BACKGROUND Little is known about healthcare experiences among people with and without disabilities. OBJECTIVE We sought to explore perceptions of people with and without disabilities related to their healthcare experiences. METHODS Nineteen persons with and without disabilities participated in one of four focus groups. Focus groups were conducted in the physical world in Milwaukee, WI and in the virtual world in Second Life® with Virtual Ability, a well-established community designed by and for people with a wide range of disabilities. A grounded theory methodology was employed to analyze focus group data. Inclusion of physical and virtual world focus groups enabled people with a wide range of disabilities to participate. RESULTS While some participants described instances of receiving good care, many discussed numerous barriers. The main themes that emerged in focus groups among both persons with and without disabilities related to their healthcare experiences including poor coordination among providers; difficulties with insurance, finances, transportation and facilities; short duration of visits with physicians; inadequate information provision; feelings of being diminished and deflated; and self-advocacy as a tool. Transportation was a major concern for persons with disabilities influencing mobility. Persons with disabilities described particularly poignant experiences wherein they felt invisible or were viewed as incompetent. CONCLUSIONS Both persons with and without disabilities experienced challenges in obtaining high quality healthcare. However, persons with disabilities experienced specific challenges often related to their type of disability. Participants stressed the need for improving healthcare coordination and the importance of self-advocacy.

We sought to develop and evaluate a health literacy measure in a multi-national study and to examine demographic characteristics associated with health literacy. Data were obtained from Demographic Health Surveys conducted between 2006–15 in 14 countries in Sub-Saharan Africa. Surveys were the same in all countries but translated to local languages as appropriate. We identified eight questions that corresponded to the National Academy of Medicine (NAM) definition of health literacy. Factor analysis was used to extract one measure of health literacy. Logistic regression was employed to examine the relationship between demographic characteristics and health literacy. A total of 224 751 individuals between the ages of 15 and 49 years were included. The derived health literacy measure demonstrated good internal consistency (Cronbach’s α = 0.72) and good content validity. The prevalence of high health literacy overall was 35.77%; females 34.08% and males 39.17%; less than or equal to primary education 8.93%, some secondary education 69.40% and ≥complete secondary 84.35%. High health literacy varied across nations, from 8.51% in Niger to 63.89% in Namibia. This is the first known study to evaluate a measure of health literacy relying on the NAM definition utilizing a large sample from 14 countries in Sub-Saharan Africa. Our study derived a robust indicator of NAM-defined health literacy. This indicator could be used to examine determinants and outcomes of health literacy in additional countries.

This study examined whether neighborhood social environment was related to patterns of adherence to oral hypoglycemic agents among primary care patients with type 2 diabetes mellitus. Residents in neighborhoods with high social affluence, high residential stability and high neighborhood advantage compared to residents in neighborhoods with one or no high features present, were significantly more likely to have an adherent pattern compared to a nonadherent pattern. Neighborhood social environment may influence patterns of adherence. Reliance on a multi-level contextual framework, extending beyond the individual, to promote diabetic self-management activities may be essential for notable public health improvements.

OBJECTIVE To examine whether patient satisfaction and perceived quality of medical care was related to stages of activity limitations among older adults. DESIGN Cross-sectional study. SETTING Medicare Current Beneficiary Survey (MCBS) for calendar years 2001-2011. PARTICIPANTS A population-based sample (n= 42,584) of persons 65 years of age and older living in the community. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) MCBS questions were categorized under 5 patient satisfaction and perceived quality dimensions: care coordination and quality, access barriers, technical skills of primary care physicians, interpersonal skills of primary care physicians, and quality of information provided by primary care physicians. Persons were classified into a stage of activity limitation (0-IV) derived from self-reported difficulty levels performing activities of daily living (ADLs) and instrumental activities of daily living (IADLs). RESULTS Compared to older beneficiaries with no limitations at ADL Stage 0, the adjusted odds ratios (OR) (95% confidence intervals (CI)) for Stage I (mild) to Stage III (severe) for satisfaction with care coordination and quality ranged from OR = 0.85 (95% CI: 0.80-0.92) to OR = 0.79 (95% CI: 0.70-0.89). Compared to ADL Stage 0, satisfaction with access barriers ranged from OR = 0.81 (95% CI: 0.76-0.87) at Stage I (mild) to a minimum of OR = 0.67 (95% CI: 0.59-0.76) at Stage III (severe). Similarly, compared to older beneficiaries at ADL Stage 0, perceived quality of the technical skills of their primary care physician ranged from OR = 0.87 (95% CI: 0.82-0.94) at Stage I (mild) to a minimum of OR = 0.81 (95% CI: 0.72-0.91) at Stage III (severe). CONCLUSIONS Medicare beneficiaries at higher stages of activity limitation although not necessarily the highest stage of activity limitation reported less satisfaction with medical care.

