Health literacy in persons at risk of and patients with coronary heart disease: A systematic review

Peltzer, Samia; Hellstern, Marc; Genske, Anna; Jünger, Saskia; Woopen, Christiane; Albus, Christian

doi:10.1016/j.socscimed.2019.112711

Cited by 31 publications

(20 citation statements)

References 64 publications

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“…There is promising evidence showing the effectiveness of health literacy interventions on health outcomes at the individual and community level [ 20 , 48 , 49 , 50 ]. However, there remain substantial gaps.…”

Section: What Is Known Already?mentioning

confidence: 99%

Moving Health Literacy Research and Practice towards a Vision of Equity, Precision and Transparency

Guo

Okan

2020

IJERPH

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Over the past two decades, health literacy research has gained increasing attention in global health initiatives to reduce health disparities. While it is well-documented that health literacy is associated with health outcomes, most findings are generated from cross-sectional data. Along with the increasing importance of health literacy in policy, there is a lack of specificity and transparency about how to improve health literacy in practice. In this study, we are calling for a shift of current research paradigms from judging health literacy levels towards observing how health literacy skills are developed over the life course and practised in the real world. This includes using a life-course approach, integrating the rationale of precision public health, applying open science practice, and promoting actionable knowledge translation strategies. We show how a greater appreciation for these paradigms promises to advance health literacy research and practice towards an equitable, precise, transparent, and actionable vision.

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Section: What Is Known Already?mentioning

confidence: 99%

Moving Health Literacy Research and Practice towards a Vision of Equity, Precision and Transparency

Guo

Okan

2020

IJERPH

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“…12 Although there were a lot of evidence confirming the association between patient demographic and socioeconomic characteristics and EOL care decisions, literature pointed out that HL which varies by education level, race/ethnicity, and age could be an independent factor affecting patients' EOL perference. 13,14 Previous studies also have suggested HL's impacts on health outcomes and medical expenditures. [15][16][17][18] For example, low health literacy (LHL) corresponded to increased healthcare utilization including hospitalizations, emergency care, and mortality.…”

Section: Introductionmentioning

confidence: 97%

Associations Between Health Literacy and End-of-Life Care Intensity Among Medicare Beneficiaries

Luo

Shi

Hung

et al. 2021

Am J Hosp Palliat Care

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Background: Despite well-documented disparities in end-of-life (EOL) care, little is known about whether patients with low health literacy (LHL) received aggressive EOL care. Objective: This study examined the association between health literacy (HL) and EOL care intensity among Medicare beneficiaries. Method: We conducted a retrospective analysis of Medicare fee-for-service decedents who died in July-December, 2011. ZIP-code-level HL scores were estimated from the 2010-2011 Health Literacy Data Map, where a score of 225 or lower was defined as LHL. Aggressive EOL care measures included repeated hospitalizations within the last 30 days of life, no hospice enrollment within the last 6 months of life, in-hospital death, and any of above. Using hierarchical generalized linear models, we examined the association between HL and aggressive EOL care. Results: Of 649,556 decedents, the proportion of decedents who received any aggressive EOL care among those in LHL areas was 82.7%, compared to 72.7% in HHL areas. In multivariable analyses, decedents residing in LHL areas, compared to those in HHL areas, had 31% higher odds of aggressive EOL care (adjusted odds ratio [AOR] 1.31; 95% confidence interval [CI]:1.21-1.42), including higher odds of no hospice use (AOR 1.35; 95% CI: 1.27-1.44), repeated hospitalization (AOR 1.07; 95% CI: 1.01-1.14) and in-hospital death (AOR 1.21; 95% CI: 1.13-1.29). Conclusion: Medicare beneficiaries who resided in LHL areas were likely to receive aggressive EOL care. Tailored efforts to improve HL and facilitate patient-provider communications in LHL areas could reduce EOL care intensity.

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“…Research indicates that patients with ischemic heart disease and low socioeconomic status are more likely to be confronted with external stressors, meaning stress-producing circumstances, and thereby experience elevated levels of psychosocial stress compared with patients with a higher socioeconomic status (Dupre et al, 2017). Furthermore, both low levels of health literacy and lack of access to social support have been associated with low socioeconomic status and poor psychosocial well-being among patients living with ischemic heart disease (Child & Albert, 2018; Peltzer et al, 2020). In addition, experiencing chronic illness, like ischemic heart disease, at midlife has been shown to create distinct psychosocial challenges (Allison & Campbell, 2009; Markle et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

An Overwhelming Burden of Psychosocial Stress: Life With Ischemic Heart Disease for Midlife Patients With Low Socioeconomic Status and Lack of Flexible Resources

2021

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The largest social inequalities in ischemic heart disease are found in the midlife population. These inequalities are often explained by lifestyle factors, while the role of structural factors and psychosocial stress are generally less acknowledged. In this study, we explore the influence of psychosocial stress on life with ischemic heart disease for midlife patients with low socioeconomic status and lack of flexible resources. In-depth interviews were conducted with 18 participants, and a critical hermeneutic approach was used to analyze and interpret data. We found that the participants were exposed to several external psychosocial stressors related to their family relationships, employment conditions, and experiences of stigmatization. These stressors reinforced each other and created an overwhelming burden of psychosocial stress. Our findings call for supportive interventions that target external psychosocial stressors and stressful feelings among this vulnerable group of patients.

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Health literacy in persons at risk of and patients with coronary heart disease: A systematic review

Cited by 31 publications

References 64 publications

Moving Health Literacy Research and Practice towards a Vision of Equity, Precision and Transparency

Moving Health Literacy Research and Practice towards a Vision of Equity, Precision and Transparency

Associations Between Health Literacy and End-of-Life Care Intensity Among Medicare Beneficiaries

An Overwhelming Burden of Psychosocial Stress: Life With Ischemic Heart Disease for Midlife Patients With Low Socioeconomic Status and Lack of Flexible Resources

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