary’s Campus, London, UK
- Nepalese Society of Community Medicine, Lalitpur, Nepal
| | - Xavier Debussche
- Centre Expert Plaies Chroniques, Centre Hospitalier Max Querrien Paimpol, Paimpol, France
| | - Sónia Dias
- NOVA National School of Public Health, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Peter Kolarčik
- Department of Health Psychology and Research Methodology, Pavol Jozef Šafárik University, Košice, Slovakia
| | - Maria Isabel Loureiro
- NOVA National School of Public Health, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Helle Maindal
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Dulce Nascimento do O
- NOVA National School of Public Health, Universidade Nova de Lisboa, Lisboa, Portugal
- Associação Protectora dos Diabéticos, Lisbon, Portugal
| | - James A Smith
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Astrid Wahl
- Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Gerald R Elsworth
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Melanie Hawkins
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Victoria, Australia
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20
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Park JH, Osborne RH, Kim HJ, Bae SH. Cultural and linguistic adaption and testing of the Health Literacy Questionnaire (HLQ) among healthy people in Korea. PLoS One 2022; 17:e0271549. [PMID: 35913913 PMCID: PMC9342716 DOI: 10.1371/journal.pone.0271549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/02/2022] [Indexed: 11/29/2022] Open
Abstract
Backgrounds This study administered the Health Literacy Questionnaire (HLQ) among Korean adults to examine its factor structure, reliability, and validity. Methods The HLQ items were translated and culturally adapted to the Korean context. The convenience sampling method was used, and data were collected. The difficulty level, confirmatory factor analysis (CFA) using diagonal weighted least squares (DWLS) estimator in R, discriminant validity, and composite reliability were performed. Results The easiest scale to obtain a high score was “Scale 4. Social support for health” and the hardest was “Scale 7. Navigating the healthcare system.” Nine one-factor models fitted well. The nine-factor structural equation model fitted the data well. All HLQ scales were homogenous, with composite reliability. Conclusions The Korean version of the HLQ has a strong construct and high composite reliability when applied to Korean adults.
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Affiliation(s)
- Jin-Hee Park
- College of Nursing Research Institute of Nursing Science, Ajou University, Suwon, Korea
| | - Richard H. Osborne
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Hee-Jun Kim
- College of Nursing Research Institute of Nursing Science, Ajou University, Suwon, Korea
| | - Sun Hyoung Bae
- College of Nursing Research Institute of Nursing Science, Ajou University, Suwon, Korea
- * E-mail:
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21
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Brørs G, Dalen H, Allore H, Deaton C, Fridlund B, Osborne RH, Palm P, Wentzel-Larsen T, Norekvål TM. Health Literacy and Risk Factors for Coronary Artery Disease (From the CONCARD PCI Study). Am J Cardiol 2022; 179:22-30. [PMID: 35853782 DOI: 10.1016/j.amjcard.2022.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 11/01/2022]
Abstract
In the setting of established coronary artery disease (CAD), lower health literacy is associated with poor outcomes. The aim of this study was to determine whether health literacy at the index admission was associated with established CAD risk factors and with changes in CAD risk factors from baseline until 6 months after percutaneous coronary intervention (PCI). A multicenter cohort study recruited 3,417 patients aged ≥18 years who were treated with PCI. Assessments were made at the index admission for PCI and at 6-month follow-up, including 4 of the 9 scales from the Health Literacy Questionnaire, an assessment of behavioral risk factors and psychologic risk factors for CAD. In this large study, key aspects of health literacy were associated with behavioral and psychologic risk factors for CAD. For each 1-unit higher score on the health literacy scales, weekly physical activity was 12 to 20 intensity-adjusted minutes higher, and the odds of being a nonsmoker were 24% to 72% higher. The risk factors for CAD improved from baseline to 6-month follow-up, although most were not significantly associated with health literacy. Still, patients with lower health literacy scores were more likely to report a greater reduction in depression symptoms from baseline to 6-month follow-up. In conclusion, the study provides evidence that several aspects of health literacy are associated with risk factors for CAD. These results serve as a reminder to healthcare teams to consider health literacy challenges in connection with secondary prevention care.
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Affiliation(s)
- Gunhild Brørs
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Håvard Dalen
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Heather Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Christi Deaton
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Richard H Osborne
- Center for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Pernille Palm
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Tore Wentzel-Larsen
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway; Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway; Center for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway.
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22
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Reed RL, Roeger L, Kwok YH, Kaambwa B, Allison S, Osborne RH. A general practice intervention for people at risk of poor health outcomes: the Flinders QUEST cluster randomised controlled trial and economic evaluation. Med J Aust 2022; 216:469-475. [PMID: 35388512 PMCID: PMC9321612 DOI: 10.5694/mja2.51484] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/13/2020] [Indexed: 11/17/2022]
Abstract
Objective To determine whether a multicomponent general practice intervention cost‐effectively improves health outcomes and reduces health service use for patients at high risk of poor health outcomes. Design, setting Clustered randomised controlled trial in general practices in metropolitan Adelaide. Participants Three age‐based groups of patients identified by their general practitioners as being at high risk of poor health outcomes: children and young people (under 18 years), adults (18–64 years) with two or more chronic diseases, and older people (65 years or more). Intervention Enrolment of patients with a preferred GP, longer general practice appointments, and general practice follow‐up within seven days of emergency department and hospital care episodes. Intervention practices received payment of $1000 per enrolled participant. Main outcome measures Primary outcome: change in self‐rated health between baseline and 12‐month follow‐up for control (usual care) and intervention groups. Secondary outcomes: numbers of emergency department presentations and hospital admissions, Medicare specialist claims and Pharmaceutical Benefits Scheme (PBS) items supplied, Health Literacy Questionnaire scores, and cost‐effectiveness of the intervention (based on the number of quality‐adjusted life‐years [QALYs] gained over 12 months, derived from EQ‐5D‐5L utility scores for the two adult groups). Results Twenty practices with a total of 92 GPs were recruited, and 1044 eligible patients participated. The intervention did not improve self‐rated health (coefficient, –0.29; 95% CI, –2.32 to 1.73), nor did it have significant effects on the numbers of emergency department presentations (incidence rate ratio [IRR], 0.90; 95% CI, 0.69–1.17), hospital admissions (IRR, 0.90; 95% CI, 0.66–1.22), Medicare specialist claims (IRR, 1.00; 95% CI, 0.91–1.09), or PBS items supplied (IRR, 0.99; 95% CI, 0.96–1.03), nor on Health Literacy Questionnaire scores. The intervention was effective in terms of QALYs gained (v usual care: difference, 0.032 QALYs; 95% CI, 0.001–0.063), but the incremental cost‐effectiveness ratio was $69 585 (95% CI, $22 968–$116 201) per QALY gained, beyond the willingness‐to‐pay threshold. Conclusions Our multicomponent intervention did not improve self‐rated health, health service use, or health literacy. It achieved greater improvement in quality of life than usual care, but not cost‐effectively. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12617001589370 (prospective).
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Affiliation(s)
- Richard L Reed
- College of Medicine and Public Health Flinders University Adelaide SA
| | - Leigh Roeger
- College of Medicine and Public Health Flinders University Adelaide SA
| | - Yuen H Kwok
- College of Medicine and Public Health Flinders University Adelaide SA
| | | | - Stephen Allison
- College of Medicine and Public Health Flinders University Adelaide SA
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23
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Nielsen AS, Hanna L, Larsen BF, Appel CW, Osborne RH, Kayser L. Readiness, acceptance and use of digital patient reported outcome in an outpatient clinic. Health Informatics J 2022; 28:14604582221106000. [PMID: 35658693 DOI: 10.1177/14604582221106000] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Use of digital patient-reported outcomes is being introduced in care of chronic conditions, including Inflammatory Bowel Disease. The aim is to supplement face-to-face follow-up sessions through symptom screening, and to inform follow-up through questions about mental health and quality of life. However, little is known about who is using this as intended. This study aimed to map differences between users and non-users among people with IBD and explore the mechanisms behind. We administered a questionnaire including the Readiness and Enablement Index for Health Technology (ReadHy) and the Service User Technology Acceptability Questionnaire (SUTAQ) to all people with IBD registered at Silkeborg Regional Hospital. Comparison between users and non-users and cluster analysis was conducted. Effect size (Cohen's d) was used to estimate magnitude of difference between groups. The user and non-user groups differed most strongly by level of emotional distress (d = 0.45). Cluster analysis of the ReadHy scales showed profiles have different sets of difficulties and reservations towards digital solutions. These difficulties correlated moderately with SUTAQ dissatisfaction and low acceptability. The dimensions of ReadHy may help to better understand particular needs of people with IBD when accessing digital PROs, which may lead to higher acceptability and improved quality of care.
