Rapid Estimate Of Adult Literacy In Medicine Research Articles

Health literacy of rheumatology patients in three clinics in Australia and its association with sociodemographic and clinical characteristics.

To describe and compare health literacy (HL) using contrasting instruments of Rapid Estimate of Adult Literacy in Medicine (REALM) and the Health Literacy Questionnaire (HLQ) in patients attending three Australian rheumatology clinics and their associations with sociodemographic and clinical characteristics. We conducted a cross-sectional study of rheumatology patients at Liverpool (Sydney) and Canberra public hospital clinics and a private Liverpool clinic using the REALM test and HLQ sociodemographic and clinical questionnaires. One-way analysis of variance and multivariate ordinal and binary logistic regressions were used to examine the association between HL and sociodemographic and clinical factors. A total of 278 people participated (111 Liverpool public, 112 private, 55 Canberra public clinic). Compared with Canberra, Liverpool patients were older, non-native English speakers, had less than a tertiary education and were more likely to have comorbidities. A total of 40% of Liverpool public, 29% of private and 13% of Canberra patients had suboptimal REALM HL scores (P < 0.05). Lower REALM scores were associated with male gender, <10 years of education, being born outside Australia/New Zealand and English as a secondary language, but was not associated with clinical characteristics. All nine HLQ domain scores did not differ across sites despite intergroup comparisons as stratified by REALM bands. Completing 10 years of schooling was associated with better scores in three HLQ scales: 'Navigating the healthcare system' (P = 0.009), 'Ability to find information' (P < 0.001) and 'Reading and understanding information' (P < 0.001). Patient HL as measured by the REALM differed across sites, explained by differences in gender distribution, country of birth, English as the primary language and years of education. HL as measured by the HLQ did not differ across sites and was more informative for understanding differing patient HL needs.

Rapid Estimate of Adult Literacy in Medicine (REALM) is associated with congestive heart failure (CHF) Discharge Summary Comprehension, but not Readmission

Rapid Estimate of Adult Literacy in Medicine (REALM) is associated with congestive heart failure (CHF) Discharge Summary Comprehension, but not Readmission

Understanding the hidden epidemic of metabolic syndrome in people accessing community rehabilitation: a cross-sectional study of physical activity, dietary intake, and health literacy

Purpose To determine the prevalence of metabolic syndrome in patients attending outpatient community rehabilitation in Melbourne, Australia and to compare health literacy, physical activity, and dietary intake of people with and without metabolic syndrome. Materials and methods A cross-sectional, multi-centre, observational study of adults (n = 193) presenting to rehabilitation with various health complaints. Metabolic syndrome was determined according to the International Diabetes Federation joint consensus worldwide definition. Health literacy was assessed using the Rapid Estimate of Adult literacy in Medicine (REALM) and the Short Test of Functional Health Literacy in Adults (S-TOFHLA). Physical activity was assessed using accelerometers and dietary intake was assessed using a food frequency questionnaire. Results One hundred and twenty three participants (64%) had metabolic syndrome. Of these, only three (2%) knew they had it. People with metabolic syndrome scored lower on health literacy (S-TOFHLA MD −2.10, 95% confidence interval (CI) −3.98 to −0.22) and took 1311 (95%CI 375 to 2246) fewer daily steps than those without metabolic syndrome. There were no differences in dietary intake. Conclusions Metabolic syndrome is a prevalent and under-recognised condition in community rehabilitation. Community healthcare professionals and health services may need to consider a broader approach to management including lifestyle assessment and intervention of patients with various conditions. Implications for rehabilitation Almost two-thirds of adults in community rehabilitation had underlying, undetected metabolic syndrome. Adults with metabolic syndrome completed less objectively measured physical activity and had lower health literacy levels than those without metabolic syndrome. A broader approach to management may need to be considered in community rehabilitation where patients presenting for rehabilitation of various conditions would likely benefit from lifestyle assessment and intervention.

Health Literacy, Numeracy, and Dietary Approaches to Stop Hypertension Accordance Among Hypertensive Adults.

