Comprehension Of Health Information Research Articles

The feasibility, acceptability and perceived impact of a theory-based intervention on non-medical prescribing students’ antibiotic prescribing behaviour: an experimental study

Abstract Introduction Acute upper respiratory tract infections (URTI) are one of the most common infections. URTIs usually resolve spontaneously but 60% of all prescriptions issued in UK primary care are for URTIs1 contributing to antimicrobial resistance. Non-medical prescribers are a growing group of prescribers but there are few if any antimicrobial stewardship (AMS) interventions to support their prescribing practices. Introducing AMS interventions when learning to prescribe can play an important role to embed appropriate practice at the start of a prescribers’ journey. Aim To test the feasibility, acceptability and perceived impact of a theory-based electronic learning intervention on the antibiotic prescribing behaviour of non-medical prescribing students. Methods Non-medical prescribing students registered at the study setting (university) were recruited via email and word of mouth. Following consent, participants completed an online pre-intervention questionnaire that explored their perceived prescribing behaviour and confidence in treating patients with URTIs. Participants then completed the intervention, accessible from any internet-enabled device via a weblink. The intervention was previously developed2 using the behaviour change wheel and comprised an animation of a prescriber opting against prescribing antibiotics for an adult with self-limiting URTI using a motivational interviewing approach. The patient felt satisfied and confident about their care. Four questions followed the scenario. Participants then completed an online post-intervention questionnaire that explored the usefulness of the intervention, and the same pre-intervention confidence questions. A one-to-one online audio-recorded semi-structured interview followed, exploring participants’ experiences of using the intervention. Questionnaire and interview questions were informed by the Capability Opportunities Motivation-Behaviour model. Questionnaire data were analysed using descriptive statistics. Interviews were transcribed verbatim and analysed using thematic analysis3. Ethical approval was given by the School Research Ethics Committee where the researchers were based. Results Twelve participants (of 50 approached) consented to take part. Eight completed the pre- and post-intervention questionnaires and the intervention. Seven completed all stages of the study. 87.5% of participants worked in a hospital setting. All were qualified for at least two years. Interviews lasted between 9-15 minutes. Participants’ confidence in treating patients with URTI increased in all statements; gain information on patient expectations, support patients’ comprehension of health information, build rapport, communicate effectively, help patients to see and examine different viewpoints (highest mean increase) and patients understand and are happy with their prescribing decision. These increases aligned with qualitative accounts. Participants agreed that the intervention would be useful to them and would change their practice positively. Participants found the intervention easy to use; access was straightforward and took between 5-20minutes to complete. The addition of a wider range of complex, challenging scenarios to the intervention were suggested. Discussion/conclusions The intervention was feasible to complete and acceptable to the participants. Participants’ confidence in treating patients increased; even though many were familiar with AMS, the intervention gave them further confidence to support a no antibiotic prescribing strategy. Participants suggested including more complex patient scenarios; this will be considered in a future study. Study limitations includes a small sample size and most participants worked in hospital settings but the intervention was set in primary care.

Navigating the infodemic through digital health literacy education in schools

Abstract Background High digital health literacy (DHL) can help to navigate the internet’s vast information landscape. This research explores the impact of learning DHL in schools on students’ DHL, and how it might mitigates confusion surrounding health-related information. Moreover, this research sheds light on how learning DHL in schools influences students’ inclinations towards specific sources of health information. Methods 1448 secondary school students aged 9-18 years participated in face-to-face interviews. Associations between learning digital health literacy (DHL) and students’ DHL, comprehension of health information, sense of being informed on health topics, and utilization of diverse health information sources were evaluated using the chi-squared test. Results The learning of DHL within school settings demonstrated a significant correlation with students’ overall DHL (X2 (6) = 120.99, p < .001). Those reporting high levels of DHL learning exhibited reduced confusion regarding health information (X2 (4) = 16.65, p = .002) and felt notably more informed (X2 (4) = 231.06, p < .001). Contrasted with peers who reported insufficient learning of DHL, students with high learning reported learning more about health from parents (X2 (2) = 55.28, p < .001), peer interactions (X2 (2) = 214.51, p < .001), online sources (X2 (2) = 78.54, p < .001), influencer content (X2 (2) = 68.46, p < .001), offline literature (X2 (2) = 24.32, p < .001), television (X2 (2) = 140.36, p < .001), and in school (X2 (2) = 205.53, p < .001). However, they were less reliant on physicians for health information (X2 (2) = 53.62, p < .001). Conclusions Integrating DHL into school curricula holds promise for enhancing students’ DHL and alleviating apprehensions regarding health-related information. Moreover, such educational initiatives have the potential to expand students’ repertoire of resources for accessing health information, encompassing both digital and non-digital sources.