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Affiliation(s)
- Amalie Søgaard Nielsen
- Department of Public Health, 4321University of Copenhagen, Copenhagen, Denmark; School of Health and Social Development, 2104Deakin University, Melbourne, VIC, Australia
| | - Lisa Hanna
- School of Health and Social Development, 95522Deakin University, Melbourne, VIC, Australia
| | - Birgit Furstrand Larsen
- Department of Clinical Medicine, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Aarhus University, Aarhus, Denmark
| | - Charlotte W Appel
- Department of Clinical Medicine, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Aarhus University, Aarhus, Denmark
| | | | - Lars Kayser
- Department of Public Health, University of Copenhagen, Denmark; School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
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24
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Cheng C, Elsworth GR, Osborne RH. Validity Evidence of the eHealth Literacy Questionnaire (eHLQ) Part 2: Mixed Methods Approach to Evaluate Test Content, Response Process, and Internal Structure in the Australian Community Health Setting. J Med Internet Res 2022; 24:e32777. [PMID: 35258475 PMCID: PMC8941428 DOI: 10.2196/32777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/08/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background Digital technologies have changed how we manage our health, and eHealth literacy is needed to engage with health technologies. Any eHealth strategy would be ineffective if users’ eHealth literacy needs are not addressed. A robust measure of eHealth literacy is essential for understanding these needs. On the basis of the eHealth Literacy Framework, which identified 7 dimensions of eHealth literacy, the eHealth Literacy Questionnaire (eHLQ) was developed. The tool has demonstrated robust psychometric properties in the Danish setting, but validity testing should be an ongoing and accumulative process. Objective This study aims to evaluate validity evidence based on test content, response process, and internal structure of the eHLQ in the Australian community health setting. Methods A mixed methods approach was used with cognitive interviewing conducted to examine evidence on test content and response process, whereas a cross-sectional survey was undertaken for evidence on internal structure. Data were collected at 3 diverse community health sites in Victoria, Australia. Psychometric testing included both the classical test theory and item response theory approaches. Methods included Bayesian structural equation modeling for confirmatory factor analysis, internal consistency and test-retest for reliability, and the Bayesian multiple-indicators, multiple-causes model for testing of differential item functioning. Results Cognitive interviewing identified only 1 confusing term, which was clarified. All items were easy to read and understood as intended. A total of 525 questionnaires were included for psychometric analysis. All scales were homogenous with composite scale reliability ranging from 0.73 to 0.90. The intraclass correlation coefficient for test-retest reliability for the 7 scales ranged from 0.72 to 0.95. A 7-factor Bayesian structural equation modeling using small variance priors for cross-loadings and residual covariances was fitted to the data, and the model of interest produced a satisfactory fit (posterior productive P=.49, 95% CI for the difference between observed and replicated chi-square values −101.40 to 108.83, prior-posterior productive P=.92). All items loaded on the relevant factor, with loadings ranging from 0.36 to 0.94. No significant cross-loading was found. There was no evidence of differential item functioning for administration format, site area, and health setting. However, discriminant validity was not well established for scales 1, 3, 5, 6, and 7. Item response theory analysis found that all items provided precise information at different trait levels, except for 1 item. All items demonstrated different sensitivity to different trait levels and represented a range of difficulty levels. Conclusions The evidence suggests that the eHLQ is a tool with robust psychometric properties and further investigation of discriminant validity is recommended. It is ready to be used to identify eHealth literacy strengths and challenges and assist the development of digital health interventions to ensure that people with limited digital access and skills are not left behind.
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Affiliation(s)
- Christina Cheng
- School of Health Sciences, Centre for Global Health and Equity, Swinburne University of Technology, Hawthorn, Australia.,Faculty of Health, School of Health and Social Development, Deakin University, Burwood, Australia
| | - Gerald R Elsworth
- School of Health Sciences, Centre for Global Health and Equity, Swinburne University of Technology, Hawthorn, Australia.,Faculty of Health, School of Health and Social Development, Deakin University, Burwood, Australia
| | - Richard H Osborne
- School of Health Sciences, Centre for Global Health and Equity, Swinburne University of Technology, Hawthorn, Australia.,Faculty of Health, School of Health and Social Development, Deakin University, Burwood, Australia
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25
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Chen YC, Cheng C, Osborne RH, Kayser L, Liu CY, Chang LC. Validity Testing and Cultural Adaptation of the eHealth Literacy Questionnaire (eHLQ) Among People With Chronic Diseases in Taiwan: Mixed Methods Study. J Med Internet Res 2022; 24:e32855. [PMID: 35044310 PMCID: PMC8811686 DOI: 10.2196/32855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background Advancements in digital technologies seek to promote health and access to services. However, people lacking abilities and confidence to use technology are likely to be left behind, leading to health disparities. In providing digital health services, health care providers need to be aware of users’ diverse electronic health (eHealth) literacy to address their particular needs and ensure equitable uptake and use of digital services. To understand such needs, an instrument that captures users’ knowledge, skills, trust, motivation, and experiences in relation to technology is required. The eHealth Literacy Questionnaire (eHLQ) is a multidimensional tool with 7 scales covering diverse dimensions of eHealth literacy. The tool was simultaneously developed in English and Danish using a grounded and validity-driven approach and has been shown to have strong psychometric properties. Objective This study aims to translate and culturally adapt the eHLQ for application among Mandarin-speaking people with chronic diseases in Taiwan and then undertake a rigorous set of validity-testing procedures. Methods The cross-cultural adaptation of the eHLQ included translation and evaluation of the translations. The measurement properties were assessed using classical test theory and item response theory (IRT) approaches. Content validity, known-group validity, and internal consistency were explored, as well as item characteristic curves (ICCs), item discrimination, and item location/difficulty. Results The adapted version was reviewed, and a recommended forward translation was confirmed through consensus. The tool exhibited good content validity. A total of 420 people with 1 or more chronic diseases participated in a validity-testing survey. The eHLQ showed good internal consistency (Cronbach α=.75-.95). For known-group validity, all 7 eHLQ scales showed strong associations with education. Unidimensionality and local independence assumptions were met except for scale 2. IRT analysis showed that all items demonstrated good discrimination (range 0.27-12.15) and a good range of difficulty (range 0.59-1.67) except for 2 items in scale 7. Conclusions Using a rigorous process, the eHLQ was translated from English into a culturally appropriate tool for use in the Mandarin language. Validity testing provided evidence of satisfactory-to-strong psychometric properties of the eHLQ. The 7 scales are likely to be useful research tools for evaluating digital health interventions and for informing the development of health technology products and interventions that equitably suit diverse users’ needs.
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Affiliation(s)
- Yu-Chi Chen
- Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Christina Cheng
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Australia
| | - Richard H Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Australia.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lars Kayser
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Chieh-Yu Liu
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Li-Chun Chang
- School of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan
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Marques MJ, Gama A, Mendonça J, Fernandes AC, Osborne RH, Dias S. Assessing health literacy among migrants and associated socioeconomic factors. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Health literacy, the ability to understand, access, appraise, remember and use health information and health services, has great potential to reduce health inequalities and improve access to and quality of health care, particularly among groups that experience vulnerability, including migrant groups. Across Europe, including in Portugal, little is known about the health literacy strengths, needs and preferences among migrants. We aimed to assess the health literacy of diverse migrants living in Portugal and identify if health literacy needs differ across sociodemographic subgroups. A cross-sectional survey was administered to migrants living in Portugal. Data were collected using the Health Literacy Questionnaire (HLQ), an internationally tested and robust multi-dimensional measurement tool with nine scales, and a demographic and socioeconomic questionnaire. Associations were tested using Welch's ANOVA. In total, 1126 adult migrants were surveyed: 53.4% female, mean age of 35.8 years (range 18-77), 48.9% from African countries, 29.5% from Middle East/Asian countries, 21.6% from Brazil. Low scores on most HLQ scales were clearly associated with sociodemographic characteristics such as lower levels of education: 1. Feeling understood and supported by healthcare providers (p = 0.045); 2. Having sufficient information to manage health (p < 0.001); 3. Actively managing health (p = 0.036); 4. Social support for health (p = 0.001); 5. Appraisal of health information (p < 0.001); 7. Navigating the health system (p = 0.031); 8. Finding health information (p = 0.007). Similar patterns were found for participants who were unemployed and with lower income (<650€). Health literacy needs of migrant communities should be taken into account when designing interventions aiming to mitigate health inequalities and to promote health literacy. This is even more pertinent in the current context of the COVID-19, where its adverse social and economic impacts are likely to aggravate health inequalities.
Key messages
Lower health literacy is related to lower socioeconomic status. Mapping health literacy needs can inform interventions to mitigate health inequalities among vulnerable migrant groups.