Health literacy (HL) and health numeracy (HN), the ability to interpret and act on quantitative health information, are important for hypertension self-management such as limiting sodium intake. We examined associations of HL, HN, and Dietary Approaches to Stop Hypertension (DASH) diet accordance. Among 1,073 hypertensive adults enrolled in a Baltimore, Maryland-based cohort study, we performed a cross-sectional analysis. Rapid Estimate of Adult Literacy in Medicine (REALM) measured HL and Test of Functional Health Literacy in Adults (TOFHLA) numeracy score measured HN. DASH accordance was based on nine key nutrients. Linear regression models estimated associations of HL and HN with DASH total and sodium score, inclusive of dietary supplement data. In our sample, 39% of participants were male, 66% were Black, 40.2% lived in poverty, and 29.5% reported food insecurity. Fully, 32.5% had limited HL and 14.5% had limited HN. Mean DASH score overall was 2 (range = 0-7.5); only 6.9% were DASH accordant (score ≥4.5). In age and sex adjusted models, higher REALM was associated with a higher DASH score in the overall sample; the relationship of HN with DASH was statistically significant among White but not Black participants. Educational attainment appeared to explain both findings. There were no significant associations between HL or HN and DASH sodium scores. Differences in educational attainment explained the relation of higher HL and greater accordance to the DASH diet in a population of hypertensive adults. Understanding these factors is vital to reducing disparities in hypertension and its sequelae.

Health literacy and health information-seeking behavior of immigrants in South Korea

Health disparities are a significant source of inequity between immigrants and native people in South Korea. The present study investigated how immigrants seek health information for their different purposes according to their health literacy ability and sociodemographic backgrounds. The study assessed immigrants' health literacy skills with the Rapid Estimate of Adult Literacy in Medicine (REALM) and conducted surveys (N = 310) in districts with high immigrant populations. Overall, there were significant associations between health literacy ability, sociodemographic characteristics, and health information-seeking behavior among participants. The findings of the study extend the literature by addressing the association between health literacy and health information-seeking behavior in diverse sociodemographic contexts. Understanding the dynamics between the three factors provides insights for developing effective health information services and public policies to mitigate health disparities experienced by immigrants, ensuring the critical roles of online health information and health professionals as preferred or credible sources.

Health Literacy, Cognitive Function, and Mortality in Patients With Heart Failure.

Health literacy has predicted mortality in heart failure. However, the role of cognitive functioning in this relationship has not been evaluated. We hypothesized that health literacy would predict all-cause mortality but that cognitive functioning would modify the relationship between health literacy and mortality in heart failure. The aim of this study was to examine the association between health literacy, cognitive functioning, and mortality in patients with heart failure. This secondary analysis of a larger study included 298 patients with heart failure with reduced ejection fraction (trial identifier: NCT01461629). Health literacy was evaluated using the Rapid Estimate of Adult Literacy in Medicine (REALM) and Medical Term Recognition Test (METER), and cognitive functioning was evaluated using the Modified Mini-Mental Status Examination (3MS). Cox proportional hazards regression was used with time-until-death as the dependent variable. After controlling for age, sex, and race, neither METER nor REALM scores predicted mortality in heart failure (Ps ≥ .37). However, 3MS predicted mortality in models using the METER (Δχ2 = 9.20, P < .01; B = -.07; hazard ratio, 0.94 [95% confidence interval, 0.89-0.98]; P < .01) and REALM (Δχ2 = 9.77, P < .01; B = -0.07; hazard ratio, 0.94 [95% confidence interval, 0.90-0.97]; P < .01). Furthermore, adding the 3MS improved model fit. Cognitive functioning predicted mortality in heart failure better than health literacy. Results suggest the need to further evaluate the contribution of cognitive functioning to increased risk of mortality in those with heart failure.

Health Literacy and Success with Glaucoma Drop Administration

To assess the relationship between health literacy and successful glaucoma drop administration. Substudy of a single-site interventional randomized controlled trial. Veterans receiving care at the Durham Veterans Affairs Eye Clinic who had a diagnosis of open-angle glaucoma were recruited if they endorsed poor drop adherence. Participants underwent a health literacy evaluation using the Rapid Estimate of Adult Literacy in Medicine (REALM) as well as a qualitative assessment of eye drop administration technique using 3 different criteria: (1) the drop was instilled in the eye, (2) only 1 drop was dispensed, and (3) the bottle was not potentially contaminated. A multivariate logistic regression model was used to assess the association of REALM score and successful drop administration, adjusting for age, disease severity, and Veterans Administration Care Assessment Needs (CAN) score. Successful drop administration. Of the 179 participants with REALM scores and observed drop administration, 78% read at a high school level (HSL) or more and 22% read at less than HSL. Of the 179 participants, 87% (n= 156) successfully instilled the drop into the eye (criterion 1). A greater proportion of participants who read at HSL or more successfully instilled the drop in the eye compared with those reading at less than HSL (90.6% vs. 75.0%; P= 0.02). Rates of success with criterion 1 were similar across different levels of visual field severity. Care Assessment Needs scores were not statistically significant between those who did and those did not have successful overall drop technique. Poor health literacy may be associated with decreased successful drop instillation in the eye in patients with glaucoma. Screening for and considering health literacy in developing interventions to improve glaucoma self-management may improve treatment adherence in a vulnerable population.