Abstract 3101: Precision Medication Communication Through Teach-back Method Among Patients With Cardiovascular Disease Admitted To The Telemetry Unit

Background: Limited qualitative research has identified clinician skills and behaviors that enhance precision communication, a challenging task when patients exhibit limited health literacy(HL). The teach-back method, a technique aimed at confirming patients' comprehension of health information has been suggested as a valuable strategy to address HL. Our quality improvement study examined the patients’ understanding of newly prescribed cardiac medications during hospitalization. We aimed to pinpoint barriers in communication between healthcare providers and patients as well as use the teach-back method to improve literacy about newly prescribed medications before their discharge. Methods: 50 participants, including 28 males and 22 females with a mean age of 71.72, (SDN+/-2:11.59) admitted to the telemetry floor between 11/2023 and 01/2024. Yes/No questionnaire interview was conducted to gauge their understanding of the newly prescribed cardiac medication and its adverse effects. The interviewer encouraged participants to articulate their understanding in their own words. A follow-up telephone interview was conducted 2-4 weeks post-discharge to assess the retention of information regarding the newly initiated medication(s). Results: Among 50 patients, 54% demonstrated awareness of the reason behind the prescription of the medication, while only 26% knew about its serious adverse effects before employing the teach-back method. Following the application of the method during the interview, 92% exhibited an enhanced understanding of the information related to their medications. Follow-up telephone interviews conducted 2-3 weeks post-discharge, 74% retained information about the indication and adverse effects of the prescribed medications. Conclusion: Integration of the teach-back method during discharge planning is a highly effective strategy in improving patient education and communication for newly prescribed cardiac medications.

Use and Utility of Patient After-Visit Instructions at a University Rheumatology Outpatient Clinic: Status and Randomized Prospective Pilot Intervention Study.

The aim of this study was to evaluate the use of after-visit instructions (AVIs) in an academic rheumatology clinic and assess the impact of standardized AVIs (sAVIs) and teach-back (TB) on comprehension of health information. A retrospective review of adult patients seen between October 1 and 8, 2021, at the rheumatology clinic collected data on patient demographics, clinical features, and the presence, content, and readability of AVIs. During a subsequent prospective proof-of-concept study, routinely scheduled patients seen at the rheumatology clinic were randomized into three groups: control (received standard of care), received sAVIs only, and received sAVIs plus TB. Patients completed a health literacy questionnaire, satisfaction survey, and a one- to two-week postvisit telephone survey to assess AVI comprehension. Out of 316 retrospective patient visits, 82 (25.9%) received AVIs. Among 210 of 316 patients (66.5%) with management changes, 76 (36.1%) received AVI, with 74.2% of the instructions considered concordant with the provider's note. Use of AVIs was higher with management changes, new patient visits, and medical trainee/teaching clinics. AVIs were written at a median 6.8 grade level. A total of 75 patients completed the prospective study: 31 (41.3%) were in the control group, 19 (25.3%) were in the group that received sAVIs only, and 25 (33.3%) were in the group that received AVIs with TB. There were no differences in overall postvisit survey comprehension/retention scores among the three patient groups evaluated. Although a lack of AVI use was identified, implementation of sAVIs did not appear to impact patient retention or comprehension of discharge health information.