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Affiliation(s)
- Maria J Marques
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Comprehensive Health Research Centre, Lisboa, Portugal
| | - Ana Gama
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Comprehensive Health Research Centre, Lisboa, Portugal
| | - Joana Mendonça
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Comprehensive Health Research Centre, Lisboa, Portugal
| | - Adalberto Campo Fernandes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Comprehensive Health Research Centre, Lisboa, Portugal
| | - Richard H Osborne
- Centre of Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Comprehensive Health Research Centre, Lisboa, Portugal
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27
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Saleem A, Steadman KJ, Osborne RH, La Caze A. Translating and validating the Health Literacy Questionnaire into Urdu: a robust nine-dimension confirmatory factor model. Health Promot Int 2021; 36:1219-1230. [PMID: 33370429 DOI: 10.1093/heapro/daaa149] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Pakistani migrants are one of the fastest-growing communities in Australia, and the majority speak Urdu at home. There is a lack of information regarding the health literacy of this population. This study aimed to translate the Health Literacy Questionnaire (HLQ) into Urdu and to explore its psychometric properties. A structured standardized procedure was followed to translate and validate HLQ into Urdu. Data were collected from 202 Pakistani migrants residing in Australia. The HLQ-Urdu was well understood by the respondents. The structural properties of HLQ-Urdu were close to the original HLQ. Data for all HLQ scales met pre-specified criteria for fit in the one-factor CFA model. The composite reliability was high, ranging from 0.84 to 0.91. A strict nine-factor CFA model was also fitted to the data with no cross-loadings or correlated residuals allowed, which showed excellent model fit statistics [χ2WLSMV = 1266.022 (df = 866, p = 0.000), comparative fit index = 0.995, Tucker-Lewis index = 0.994, root mean square error of approximation = 0.050 and standardized root mean square residual = 0.069]. The Urdu version of HLQ showed robust psychometric properties. This HLQ-Urdu tool is now ready to be used to assess health literacy in Pakistani migrants in Australia. Availability of health literacy tools in migrant languages may help healthcare providers better understand the health literacy needs of migrant communities.
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Affiliation(s)
- Ahsan Saleem
- School of Pharmacy, The University of Queensland, Pharmacy Australia Centre of Excellence (PACE), Level 4, 20 Cornwall Street, Woolloongabba QLD 4102, Australia
| | - Kathryn J Steadman
- School of Pharmacy, The University of Queensland, Pharmacy Australia Centre of Excellence (PACE), Level 4, 20 Cornwall Street, Woolloongabba QLD 4102, Australia
| | - Richard H Osborne
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia
| | - Adam La Caze
- School of Pharmacy, The University of Queensland, Pharmacy Australia Centre of Excellence (PACE), Level 4, 20 Cornwall Street, Woolloongabba QLD 4102, Australia
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28
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Cheng C, Elsworth G, Osborne RH. Validity Evidence Based on Relations to Other Variables of the eHealth Literacy Questionnaire (eHLQ): Bayesian Approach to Test for Known-Groups Validity. J Med Internet Res 2021; 23:e30243. [PMID: 34647897 PMCID: PMC8554672 DOI: 10.2196/30243] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/07/2021] [Accepted: 07/27/2021] [Indexed: 12/03/2022] Open
Abstract
Background As health resources and services are increasingly delivered through digital platforms, eHealth literacy is becoming a set of essential capabilities to improve consumer health in the digital era. To understand eHealth literacy needs, a meaningful measure is required. Strong initial evidence for the reliability and construct validity of inferences drawn from the eHealth Literacy Questionnaire (eHLQ) was obtained during its development in Denmark, but validity testing for varying purposes is an ongoing and cumulative process. Objective This study aims to examine validity evidence based on relations to other variables—using data collected with the known-groups approach—to further explore if the eHLQ is a robust tool to understand eHealth literacy needs in different contexts. A priori hypotheses are set for the expected score differences among age, sex, education, and information and communication technology (ICT) use for each of the 7 eHealth literacy constructs represented by the 7 eHLQ scales. Methods A Bayesian mediated multiple indicators multiple causes model approach was used to simultaneously identify group differences and test measurement invariance through differential item functioning across the groups, with ICT use as a mediator. A sample size of 500 participants was estimated. Data were collected at 3 diverse health sites in Australia. Results Responses from 525 participants were included for analysis. Being older was significantly related to lower scores in 4 eHLQ scales, with 3. Ability to actively engage with digital services having the strongest effect (total effect –0.37; P<.001), followed by 1. Using technology to process health information (total effect –0.32; P<.001), 5. Motivated to engage with digital services (total effect –0.21; P=.01), and 7. Digital services that suit individual needs (total effect –0.21; P=.02). However, the effects were only partially mediated by ICT use. Higher education was associated with higher scores in 1. Using technology to process health information (total effect 0.22; P=.01) and 3. Ability to actively engage with digital services (total effect 0.25; P<.001), with the effects mostly mediated by ICT use. Higher ICT use was related to higher scores in all scales except 2. Understanding health concepts and language and 4. Feel safe and in control. Either no or ignorable cases of differential item functioning were found across the 4 groups. Conclusions By using a Bayesian mediated multiple indicators multiple causes model, this study provides supportive validity evidence for the eHLQ based on relations to other variables as well as established evidence regarding internal structure related to measurement invariance across the groups for the 7 scales in the Australian community health context. This study also demonstrates that the eHLQ can be used to gain valuable insights into people’s eHealth literacy needs to help optimize access and use of digital health and promote health equity.
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Affiliation(s)
- Christina Cheng
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia.,School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Australia
| | - Gerald Elsworth
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia.,School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Australia
| | - Richard H Osborne
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia.,School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Australia
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Falsey AR, Walsh EE, Osborne RH, Vandendijck Y, Ren X, Witek J, Kang D, Chan E, Scott J, Ispas G. Comparative assessment of reported symptoms of influenza, respiratory syncytial virus, and human metapneumovirus infection during hospitalization and post-discharge assessed by Respiratory Intensity and Impact Questionnaire. Influenza Other Respir Viruses 2021; 16:79-89. [PMID: 34472708 PMCID: PMC8692817 DOI: 10.1111/irv.12903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/15/2021] [Indexed: 11/28/2022] Open
Abstract
Background The hospitalized acute respiratory tract infection (HARTI) study used the Respiratory Intensity and Impact Questionnaire (RiiQ™) Symptom Scale, derived from FluiiQ™, to assess and compare the burden of respiratory infection symptoms for patients with influenza, respiratory syncytial virus (RSV), and human metapneumovirus (hMPV) infection, with or without core risk factors (CRF) (age ≥65; chronic heart, renal, obstructive pulmonary disease; asthma). Methods This was a prospective cohort study in adult patients hospitalized with acute respiratory tract infection (40 centers, 12 countries) during two consecutive influenza/RSV/hMPV seasons (2017–2019). The RiiQ™ Symptom Scale and EuroQol 5‐Dimensions 5‐Levels (EQ‐5D‐5L) were assessed by interview at two timepoints during hospitalization and at 1, 2, and 3 months post‐discharge. Results Mean lower respiratory tract (LRT) symptom scores were higher for RSV and hMPV participants compared to influenza at 48 h after enrollment/early discharge (p = 0.001) and 3 months post‐discharge (p = 0.007). This was driven by LRT symptoms, including shortness of breath (SOB) (p < 0.01) and wheezing (p < 0.01) during hospitalization, and SOB (p < 0.05) and cough (p < 0.05) post‐discharge. Participants with CRF reported more moderate‐to‐severe SOB (p < 0.05) and wheezing (p < 0.05) compared to CRF(−) participants post‐discharge. EQ‐5D‐5L scores were moderately associated with RiiQ™ LRT and systemic symptoms domains. Conclusions Results from the HARTI study suggest that in the study population, LRT symptoms were more severe for RSV and hMPV groups and for patients with CRF. RiiQ™ Symptom Scale scores shows a moderate association with EQ‐5D‐5L indicating that the RiiQ™ may provide useful insights and offer advantages over other measures for use in interventional RSV adult clinical studies.
