Risk For Health Literacy Research Articles

Exploring the Influencing Factors of Health Literacy among Older Adults: A Cross-Sectional Survey.

Background and Objectives: To investigate the health literacy (HL) among older adults in Taiwan, we referenced an existing integrated model of HL to confirm the influencing factors of HL in older adults. We propose this study to examine the personal, situational, and socioenvironmental factors influencing HL among older adults. Materials and Methods: A cross-sectional survey was conducted at a district hospital and affiliated community center in northern Taiwan from August 2016 to May 2017. This study used the Mandarin Chinese version of the European Health Literacy Survey Questionnaire (EU-Q47). We designed three models based on the three domains of HL. Model 1 assesses personal factors. Model 2 incorporates situational factors. Model 3 adds the socioenvironmental factor. Results: We recruited 161 participants aged over 65 years. Most adults in this study had limited overall HL. The final regression model revealed that age >85 years, unknown insurance status, and dominant spoken dialect of Hakka or Taiwanese were significantly associated with higher scores of HL. Conclusions: Our study results may help clinicians with early identification of older adults at high risk for poor HL and help health administrators establish geriatric policies and health education plans.

Health Literacy Risk in Older Adults With and Without Mild Cognitive Impairment: Erratum.

Health Literacy Risk in Older Adults With and Without Mild Cognitive Impairment: Erratum.

Healthy Child Curriculum for Refugees: a family-based pediatric health education program for refugees

Introduction: The refugee population is at risk for lower health literacy and higher rates of illness compared to the general population. Refugees resettled by Integrated Refugee and Immigrant Services (IRIS) in Connecticut identified four pediatric health topics, nutrition, safety, oral health, and parenting, as areas of particular interest for further education. We therefore developed an innovative family-based, interactive pediatric health education curriculum addressing these topics for local refugee families. Program Report: We created four one-hour-long interactive classes based on literature review and …

The Urban-Rural Disparity in the Status and Risk Factors of Health Literacy: A Cross-Sectional Survey in Central China.

Health literacy is the ability of individuals to access, process, and understand health information to make decisions regarding treatment and their health on the whole; it is critical to maintain and improve public health. However, the health literacy of urban and rural populations in China has been little known. Thus, this study aims to assess the status of health literacy and explore the differences of its possible determinants (e.g., socio-economic factors) among urban and rural populations in Henan, China. A cross-sectional study, 78,646 participants were recruited from a populous province in central China with a multi-stage random sampling design. The Chinese Resident Health Literacy Scale was adopted to measure the health literacy of the respondents. In the participants, the level of health literacy (10.21%) in central China was significantly lower than the national average, and a big gap was identified between urban and rural populations (16.92% vs. 8.09%). A noticeable difference was reported in different aspects and health issues of health literacy between urban and rural populations. The health literacy level was lower in those with lower levels of education, and a significant difference was identified in the level of health literacy among people of different ages and occupations in both urban and rural areas. Note that in rural areas, as long as residents educated, they all had higher odds to exhibit basic health literacy than those uneducated; in rural areas, compared with those aged 15 to 24 years, residents aged 45 to 54 years (OR = 0.846,95% CI (0.730, 0.981)), 55 to 64 years (OR = 0.716,95% CI (0.614, 0.836)) and above 65 years (OR = 0.679, 95% CI (0.567, 0.812)) were 84.6%, 71.6%, and 67.9%, respectively, less likely to exhibit basic health literacy. Considering the lower health literacy among rural residents compared with their urban counterparts, a reorientation of the health policy-making for Chinese rural areas is recommended. This study suggests that urban–rural disparity about health literacy risk factors should be considered when implementing health literacy promotion intervention.

Neurocognitive Functioning is Associated with Self-Reported and Performance-Based Treatment Management Abilities in People Living with HIV with Low Health Literacy.

