Health literacy has been put forward as a potential mechanism explaining the well-documented relationship between education and health. However, little empirical research has been undertaken to explore this hypothesis. The present study aims to study whether health literacy could be a pathway by which level of education affects health status. Health literacy was measured by the Health Activities and Literacy Scale, using data from a subsample of 5,136 adults between the ages of 25 and 65 years, gathered within the context of the 2007 Dutch Adult Literacy and Life Skills Survey. Linear regression analyses were used in separate models to estimate the extent to which health literacy mediates educational disparities in self-reported general health, physical health status, and mental health status as measured by the Short Form-12. Health literacy was found to partially mediate the association between low education and low self-reported health status. As such, improving health literacy may be a useful strategy for reducing disparities in health related to education, as health literacy appears to play a role in explaining the underlying mechanism driving the relationship between low level of education and poor health.

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Background: Patient record review of hospitalised patients is by far the most applied method to assess adverse events (AEs) in hospitals. The diligence with which information is recorded may influence the visibility of AEs. On the other hand, poor quality of the information in patient records may be a cause or a consequence of poor quality of care and may thus be associated with higher rates of AEs. The objective of this study was to assess the relation between the quality of patient records and the occurrence of AEs. Methods: In this study, 7926 hospital admissions of 21 Dutch hospitals were analysed with a structured record review method. The occurrence of AEs, the presence of patient information and the quality of the present information (completeness, readability and adequacy) were assessed. Their association was analysed using multilevel logistic regression analyses. Results: The absence of record components was associated with lower rates of AEs, suggesting that missing record components lead to an underassessment of AEs in record-review studies. In contrast, poor quality of the information present in patient records was associated with higher rates of AEs, implying that the quality of the present patient information is a predictor of the quality of care. Conclusions: Evidence-based standards and a (electronic) format for record keeping are necessary for standardisation of recording patient information. This will improve the completeness, readability, accessibility, accuracy and exchange of patient information between healthcare providers and institutions. Better registration of patient information will benefit the quality of the healthcare process and will reduce the risk of AEs.

Measuring patient safety culture Smits, M.; Wagner, C.; Spreeuwenberg, P.; Wal, G. van der; Groenewegen, P.P. Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. One is The Hospital Survey on Patient Safety Culture (HSOPS).13 It aims to measure multiple dimensions of patient safety culture in hospitals. Previous research has shown that the psychometric properties of the HSOPS are good.11 13 The questionnaire is being used in several countries. It has been translated into Dutch for use in The Netherlands. The factor structure and psychometric properties of the Dutch translation (COMPaZ) have been described earlier.14 Like many other safety culture questionnaires, the HSOPS has to be administered individually to employees at a hospital or a hospital unit. However, the aim of the questionnaire is to measure the group culture within the hospital or unit. The assumption that the HSOPS measures culture and not just individual attitudes has not been examined before. It can be tested by analysing whether individual responses cluster within units or within hospitals. By examining the clustering of individual responses by means of multilevel analysis, one can identify contextual phenomena. 15Clustering of individual responses would support the validity of the instrument.Moreover, when healthcare organisations are planning to improve patient safety culture, they have to know the most appropriate level at which to direct their interventions. At first sight, a centralised (hospital level) approach might seem least time-and money-consuming, but in reality it is very possible that a decentralised approach (unit level) is the most efficient way of improvement for some or even all aspects of patient safety culture. Unit-level interventions can be tailored to the specific needs of a unit, while only a small part of the units within a hospital will gain from interventions implemented at hospital level.Clustering of staff responses at unit or at hospital level indicates which dimensions of patient safety culture belong to and can be addressed at which organisational level.In this study, we examine two main research questions: 1. Does the HSOPS measure group culture or only individual attitudes? 2. Which dimensions of the HSOPS reflect hospital characteristics, and which reflect unit characteristics?Error management With respect to the first research question, we expect all 11 dimensions to cluster significantly at either the unit level or hospital level (hypothesis 1). Some dimensions will show more clustering at hospital level than others. When considering the contents of the dimensions, three of the 11 dimensions seem to reflect hospital...

Overall, at the group level, limitations in activities of patients with OA of the hip or knee recruited from hospitals and rehabilitation centers seem fairly stable during the first 3 years of follow-up. However, at the level of individual patients, considerable variation occurs. Prognostic factors for worsening of limitations in activities include increased pain, reduced ROM, and decreased muscle strength at 1-year follow-up; higher morbidity count; and to a lesser extent poor cognitive functioning.

