Rates Of Low Health Literacy Research Articles

557-P: Effect of MyPlate Nutrition and Diabetes Education Delivered by Promotoras de Salud in Low-Income Latinx Adults Living in Rural Communities

Background: Latinx individuals have over a 50% chance of developing type II diabetes within their lifetime compared to 40% of the general population1,2. Further, a lack of diabetes education significantly contributes to poor health literacy surrounding diabetes treatment and management among ethnic minorities3. Methods: The study utilized a pre and posttest design using the General Nutrition Knowledge Questionnaire-Revised to assess changes in the nutrition knowledge of individuals 18 years or older, after receiving a tailored nutrition education presentation based on U.S. Department of Agriculture MyPlate's dietary guidelines. The difference between pre and posttest nutrition knowledge scores was measured using paired samples t-test for the overall survey and separately for three questions that assessed the diet-diabetes relationship. Results: Most participants were Spanish-speaking Latinx/Hispanic females between the ages of 40-49, where 66% reported middle school education or lower, 26.4% reported being diagnosed with diabetes, and 56% had a family history of diabetes. The paired t-test of the pre and posttests (n=82) resulted in one and two-sided p-values < 0.001. The comparative pre versus posttest analysis for the diabetes knowledge-related questions showed that the diabetes-related questions one, two, and three resulted in p-values <0.227, <0.02, and <0.03, respectively. Conclusion: Latinx individuals in rural communities face systemic barriers, including poor medical coverage, low health literacy rates, language and immigration barriers4. Our study brought together promotoras to create and deliver culturally-conscious, evidence-based nutrition education material through platicas. Increased access to nutrition and diabetes education contributes to improved patient health knowledge and addresses negatively impactful social determinants of health among rural Latinx American populations. Disclosure S.C.Marin: None. I.Marquez: None. R.R.Flores: None. D.Lee: None. D.Wraich: None. H.Duran: None. A.M.Cheney: None. Funding University of California, Riverside School of Medicine

MP49-03 EXPLORING THE PREVALENCE OF URINARY INCONTINENCE IN MULTI-ETHNIC REFUGEE WOMEN IN MARICOPA COUNTY, ARIZONA

You have accessJournal of UrologyCME1 Apr 2023MP49-03 EXPLORING THE PREVALENCE OF URINARY INCONTINENCE IN MULTI-ETHNIC REFUGEE WOMEN IN MARICOPA COUNTY, ARIZONA Aqsa Khan, Sheila Malekian, Olufunmilola Adeleye, and Lubayna Fawcett Aqsa KhanAqsa Khan More articles by this author , Sheila MalekianSheila Malekian More articles by this author , Olufunmilola AdeleyeOlufunmilola Adeleye More articles by this author , and Lubayna FawcettLubayna Fawcett More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003297.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Data regarding urinary symptoms among refugee women is sparse, but multiple risk factors associated with urinary incontinence (UI) such as high parity and diabetes have been reported to be more prevalent in resettled refugee populations. Refugees often have low socioeconomic status and low health literacy rates, which may decrease their likelihood of initiating a discussion of UI with their healthcare providers, exacerbating existing barriers to care such as culture and language. Data from the Arizona Refugee Resettlement Program reports over 90,000 refugees have resettled in Arizona. We sought to investigate the prevalence of incontinence amongst women of this group and to assess their comfort and patterns in discussing incontinence with healthcare providers. METHODS: In this cross-sectional study, multi-ethnic refugee women recruited with convenience sampling and word-of-mouth strategies within refugee community spaces from July 2021 to November 2021 were administered a 20-item questionnaire that was translated into Arabic, Burmese, Swahili, and Somali. Urinary incontinence was defined by an affirmative response to any of the 6-item Urogenital Distress Inventory (UDI-6) questions or having more than one reported occurrence of stress or urgency incontinence per month. Additional questions also addressed comfort with discussing UI with healthcare providers. RESULTS: In total, 58 participants were included in the study, 68.4% of whom originated from Sub-Saharan Africa, primarily the Democratic Republic of Congo, Somalia, and Burundi. The prevalence of UI in this sample was 50%, with higher reports of urgency compared to stress incontinence. 82.8% reported they never discussed urinary symptoms with their healthcare provider, despite 59.6% of participants reporting feeling comfortable having these discussions. Additionally, 77.6% of these women reported never being asked about these symptoms by a healthcare provider. CONCLUSIONS: Refugee women have a high prevalence of urinary incontinence, which exceeds or at least matches the prevalence of urinary incontinence in the general female population. Many of these women are not discussing urinary symptoms with their healthcare providers, which may be in part due to the lack on inquiry by the provider. Healthcare providers caring for refugee women should consider screening for this condition during regular office visits. The long-term goal is to identify and minimize health disparities within refugee populations. Source of Funding: Mayo Clinic in Arizona (AZ) Small Grants © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e679 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aqsa Khan More articles by this author Sheila Malekian More articles by this author Olufunmilola Adeleye More articles by this author Lubayna Fawcett More articles by this author Expand All Advertisement PDF downloadLoading ...

