Low Levels Of Health Literacy Research Articles

Improving refugees’ health literacy: An assessment of the Swedish ‘teach-back’ method at group level

Abstract Background Refugees report lower levels of self-assessed health and underutilize healthcare services compared to host populations. In Sweden, a course in civic orientation is offered to all refugees to facilitate their establishment and help them make informed health choices. However, an evaluation of the civic orientation indicates that refugees with lower health literacy levels do not benefit from the orientation to the same extent. To address this, the ‘teach-back' method has been taught to about 200 cultural mediators participating in the EU project ‘MILSA training platform for civic and health communication'. This study investigated perceptions of the communicators in implementing a Swedish version of the ‘teach-back' method at group level for improved health information recall called Förstå Mig Rätt (FMR). Methods The data was collected through semi-structured interviews and analyzed by content analysis. Deriving from a holistic view of health, Sørensen's integrated model for health literacy guided the discussion in examining how FMR contributed to health literacy. Results Three themes emerged: (i) Appreciating the impact of FMR; (ii) valuing the role of a communicator and; (iii) practical challenges of implementing FMR. The findings demonstrated an overall appreciation for FMR as it empowered the communicators with the ability to discover misunderstandings easier. Nevertheless, it was sometimes perceived as challenging to ask the refugees to retell information and some refugees even expressed feelings of insult. Lack of time and struggle to adapt the information to fit all also generated concerns. Conclusions FMR makes its largest contribution to health literacy improvements in the second competence outlined by Sørensen's model (understanding). However, for optimal utilization, groups should be adjusted for participant educational level while further clarification on when the second and third phase of the teach-back concept should transpire, is recommended. Key messages FMR (a Swedish version of the method ‘teach-back’) can be used for health communication on group level. The use of FMR makes it easier to detect misunderstandings when communicating.

Adherence and Related Factors in Pregnant Women With Gestational Diabetes

Gestational diabetes is a metabolic disease that can have multiple maternal and fetal complications. Therapeutic adherence can help controlling blood sugar and reducing its complications. This study investigates the medication adherence among pregnant women and the effective factors on it. This cross-sectional study was conducted on 104 pregnant women with gestational diabetes who were referred to the endocrinology clinic of Shahid Beheshti hospital in Hamadan, Iran, in 2018. Input criteria were those over 18 years of age, and output criteria included heart, kidney, and thyroid disorders. Medication adherence was evaluated using Morisky's 6-question questionnaire (MMAS-6). Analyzes were conducted using SPSS version 21 at the significance level of less than 0.05. Based on the results, 77.9% of the women lived in the city, 65.4% had a college education, and 73.1% were housewives. 58.7% of them had good medication adherence. There was a significant relationship between adherence and glycemic control. Address and level of education had a significant relationship with medication adherence. People with higher levels of health literacy had significantly higher medication adherence. Low education level, rural residence, and low health literacy level are determinants of poor medication adherence in pregnant women with gestational diabetes, which indicates the need for more training for these people.

Faktor-Faktor Yang Berhubungan Dengan Tingkat Literasi Kesehatan Pasien Pelayanan Kedokteran Keluarga

ABSTRACT
 Introduction: Health literacy is crucial for health management, but still has become a problem in many countries. The objective of this study was to assess patient’s health literacy levels in Kiara Family Medicine Clinic of the Medical Faculty University of Indonesia and its determinants. Method: This was quantitative research with cross- sectional design. The population was all patients visiting the clinic during the data collection period. The samples were patients who met the inclusion and exclusion criteria, chosen with consecutive sampling technique. Minimal sample size was counted using different proportion hypothesis test formula, results in minimum of 134 respondents. The independent variables were age, language, ethnicity, sex, level of education, length of education, occupation, income, access to health services, and health information access. The dependent variable was levels of health literacy.The instruments were questionnaires on health literacy determinats and Newest Vital Sign adapted in bahasa Indonesia (NVS-I). Univariate, bivariate (chi-square test), and multivariate (logistic regression) analyses were conducted. Results: 27.4% of respondents had high health literacy level and 72.6% of respondents had low health literacy level. Factors associated with health literacy levels were health information access and length of education. The most dominant influencing factor of health literacy was accessibility to health information. Conclusion: Most of the patients had low health literacy level with NVS-I measurement. The factor most associated with health literacy level was health information access. More efforts are needed in promoting patient’s health literacy through improving health information access.
 
