Systematic Review Of Quantitative Studies Research Articles

Health Risk Behaviors and Self-Esteem Among College Students: Systematic Review of Quantitative Studies.

Due to their impact on premature mortality and long-term disabilities, a better understanding of health risk behavior (HRB) determinants among college students is crucial in order to build the most appropriate prevention tools. Although self-esteem appears to be a relevant candidate, a clear picture summarizing its multiple links with HRB is lacking to guide clinicians and researchers. This study aims to provide a systematic review of the associations between health risk behavior and self-esteem among college students. This search was performed in several databases on 02/02/17. Study eligibility criteria were original articles in peer-reviewed journals, in English; observational quantitative studies; among college students; and investigated the association between self-esteem and HRB. The PRISMA statements were complied with. One hundred fifteen articles were included: 46 on substance use, 35 on sexual behavior, 11 on nutritional habits, 27 on physical activity, and 5 on other HRB. Most studies reported an association between higher self-esteem and healthier behavior. For alcohol consumption and number of sexual partners, both negative and positive associations have been reported. Directionality was investigated in a few studies suggesting potential bidirectional effects. This review points out the need for consensus for the definition of self-esteem and HRB. There was high heterogeneity in (1) the measurement of self-esteem either in the concept measured (global vs. domain) or in the way to implement validated tools; and (2) the definition of HRB. Self-esteem seems to be a relevant target to intervene on HRB, especially alcohol abuse and physical activity. Registration number: PROSPERO (ID = CRD42017056599).

N31 What factors affect quality of life and psychological well-being in patients with intestinal failure? A systematic review of quantitative studies

Abstract Background The most common cause of intestinal failure (IF) is Crohn’s disease (CD). The definition of IF is ‘the reduction of gut function below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation is required to maintain health and/or growth’. It is a result of the most severe phenotype of CD, where an individual can no longer obtain sufficient nutrients and fluids from their gut to sustain life without supplementation in the form of parenteral nutrition (PN) or intravenous fluids. Home PN (HPN) allows people to receive infusion at home and increases survival rates (65% after 6 years). Whilst HPN improves length of life, studies have demonstrated this treatment can severely negatively affect an individuals’ quality of life (QoL) and employment. The aim of this systematic review was to identify factors affecting QoL in people with IF. Methods A search of databases MEDLINE, PubMed, PsycINFO, Web of Science, Global Health, and Scopus was conducted in July 2019. Search terms included ‘Crohn’s disease’, ‘short bowel syndrome’, ‘intestinal failure’, ‘quality of life’, and ‘health-related quality of life’. Titles and abstracts were screened by one reviewer. Any uncertainties about inclusion of the papers were discussed with two reviewers. Full texts were screened by 3 reviewers. Quantitative studies that measured QoL as an outcome in people with IF were included. Results Nineteen studies including a total of 924 participants met the inclusion criteria. Six key themes of factors affecting QoL were identified: (1) Practicalities of IF and HPN, e.g. sleep disturbances from the noise of the pump; managing a high output stoma. (2) Impact of medical interventions, e.g. blood tests. (3) Social impact/physical activity/personal relationships, e.g. restricted ability to travel, socialise and eat with friends. (4) Personal and sexual impact, e.g. lack of sexual desire. (5) Impact of symptoms, e.g. fatigue. (6) Patient characteristics, e.g. age. Some studies also reported positive effects on health (such as more energy), improved symptoms and QoL with HPN, especially for those who had been very unwell previously. Conclusion People with IF often have poor QoL that is affected by many factors, from their symptoms to practical aspects of HPN. However, themes related to the ‘social’ and ‘personal’ impact of IF dominated in the literature. While there is considerable evidence on what affects QoL in people with IF, there appears to very little research on attempting to improve QoL in this patient group.

Mentors' self-assessed competence in mentoring nursing students in clinical practice: A systematic review of quantitative studies.