Podcast on the Art of the Patient Conversation: Healthcare Provider Perspectives to Improve Outcomes in Multiple Sclerosis.

Health literacy has been identified as key to improving patient outcomes and is particularly important for patients facing chronic illnesses such as multiple sclerosis (MS). Low health literacy rates can negatively impact communication between healthcare providers and patients and is associated with poor health outcomes. It is critical to raise awareness of conversational techniques to healthcare providers that can support more effective communication with patients. In this podcast article, nurse practitioners discuss multimodal strategies that enable appropriate conversations to meet patients' needs through the following four techniques: patient-centric language, teach-back, open-ended questions, and active listening and paraphrasing. These techniques are incorporated into example patient-provider conversations to demonstrate their effectiveness in clinical practice. Comprehensive patient conversations and optimizing patient interactions builds a trustworthy foundation for shared decision-making to improve health literacy and outcomes in patients with MS. Podcast Discussion (mp4 37425 KB).

The Role of the Nurse in the Prehabilitation Unit.

To address some of the main nurse's role in facilitating patients' participation and engagement to prepare for the stress of surgery. These include published peer reviewed literature, web-based resources, and professional organizations' resources. Psychological and physical optimization of surgical patients during the preoperative phase is a novel approach known as the prehabilitation program. A multidisciplinary team of health professionals work in synergy to prepare patients for the upcoming surgery. Different roles and responsibilities may be allotted to the nurse, whereas one of which may focus on patient education. Being cognizant of low health literacy rates while using various teaching strategies known to promote patient understanding may increase patient participation to prepare for surgery. This article may guide nurses who are new to the concept of health literacy and patient activation. We wish to sensitize nurses to a few strategies to support patient understanding and involvement. This overview can help others who are establishing a prehabilitation unit in their institution to highlight the important role a nurse can play toward patient education.

Hepatitis B and C prevalence in waste pickers: a global meta-analysis.

The objective of this research was to use a meta-analysis to understand the prevalence of hepatitis B or C in waste pickers worldwide. Epidemiological studies on hepatitis B and C in waste pickers were included adopting a systematic review with meta-analysis. Each selected article had its quality scored by all authors, evaluated according to the Loney's criteria, and evaluated for quality and bias verified with a funnel plot. After employing Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, there were 12 studies used for this meta-analysis. The rate of hepatitis B seropositivity was 0.15 (95% CI 0.10-0.20), and hepatitis C was 0.08 (95% CI 0.04-0.12). This information suggests that waste pickers are exposed to many risks associated with poor quality of life working conditions as well as low health literacy rates. The results of this meta-analysis confirm the vulnerability of waste pickers to hepatitis B and C infection and reinforce the importance of using personal protective equipment and immunizing workers.

Health literacy of people living with mental illness or substance use disorders: A systematic review

Health literacy is one's ability to use cognitive and social skills to access, understand and appraise health information. Despite poor health outcomes of people living with mental illness there is limited research assessing their health literacy. This systematic review aims to synthesise research on health literacy rates, conceptualizations, and outcomes of people living with mental illness, including substance use disorders. This will provide insights into how health literacy might be targeted to reduce these health inequities. A search of published literature in multiple databases up until February 2019 was conducted. One reviewer screened the titles, abstracts and keywords of identified publications and the eligibility of all full-text publications were assessed for inclusion along with a second reviewer. Both reviewers independently rated the quality of the included studies. Fourteen studies were included in the review. Rates and measures of health literacy varied. Low health literacy and health literacy weaknesses were identified. There is a lack of research on the relationship between health literacy and other outcomes, particularly health service engagement. The review highlights the high rates of low health literacy within this population compared with general populations. Most studies used a functional health literacy measure, despite its limitations, with only a few using multidimensional measures. Overall, there is limited research examining the impact that this populations health literacy has on their recovery and how it affects them over time. The review emphasizes the importance of practitioners assessing and targeting health literacy needs when working with this population.

