Time to sign: The relationship between health literacy and signature time

Objective

To evaluate the relationship between amount of time taken to sign one's name and health literacy.

Methods

A prospective, one time assessment was conducted on a convenience sample of 98 patients recruited in an inner-city outpatient internal medicine clinic. The amount of time required to sign (i.e. initiation to completion of writing) was measured by stopwatch. Health literacy was measured with the REALM.

Results

The sample averaged 54.1 (SD 16.2) years of age. Twenty-seven percent had less than high school education and 33% had a terminal general equivalency diploma or high school degree. The time required to sign ranged from 0.91 to 21.3 s. Sixty-two percent of the sample had health literacy challenges. Signature time was longest for those with inadequate health literacy (mean 10.0 s), compared with marginal (7.3 s) and adequate (4.7 s, p ≤ 0.001). Signature time remained significant in a logistic regression model after controlling for education and age (AOR = 0.785, CI = 0.661–0.932).

Conclusion

Individuals with signatures completed in six seconds or less were highly likely to display adequate health literacy.

Practice implications

Signature time may offer a practical and quick approach to health literacy screening in the health care setting.     

The relationship between health literacy and perceived shared decision making in patients with breast cancer

Objectives

We explored the relationship between patient-perceived shared decision making (SDM) and three domains of health literacy (HL) in patients with breast cancer.

Quality of life,health status,and health service utilization related to a new measure of health literacy: FLIGHT/VIDAS

Objective

Researchers have identified significant limitations in some currently used measures of health literacy. The purpose of this paper is to present data on the relation of health-related quality of life, health status, and health service utilization to performance on a new measure of health literacy in a nonpatient population.

Methods

The new measure was administered to 475 English- and Spanish-speaking community-dwelling volunteers along with existing measures of health literacy and assessments of health-related quality of life, health status, and healthcare service utilization. Relations among measures were assessed via correlations and health status and utilization was tested across levels of health literacy using ANCOVA models.

Results

The new health literacy measure is significantly related to existing measures of health literacy as well as to participants’ health-related quality of life. Persons with lower levels of health literacy reported more health conditions, more frequent physical symptoms, and greater healthcare service utilization.

Conclusion

The new measure of health literacy is valid and shows relations to measures of conceptually related constructs such as quality of life and health behaviors.

Practice implications

FLIGHT/VIDAS may be useful to researchers and clinicians interested in a computer administered and scored measure of health literacy.     

Effect of cognitive dysfunction on the relationship between age and health literacy

Objective

Age is generally an inverse predictor of health literacy. However, the role of cognitive dysfunction among older adults in this relationship is not understood.

Methods

We conducted a cross-sectional survey of 446 adult patients in a large urban academic level one trauma center, assessing health literacy and cognitive dysfunction.

Results

Removing older patients (60 years of age and older) who screened positive for cognitive dysfunction attenuated the relationship between age and health literacy (r = −0.16, p = 0.001 vs. r = −0.35, p < 0.0001). Older patients screening positive for cognitive dysfunction had significantly lower health literacy than older patients screening negative and patients less than 60 years; health literacy scores did not generally differ significantly between the latter groups.

Conclusion

Much of the relationship between age and health literacy was driven by cognitive dysfunction among a subset of older adults.

Practice implications

Our findings suggest that older patients with cognitive dysfunction have the greatest need for health literacy interventions.     

Preferences for a polygenic test to estimate cancer risk in a general Australian population

PurposeThere is significant interest in the use of polygenic risk score (PRS) tests to improve cancer risk assessment and stratified prevention. Our current understanding of preferences regarding different aspects of this novel testing approach is limited. This study examined which attributes of a PRS test most influence the likelihood of testing.MethodsA discrete choice experiment was developed to elicit preferences for different aspects of a PRS test by surveying an online sample of the Australian population. Preferences were assessed using mixed logistic regression, latent class analysis, and marginal willingness to pay.ResultsThe 1002 surveyed respondents were more likely to choose a PRS test that was more accurate, tested for multiple cancer types, and enabled cancer risk reduction through lifestyle modification, screening, or medication. There was also a preference for testing through a primary care physician rather than online or through a genetic specialist. A test that did not impact life insurance eligibility or premiums was preferred over the one that did.ConclusionThis study found that the Australian population prefer a PRS test that is highly accurate, tests for multiple cancers, has noninvasive risk reduction measures, and is performed through primary care.     

