Abilities, skills and knowledge in measures of health literacy

Ownby, Raymond L.; Acevedo, Amarilis; Waldrop‐Valverde, Drenna; Jacobs, Robin J.; Caballero, Joshua

doi:10.1016/j.pec.2014.02.002

Cited by 55 publications

(68 citation statements)

References 45 publications

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“…Further, performance-based and self-reported measures may interact differently with measures of cognition, a proposed driver of limited health literacy in certain populations. [40][41][42] One final possible explanation is differentially aligned cutoffs for performance (Table 1). There is currently a lack of consensus on how high or low self-reported literacy and numeracy relate to performance-based cutoffs.…”

Section: Discussionmentioning

confidence: 99%

Different Measures, Different Outcomes? A Systematic Review of Performance-Based versus Self-Reported Measures of Health Literacy and Numeracy

Kiechle¹,

Bailey

Hedlund³

et al. 2015

J GEN INTERN MED

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BACKGROUND: Health literacy (HL) and numeracy are measured by one of two methods: performance on objective tests or self-report of one's skills. Whether results from these methods differ in their relationship to health outcomes or use of health services is unknown. METHODS: We performed a systematic review to identify and evaluate articles that measured both performancebased and self-reported HL or numeracy and examined their relationship to health outcomes or health service use. To identify studies, we started with an AHRQfunded systematic review of HL and health outcomes. We then looked for newer studies by searching MEDLINE from 1 February 2010 to 9 December 2014. We included English language studies meeting pre-specified criteria. Two reviewers independently assessed abstracts and studies for inclusion and graded study quality. One reviewer abstracted information from included studies while a second checked content for accuracy. RESULTS: We identified four Bfair^quality studies that met inclusion criteria for our review. Two studies measuring HL found no differences between performance-based and self-reported HL for association with self-reported outcomes (including diabetes, stroke, hypertension) or a physician-completed rheumatoid arthritis disease activity score. However, HL measures were differentially related to a patientcompleted health assessment questionnaire and to a patient's ability to interpret their prescription medication name and dose from a medication bottle. Only one study measured numeracy and found no difference between performance-based and self-reported measures of numeracy and colorectal cancer (CRC) screening utilization. However, in a moderator analysis from the same study, performance-based and self-reported numeracy were differentially related to CRC screening utilization when stratified by certain patient-provider communication behaviors (e.g., the chance to always ask questions and get the support that is needed). DISCUSSION: Most studies found no difference in the relationship between results of performance-based and self-reported measures and outcomes. However, we identified few studies using multiple instruments and/or objective outcomes.

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Section: Discussionmentioning

confidence: 99%

Different Measures, Different Outcomes? A Systematic Review of Performance-Based versus Self-Reported Measures of Health Literacy and Numeracy

Kiechle¹,

Bailey

Hedlund³

et al. 2015

J GEN INTERN MED

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“…34 Increasing information-management skills and patientprovider interactions may improve health literacy in older adults, 35 and health care professionals may need to spend more time with older patients with low health literacy for both information dissemination and information skills training. The concept of health literacy involves an array of cognitive, social, and personal skills, abilities, and knowledge necessary to successfully navigate the health care system and manage one's own health challenges.…”

Section: Active Cognitive Training Intervention and Health Literacymentioning

confidence: 99%

Health literacy, sociodemographic factors, and cognitive training in the active study of older adults

Verney

Gibbons

Dmitrieva

et al. 2019

Int J Geriat Psychiatry

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Objective Health literacy is critical for understanding information from health‐care providers and correct use of medications and includes the capacity to filter other information in navigating health care systems. Older adults with low health literacy exhibit more chronic health conditions, worse physical functioning, and poorer mental health. This study examined the relationship between sociodemographic variables and health literacy, and the impact of cognitive training on change in health literacy over 10 years in older adults. Methods Participants (N = 2,802) aged 65 years and older completed assessments, including reading and numeracy health literacy items, as part of the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study. We evaluated baseline sociodemographic variables and change in health literacy over a 10‐year period in individuals exposed to cognitive training in reasoning, processing speed, memory, or a no‐contact control condition. Results Age, sex, race, education level, and general cognitive functioning at baseline were all associated with baseline health literacy in older adults. Predictors of change in health literacy over the 10‐year follow‐up were age, race, education level, general cognitive functioning, and neighborhood income; disparities in health literacy because of race attenuated over time, while the effect of age increased over time. Health literacy was generally stable across the ACTIVE intervention groups over 10 years. Conclusions The present study showed important disparities in health literacy level and change over 10 years. Cognitive training did not significantly impact health literacy, suggesting that alternative approaches are needed to reduce the disparities.

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“…Analyses showed that the magnitude of the intervention’s effect was related to a patient’s baseline level of adherence but averaged an increase of 10% [45] in patients with baseline adherence less than 85%, similar to the increase obtained in a study of a similar intervention among elderly patients with memory impairments [46]. Participants with low levels of adherence at baseline showed greater increases in adherence than those with higher baseline levels.…”

Section: Methodsmentioning

confidence: 79%

Cost effectiveness of a computer-delivered intervention to improve HIV medication adherence

Ownby

Waldrop‐Valverde

Jacobs

et al. 2013

BMC Med Inform Decis Mak

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BackgroundHigh levels of adherence to medications for HIV infection are essential for optimal clinical outcomes and to reduce viral transmission, but many patients do not achieve required levels. Clinician-delivered interventions can improve patients’ adherence, but usually require substantial effort by trained individuals and may not be widely available. Computer-delivered interventions can address this problem by reducing required staff time for delivery and by making the interventions widely available via the Internet. We previously developed a computer-delivered intervention designed to improve patients’ level of health literacy as a strategy to improve their HIV medication adherence. The intervention was shown to increase patients’ adherence, but it was not clear that the benefits resulting from the increase in adherence could justify the costs of developing and deploying the intervention. The purpose of this study was to evaluate the relation of development and deployment costs to the effectiveness of the intervention.MethodsCosts of intervention development were drawn from accounting reports for the grant under which its development was supported, adjusted for costs primarily resulting from the project’s research purpose. Effectiveness of the intervention was drawn from results of the parent study. The relation of the intervention’s effects to changes in health status, expressed as utilities, was also evaluated in order to assess the net cost of the intervention in terms of quality adjusted life years (QALYs). Sensitivity analyses evaluated ranges of possible intervention effectiveness and durations of its effects, and costs were evaluated over several deployment scenarios.ResultsThe intervention’s cost effectiveness depends largely on the number of persons using it and the duration of its effectiveness. Even with modest effects for a small number of patients the intervention was associated with net cost savings in some scenarios and for durations greater than three months and longer it was usually associated with a favorable cost per QALY. For intermediate and larger assumed effects and longer durations of intervention effectiveness, the intervention was associated with net cost savings.ConclusionsComputer-delivered adherence interventions may be a cost-effective strategy to improve adherence in persons treated for HIV.Trial registrationClinicaltrials.gov identifier NCT01304186.

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Abilities, skills and knowledge in measures of health literacy

Cited by 55 publications

References 45 publications

Different Measures, Different Outcomes? A Systematic Review of Performance-Based versus Self-Reported Measures of Health Literacy and Numeracy

Different Measures, Different Outcomes? A Systematic Review of Performance-Based versus Self-Reported Measures of Health Literacy and Numeracy

Health literacy, sociodemographic factors, and cognitive training in the active study of older adults

Cost effectiveness of a computer-delivered intervention to improve HIV medication adherence

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