Quality assessment of cancer patient education materials: the current state of systemic therapy patient education in fourteen cancer centres across Ontario, Canada.

Most patients diagnosed with cancer are administered systemic therapy and thesepatients are counselled and given printed education (PE) materials. High rates of low health literacy highlight the need to evaluate the quality of thesePE materials. A current state assessment of the quality of PE materials was conducted in Ontario, Canada. Patient education leaders from 14 cancer centres submitted print materials on the topic of systemic cancer therapy to the assessment team. To report adherence to PE quality and health literacy best practices, the following validated measures were used: readability (FRY, SMOG and Flesch Reading Ease), understandability and actionability (Patient Education Materials Assessment Tool (PEMAT)). Materials at grade level 6 or lower and with PEMAT scores greater than 80% were considered to meet health literacy best practices. A total of 1146 materials were submitted; 366 met inclusion criteria and 83 were selected for assessment. Most materials scored below the 80% target for understandability (x̄ = 73%, 31-100%) and actionability (x̄ = 68%, 20-100%), and above the recommended grade 6 readability level (x̄ = grade 9) meaning that the majority did not meet quality standards or best practices. Results suggest that there is significant opportunity to improve the quality of PE materials distributed by cancer centres. The quality of PE materials is a critical safety and equity consideration when these materials convey important safety and self-care directives.

Health Literacy and Health Behaviors Among Adults With Prediabetes, 2016 Behavioral Risk Factor Surveillance System.

Evidence is needed for designing interventions to address health literacy-related issues among adults with prediabetes to reduce their risk of developing type 2 diabetes. This study assessed health literacy and behaviors among US adults with prediabetes and the mediating role of health literacy on health behaviors. We used data from the 2016 Behavioral Risk Factor Surveillance System (BRFSS) (N = 54 344 adults). The BRFSS health literacy module included 3 questions on levels of difficulty in obtaining information, understanding health care providers, and comprehending written information. We defined low health literacy as a response of "somewhat difficult" or "very difficult" to at least 1 of these 3 questions. Respondents self-reported their prediabetes status. We included 3 health behavior indicators available in the BRFSS survey-current smoking, physical inactivity, and inadequate sleep, all measured as binary outcomes (yes/no). We used a path analysis to examine pathways among prediabetes, health literacy, and health behaviors. About 1 in 5 (19.0%) adults with prediabetes had low health literacy. The rates of physical inactivity (31.0% vs 24.6%, P < .001) and inadequate sleep (38.8% vs 33.5%, P < .001) among adults with prediabetes were significantly higher than among adults without prediabetes. The path analysis showed a significant direct effect of prediabetes and health literacy on health behaviors. The indirect effect of prediabetes through health literacy on health behaviors was also significant. BRFSS data from 2016 showed that rates of low health literacy and unhealthy behaviors were higher among adults with prediabetes than among adults without prediabetes. Interventions are needed to assist adults with prediabetes in comprehending, communicating about, and managing health issues to reduce the risk of type 2 diabetes.

Preparedness for COVID-19 in the oncology community in Africa

Preparedness for COVID-19 in the oncology community in Africa

Readability and quality of online information regarding dental treatment for patients with ischaemic heart disease.

Background Healthcare information is increasingly being sought on the Internet. Ischaemic heart disease (IHD) poses a significant health burden. Concern often arises for patients with IHD when undergoing dental treatment, leading to online searching for relevant healthcare information.Objective To evaluate the readability and quality of webpages regarding IHD and dental treatment.Materials and methods Three searches were performed on the Google search engine. The first hundred results of each search were collated and exclusion criteria applied. The remaining 66 webpages were categorised. Readability was assessed using the FRES and SMOG readability tools. Quality was assessed using the PEMAT questionnaire, the JAMA benchmarks and the Health On the Net (HON) seal.Results Most examined webpages were commercial. Readability of 90.1% of webpages was deemed fairly to very difficult. Understandability and actionability scores were generally below the comprehension level of the general population. Less than 50% of websites achieved the authorship, attribution and disclosure JAMA benchmarks. Only 12.1% of websites displayed the HON seal.Conclusions Online health information related to IHD and dental treatment is generally too difficult for the average individual to read, understand, or act upon, and may be of questionable quality. Given the low health literacy rates among the general population, future revisions of educational materials by non-commercial sources regarding IHD and dental treatment are warranted, in order to ensure online health information is understandable and of genuine benefit to patients and/or their carers.