Change in Health Literacy over a Decade in a Prospective Cohort of Community-Dwelling Older Adults.

Health literacy is often viewed as a static trait in longitudinal studies, which may over or underestimate an individual's ability to manage one's health. We sought to examine health literacy over time among older adults using three widely used measures. A prospective cohort study. Community-dwelling adults ages 55 to 74 at baseline with at least one follow-up visit (N = 656) recruited from one academic internal medicine clinic and six community health centers in Chicago, IL. Health literacy was measured using the Test of Functional Health Literacy in Adults (TOFHLA), Newest Vital Sign (NVS), and Rapid Estimate of Adult Literacy in Medicine (REALM) at baseline and up to three follow-up time points. In unadjusted analyses, significant changes since baseline were found beginning at the second follow-up (mean (M) = 6.0 years, SD = 0.6) for the TOFHLA (M = - 0.9, SD = 0.95, p = 0.049) and the REALM (M = 0.3, SD = 2.5, p = 0.004) and at the last follow-up (M = 8.6 years, SD = 0.5) for the NVS (M = - 0.2, SD = 1.4, p = 0.02). There were non-linear effects of baseline age on TOFHLA and NVS scores over time (piecewise cubic spline p = 0.01 and p < 0.001, respectively) and no effect on REALM scores (B = 0.02, 95% CI - 0.01 to 0.04, p = 0.17) using multivariable mixed-effects linear regression models, controlling for race, education, income, and comorbidity. We found a negative relationship between age and health literacy over time as measured by the TOFHLA and NVS. Health literacy barriers appear to be more prevalent among individuals in later life, when self-care demands are similarly increasing. Clinicians might consider strategies to assess and respond to limited health literacy, particularly among patients 70 and older. REALM performance remained stable over 10 years of follow-up. This questions whether health literacy tools measure the same attribute. Prospective health literacy studies should carefully consider what measures to use, depending on their objective.

Considerations on Health Literacy and Hearing Aid Use

Considerations on Health Literacy and Hearing Aid Use

The Relationship Between Attitudes about Research and Health Literacy among African American and White (Non-Hispanic) Community Dwelling Older Adults.

BackgroundEthnic minority representation lacks in research. Understanding factors that promote minorities in research helps address this participation gap. Minorities often face representation disparities, including health education, socioeconomic status, and race. Compared to other races in the USA, over 50% of African Americans (AA) over age 65 face obstacles towards achieving basic health literacy skills. This study aims to investigate differences in beliefs regarding research and health literacy between White and AA participants.MethodsThis cross-sectional study compared 46 AA vs. 60 White healthy older adults (n = 106; age = 73.97 ± 10.6 years). Participants were assessed once with the Participant Attitudes and Beliefs towards Research Questionnaire (PABRQ) and two validated health literacy measures, the Rapid Estimate of Adult Literacy in Medicine (REALM) and the Short Test of Functional Health Literacy for Adults (S-TOFHLA).ResultsControlling for age, sex, and education, AA performed significantly worse on REALM. Compared to White participants, AA more likely believed that researchers were motivated to perform studies to increase their general knowledge. Participants with lower health literacy scores more likely believed that scientists were motivated to conduct research to minimize treatment expenses. About 83–85% of participants reported not being familiar with the informed consent process, 90–95% had positive attitudes towards research involvement, and 38–52% believed researchers performed to promote their own careers.ConclusionThis work helps link older adults’ beliefs towards research, health literacy, and their participation in research. Future research is needed to remove barriers to participation in research for underserved, older adults.