To examine registered nurses' self-evaluation of their competence in mentoring nursing students in clinical practice. Clinical mentors have significant roles and responsibility for nursing students' clinical learning. Moreover, the mentors' role is becoming increasingly important internationally, as the role of nurse teachers in mentoring students in clinical practice has declined. However, in most EU countries there are no specific educational requirements for clinical mentors, although they need targeted education to increase their competence in mentoring nursing students. The systematic review of quantitative studies was designed according to guidelines of the Centre for Reviews and Dissemination and PRISMA protocol. Studies published during 2000-2019 that met inclusion criteria formulated in PiCOS format were systematically reviewed by three independent reviewers. CINAHL (Ebsco), PubMed (MEDLINE), Scopus, ERIC and Medic databases were used to retrieve the studies. Three independent reviewers conducted the systematic review process. The studies were tabulated, thematically compared and narratively reported. In total, 16 peer-reviewed studies met the inclusion criteria. The studies identified various dimensions of mentors´ competence and associated environmental factors. Generally, participating mentors rated competences related to the clinical environment, mentoring, supporting students' learning processes and relevant personal characteristics fairly high. They also rated organisational practices in their workplaces, resources in the clinical environment and their mentor-student and mentor-stakeholder pedagogical practices, as respectable or satisfactory. The results indicate considerable scope for improving mentors' competence, particularly through enhancing organisational mentoring practices and relevant resources in clinical environments. Pedagogical practices of mentors in relations with both students and stakeholders should be enhanced to improve future nurses' learning. This systematic review addresses a gap in knowledge of mentors' self-evaluated competence that could assist the formulation of effective educational programmes for mentors internationally and improving clinical environments.

Religiosity and the psychological outcomes of trauma: A systematic review of quantitative studies

This is a broad review examining the relationships between religiosity and the psychological outcomes of trauma. Previous studies showed that some constructs of religiosity are associated with lower severity of symptoms of mental disorders, whereas others, for instance, negative religious coping, predict deteriorated mental health. A systematic review of peer-reviewed quantitative studies was conducted to examine the patterns of relationships between religiosity and psychological outcomes of trauma, potential causal relationships, and specific effect of religiosity on the outcomes on trauma. A total of 79 quantitative studies were included. The majority focused on military trauma or various types of traumatic exposure in the general population. Most of the studies employed a cross-sectional design. The associations between religiosity and psychological outcomes of trauma depend on the concept of religion used in a study, type of trauma. There is not enough evidence to support the causal effect of religiosity.

Measuring and mapping displacement: The problem of quantification in the battle against gentrification

Debates concerning residential population displacement in the context of gentrification remain vociferous, but are hampered by a lack of empirical evidence of the extent of the displacement occurring. The lack of quantitative evidence on gentrification-induced displacement and the difficulties in collecting it has long hampered the fight against it. Based on a systematic review of quantitative studies of the displacement associated with gentrification, this article considers how researchers have attempted to measure displacement using a range of statistical and mapping techniques reflecting the multi-dimensional character of gentrification. We note that these techniques often struggle to provide meaningful estimates of the number of individuals and households displaced by gentrification, something compounded by the lack of data available on a sufficiently granular temporal and spatial scale. Noting the limitations of extant methods, we conclude by considering the potential of more novel data sources and emergent methods involving the processing of larger amounts of (micro)data, as well as participatory GIS methods that involve affected communities themselves. This implies that whilst the quantitative study of displacement remains difficult, patterns and processes of displacement can be inferred through existing data sources, as well as data generated from those who themselves have experienced displacement.