 Keywords: family medicine, health information access, health literacy

Effectiveness of pictograms in patients or caregivers in healthcare settings: a systematic review

Abstract Objectives Pictorial representation has shown to be potential in enhancing patient knowledge. This study aimed to identify the usefulness of pictograms improving the knowledge of the patients or their caregivers. Key findings The electronic databases such as PubMed, CINAHL, Embase and Scopus were searchedfor relevant studies. The Cochrane risk of bias tool was used to assess the quality of the included studies. The study was conducted following PRISMA guidelines. Pictograms were used alone or in combination with the text-based/written or verbal/ oral instructions of medication used in study intervention. All the included studies showed similar outcomes that had a positive impact on improving patient adherence and helped in decreasing the dosing error. Factors such as age, gender, literacy level had a negative impact on adherence. Pictograms had a positive impact on the adherence in patients with low health literacy levels than the written/oral interventions. Summary The current review provided insights on the effectiveness of pictograms in patients or their caregivers of various age groups in healthcare settings. Future studies should be aimed to identify the knowledge gaps and barriers impacting the effectiveness of pictograms in various settings.

Health Literacy Levels among Italian Students: Monitoring and Promotion at School.

Health literacy was identified as an important determinant of health, particularly for adolescents. However, more efforts are needed to monitor this construct and provide inputs for policy development. This study aims to: (a) Assess the validity and reliability of the Italian version of the Health Literacy for School-Aged Children (HLSAC-I); (b) Identify the health literacy levels among Italian students and compare them with other countries’ levels; and (c) Identify the associations between health literacy and multiple social determinants (social stratifiers, family, and school connectedness). Data came from the Health Behaviour School-Aged Children survey, carried out in the Lombardy region in northern Italy in 2018. A representative sample of 2,287 13- and 15-year-old Lombardian students was involved. The results support the validity and reliability of the HLSAC-I. A total of 18.7% of the sample reported low levels, and only 6.8% reported high levels. Italian students reported the lowest levels of health literacy compared with other countries. School connectedness and educational approach are the most relevant associated factors. This study confirms a school’s role in reducing inequalities and promoting health. It highlights the importance of monitoring health literacy and implementing health promotion policies at school through a whole-school approach.

Does higher health literacy lead to higher trust in public hospitals?

BackgroundDoes higher health literacy lead to higher trust in public hospitals? Existing literature suggests that this is the case since a positive association between the level of health literacy and the level of trust in physicians and the health care system has been shown. This study aims to challenge this assumption.MethodsBased on theoretical arguments from game theory and analysis of empirical data, we argue that the association is better described as an inversely u-shaped curve, suggesting that low and high levels of health literacy lead to a lower level of trust than a medium level of health literacy does. The empirical analysis is based on a study of the Danes’ relationship to the overall health care system. More than 6000 Danes have been asked about their overall expectations of the health service, their concrete experiences and their attitudes to a number of change initiatives.ResultsGame theory analysis show that the combined perceived cooperation and benefit effects can explain an inversely u-shaped relationship between social groups and trust in the health care system. Based on quantitative, binary regression analyses of empirical data, the lowest degree of trust is found among patients from the lowest and highest social groups, while the highest degree of trust is found in the middle group. The main driver for this result is that while patients having low health literacy perceive that the health care system is not cooperative, patients with a high level of health literacy have high expectations about the quality, which the health care system might not be able to provide. This reduces the perceived benefit from their encounter with the health care system.ConclusionIt is important that health care professionals understand that some patient groups have a higher chance of cooperation (e.g., agreeing on the choice of treatment) or defection (e.g. passing a complaint) than others. In perspective, future research should undertake further qualitative examinations of possible patient types and their demands in relation to different health care sectors, focusing specifically on the opportunities to improve the handling of different patient types.

