Monitoring universal precautions: a new assessment tool.

OBJECTIVES: Two pilot studies were conducted to produce efficacy data on an observational tool designed to assess the use of Universal Precautions (UP) in patient care settings. The instrument addresses barrier precautions, hand-washing, handling of sharps, and avoidance of unprotected mouth to mouth resuscitation. DESIGN: The Universal Precautions Assessment Tool was submitted to a panel of 3 experts to establish consensual validity. It was pilot tested by 2 simultaneous observers to establish interrater reliability. SETTING: Pilot Study I was conducted in 3 different units within a 100-bed U.S. Army hospital. Pilot Study II was conducted in the emergency department of a large university-based hospital. PARTICIPANTS: Subjects observed were registered nurses providing acute patient care. RESULTS: Two simultaneous raters calculated UP compliance rates of 76.4% and 78.6%, respectively, for 9 nurses in Pilot Study I, and 62% and 65%, respectively, for 5 nurses in Pilot Study II. The intraclass correlation coefficient for the raters' scores in Pilot Study I was 0.992 with a 95% confidence interval (0.979, 0.997). Consensual validity was established. CONCLUSIONS: The instrument has acceptable interrater reliability under the conditions used. Limitations to use include the possibility of a Hawthorne effect and the fact that assessing proper implementation of UP occasionally relies on a "judgment call" by the observer. With test conditions adjusted to minimize these limitations and with proper consideration of sample size, the tool can be used by researchers and by monitors of hospital quality control to measure UP compliance of caregivers individually or collectively.     

Compliance with universal precautions in correctional health care facilities

There were three main objectives of this cross-sectional study of Maryland State correctional health care workers. The first was to evaluate compliance with work practices designed to minimize exposure to blood and body fluids; the second, to identify correlates of compliance with universal precautions (UPs); and the third was to determine the relationship, if any, between compliance and exposures. Of 216 responding health care workers, 34% reported overall compliance across all 15 items on a compliance scale. Rates for specific items were particularly low for use of certain types of personal protective equipment, such as protective eyewear (53.5%), face mask (47.2%) and protective clothing (33.9%). Compliance rates were highest for glove use (93.2%) waste disposal (89.8%), and sharps disposal (80.8%). Compliance rates were generally not associated with demographic factors, except for age; younger workers were more likely to be compliant with safe work practices than were older workers (P < 0.05). Compliance was positively associated with several work-related variables, including perceived safety climate (i.e., management's commitment to infection control and the overall safety program) and job satisfaction, and was found to be inversely associated with security-related work constraints, job/task factors, adverse working conditions, workplace discrimination, and perceived work stress. Bloodborne exposures were not uncommon; 13.8% of all respondents had at least one bloodborne exposure within the previous 6 months, and compliance was inversely related to blood and body fluid exposures. This study identified several potentially modifiable correlates of compliance, including factors unique to the correctional setting. Infection-control interventional strategies specifically tailored to these health care workers may therefore be most effective in reducing the risk of bloodborne exposures.     

Health literacy: implications for family medicine

As many as 90 million Americans have difficulty understanding and acting on health information. This health literacy epidemic is increasingly recognized as a problem that influences health care quality and cost. Yet many physicians do not recognize the problem or lack the skills and confidence to approach the subject with patients. In this issue of Family Medicine, several articles address health literacy in family medicine. Wallace and Lennon examined the readability of American Academy of Family Physicians patient education materials available via the Internet. They found that three of four handouts were written above the average reading level of American adults. Rosenthal and colleagues surveyed residents and found they lacked the confidence to screen and counsel adults about literacy. They used a Reach Out and Read program with accompanying resident education sessions to provide a practical and effective means for incorporating literacy assessment and counseling into primary care. Chew and colleagues presented an alternative to existing health literacy screening tests by asking three questions to detect inadequate health literacy. Likewise, Shea and colleagues reviewed the prospect of shortening the Rapid Estimate of Adult Literacy in Medicine (REALM), a commonly used health literacy screening tool. Both the Chew and Shea articles highlight the need for improved methods for recognizing literacy problems in the clinical setting. Further research is required to identify effective interventions that will strengthen the skills and coping strategies of both patients and providers and also prevent and limit poor reading and numeracy ability in the next generation.     