Effects of Video Discharge Instructions on Patient Understanding: A Prospective, Randomized Trial.

Previous studies demonstrated that patients have difficulty understanding and retaining discharge instructions due to the lack of time spent counseling patients and low health literacy rates. The purpose of this study was to evaluate the effects of video instructions on patient understanding of their discharge instructions. This was a prospective, randomized, controlled trial of a convenience sample conducted in a military hospital emergency department. Adult patients with a diagnosis of upper respiratory tract infection, pharyngitis, or gastroenteritis were included into the study. Investigators randomized subjects to either standard discharge procedures or standard discharge procedures plus video discharge instructions, using a random number generator. Ten minutes after receiving one of these 2 discharge education methods, subjects demonstrated their knowledge of their discharge instructions using a predefined 5-question, multiple-choice questionnaire. From October 1, 2015, to January 8, 2016, a total of 60 subjects volunteered to participate in the study. Zero subjects were excluded, and all subjects completed the study protocol. Baseline characteristics between groups were not significantly different (30 video discharge instructions and 30 standard discharge instructions). We found a significant difference between groups with respect to discharge instructions knowledge in favor of the video discharge instructions group (4.53 vs. 4; p = 0.009). Video discharge instructions, used as an adjunct to standard verbal and written discharge methods, improved patient understanding and retention of their discharge instructions.

Quality and Readability of Online Information on In-Office Vocal Fold Injections.

Vocal fold injection augmentations are increasingly being performed in the office setting on awake patients, as opposed to the operating room. These procedures thus require patient cooperation and education. As the Internet is a widely-used resource for patients, our aim was to assess the quality and readability of online resources on in-office awake vocal fold injections. An online Google search using the terms "office vocal fold injection medialization" and "awake vocal fold injection" was conducted. The first 50 English-language websites were categorized into professional- and patient-targeted, and major and minor sources. They were analyzed using the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL) test, and DISCERN quality score. Fifty websites were evaluated, and the overall DISCERN score was 2.60 ± 1.01, the mean FRES was 32.16 ± 19.10, and the mean FKGL was 13.76 ± 4.12. Between the 25 professional-targeted and 25 patient-targeted websites, professional-targeted sites had significantly higher DISCERN (P < .05) and FKGL (P < .05) scores, and lower FRES (P < .05) scores. Between the 30 major and 20 minor websites, major websites had significantly lower FRES (P < .05) and higher FKGL (P < .05) scores, and there was a trend toward significance for higher DISCERN scores (P = .052). Our study shows that half of the top Google results for our topic were not written for patient education, but rather for health care professionals. The reading level of this information exceeds the recommended grade level for patient education materials, and may be less comprehensible than intended. While patient-targeted materials are easier to read than professional-targeted sites, they are of lower quality. The quality of the available online information on this topic is suboptimal for both patients and health care providers. This research highlights the need for more appropriate patient education materials given low health literacy rates.

Effective communication in the era of precision medicine: A pilot intervention with low health literacy patients to improve genetic counseling communication

Effective communication, where all parties share a common understanding, is necessary to realize the promise of Genomic Medicine. It is especially salient given the imperative to increase the participation of diverse populations in genomics research and to expand the reach of clinical genomics. We have previously shown that cancer genetic counseling is suboptimal for patients with limited health literacy. To address this finding, we implemented a pilot study to improve verbal communication between genetic counselors and their patients of limited health literacy that consisted of: i) curriculum development and delivery of a Genetic Counselors (GC) communication workshop; ii) two-month post-workshop interviews with GC participants (n = 9); iii) observations/audio recordings of counseling sessions involving 24 patients and two GC workshop participants; iv) post-counseling interviews with patients (n = 9). The 4.5-h workshop presented evidenced-based principles and strategies for effective communication with limited health literacy patients (e.g. use of plain language and teach-back), and offered specific techniques and exercises to practice adoption of such practices in the genetic counseling context. GCs expressed appreciation for the opportunity to refine their skills; however, they reported that some strategies were challenging given their professional training and communication habits. For example, GCs were concerned that use of plain language could undermine efforts to obtain informed consent and provide scientifically accurate information. Observations and patient interviews after the workshop revealed that GCs were able to employ the communication strategies with positive effects, with patients indicating sufficient understanding of the genetic test and its implications as well as satisfaction with the counselors’ communication. While derived from research on communication with those of limited health literacy, the communication approaches taught in the GC workshop could benefit most patients, given the high rates of low health literacy in many countries, and the many factors beyond health literacy that can contribute to reduced comprehension in health care environments.