Building the case for health literacy in gastroenterology

Living with a chronic gastrointestinal (GI) disorder, such as inflammatory bowel disease, can be a very challenging for patients. A range of skills can be required to deal with some of the issues and uncertainties associated with living with a GI disease, including the ability to identify and find appropriate healthcare services for worsening symptoms; communicate concerns to health professionals; understand information pertaining to illness prevention and self-management; weigh up the potential risks and benefits of adherence to complex medication regimes; and comprehend the written instructions on prescribed medication. All of these activities represent important features of the concept of health literacy, involving the ability to read textual information, understand material in forms and documents, deal with issues of numeracy, engage in verbal communication and navigate healthcare services. Although the full impact of health literacy in chronic GI disease remains unknown, lower levels of health literacy have been identified as a potentially modifiable risk factor, related to communication barriers and poorer health-related outcomes in other chronic illnesses. In this clinical review, issues associated with health literacy in chronic GI disease are explored, highlighting the impact of low health literacy in gastroenterology; identifying potential factors of living with low levels of health literacy; and introducing approaches to measurement of health literacy and interventions that can be used by nurses to help improve health literacy in patients. Focus is placed on health literacy related to reading and comprehension of vital GI health-related materials.

Minority status and 30-day readmission: a moderated mediation model of informal caregivers’ ensuring and explaining medical care during hospitalization and caregivers’ health literacy

Introduction: Studies have shown that informal caregivers help patients to understand informa¬tion during clinical encounters, adhere to discharge recommendations, and perform self-care tasks. There is also evidence that patients with informal caregiver have a lower risk of readmission compared with patients without an informal caregiver. Less is known about factors that may affect Informal Caregiver’s Ensuring and Explaining Medical Care (ICEEMC) during hospitalization and its impact on improved health outcomes, especially in different cultural groups. This study examined whether ICEEMC during hospitalization mediated the association between minority status of patients and 30-day readmissions. In addition, it was investigated whether levels of Health Literacy (HL) of caregivers moderated this mediated association.Methods: A prospective cohort study of 517 internal medicine patients, Hebrew (general population, coded as 0) and Russian, or Arabic native speakers (minority status, coded as 1), at a tertiary medical center in central Israel (2013 to 2014), who were accompanied by an informal caregiver. The in-hospital baseline questionnaire included sociodemographic, physical, mental, and functional health status [covariates]. In addition, it included questions about informal caregiver HL [moderator] and amount of ICEEMC (e.g., did he/she communicated with the health care team about the treatment; three items - 1: did not receive any help to 5: received help all the time) taken from the Informal Assistance and Support for Hospitalized Older Adults (ICHOA) instrument)) [mediator]. Information on 30-day readmissions [outcome], chronic conditions, and prior hospitalization [covariates] was retrieved from the healthcare organization’s data warehouse. Testing a moderated mediation model was conducted using Hayes PROCESS procedure, model 7.Results: A total of 95 patients (18.4%) were readmitted within 30 days. Logistic regression indicated that minority status was not associated with 30-day readmission when the mediator ICEEMC was not included (B=0.98; p>0.05). However, moderated mediation analysis indicated significant direct (B=-1.08; p=0.003) and inconsistent indirect effect of minority status on readmission through high ICEEMC during hospitalization among patients who had informal caregivers with high HL level (Mediated effect (ME)=−0.62; CI= -1.07 to -0.29) but not among ones with low HL level (ME= 0.37; CI=-0.24 to 1.06).Discussions: These findings suggest that high level of informal caregivers' HL may be an essential factor in improving ICEEMC among minorities, which in turn improves their health outcomes by reducing 30-day readmissions.Conclusions: The association between patients’ minority status and 30-day readmission is mediated by ICEEMC during hospitalization and depends on high level of informal caregiver HL.Lessons learned: Our findings suggest that identifying informal caregivers with high HL levels at time of admission to the hospital and encouraging their involvement during patients’ hospital stay might be a useful strategy to improve transitions and reducing 30-day readmission, especially among minority patients.Limitations: Generalizability may be limited due to characteristics of the Israeli society. Nonetheless, health practices and outcomes of minority patients are challenging in various healthcare systems worldwide.Suggestions for future research: Future studies should explore these findings as an intervention study aimed at improving health practices and outcomes of minority patients.

