Development and validation of the General Health Numeracy Test (GHNT)

Objective

Because existing numeracy measures may not optimally assess ‘health numeracy’, we developed and validated the General Health Numeracy Test (GHNT).

Methods

An iterative pilot testing process produced 21 GHNT items that were administered to 205 patients along with validated measures of health literacy, objective numeracy, subjective numeracy, and medication understanding and medication adherence. We assessed the GHNT's internal consistency reliability, construct validity, and explored its predictive validity.

Results

On average, participants were 55.0 ± 13.8 years old, 64.9% female, 29.8% non-White, and 51.7% had incomes ≤$39 K with 14.4 ± 2.9 years of education. Psychometric testing produced a 6-item version (GHNT-6). The GHNT-21 and GHNT-6 had acceptable-good internal consistency reliability (KR-20 = 0.87 vs. 0.77, respectively). Both versions were positively associated with income, education, health literacy, objective numeracy, and subjective numeracy (all p < .001). Furthermore, both versions were associated with participants’ understanding of their medications and medication adherence in unadjusted analyses, but only the GHNT-21 was associated with medication understanding in adjusted analyses.

Conclusions

The GHNT-21 and GHNT-6 are reliable and valid tools for assessing health numeracy.

Practice implications

Brief, reliable, and valid assessments of health numeracy can assess a patient's numeracy status, and may ultimately help providers and educators tailor education to patients.     

Low literacy is associated with uncontrolled blood pressure in primary care patients with hypertension and heart disease

Objectives

To evaluate the association between low literacy and uncontrolled blood pressure (BP) and their associations with medication adherence.

Methods

Cross-sectional study of 423 urban, primary care patients with hypertension and coronary disease. The relationship between low literacy (Rapid Estimate of Adult Literacy in Medicine ≤ 44) and uncontrolled BP (≥140/90 mmHg, ≥130/80 mmHg for patients with diabetes) was evaluated by crude and adjusted logistic regression. Relationships with self-reported adherence and refill adherence were explored using adjusted linear and logistic regression.

Results

Overall, 192 (45%) subjects had low literacy and 227 (52.9%) had uncontrolled BP. Adjusting for age, gender, race, employment, education, mental status, and self-reported adherence, low literacy was associated with uncontrolled BP (OR 1.75, 95% CI 1.06–2.87). Lower self-reported adherence was associated with uncontrolled BP; the relationship between refill adherence and uncontrolled BP was not statistically significant.

Conclusion

Low literacy is independently associated with uncontrolled BP.

Practice implications

Awareness of the relationships among patient literacy, BP control, and medication adherence may guide healthcare providers as they communicate with patients.     

Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care

Context  Delayed or inaccurate communication between hospital-based and primary care physicians at hospital discharge may negatively affect continuity of care and contribute to adverse events. Objectives  To characterize the prevalence of deficits in communication and information transfer at hospital discharge and to identify interventions to improve this process. Data Sources  MEDLINE (through November 2006), Cochrane Database of Systematic Reviews, and hand search of article bibliographies. Study Selection  Observational studies investigating communication and information transfer at hospital discharge (n = 55) and controlled studies evaluating the efficacy of interventions to improve information transfer (n = 18). Data Extraction  Data from observational studies were extracted on the availability, timeliness, content, and format of discharge communications, as well as primary care physician satisfaction. Results of interventions were summarized by their effect on timeliness, accuracy, completeness, and overall quality of the information transfer. Data Synthesis  Direct communication between hospital physicians and primary care physicians occurred infrequently (3%-20%). The availability of a discharge summary at the first postdischarge visit was low (12%-34%) and remained poor at 4 weeks (51%-77%), affecting the quality of care in approximately 25% of follow-up visits and contributing to primary care physician dissatisfaction. Discharge summaries often lacked important information such as diagnostic test results (missing from 33%-63%), treatment or hospital course (7%-22%), discharge medications (2%-40%), test results pending at discharge (65%), patient or family counseling (90%-92%), and follow-up plans (2%-43%). Several interventions, including computer-generated discharge summaries and using patients as couriers, shortened the delivery time of discharge communications. Use of standardized formats to highlight the most pertinent information improved the perceived quality of documents. Conclusions  Deficits in communication and information transfer at hospital discharge are common and may adversely affect patient care. Interventions such as computer-generated summaries and standardized formats may facilitate more timely transfer of pertinent patient information to primary care physicians and make discharge summaries more consistently available during follow-up care.      

Concurrent validity of the Arabic version of General Medication Adherence Scale using two validated indirect adherences measures in Saudi patients with non-communicable diseases

PurposeThis study aimed to evaluate the concurrent validity of the Arabic version of the General Medication Adherence Scale (GMAS) using two validated scales namely Adherence to Refills and Medications Scale (ARMS) and Medication Adherence Rating Scale (MARS) in Saudi patients with non-communicable diseases.MethodsA cross sectional study was conducted for 2 months in out-patient departments at a tertiary care hospital in Khobar, Saudi Arabia. The study collected data from patients with chronic illnesses through convenience sampling. Pearson correlation (ρ) was conducted to report concurrent validity of GMAS. A correlation coefficient value ≥ 0.5 with p-value < 0.01 was considered threshold for establishing concurrent validity. The study was approved by an ethics committee (IRB-2019–05-002).ResultsA total of 406 patients responded to the study. The average age was 42.4 ± 5.94 years, and most patients were females (53.7%), married (70%), graduates (65.3%), employed (39.9%) and, had a monthly family income > SAR 10,000, i.e., USD 2666.2 (56.4%). The mean adherence scores obtained from MARS, ARMS and GMAS were 7.09, 19.9, and 27.4. The correlation (ρ) between GMAS and MARS scores was 0.65, and between GMAS and ARMS scores was −0.79, p < 0.01 for both comparisons.ConclusionThe concurrent validity of GMAS-AR was established in this study that would further substantiate psychometric properties of the scale in this population.