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Affiliation(s)
- Ann R Falsey
- School of Medicine Rochester Regional Health, University of Rochester, Rochester, New York, USA
| | - Edward E Walsh
- School of Medicine Rochester Regional Health, University of Rochester, Rochester, New York, USA
| | - Richard H Osborne
- Department of Health and Medical Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | | | - Xiaohui Ren
- Janssen Infectious Diseases, Beerse, Belgium
| | - James Witek
- Janssen Research & Development, LLC, Titusville, New Jersey, USA
| | - Diye Kang
- Janssen Infectious Diseases, Beerse, Belgium
| | - Eric Chan
- Janssen Global Services, LLC, Raritan, New Jersey, USA
| | - Jane Scott
- Janssen Global Services, LLC, Raritan, New Jersey, USA
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Drixler K, Wiedemann R, Nolte S, Osborne RH, Kayser L, Bitzer EM. Die Vorbereitung auf das digitale Zeitalter in Deutschland: Adaption des eHealth Literacy Fragebogens (eHLQ). Das Gesundheitswesen 2021. [DOI: 10.1055/s-0041-1732101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- K Drixler
- Public Health & Health Education, Pädagogische Hochschule Freiburg
| | - R Wiedemann
- Public Health & Health Education, Pädagogische Hochschule Freiburg
| | - S Nolte
- Medizinische Klinik mit Schwerpunkt Psychosomatik, Charité – Universitätsmedizin
| | - RH Osborne
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology
| | - L Kayser
- Department of Public Health, University of Copenhagen
| | - EM Bitzer
- Public Health & Health Education, Pädagogische Hochschule Freiburg
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Hawkins M, Massuger W, Cheng C, Batterham R, Moore GT, Knowles S, Nadarajah RG, Raven L, Osborne RH. Codesign and implementation of an equity-promoting national health literacy programme for people living with inflammatory bowel disease (IBD): a protocol for the application of the Optimising Health Literacy and Access (Ophelia) process. BMJ Open 2021; 11:e045059. [PMID: 34446478 PMCID: PMC8395357 DOI: 10.1136/bmjopen-2020-045059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Non-government organisations (NGOs) often represent people who are underserved or experiencing vulnerability. Crohn's & Colitis Australia (CCA) is aware that many Australians with inflammatory bowel disease (IBD) are not reached by current communication and engagement activities. The aim of the CCA IBD project is to implement the Optimising Health Literacy and Access (Ophelia) process over 3 years to collaboratively codesign ways to improve delivery of information, services and resources for people with IBD and their carers. METHODS AND ANALYSIS Health literacy and other data for phase 1 will be collected using the Health Literacy Questionnaire, eHealth Literacy Questionnaire, IBD-related questions and qualitative interviews with people with IBD and their carers to ascertain their lived experience. Quantitative data will be analysed using descriptive statistics and cluster analysis. Identified clusters will be combined with qualitative data to develop vignettes (narratives of people's experiences of living with IBD) for stakeholder workshops to generate ideas for useful, accessible and sustainable solutions for identified health literacy needs. Selection and testing of health literacy actions happens in phase 2 and implementation and evaluation in phase 3 (2021-2023). Outcomes of this project include giving voice to people living with IBD, their carers and frontline healthcare practitioners. Genuine codesign informs the development and implementation of what is needed and wanted to improve access to and availability and quality of information and resources that support people to manage their health. There is potential for other NGOs to use the CCA Ophelia model in other health contexts to improve engagement with and understanding of the needs of the people they serve and to reduce health inequalities and improve health outcomes. ETHICS AND DISSEMINATION Ethics approval for Ophelia phase 1 has been obtained from the Human Research Ethics Committee of Swinburne University of Technology (Ref: 20202968-4652) and by the South West Sydney Local Health District Research and Ethics Office for the purposes of questionnaire recruitment at Liverpool Hospital (Ref: 20202968-4652). Dissemination of the study findings will be the national codesign process and ownership development across the CCA community and through the genuine engagement of clinicians and relevant managers across Australia. The model and process will be directly distributed to international IBD associations and to other NGOs. It will also be disseminated through publication in a peer-reviewed journal, conference presentations and public reports on the CCA and Swinburne University of Technology website.
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Affiliation(s)
- Melanie Hawkins
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Wayne Massuger
- Crohn's and Colitis Australia, Camberwell, Victoria, Australia
| | - Christina Cheng
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Roy Batterham
- Faculty of Public Health, Thammasat University - Rangsit Campus, Khlong Nueng, Pathum Thani, Thailand
| | - Gregory T Moore
- Gastroenterology and Hepatology Unit, Monash Health, Clayton, Victoria, Australia
- Centre for Inflammatory Diseases, Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Simon Knowles
- Department of Psychological Sciences and Statistics, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Ranjit G Nadarajah
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Leanne Raven
- Crohn's and Colitis Australia, Camberwell, Victoria, Australia
| | - Richard H Osborne
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
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Abstract
INTRODUCTION Communities of practice are used for knowledge sharing and learning in health settings. However, more needs to be known to understand how they work, if they work different in different settings and what outcomes they might generate. Of particular interest is their potential role in health literacy development. METHODS AND ANALYSIS This realist review will be undertaken in seven stages, aiming to develop a framework to show how the various contexts of communities of practice in health settings trigger mechanisms that lead to improved health literacy outcomes. The first stage of a realist review is considered important as it clarifies the scope of the review, yet it is rarely elaborated in detail. This paper describes this first stage in detail and shows how scoping techniques can support drafting an initial framework which can guide the rest of the review. After the initial scoping review, the subsequent stages follow an iterative and recurring process (until saturation is reached) that includes searching and appraising evidence, extracting and organising results, and analysing and summarising. The review will then generate conclusions and recommendations for stakeholders seeking to use communities of practice for their health literacy challenges. Findings of the scoping review are presented in this paper as part of the methods description to show the relevance of conducting a scoping review prior to a realist review. ETHICS AND DISSEMINATION Ethical review is not required for this review. Experts and stakeholders will be involved in the process after the first stage to increase the quality of the process and to ensure practical relevance and uptake. This review focuses on communities of practice and health literacy, yet findings will likely be relevant for other health settings. Findings will be disseminated through stakeholders, publications, presentations and formal and informal reports.
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Affiliation(s)
- Sanne H Elbrink
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Shandell L Elmer
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Richard H Osborne
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria, Australia
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Hawkins M, Elsworth GR, Nolte S, Osborne RH. Validity arguments for patient-reported outcomes: justifying the intended interpretation and use of data. J Patient Rep Outcomes 2021; 5:64. [PMID: 34328558 PMCID: PMC8324704 DOI: 10.1186/s41687-021-00332-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 06/23/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Contrary to common usage in the health sciences, the term "valid" refers not to the properties of a measurement instrument but to the extent to which data-derived inferences are appropriate, meaningful, and useful for intended decision making. The aim of this study was to determine how validity testing theory (the Standards for Educational and Psychological Testing) and methodology (Kane's argument-based approach to validation) from education and psychology can be applied to validation practices for patient-reported outcomes that are measured by instruments that assess theoretical constructs in health. METHODS The Health Literacy Questionnaire (HLQ) was used as an example of a theory-based self-report assessment for the purposes of this study. Kane's five inferences (scoring, generalisation, extrapolation, theory-based interpretation, and implications) for theoretical constructs were applied to the general interpretive argument for the HLQ. Existing validity evidence for the HLQ was identified and collated (as per the Standards recommendation) through a literature review and mapped to the five inferences. Evaluation of the evidence was not within the scope of this study. RESULTS The general HLQ interpretive argument was built to demonstrate Kane's five inferences (and associated warrants and assumptions) for theoretical constructs, and which connect raw data to the intended interpretation and use of the data. The literature review identified 11 HLQ articles from which 57 sources of validity evidence were extracted and mapped to the general interpretive argument. CONCLUSIONS Kane's five inferences and associated warrants and assumptions were demonstrated in relation to the HLQ. However, the process developed in this study is likely to be suitable for validation planning for other measurement instruments. Systematic and transparent validation planning and the generation (or, as in this study, collation) of relevant validity evidence supports developers and users of PRO instruments to determine the extent to which inferences about data are appropriate, meaningful and useful (i.e., valid) for intended decisions about the health and care of individuals, groups and populations.
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Affiliation(s)
- Melanie Hawkins
- Swinburne University of Technology, Centre for Global Health and Equity, School of Health Sciences, PO Box 218, Hawthorn, Melbourne, Victoria 3122 Australia
| | - Gerald R. Elsworth
- Swinburne University of Technology, Centre for Global Health and Equity, School of Health Sciences, PO Box 218, Hawthorn, Melbourne, Victoria 3122 Australia
| | - Sandra Nolte
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Medical Department, Division of Psychosomatic Medicine, Berlin, Germany
| | - Richard H. Osborne
- Swinburne University of Technology, Centre for Global Health and Equity, School of Health Sciences, PO Box 218, Hawthorn, Melbourne, Victoria 3122 Australia
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Dias S, Gama A, Maia AC, Marques MJ, Campos Fernandes A, Goes AR, Loureiro I, Osborne RH. Migrant Communities at the Center in Co-design of Health Literacy-Based Innovative Solutions for Non-communicable Diseases Prevention and Risk Reduction: Application of the OPtimising HEalth LIteracy and Access (Ophelia) Process. Front Public Health 2021; 9:639405. [PMID: 34136449 PMCID: PMC8200814 DOI: 10.3389/fpubh.2021.639405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/27/2021] [Indexed: 11/25/2022] Open
Abstract
The drivers of high prevalence of non-communicable diseases (NCD) among migrants are well-documented. Health literacy is regarded as a potential tool to reduce health inequalities and improve migrant's access to and quality of health care. Yet, little is known about the health literacy needs among these groups and how to address them. This paper outlines the protocol for a migrant community-based co-design project that seeks to optimize health literacy, health promotion, and social cohesion in support of prevention of NCDs among migrants in Lisbon using the OPtismizing HEalth LIteracy and Access (Ophelia) process. This participatory implementation research project starts with a mixed-methods needs assessment covering health literacy strengths, weaknesses and needs of migrants, and local data about determinants of health behaviors, service engagement, and organizational responsiveness. Diverse migrant groups will be engaged and surveyed using the Health Literacy Questionnaire and questions on sociodemographic and economic characteristics, health status, use of health services, and perceived impact of the COVID-19 pandemic. Semi-structured interviews with migrants will also be conducted. Based on data collected, vignettes will be developed representing typical persons with diverse health literacy profiles. Migrants and stakeholders will participate in ideas generation workshops for depth co-creation discussions in simulated real-world situations based on the vignettes, to design health literacy-based multisectoral interventions. Selected interventions will be piloted through quality improvement cycles to ensure ongoing local refinements and ownership development. Through a genuine engagement, the project will evaluate the uptake, effectiveness and sustainability of the interventions. This protocol takes a grounded approach to produce evidence on real health literacy needs from the perspective of key stakeholders, especially migrants, and embodies strong potential for effective knowledge translation into innovative, locally relevant, culturally and context congruent solutions for prevention of NCDs among migrants. Given the diverse communities engaged, this protocol will likely be adaptable to other migrant groups in a wide range of contexts, particularly in European countries. The scale-up of interventions to similar contexts and populations will provide much needed evidence on how health literacy interventions can be developed and applied to reduce health inequality and improve health in diverse communities.