Factors influencing self-management among Indonesian patients with early-stage chronic kidney disease: A cross-sectional study.

The purpose of this study was to explore the self-management of patients with early-stage chronic kidney disease (CKD) and its influencing factors. A convenient sample of 226 patients with early-stage CKD was recruited from 63 Public Health Centers in Indonesia, from June to September 2020. Demographic characteristics, health literacy, illness perception, self-efficacy and self-management were assessed using self-reported questionnaires. Stepwise multiple linear regression analysis was performed to identify the factors influencing self-management. This study adhered to the EQUATOR checklist, STROBE. The mean estimated glomerular filtration rate was 63.45ml/min/1.73m2 (standard deviation [SD] = 15.34). The average scores for health literacy, illness perception, self-efficacy and self-management were 32.11 (SD =4.46), 4.57 (SD =1.46), 183.64 (SD =38.23) and 76.92 (SD = 9.45), respectively. The influencing factors were education level, monthly income, family history of comorbidity, health literacy and self-efficacy, which accounted for 45% of total self-management score. Indonesian patients with early-stage CKD showed low level of health literacy, but positive illness perception and self-efficacy; these factors significantly affected CKD self-management. Health literacy was found to influence all dimensions of self-management: self-integration, problem-solving, seeking social support and adherence to the recommended regimen. Adherence to the recommended regimen is the most challenging dimension of CKD self-management. Health literacy was found to be a major determinant of self-management. Improving health literacy and motivation of patients with early-stage CKD may help sustain positive illness perception and self-efficacy, and improve self-management.

The Role of Health Literacy in Prostate Cancer Screening

ObjectiveTo determine if there is an association between self-reported health literacy and rates of prostate cancer screening through PSA testing. MethodsThis secondary data analysis utilized information from the 2016 Behavioral Risk Factor Surveillance System (BRFSS). The primary exposure was self-reported health literacy, and the primary outcome was whether patients underwent prior PSA testing. Males 55-69 years old from 13 states were included in the study and were excluded if they had any missing data. Participants were categorized into low, moderate, or high level of health literacy. Confounders were adjusted for using binary logistic regression. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. ResultsA total of 12,149 participants were included. Five percent of participants reported low health literacy, 54% moderate health literacy, and 41% high health literacy. Compared with study participants who self-reported high levels of health literacy, the odds of undergoing PSA testing were 59% lower in those with low health literacy (OR 0.41; 95% CI 0.28-0.64) and 30% lower in those with moderate health literacy (OR 0.70; 95% CI 0.60-0.83). ConclusionsOur research demonstrates a positive association between self-reported health literacy and the likelihood of PSA screening. While PSA screening can be controversial, health literacy may serve as a window into which patients are more likely to be proactive in their urologic care. Future studies examining how health literacy effects other urologic conditions is necessary.