People living with HIV (PLWH) are at higher risk for poorer neurocognitive functioning and health literacy than uninfected persons, which are associated with worse medical outcomes. Aging research suggests that the effect of neurocognitive functioning on health outcomes may be more pronounced in those with low health literacy. We aimed to determine whether low health literacy might amplify the adverse effects of neurocognitive functioning on treatment management outcomes in 171 PLWH aged 40+. In this cross-sectional, observational study, participants completed a well-validated battery of neurocognitive, health literacy, and treatment management measures. A binary health literacy variable (low vs. adequate) was determined via established cut points on the well-validated health literacy tests. Treatment management outcomes included biomarkers of HIV (i.e., CD4 counts and viral load), self-management of HIV disease (i.e., self-reported medication adherence and self-efficacy for HIV disease management), and performance-based health-related decision-making. Forty-seven percent of the sample met the criteria for low health literacy. Multivariable regressions adjusting for clinicodemographic (e.g., race, socioeconomic status) covariates revealed significant interactions for self-efficacy for HIV disease management and health-related decision-making, such that neurocognitive functioning was associated with these outcomes among those with low, but not adequate health literacy. Findings suggest that low health literacy may increase the vulnerability of PLWH to the adverse effects of neurocognitive impairment on health outcomes, or conversely that adequate health literacy may provide a buffer against the health risks associated neurocognitive impairment. Interventions targeting health literacy in PLWH may mitigate the effects of neurocognitive impairment on health outcomes.

Abstract P6-11-06: The association of health literacy with internet usage for breast cancer patient education

Abstract Introduction: As more breast cancer educational resources are transitioned from printed materials to online formats, it is important to identify the patients that are at risk for low health literacy and who still need access to printed materials. The purpose of this study is to evaluate breast cancer patient health literacy and internet access in the South Texas region and to establish how they prefer to learn about their condition and surgical options. Methods: A 15-item questionnaire was given to patients with newly diagnosed breast cancer at the University Texas Health San Antonio Mays Cancer Center including a validated 3-question health question health literacy assessment, defining patients with high (HHL) or low health literacy (LHL). Patients enrolled in the study were 21 years old or older and planning to undergo mastectomy or lumpectomy for ductal carcinoma in situ, stage I, II, III, or prophylaxis (n=112). Patients who had cancers other than breast cancer were not eligible to participate. Questionnaires were included in the analysis if they were greater than 90% completed. Relationships between demographics, and type of media use were assessed. Results: English was the preferred language for 79.5% of the patients followed by Spanish for 17.9%. Seventy nine percent of breast cancer patients had high health literacy while 21% had low healthy literacy. LHL was associated with high school level education (High school: 83%, College: 17%, p=0.001) and patients with LHL were less likely to access the Internet for healthcare information, (LHL: 28%, HHL 69%, p< 0.001). After adjusting for differences: language, education, age, and cancer stage, possession of a smartphone and access to Internet at home was not associated with Internet use for healthcare information. Regardless of level of education, patients preferred receiving information via printed materials (High school: 60.2%, College: 71%, p=0.581). Neither groups preferred using supplemental videos (High school: 79% and College: 89%, p=0.58). There was no correlation between the level of education and the number of resources patients used to gain knowledge about their breast cancer and reconstructive options (Spearman correlation = 0.111). Conclusion: The majority of South Texas breast cancer patients do have access to the internet but still prefer written materials over online resources. This preference was not driven by patients’ language, educational level, or access to the internet or a smartphone. However, patients that had low health literacy were less likely to use the internet for health related information. As more healthcare information is being digitized, access to printed materials and traditional methods of education should still be available to avoid disparities in health education delivery. Further study will be done to determine the reason for preference of written over online educational materials and the utility of implementing interventions such as courses to teach patients about utilization of online resources. Citation Format: Bao-Quynh Julian, Efstathios Karamanos, Kari Eugenia Smith, Maryam Elmi, Amita Rashmikant Shah. The association of health literacy with internet usage for breast cancer patient education [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-11-06.

Leaving Paper Behind: Improving Healthcare Navigation by Latino Immigrant Parents Through Video-Based Education.