Environmental Factors Associated with Older Adult’s Walking Behaviors: A Systematic Review of Quantitative Studies

The aim of this study is to systematically review the relationship between neighborhood environments and all types of walking behaviors among older adults. Seventy peer-reviewed journal articles which met the selection criteria were examined. Research designs were summarized by geographical location and the associations of environmental characteristics and walking were calculated. Interactions between moderators and environmental characteristics for all types of walking were also categorized. Results have shown that transport walking is the most supported by neighborhood environmental characteristics. The positively related environmental characteristics are walkability, urbanization, land use mix-diversity and accessibility, walking amenities, and bicycle lanes. Total walking was positively associated with walkability and urbanization. Recreational walking was associated with neighborhood employment/income level, nearness to public transport/bus stops, and social cohesion. The most commonly used moderators were age and gender, but inconsistent moderating effects between neighborhood environments and walking were also found. In densely populated environments such as Hong Kong, older adults walked mostly for both transport and recreation. In contrast, American older adults in low density areas walked less for transport and more for recreation. Findings support a strong relationship between neighborhood environments and older adults’ walking. Future research should focus on longitudinal studies and comparison studies by geographic location.

Early Intervention to Improve Sucking in Preterm Newborns: A Systematic Review of Quantitative Studies.

In Brief The CE Test for this issue is available online on the journal Web site and can be taken at http://www.nursingcenter.com/CE/ANC

Indoor Nature Interventions for Health and Wellbeing of Older Adults in Residential Settings: A Systematic Review.

Having contact with nature can be beneficial for health and wellbeing, but many older adults face barriers with getting outdoors. We conducted a systematic review of quantitative studies on health and wellbeing impacts of indoor forms of nature (both real and simulated/artificial), for older adults in residential settings. Search terms relating to older adults and indoor nature were run in 13 scientific databases (MEDLINE, CINAHL, AgeLine, Environment Complete, AMED, PsychINFO, EMBASE, HMIC, PsychARTICLES, Global Health, Web of Knowledge, Dissertations and Theses Global, and ASSIA). We also pursued grey literature, global clinical trials registries, and a range of supplementary methods. Of 6,131 articles screened against eligibility criteria, 26 studies were accepted into the review, and were quality-appraised using the Effective Public Health Practice Project (EPHPP) tool. The participants were 930 adults aged over 60. Nature interventions and health/wellbeing outcomes were heterogeneous, which necessitated a narrative synthesis. The evidence base was generally weak, with 18 of 26 studies having a high risk of bias. However, several higher-quality studies found indoor gardening and horticulture programs were effective for cognition, psychological wellbeing, social outcomes, and life satisfaction. There is inconsistent evidence that indoor nature exposures are beneficial for older care residents. We expect that successful interventions were, at least partly, facilitating social interaction, supporting feelings of autonomy/control, and promoting skill development, that is, factors not necessarily associated with nature per se. Higher-quality studies with improved reporting standards are needed to further elucidate these mechanisms.

The effect of nature exposure on the mental health of patients: a systematic review

The effect of nature-based interventions on self-reported mental well-being in patients with physical disease is gaining increasing attention. However, there is a lack of randomized controlled trials investigating this area. Due to the massive costs in health care systems, there is a need for new strategies to address these issues and an urgent need for attention to this field. Nature-based interventions are low cost, easy to implement, and should get attention within the health care field. Therefore, the objective was to find the impact of nature interventions on mental well-being in humans with a physical disease. In four major databases (PubMed, Cinahl, PsycINFO, and Cochrane Library), a systematic review of quantitative studies of nature's impact on self-reported mental health in patients with physical disease was performed. A total of 1909 articles were retrieved but only five met the inclusion criteria and were summarized. All five studies were quantitative, with a control group and a nature-based intervention. A source of heterogeneity was identified: the patients in one of the five studies were psychosomatic. In the four studies with somatic patients, significant benefit of nature on self-reported mental health outcomes was found; the only study that failed to show a significant benefit was the one with psychosomatic patients. A significant effect of nature on mental well-being of patients with somatic disease was found. The result in patients with psychosomatic disease is inconclusive, and more studies in this category are needed. Further research on the effect of nature on mental health is merited, with special attention to standardizing intervention type and dose as well as outcome measures within each medical discipline.

