Browsing by Subject "Health literacy"
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Item 4382 All IN for Health: Promoting good health and engaging a health research volunteer community in the Hoosier state(Cambridge University Press, 2020-07-29) Hall, Jessica; Drury, Christine; Egan, Carmel; Indiana Clinical and Translational Sciences InstituteOBJECTIVES/GOALS: To improve and expand health and research literacy throughout Indiana by sharing health-focused resources and research outcomes. To encourage and increase health research participation throughout Indiana by promoting health research opportunities, including clinical studies. METHODS/STUDY POPULATION: Discover and understand community concerns and barriers to good health and clinical research participation by providing a platform for individuals and communities to share their voices. Educate Indiana residents on the importance of participating in health research. Engage with the community to meet them where they are (online) and continue to build relationships throughout the state. Promote healthy living for Indiana residents by sharing health education and resources from existing state health organizations and initiatives. Develop and maintain the largest statewide database of research volunteers. RESULTS/ANTICIPATED RESULTS: The anticipated results from this program include engagement of all populations and all communities throughout the state in conversation and education around good health and health research, as well as participation in health research across the CTSI’s partner organizations. Large-scale growth is expected in both the online community and consented volunteer registry is expected to include and engage racially and ethnically diverse populations, as well as special health populations, such as representatives of rural communities, aged, rare disease survivors, and transgender individuals. DISCUSSION/SIGNIFICANCE OF IMPACT: Thorough this work, the Indiana CTSI has developed a unique program, educating the public about health research and opportunities to participate, while simultaneously supporting research departments with marketing promotion of their efforts, and a ready statewide volunteer community.Item African American patients' intent to screen for colorectal cancer: Do cultural factors, health literacy, knowledge, age and gender matter?(Johns Hopkins University Press, 2016-02) Brittain, Kelly; Christy, Shannon M.; Rawl, Susan M.; Department of Psychology, School of ScienceAfrican Americans have higher colorectal cancer (CRC) mortality rates. Research suggests that CRC screening interventions targeting African Americans be based upon cultural dimensions. Secondary analysis of data from African-Americans who were not up-to-date with CRC screening (n=817) was conducted to examine: 1) relationships among cultural factors (i.e., provider trust, cancer fatalism, health temporal orientation (HTO)), health literacy, and CRC knowledge; 2) age and gender differences; and 3) relationships among the variables and CRC screening intention. Provider trust, fatalism, HTO, health literacy and CRC knowledge had significant relationships among study variables. The FOBT intention model explained 43% of the variance with age and gender being significant predictors. The colonoscopy intention model explained 41% of the variance with gender being a significant predictor. Results suggest that when developing CRC interventions for African Americans, addressing cultural factors remain important, but particular attention should be given to the age and gender of the patient.Item The association between cancer care coordination and quality of life is stronger for breast cancer patients with lower health literacy: A Greater Plains Collaborative study(Springer, 2020) McDowell, Bradley D.; Klepm, Jennifer; Blaes, Anne; Cohee, Andrea A.; Trentham-Dietz, Amy; Kamaraju, Sailaja; Otte, Julie L.; Mott, Sarah L.; Chrischilles, Elizabeth A.Purpose Health literacy (HL) and cancer care coordination (CCC) were examined for their relationship to quality of life (QOL) among breast cancer survivors. CCC was hypothesized to have a stronger relationship to QOL for women with lower HL. Methods Women (N = 1138) who had completed treatment for Stage 0–III, ductal carcinoma breast cancer between January 2013 and May 2014 at one of eight large medical centers responded to a mailed questionnaire. Responses to questions about survivorship care planning and presence of professional care coordinator were combined to form an index of CCC. An index of HL was also derived. QOL was measured using the Functional Assessment of Cancer Therapy-Breast (FACT-B) scales. Results 74.3% (N = 845) of patients reported having a health professional coordinate their care during treatment and 78.8% (N = 897) reported receiving survivorship care planning. CCC was classified as none, partial, or high for 7.1%, 32.7%, and 60.2% of the patients, respectively. Except for emotional well-being, the interaction between HL and CCC was significant for all QOL domains (p < .05); the effect of CCC on FACT-B scores was largest for people with lower HL. For the 39.8% of