Race matters: cardiovascular disease risk in male US prisoners

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NIH/National Institute of Nursing Research, 1RC2NR011948 Introduction Approximately 10% of the 2.2 million prisoners in the US have a diagnosis of cardiovascular disease (CVD) and in 2016, 28% of all deaths in custody were attributable to CVD. Black race, inadequate health literacy, and poor perceived control are predictors of increased cardiovascular disease (CVD) risk, which are prevalent in prisoners. However, little is known about the relationships among race, health literacy, and perceived control in CVD risk for male prisoners. Objective The purpose of this study was to explore the relationships among race, health literacy, perceived control, and CVD risk while controlling for well-known risk factors (education, partner status, and body mass index) in male prisoners. Methods We used baseline data from 349 male prisoners in a biobehavioral CVD risk reduction intervention. Health literacy was measured using the Newest Vital Sign and perceived control by the Control Attitudes Scale- Revised. CVD risk was quantified with the Framingham Risk Score (FRS). Three indirect effects of race on CVD risk were examined using serial mediation model with two sequential mediators (i.e., health literacy and perceived control) and 95% confidence intervals from 5000 bootstrap samples. Results Of the participants (mean age = 36 + 10 years), 64.2% were white and 35.8% were black. Mean education level was 12 years and most (85.8%) were not married or partnered. Mean BMI was 28.3 + 5.0. Mean FRS was 6.63 + 4.90, indicating risk percentages of 2.3 to 13.3% over the next ten years. Black prisoners were younger (35 + 9 versus 37 + 10, p = .047) and had lower levels of health literacy (3.84 + 1.90 versus 4.69 + 1.63, p < .001) than white prisoners. No statistically significant differences in perceived control, education, partner status, or body mass index were noted between races. All three indirect effects of race on CVD were significant while the direct effect of race was not. Compared to white prisoners, black prisoners had higher levels of CVD risk through health literacy (a1b1 = .3571, 95% CI [.0948, .7162]) and lower levels of CVD risk through perceived control (a2b2 = -.1855, 95% CI [-.4388, -.0077]). Black prisoners had higher levels of CVD risk through health literacy influenced by perceived control (a1b2d21 = .0627, 95% CI [.0028, .1409]) indicating that despite the protective effect of higher levels of perceived control in black prisoners, CVD risk remained higher compared to their white counterparts. Conclusion Future CVD risk reduction interventions in prisoners of all races, but specifically black male prisoners, should include goals of improving health literacy and perceived control in addition to the traditional modifiable risk factors often included in biobehavioral interventions.

The Impact of Health Literacy on the ERCP Process

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive method commonly used for the diagnosis and treatment of hepatopancreaticobiliary diseases. The aim of this study is to assess whether there is a relationship between Health Literacy (HL) levels and the ERCP process. 
 Material and Methods: The study prospectively evaluated the HL data of 72 patients who had ERCP in our hospital between July-November 2020. The Turkish version of the 47-item European Health Literacy Survey Questionnaire (HLS-EU-Q47) was used to assess health literacy. The patients’ demographic characteristics, duration of referral to hospital, duration of the ERCP procedure, white blood cells (WBC), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma glutamyl transferase (GGT), and total-direct bilirubin levels and HLS-EU-Q47 results were recorded and evaluated.
 Results: In our study, 77.7% of the patients had insufficient HL levels. The median body mass index (BMI) was statistically higher in patients with an insufficient HL level (p= .046). GGT, total and direct bilirubin levels were higher in patients with a low HL level (p= .009, p= .031, p= .008, respectively). The assessment of the duration of referral for ERCP revealed that the median duration of referral was statistically significantly longer in patients with an insufficient HL level (p< .001). The median duration of cannulation during ERCP was statistically higher in patients with an insufficient HL level (p= .002).
 Conclusions: The level of Health Literacy affects the early diagnosis and the success of the procedure in hepatopancreaticobiliary diseases that require ERCP.

The mediating role of health literacy on the relationship between health care system distrust and vaccine hesitancy during COVID-19 pandemic.

This study explores the mediating role of health literacy on the association between health care system distrust and vaccine hesitancy. An online survey including Personal Information Form, Health Care System Distrust Scale, Vaccine Hesitancy Scale, and Health Literacy Scale were applied to 620 participants. The degree of applying mask-wearing, hygiene rule and physical distance, and the level of COVID-19 vaccine literacy were modeled with hierarchical multiple regression analysis to have a deeper analysis of participants’ actions towards COVID-19 vaccine hesitancy. It was found that health care system distrust and health literacy were the most important variables that had an impact on vaccine hesitancy. Based on the mediation analysis, the total effect of health care system distrust on vaccine hesitancy was statistically significant. Participants who held a low level of health literacy and a high perception of the health care system distrust experienced more vaccine hesitancy. The findings suggested the health literacy mediated the relationship between health care system distrust and vaccine hesitancy. Health authorities need to consider the dynamic and complex factors around the health care system distrust and health literacy to reduce vaccine hesitancy during COVID-19.

Healthcare systems and professionals are key to improving health literacy in chronic kidney disease.

