PURPOSE Limited health literacy is increasingly recognized as a barrier to receiving adequate health care. Identifying patients at risk of poor health outcomes secondary to limited health literacy is currently the responsibility of clinicians. Our objective was to identify which screening questions and demographics independently predict limited health literacy and could thus help clinicians individualize their patient education. METHODSBetween August 2006 and July 2007, we asked 225 patients being treated for diabetes at an academic primary care offi ce several questions regarding their reading ability as part of a larger study (57% response rate). We built a logistic regression model predicting limited health literacy to determine the independent predictive properties of these questions and demographic variables. Patients were classifi ed as having limited health literacy if they had a Short Test of Functional Health Literacy in Adults (S-TOFHLA) score of less than 23. The potential predictors evaluated were self-rated reading ability, highest education level attained, Single-Item Literacy Screener (SILS) result, patients' reading enjoyment, age, sex, and race.RESULTS Overall, 15.1% of the patients had limited health literacy. In the fi nal model, 5 of the potential predictors were independently associated with increased odds of having limited health literacy. Specifi cally, patients were more likely to have limited health literacy if they had a poorer self-rated reading ability (odds ratio [OR] per point increase in the model = 3.37; 95% confi dence interval [CI], 1.71-6.63), more frequently needed help reading written health materials (assessed by the SILS) (OR = 2.03; 95% CI, 1.26-3.26), had a lower education level (OR = 1.89; 95% CI, 1.12-3.18), were male (OR = 4.46; 95% CI, 1.53-12.99), and were of nonwhite race (OR = 3.73; 95% CI, 1.04-13.40). These associations were not confounded by age. The area under the receiver operating characteristic curve was 0.9212. CONCLUSIONS Self-rated reading ability, SILS result, highest education level attained, sex, and race independently predict whether a patient has limited health literacy. Clinicians should be aware of these associations and ask questions to identify patients at risk. We propose an "SOS" mnemonic based on these fi ndings to help clinicians wishing to individualize patient education. 17 Not all of these associations have been found with perfect consistency, however. [18][19][20] We refer the interested reader to larger literature reviews and summary analyses for a more comprehensive look at the effects of literacy on health-related outcomes. 21,22 Interventions exist to aid persons with limited health literacy. Simplifying instruction forms is an effective means of ensuring better comprehension for entire patient populations. [23][24][25] Patients' health care teams may be of assistance by providing simplifi ed education and ensuring that patients understand and retain what is being said. [26][27][28] Although the use of such strategies should ...
Peer mentoring is a useful method for teaching sonography to preclinical medical students.
The SKILLD is an adequate diabetes knowledge test and is appropriate for people of all literacy levels. However, it should be expanded to more completely evaluate diabetes knowledge.
The concordance between Vanggaard's concept of character neurosis and three personality questionnaires (Marke-Nyman Temperament Scale, Cesarec-Marke Personality Scale, and Eysenck Personality Questionnaire) was evaluated in 73 patients who were treated for a major depression in general practice. After an interview with the patients Vanggaard classified 57 of them to be without character neurosis, and the remaining 16 patients were considered to have a character neurosis. It was found that Eysenck's Neuroticism scale significantly corresponded to Vanggaard's classification. Among the other personality scales Acquiescence and Autonomy were the most important. Studies on the predictive validity of these subscales are in progress.
SummaryIn patients with chronic idiopathic pain disorders we have analysed the construct validity of the Melancholia Scale as compared to the results with the scale in primary depression. The patients (n= 253) were treated in a placebo controlled trial with either clomipramine or mianserin independently of the Melancholia score. The construct validity of the Melancholia Scale was further analysed by the testing of the intensity model of depression versus anxiety using the Beck Depression Inventory, the Hamilton Anxiety Scale, the Spielberger State-Trait Anxiety Scale, and the Melancholia Scale. The construct validity in terms of scale homogeneity was analysed by Loevinger coefficients which can be considered as a latent structure evaluation. The Melancholia Scale showed acceptable homogeneity, while the Hamilton Anxiety Scale lacked sufficient homogeneity. In total, 33% of the patients had a score of 10 or more on the Melancholia Scale (corresponding to 13 or more on the Hamilton Depression Scale). The predictive validity of the Melancholia Scale was evaluated using active treatment versus placebo response after 6 weeks of therapy. It was shown that in patients with a Melancholia Scale score of 10 or more (corresponding to “less than major depression”) 72% had full recovery when treated with clomipramine, while 36% of the placebo treated patients obtained a full recovery (P≤0.05). The patients treated with mianserin obtained a full recovery in 52%. The group of patients with a Melancholia Scale score of 10 or more scored higher also on the anxiety scales indicating that the relation between depression and anxiety is a matter of severity. The depressed patients had significantly lower imipramine binding sites than the non-depressed patients.
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