patients with less than high CCC, 111 (27.3%) had a level of HL associated with clinically meaningful lower QOL. Conclusions The association between CCC and later QOL is strongest for people who have lower HL. Prioritizing care coordination for patients with lower health literacy may be an effective strategy in a setting of limited resources.Item Association of Health Literacy Among Nulliparous Individuals and Maternal and Neonatal Outcomes(American Medical Association, 2021-09-01) Yee, Lynn M.; Silver, Robert; Haas, David M.; Parry, Samuel; Mercer, Brian M.; Wing, Deborah A.; Reddy, Uma; Saade, George R.; Simhan, Hyagriv; Grobman, William A.; Obstetrics and Gynecology, School of MedicineImportance: Health literacy is considered an important social determinant of health that may underlie many health disparities, but it is unclear whether inadequate health literacy among pregnant individuals is associated with adverse maternal and neonatal outcomes. Objective: To assess the association between maternal health literacy and maternal and neonatal outcomes among nulliparous individuals. Design, setting, and participants: This was a secondary analysis of a large, multicenter cohort study of 10 038 nulliparous individuals in the US (2010-2013). Participants underwent 3 antenatal study visits and had detailed maternal and neonatal data abstracted. Data analysis was performed from July to December 2019. Exposures: Between 16 and 21 weeks of gestation, health literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine-Short Form, a validated 7-item word recognition test. In accordance with standard scoring, results were dichotomized as inadequate vs adequate health literacy. Main outcomes and measures: On the basis of theoretical causal pathways between health literacy and health outcomes, a priori maternal and neonatal outcomes (determined via medical records) were selected for this analysis. Multivariable Poisson regression models were constructed to estimate the associations between health literacy and outcomes. Sensitivity analyses in which education was removed from models and that excluded individuals who spoke English as a second language were performed. Results: Of 9341 participants who completed the Rapid Estimate of Adult Literacy in Medicine-Short Form, the mean (SD) age was 27.0 (5.6) years, and 2540 (27.4%) had publicly funded prenatal care. Overall, 1638 participants (17.5%) had scores indicative of inadequate health literacy. Participants with inadequate health literacy were more likely to be younger (mean [SD] age, 22.9 [5.0] vs 27.9 [5.3] years), have less educational attainment (some college education or greater, 1149 participants [73.9%] vs 5279 participants [94.5%]), have publicly funded insurance (1008 participants [62.2%] vs 1532 participants [20.0%]), and report they were a member of an underrepresented racial or ethnic group (non-Hispanic Black, 506 participants [30.9%] vs 780 participants [10.1%]; Hispanic, 516 participants [31.5%] vs 948 participants [12.3%]) compared with those with adequate health literacy. Participants who had inadequate health literacy had greater risk of cesarean delivery (adjusted risk ratio [aRR], 1.11; 95% CI, 1.01-1.23) and major perineal laceration (aRR, 1.44; 95% CI, 1.03-2.01). The adjusted risks of small-for-gestational-age status (aRR, 1.34; 95% CI, 1.14-1.58), low birth weight (aRR, 1.33; 95% CI, 1.07-1.65), and 5-minute Apgar score less than 4 (aRR, 2.78; 95% CI, 1.16-6.65) were greater for neonates born to participants with inadequate health literacy. Sensitivity analyses confirmed these findings. Conclusions and relevance: These findings suggest that inadequate maternal health literacy is associated with a variety of adverse maternal and neonatal outcomes.Item Associations of Health and Financial Literacy with Mortality in Advanced Age(SpringerLink, 2020-05) Stewart, Christopher C.; Yu, Lei; Lamar, Melissa; Wilson, Robert S.; Bennett, David A.; Neurology, School of MedicineBackground: Health and financial literacy are central to older adults' well-being and financial standing, but the relation of literacy with mortality in advanced age remains unclear. Aims: To determine whether lower literacy, as reflected in measures of total literacy and subscales of health and financial literacy, was associated with an increased risk of mortality. Methods: Participants were 931 community-based older adults from the Rush Memory and Aging Project [age: mean (SD) = 80.9 (7.6), range 58.8-100.8], an ongoing, prospective observational cohort study of aging. Participants were without dementia at the time literacy was assessed. Proportional hazards models were used to determine whether literacy measures were associated with mortality. Results: During up to 8 years of follow-up, 224 (24.1% of 931) participants died. In models that adjusted for age, sex, and education, lower total, health, and financial literacy were each associated with an increased risk of mortality (total literacy: HR = 1.020, 95% CI 1.010-1.031, p < 0.001; health literacy: HR = 1.015, 95% CI 1.008-1.023, p < 0.001; financial literacy: HR = 1.013, 95% CI 1.003-1.023, p = 0.014). These