Comorbidity is prevalent in people with chronic kidney disease (CKD) and this status burdens one's health literacy skills to understand about their health, make decisions, and to adhere with treatment. To examine health literacy in people with CKD and comorbidities. A cross-sectional study was conducted between November 2018 and April 2019. Convenience sampling recruited 367 adults with CKD and at least one comorbid disease. Data were collected using the 9-domain Health Literacy Questionnaire. Demographic and clinical characteristics were also collected. Charlson Comorbidity Index calculated comorbidity status. Parametric tests were used to distinguish health literacy between various groups. Participants' average age was 58.8 years, 54.7% had CKD Grade 5, 72.5% had a severe comorbidity index (≥6), and nearly 40% were on haemodialysis. Lower health literacy proportions were found in domains related to Healthcare providers' support (58.3%) and Appraisal of health information (38.4%). Lower levels of education, income, or living in rural areas were each significantly more likely to contribute to lower health literacy levels (range 4-7 domains). Greater comorbidity severity was also significantly associated with lower health literacy in two domains. People with CKD had difficulties in various health literacy domains primarily related to communication and critical appraisal. These domains can be improved by healthcare professionals and changes in hospital policies. Due to frequent contact with patients in kidney services, renal clinicians have a crucial role in ensuring greater communication occurs as this will better assist patients to understand their healthcare needs.

Videos improve patient understanding of chemotherapy terminology in a rural setting.

It is critical patients understand the terms used to describe oncology treatments; however, even basic chemotherapy terminology can be misunderstood. Rural communities tend to have especially low levels of health literacy compared with nonrural communities. To address low health literacy in rural communities, this study tested rural participants' understanding of previously developed educational chemotherapy videos that were designed for an underserved urban population. Participants were also asked for feedback to determine if the videos could be improved. Fifty English-speaking patients who reside in counties classified as rural according to the Rural-Urban Continuum Code designations (RUCC 4-9) participated in the study. Participants were asked to define 6 chemotherapy terms before and after viewing a short, animated video explaining the term in English. Rates of correct and incorrect definitions provided by participants were also compared with previously published results from an urban cohort. All participants had statistically significantly higher rates of correct definitions for all 6 terms following the video intervention. Palliative chemotherapy understanding improved the most (10% correct prevideo and 76% postvideo intervention). For each video, the majority of participants (77%-92%) suggested no changes to the videos. Given the prevalence of low health literacy in rural communities, it is important to have effective educational interventions to improve the understanding of basic oncology-treatment terminology. This study found that short, educational videos, originally designed for an underserved urban population, can significantly improve understanding of commonly misunderstood chemotherapy terminology in a rural setting as well. Chemotherapy terminology can be confusing to patients. Understanding can be especially difficult in areas with low health literacy, such as underserved urban and rural communities. To address this concern, previously developed short, animated videos describing basic chemotherapy terminology were found to improve patient understanding in an underserved urban setting. In this study, the videos were tested in a rural population and their effectiveness was established. Participants in the rural setting were significantly more likely to correctly define all 6 tested terms after watching the videos. Educational tools for high-need populations are essential to ensure patients can understand the treatment they receive.

Determining Health Literacy Level and Its Related Factors Among Pregnant Women Referred to Medical and Health Centers of Tehran in 2019: A Cross-sectional Study

Background: The ability to acquire, process, and understand health information to make informed decisions about health is defined as health literacy. A low level of health literacy disrupts women’s ability to understand and use health information in order to take appropriate and timely measures during pregnancy. Objectives: Due to the importance of health literacy during pregnancy and its direct impact on fetal health, this study was conducted to determine the level of health literacy and its related items among the pregnant women referred to medical and health centers in Tehran. Methods: This descriptive-analytical study was conducted on 270 pregnant women referred to the medical and health centers of Tehran in 2019. The participants in this study were selected by the mixed sampling method (cluster and random methods to select health centers and the convenience method to select participants). Data collection tools included a questionnaire for demographic and midwifery characteristics and a specialized questionnaire for maternal health literacy in pregnancy (MHELIP). Data analysis was performed by SPSS-19 software. Results: The mean age of the participants was 28.16 ± 5.70 years, and the mean gestational age was 24.50 ± 9.25 weeks. The mean score of health literacy among pregnant women was 63.14 ± 9.63, and 48.9% of them had limited (inadequate and insufficient) health literacy. The results showed positive correlations between the total score of health literacy and the demographic variables of age (P = 0.025), education (P = 0.003), and income (0.008), but no significant relationship was found between the mean total score of health literacy and employment status (P = 0.614) or parity (P = 0.614). Conclusions: It was found that limited health literacy had a high prevalence among pregnant women. Given the importance of pregnancy, it seems necessary for healthcare policymakers to design programs to promote women’s health literacy during pregnancy.