System barriers to effective healthcare engagement and navigation contribute to healthcare disparities among Latino children with immigrant parents in the US. We evaluated a nine-minute educational video supporting healthcare navigation and engagement skills of Spanish-speaking Latino parents of infants. Participants viewed the video at their child's 2-month well-visit, completed a pre-and post-video knowledge evaluation, and answered open-ended questions on video style. A paired t test was used to examine differences in knowledge and open-ended responses were coded using an iterative, consensus-based process. Of the 79 participants, 63.3% had an education level below high school diploma/GED and 84.8% were at risk for limited health literacy. There was a significant gain in healthcare navigation and engagement knowledge after watching the video (p < 0.001). Parents expressed that the video was interesting and provided useful information. Parents valued the knowledge gained and preferred videos over written materials for receiving culturally and linguistically tailored health education.

Sociodemographic factors associated with health literacy in a large sample of mothers of newborn children: cross-sectional findings from the KUNO-Kids birth cohort study.

Health literacy is an important public health goal and of particular relevance when people are starting a family. Health literacy is thought to be crucial for the management of the manifold demands relating to child health which are imposed on parents. The aim of this study was to investigate health literacy in a large sample of mothers of newborn children in Germany. Sociodemographic factors and health literacy (as assessed by the HLS-EU health care scale) were analyzed using data from 2403 mothers of newborns who take part in an ongoing birth cohort study (KUNO-Kids health study). Almost 40% of mothers had a limited health literacy level. Being primiparous was significantly associated with lower health literacy, while having a high level of education compared with a medium level of education was significantly associated with higher health literacy.Conclusion: The finding of a substantial amount of mothers experiencing problems in dealing with and navigating through the healthcare system is important for the design of pediatric health services.What is Known:• New parents are confronted with many recommendations about child health.• Health literacy of parents is considered crucial for child health outcomes.What is New:• Many mothers of newborns have a limited health literacy level.• First-time mothers and mothers with lower education are particularly at risk for low health literacy.

Health Literacy Risk in Older Adults With and Without Mild Cognitive Impairment.

BackgroundThe relationship between an increasing elderly population and wide-ranging neurological conditions has led to heightened rates of cognitive function impairment. Some researchers have found that health literacy risk may be associated with cognitive impairment in older adults.ObjectivesThe purpose of this study was to delineate the difference in health literacy risk between older adults with mild cognitive impairment and those with normal cognitive function.MethodsWe conducted a survey study to explore the health literacy risk in older adults with and without mild cognitive impairment. Data were collected from 412 subjects between 60 and 91 years of age (260 without and 152 with mild cognitive impairment) between June and December 2016 in China. Cognitive function was measured using the Mini-Mental Status Examination, Montreal Cognitive Assessment, Global Deterioration Scale, Activities of Daily Living, and Hamilton Depression Rating Scale. Health literacy was measured using the Chinese Citizen Health Literacy Questionnaire.ResultsThe scores of total health literacy and its three dimensions (basic health knowledge and mind, basic skills, and health lifestyle and behavior) were lower in those with mild cognitive impairment. Older adults with normal cognitive function had adequate or marginal health literacy levels, whereas those with mild cognitive impairment had marginal or inadequate health literacy levels. Using multiple logistic regression analysis, we found that health literacy risk, education level, age, marital status, and body mass index were independent risk factors for mild cognitive impairment.DiscussionThese results suggest that low health literacy may be a predictor of mild cognitive impairment. Screening for lower health literacy risk should be included in multidimensional geriatric evaluation.

READING BETWEEN THE LINES: HEALTH LITERACY AMONG OLDER ADULTS: Session 212

Adequate health literacy is necessary for effective communication between healthcare professionals and patients. Health literacy is defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (Ratzan et al., 2000). An individual's health literacy is impacted by factors unique to the individual, the culture, and the social context. Studies have estimated poor health literacy in 27-44% of the population (Gazmararian et al., 1999). Understanding who is at risk for low health literacy, and knowing how to assess and intervene with these patients is of utmost importance for healthcare providers. In addition, there are special populations and circumstances under which adequate health literacy may be even more critical; namely, during end-of-life decision making and with patients who have limited access to healthcare. The presenters of this symposium work in two different areas of geriatric medicine that are relevant to the discussion of health literacy among older and/or chronically ill patients: Home Based Primary Care (HBPC) and Palliative Care. HBPC is a national program within Veterans Affairs hospitals designed to provide longitudinal care for medically complex, frail, elderly Veterans in their home. The interdisciplinary HBPC treatment team consists of primary care physicians, nurses, social workers, dietitians, pharmacists, kinesiotherapists, psychiatrists, and psychologists. Many of the patients enrolled in HBPC live in rural areas, and would otherwise lack access to appropriate care; they are thus a vulnerable population, and having a comprehensive understanding of their ability to utilize health-related information is critical. Palliative Care is an area of medicine in which patients are asked to make complex, serious decisions about their healthcare. These patients, too, are vulnerable; having healthcare providers who understand their unique circumstance is important.

