Improving health literacy in patients with chronic conditions: A call to action

Dunn, Patrick; Conard, Scott

doi:10.1016/j.ijcard.2018.08.090

Cited by 76 publications

(69 citation statements)

References 11 publications

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“…A "National Action Plan to Improve Health Literacy" has been set forth by the US Department of Health and Human Services as part of its "Healthy People 2020" initiative, and there is evidence that HL is a modifiable construct through the implementation of both health system level and community-based interventions. (35)(36)(37) Moreover, the National Academy of Medicine has called on health care organizations and policy makers to recognize HL as an essential component of high-quality health care services. (38) Multiple resources, such as the Centers for Disease Control and Prevention's Clear Communication Index (39) and the Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit, are available for medical centers to measure and subsequently tailor the HL of educational materials, improve patient communication, and reduce health care complexity.…”

Section: Original Article | 1419mentioning

confidence: 99%

Low Health Literacy Is Associated With Frailty and Reduced Likelihood of Liver Transplant Listing: A Prospective Cohort Study

et al. 2020

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The effect of low health literacy (HL) on outcomes in end-stage liver disease (ESLD) is largely unknown. The association of low HL on clinical outcomes was investigated in a prospective cohort of outpatients with ESLD undergoing liver transplantation (LT) evaluation. From 2014 to 2017, 276 patients underwent LT evaluation with assessments of liver disease severity, medical and psychosocial comorbidities, physical frailty, and malnutrition. Literacy was measured with the Newest Vital Sign, a brief validated assessment. Multivariate models assessed relationships between HL and clinical outcomes adjusting for clinical and psychosocial variables. The median Model for End-Stage Liver Disease-sodium score of the study sample was 15 (interquartile range, 11-19), 71 (25.7%) of candidates were frail, 117 (42.4%) had malnutrition, 151 (54.7%) had hepatic encephalopathy, 104 (37.7%) had low HL, and 85 (39.2%) had marginal or poor social support. Adjusting for education level, socioeconomic factors, and severity of illness, low HL was independently associated with physical frailty (adjusted odds ratio [aOR], 3.59; 95% confidence interval [CI], 1.50-8.59; P = 0.004) and not being wait-listed (aOR 1.96; 95% CI, 1.03-3.75; P = 0.04). Strong social support attenuated the relationship between low HL and not being wait-listed (aOR, 1.58; 95% CI, 0.74-3.36; P = 0.24). Low HL is common and a largely unrecognized risk factor for poor health outcomes among patients with ESLD. Patient-oriented infrastructure and support are needed at the health system level to ensure all patients can successfully navigate the complex process of LT evaluation and wait-listing.

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Section: Original Article | 1419mentioning

confidence: 99%

Low Health Literacy Is Associated With Frailty and Reduced Likelihood of Liver Transplant Listing: A Prospective Cohort Study

et al. 2020

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“…Health literacy has been conceptualised in different manners, as a set of abilities (reading, writing and numeracy skills), a range of skills including social and communication skills, and as the ability to apply these skills in different settings or life situations (Heijmans, Waverijn, Rademakers, van der Vaart, & Rijken, ). The relationship between HL and self‐management abilities both in health and chronic care conditions has been well established not only with regards to high or low levels of HL but also with regards to multiple levels of HL (Dunn & Conard, ; Nutbeam, ). For example, Nutbeam's () model has documented the existence of three different types of HL: functional, communicative and critical (Nutbeam, ).…”

Section: Introductionmentioning

confidence: 99%

“…the ability to calculate insulin requirements) and navigation (e.g. the ability to call the emergency number) (Dunn & Conard, ). The “Communicative or interactive literacy” refers instead to more advanced skills needed to extract information from health documentation, to apply this information, or to provide a precise description of a medication side effects and symptoms (Nutbeam, ).…”

Section: Introductionmentioning

confidence: 99%

Evaluating self‐directed learning abilities as a prerequisite of health literacy among older people: Findings from a validation and a cross‐sectional study