Health Literacy of the Elderly During the COVID-19 Pandemic: A Cross-Sectional Study

This study assessed health literacy (HL) and its associated factors among the elderly during the COVID-19 pandemic, in which HL affected disaster risk management. This cross-sectional study included elderly individuals from Dusit District, Bangkok, Thailand. A total sample of 500 was obtained through simple random sampling conducted between March and October 2022. Spearman’s rank correlation and the eta coefficient were used to analyze the relationships. As for the results, the total HL of the elderly was fair (x̄ = 54.01, S.D. = 14.05). Considering each aspect, it was found that 1) access to information and health services was poor (x̄ = 11.91, S.D. = 2.97), 2) comprehension of health information was fair (x̄ = 14.01, S.D. = 3.65), 3) assessment of health information and services was fair (x̄ = 13.60, S.D. = 3.83), and 4) application of information and health services was fair (x̄ = 14.49, S.D. = 3.60). Age, education, and comorbidity were factors related to the HL of the elderly during the COVID-19 pandemic in Dusit District (p < 0.001). The results elucidate the HL of the population of this community during the COVID-19 pandemic, providing an indicator of the community’s potential for disaster risk management, including the preparedness, mitigation, response, and recovery phases.

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

BackgroundNon-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.MethodsTwo 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.ResultsOverall 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).ConclusionsA 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.

HIV-TB Treatment Pictogram Tool Designed from Semiotic Analysis for Community Pharmacists in India

A pictogram-based counselling pamphlet for pharmacists in India for HIV-TB co-infection and treatment was developed. Pictograms have been shown to improve health literacy and adherence by increasing retention and comprehension of health information, especially in persons with lower levels of literacy. The development of the draft pictogram pamphlet for HIV-TB treatment was based on semiology and adaptation of existing pictograms and incorporation of key counselling points identified in a literature review. A total of 103 articles were reviewed and 21 (n=9 for HIV; n=12 for TB) were identified as applicable to pharmacist counselling and were used in the development of key counselling points. Of the 22 pictograms in the draft pamphlet, n=5 were redesigned based on existing pictograms, n=11 were based on semiotic analysis of existing pictograms, n=5 were based on semiology of a web-based image search, and n=1 was developed in consultation with Indian pharmacists. The future goal is to validate the pictogram pamphlet as there is a scarcity and oversimplification of validated pictograms targeted to counselling patients with HIV-TB. Although validation of more complicated pictograms in a low-literacy population may be challenging, the aim of pictograms is to enhance recall and deliver the pictogram information in combination with verbal instruction in order to improve adherence and patient outcomes.

Health literacy of Pacific mothers in New Zealand is associated with sociodemographic and non-communicable disease risk factors: surveys, focus groups and interviews.

Abstract
 Introduction: Pacific people living in New Zealand, suffer from inequitably high rates of non-communicable diseases and their associated risk factors. This disease burden may be compounded by low health literacy levels. The objectives of this research were: (1) measure relationships between health literacy, socio-demographic factors and non-communicable disease risk factors in a large sample of Pacific mothers living in New Zealand and (2) gain in-depth understanding of social and cultural factors contributing to these relationships.
 Methods: Logistic regression was employed to investigate health literacy and: acculturation, socioeconomic status, physical activity, education, smoking status, health status, and alcohol consumption. Semi-structured focus groups were conducted with Pacific mothers and interviews with Pacific health professionals adopting the culturally appropriate talanoa, and kakala methods, within the Fonofale framework.
 Findings: Associations between low health literacy and age, ethnicity, acculturation, employment, education, smoking status, and alcohol status were shown. Novel findings from the focus groups were: the use and comprehension of health information and what constitutes preferred information and health service delivery modes.
 Conclusions: Findings suggest current health related information is not being used to its fullest extent by Pacific mothers. This may be due to underlying socio-demographic factors. This is the first study to examine the factors related to health literacy among Pacific mothers in NZ. Findings should be used to inform future interventions and delivery of public health nutrition messages.