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Affiliation(s)
- Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Comprehensive Health Research Centre, Lisboa, Portugal
| | - Ana Gama
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Comprehensive Health Research Centre, Lisboa, Portugal
| | - Ana Catarina Maia
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Comprehensive Health Research Centre, Lisboa, Portugal.,Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Maria J Marques
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Comprehensive Health Research Centre, Lisboa, Portugal
| | - Adalberto Campos Fernandes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Comprehensive Health Research Centre, Lisboa, Portugal
| | - Ana Rita Goes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Comprehensive Health Research Centre, Lisboa, Portugal
| | - Isabel Loureiro
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Comprehensive Health Research Centre, Lisboa, Portugal
| | - Richard H Osborne
- Faculty of Health, Arts and Design, Centre of Global Health and Equity, Swinburne University of Technology, Melbourne, VIC, Australia.,Department of Health Services Research, The University of Copenhagen, Copenhagen, Denmark
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Brorsen E, Rasmussen TD, Ekstrøm CT, Osborne RH, Villadsen SF. Health literacy responsiveness: a cross-sectional study among pregnant women in Denmark. Scand J Public Health 2021; 50:507-515. [PMID: 33863261 DOI: 10.1177/14034948211004320] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: Communication barriers in healthcare encounters contribute to ethnic inequality in health outcomes. This study aimed to examine, in a large national Danish sample of women, whether ethnicity was associated with pregnant women's Active engagement with healthcare providers. Methods: A cross-sectional survey of 1898 pregnant women attending 19 Danish maternity wards. The key variable of interest was maternal ethnicity among ethnic Danish, European, African and Asian immigrant women and their descendants. Syrian immigrant women were studied as a subgroup. The outcome was the health literacy questionnaire domain Ability to engage actively with healthcare providers (five-item domain scored from 'cannot do/always difficult' (1) to 'always easy' (5)) which is a reflection of a respondent's lived experiences of engaging with healthcare providers. Adjusted mixed effect multivariate linear regression was used to compare Active engagement across groups expressed as the mean difference (95% confidence interval). Results: Lower means of Active engagement were reported for immigrant women compared to ethnic Danish women in all models. When adjusting for age, parity, complications and occupation, the difference between ethnic Danish women's Active engagement and other groups was smallest among European -0.15 (-0.26 to -0.05), slightly larger in African -0.19 (-0.40 to 0.02), and largest in Asian immigrant women -0.31 (-0.41 to -0.21). Syrian immigrant women had the largest difference -0.42 (-0.58 to -0.27). Conclusions: Pregnant immigrant women reported lower means of Active engagement than ethnic Danish women did. Increased health literacy responsiveness in maternity care is required to mitigate the potential for differential care and health inequity.
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Affiliation(s)
- Eva Brorsen
- Section of Social Medicine, University of Copenhagen, Denmark
| | | | | | - Richard H Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Australia
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Brorsen E, Rasmussen TD, Ekstrøm CT, Osborne RH, Villadsen SF. Health literacy responsiveness: a cross-sectional study among pregnant women in Denmark. Scand J Public Health 2021. [PMID: 33863261 DOI: 10.1177/14034948211004320.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: Communication barriers in healthcare encounters contribute to ethnic inequality in health outcomes. This study aimed to examine, in a large national Danish sample of women, whether ethnicity was associated with pregnant women's Active engagement with healthcare providers. Methods: A cross-sectional survey of 1898 pregnant women attending 19 Danish maternity wards. The key variable of interest was maternal ethnicity among ethnic Danish, European, African and Asian immigrant women and their descendants. Syrian immigrant women were studied as a subgroup. The outcome was the health literacy questionnaire domain Ability to engage actively with healthcare providers (five-item domain scored from 'cannot do/always difficult' (1) to 'always easy' (5)) which is a reflection of a respondent's lived experiences of engaging with healthcare providers. Adjusted mixed effect multivariate linear regression was used to compare Active engagement across groups expressed as the mean difference (95% confidence interval). Results: Lower means of Active engagement were reported for immigrant women compared to ethnic Danish women in all models. When adjusting for age, parity, complications and occupation, the difference between ethnic Danish women's Active engagement and other groups was smallest among European -0.15 (-0.26 to -0.05), slightly larger in African -0.19 (-0.40 to 0.02), and largest in Asian immigrant women -0.31 (-0.41 to -0.21). Syrian immigrant women had the largest difference -0.42 (-0.58 to -0.27). Conclusions: Pregnant immigrant women reported lower means of Active engagement than ethnic Danish women did. Increased health literacy responsiveness in maternity care is required to mitigate the potential for differential care and health inequity.
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Affiliation(s)
- Eva Brorsen
- Section of Social Medicine, University of Copenhagen, Denmark
| | | | | | - Richard H Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Australia
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Wahl AK, Osborne RH, Larsen MH, Andersen MH, Holter IA, Borge CR. Exploring health literacy needs in Chronic obstructive pulmonary disease (COPD): Associations between demographic, clinical variables, psychological well-being and health literacy. Heart Lung 2021; 50:417-424. [PMID: 33618148 DOI: 10.1016/j.hrtlng.2021.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/25/2021] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The World Health Organization (WHO) points to health literacy as an important factor in prevention and control of non-communicable diseases (NCDs), including COPD. OBJECTIVE To investigate associations between selected demographic and clinical variables, psychological well-being and health literacy. METHODS Health literacy was measured using the nine domain Health Literacy Questionnaire (HLQ) and one domain from the eHealth Literacy Questionnaire (eHLQ). Using data from a cross-sectional sample of 158 people with COPD, recruited from a hospital-based patient list period (2014-2016), multiple regression analyses were performed. RESULTS The strongest associated variables with health literacy were psychological well-being, measured by the WHO-5 well-being index and education, indicating that higher psychological well-being and educational level are associated with higher levels of health literacy. CONCLUSION The present study highlights the importance of specifically looking to psychological factors in determining potentially health literacy needs among people with COPD.
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Affiliation(s)
- Astrid K Wahl
- Department of Interdisciplinary Health Sciences, University of Oslo, Norway.
| | - Richard H Osborne
- Centre of Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia
| | - Marie H Larsen
- Department of Interdisciplinary Health Sciences, University of Oslo, Norway; Lovisenberg Diaconal University College, Oslo, Norway
| | - Marit H Andersen
- Department of Interdisciplinary Health Sciences, University of Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Christine R Borge
- Department of Interdisciplinary Health Sciences, University of Oslo, Norway; Lovisenberg Diaconal Hospital, Oslo, Norway
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Bakker MM, Putrik P, Rademakers J, van de Laar M, Vonkeman H, Kok MR, Voorneveld-Nieuwenhuis H, Ramiro S, de Wit M, Buchbinder R, Batterham R, Osborne RH, Boonen A. Addressing Health Literacy Needs in Rheumatology: Which Patient Health Literacy Profiles Need the Attention of Health Professionals? Arthritis Care Res (Hoboken) 2021; 73:100-109. [PMID: 33026713 PMCID: PMC7839720 DOI: 10.1002/acr.24480] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 10/01/2020] [Indexed: 12/16/2022]
Abstract
Objective To identify and describe health literacy profiles of patients with rheumatic diseases and explore whether the identified health literacy profiles can be generalized to a broader rheumatology context. Methods Patients with rheumatoid arthritis, spondyloarthritis, and gout from 3 hospitals in different regions in The Netherlands completed the Health Literacy Questionnaire (HLQ). Hierarchical cluster analysis was used to identify patients’ health literacy profiles based on 9 HLQ domains. A multinomial regression model with the identified health literacy profiles as the dependent variable was fitted to assess whether patients with a given disease type or attending a given hospital were more likely to belong to a specific profile. Results Among 895 participating patients, the lowest mean HLQ domain scores (indicating most difficulty) were found for “critical appraisal,” “navigating the health system,” and “finding good health information.” The 10 identified profiles revealed substantial diversity in combinations of strengths and weaknesses. While 42% of patients scored moderate to high on all 9 domains (profiles 1 and 3), another 42% of patients (profiles 2, 4, 5, and 6) clearly struggled with 1 or several aspects of health literacy. Notably, 16% (profiles 7–10) exhibited difficulty across a majority of health literacy domains. The probability of belonging to one of the profiles was independent of the hospital where the patient was treated or the type of rheumatic disease. Conclusion Ten distinct health literacy profiles were identified among patients with rheumatic diseases, independent of disease type and treating hospital. These profiles can be used to facilitate the development of health literacy interventions in rheumatology.