Edmonton Symptom Assessment Scale Time Duration of Self-Completion Versus Assisted Completion in Patients with Advanced Cancer: A Randomized Comparison.

To compare the time duration of self-completion (SC) of the Edmonton Symptom Assessment Scale (ESAS) by patients with advanced cancer (ACPs) versus assisted completion (AC) with a health care professional. In this randomized comparison of ACPs seen in initial consultation at the outpatient Supportive Care Center at MD Anderson, ACPs who have never completed the ESAS at MD Anderson were allocated (1:1) to either SC of the ESAS form versus AC by a nurse. Time of completion was measured by the nurse using a stopwatch. Patients completed the Rapid Estimate of Adult Literacy in Medicine (REALM) test prior to administration of the ESAS. In the SC group, the nurse reviewed the responses to verify that the reported ESAS scores were correct. A total of 126 ACPs were enrolled (69 patients to AC and 57 to SC). Seventy-one patients were female, median age was 60 years, and median REALM score was 65. Median (interquartile range) time (in seconds) of SC was significantly less than AC (73 [42.9-89.1] vs. 109 [79.5-136.7], p < .0001). With nurse review time included, median time of SC increased to 117 seconds, which was not significantly different from AC (p = .28). Lower literacy (REALM) score and shortness of breath were significantly associated with increased completion time (p = .007). Regular use of ESAS will have minimal impact on clinical time, as it can be completed in about 1 minute and provides a concise yet comprehensive and multidimensional perspective of symptoms that affect quality of life of patients with cancer. Because the Edmonton Symptom Assessment Scale can be completed in less than 2 minutes, hopefully the routine use of this simple yet comprehensive and multidimensional symptom assessment tool will be used at all medical visits in all patients with cancer so that the timely management of symptoms affecting patients' lives and treatment courses can occur, further enhancing personalized cancer care.

Validation of a Short Form for Health Literacy Assessment Using Talking Touchscreen Technology.

Background:Health literacy is an area of growing research and clinical interest, necessitating short, accurate measures of this complex construct. Health Literacy Assessment Using Talking Touchscreen Technology (Health LiTT) measures prose, document, and quantitative literacy by self-administration on a touchscreen computer.Objective:The objective of this study was to assess the validity of a short form of Health LiTT and to identify a meaningful cutoff score for adequate health literacy.Methods:A subsample of 137 participants from the Literacy and Cognitive Function among Older Adults study completed a 10-item Health LiTT short form and three interviewer-administered health literacy measures: Test of Functional Health Literacy in Adults (TOFHLA), Rapid Estimate of Adult Literacy in Medicine (REALM), and Newest Vital Sign (NVS). Convergent validity was assessed by correlating scores for all measures, and known-groups validity was assessed by comparing mean Health LITT scores across TOFHLA levels (inadequate, marginal, adequate). Internal consistency reliability was estimated with Cronbach's alpha. A cutoff score for adequate health literacy was established using the TOFHLA cutoff for adequate versus inadequate/marginal health literacy.Key Results:Spearman correlations between Health LiTT scores and total TOFHLA, REALM, and NVS scores were 0.65, 0.69, and 0.56, respectively (all p < .001). Mean Health LiTT scores were significantly and meaningfully different across inadequate (40.4), marginal (50.1), and adequate (57.1) TOFHLA categories (F = 60.6; p < .001). Cronbach's alpha for the Health LiTT short form was .73. A cutoff score of 55 on Health LiTT showed acceptable sensitivity and specificity to identify adequate health literacy.Conclusions:This 10-item Health LiTT short form demonstrated excellent convergent and known-groups validity and acceptable internal consistency reliability in older adults. The established cutoff also showed excellent sensitivity and specificity. Validation of other custom Health LiTT short forms with varying items from the bank and computer adaptive test-generated Health LiTT scores is ongoing. [HLRP: Health Literacy Research and Practice. 2020;4(4):e200–e207.]Plain Language Summary:This article provides evidence of the need for and psychometric properties of a valid and reliable short form of the flexible, technologically advanced Health Literacy Assessment Using Talking Touchscreen Technology measure, as well as a cutoff score to note adequate versus marginal/inadequate health literacy.