건강정보 제시유형이 정보의 인지에 미치는 영향에 관한 연구

본 연구는 이미지와 텍스트로 구성된 건강정보의 제시 유형이 정보의 인지에 미치는 차이에 대해 분석하였다. 이를 위해 대학생 47명을 대상으로 정보의 제시유형에 따른 정보의 인지 차이를 측정하였다. 또한, 피험자가 주관적으로 느끼는 이미지의 생생함과 질병의 인지도를 변수로 함께 대입하여 정보의 인지도를 측정하였다. 분석결과를 살펴보면 먼저 본문에 이미지가 함께 제시된 건강정보는 텍스트로만 구성된 건강정보보다 정보의 인지가 높은 것으로 나타났으며 이미지가 포함된 건강정보의 유형에서는 그림이 제시된 경우 정보의 인지가 가장 높게 측정되었다. 또한, 이미지의 유형 중 사진은 생생함이 가장 높게 측정되었으나 생생함이 높을수록 정보의 회상률은 낮은 것으로 측정되었다. 질병에 대한 인지도는 건강정보 제시유형별 회상과 재인에 통계적으로 유의미한 차이를 보이지 않았다. 본 연구는 도서관에서 건강정보서비스를 시작하고자 할 때 정보원 구축 및 콘텐츠 설계를 위한 기초자료로 활용할 수 있을 것이다. We investigated how combining different types of images with written text affects the comprehension of health related information. The types of images were picture, photograph, and X-ray. 47 four year college students were recruited for the experiment. The independent variables in this study included information presentation format, vividness of image, and the degree of awareness for the disease. The dependent variables were recognition and recall for information. The results showed that the information with images in recognition and recall had higher score than information with written text only. In regard to the effect of different kinds of images on comprehension of health information, information with picture had higher score than the information with photograph and X-ray. The vividness of image were found to work as a negative factor on the recognition of information. Finally, the degree of awareness of disease also failed to have any significant effect on subjects' recall and recognition. This research has implications for the contents design of health related website.

A Survey of the Prevalence of Cell Phones Capable of Receiving Health Information among Patients Presenting to an Urban Emergency Department

BackgroundMobile devices have been shown to assist patients with comprehension of health information, yet sparse data exist on what mobile devices patients own and preferences for receiving health information. ObjectivesTo determine the prevalence of mobile devices capable of receiving health information among patients/visitors presenting to an urban Emergency Department (ED). MethodsA random sample of patients/visitors ≥18 years was surveyed. The primary outcome was prevalence of mobile devices capable of receiving health information among patient/visitor units presenting to the ED. Means and 95% confidence intervals were derived for continuous data; proportions with Fisher’s exact 95% confidence intervals were derived for categorical data. Institutional review board approval was received before study initiation. ResultsSurveyors approached 1307 subjects: 68% (885) were eligible; 70% (620) agreed to participate; 4 participants were excluded, leaving 70% (616) in the final sample. Of the 616 participants, 82% stated cell phone ownership (95% confidence interval [CI] 0.79–0.85). Among cell phone owners (n = 507), 90% had the device with them (95% CI 0.87–0.92) in the ED. Of these participants (n = 456), 77% had text messaging (95% CI 0.73–0.81), 51% had Internet (95% CI 0.47–0.56), 51% had e-mail (95% CI 0.46–0.56), 39% could download audio content (95% CI 0.34–0.43), and 35% could download videos (95% CI 0.31–0.40). Even among those having an annual income ≤$20,000, nearly 80% of persons owned cell phones. ConclusionsCell phones capable of receiving health information are prevalent among patients/visitors presenting to an urban ED.