Analysis of the relationship among health awareness and health literacy,patient satisfaction levels with primary care in patients admitting to primary care health centers

Objective

The aim of the study was to examine the relationships between health literacy, primary care satisfaction levels and health awareness of the patients who were admitted to primary care centers (Family Health Centers).

Communicative and critical health literacy,and self-management behaviors in end-stage renal disease patients with diabetes on hemodialysis

Objective

Health Literacy (HL) has been linked to disease self-management and various health outcomes, and can be separated into components of functional, communicative and critical skills. The high comorbidity between diabetes and end-stage renal disease (ESRD) poses concerns for compromised disease self-management. This study aimed to identify the relationships between HL and self-management behaviors in end-stage renal disease patients with diabetes.

Methods

Self-report questionnaires measuring HL and self-management with the Functional, Communicative and Critical HL scale and Summary of Diabetes Self-Care Activities, respectively, were implemented with a sample of 63 patients. Socio-demographic and clinical characteristics were obtained from medical records.

Results

Self-management in diabetes was associated with communicative and critical HL, but not functional HL. Educational attainment was associated only with functional HL. No relationship between HL and glycated hemoglobin (Hb_A1c) was identified.

Conclusion

Communicative and critical HL skills are associated with self-management in ESRD patients with diabetes. Education levels are not related to self-management.

Practice implications

Healthcare professionals and health information aiming to improve self-management in ESRD patients with diabetes should consider their capacities of communicative and critical HL instead of solely assessing functional HL.     

Cross-cultural adaptation and validation of the health literacy assessment tool METER in the Portuguese adult population

Objective

We aimed to culturally adapt and validate METER in the Portuguese population, and to define cut-off values for adequate health literacy.

Methods

We used the standard procedure for the adaptation of the words and surveyed health professionals to select the non-words. The instrument was administered to a total sample of 249 participants and retested in a sub-sample of 45 after three months. Cut-offs were defined using the modified Angoff procedure. Construct validity was assessed through association with educational attainment and health-related occupation.

Results

Exploratory factor analysis revealed two dimensions of the instrument, one for words and another for non-words. METER showed a high degree of internal consistency, and acceptable test–retest reliability. Adequate health literacy was defined as scoring at least 35/40 in words and 18/30 in non-words. Physicians scored higher than any other group, followed by health researchers, researchers from other areas and by people with progressively lower levels of education (p < 0.001).

Conclusion

We culturally adapted a brief and simple instrument for health literacy assessment, and showed it was valid and reliable.

Practice implications

The Portuguese version of METER can be used to assess health literacy in Portuguese adults and to explore associations with health outcomes.     

Analyzing paths from online health information seeking to colorectal cancer screening using health literacy skills frame and cognitive mediation model

Objective

To test the hypothesized paths for Online Health Information Seeking (OHIS) behaviors in developing health literacy, leading to colorectal cancer (CRC) screening among Korean Americans (KAs) using Health Literacy Skills Frameworks (HLSF) and Cognitive Mediation Model (CMM).

A structural equation model of relationships of health literacy,illness and medication beliefs with medication adherence among patients with chronic obstructive pulmonary disease

ObjectiveTo determine the relative contributions of health literacy (HL) and illness and medication beliefs to medication adherence among older COPD patients and determine the pathways through which they operate.MethodsThe study was conducted using data from a prospective cohort of COPD patients in New York City and Chicago. We used structural equation modeling to examine the pathways linking HL, through medications and illness beliefs, with COPD medication adherence.ResultsOut of 393 older adults with COPD, 123 (31%) had limited HL and 208 (53%) reported low adherence to daily COPD medications. Those with limited HL were more likely to have low medication adherence (p < 0.0001). Medications concerns (p = 0.001) and medication necessity (p = 0.003) demonstrated a mediational role between HL and adherence. However, in the final multivariate model, HL did not have direct effect on medication adherence (p = 0.12) and illness beliefs (p = 0.16) did not demonstrate a mediational role between HL and adherence.ConclusionOur findings suggest that low HL is not a direct predictor of poor medication adherence among COPD patients.Practice implicationsAddressing medication concerns and reinforcing the need for daily COPD medications may be a more effective strategy for increasing adherence in this population.     