Social Disparities in Health Literacy in the United States.

Health literacy has been identified as a contributor to both health disparities and social determinants of health. There is significant overlap in demographic characteristics of those who are at risk for health disparities and low health literacy. This study expanded the research on health literacy and disparities by quantifying the social disparities within health literacy using a relatively new methodology. We analyzed data from the 2013 Health Information National Trends Survey (N = 1,675). The Extended Gastwirth Index was used to determine the disparities in health literacy. Participants who were female, age 18 to 34 years, White, highly educated (postbaccalaureate), and with incomes ≥$200,000 had the highest health literacy and served as the reference groups. Males, age 35 to 49 years, who had high school graduates, and people who were Hispanic and with incomes between $50,000 and $74,999 had the highest disparities in health literacy. Income (∼30%) and education (∼37%) were the highest contributors to overall disparities in health literacy, whereas sex (∼3%) was the lowest contributor. The overwhelming contribution of income and education to disparities in health literacy and the range of disparities within these demographic characteristics highlight populations that could benefit from tailored interventions to improve their health literacy. [HLRP: Health Literacy Research and Practice. 2019;3(1):e47–e52.]

Readability and Quality of Patient Education Materials Targeted Toward Vulnerable Populations

Abstract Date Presented 4/20/2018 Vulnerable populations are at risk for low health literacy and are more susceptible to poor health outcomes. Findings indicate that occupational therapy patient education materials aimed at these populations were difficult to read and understand. The profession should lead efforts to provide quality education materials. Primary Author and Speaker: Mary Dumas Additional Authors and Speakers: Vanessa Carmody, Johanna Black, Michael Blake

A QI initiative for bridging the health literacy gap by Educating internal medicine residents at a community hospital

ABSTRACTIntroduction: Only 12% of Americans have proficient health literacy (HL). Patients hide this fact from others including physicians. This quality improvement (QI) project was developed to compare internal medicine (IM) resident physicians’ (RPs) ability to accurately predict patients with low HL and to improve IM-RPs’ understanding of low HL and its impact on patients.Aim statement: Over six-months, our aim was to increase the IM residents’ HL-knowledge by 30% as measured by an HL-Knowledge-Based-Survey.Methods: After IRB exemption, patients visiting the residency-clinic within a two-week period were screened for low HL with the REALM-R, a validated tool. Post-visit, IM-RPs were asked to predict their patients’ HL. A comparison of predicted-HL and measured-HL was made. IM-RPs were emailed an HL-Knowledge-Based-Survey (pre-education and post-education) to measure their background knowledge of HL. Education included HL-workshop, pre-clinic conference and lectures. Pre-education and post-education scores were compared.Results: HL-RPs’ prediction and patients’ REALM-R results were completed by 108 RP-patient pairs. IM-RPs correctly identified 5 of 40 patients who were at risk for low HL (sensitivity = 12.5%). They correctly identified 97.1% of 68 who were not at risk (specificity = 97.1%). Our residents’ knowledge pre-education and post-education did not improve – 58% (n = 18) vs 62% (n = 10).Conclusion: Our QI result verified that IM-RPs overestimate patients’ HL and do not understand the magnitude or consequences of low HL nor techniques to improve such patients’ understanding. This suggests an area for residency curricular development in order to improve patients’ ability to navigate the healthcare system successfully.