Abstract B135: Health literacy disparities among Hispanic caregivers of children with newly diagnosed cancer

Abstract Objective: Health literacy (HL) is the ability to understand process and act on health-related information to function effectively in a healthcare environment. Thirty-six percent of U.S. adults have limited HL and Hispanics have the lowest among all racial/ethnic groups. Individuals with limited HL have higher healthcare utilization and poorer health status. Caregivers of children with cancer must process complex information about the disease to effectively navigate the healthcare system. Research on HL in the pediatric cancer setting is lacking. We assessed HL in Hispanic and non-Hispanic White (NHW) caregivers (primarily parents) of children with newly diagnosed cancer and the correlation of different measures of HL among each other. Additionally, we assessed socio-demographic factors and acculturation levels in Hispanic caregivers as covariates. Methods: Sixty-one caregivers of children with cancer (ages 0-17 y), newly diagnosed at Rady Children’s Hospital-San Diego were enrolled. To assess HL, we used the English or Spanish form of the 1) Short-form of the Test of Functional Health Literacy Assessment (S-TOFHLA), 2) Newest Vital Sign (NVS), 3) Parental Health Literacy Activities Test (PHLAT), 4) Rapid Estimate of Adult Literacy in Medicine (REALM) or Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50), and 5) Brief Health Literacy Screen (BHLS). To measure acculturation, we used the Hispanic Acculturation Questionnaire (SASH). Two-sample t-tests, univariate/multivariate linear regression, and Pearson-correlation analyses were used for statistical analysis. Results: Hispanic caregivers had significantly lower HL, as measured by the NVS, than NHWs (p&amp;lt;0.001). In caregivers, lower HL levels (measured by the NVS and S-TOFHLA) were positively correlated with older age (p&amp;lt;0.001), lower education level (p&amp;lt;0.001), informal employment (p&amp;lt;0.006), and Spanish primary language (p&amp;lt;0.001). Additionally, S-TOFHLA was significantly correlated with NVS (p&amp;lt;0.001). The odds of having adequate HL decreased by 94% in caregivers with low acculturation compared to caregivers with high acculturation (95% CI: 83%, 98%, p&amp;lt; 0.001). Conclusion: We show significant differences in HL levels between Hispanic and NHW caregivers of children with newly diagnosed cancer. NVS was correlated with S-TOFLHA and could serve as a rapid assessment of HL in the clinical setting for caregivers. Cancer treatment is complex, involving intensive treatments, enrollment in clinical trials, and requiring advanced caregiver knowledge about the disease. By identifying caregivers with limited HL, we can help them navigate cancer therapy effectively. Future research should test culture and language-appropriate interventions, including the systematic use of teach-back, pictorial instruction, and patient navigation. Effective HL interventions may improve cancer care for underserved children and help mitigate disparities in outcomes. Citation Format: M. Elena Martinez, Paula Aristizabal, Bianca Perdomo, Nassim Durali, Shilpa Nataraj, Jesse Nodora. Health literacy disparities among Hispanic caregivers of children with newly diagnosed cancer [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B135.

Evaluation of individual health literacy among inpatients of different types of hospitals in Istanbul

Objective: The objective of our study is to evaluate the individual health literacy level among patients who received health servicesfrom different types of hospitals in Istanbul.Materials and Methods: This cross-sectional study was conducted among inpatients of a public, private and university hospital inIstanbul. Data were collected by the application of a questionnaire to 1500 adult inpatients who were discharged between February-July2017. The study questionnaire included questions to determine the health literacy competency and sociodemographic characteristicsof patients. Rapid Estimate of Adult Literacy in Medicine (REALM) scale was used to measure the health literacy level.Results: The mean REALM score was higher among females than males (p&amp;lt;0.013). Health literacy mean score was lowest amongpublic hospital inpatients and highest among university hospital inpatients (p&amp;lt;0.001). Primary-school graduate patients hadsignificantly lower scores (p&amp;lt;0.001) than the other groups. The findings of the REALM test were in agreement with the health literacycompetencies.Conclusion: Males, patients older than 35 years old, primary-school graduates, and public hospital inpatients had lower levels ofhealth literacy.

Over-the-Counter Tamsulosin for Men with Urinary Symptoms: A Simulated Self-Selection Study.