MP69-16 THE ASSOCIATION OF HEALTH LITERACY AND NUMERACY ON UNDERSTANDING OF PROSTATE CANCER TERMINOLOGY

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making III1 Apr 2017MP69-16 THE ASSOCIATION OF HEALTH LITERACY AND NUMERACY ON UNDERSTANDING OF PROSTATE CANCER TERMINOLOGY Jeremiah Umoh, Shaquille Brown, Daniel Heslop, Ken Wallston, and Kelvin Moses Jeremiah UmohJeremiah Umoh More articles by this author , Shaquille BrownShaquille Brown More articles by this author , Daniel HeslopDaniel Heslop More articles by this author , Ken WallstonKen Wallston More articles by this author , and Kelvin MosesKelvin Moses More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2312AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A source of treatment regret and less engaged treatment decision making may be lack of health literacy and numeracy regarding terms commonly associated with prostate cancer treatment. The objective of this study was to determine community levels of health literacy and numeracy and their association with terminology commonly used when discussing prostate cancer treatment. METHODS A total of 52 men from the outpatient clinics of Nashville General Hospital (n=41), which primarily serves the uninsured, Medicaid/Medicare, and indigent populations in the greater Nashville area, and Vanderbilt University Medical Center (n=11) participated. Demographic information was collected, and health literacy and numeracy were assessed using the revised Rapid Estimate of Adult Literacy in Medicine (REALM-R), the Brief Health Literacy Screen (BHLS), the Subjective Numeracy Scale (SNS-3), and Schwartz-Woloshin (S-W) questionnaires. Men were asked to identify the location of the prostate on a standardized model of the male pelvis. They were then asked to complete a 29-term questionnaire which asks men to define terms associated with sexual, bowel and urinary function. Adequate health literacy (AHL) was defined as a REALM-R score >=6, and inadequate health literacy (IHL) was REALM-R <6. RESULTS Median age of the cohort was 55y, 57.7% were Black, 75% had annual household income <$20,000, and 28.8% had less than 12th grade education. Median REALM-R score was 8 (IQR 2-8), median BHLS score was 11 (IQR 9-14.25), median SNS-3 score was 11 (IQR 8-14), and median S-W score was 1 (IQR 1-2). Overall, 40.4% of men were able to identify the location of the prostate. For the 29-item questionnaire, the median number of correct responses was 23.5. Men with AHL had significantly higher percent of correct responses compared to men with IHL (89.5% vs 54.5%, p<0.005). There was a significant, positive linear relationship with amount of formal education and total correct responses (p=0.002). Men with annual incomes <$20,000 had significantly lower correct scores (19.5 vs 25.3 for >$20,000, p <0.02). Each of the measures of health literacy and numeracy were strongly related to understanding of the functional terms (Spearman correlation REALM-R r=0.72, BHLS r=0.72, SNS-3 r=0.62; all p<0.001). CONCLUSIONS The rates of low health literacy and numeracy are high and are associated with lack of knowledge of prostate cancer related terminology. Efforts to improve effective communication regardless of patient health literacy level are needed. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e932 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Jeremiah Umoh More articles by this author Shaquille Brown More articles by this author Daniel Heslop More articles by this author Ken Wallston More articles by this author Kelvin Moses More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Promoting Health Literacy for Children and Adolescents.

* Abbreviations: NAM — : National Academy of Medicine NHES — : National Health Education Standards Only 12% of American adults have proficient health literacy, defined as a set of skills needed to effectively function in the health care system.1 This is troubling given that health literacy is a stronger predictor of health than age, income, employment status, educational level, or race.2 A growing body of research also shows that low health literacy is associated with worse child health outcomes,3 higher health care costs, and elevated mortality rates.1 Although Americans are increasingly expected to be knowledgeable consumers of health care, it is clear that many individuals lack the core health literacy skills needed to understand their health insurance.4 This inadequate understanding of health care information creates challenges beyond the selection of a health insurance plan or payment calculations. Poor health literacy, including health numeracy, extends into one’s ability to seek care at an appropriate time, navigate through the health system, and share in important medical decisions. In this Perspective, we describe national efforts to combat low health literacy rates and argue that they fail to adequately prepare children and adolescents to be health-literate adults. We then propose several steps for educators, health care providers, and policymakers to improve health literacy among children and adolescents in the United States. The US Department of Health and Human Services, the National Academy of Medicine … Address correspondence to Tyler N.A. Winkelman, MD, MSc, University of Michigan, Robert Wood Johnson Foundation Clinical Scholars Program, North Campus Research Center, 2800 Plymouth Rd, Building 14, Room G100-20, Ann Arbor, MI 48109-2800. E-mail: tywink{at}med.umich.edu

