Influence of Caretakers’ Health Literacy on Delays to Traumatic Brain Injury Care in Uganda

Abstract

Background The global incidence of traumatic brain injury (TBI) is disproportionately concentrated in low-and middle-income countries (LMICs) [1] and is associated with substantial morbidity and mortality. In addition to its detrimental effects on health, TBI presents a financial burden to families, healthcare systems, and economies through lost productivity and high healthcare costs [2]. In hospitals across many African countries, family members are the primary caretakers of patients during and after their hospital stays [3, 4]. As of 2011, there is a 42% shortage of nurses within the public health sector in Uganda and a 10% shortage at the largest public hospital in the country, Mulago National Referral Hospital (MNRH); this has severely affected health delivery services [5]. With the scarcity of health workers, caretakers with little to no training in patient care are entrusted with relatively highlevel tasks. Depending on the diagnosis and severity of illness, caregivers may engage in various care tasks such as wound care, medication and symptom management, transportation, and the provision of emotional support [6]. These tasks are particularly relevant in a neurosurgical ward, where many TBI patients are immobile and unable to speak or comprehend instructions. Caretakers play a significant role in the care and support of patients with chronic illnesses and seek health information to facilitate this role [7]. They are also an essential source of health information for patients and assist in decision-making throughout the care continuum. Three types of health literacy have been defined based on their application in the real world: functional, interactive, and critical [8]. Functional health literacy encompasses the basic skills needed to understand health

Novel application of multi-facility process map analysis for rapid injury care health system assessment in Northern Malawi

“…A belief that there was no need for care following bone fracture was markedly observed in China,40 while few Rwandans thought it unnecessary 46. Knowing how best to respond has delayed injury care seeking in South Africa and Uganda,4 47 and represents another important dimension of health literacy.…”

Impact of Educational Background on Preoperative Disease Severity and Postoperative Outcomes Among Patients With Cervical Spondylotic Myelopathy

“…11 The role of appropriate patient and caretaker education is critical and must be provided at an educational level that is appropriate for the audience. 1,7,23,29 Various strategies, such as utilizing multimedia-based educational interventions, have been proposed to improve the efficacy of educational material regardless of a patient's baseline educational status. 23 Finally, given the strong, known association between educational level and postoperative outcomes, educational level should be incorporated into routine preoperative screening and prehabilitation strategies.…”

“…Primary care and community-based practitioners must retain a higher index of suspicion to identify this debilitating disease to prevent unnecessary delays in care and irreversible neurological injury 11 . The role of appropriate patient and caretaker education is critical and must be provided at an educational level that is appropriate for the audience 1,7,23,29 . Various strategies, such as utilizing multimedia-based educational interventions, have been proposed to improve the efficacy of educational material regardless of a patient’s baseline educational status 23 .…”

“…4 Among these factors, education level and health literacy play a pivotal role. 2,[5][6][7][8] Lower education levels of the patient and/or the primary caregiver have been associated with prolonged disease duration, poor follow-up and retention rates, and increased diseaserelated morbidity. 1 Surgical interventions for spinal pathologies are particularly susceptible to being impacted by poor patient educational levels and poor health literacy due to the inherent complexity of these pathologies.…”

“…These social determinants of health are composed of a multitude of factors, including sex, race, socioeconomic status (SES), employment status, and housing status 4 . Among these factors, education level and health literacy play a pivotal role 2,5–8 . Lower education levels of the patient and/or the primary caregiver have been associated with prolonged disease duration, poor follow-up and retention rates, and increased disease-related morbidity 1 .…”