We determined whether consumers who self-select to use tamsulosin for urinary symptoms can make appropriate decisions without health care provider guidance in a simulated over-the-counter setting. In a simulated retail setting eligible participants (18 years old or older) reviewed a mock-up of Flomax® over-the-counter packaging and determined whether it was right for them to use tamsulosin capsules (0.4 mg). Per an a priori mitigation procedure 3 urologists reviewed self-reported data, dipstick urinalysis results and AUA-SI (American Urological Association symptom index) scores of men who self-selected tamsulosin as appropriate to use despite information on the drug facts label instructing otherwise. Seemingly incorrect decisions were revised to "appropriate" if deemed well-informed and medically acceptable by 2 or 3 urologists. Overall 619 men and 38 women (mean age 60.9 and 51.6 years, respectively) were enrolled. Of the 470 (75.9%) men who self-selected to use tamsulosin 82 (17.4%) had low health literacy per the REALM (Rapid Estimate of Adult Literacy in Medicine) test and 365 (77.7%) reported seeing a physician at least once a year. Mean AUA-SI total score was 16.5 and 380 (80.9%) men reported urinary symptoms for 1 year or more. The proportions of men who made appropriate self-selection decisions in unmitigated and mitigated analyses were 92.8% (95% CI 90.0-94.9) and 97.9% (95% CI 96.1-99.0), respectively, and findings were similar regardless of health literacy level. Overall 36 of the 38 women (94.7%) made an appropriate decision not to use tamsulosin. These findings support the potential use of over-the-counter tamsulosin for male urinary symptoms.

Associations of Acculturation with English- and Spanish-Language Health Literacy Among Bilingual Latino Adults

Background:Low health literacy (HL) is associated with poor health status and outcomes. Racial/ethnic minorities in the United States disproportionately experience low HL and HL-related health disparities. Among Latinos, acculturation is associated with health outcomes, but little is known about the relationship between acculturation and HL.Objective:We examined associations of sociodemographic and acculturation variables with English- and Spanish-language HL among 142 bilingual Latino adults with adequate HL.Methods:HL was assessed in English using the Rapid Estimate of Adult Literacy in Medicine (REALM) and in Spanish with the Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA). Acculturation was assessed using the four subscales of the Multidimensional Acculturation Scale-II. Associations of sociodemographic data and acculturation with HL were examined using linear regression.Key Results:Higher education, higher income, higher English proficiency, and lower Latino cultural identification predicted REALM scores (ps <.05) in univariate models. When these variables were entered into a single model, only education and Latino cultural identification were associated with REALM scores. In univariate analyses, the following characteristics were associated with SAHLSA scores: female gender, being partnered, higher education, higher income, being non-US born, lower English proficiency, and higher Spanish proficiency (ps < .05). Education, being non-US born, English proficiency, and Spanish proficiency were each significant in the multivariate model.Conclusions:Results revealed a significant association between acculturation and English- and Spanish-language HL among bilingual Latino adults with adequate HL, suggesting that HL should be assessed in the language in which individuals are most proficient. HL assessed in a nonprimary language may be confounded with language proficiency. [HLRP: Health Literacy Research and Practice. 2019;3(2):e81–e89.]Plain Language Summary:The results of this investigation revealed a significant association between acculturation and English- and Spanish-language health literacy among bilingual Latino adults. This suggests that health literacy should be assessed in the language in which individuals are most proficient. Health literacy assessed in a nonprimary language may be influenced by language proficiency.

Providers’ inability to estimate health literacy among African American (AA) patients (pts) with early prostate cancer (PCa).

77 Background: Providers’ estimates of a pt’s health literacy are important for communication and shared decision making among men with early PCa. We explored differences between providers’ estimates of health literacy and measured health literacy among AA pts in a prospective cohort study at Grady Memorial Hospital and the Atlanta Veterans Administration Hospital. Methods: Providers (n=18) estimated the health literacy of 124 newly diagnosed, early-stage, AA PCa pts after discussions with each pt regarding his PCa treatment options, categorized as ≤Grade (Gr) 3; Gr 4-6; Gr 7-8; and High school. At a subsequent visit, prior to choosing his cancer treatment, each pt’s health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), using the same categories. Domains of numeracy, comprehension of common PCa terms, and anatomic knowledge were assessed using published methods. Concordance between estimated and actual health literacy was evaluated via Cohen’s Kappa coefficient (1.00 = perfect agreement). Results: Despite their discussions with the pts, providers consistently overestimated pts’ health literacy. Agreement between provider estimates and pts’ measured values was consistently low (32.0%-37.6%). These rates were approximately what would be expected by chance. Among the 75 patients with the lowest levels of health literacy, agreement was even lower (12.3%-35.6%). In this group 26.7% of provider assessments were off by ≥2 REALM categories. Conclusions: Healthcare providers are surprisingly ineffective at estimating the health literacy of their pts with early stage PCa. This poor accuracy may diminish providers’ ability to communicate successfully with pts and engage in shared decision making, especially among pts with poor health literacy. [Table: see text]

Health literacy is a barrier to shared decision making in early prostate cancer (PCA) among African American (AA) men.

