RESUMEN
BACKGROUND: A videotaped declaration by patients of their advance care planning preferences could be an opportunity to supplement advance directive forms and be a source of information for family, caregivers, and clinicians, yet research is needed to examine the content and acceptability of making declarations among patients. OBJECTIVE: To evaluate the content and acceptability of 'video declarations': the process of patients videotaping themselves describing their advance care planning preferences. DESIGN: We showed a brief video describing three approaches to end-of-life care and then invited participants to use an iPad to videotape themselves making a declaration about their wishes. SETTING/SUBJECTS: Hospitalized patients from a large urban U.S. safety net hospital. MEASUREMENTS: We interviewed participants about the acceptability of the declaration process. Declarations were transcribed and coded by a team, with multiple stakeholder input. RESULTS: There were 16 participants; mean age was 60 (SD = 14) years. One participant declined. Out of 15 declarations, most were able to express their wishes for CPR (n = 12) and intubation (n = 13). Participants frequently discussed their family structure (n = 11), religious/spiritual well-being (n = 8), legacy/dignity issues (n = 6), and physical symptoms (n = 6). Nine declarations had directives judged to be unclear. The majority (66%) thought that this process was quite a bit or extremely helpful. CONCLUSIONS: Findings show that asking hospitalized patients to make videos describing their advance care planning preferences was feasible and acceptable. While the majority described their wishes around CPR and intubation, a fair amount of uncertainty remained. Further research is needed to support patients in describing their wishes clearly and test the effectiveness of video declarations to promote care concordant with preferences.
Asunto(s)
Planificación Anticipada de Atención , Directivas Anticipadas/psicología , Prioridad del Paciente/psicología , Pacientes/psicología , Cuidado Terminal/psicología , Grabación en Video , Anciano , Toma de Decisiones , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos , Población UrbanaRESUMEN
OBJECTIVES: To examine the effect of the relationship between literacy and other individual-level factors on having an advance directive (AD). DESIGN: Face-to-face structured interview. SETTING: Participants were recruited from an academic general internal medicine clinic and one of four federally qualified health centers in Chicago. PARTICIPANTS: Seven hundred eighty-four adults aged 55 to 74. MEASUREMENTS: Assessment of participant literacy, sociodemographic factors, and having an AD for medical care. RESULTS: One-eighth (12.4%) of participants with low literacy, 26.6% of those with marginal literacy, and 49.5% of those with adequate literacy reported having an AD (P < .001). In multivariable analyses, literacy and race were independently associated with less likelihood of having an AD. Specifically, participants with limited literacy (risk ratio (RR) = 0.45, 95% confidence interval (CI) = 0.22-0.95) and African Americans (RR = 0.64, 95% CI = 0.47-0.88) were less likely to have an AD. Exploratory analyses showed that there was not a significant interaction between the effect of literacy and race. CONCLUSION: Limited literacy and African-American race were significant risk factors for not having an AD in this cohort of older adults. Literacy and race probably represent two separate but important causal pathways that need to be understood to improve how the healthcare system ascertains and protects individuals' advance care preferences.
Asunto(s)
Directivas Anticipadas , Negro o Afroamericano , Alfabetización en Salud , Aceptación de la Atención de Salud/etnología , Población Blanca , Negro o Afroamericano/estadística & datos numéricos , Anciano , Chicago , Estudios Transversales , Escolaridad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Población Blanca/estadística & datos numéricosRESUMEN
OBJECTIVE: Evaluate the evidence regarding the relative effectiveness of multimedia and print as modes of dissemination for patient education materials; examine whether development of these materials addressed health literacy. METHODS: A structured literature review utilizing Medline, PsycInfo, and the Cumulative Index to the Nursing and Allied Health Literature (CINAHL), supplemented by reference mining. RESULTS: Of 738 studies screened, 30 effectively compared multimedia and print materials. Studies offered 56 opportunities for assessing the effect of medium on various outcomes (e.g., knowledge). In 30 instances (54%), no difference was noted between multimedia and print in terms of patient outcomes. Multimedia led to better outcomes vs. print in 21 (38%) comparisons vs. 5 (9%) instances for print. Regarding material development, 12 studies (40%) assessed readability and 5 (17%) involved patients in tool development. CONCLUSIONS: Multimedia appears to be a promising medium for patient education; however, the majority of studies found that print and multimedia performed equally well in practice. Few studies involved patients in material development, and less than half assessed the readability of materials. PRACTICE IMPLICATIONS: Future research should focus on comparing message-equivalent tools and assessing their effect on behavioral outcomes. Material development should include explicit attention to readability and patient input.