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Affiliation(s)
- Mark M Bakker
- Maastricht UMC+ and Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Polina Putrik
- Maastricht UMC+ and Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Jany Rademakers
- Nivel Netherlands Institute for Health Services Research, Utrecht, and Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Mart van de Laar
- Medisch Spectrum Twente, Arthritis Center Twente and University of Twente, Enschede, The Netherlands
| | - Harald Vonkeman
- Medisch Spectrum Twente, Arthritis Center Twente and University of Twente, Enschede, The Netherlands
| | - Marc R Kok
- Maasstad Hospital, Rotterdam, The Netherlands
| | | | - Sofia Ramiro
- Leiden University Medical Center, Leiden, and Zuyderland Medical Center, Heerlen, The Netherlands
| | - Maarten de Wit
- Tools2use patient association, Amsterdam, The Netherlands
| | | | - Roy Batterham
- Swinburne University of Technology, Centre for Global Health and Equity, Melbourne, Victoria, Australia, and Thammasat University, Bangkok, Thailand
| | - Richard H Osborne
- Swinburne University of Technology, Centre for Global Health and Equity, Melbourne, Victoria, Australia
| | - Annelies Boonen
- Maastricht UMC+ and Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Debussche X, Caroupin-Soupoutevin J, Balcou-Debussche M, Fassier M, Boegner C, Hawkins M, Ballet D, Osborne RH, Corbeau C. Health literacy needs among migrant populations in France: validity testing and potential contribution of the Health Literacy Questionnaire (HLQ). J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-020-01423-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Burgess RA, Osborne RH, Yongabi KA, Greenhalgh T, Gurdasani D, Kang G, Falade AG, Odone A, Busse R, Martin-Moreno JM, Reicher S, McKee M. The COVID-19 vaccines rush: participatory community engagement matters more than ever. Lancet 2021; 397:8-10. [PMID: 33308484 PMCID: PMC7832461 DOI: 10.1016/s0140-6736(20)32642-8] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/26/2020] [Indexed: 01/19/2023]
Affiliation(s)
| | - Richard H Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Kenneth A Yongabi
- AU-ASRIC Afro-centric COVID-19 Working Group, Faculty of Health Sciences, Imo State University, Owerri, Nigeria
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Deepti Gurdasani
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Gagandeep Kang
- Division of Gastrointestinal Sciences Christian Medical College, Vellore, TN, India
| | - Adegoke G Falade
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - Reinhard Busse
- Department of Health Care Management, Technical University Berlin, Germany
| | - Jose M Martin-Moreno
- Department of Preventive Medicine and INCLIVA, University of Valencia, Valencia, Spain
| | - Stephen Reicher
- School of Psychology and Neuroscience, St Andrews University, Fife, UK
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Friis K, Aaby A, Lasgaard M, Pedersen MH, Osborne RH, Maindal HT. Low Health Literacy and Mortality in Individuals with Cardiovascular Disease, Chronic Obstructive Pulmonary Disease, Diabetes, and Mental Illness: A 6-Year Population-Based Follow-Up Study. Int J Environ Res Public Health 2020; 17:ijerph17249399. [PMID: 33333909 PMCID: PMC7765354 DOI: 10.3390/ijerph17249399] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The objective of the study was to examine the impact of health literacy on mortality in the general population and among individuals with cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), diabetes, and mental illness. METHODS Data from a large Danish health survey (n = 29,473) from 2013 were linked with national mortality registry data to permit a 6-year follow-up. RESULTS Individuals reporting difficulties in understanding information about health, had higher risk of dying during follow-up (hazard rate (HR) 1.38 (95% CI 1.11-1.73)) compared with those without difficulties. Higher risk was also observed among people reporting CVD (HR 1.47 (95% CI 1.01-2.14)), diabetes (HR 1.91 (95% CI 1.13-3.22)) and mental illness (HR 2.18 (95% CI 1.25-3.81)), but not for individuals with COPD. Difficulties in actively engaging with healthcare providers was not associated with an increase in the risk of dying in the general population or in any of the four long-term condition groups. CONCLUSIONS Aspects of health literacy predict a higher risk of dying during a 6-year follow-up period. Our study serves as a reminder to healthcare organizations to consider the health literacy responsiveness of their services in relation to diverse health literacy challenges and needs.
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Affiliation(s)
- Karina Friis
- DEFACTUM, Central Denmark Region, 8200 Aarhus, Denmark; (M.L.); (M.H.P.)
- Correspondence: ; Tel.: +45-78414335
| | - Anna Aaby
- Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, 8000 Aarhus, Denmark; (A.A.); (H.T.M.)
| | - Mathias Lasgaard
- DEFACTUM, Central Denmark Region, 8200 Aarhus, Denmark; (M.L.); (M.H.P.)
| | | | - Richard H. Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne 3025, Australia;
| | - Helle Terkildsen Maindal
- Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, 8000 Aarhus, Denmark; (A.A.); (H.T.M.)
- Health Promotion, Steno Diabetes Centre Copenhagen, 2820 Gentofte, Denmark
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42
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Bird ML, Elmer S, Osborne RH, Flittner A, O'Brien J. Training physiotherapists to be responsive to their clients' health literacy needs. Physiother Theory Pract 2020; 38:1398-1406. [PMID: 33225778 DOI: 10.1080/09593985.2020.1850956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: To evaluate health literacy learning modules designed specifically for physiotherapists in private practice.Methods: Mixed-method design was used, evaluating pre-post physiotherapist health literacy knowledge and competencies using questionnaires and semi-structured interviews. One rural and one metropolitan private physiotherapy practice were recruited.Participants: Clients, physiotherapists, and other clinic staff. The OPHELIA (Optimizing Health Literacy and Access) process was applied to identify the health literacy needs of clients; co-design interventions; and implement and evaluate the interventions. The health literacy learning modules were co-designed with the physiotherapists and included one 3-h face-to-face workshop, followed by two 1-h videoconference workshops. Health literacy knowledge (rated 1-5 for 10 items, max score 50) and skills (rated 1-5 for 5 items, max score 25) were assessed before and after the workshops. Data were analyzed by paired t-test. Interviews were recorded, transcribed, and thematically analyzed.Results: Health literacy knowledge of 19 health professionals improved after the workshop by 63% (pre 26.0 (7.5), post 41.0 (2.7), p < .001). Health literacy skills improved by 65% (pre 4.2 (3.3), post 21.8 (2.3), p < .001). We identified three themes from interview data: 1) 'the multi-faceted nature of health literacy requires multiple strategies'; 2) 'changing practice to promote understanding'; and 3) 'reflection on roles of multidisciplinary private practice.'Practice Implications: Improvements in health literacy knowledge and skills are possible through post-graduate professional development.Conclusion: Workshops changed physiotherapists' understanding of their role in promoting health literacy.