Burden of Care and Quality of Life Among Caregivers for Adults Receiving Maintenance Dialysis: A Systematic Review

Dialysis is a burdensome and complex treatment for which many recipients require support from caregivers. The impact of caring for people dependent on dialysis on the quality of life of the caregivers has been incompletely characterized. Systematic review of quantitative studies of quality of life and burden to caregivers. Caregivers of adults receiving maintenance dialysis. The Cochrane Library, Embase, PsycINFO, CINAHL, PubMed, and MEDLINE were systematically searched from inception until December 2016 for quantitative studies of caregivers. Pediatric and non-English language studies were excluded. Study quality was assessed using a modified Newcastle-Ottawa scale. 2 independent reviewers selected studies and extracted data using a prespecified extraction instrument. Descriptive reports of demographics, measurement scales, and outcomes. Quantitative meta-analysis using random effects when possible. 61 studies were identified that included 5,367 caregivers from 21 countries and assessed the impact on caregivers using 70 different scales. Most (85%) studies were cross-sectional. The largest identified group of caregivers was female spouses who cared for recipients of facility-based hemodialysis (72.3%) or peritoneal dialysis (20.6%). Caregiver quality of life was poorer than in the general population, mostly comparable with caregivers of people with other chronic diseases, and often better than experienced by the dialysis patients cared for. Caregiver quality of life was comparable across dialysis modalities. Heterogeneity in study design and outcome measures made comparisons between studies difficult and precluded quantitative meta-analysis. Study quality was generally poor. Quality of life of caregivers of dialysis recipients is poorer than in the general population and comparable to that of caregivers of individuals with other chronic diseases. The impact of caring for recipients of home hemodialysis or changes in the impact of caring over time have not been well studied. Further research is needed to optimally inform dialysis programs how to educate and support caregivers.

A Review Article on Internet-based Psychological Interventions in Primary Care. What is the Global Experience? How Reliable are Results from RCTs? Lessons Learned from the European, US and Australian Case Studies

Abstract In the context of the EU’s Digital Single Market (eHealth) Strategy, the deployment of digital tools for patients’ empowerment and person-centred care is of high demand and importance. Shifting from treatment to health promotion and disease prevention, a variety of internet-based cognitive behavioural therapy programmes have been proven to be effective for managing common mental health disorders in secondary care even hough the effectiveness and the clinical use of internet-based cognitive behavioural therapy programmes alone in primary care have not been approved yet. Additionally, such interventions are neither included in the international clinical guidelines for treating common mental health disorders nor regulated by Member States as a healthcare service. Despite that, the UK National Health Service and the Swedish National Board of Health and Welfare endorse the use of internet-based cognitive behavioural therapy as a first treatment option. The aim of this research is to investigate the global experience of internet-based cognitive behavioural therapy programmes in controlled and real-life conditions in general practice and to evaluate the reliability of the results and concomitantly their compliance with the European Commission’s eHealth Strategy. A systematic review of quantitative studies was conducted from January 2007 to December 2017. The results indicated that unsupported internet-based cognitive behavioural therapy programmes alone are less effective than combined therapy options for treatment purposes, if no additional therapy is prescribed. Guided internet-based cognitive behavioural therapy may supplement traditional treatment methods resulting in improving the control of mental disorders, but are unable to demonstrate consistent quality or replace face-to-face therapy.

Restructuring physical micro-environments to reduce the demand for meat: a systematic review and qualitative comparative analysis