Asunto(s)
Comunicación en Salud/métodos , Difusión de la Información/métodos , Multimedia , Publicaciones , Alfabetización en Salud , Humanos , Educación del Paciente como AsuntoRESUMEN
BACKGROUND: Emerging evidence suggests the relationship between health literacy and health outcomes could be explained by cognitive abilities. OBJECTIVE: To investigate to what degree cognitive skills explain associations between health literacy, performance on common health tasks, and functional health status. DESIGN: Two face-to-face, structured interviews spaced a week apart with three health literacy assessments and a comprehensive cognitive battery measuring 'fluid' abilities necessary to learn and apply new information, and 'crystallized' abilities such as background knowledge. SETTING: An academic general internal medicine practice and three federally qualified health centers in Chicago, Illinois. PATIENTS: Eight hundred and eighty-two English-speaking adults ages 55 to 74. MEASUREMENTS: 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). Performance on common health tasks were globally assessed and categorized as 1) comprehending print information, 2) recalling spoken information, 3) recalling multimedia information, 4) dosing and organizing medication, and 5) healthcare problem-solving. RESULTS: Health literacy measures were strongly correlated with fluid and crystallized cognitive abilities (range: r=0.57 to 0.77, all p<0.001). Lower health literacy and weaker fluid and crystallized abilities were associated with poorer performance on healthcare tasks. In multivariable analyses, the association between health literacy and task performance was substantially reduced once fluid and crystallized cognitive abilities were entered into models (without cognitive abilities: ß= -28.9, 95 % Confidence Interval (CI) -31.4 to -26.4, p; with cognitive abilities: ß= -8.5, 95 % CI -10.9 to -6.0). LIMITATIONS: Cross-sectional analyses, English-speaking, older adults only. CONCLUSIONS: The most common measures used in health literacy studies are detecting individual differences in cognitive abilities, which may predict one's capacity to engage in self-care and achieve desirable health outcomes. Future interventions should respond to all of the cognitive demands patients face in managing health, beyond reading and numeracy.
Asunto(s)
Cognición , Conocimientos, Actitudes y Práctica en Salud , Alfabetización en Salud/métodos , Estado de Salud , Autocuidado/psicología , Anciano , Cognición/fisiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Autocuidado/métodosRESUMEN
BACKGROUND: Limited literacy has repeatedly been linked to problems comprehending health information, although the majority of studies to date have focused on reading various print health materials. We sought to investigate patients' ability to recall spoken medical instructions in the context of a hypothetical clinical encounter, and whether limited health literacy would adversely affect performance on the task. METHODS: A total of 755 patients aged 55 to 74 were recruited from 1 academic internal medicine clinic and 3 federally qualified health centers. Participants' health literacy skills and recall of spoken medical instructions for 2 standard hypothetical video scenarios [wound care, gastroesophageal reflux disease (GERD) diagnosis] were assessed. RESULTS: The majority (71.6%) of participants had adequate health literacy skills, and these individuals performed significantly better in correctly recalling spoken information than those with marginal and low literacy in both scenarios: [wound care-mean (SD): low 2.5 (1.3) vs. marginal 3.5 (1.3) vs. adequate 4.6 (1.1); P<0.001), GERD: low 4.2(1.7) vs. marginal 5.2 (1.7) vs. adequate 6.5 (1.7); P<0.001]. Regardless of literacy level, overall recall of information was poor. Few recognized pain (28.5%) or fever (28.2%) as signs of infection. Only 40.5% of participants correctly recalled when to take their GERD pills. CONCLUSIONS: Many older adults may have difficulty remembering verbal instructions conveyed during clinical encounters. We found those with lower health literacy to have poorer ability to recall information. Greater provider awareness of the impact of low health literacy on the recall of spoken instructions may guide providers to communicate more effectively and employ strategies to confirm patient understanding.
Asunto(s)
Alfabetización en Salud , Recuerdo Mental , Anciano , Comprensión , Escolaridad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cooperación del Paciente/psicología , Relaciones Médico-Paciente , Grabación en VideoRESUMEN
OBJECTIVE: To explore the extent to which pregnant women understand the symptoms and potential complications related to preeclampsia and to determine the factors that are associated with better understanding. METHODS: This was a cross-sectional study in which 112 pregnant patients were interviewed to determine their preeclampsia knowledge. Knowledge was evaluated using a 25-item survey addressing the symptoms, consequences, and proper patient actions associated with preeclampsia. Patients were also asked in an open-ended question to define preeclampsia; all responses were rated by three obstetricians. Information about demographics, medical and obstetrical history, and health literacy was also obtained. Health literacy was assessed using the short Test of Functional Health Literacy in Adults (S-TOFHLA). RESULTS: Patients correctly answered only 43% of the 25 questions assessing preeclampsia knowledge. Moreover, only 14% of the patients were able to provide a definition that correctly reflected the syndrome. Factors associated with a greater proportion of correct answers on the questionnaire were higher literacy, multiparity, history of preeclampsia, and receipt of information about preeclampsia from a clinician or another information source (e.g., the Internet, television, a book, or a friend). CONCLUSIONS: Pregnant patients have a generally poor understanding of preeclampsia, although improved understanding is associated with having received information about the disease. Further investigation will be needed to determine how best to educate patients and whether this education can also decrease adverse outcomes associated with this syndrome.
Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Preeclampsia/psicología , Adulto , Estudios Transversales , Femenino , Humanos , Embarazo , Adulto JovenRESUMEN
The relationship between literacy and health outcomes are well documented in adult medicine, yet specific causal pathways are not entirely clear. Despite an incomplete understanding of the problem, numerous interventions have already been implemented with variable success. Many of those who proposed earlier strategies assumed the problem to originate from reading difficulties only. Given the timely need for more effective interventions, it is of increasing importance to reconsider the meaning of health literacy to advance our conceptual understanding of the problem and how best to respond. One potentially effective approach might involve recognizing the known associations between a larger set of cognitive and psychosocial abilities with functional literacy skills. Here we review the current health literacy definition and literature and draw on relevant research from the fields of education, cognitive science, and psychology. In this framework, a research agenda is proposed that considers an individual's "health-learning capacity," which refers to the broad constellation of cognitive and psychosocial skills from which patients or family members must draw to effectively promote, protect, and manage their own or a child's health. This new, related concept will lead, ideally, to more effective ways of thinking about health literacy interventions, including the design of health-education materials, instructional strategies, and the delivery of health care services to support patients and families across the life span.
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Escolaridad , Educación en Salud , Disparidades en el Estado de Salud , Adulto , Niño , Enfermedad Crónica/prevención & control , Educación , Conocimientos, Actitudes y Práctica en Salud , Humanos , Evaluación de Necesidades , Evaluación de Procesos y Resultados en Atención de Salud , Participación del Paciente , Estados UnidosRESUMEN
Asthma 1-2-3 is a newly-developed low-literacy multimedia education tool designed to promote asthma self-care concepts among African American adults. An expert panel (n = 10) informed content development for the tool. The video script and storyboard imagery were shown to 30 African Americans recruited from the American Lung Association, whose reactions and comments guided further revisions. The final version was pilot tested in three diverse community settings in Chicago to determine the efficacy of Asthma 1-2-3 at improving patient understanding of asthma and its symptoms. In all, 130 adults participated in the pilot test. Knowledge scores significantly improved from pretest to posttest following presentation of the developed tool for subjects across all literacy levels (Pretest: Mean = 4.2 [SD = 1.6]; Posttest: M = 6.8 [SD = 2.0], P < 0.001). Symptom pathophysiology concepts were the least understood. Individuals with low literacy had less total knowledge score gains compared to those with marginal and adequate literacy (1.8, 2.6, and 3.2 respectively; P = 0.002). The multimedia tool significantly improved understanding of asthma. Individuals with limited literacy may require additional instruction, repeated viewing, or added tangible cues (i.e. supplementary print materials) to support knowledge retention. In general, feedback from the target population was particularly helpful in the development of the tool and its initial evaluation, and should be considered as a necessary step in the creation of other patient education materials.
Asunto(s)
Asma/terapia , Negro o Afroamericano , Educación en Salud/métodos , Conocimientos, Actitudes y Práctica en Salud , Multimedia , Autocuidado , Adulto , Anciano , Asma/etnología , Chicago , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Proyectos PilotoRESUMEN
BACKGROUND: Prior studies have linked limited literacy to poorer HIV medication adherence, although the precise causal pathways of this relationship have only been initially investigated. OBJECTIVE: To examine whether social stigma is a possible mediator to the relationship between literacy and self-reported HIV medication adherence. DESIGN: Structured patient interviews with a literacy assessment, supplemented by medical chart review, were conducted among patients receiving care at infectious disease clinics in Shreveport, Louisiana and Chicago, Illinois. Literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), while stigma was measured using items taken from the Patient Medication Adherence Questionnaire (PMAQ). PARTICIPANTS: Two hundred and four consecutive patients participated. RESULTS: Approximately one-third of the patients (30.4%) were less than 100% adherent to their regimen, and 31.4% had marginal (7th-8th grade) or low (< or = 6th grade) literacy. In multivariate analyses, patients with low literacy were 3.3 times more likely to be non-adherent to antiretroviral regimens (95% CI 1.3-8.7; p < 0.001). Perceived social stigma was found to mediate the relationship between literacy and medication adherence (AOR 3.1, 95% CI 1.3-7.7). CONCLUSIONS: While low literacy was a significant risk factor for improper adherence to HIV medication regimens in our study, perceived social stigma mediated this relationship. Low literacy HIV intervention strategies may also need to incorporate more comprehensive psychosocial approaches to overcome stigma barriers.