Health Literacy Considerations for Users of Complementary and Alternative Medicine

ABSTRACTComplementary and alternative medicine (CAM) users may present a unique challenge for health literacy. Though the average CAM user is not considered at high risk for limited health literacy, CAM use is multi-faceted and cannot be generalized to a single population. There may be different reasons for use of CAM in place of, or alongside, conventional medicine. Health literacy must be assessed, not only in terms of functional skills, but in the context of personal belief systems. Health literacy can be considered a holistic construct composed of functional, critical, and communicative skills, with the goal of understanding how belief systems and personal philosophy affect medical decision-making.

Cross-Sectional Study of the Relation of Health Literacy to Primary Language and Emergency Department Length of Stay.

The primary aim of this study was to determine whether emergency department (ED) length of stay (LOS) or primary language was related to the degree of health literacy of patients. Adult English-speaking and Spanish-speaking patients were recruited for the study. Participants completed the Newest Vital Sign (NVS) tool (English and Spanish versions), a 6-question validated scale. Patients with NVS scores of 0 to 3 were considered to be at risk for limited health literacy, whereas those with adequate health literacy were defined as scoring a 4 to 6. After completion of their ED visit, a retrospective chart review was performed to identify the patient's ED LOS (time from registration to time of disposition) and ED disposition. In addition, 2 single-item questions were compared with the NVS for validity. Participants included 250 English-speaking and 257 Spanish-speaking subjects. Per the NVS, 71% (359 of 507) of all patients had limited health literacy. By language group, significantly more Spanish-speaking than English-speaking patients had limited health literacy (93% vs 48%, diff 45%, 95% confidence interval 37-51). There was no significant difference in LOS between the limited health literacy group and adequate health literacy group (medians 440 vs 461 min). The 2 single-item questions had fair validity in comparison to the NVS scale (κ 0.2-0.3). There was a significant difference in health literacy based on language, with 93% of all Spanish-speaking patients in our sample having limited health literacy. We found no significant difference in ED LOS between patients with limited health and adequate health literacy in an academic urban ED setting.

Supplemental Material for Social Isolation, Health Literacy, and Mortality Risk: Findings From the English Longitudinal Study of Ageing

Supplemental Material for Social Isolation, Health Literacy, and Mortality Risk: Findings From the English Longitudinal Study of Ageing

Health literacy and its correlates in informal caregivers of adults with memory loss

This secondary analysis examined health literacy among informal caregivers of community-dwelling older adults with memory loss and assessed correlates of caregiver health literacy using the Abilities, Skills and Knowledge Model. Caregiver health literacy (n = 91) was assessed by the Newest Vital Sign. Limited health literacy presented in 38.5% caregivers, with significantly low document literacy. Health literacy was associated bivariately with age, education, global cognitive function, executive function, and working memory (all ps < 0.001), as well as medication knowledge (p = 0.015). Hierarchical regression analyses revealed that older age (p = 0.017), and lower global cognitive function (p < 0.001), working memory (p = 0.001), and academic skills (years of education) (p = 0.004), independently predicted lower health literacy (R2 = 0.54). Medication knowledge, however, was not found to be an independent predictor in the model. Findings suggest limited health literacy is a potential issue among informal caregivers of adults with memory loss. Appropriate assessment and personalized support are needed for informal caregivers who are at high risk for poor health literacy.

Health Literacy among Medically Underserved: The Role of Demographic Factors, Social Influence, and Religious Beliefs

The current study examined the sociodemographic and psychosocial variables that predicted being at risk for low health literacy among a population of racially and ethnically diverse patients accessing primary care services at community-based clinics. Participants (N = 416) were aged 50–75 years, currently not up-to-date with colorectal cancer (CRC) screening, at average CRC risk, and enrolled in a randomized controlled trial (RCT) aimed at promoting CRC screening. Participants completed a baseline interview that assessed health literacy as measured by Rapid Estimate of Adult Literacy in Medicine-Revised, sociodemographic factors, and psychosocial variables (e.g., health beliefs) prior to randomization and receipt of an intervention. Thirty-six percent of the participants were found to be at risk for low health literacy. Sociodemographic and psychosocial variables were assessed as predictors of being at risk for low health literacy using logistic regression. In the final model, predictors were male gender, being from a racial/ethnic minority group, being unable to work, having higher social influence scores, and having higher religious belief scores. These findings suggest several patient characteristics that may be associated with low health literacy, and highlight the importance of supporting all patients through simplified and clear communications and information to improve understanding of CRC screening information.