Cadorin

Grassetti

Paoletti

et al. 2019

Int J Older People Nursing

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Aims and objectives: To validate a tool measuring self-directed learning (SDL) abilities and to determine these abilities among older individuals attending the University of the Third Age.Background: Health literacy (HL) and SDL abilities have been documented as being closely linked to each other and as prerequisites in enhancing self-management competences required by older people to protect their health and to manage health issues. Furthermore, individuals with SDL abilities have been documented to have a full understanding of their health treatment prescriptions, to be able to demonstrate increased compliance and to further develop self-care competences. Design: A validation and a cross-sectional study design.Methods: A consecutive sample of 313 older people (68.7% female) who attended lessons in two Italian Universities of the Third Age and who were willing to participate in the study were enrolled. The Self-Rating Scale of Self-Directed Learning (SRSSDL) validated previously in the healthcare context, was used.Results: At the exploratory and confirmatory factor analysis, the SRSSDL in Older people (SRSSDLO) has demonstrated good psychometric properties: the tool is composed by four factors ("Awareness," "Attitudes," "Availability" and "Motivation") and 13 items. According to the findings, the average SDL score was 54.27 ± 6.69 out of 65, and women achieved significantly higher scores compared with men (54.81 ± 6.69 vs.53.08 ± 6.54, p = .033), while participants with a university degree (55.95 ± 6.56) or secondary education (54.75 ± 6.13) had higher scores than those with lower secondary education (50.37 ± 7.34, p = .002). Conclusions:Participants were responsible for their learning processes and were capable of identifying learning needs and goals. They were also internally motivated to develop learning methods and to organise learning activities. However, they were less able to keep up to date with the learning resources available.

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“…Some patients with a lower level of formal education may require additional self-management support initiatives to improve their capacity to understand and use health information [49]. In fact recent literature recommends clinicians self-evaluate health literacy strategies within their service with a focus on how information is presented to patients [61]. Suggested strategies to facilitate health literacy include simplifying the focus of consultations and provided information, avoiding medical jargon, and assessing patient comprehension of information [60,62].…”

Section: Discussionmentioning

confidence: 99%

“…Health literacy was also not measured specifically in this study. Future studies will need to specifically evaluate the relationship between health literacy skills and outcome within this service, as well as evaluate the impact of implemented health literacy enhancement strategies [61] on outcomes within the service.…”

Section: Discussionmentioning

confidence: 99%

A multisite longitudinal evaluation of patient characteristics associated with a poor response to non-surgical multidisciplinary management of low back pain in an advanced practice physiotherapist-led tertiary service

O’Leary

Raymer

Window

et al. 2020

BMC Musculoskelet Disord

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Background Non-surgical multidisciplinary management is often the first pathway of care for patients with chronic low back pain (LBP). This study explores if patient characteristics recorded at the initial service examination have an association with a poor response to this pathway of care in an advanced practice physiotherapist-led tertiary service. Methods Two hundred and forty nine patients undergoing non-surgical multidisciplinary management for their LBP across 8 tertiary public hospitals in Queensland, Australia participated in this prospective longitudinal study. Generalised linear models (logistic family) examined the relationship between patient characteristics and a poor response at 6 months follow-up using a Global Rating of Change measure. Results Overall 79 of the 178 (44%) patients completing the Global Rating of Change measure (28.5% loss to follow-up) reported a poor outcome. Patient characteristics retained in the final model associated with a poor response included lower Formal Education Level (ie did not complete school) (Odds Ratio (OR (95% confidence interval)) (2.67 (1.17–6.09), p = 0.02) and higher self-reported back disability (measured with the Oswestry Disability Index) (OR 1.33 (1.01–1.77) per 10/100 point score increase, p = 0.046). Conclusions A low level of formal education and high level of self-reported back disability may be associated with a poor response to non-surgical multidisciplinary management of LBP in tertiary care. Patients with these characteristics may need greater assistance with regard to their comprehension of health information, and judicious monitoring of their response to facilitate timely alternative care if no benefits are attained.

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Improving health literacy in patients with chronic conditions: A call to action

Cited by 76 publications

References 11 publications

Low Health Literacy Is Associated With Frailty and Reduced Likelihood of Liver Transplant Listing: A Prospective Cohort Study

Low Health Literacy Is Associated With Frailty and Reduced Likelihood of Liver Transplant Listing: A Prospective Cohort Study

Evaluating self‐directed learning abilities as a prerequisite of health literacy among older people: Findings from a validation and a cross‐sectional study

A multisite longitudinal evaluation of patient characteristics associated with a poor response to non-surgical multidisciplinary management of low back pain in an advanced practice physiotherapist-led tertiary service

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