Effect of race on patient expectations regarding their primary care physicians.

Poor comprehension of prostate cancer (PCa) medical terms can create barriers to PCa treatment discussions. The authors measured comprehension of PCa terms and its relationship to health literacy in a group of Black men who were newly diagnosed with PCa. Theyexaminedwhether tailoring communication with alternative colloquial words would be helpful and acceptable. Patients were recruited from urology clinics (N=152). After they met with their providers to discuss PCa treatment options, they participated in an educational supplement delivered as a structured interview. The supplement tailored PCa treatment information by allowing men to choose between colloquial and medical terms for genitourinary (GU) function. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine, and comprehension of common PCa terms was assessed using published methods. Pearson correlation was used to estimate the association between health literacy and comprehension of PCa terms. Spearman rank correlation (r) was used to assess the relation between the total number of medical terms preferred (range, 0-10) and Rapid Estimate of Adult Literacy in Medicine scores (range, 0-66). Most patients (62%) had low health literacy, which was strongly correlated with their understanding of PCa terms (r=0.526; p<.001). Poor comprehension of many PCa terms established the need to use alternative language for GU function (only 20% knew the word incontinence). There was a statistically significant positive association between the number of medical terms preferred and health literacy (r=0.358; p<.001). A majority of patients (91%) preferred a mixture of medical and colloquial terms. Tailoring communications with colloquial terms for GU function was preferred by most patients regardless of health literacy.

Patient Input into the Development and Enhancement of ED Discharge Instructions: A Focus Group Study

The purpose was to collect assessment data with three separate health literacy tools and compare the efficiency of identifying individuals that are at risk for low health literacy levels.Health Literacy is defined as the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions. Adults with basic or below basic health literacy skills (35% in the U.S.) have problems reading a chart and understanding simple medical instructions. Literature supports the association between low health literacy levels and poor health outcomes.Approval for the project was obtained from the Human Subjects Committee. A partnership was formed with a local physician office to assess a total of 50 patients. Students worked in pairs and collected the following data: highest level of education, a single question assessment, the Newest Vital Sign (NVS) assessment, and the Rapid Estimate of Adult Literacy in Medicine- Short Form (REALM-SF) assessment.Using linear correlation, the three tools are not well related. Of all participants, 96% reported that they never or rarely ask for help, yet on the NVS, 43% scored a limited or possibly limited health literacy result. Correlating education level: of those participants with a high school, technical, and associate degree, the average scores put them at a limited or possibly limited health literacy level. However, with those participants with a bachelor degree or higher, the average score was at a level of adequate health literacy.

Considerations on Health Literacy and Hearing Aid Use

Health Illiteracy Challenges Long-Term Care

Introduction Comprehension of healthcare terminology across diverse populations is critical to patient education and engagement. Methods Women in Oahu, Hawai'i with a recent delivery were interviewed about their understanding of ten common obstetric terms. Health literacy was assessed by the rapid estimate of adult literacy in medicine (REALM). Multivariable models predicted total terms comprehended by demographic factors. Results Of 269 participants, self-reported primary race was 20.5% Japanese, 19.0% Native Hawaiian, 19.0% White, 16.7% Filipino, 11.5% other Asian, 9.7% other Pacific Islander, and 3.7% other race/ethnicity; 12.7% had low health literacy. On average, participants understood 6.0 (SD: 2.2) of ten common obstetric terms. Comprehension varied by term, ranging from 97.8% for "Breastfeeding" to 27.5% for "VBAC routinely available." Models showed (1) being Filipino, Japanese, Native Hawaiian, or other Pacific Islander (vs. white); (2) having low (vs. adequate) health literacy; (3) having a high school (vs. a college) degree; and (4) being under 25-years-old (vs. 35 +) were significantly associated with less comprehension. Discussion Participants were unfamiliar with common obstetrics terminology. Comprehension struggles were more common among populations with maternal health disparities, including Asian and Pacific Islander subgroups, and those with low health literacy.