Cancer Information Comprehension by English-as-a-Second-Language Immigrant Women

Limited acculturation and socioeconomic factors have been associated with lower participation in cancer screening. Limited comprehension of cancer prevention information may contribute to this association. The authors used a stepwise linear regression to model acculturation and socioeconomic factors as predictors of comprehension (colon cancer and general health information) and screening intention in a sample of 78 Spanish-speaking immigrant women in Canada. The authors used the McNemar test to look for changes in women's screening intention. They used the Bidimensional Acculturation Scale, a language-based scale, to assess acculturation. Among English-as-a-second-language immigrant women, acculturation, television and Internet use, age, and Spanish-language education predicted comprehension of cancer prevention information, F(3, 69) = 6.76, p < .001, R 2 = .23. These variables also predicted comprehension of general health information, via the short form of the Test of Functional Health Literacy in Adults, F(4, 68) = 12.13, p < .001, R 2 = .42; and the Rapid Estimate of Adult Literacy in Medicine, F(2, 70) = 7.54, p = .001, R 2 = .17. However, the variables did not predict screening intention. More women expressed intention to be screened after reading the cancer prevention information than expected by chance alone, p = .002. Acculturation is an important influence on the comprehension of health information by older English-as-a-second-language immigrant women. However, other culture-related factors not measured by the Bidimensional Acculturation Scale likely influence their exposure to and understanding of health and cancer prevention information.

Public Health: An Epidemiological Study to Explore the Relationship between Literacy, Language, Aging, and Familiarity on Comprehension of Health Information

Studies concerning health literacy indicate that health-related materials cannot be understood by most of the people for whom they are intended. A primary aim of the current study was to evaluate the extent to which medication information sheets effectively convey instructions and health information to populations who may be at risk of making errors: seniors (65+), new and inexperienced medication users (ages 16–21), and English learners. An “experimental” information sheet was created for this study by reformatting existing sheets to comport with results of my prior science fair research. A comprehension test was also created for this study. Two existing information sheets (one commonly used by pharmacy chains and one by the U.S. Food and Drug Administration [FDA]) were compared to the experimental sheet using a mixed-model ANOVA. Results indicate that the young, inexperienced users and seniors performed significantly better when tested using the reformatted, experimental sheet. Since seniors use significantly more drugs, and the more drugs taken the greater risk of misunderstanding instructions, it is critical that these sheets are redesigned to be usable by this population group.

The use of illustration to improve older adults’ comprehension of health-related information: Is it helpful?

Objective To examine whether explanatory illustrations can improve older adults’ comprehension of written health information. Methods Six short health-related texts were selected from websites and pamphlets. Young and older adults were randomly assigned to read health-related texts alone or texts accompanied by explanatory illustrations. Eye movements were recorded while reading. Word recognition, text comprehension, and comprehension of the illustrations were assessed after reading. Results Older adults performed as well as or better than young adults on the word recognition and text comprehension measures. However, older adults performed less well than young adults on the illustration comprehension measures. Analysis of readers’ eye movements showed that older adults spent more time reading illustration-related phrases and fixating on the illustrations than did young adults, yet had poorer comprehension of the illustrations. Conclusion Older adults might not benefit from text illustrations because illustrations can be difficult to integrate with the text. Practice implications Health practitioners should not assume that illustrations will increase older adults’ comprehension of health information.