“What Are My Injuries?” Health Literacy and Patient Comprehension of Trauma Care and Injuries

Trauma patients often have complex injuries treated by multidisciplinary providers with wide-ranging expertise. We hypothesized that trauma patients would frequently incorrectly identify both their injuries and care teams. We also hypothesized that low health literacy level would be correlated with low levels of comprehension about injuries or care teams. We performed a prospective study of adult trauma inpatients >18 years. Participants were surveyed to report on 1) injured body regions 2) their care teams, and 3) health literacy via a validated survey. Self-reported injuries and care teams were compared to the patient's medical record. We also studied whether health literacy was associated with patient knowledge of injuries and care teams. Fifty participants were surveyed; thirty-two percent could not identify ≥50% of their injuries. Patients reliably identified injuries to the head, but injuries to other body areas were often misidentified. Forty-two percent of patients were not able to identify ≥50% of their medical teams, and 28% could not identify ≥75% of their medical teams. Patients often did not recognize teams such as nutrition, physical/occupationalt, or social work as part of their care. Thirteen participants reported adequate health literacy. Health literacy was not related to participant knowledge of injuries or care teams (both P=0.9). Many trauma inpatients were unable to correctly identify their injuries and care teams despite a range of self-reported health literacy scores.

The effectiveness of a psycho-education intervention on mental health literacy in communities affected by the COVID-19 pandemic\u2014a cluster randomized trial of 24 villages in central Uganda\u2014a research protocol

BackgroundLiterature shows a high prevalence of psychological distress (PD) as well as common mental disorders (CMD) such as major depressive disorders (MDD), generalized anxiety disorders (GAD), post-traumatic stress disorders (PTSD), and substance misuse disorders (SUD) among people exposed to disasters and pandemics like the COVID-19. Moreover, CMD are associated with increased mortality (mainly through suicide) and morbidity (loss of productivity). A number of countries have made deliberate efforts to identify and manage CMD in light of COVID-19. However, low levels of mental health literacy (MHL) manifested by the individual’s unawareness of CMD symptoms, limited human and mental health infrastructure resources, and high levels of mental illness stigma (MIS) are barriers to integration of mental health care in general health care during pandemics and epidemics such as the COVID-19.ObjectivesFor the proposed study, we will determine effectiveness of a psycho-education intervention delivered by village health team (VHT) members.MethodsWe will employ a cluster randomized trial design in 24 villages in central Uganda. We will collect baseline data to and document the prevalence of MHL, PD, MDD, PTSD, GAD, and SUD. We will distribute information education and communication materials (IEC) aimed at improving MHL to 420 adult individuals in the intervention arm (n = 12 villages). In the control arm (n = 12 villages), VHTs will distribute ministry of health COVID-19 information leaflets to 420 participants. Within 7 days of distributing the materials, research assistants will conduct a follow-up interview and assess for the same parameters (MHL, PD, MDD, PTSD, GAD, and SUD). We will use an intention to treat analysis to estimate the effectiveness of the psycho-education intervention.DiscussionFindings from this research will guide policy and practice regarding the integration of mental health services in the community in the context of epidemic preparedness and response.Trial registrationClinicalTrials.govNCT04616989. Registered on 05 November 2020

Patient Perspective: We have embraced digital technologies to support arrhythmia patients during the COVID-19 pandemic

Patient Perspective: We have embraced digital technologies to support arrhythmia patients during the COVID-19 pandemic