This study aims to conduct a systematic literature review (SLR) to summarise associations between health literacy and inflammatory arthritis (IA) outcomes, to inform management. Inclusion criteria were adults with IA; studies assessing health literacy or interventions targeting health literacy; observational and qualitative studies, randomised controlled trials. Searches were performed using MeSH headings for health literacy and IA. Data were extracted on demographics, health literacy assessment and relevant outcomes, grouped into themes using vote-counting. Of 3087 identified articles, 29 were included. The total number of participants across all studies was 16,402, comprising mostly females, with a mean age of 46 to 70 years. Ethnicity was reported in 13 studies; most participants were Caucasian. The most frequently reported IA was rheumatoid arthritis. Health literacy measures included: Test of Functional Health Literacy in Adults (n = 13); Single Item Literacy Screener (n = 10); Rapid Estimate of Adult Literacy in Medicine (n = 6); Health Literacy Questionnaire (n = 2). Six main associations were identified with low health literacy: higher disease activity; more disability; more mental health symptoms (including depression and anxiety); higher healthcare use; lower medication adherence; lower use of internet, telehealth and technology. In people with IA, low health literacy is generally associated with worse outcomes including higher disease activity, mental health symptoms and disability, higher healthcare use, lower medication adherence, and lower use of technology. This is the first SLR to synthesise associations between health literacy and outcomes in IA. Our findings should inform policy and resource allocation and improve the quality of care for patients with IA and low health literacy.

The objective of this paper is to measure health literacy in a representative sample of the Australian general population using three health literacy tools; to consider the congruency of results; and to determine whether these assessments were associated with socio-demographic characteristics. Face-to-face interviews were conducted in a stratified random sample of the adult Victorian population identified from the 2004 Australian Government Electoral Roll. Participants were invited to participate by mail and follow-up telephone call. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), Test of Functional Health Literacy in Adults (TOFHLA) and Newest Vital Sign (NVS). Of 1680 people invited to participate, 89 (5.3%) were ineligible, 750 (44.6%) were not contactable by phone, 531 (32%) refused and 310 (response rate 310/1591, 19.5%) agreed to participate. Compared with the general population, participants were slightly older, better educated and had a higher annual income. The proportion of participants with less than adequate health literacy levels varied: 26.0% (80/308) for the NVS, 10.6% (51 33/310) for the REALM and 6.8% (21/309) for the TOFHLA. A varying but significant proportion of the general population was found to have limited health literacy. The health literacy measures we used, while moderately correlated, appear to measure different but related constructs and use different cut offs to indicate poor health literacy.

ObjectivesKnowledge of patient's health literacy (HL) in the emergency department (ED) can facilitate care delivery and reduce poor health outcomes. This systematic review investigates HL measurement instruments used in the ED and their psychometric properties, accuracy in detecting limited HL, and feasibility.MethodsWe searched in five biomedical databases for studies published between 1990 and January 2021, evaluating HL measurement instruments tested in the ED on internal consistency, criterion validity, diagnostic accuracy, or feasibility. Reviewers screened studies for relevance and assessed methodologic quality with published criteria. Data were synthesized around study and instrument characteristics and outcomes of interest.ResultsOf the 2,376 references screened, seven met our inclusion criteria. Studied instruments varied in objective (n = 5) and subjective (n = 6) measurement of HL skills, and in HL constructs measured. The Brief Health Literacy Screen (BHLS) and the Subjective Numeracy Scale demonstrate acceptable and good internal consistency across studies. None of the instruments perform consistently well on criterion validity. The Rapid Estimate of Adult Literacy in Medicine–Revised and the Newest Vital Sign, both objective tests with short administration times, demonstrate good accuracy in one study with high risk of bias. The BHLS, a short subjective measure, shows moderate accuracy across studies including one with low risk of bias.ConclusionsSeveral short instruments seem valid in measuring HL and accurate in detecting limited HL among ED patients, each with its practical advantages and disadvantages and specific measurement of HL. Additional research is necessary to develop a robust evidence base supporting these instruments.

This chapter reviews the translation process for six health literacy instruments: Rapid Estimate of Adult Literacy in Medicine, Test of Functional Health Literacy in Adults (TOFHLA), European Health Literacy Survey Questionnaire (HLS-EU-Q), All Aspects of Health Literacy Scale, Newest Vital Sign, and Functional, Communicative and Critical Health Literacy. Some instruments, developed in the United States and the United Kingdom, targeted English-speaking populations only. Later, researchers translated several into the languages of immigrant and refugee groups with limited English proficiency. For example, the TOFHLA was translated and adapted to target Korean and Vietnamese Americans. Some instruments were translated and employed for conducting health literacy research worldwide. One example is the HLS-EU-Q for health literacy research conducted in Indonesia, Kazakhstan, Malaysia, Myanmar, Taiwan, and Vietnam. This chapter describes how health literacy instruments were translated into various languages and revised to account for cultural and health system differences across countries and population groups.