A mismatch between population health literacy and the complexity of health information: an observational study

Background

Low health literacy is associated with poorer health and higher mortality. Complex health materials are a barrier to health.

Aim

To assess the literacy and numeracy skills required to understand and use commonly used English health information materials, and to describe population skills in relation to these.

Design and setting

An English observational study comparing health materials with national working-age population skills.

Method

Health materials were sampled using a health literacy framework. Competency thresholds to understand and use the materials were identified. The proportion of the population above and below these thresholds, and the sociodemographic variables associated with a greater risk of being below the thresholds, were described.

Results

Sixty-four health materials were sampled. Two competency thresholds were identified: text (literacy) only, and text + numeracy; 2515/5795 participants (43%) were below the text-only threshold, while 2905/4767 (61%) were below the text + numeracy threshold. Univariable analyses of social determinants of health showed that those groups more at risk of socioeconomic deprivation had higher odds of being below the health literacy competency threshold than those at lower risk of deprivation. Multivariable analysis resulted in some variables becoming non-significant or reduced in effect.

Conclusion

Levels of low health literacy mirror those found in other industrialised countries, with a mismatch between the complexity of health materials and the skills of the English adult working-age population. Those most in need of health information have the least access to it. Efficacious strategies are building population skills, improving health professionals’ communication, and improving written health information.     

Measurement properties and comparative performance of health literacy screening questions in a predominantly low income African American population with diabetes

Objective

To examine the measurement properties of the 16 screening questions (16-SQ) of inadequate health literacy (HL) and their briefer version (3-SQ), and identify the best screen for inadequate HL in non-white populations.

Methods

Sample included 378 individuals with type-2 diabetes. We computed sensitivity, specificity, positive and negative likelihood ratios, and C-indices, using the s-TOFHLA as a reference measure. We also conducted exploratory factor analysis, and used structural equation modeling (SEM) for confirmatory purposes.

Results

Mean age was 56.1 years, 69% were female, and 83% were African–American. 10% had limited HL (s-TOHFLA scores <23). Six questions (6-SQ) were identified and included in the final item-reduced factor analysis, which showed good fit in confirmatory SEM (chi-square = 9.5; P = 0.305; RMSEA = 0.023). Weighted summative score of the 6-SQ and the item “difficulty understanding written information” performed better than the 3-SQ in identifying patients with inadequate HL (C-indices 0.67 versus 0.75).

Conclusion

The weighted summative score of the 6-SQ and the item “difficulty understanding written information” performed better than the other items or combinations of these items in identifying individuals with inadequate HL.

Practice implications

The proposed weighting of scores could be applied in studies using these screening questions for better classification of inadequate HL.     

Effects of health literacy skills,educational attainment,and level of melanoma risk on responses to personalized genomic testing

ObjectiveFew studies have examined how health literacy impacts responses to genetic information.MethodsWe examined this issue among 145 English or Spanish-speaking adult primary care patients enrolled in a trial that offered testing for MC1R gene variants that confer moderately increased melanoma risk. We investigated whether health literacy skills, educational attainment, or melanoma risk were related to short-term cognitive and affective responses to genetic test results.ResultsOn average, participants found the test results to be highly believable and clear, with low levels of negative emotional responses and moderate levels of positive responses. In adjusted models, health literacy skills were significantly inversely associated with confusion (OR = 0.75, 95 % CI = 0.58, 0.96); those with higher education thought significantly less about their test results (β = ?0.66), were less hopeful (β = ?0.89), and had lower distress (β = ?1.15). We also observed a significant interaction (p < .001) between health literacy and melanoma risk in affecting the frequency of thoughts about test results.ConclusionThe findings indicate that health literacy skills may affect to what extent individuals elaborate cognitively on genetic information.Practice implicationsPatients with lower health literacy skills or education may need support in understanding genetic test results.     