SummaryBackgroundReducing meat consumption could help to protect the natural environment and promote population health. Interventions restructuring physical micro-environments might help to change habitual behaviour. We synthesised the scientific evidence pertaining to whether, and which, interventions restructuring physical micro-environments effectively reduce the demand for meat.MethodsWe did a systematic review of quantitative studies evaluating the effectiveness of interventions restructuring physical micro-environments to reduce the demand for meat. We identified relevant records by searching six electronic databases (CAB s, Embase, PsycINFO, Science Citation Index, MEDLINE, and Dissertations & Theses) on Aug 31, 2017, contacting experts, screening publicly accessible online resources, and searching references. We included studies that evaluated the effectiveness of interventions restructuring physical micro-environments to reduce the demand for meat, defined as the actual or intended consumption, purchase, or selection of meat in real or virtual environments. We extracted data pertaining to the study samples, the interventions, and meat demand at the follow-up closest to intervention completion and at the longest follow-up, with the former representing our primary outcome. We synthesised data narratively and did a qualitative comparative analysis to identify configurations of intervention characteristics associated with, and those not found to be associated with, significant reductions in meat demand. Our Systematic Review is registered with PROSPERO, number CRD42017081532.ResultsOf 10 733 titles and abstracts screened for eligibility, we assessed 60 full papers and included 14 papers reporting on 18 studies with 22 intervention conditions. Three interventions reducing the portion size of meat servings reduced meat consumption in randomised trials. Three interventions providing meat alternatives with supporting educational material were associated with reduced meat demand in pre-post design studies. Three of four interventions altering the sensory properties (eg, visual presentation) of meat or meat alternatives at point of purchase reduced meat demand in randomised trials. Four interventions repositioning meat products to be less prominent at point of purchase were associated with lower meat demand, but only two such interventions reached statistical significance in a randomised trial and a multiple treatment reversal design. Only one of five interventions manipulating the description of meat or meat alternatives at point of purchase was associated with lower meat demand in a multiple treatment reversal design. Evidence from randomised trials evaluating a pricing intervention or interventions restructuring several aspects of micro-environments was too scarce or inconsistent to be conclusive. The results from our qualitative comparative analysis supported the findings of this narrative synthesis.InterpretationSome interventions restructuring physical micro-environments could help to promote lower demand for meat. Interventions reducing portion sizes of meat servings, providing meat alternatives, or changing the sensory properties of meat and meat alternatives at point of purchase offered the most promise in the context of experimental studies.FundingNone.

The relationship between buildings and health: a systematic review.

BackgroundThe built environment exerts one of the strongest directly measurable effects on physical and mental health, yet the evidence base underpinning the design of healthy urban planning is not fully developed.MethodThis study provides a systematic review of quantitative studies assessing the impact of buildings on health. In total, 7127 studies were identified from a structured search of eight databases combined with manual searching for grey literature. Only quantitative studies conducted between January 2000 and November 2016 were eligible for inclusion. Studies were assessed using the quality assessment tool for quantitative studies.ResultsIn total, 39 studies were included in this review. Findings showed consistently that housing refurbishment and modifications, provision of adequate heating, improvements to ventilation and water supply were associated with improved respiratory outcomes, quality of life and mental health. Prioritization of housing for vulnerable groups led to improved wellbeing. However, the quality of the underpinning evidence and lack of methodological rigour in most of the studies makes it difficult to draw causal links.ConclusionThis review identified evidence to demonstrate the strong association between certain features of housing and wellbeing such as adequate heating and ventilation. Our findings highlight the need for strengthening of the evidence base in order for meaningful conclusions to be drawn.

A systematic review of interventions to increase physical activity among South Asian adults.

To identify interventions aimed at increasing physical activity (PA) levels among South Asian (SA) adults and identify the specific changes in the content and delivery mode of interventions designed to increase PA levels among SA people aged ≥18 years. A systematic review of quantitative studies. Extracted data were synthesized using a narrative approach. ASSIA, CINHAL, EMBASE, Medline, SPORTDiscus and PsychINFO were searched. Included articles met the following criteria: (1) population: community-dwelling SA adults aged ≥18 years and (2) outcome: reporting determinants of PA, exercise, or a combination of the two, measured objectively or using self-report. The search was restricted to articles published in the English language up to 31 January 2017. Fifteen trials/programmes (16 articles) met the review criteria. The findings show that involving the target community in developing culturally appropriate interventions appears to be important in their acceptability, delivery and uptake. Using community-based participation in intervention planning, evaluation and research appears to produce culturally and linguistically tailored interventions that address core values, attitudes, beliefs and norms, and encourage participation in PA. Furthermore, the use of community health workers and underpinning the interventions with a psychological theory show promise in increasing PA uptake. This systematic review suggests that making cultural adaptations to PA interventions shows promise, but the evidence base presented is not strong. This does not mean that adopting such an approach is ineffective but that the evidence base is currently lacking.