Health literacy skills of kidney transplant recipients

Although low health literacy can affect patients' treatment decision making, comprehension of health information, and medication adherence, little is known about health literacy skills of kidney transplant recipients. To examine the relationship among kidney transplant recipients' health literacy levels, transplant knowledge, and graft function. Cross-sectional study of 124 adult kidney transplant recipients. Health literacy was assessed via the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the Rapid Estimate of Adult Literacy in Medicine-Transplantation (REALM-T). Data on recipients' transplant numeracy, knowledge needs, and demographics were collected via semistructured interviews. Multivariable linear regressions were used to assess the relationship between health literacy and graft function. Most kidney recipients (91%) had adequate health literacy (S-TOFHLA); however, 81% were unfamiliar with at least 1 kidney transplant-related term (REALM-T). The 5 least familiar terms were sensitization (50%), urethra (45%), trough level (41%), blood urea nitrogen (32%), and toxicity (31%). Numeracy levels varied: 21% knew the likelihood of 1-year graft survival; 29% knew that half of kidney recipients have problems with the transplant in the first 6 months; 68% were aware of the risk of death within the first year after transplantation; and 86% knew the normal range for creatinine in kidney recipients. Patients with lower health literacy (REALM-T) had higher creatinine levels. Transplant providers should intervene with better patient education materials to improve patients' health literacy, which may improve patients' medication adherence or transplant outcomes.

Health Literacy Skills of Kidney Transplant Recipients

Although low health literacy can affect patients' treatment decision making, comprehension of health information, and medication adherence, little is known about health literacy skills of kidney transplant recipients. To examine the relationship among kidney transplant recipients' health literacy levels, transplant knowledge, and graft function. Cross-sectional study of 124 adult kidney transplant recipients. Health literacy was assessed via the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the Rapid Estimate of Adult Literacy in Medicine-Transplantation (REALM-T). Data on recipients' transplant numeracy, knowledge needs, and demographics were collected via semistructured interviews. Multivariable linear regressions were used to assess the relationship between health literacy and graft function. Most kidney recipients (91%) had adequate health literacy (S-TOFHLA); however, 81% were unfamiliar with at least 1 kidney transplant-related term (REALM-T). The 5 least familiar terms were sensitization (50%), urethra (45%), trough level (41%), blood urea nitrogen (32%), and toxicity (31%). Numeracy levels varied: 21% knew the likelihood of 1-year graft survival; 29% knew that half of kidney recipients have problems with the transplant in the first 6 months; 68% were aware of the risk of death within the first year after transplantation; and 86% knew the normal range for creatinine in kidney recipients. Patients with lower health literacy (REALM-T) had higher creatinine levels. Transplant providers should intervene with better patient education materials to improve patients' health literacy, which may improve patients' medication adherence or transplant outcomes.

Use of Pictures to Facilitate Nutrition Education for Low-income African American Women

Dietary patterns among low-income African Americans are associated with high cancer incidence and mortality. Dietary fiber consumption, especially from fruits and vegetables sources, is low in this population, and intakes of fat, saturated fat, cholesterol, and salt are high. Consequently, there is a need for effective nutrition education programs for this population. But changing eating behaviors is difficult in any population, and 2 problems that make change especially difficult for this group: (1) strong cultural support for existing dietary behaviors, as well as resistance to change to unfamiliar foods; and (2) varied literacy skills, which can restrict people’s ability to use recipes and written guidelines for food purchases and preparation. These problems were addressed through the extensive use of pictures in a nutrition education program intended to increase fruit and vegetable consumption among low-income African American women living in public housing in Washington, DC. The pictures depicted fruits and vegetables as African American food, and they were also used to reduce dependence on written recipes and guidelines.

Patient and physician factors predict patients’ comprehension of health information

While patients frequently do not comprehend health information, little is known about patient and physician factors that influence lack of comprehension. To assess effectiveness of health information exchange, 19 physicians and 145 patients were given post-encounter questionnaires to evaluate the preceding visit. We analyzed differences in beliefs between patients who comprehended health information and patients who did not, and whether physicians’ attitudes and self-assessment of their educational abilities influenced this comprehension. Patients with insufficient comprehension were more likely to have schooling below college and cited language as a barrier. Physicians who believed health information delivery to be important had fewer patients with comprehension difficulties, while physicians who assessed themselves as very effective educators had significantly more patients with lack of comprehension, compared with physicians who did not feel as effective. Patients’ comprehension of health information was associated not only with patient factors but also with physicians’ attitude and self-assessment.