北京市怀柔区居民传染病健康素养水平调查

目的 了解北京市怀柔区居民传染病相关知识知晓率和技能性健康素养水平.方法 采用多阶段随机抽样方法对怀柔区1250名18岁以上居民进行抽样和现场问卷调查,应用趋势,检验比较不同组间传染病知识和技能掌握情况的差异.结果 “预防麻疹最有效的措施是接种疫苗”的知晓率最高(82.48％),而“发热体温标准”、“甲肝主要传播途径”、“乙肝感染途径”、“艾滋病感染途径”知识的知晓率均低于40％.“正确使用温度计”、“看懂药品说明书”、“看懂宣传折页”、“看懂化验单”、“获取传染病知识”的技能掌握率分别是69.91％、56.00％、53.28％、41.19％和38.56％.随年龄降低和文化程度增高,居民对大部分传染病知识知晓和健康技能的掌握率上升(P＜0.05).结论 怀柔区部分居民已掌握了部分传染病相关知识和技能,然而整体健康素养水平仍有待进一步提高.老年人与文化程度低的人群为健康教育的重点人群.     

Online cancer communication: meeting the literacy, cultural and linguistic needs of diverse audiences

OBJECTIVE: This article provides an analysis of issues and empirical evidence related to literacy, cultural, and linguistic factors in online health and cancer communication, and recommendations to improve cancer communication for diverse audiences. METHODS: We examined English-language online literature and selected books and policy documents related to literacy, cultural, and linguistic factors in health and cancer communication. RESULTS: Studies about literacy, cultural, and linguistic factors in online cancer communication for diverse audiences are limited, but have increased during the past 15 years. Empirical evidence and theoretical guidance describe the critical importance of these factors, significant unmet needs among low-literate, multicultural and non-English-speaking populations, and strategies to improve communication. CONCLUSION: Overall, online cancer communication has not met the literacy, cultural, and linguistic needs of diverse populations. The literature offers valuable recommendations about enhancing research, practice, and policy for better cancer communication. PRACTICE IMPLICATIONS: Practitioners should understand the strengths and weaknesses of online cancer communication for vulnerable groups, guide patients to better Websites, and supplement that information with oral and tailored communication.     

Perception of risk, anxiety, and health behaviors in women at high risk for breast cancer

Perception of risk, anxiety, psychological distress, and early detection behavior were investigated in 23 women with a family history of breast cancer who attended genetic counseling and 21 women without a family history of breast cancer. In addition to a breast cancer-specific questionnaire, the Symptom Checklist 90-Revised and the State-Trait Anxiety Inventory were used. Thirty-nine percent of the women with a family history of breast cancer correctly identified and 48% overestimated their own lifetime risk. Risk perception was independent of genetic counseling. Levels of general psychological morbidity were similar between women with a family history of breast cancer and controls. For controls, early detection behavior was related to lifetime risk estimate and was, in general, independent of level of anxiety. Despite genetic counseling, many women continued to perceive their own lifetime risk of breast cancer inaccurately. They might benefit from additional counseling on risk assessment.     

Obesity Status on associations between cancer-related beliefs and health behaviors in cancer survivors: Implications for patient-clinician communication

ObjectiveAssociations between cancer beliefs and health behavior engagement are largely unexplored in cancer survivors, particularly among those with overweight and obesity. We investigated belief-behavior associations for cancer survivors, and whether obesity altered these associations.MethodsCancer survivors were identified from the National Cancer Institute HINTS Survey 5 data and classified as having had an obesity-related cancer or not. Linear and multiple logistic regression analyses examined whether cancer risk beliefs and self-efficacy predicted dining out behaviors and physical activity (PA). Restricted analyses were conducted in those with overweight or obesity.ResultsLow self-efficacy to take care of one’s health was associated with longer sitting time in the overall sample (p = 0.04). In cancer survivors with overweight or obesity, engagement in healthier behaviors was associated with 1) feeling less overwhelmed by cancer risk recommendations and 2) believing that PA or obesity influences cancer development (both p < 0.05). Among those with overweight and obesity, associations between cancer beliefs and health behaviors were not significantly different by cancer type (obesity-related vs. not).ConclusionsObesity altered associations between cancer risk beliefs and health behavior engagement from the overall sample.Practice ImplicationsWeight status may be a useful tailoring factor when delivering health-promoting interventions for cancer survivors.     