associations persisted after additionally adjusting for income and indices of health status; however, only the association of lower health literacy with mortality persisted after further adjusting for a robust measure of global cognition. Discussion: We suspect that the current associations of lower literacy with mortality reflect the detrimental effect of early pathologic brain aging on literacy. Conclusions: Lower literacy, particularly lower health literacy, is associated with mortality in advanced age.Item Designing for Health Literacy(2018) Gottschild, Kimberly; Wada, Terri; Richards, Bryan; Stump, EmilyHealth literacy is recognized worldwide as a key to obtaining and maintaining personal health. A health literate individual who has the access to resources that they can both understand and navigate can make empowered, personal health decisions both on their own and with their health care provider, and the benefits thereof are many. For example, health literacy has been shown to prevent disease, lead to early detection of disease, and lead to improved adherence to chronic disease treatment. Yet, only a fraction of the population is considered health literate. Women and immigrants in particular need health provider supported health literacy development strategies that focus on empathy and emotional support to help motivate them to make health decisions for a preferred health outcome. Health literacy is dependent upon the communication of health information. Various communication strategies exist to support the delivery of health information and ecological models have also been developed to support heath information delivery more effectively through multiple sources. Regarding the type of health information communicated, research has suggested that patients prefer information on actionable solutions rather than facts about the condition itself. Solution-focused, strengths-based, and participatory design strategies have also been shown to be effective in increasing health literacy skills. Participatory, generative design research tools engage participants to elicit deeper emotions regarding their current state and preferred future state and could be useful in supporting health literacy development. How might generative tools support women's and immigrants' health literacy development within an ecological health literacy model? Research was conducted to explore how participatory, generative design research tools could be an effective approach to help female and immigrant patients realize their health potential by empowering them with health literacy skills through accessible and engaging health information aligned with their personal strengths and identified solutions. Generative tools, such as interviews, worksheets, and journey mapping, that could potentially help women and immigrants express both their current and ideal future state, were explored. Generative tools were iterated to allow patients to align their personal strengths, solutions, and health information with their ideal future state in order to create a roadmap tool that could support health literacy development and assist them in realizing their potential in health situations. The resulting literature review-based generative health literacy toolkit was tested at the Indiana University School of Medicine Student Outreach Clinic. Nursing students, who serve the role of patient navigators, engaged their patients with the toolkit activities. Surveys to measure patient confidence in realizing their health potential were also conducted before and after intervention. Findings included a health literacy ecosystem that comprises at least two levels for health information communication, actionable health information patients can utilize to improve their health condition, and patient generated strategies for treatment plan and lifestyle change adherence in everyday life outlined in a journey map form that can be taken home for reference and motivation. Outcomes of toolkit use in the clinic included improved communication between providers and patients, as well as patient empowerment to move forward with improved health behaviors.Item Focused Education Increases Hepatocellular Cancer Screening in Patients with Cirrhosis Regardless of Functional Health Literacy(Springer Nature, 2021) Shaw, Jawaid; Patidar, Kavish R.; Reuter, Bradley; Hajezifar, Navid; Dharel, Narayan; Wade, James B.; Bajaj, Jasmohan S.; Medicine, School of MedicineBackground: Health education interventions are successful in modifying lifestyle. Functional health literacy (FHL) can determine patient adherence to clinic visits and procedures and may adversely impact the success of these interventions. Aims: We sought to evaluate the hypothesis that a health education intervention would improve compliance with hepatocellular cancer (HCC) screening and that poor FHL would reduce such compliance. Methods: We assessed FHL using a short version test of functional health literacy in adults (STOFHLA). Cirrhotic patients free of HCC were prospectively enrolled from clinics and provided an educational intervention consisting of focused physician-led discussion