Health Literacy as a Predictor of Adverse Outcomes after Implantation of Left Ventricular Assist Device

Evidence suggests low health literacy is prevalent in the United States and associated with worse clinical outcomes, yet few studies have investigated health literacy in systemic lupus erythematosus (SLE). The objective of this study was to determine the prevalence of low health literacy and numeracy in lupus patients and to examine its association with disease characteristics. Patients with SLE were recruited from an academic center clinic. Participants completed in-person assessments of health literacy (Rapid Estimate of Adult Literacy in Medicine, REALM) and numeracy (Numeracy Understanding in Medicine Instrument Shortened Version, S-NUMi). Clinical disease activity measures were obtained, including urine protein to creatinine ratio (UPC), Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and physician global assessment (PhGA) scores. Ninety-five SLE patients participated in the study; 13% had low health literacy and 73% had limited health numeracy. Patients with lower health literacy and numeracy were more likely to be Black, have Medicaid insurance, and earn income <$50 K annually. In linear regression models, patients with limited health numeracy had, on average, PhGA scores 0.31 points higher (95% CI: 0.02, 0.60) than patients with adequate numeracy, after adjusting for race and age. No clinical outcomes were associated with health literacy. In this exploratory study, we found SLE patients with low numeracy had higher disease activity. Our findings indicate that lower health literacy and numeracy are more common among Black and socioeconomically disadvantaged patients. Additional research will be needed to investigate the impact of health literacy on other outcomes and racial disparities in SLE.

Background:Health literacy is an area of growing research and clinical interest, necessitating short, accurate measures of this complex construct. Health Literacy Assessment Using Talking Touchscreen Technology (Health LiTT) measures prose, document, and quantitative literacy by self-administration on a touchscreen computer.Objective:The objective of this study was to assess the validity of a short form of Health LiTT and to identify a meaningful cutoff score for adequate health literacy.Methods:A subsample of 137 participants from the Literacy and Cognitive Function among Older Adults study completed a 10-item Health LiTT short form and three interviewer-administered health literacy measures: Test of Functional Health Literacy in Adults (TOFHLA), Rapid Estimate of Adult Literacy in Medicine (REALM), and Newest Vital Sign (NVS). Convergent validity was assessed by correlating scores for all measures, and known-groups validity was assessed by comparing mean Health LITT scores across TOFHLA levels (inadequate, marginal, adequate). Internal consistency reliability was estimated with Cronbach's alpha. A cutoff score for adequate health literacy was established using the TOFHLA cutoff for adequate versus inadequate/marginal health literacy.Key Results:Spearman correlations between Health LiTT scores and total TOFHLA, REALM, and NVS scores were 0.65, 0.69, and 0.56, respectively (all p < .001). Mean Health LiTT scores were significantly and meaningfully different across inadequate (40.4), marginal (50.1), and adequate (57.1) TOFHLA categories (F = 60.6; p < .001). Cronbach's alpha for the Health LiTT short form was .73. A cutoff score of 55 on Health LiTT showed acceptable sensitivity and specificity to identify adequate health literacy.Conclusions:This 10-item Health LiTT short form demonstrated excellent convergent and known-groups validity and acceptable internal consistency reliability in older adults. The established cutoff also showed excellent sensitivity and specificity. Validation of other custom Health LiTT short forms with varying items from the bank and computer adaptive test-generated Health LiTT scores is ongoing. [HLRP: Health Literacy Research and Practice. 2020;4(4):e200–e207.]Plain Language Summary:This article provides evidence of the need for and psychometric properties of a valid and reliable short form of the flexible, technologically advanced Health Literacy Assessment Using Talking Touchscreen Technology measure, as well as a cutoff score to note adequate versus marginal/inadequate health literacy.

Inadequate health literacy has been associated with worse health status and more hospitalizations. We examined the influence of personal characteristics and health literacy on body change distress, depressive symptoms, and HIV symptom intensity in a convenience sample of 489 HIV-seropositive adults throughout the United States. Health literacy was measured with the Rapid Estimate of Adult Literacy in Medicine (REALM) instrument. Those with higher health literacy scores reported more body change distress, depressive symptoms, and HIV symptom intensity. Being Latino and having higher health literacy scores were associated with poorer health outcomes. These results challenge the utility of the REALM to examine the relationship between health literacy and adverse health status.

Health Literacy and Success with Glaucoma Drop Administration