Protocol for a meta-integration: investigating positive aspects of caregiving in dementia

IntroductionThe current work describes the protocol for a meta-integration investigating the positive aspects of providing care to someone living with dementia. We aim to understand the position of positive aspects...

Mental health supported accommodation services: a systematic review of mental health and psychosocial outcomes

BackgroundPost-deinstitutionalisation, mental health supported accommodation services have been implemented widely. The available research evidence is heterogeneous in nature and resistant to synthesis attempts, leaving researchers and policy makers with no clear summary what works and for whom. In this context, we undertook a comprehensive systematic review of quantitative studies in order to synthesise the current evidence on mental health and psychosocial outcomes for individuals residing in mental health supported accommodation services.MethodsUsing a combination of electronic database searches, hand searches, forward-backward snowballing and article recommendations from an expert panel, 115 papers were identified for review. Data extraction and quality assessments were conducted, and 33 articles were excluded due to low quality, leaving 82 papers in the final review. Variation in terminology and service characteristics made the comparison of service models unfeasible. As such, findings were presented according to the following sub-groups: ‘Homeless’, ‘Deinstitutionalisation’ and ‘General Severe Mental Illness (SMI)’.ResultsResults were mixed, reflecting the heterogeneity of the supported accommodation literature, in terms of research quality, experimental design, population, service types and outcomes assessed. There is some evidence that supported accommodation is effective across a range of psychosocial outcomes. The most robust evidence supports the effectiveness of the permanent supported accommodation model for homeless SMI in generating improvements in housing retention and stability, and appropriate use of clinical services over time, and for other forms of supported accommodation for deinstitutionalised populations in reducing hospitalisation rates and improving appropriate service use. The evidence base for general SMI populations is less developed, and requires further research.ConclusionsA lack of high-quality experimental studies, definitional inconsistency and poor reporting continue to stymie our ability to identify effective supported accommodation models and practices. The authors recommend improved reporting standards and the prioritisation of experimental studies that compare outcomes across different service models.

The relationship between frailty and polypharmacy in older people: A systematic review.

Frailty is a complex geriatric syndrome resulting in decreased physiological reserves. Frailty and polypharmacy are common in older adults and the focus of extensive studies, although little is known about the impact they may have on each other. This is the first systematic review analysing the available evidence on the relationship between frailty and polypharmacy in older adults. Systematic review of quantitative studies. A comprehensive literature search for publications in English or Spanish was performed on MEDLINE, CINAHL, the Cochrane Database and PsycINFO in September 2017 without applying restrictions on the date of publication. Studies reporting any relationship between frailty and polypharmacy in older adults were considered. A total of 25 publications were included, all of them observational studies. Evaluation of Fried's frailty criteria was the most common approach, followed by the Edmonton Frail Scale and FRAIL scale. Sixteen of 18 cross-sectional analyses and five of seven longitudinal analyses demonstrated a significant association between an increased number of medications and frailty. The causal relationship is unclear and appears to be bidirectional. Our analysis of published data suggests that polypharmacy could be a major contributor to the development of frailty. A reduction of polypharmacy could be a cautious strategy to prevent and manage frailty. Further research is needed to confirm the possible benefits of reducing polypharmacy in the development, reversion or delay of frailty.

The impact of negative childbirth experience on future reproductive decisions: A quantitative systematic review.