regarding cirrhosis and HCC, along with written material on these topics for the subject to review at home. Patients were subsequently followed for 6 months (prospective time period), and the same cohort's clinic/HCC screening behavior between 6 and 12 months prior to the educational intervention (retrospective time period) was compared. Results: In total, 104 cirrhotic patients (age 60.01 ± 8.58 years, 80% men, MELD 12.70 ± 5.76) were included. Of these, 89 (85.57%) of patients had educational level 12th grade and higher. There were 76% (n = 79) with adequate, while 24% (n = 25) had inadequate/marginal FHL on S-TOHFLA. The number of HCC-related imaging increased from 59 (56.7%) to 86 (82.6%, p < 0.0001) post-education in the prospective compared to prior time period which was similar regardless of FHL. Conclusions: While the educational intervention was successful in improving compliance with HCC screenings, FHL status did not impact the power of this intervention. Hence, the combination of specific verbal information, along with targeted written material, improved compliance with clinic visits and liver imaging for HCC.Item Health Literacy among Medically Underserved: The Role of Demographic Factors, Social Influence, and Religious Beliefs(Taylor & Francis, 2017-11) Christy, Shannon M.; Gwede, Clement K.; Sutton, Steven K.; Chavarria, Enmanuel; Davis, Stacy N.; Abdulla, Rania; Ravindra, Chitra; Schultz, Ida; Roetzheim, Richard; Meade, Cathy D.; Psychology, School of ScienceThe current study examined the sociodemographic and psychosocial variables that predicted being at risk for low health literacy among a population of racially and ethnically diverse patients accessing primary care services at community-based clinics. Participants (N = 416) were aged 50-75 years, currently not up-to-date with colorectal cancer (CRC) screening, at average CRC risk, and enrolled in a randomized controlled trial (RCT) aimed at promoting CRC screening. Participants completed a baseline interview that assessed health literacy as measured by Rapid Estimate of Adult Literacy in Medicine-Revised, sociodemographic factors, and psychosocial variables (e.g., health beliefs) prior to randomization and receipt of an intervention. Thirty-six percent of the participants were found to be at risk for low health literacy. Sociodemographic and psychosocial variables were assessed as predictors of being at risk for low health literacy using logistic regression. In the final model, predictors were male gender, being from a racial/ethnic minority group, being unable to work, having higher social influence scores, and having higher religious belief scores. These findings suggest several patient characteristics that may be associated with low health literacy, and highlight the importance of supporting all patients through simplified and clear communications and information to improve understanding of CRC screening information.Item Kidney Nutrition in the Era of Social Media: Bridging the Gap of Nutrition Education and Kidney Health Literacy by Leveraging Resources of Social Networking(Elsevier, 2022) Biruete, Annabel; Kistler, Brandon M.; Kalantar-Zadeh, Kamyar; Moore, Linda W.; Medicine, School of MedicineItem Orthodontic and oral health literacy in adults(Public Library of Science, 2022-08-18) McCarlie, V. Wallace, Jr.; Phillips, Morgan E.; Price, Barry D.; Taylor, Peyton B.; Eckert, George J.; Stewart, Kelton T.; Orthodontics and Oral Facial Genetics, School of DentistryObjective: The primary aim of the study was to determine levels of literacy in both oral health and orthodontics in an adult population. The secondary study aim was to investigate differences in literacy between males and females. Methods: Participants included individuals 18 years or older seeking dental treatment at the East Carolina University (ECU) School of Dental Medicine. To determine levels of oral health literacy (OHL) and orthodontic literacy (OrthoL), validated instruments were administered, including the Rapid Estimate of Adult Literacy in Medicine and Dentistry, the Oral Health Literacy Instrument and its separate scales, and a questionnaire on orthodontic literacy. Summary statistics were computed, and statistical significance was set at 0.05. Results: One hundred seventy-two individuals participated in the study and had a mean age of 55.03 (range:18-88). Greater than 70% of the sampled population exhibited inadequate or marginal oral health knowledge. Additionally, greater than 70% of the sample possessed no more than an 8th grade reading level, with regard to basic medical and dental terms. Higher education was weakly associated with higher OrthoL and OHL. Higher age was also weakly associated with lower OrthoL and OHL. Males on average exhibited significantly higher OHL (p < .05) but there were no OrthoL differences between males and females. Dental visit frequency was not associated with OrthoL or OHL. Conclusion: Low levels of OrthoL and OHL were observed in the study. While males demonstrated a higher level of OHL than females, neither age nor the occurrence of dental appointments significantly influenced levels of literacy.