Health literacy in Suriname

Background: Low health literacy is an independent predictor of cardiovascular mortality. However, data on health literacy in low- and middle-income countries are scarce. Therefore, we assessed the level of health literacy in Suriname, a middle-income country with a high cardiovascular mortality.

Methods: We estimated health literacy in a convenience sample at an urban outpatient center in the capital and at a semirural health center, using the validated Rapid Estimate of Adult Literacy in Medicine adapted for the Dutch language (REALM-D) instrument. REALM-D scores vary from 0 to 66 (all correct). The primary outcome was the level of health literacy. Furthermore, we assessed the effect of age, sex, ethnicity, disease history, research location, and level of education on health literacy with multivariable linear regression.

Results: We included 99 volunteers (52% men; 51% urban research location) with a mean age of 44.9 years (SD 13.4). The mean REALM-D score was moderate: 48.6 (SD 8.1). Greater health literacy was associated with male sex, an urban research location, and a higher educational level.

Conclusion: Health literacy was moderate in these Surinamese participants. Health care workers should take health literacy into account, and targeted interventions should be developed to improve health literacy in Suriname.     

Health literacy research in Europe: a snapshot

Sirs, Researchers have previously reported that individuals with lowhealth literacy are more likely to have poor health, are lesslikely to understand their health problems and treatment management,and are at higher risk of hospitalization.^1,2     

2008年中国居民健康素养知识和行为调查分析

目的 了解武汉市居民基本医疗素养水平及影响因素,有针对性为武汉市居民基本医疗素养的干预策略提供理论依据。 方法 采用多阶段分层整群抽样方法,于2016年10 — 12月对全市13个行政区4 165名15～65岁城乡非集体居住的常住居民进行问卷调查。 结果 武汉市居民基本医疗素养水平为12.75%,城市居民基本医疗素养水平高于农村（P < 0.05）;年龄越大,基本医疗素养水平越低（P < 0.05）,15～24岁组居民基本医疗素养得分最高,为（7.80 ± 3.25）分,65～69岁组居民得分最低,为（6.10 ± 2.89）分;随着文化水平的提升,基本医疗素养水平逐步提高（P < 0.05）,硕士及以上人群得分最高,为（8.96 ± 2.94）分;不同职业人群基本医疗素养水平差异有统计学意义（P < 0.05）,医务人员得分最高,为（9.68 ± 2.82）分;家庭月收入 ≥ 5 000元的人群基本医疗素养水平最高,为（7.36 ± 3.02）分,高于其他收入水平人群（P < 0.05）;不同性别、民族人群间基本医疗素养水平差异无统计学意义（P > 0.05）。 结论 武汉市居民基本医疗素养水平较低,应针对不同城乡、年龄、文化程度、家庭收入、职业等社会特征的人群,加强开展居民科学就医和合理用药能力方面的宣传教育工作,整体提高武汉市居民基本医疗素养水平。     

Health literacy: communication for the public good

This article builds upon a presentation at the Fifth Global Health Conference on Health Promotion (Mexico City, 9 June 2000), seeking to advance the development of health literacy through effective communication. First, it offers a timely reflection for health promotion epistemology in particular, and the potential approach to framing health promotion activities in general, with health literacy as a bridging concept. The concept of health literacy is briefly explained and defined, followed by identification of some promising communication interventions to diffuse health literacy. Four predominant areas within the communication field are described that shed light on approaches for developing health literacy: integrated marketing communication, education, negotiation and social capital. Each component can contribute to strategic science-based communication. Finally, the article elucidates that communication and developing health literacy are not simple solutions. Communication is not simply message repetition, but includes the development of an environment for community involvement to espouse common values of humankind. With effective communication, worldwide health literacy can become a reality in the 21st century, embodying health as a central tenet of human life.     

Health literacy measurement: a proposed research agenda

Although the field of health literacy is experiencing tremendous growth in terms of producing peer-reviewed journal articles and attracting practitioners, the foundation of that growth is potentially unstable. Despite a steady increase in their number, existing measures and screeners of health literacy are not based on an accepted conceptual framework and fail to align with the growing body of theoretical and applied work. Existing measures are mainly focused on assessing what individuals can read and understand in clinical contexts. This leaves important factors untested, such as how individuals use information, and how health professionals and systems communicate with patients. This article outlines key elements of a proposed research agenda focusing on development of a new, comprehensive approach to measuring health literacy.