84 Background: ASCO, AUA, ASTRO and SUO endorse shared decision making for men with localized PCa. We explored treatment decisions among providers and their AA patients (pts) in a prospective cohort study at Grady Memorial Hospital and the Atlanta Veterans Administration Hospital. Methods: Following their visit, 18 providers documented the PCa treatment options they had discussed with 124 newly diagnosed, early-stage, African American PCa pts. At a subsequent visit, prior to choosing their cancer treatment, pts were asked to name the options they had discussed with their provider. Demographics were collected. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM). Numeracy, comprehension of common PCa terms, and anatomic knowledge were assessed using published methods (Kilbridge K, et al. J Clin Oncol 27:2015-2021, 2009). Chi-square, t-tests and multivariate logistic regression were used to identify variables associated with correct understanding of treatment choices. Results: Just 23.4% of pts correctly understood their treatment options. In univariate analysis, only health literacy was statistically significantly associated with comprehension of PCa treatment options (p &lt; 0.05). In a multivariate logistic model adjusting for age, education, income, numeracy, comprehension of common PCa terms, and anatomic knowledge; health literacy remained the only significant predictor of pts’ comprehension of their treatment choices (OR 3.8, 95% CI 1.2-11.9, p = 0.021). Even among the 49 pts with the highest level of health literacy, only 34.7% correctly understood their cancer treatment options (compared to 16.0% among low literacy patients). Conclusions: Successful shared decision making requires pts to understand their treatment choices. Information presented by healthcare providers may be overwhelming for newly diagnosed pts, particularly those with lower health literacy. Our study suggests that even pts with the highest level of health literacy may need additional support to understand their PCa treatment options.

Measurement of health literacy in patients with cardiovascular diseases: A systematic review.

While many instruments have been developed, validated, and used to assess health literacy skills, their use and appropriateness among patients with cardiovascular diseases (CVDs) are not widely studied. To identify, appraise, and synthesize available health literacy assessment instruments used in patients with CVDs. Electronic databases were searched for studies that used validated measures to assess health literacy in patients with CVDs. Included studies were assessed for risk of bias and the identified instruments were evaluated based on their psychometric properties. Data were synthesized using a narrative approach. Forty-three studies were included in the review, of which 20 were cross-sectional studies and 12 were randomized controlled trials. Eleven health literacy assessment instruments were identified, of which only one was disease-specific. The Abbreviated version of the Test of Functional Health Literacy in Adults (S-TOFHLA) (n = 19) and the Rapid Estimate of Adult Literacy in Medicine (REALM) (n = 13) were found to be the most commonly used instruments to assess health literacy in CVDs. The S-TOFHLA and the REALM are the most widely used instruments to evaluate health literacy in CVD population. More CVD-specific health literacy screening instruments are warranted. Assessment of health literacy should be a standard of care in patients with CVDs and effective interventions should be developed to improve the impact of limited health literacy on health outcomes in this population.

Instruments used to evaluate functional health literacy in elderly persons with chronic kidney disease: Integrative review

Abstract Objective: To identify the instruments used to evaluate the functional health literacy of elderly persons with chronic kidney disease, and to assess whether they are suitable for this population. Method: An integrative review of the Lilacs, PubMed, Ibecs, Scopus and Cochrane databases was carried out in July and August 2018, seeking original articles dealing with functional health literacy and chronic kidney disease in the elderly. Results: A total of 15 articles were evaluated and seven different instruments used in the research were identified, with the Rapid Estimate of Adult Literacy in Medicine (REALM) and Test of Functional Health Literacy in Adults (TOFHLA) the most prevalent. Conclusion: The instruments identified are applicable for the elderly, but are not specific for this population. The construction and/or adaptation of new instruments is suggested considering the specific characteristics of this age group.