We sought to examine whether there are patterns of oral hypoglycemic agent adherence among primary care patients with type 2 diabetes that are related to patient characteristics and clinical outcomes. Longitudinal analysis via growth curve mixture modeling was carried out to classify 180 patients who participated in an adherence intervention according to patterns of adherence to oral hypoglycemic agents across 12 weeks. Three patterns of change in adherence were identified: adherent, increasing adherence, and nonadherent. Global cognition and intervention condition were associated with pattern of change in adherence (p<0.05). Patients with an increasing adherence pattern were more likely to have an Hemoglobin A1c (HbA1c) < 7% (adjusted odds ratio = 14.52, 95% CI [2.54, 82.99]) at 12 weeks in comparison with patients with the nonadherent pattern. Identification of patients with type 2 diabetes at risk of nonadherence is important for clinical prognosis and the development and delivery of interventions.

Background Education and literacy are key determinants of health, but these do not ensure health literacy. A definition of health literacy from the US Institute of Medicine (IOM) is widely accepted, but there is no consensus on the traits by which health literacy can be measured. Some questions in Demographic and Health Surveys (DHS) represent domains of health literacy as defined by the IOM (ie, the capacity to interpret, obtain, and understand health information; and the ability to make appropriate health decisions), and could be a valuable untapped resource for the measurement of health literacy. Building on pilot work in Zambia, we aimed to derive a measure of health literacy from information recorded in the DHS that aligned with the IOM definition. Methods We accessed data from surveys conducted between 2006 and 2015 in 14 sub-Saharan African countries:Cameroon, Democratic Republic of the Congo, Ethiopia, Ghana, Guinea, Côte d'Ivoire, Lesotho, Rwanda, Niger, Namibia, Sierra Leone, Swaziland, Togo, and Zambia. Surveys were the same in all countries, but translated to local languages as appropriate. We used factor analysis to extract one measure of health literacy and assessed its reliability and validity. We reclassified the continuous measure into tertiles and collapsed observations in the lower two groups to derive a dichotomous indicator. We then used χ² tests to assess whether the prevalence of (high) health literacy varied by demographics and country, accounting for sample weights. FindingsWe included 259 684 survey respondents aged 15-49 years. We identified eight survey questions that corresponded to elements of the four domains of IOM-defined health literacy. The questions addressed school and reading comprehension (capacity to interpret); reading magazines or listening to the radio or TV (capacity to obtain); learning family planning information (capacity to understand); and knowledge of a place to get an HIV test or acquire condoms (make appropriate health decisions). The derived continuous measure of health literacy demonstrated internal consistency (Cronbach's α = 0·72), and good content validity. Using the dichotomous indicator, overall prevalence of health literacy was 35·2% (95%CI 34·9-36·6%). Health literacy varied by sex (women 34·1% vs men 39·2%, p<0·001) and education level (primary education or less 8·9%, some secondary education 69·4%, and completed secondary education or higher 84·4%, p<0·001). Health literacy also varied greatly between countries, from 8·5% in Niger to 63·9% in Namibia (p<0·001) Interpretation Our study derives a robust indicator of IOM-defined health literacy in a large population in sub-Saharan Africa. Researchers could use this indicator with DHS datasets to measure health literacy in other countries, and ultimately examine how health literacy relates to health behaviour and outcomes, including for HIV/AIDS and domestic violence.Funding None.

Intimate partner violence (IPV), commonly accompanied by controlling behavior, is a serious public health concern in sub-Saharan Africa. Data from women (n = 37,115) aged 15 to 49 years who completed the Demographic Health Survey's (DHS) domestic violence module in eight countries in sub-Saharan Africa (Cameroon, Democratic Republic of the Congo [DRC],

Our pilot trial results indicate that an integrated care intervention employing PPP to incorporate financial, social and emotional needs for primary care patients with T2DM and depression may be effective.