Disruptive and Deliberate Innovations in Healthcare

Disruptive and Deliberate Innovations in Healthcare

Implications For Reform: Survey Of California Adults Suggests Low Health Literacy Predicts Likelihood Of Being Uninsured

Despite high rates of low health literacy among uninsured American adults, empirical research until now has not quantified whether low health literacy is associated with lack of health insurance above and beyond other related factors, such as employment, the availability of employment-based insurance, race or ethnicity, and poverty. This study analyzed a large, representative sample of adults in California and found that even when these related factors were considered, people with low health literacy were more likely to be uninsured than those with adequate health literacy. This finding represents the first empirical evidence that low health literacy predicts the lack of health insurance in adults. The study also found that among people who were uninsured, those with low health literacy were sicker and less likely to have ever had health insurance. They were also more likely to be eligible for the expanded Medicaid program under the Affordable Care Act, compared to uninsured respondents with adequate health literacy. These findings suggest that it will be critical to keep health literacy in mind in implementing the law--for example, in the design of eligibility documents and required forms, insurance exchange interfaces, and educational and outreach campaigns related to the Medicaid expansion and the insurance exchanges.

Obesity Prevalence in Nepal: Public Health Challenges in a Low-Income Nation during an Alarming Worldwide Trend

The future toll of the obesity epidemic will likely hit hardest in low- and middle-income countries. Ongoing urbanization promotes risk factors including sedentary lifestyle and fat- and sugar-laden diets. Low-income countries like Nepal experience a double disease burden: infectious diseases as well as rising incidence of noncommunicable diseases (e.g., cardiovascular disease and diabetes mellitus) frequently characterized by obesity. Nepal currently directs efforts towards curing disease but pays little attention to preventive actions. This article highlights obesity prevalence in Nepal, delineates the challenges identified by our pilot study (including low health literacy rates), and suggests strategies to overcome this trend.

Effectiveness of patient-caregiver dyad discharge interventions on hospital readmissions of elderly patients with community acquired pneumonia: A systematic review

Effectiveness of patient-caregiver dyad discharge interventions on hospital readmissions of elderly patients with community acquired pneumonia: A systematic review

Editorial: the emerging field of health literacy research.

Michael S. Wolf, Assistant Professor and Director, Health Literacy and Learning Program, Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL. Terry C. Davis, Professor, Department of Medicine/Pediatrics, Louisiana State University Health Center-Shreveport, Shreveport, LA. Ruth M. Parker, Professor, Division of General Internal Medicine, Emory University School of Medicine, Atlanta, GA. Address correspondence to Dr Wolf, Health Literacy and Learning Program, Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, 676 N St Clair Street, Suite 200, Chicago, IL 60611. E-mail: mswolf@northwestern.edu Over the past 2 decades, several hundred studies have depicted associations between limited literacy skills and various problems with health and health care among adults in the United States, lending to the creation of a new field of study that has been aptly named health literacy. Specifically, limited health literacy has been linked to problems with the use of preventive services,1 delayed diagnoses,2 understanding of one’s medical condition,3-5 adherence to medical instructions,6 self-management skills,5-7 physical and mental health,8,9 and increased mortality risk.10 Although less studied, limited literacy has also been associated with higher health care costs.11 But what exactly is health literacy? The definition that has been most widely accepted by academics, policy makers, and clinicians alike is “the capacity to obtain, process, and understand health information and materials needed to make appropriate decisions regarding one’s health.”12 According to the Institute of Medicine’s report, A Prescription to End Confusion, health literacy reflects not only the most fundamental cognitive and social processes associated with learning about one’s health, but it is also the level of complexity attributed to the requisite tasks imparted by the health care system. Despite the dual emphasis in defining the term, the reported prevalence of limited health literacy has usually been derived from estimates of the more general prose, document, and quantitative literacy skills of adult Americans. However, the first national assessment of health literacy skills was recently released.13 The report found more than one third of men and women in the United States to be at the lowest levels of health literacy. More alarming were the disproportionately high rates of low health literacy among racial/ ethnic minorities and low-income adults; more than half of African Americans, adults without insurance coverage, and the elderly had basic or below basic health literacy skills. This reminds us that health literacy is closely aligned with the national concern regarding health disparities.