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Affiliation(s)
- Marie-Louise Bird
- College of Health and Medicine, University of Tasmania, Launceston, Australia
| | - Shandell Elmer
- Faculty of Health, Arts and Design, Swinburne University, Melbourne, Australia
| | - Richard H Osborne
- Faculty of Health, Arts and Design, Swinburne University, Melbourne, Australia
| | - Anna Flittner
- College of Health and Medicine, University of Tasmania, Launceston, Australia
| | - Jane O'Brien
- College of Health and Medicine, University of Tasmania, Launceston, Australia
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Cheng C, Elsworth GR, Osborne RH. Co-designing eHealth and Equity Solutions: Application of the Ophelia (Optimizing Health Literacy and Access) Process. Front Public Health 2020; 8:604401. [PMID: 33330344 PMCID: PMC7718029 DOI: 10.3389/fpubh.2020.604401] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/27/2020] [Indexed: 12/23/2022] Open
Abstract
Background: The unequal access, challenges and outcomes related to using technology have created the digital divide, which leads to health inequalities. The aim of this study was to apply the Ophelia (Optimizing Health Literacy and Access) process, a widely used systematic approach to whole of community co-design, to the digital context to generate solutions to improve health and equity outcomes. Methods: This was a mixed method study. A cross-sectional survey was undertaken at 3 health organizations in Victoria, Australia using the eHealth Literacy Questionnaire (eHLQ) as a needs assessment tool. Cluster analysis was conducted to identify subgroups with varying eHealth literacy needs. These data, combined with semi-structured interviews with clients, were used to generate vignettes representing different eHealth literacy profiles. The vignettes were presented at co-design workshops with clients and health professionals to generate solutions for digital health services improvement. Expert validation and proof-of-concept testing was explored through mapping the process against Ophelia guiding principles. Results: The cluster analyses identified 8 to 9 clusters with different profiles of eHealth literacy needs, with 4 to 6 vignettes developed to represent the eHealth literacy strengths and weaknesses of clients at each of the 3 sites. A total of 32, 43, and 32 solutions across 10 strategies were co-created based on ideas grounded in local expertise and experiences. Apart from digital solutions, non-digital solutions were frequently recommended as a strategy to address eHealth literacy needs. Expert validation identified at least half of the ideas were very important and feasible, while most of the guiding principles of the Ophelia process were successfully applied. Conclusion: By harnessing collective creativity through co-design, the Ophelia process has been shown to assist the development of solutions with the potential to improve health and equity outcomes in the digital context. Implementation of the solutions is needed to provide further evidence of the impact of the process. The suggested inclusion of non-digital solutions revealed through the co-design process reminds health organizations and policymakers that solutions should be flexible enough to suit individual needs. As such, taking a co-design approach to digital health initiatives will assist in preventing the widening of health inequalities.
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Affiliation(s)
- Christina Cheng
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia.,School of Health and Social Development, Faculty of Health, Deakin University, Burwood, VIC, Australia
| | - Gerald R Elsworth
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia.,School of Health and Social Development, Faculty of Health, Deakin University, Burwood, VIC, Australia
| | - Richard H Osborne
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
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44
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Spillane A, Belton S, McDermott C, Issartel J, Osborne RH, Elmer S, Murrin C. Development and validity testing of the Adolescent Health Literacy Questionnaire (AHLQ): Protocol for a mixed methods study within the Irish school setting. BMJ Open 2020; 10:e039920. [PMID: 33177140 PMCID: PMC7661365 DOI: 10.1136/bmjopen-2020-039920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Health literacy research has focused predominantly on the adult population, and much less is understood about this concept from an adolescent perspective. The tools currently available to measure adolescent health literacy have been adapted from adult versions. This limits their applicability to young people because of the developmental characteristics that impact on adolescents' behaviour, including impulse control and judgement skills. This protocol describes the intended development and validity testing of a questionnaire to measure health literacy in adolescents. METHODS AND ANALYSIS This protocol describes this mixed methods study that has three phases: the first phase will involve grounded research with adolescents using qualitative group interviews, co-design and concept mapping workshops to understand what health and healthy behaviours mean to adolescents and to explore their health literacy needs and the potential domains for the questionnaire. The draft health literacy domains identified will be presented to the youth advisory panel, and the questionnaire will be altered based on their feedback. Cognitive pretesting of the questionnaire items will also be conducted. Phase 2 will involve piloting the questionnaire to a two-stage random sample of young people in five urban and rural schools in Ireland. Test-retest reliability will be conducted using Pearson correlation coefficient. Confirmatory factor analysis will also be conducted to analyse the psychometric properties of the questionnaire. Phase 3 will involve the questionnaire being rolled out to a nationally representative sample of adolescents (n=6052) in Ireland to assess their levels of health literacy. ETHICS AND DISSEMINATION Ethical approval to conduct this study has been granted from the University College Dublin Human Research Ethics Committee - Sciences (LS-20-08). Informed assent from adolescents and informed consent from parents/guardians will be sought. The findings of this research will be disseminated at national and international conferences, as well as through publication in peer-reviewed journals.
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Affiliation(s)
- Ailbhe Spillane
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Sarahjane Belton
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Clare McDermott
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Johann Issartel
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Richard H Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Shandell Elmer
- Centre for Global Health and Equity, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Celine Murrin
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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45
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Klassen KM, Millard T, Stout J, McDonald K, Dodson S, Osborne RH, Battersby MW, Fairley CK, Kidd MR, McMahon J, Baker D, Elliott JH. Recruiting people with HIV to an online self-management support randomised controlled trial: barriers and facilitators. Sex Health 2020; 16:340-347. [PMID: 31234962 DOI: 10.1071/sh18130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 03/08/2019] [Indexed: 11/23/2022]
Abstract
Background Recruitment of people to randomised trials of online interventions presents particular challenges and opportunities. The aim of this study was to evaluate factors associated with the recruitment of people with HIV (PWHIV) and their doctors to the HealthMap trial, a cluster randomised trial of an online self-management program. METHODS Recruitment involved a three-step process. Study sites were recruited, followed by doctors caring for PWHIV at study sites and finally PWHIV. Data were collected from study sites, doctors and patient participants. Factors associated with site enrolment and patient participant recruitment were investigated using regression models. RESULTS Thirteen study sites, 63 doctor participants and 728 patient participants were recruited to the study. Doctors having a prior relationship with the study investigators (odds ratio (OR) 13.3; 95% confidence interval (CI) 3.0, 58.7; P = 0.001) was positively associated with becoming a HealthMap site. Most patient participants successfully recruited to HealthMap (80%) had heard about the study from their HIV doctor. Patient enrolment was associated with the number of people with HIV receiving care at the site (β coefficient 0.10; 95% CI 0.04, 0.16; P = 0.004), but not with employing a clinic or research nurse to help recruit patients (β coefficient 55.9; 95% CI -2.55, 114.25; P = 0.06). CONCLUSION Despite substantial investment in online promotion, a previous relationship with doctors was important for doctor recruitment, and doctors themselves were the most important source of patient recruitment to the HealthMap trial. Clinic-based recruitment strategies remain a critical component of trial recruitment, despite expanding opportunities to engage with online communities.
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Affiliation(s)
- Karen M Klassen
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Vic. 3004, Australia; and Corresponding author.
| | - Tanya Millard
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Vic. 3004, Australia
| | - Julia Stout
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Vic. 3004, Australia
| | - Karalyn McDonald
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Vic. 3004, Australia
| | - Sarity Dodson
- Health Systems Improvement Unit, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, Vic. 3125, Australia
| | - Richard H Osborne
- Health Systems Improvement Unit, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, Vic. 3125, Australia
| | - Malcolm W Battersby
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, SA 5001, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre and Department of Medicine, Central Clinical School, Monash University, Melbourne, Vic. 3000, Australia
| | - Michael R Kidd
- Department of Family and Community Medicine, University of Toronto, Toronto M5G 1V7, Canada
| | - James McMahon
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Vic. 3004, Australia
| | - David Baker
- East Sydney Doctors, 102 Burton Street, Darlinghurst, NSW 2010, Australia
| | - Julian H Elliott
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Vic. 3004, Australia; and Cochrane Australia, School of Public Health and Preventative Medicine, Monash University, Melbourne, Vic. 3004, Australia
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Smith JA, Merlino A, Christie B, Adams M, Bonson J, Osborne RH, Drummond M, Judd B, Aanundsen D, Fleay J, Gupta H. Using social media in health literacy research: A promising example involving Facebook with young Aboriginal and Torres Strait Islander males from the Top End of the Northern Territory. Health Promot J Austr 2020; 32 Suppl 1:186-191. [PMID: 32946620 PMCID: PMC7984039 DOI: 10.1002/hpja.421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/17/2020] [Accepted: 09/10/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- James A Smith
- Freemasons Centre for Male Health & Wellbeing - Northern Territory, Menzies School of Health Research, Casuarina, NT, Australia.,Charles Darwin University, Darwin, NT, Australia
| | - Anthony Merlino
- Freemasons Centre for Male Health & Wellbeing - Northern Territory, Menzies School of Health Research, Casuarina, NT, Australia
| | - Ben Christie
- Freemasons Centre for Male Health & Wellbeing - Northern Territory, Menzies School of Health Research, Casuarina, NT, Australia
| | - Mick Adams
- Edith Cowan University, Joondalup, WA, Australia
| | - Jason Bonson
- Northern Territory Department of Health, Darwin, NT, Australia
| | | | | | - Barry Judd
- Charles Darwin University, Darwin, NT, Australia.,University of Melbourne, Melbourne, VIC, Australia
| | | | - Jesse Fleay
- Edith Cowan University, Joondalup, WA, Australia
| | - Himanshu Gupta
- Freemasons Centre for Male Health & Wellbeing - Northern Territory, Menzies School of Health Research, Casuarina, NT, Australia
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Friis K, Aaby A, Lasgaard M, Pedersen MH, Osborne RH, Maindal HT. Health literacy and mortality in individuals with NCDs: A 6-year Danish follow-up study (N = 29.473). Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Non-communicable diseases impact to the globally unequal distribution of health. From a public health perspective, health literacy (HL) may be a promising modifiable social determinant, suggested to be associated with adverse health outcomes. Few studies have explored how HL is related to mortality in the general population and in subgroups. This study examines HL as a predictor for mortality in the general population and among individuals with cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), diabetes, and mental illness.