Associations between Socioeconomic Status and Health-Related Quality of Life in Patients with AL Amyloidosis

Introduction: Socioeconomic status (SES) can affect health-related quality of life (HRQoL) through a variety of mechanisms, including poor access to healthcare, physical and mental health comorbidities, low levels of health literacy or health activation, and consequent negative health behaviors. The impact of low SES on HRQoL of patients with AL amyloidosis, however, has not been well described. AL amyloidosis is a rare, complex disease associated with significant organ dysfunction, disability, and death. Although patients with AL amyloidosis report significant HRQoL impairments, it is likely that patients in lower SES groups report even greater deficits. The aim of this study was to assess the impact of SES on HRQoL in AL amyloidosis patients.Methods: This was a cross-sectional, observational study. A total of 1,289 patients with AL amyloidosis were evaluated at the Amyloidosis Center at Boston University between 1994 and 2014 and completed the SF-36v1 Health Survey within seven days of their initial evaluation. The SF-36v1 assessed HRQoL across eight domains and two component summary measures: physical functioning (PF); role limitations due to physical health problems (RP); bodily pain (BP); general health (GH); vitality (VT); social functioning (SF); role limitations due to emotional health problems (RE); mental health (MH); and physical (PCS) and mental (MCS) component summaries. SES was based on patients' occupation type (ie, professional/managerial positions vs. other occupations, including administrative/clerical, service, blue-collar, and farming positions vs. retired vs. disability) and educational attainment (≤ high school diploma versus > a high school diploma). Regression models using each SF-36v1 domain or summary score as a dependent variable were fit to examine whether there was an association between SES and HRQoL, independent of other demographic and clinical characteristics including type of organ involvement, multi-organ involvement, eligibility for stem cell transplantation, and time since diagnosis. Adjusted least-square means for each SF-36v1 domain and summary were obtained from two sets of models using educational or occupational group as the measure of SES. Established minimally important differences (MIDs) were used to determine whether differences in adjusted mean scores across groups were also clinically meaningful.Results: The mean age of the population was 61.6 years and the average time since diagnosis was 7.3 months. Based on multivariable models, patients with fewer years of education reported worse HRQoL impairment (i.e., significantly worse scores for all SF-36v1 domain and summary scores) compared to patients with more education (p < 0.05 for all) [Figure 1]. With the exception of GH, MH, and MCS, differences by educational attainment all exceeded the threshold of 1 MID.In multivariable models using occupation as the independent variable for SES, SF-36v1 scores also differed significantly by occupation (Figure 2). Relative to scores among patients with professional/managerial occupations: •Patients in other occupations reported statistically (p < 0.05 for all) and clinically (i.e. exceeding 1 MID) significant deficits on all SF-36v1 scores.•Patients on disability also exhibited significantly worse SF-36v1 scores (p < 0.05 for all). Deficits exceeded 1 MID for all scores. For PF, VT, and PCS, these differences exceeded 2 MIDs.•Retired patients reported only significant deficits for PF and RP (p < 0.05 for both); however these differences did not meet the threshold for an MID.Conclusions: Patients from lower SES groups, defined in terms of education or employment, had poorer HRQoL as compared to those with more years of education or professional/managerial positions. These relationships were independent of other clinical variables that served as proxies for disease severity. Outreach efforts designed to increase the understanding of the disease among community-based clinicians should highlight the additional HRQoL burden and potential need for more comprehensive care among patients in lower SES groups. As treatments of AL amyloidosis and healthcare resource utilization can be costly, future research should examine whether SES is associated with costs associated with treatment, type of health care received, and consequently HRQoL.Supported by Amyloid Research Fund at BUMC and a grant from Prothena Biosciences Inc. [Display omitted] DisclosuresMcCausland:Optum: Employment; Prothena Biosciences: Research Funding. White:Prothena Biosciences: Research Funding; Optum: Employment. Yokota:Optum: Employment; Prothena Biosciences: Research Funding. Quock:Prothena Biosciences Inc: Employment, Other: Stockholder. Bayliss:Optum: Employment; Prothena Biosciences: Research Funding.