The aim of this study was to systematically retrieve, critique and synthesize available evidence regarding the association between negative childbirth experiences and future reproductive decisions. A child's birth is often a joyous event; however, there is a proportion of women who undergo negative childbirth experiences that have long-term implications on their reproductive decisions. A systematic review of quantitative studies was undertaken using Joanna Briggs Institute's methods. A search was carried out in CINAHL Plus with Full Text, Embase, PsycINFO, PubMed, Scopus and Web of Science from January 1996 - July 2016. Studies that fulfilled the inclusion criteria were assessed by two independent reviewers using the Joanna Briggs Institute's Critical Appraisal Tools. Data were extracted under subheadings adapted from the institute's data extraction forms. Twelve studies, which examined either one or more influences of negative childbirth experiences, were identified. The included studies were either cohort or cross-sectional designs. Five studies observed positive associations between prior negative childbirth experiences and decisions to not have another child, three studies found positive associations between negative childbirth experiences and decisions to delay a subsequent birth and six studies concluded positive associations between negative childbirth experiences and maternal requests for caesarean section in subsequent pregnancies. To receive a holistic understanding on negative childbirth experiences, a suitable definition and validated measuring tools should be used to understand this phenomenon. Future studies or reviews should include a qualitative component and/or the exploration of specific factors such as cultural and regional differences that influence childbirth experiences.

The Social Determinants of Healthcare Access for Rural Elderly Women - A Systematic Review of Quantitative Studies

Objective:This review aimed to explore and analyze the social determinants that impact rural women’s aged 60 years and older healthcare access in low or middle income and high income countries.Methods:Major healthcare databases including MEDLINE and MEDLINE In-Process, PsycINFO, PubMed, ProQuest, Web of Science, CINAHL and ERIC were searched from April 2016 to August 2016 and a manual search was also conducted. A rigorous selection process focusing on the inclusion of rural elderly women in study population and the social determinants of their healthcare access resulted in 38 quantitative articles for inclusion. Data were extracted and summarized from these studies, and grouped into seven categories under upstream and downstream social determinants.Results:Prevailing healthcare systems in combination with personal beliefs and ideas about ageing and healthcare were identified as significant determinants. Socioeconomic and cultural determinants also had a statistically significant negative impact on the access to healthcare services, especially in developing countries.Conclusion:Potentially, improvements to healthcare access can be achieved through consideration of rural elderly women’s overall status including healthcare needs, socioeconomic determinants and cultural issues rather than simply establishing healthcare centers.

Health literacy and patient outcomes in chronic kidney disease: a systematic review.

Limited health literacy affects 25% of people with chronic kidney disease (CKD), and may reduce self-management skills resulting in poorer clinical outcomes. By disproportionately affecting people with low socio-economic status and non-white ethnicity, limited health literacy may promote health inequity. We performed a systematic review of quantitative studies of health literacy and clinical outcomes among adults with CKD. A total of 29 studies (13 articles; 16 conference abstracts) were included. One included non-USA patients. Of the 29 studies, 5 were cohort studies and 24 were cross-sectional. In all, 18 300 patients were studied: 4367 non-dialysis CKD; 13 202 dialysis; 390 transplant; 341 unspecified. Median study size was 127 [interquartile range (IQR) 92-238)], but 480 (IQR 260-2392) for cohort studies. Median proportion of non-white participants was 48% (IQR 17-70%). Six health literacy measures were used. Outcomes included patient attributes, care processes, clinical/laboratory parameters and 'hard' clinical outcomes. Limited health literacy was significantly, independently associated with hospitalizations, emergency department use, missed dialysis sessions, cardiovascular events and mortality (in cohort studies). Study quality was high (1 study), moderate (3 studies) and poor (25 studies), limited by sampling methods, variable adjustment for confounders and reduced methodological detail given in conference abstracts. There is limited robust evidence of the causal effects of health literacy on patient outcomes in CKD. Available evidence suggests associations with adverse clinical events, increased healthcare use and mortality. Prospective studies are required to determine the causal effects of health literacy on outcomes in CKD patients, and examine the relationships between socio-economic status, comorbidity, health literacy and CKD outcomes. Intervention development and evaluation will determine whether health literacy is a modifiable determinant of poor outcomes in CKD.