Methods
Design: Data from a large Danish health survey (n = 29,473) from 2013 were linked with national mortality registry data to permit a 6-year survival analysis using Cox regression analyses. Participants: The study included people in the general population people reporting different long-term conditions: CVD (n = 2,389), COPD (n = 1,214), diabetes (n = 1,685) and mental illness (n = 1,577). Outcome Measures: Two subscales from the Health Literacy Questionnaire (HLQ) were included: 1) Ability to understand information about health well enough to know what to do, and 2) Ability to actively engage with healthcare providers.
Results
After adjusting for sociodemographic factors, multimorbidity and health behaviour, individuals reporting difficulties in understanding information about health, had higher risk of dying during follow-up (hazard rate (HR) 1.38 [95% CI 1.11-1.73]). Higher risk was also observed among people reporting CVD (HR 1.47 [95% CI 1.01-2.14]), diabetes (HR 1.91 [95% CI 1.13-3.22]) and mental illness (HR 2.18 [95% CI 1.25-3.81]), but not for individuals with COPD. Difficulties in actively engaging with healthcare providers was not associated with mortality.
Conclusions
Aspects of HL predict higher risk of dying during a 6 years follow-up period. Our study serves as a reminder to public health organizations to consider the HL responsiveness of their services in relation to diverse HL challenges and needs.
Key messages
Aspects of health literacy predict higher risk of dying during a 6 years follow-up period in individuals with CVD, diabetes and mental illness. Our study serves as a reminder to public health organizations to consider the health literacy responsiveness of their services in relation to diverse health literacy challenges and needs.
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Affiliation(s)
- K Friis
- DEFACTUM, Central Denmark Region, Aarhus C, Denmark
| | - A Aaby
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - M Lasgaard
- DEFACTUM, Central Denmark Region, Aarhus C, Denmark
| | - M H Pedersen
- DEFACTUM, Central Denmark Region, Aarhus C, Denmark
| | - R H Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Australia
| | - H T Maindal
- Department of Public Health, Aarhus University, Aarhus C, Denmark
- Health Promotion, Steno Diabetes Center CpH, Gentofte, Denmark
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48
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Cheng C, Beauchamp A, Elsworth GR, Osborne RH. Applying the Electronic Health Literacy Lens: Systematic Review of Electronic Health Interventions Targeted at Socially Disadvantaged Groups. J Med Internet Res 2020; 22:e18476. [PMID: 32788144 PMCID: PMC7453328 DOI: 10.2196/18476] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/30/2020] [Accepted: 06/03/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Electronic health (eHealth) has the potential to improve health outcomes. However, eHealth systems need to match the eHealth literacy needs of users to be equitably adopted. Socially disadvantaged groups have lower access and skills to use technologies and are at risk of being digitally marginalized, leading to the potential widening of health disparities. OBJECTIVE This systematic review aims to explore the role of eHealth literacy and user involvement in developing eHealth interventions targeted at socially disadvantaged groups. METHODS A systematic search was conducted across 10 databases for eHealth interventions targeted at older adults, ethnic minority groups, low-income groups, low-literacy groups, and rural communities. The eHealth Literacy Framework was used to examine the eHealth literacy components of reviewed interventions. The results were analyzed using narrative synthesis. RESULTS A total of 51 studies reporting on the results of 48 interventions were evaluated. Most studies were targeted at older adults and ethnic minorities, with only 2 studies focusing on low-literacy groups. eHealth literacy was not considered in the development of any of the studies, and no eHealth literacy assessment was conducted. User involvement in designing interventions was limited, and eHealth intervention developmental frameworks were rarely used. Strategies to assist users in engaging with technical systems were seldom included in the interventions, and accessibility features were limited. The results of the included studies also provided inconclusive evidence on the effectiveness of eHealth interventions. CONCLUSIONS The findings highlight that eHealth literacy is generally overlooked in developing eHealth interventions targeted at socially disadvantaged groups, whereas evidence about the effectiveness of such interventions is limited. To ensure equal access and inclusiveness in the age of eHealth, eHealth literacy of disadvantaged groups needs to be addressed to help avoid a digital divide. This will assist the realization of recent technological advancements and, importantly, improve health equity.
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Affiliation(s)
- Christina Cheng
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia.,Deakin University, School of Health and Social Development, Faculty of Health, Burwood, Australia
| | - Alison Beauchamp
- Department of Rural Health, Monash University, Melbourne, Australia.,Department of Medicine - Western Health, The University of Melbourne, Melbourne, Australia.,Australian Institute for Musculoskeletal Science, Sunshine Hospital, St Albans, Australia
| | - Gerald R Elsworth
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia
| | - Richard H Osborne
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia
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Anwar WA, Mostafa NS, Hakim SA, Sos DG, Abozaid DA, Osborne RH. Health literacy strengths and limitations among rural fishing communities in Egypt using the Health Literacy Questionnaire (HLQ). PLoS One 2020; 15:e0235550. [PMID: 32673345 PMCID: PMC7365439 DOI: 10.1371/journal.pone.0235550] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 06/17/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction Health literacy is an important determinant of health. The aim of this study was to use a multi-dimensional measurement tool to describe the health literacy of people living in a fishing community in northern Egypt. Methods and analysis Data were collected from 436 people (fisherman and their families), using the Health Literacy Questionnaire (HLQ), which includes 9 scales. Effect sizes (ES) for standardized mean differences estimated the magnitude of difference between demographic groups. Results The mean age of participants was 42 years, 50% were male, 42% were working in the fishing sector, 17.9% had access to the Internet and 36.8% were illiterate. Male participants showed higher capabilities in scales 3. Actively managing my health and 4. Social support for health (ES = 0.21 and 0.27, respectively). In comparison to other occupations, fishing occupation had a negative impact on scale 7. Navigating the healthcare system (ES -0.23). Also, higher educational level was associated with higher HLQ indicators. Across all scales, scale 2. Having sufficient information to manage my health showed the lowest mean (SD) score; 2.23 (0.76) indicating that most people reported they didn’t have enough information. Conclusions This study has revealed that fishermen and their families have a wide range of health literacy difficulties which are likely to have profound negative effects on health behavior and health outcomes.
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Affiliation(s)
- Wagida A. Anwar
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nayera S. Mostafa
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- * E-mail:
| | - Sally Adel Hakim
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Dalia G. Sos
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Dena A. Abozaid
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Richard H. Osborne
- Centre for Global Health and Equity, Faculty of Health, Design and Arts, Swinburne University of Technology, Melbourne, Australia
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Wahl AK, Hermansen Å, Osborne RH, Larsen MH. A validation study of the Norwegian version of the Health Literacy Questionnaire: A robust nine-dimension factor model. Scand J Public Health 2020; 49:471-478. [PMID: 32508258 PMCID: PMC8135233 DOI: 10.1177/1403494820926428] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objective: This study aimed to undertake a rigorous psychometric evaluation of the nine-scale Norwegian version of the Health Literacy Questionnaire (HLQ) based on data from a sample of people with psoriasis. Methods: Cross-sectional survey data were collected from 825 adults with psoriasis who previously participated in the Norwegian Climate Heliotherapy programme. To investigate the factorial validity of the Norwegian HLQ, confirmatory factor analyses were carried out using Stata. Results: A highly restricted model fit with no cross-loadings or correlated residuals was acceptable for three of the nine scales (‘Feeling understood and supported by health-care providers’, ‘Appraisal of health information’ and ‘Ability to find good health information’). After minor model adjustments of the other scales, one-factor models were acceptable. All scales showed acceptable internal consistency, with Cronbach’s alpha ranging from 0.71 to 0.87. Except for three items, all items had high to acceptable factor loadings. Conclusions: This study of the Norwegian HLQ replicates the original factor structure of the Australian HLQ, indicating the questionnaire has cogent and independent scales with good reliability. Researchers, programme implementers and policymakers could use the Norwegian version of the HLQ with confidence to generate reliable information on health literacy for different purposes.
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Affiliation(s)
- Astrid K. Wahl
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Norway
- Astrid K. Wahl, Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, PB 1089 Blindern, 0317 Oslo, Norway. E-mail:
| | - Åsmund Hermansen
- Department of Social Work, Child Welfare and Social Policy, Faculty of Social Sciences, Oslo Metropolitan University, Norway
| | - Richard H. Osborne
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Australia
| | - Marie Hamilton Larsen
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Norway
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