BackgroundThe Internet is increasingly considered to be an efficient medium for assessing the quality of health care seen from the patients’ perspective. Potential benefits of Internet surveys such as time efficiency, reduced effort, and lower costs should be balanced against potential weaknesses such as low response rates and accessibility for only a subset of potential participants. Combining an Internet questionnaire with a traditional paper follow-up questionnaire (mixed-mode survey) can possibly compensate for these weaknesses and provide an alternative to a postal survey.ObjectiveTo examine whether there are differences between a mixed-mode survey and a postal survey in terms of respondent characteristics, response rate and time, quality of data, costs, and global ratings of health care or health care providers (general practitioner, hospital care in the diagnostic phase, surgeon, nurses, radiotherapy, chemotherapy, and hospital care in general).MethodsDifferences between the two surveys were examined in a sample of breast care patients using the Consumer Quality Index Breast Care questionnaire. We selected 800 breast care patients from the reimbursement files of Dutch health insurance companies. We asked 400 patients to fill out the questionnaire online followed by a paper reminder (mixed-mode survey) and 400 patients, matched by age and gender, received the questionnaire by mail only (postal survey). Both groups received three reminders.ResultsThe respondents to the two surveys did not differ in age, gender, level of education, or self-reported physical and psychological health (all Ps > .05). In the postal survey, the questionnaires were returned 20 days earlier than in the mixed-mode survey (median 12 and 32 days, respectively; P < .001), whereas the response rate did not differ significantly (256/400, 64.0% versus 242/400, 60.5%, respectively; P = .30). The costs were lower for the mixed-mode survey (€2 per questionnaire). Moreover, there were fewer missing items (3.4% versus 4.4%, P = .002) and fewer invalid answers (3.2% versus 6.2%, P < .001) in the mixed-mode survey than in the postal survey. The answers of the two respondent groups on the global ratings did not differ. Within the mixed-mode survey, 52.9% (128/242) of the respondents filled out the questionnaire online. Respondents who filled out the questionnaire online were significantly younger (P < .001), were more often highly educated (P = .002), and reported better psychological health (P = .02) than respondents who filled out the paper questionnaire. Respondents to the paper questionnaire rated the nurses significantly more positively than respondents to the online questionnaire (score 9.2 versus 8.4, respectively; χ2 1 = 5.6).ConclusionsMixed-mode surveys are an alternative method to postal surveys that yield comparable response rates and groups of respondents, at lower costs. Moreover, quality of health care was not rated differently by respondents to the mixed-mode or postal survey. Researchers should consider using mixed-mode surveys in...

A cognitive-behavioral intervention on pocket-type computers appears feasible and efficacious for improving IBS-related complaints and cognitions in the short-term. The intervention group improved on several aspects, but most on catastrophizing thoughts, and these improvements even persisted after 3 months. Future studies should focus on unravelling the effective components of this innovative e-health intervention.

ObjectiveEvidence regarding the benefits of strong primary care has influenced health policy and practice. This study focuses on changes in the breadth of services provided by general practitioners (GPs) in Europe between 1993 and 2012 and offers possible explanations for these changes.DesignData on the breadth of service profiles were used from two cross-sectional surveys in 28 countries: the 1993 European GP Task Profile study (6321 GPs) and the 2012 QUALICOPC study (6044 GPs). GPs’ involvement in four areas of clinical activity (first contact care, treatment of diseases, medical procedures, and prevention) was established using ecometric analyses. The changes were measured by the relative increase in the breadth of service profiles. Associations between changes and national-level conditions were examined though regression analyses. Data on the national conditions were used from various other public databases including the World Databank and the PHAMEU (Primary Health care Activity Monitor) database.SettingA total of 28 European countries.SubjectsGPs.Main outcome measureChanges in the breadth of GP service profiles.ResultsA general trend of increased involvement of European GPs in treatment of diseases and decreased involvement in preventive activities was observed. Conditions at the national level were associated with changes in the involvement of GPs in first contact care, treatment of diseases and, to a limited extent, prevention. Especially in countries with stronger growth of health care expenditures between 1993 and 2012 the service profiles have expanded. In countries where family values are more dominant the breadth in service profiles decreased. A stronger professional status of GPs was positively associated with the change in first contact care.ConclusionsGPs in former communist countries and Turkey have increased their involvement in the provision of services. Developments in Western Europe were less evident. The developments in the service profiles could only to a very limited extent be explained by national conditions. A main driver of reform seems to be the changes in health care expenditure, which may indicate a notion of urgency because there may be a pressure to curb the rising expenditures. Key pointsBroad GP service profiles are an indicator of strong primary care in a country. It is expected that developments in the breadth of GP service profiles are influenced by various national conditions related to the urgency to reform, politics, and means.Between 1993 and 2012 the involvement of GPs in European countries in treatment of diseases increased and their involvement preventive activities decreased.The national conditions were found to be associated with changes in GPs’ involvement as first contact of care, treatment of diseases, and, to a limited extent, prevention.More specifically, in countries with a stronger growth in health care expenditures, service profiles of European GPs have expanded more in the past decades.