Abstract A75: Understanding Baseline Cancer Medication Adherence and Health Literacy among Cancer Patients in Eastern North Carolina

Abstract Background: Oral chemotherapeutic agents (OCAs) are often prescribed to cancer patients during treatment to reduce tumor size, burden of disease, and increase overall survival. Although OCAs are increasingly being used and are commonly preferred by patients, adherence varies with compliance rates as low as 16%. Poor medication adherence encompasses more than patients not taking their medicines as directed. The National Council on Patient Education provided a comprehensive overview of factors that contribute to poor adherence, which include medication-, patient-, prescriber-, pharmacy-related factors. Compounding these issues is low health literacy and transportation barriers that affect timely access to follow-up care which are prominent issues among rural populations. The main objective of this study is to conduct a baseline quantitative assessment to assess baseline medical adherence rates and health literacy among a sample of patients in a regional Cancer Center in Eastern North Carolina. Methods: A baseline survey was created using already validated instruments (Morisky Medication Adherence Scale-8 (MMAS-8), Ask 12, and Realm-Revised). Demographic data includes gender, age, race or ethnicity, highest level of school completed, smart phone possession, type of health insurance, coverage for medication and annual household income. Eligibility criteria included adults over 18 years of age, English-speaking, and currently taking at least one medication in pill-form daily. Surveys were administered to patients in the waiting area in a regional Cancer Center in Eastern North Carolina from March-June 2016. A total of 75 patients completed the baseline survey. Results: Over half of our sample were female (53%), 84% were cancer patients, 49% were African-American and 47% were white, and had a mean age of 59 (SD=13.44). The majority of our sample had a high school education or less (68%), 56% had Medicare/Medicaid, and 72% had an income of less than $40,000 a year. In regards to health literacy, 55% of participants were at risk for poor health literacy. The health literacy is approximately at a fourth grade level or below, and so patients may not be able to read prescription labels, may not be able to read most low-literacy materials; will need repeated oral instructions, materials composed primarily of illustrations, or audio or video tapes. For medication adherence, just over a quarter of our sample fell into the low adherent group (25%), 39% were medium adherent, and a third were highly adherent (32%). This means that the greater majority (64%) fell into the low or medium adherent categories. Conclusion: This study shows that the majority of ENC cancer patients are at risk for poor literacy and have medium to low medication adherence. The next phase of this study will test two telehealth adherence strategies among cancer patients taking OCAs who are at high-risk for non-adherence. We will include multiple levels of education and different education strategies based on each patient's health literacy level and identified barriers to adherence. Supported in part by a research grant from Investigator-Initiated Studies Program of Merck Sharp &amp; Dohme Corp. The opinions expressed in this abstract are those of the authors and do not necessarily represent those of Merck Sharp &amp; Dohme Corp. Citation Format: Essie Torres, Alice Richman, Shawna O'Rorke, Paige Field, Lauren Carlston. Understanding Baseline Cancer Medication Adherence and Health Literacy among Cancer Patients in Eastern North Carolina. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A75.

Relationship between Rural, Low-Income Mothers’ Health Literacy and Depressive Symptoms in the Family Context

Rural, low-income mothers face higher risk for poor health literacy and depression compared to the general population. While the association between health literacy and depression has been documented, the underlying mechanism of this relationship is not clear. Focusing on 304 low-income mothers in rural communities, this study examined the role of family context—alliance between parents and prevalence of healthful eating and physical activity in the home—in this association. Hierarchical regression followed by mediation analyses were conducted on mother’s depressive symptoms controlling for mothers’ demographic characteristics and access to healthcare. Lower health literacy was significantly associated with higher risk for depressive symptoms with parenting alliance partially mediating the relationship between health literacy and depressive symptoms. The finding suggests that alliance between parents is a critical aspect of mothers’ social support system that may offset the negative impacts of poor health literacy on their mental health. Possible discrepancies between mothers’ knowledge and their actual behaviors as well as mothers’ awareness of low health literacy and their sense of need for assistance are presented along with implications for healthcare professionals and social workers.