The association study between CYP24A1 gene polymorphisms and risk of liver,lung and gastric cancer in a Chinese population

Recently, four single nucleotide polymorphisms (rs2585428, rs4809960, rs6022999 and rs6068816) in CYP24A1 gene were extensively studied for their associations with cancer risk. However, these studies included only a few types of cancer, which calls for further investigations. In view of this, we here conducted a case-control study to explore the associations between these four CYP24A1 gene polymorphisms and risk of liver, lung and gastric cancer in a Chinese population. A total of 480 liver cancer patients, 550 lung cancer patients, 460 gastric cancer patients and 800 normal controls were recruited in this study. The genotyping of CYP24A1 gene polymorphisms was applied with Sanger sequencing assay. Single-locus analysis demonstrated that rs6022999 was significantly associated with risk of liver and lung cancer, while rs6068816 was significantly associated with the risk of gastric cancer. Haplotype analysis revealed that haplotype GTAT was associated with an increased risk of liver cancer and a decreased risk of lung cancer, and haplotype ATGC was associated with a decreased risk of lung cancer. The further meta-analysis of rs6068816 and lung cancer risk showed that rs6068816 was not associated with lung cancer risk in Chinese population, which confirmed our present finding. Conclusively, rs6022999 may be a genetic biomarker for liver and lung cancer susceptibility in Chinese population, and rs6068816 may be used to predict gastric cancer risk in Chinese population.     

The association between lifestyle-related risk factors and survival in patients with colorectal cancer in an urban South African cohort

BackgroundLifestyle-related factors have been linked with risk for colorectal cancer. Data describing the relationship between lifestyle factors of South African patients who present with colorectal cancer and their survival is sparse.ObjectivesThe objectives were to describe the profile of patients with colorectal cancer; to determine the association between lifestyle-related factors and survival, and to compare results of patients in the private and public sectors.MethodsA retrospective review and secondary analysis of information of patients with colorectal cancer were conducted. The independent samples t-test and Mann Whitney U test were administered to determine differences in the clinical presentation. Pearson''s Chi-Squared and Eta (η) tests were used to determine the association between survival and lifestyle-related factors.ResultsData of 441 patients were included. When compared to the public sector cohort, patients in the private sector cohort were older (p=0.0110), had earlier stages of cancer at the time of diagnosis (p<0.001), had a higher percentage of current alcohol consumption (p<0.001) and had higher survival rates (p<0.001). Waist circumference was shown to have a large-strength effect on survival (η2=0.266).ConclusionEmphasis should be placed on anthropometric screening and education to effect long-term behaviour change. Physiotherapists are well placed to provide screening and non-pharmacological interventions for patients with colorectal cancer.     

Representing randomness in the communication of individualized cancer risk estimates: effects on cancer risk perceptions, worry, and subjective uncertainty about risk

Objective

To test the effect of novel representations of randomness on risk perceptions, worry, and subjective uncertainty about individualized colorectal cancer risk estimates.

Methods

A web-based factorial experiment was conducted, in which 225 adults aged 40 years and older were provided with hypothetical individualized colorectal cancer risk estimates, using 5 different textual and visual representations varying in expressed randomness. Outcome measures were perceived cancer risk, cancer worry, and subjective uncertainty about cancer risk; the moderating effect of dispositional optimism was also examined.

Results

Representational format was significantly associated with subjective uncertainty about cancer risk, but not with perceived cancer risk or worry. A format using software-based animation to express randomness dynamically led to the highest subjective uncertainty, although a static visual non-random format also increased uncertainty. Dispositional optimism moderated this effect; between-format differences in uncertainty were significant only for participants with low optimism.

Conclusion

Representing randomness in individualized estimates of cancer risk increases subjective uncertainty about risk. A novel dynamic visual format produces the greatest effect, which is moderated by individual differences in optimism.

Practice implications

Novel representations of randomness may be effective in improving people's understanding of the essential uncertainty pertaining to individualized cancer risk estimates.