Health Literacy and Education as Mediators of Racial Disparities in Patient Activation Within an Elderly Patient Cohort

Eneanya, Nwamaka D.; Winter, Michael; Cabral, Howard; Waite, Katherine; Henault, Lori; Bickmore, Timothy; Hanchate, Amresh; Wolf, Michael S.; Paasche‐Orlow, Michael K.

doi:10.1353/hpu.2016.0133

Cited by 47 publications

(38 citation statements)

References 49 publications

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“…Additionally, although we did not assess health literacy, in prior evaluations of internal medicine and geriatric populations, the relationship between race and patient activation was significantly mediated by education and health literacy. 38,39 Our study was large, including a cohort of patients with self-reported UC or CD and careful methodology that has been utilized in numerous other studies within IBD Partners. 17-19, 28, 29 However, our study also has limitations.…”

Section: Discussionmentioning

confidence: 99%

High Patient Activation Is Associated With Remission in Patients With Inflammatory Bowel Disease

Barnes

Long

Kappelman

et al. 2018

Inflammatory Bowel Diseases

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Background High levels of patient activation (having the knowledge, skills, and confidence to effectively manage one’s care), have been associated with improved outcomes in many chronic conditions. There have been few studies of the effects of activation in patients with inflammatory bowel disease (IBD). We performed a large, prospective Internet-based study to assess the relationship between patient activation level and clinical remission in patients with Crohn’s disease or ulcerative colitis. Methods We administered the Patient Activation Measure (Insignia Health) to 1486 cohort participants. Patients completed a follow-up survey within 13 months (median, 189 days). We collected demographic and clinical data; anxiety and depression were assessed using Patient-Reported Outcomes Measurement Information System instruments. We used bivariate analyses and multivariable logistic regression to identify characteristics associated with low or high patient activation and to evaluate the association between levels of patient activation and subsequent disease activity. Results Higher anxiety (adjusted odds ratio [aOR], 0.32; 95% confidence interval [CI], 0.29–0.36) and depression (aOR, 0.33; 95% CI, 0.29–0.37) scores were associated with a decreased odds of high patient activation. After we adjusted for education status, smoking, medication use, and other confounders, we found that patients with high activation at baseline were more likely to be in clinical remission during the follow-up period (aOR, 1.71; 95% CI, 1.20–2.45). Conclusions In a large, prospective Internet-based cohort of patients with IBD, we found a strong association between patient activation and clinical remission. These findings suggest that patient activation affects disease outcomes.

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Section: Discussionmentioning

confidence: 99%

High Patient Activation Is Associated With Remission in Patients With Inflammatory Bowel Disease

Barnes

Long

Kappelman

et al. 2018

Inflammatory Bowel Diseases

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“…Participants also expressed support for the ideas that patient involvement and high levels of health literacy are necessary in illness management and that knowledge is needed to guarantee patient involvement (Liu et al., ). These may be important precursors to improved preventative and therapeutic self‐management behaviour (Eneanya et al., ). Supporting these findings, prior studies have found that though the level of people's education may not rise as they get older, their health literacy may improve due to social interactions and meetings with professionals (Bostock & Steptoe, ; Tennant et al., ).…”

Section: Discussionmentioning

confidence: 99%

A qualitative inquiry of old people's health literacy in situations of health uncertainty

Matas

Bronstein

2018

Health Info Libraries J

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Background This paper examines the health literacy of seniors and the strategies they use to deal with health uncertainty in the context of changes in the health system in Israel that have created a need to examine health literacy in this sector of the population who use the health system the most. The oldest were born and grew up in an era when a physician's knowledge was unchallenged; now, they find it difficult to cope with the expectation of patients taking a role in decision making. Methods In‐depth interviews were carried out with 17 seniors between the ages of 70–87 that focused on their perception of their health and their health literacy. Data were analysed using thematic analysis. Findings Seniors used different information sources when looking for medical information. Participants reported three coping mechanisms that help them deal with the uncertainty: disregarding the problem, relying on the physician and searching for information. Conclusions The study found different levels of health literacy among participants but, overall, participants who lead an active and optimistic lifestyle tend to take more responsibility for their health and have higher health information literacy.

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“…16 Enhancing patient activation and self-care by strengthening therapeutic alliance could be an important strategy to mitigate racial/ethnic disparities in hemodialysis treatment adherence and improve overall outcomes for patients with ESKD. 17 Despite the substantial evidence of reduced hemodialysis treatment adherence among Blacks, no report to our knowledge has systematically reviewed the hemodialysis treatmentadherence literature specifically on Blacks to garner input that will inform clinical practice and research. Nor do there appear to be any reports that have undertaken an assessment of the application of theoretical frameworks or the inclusion of therapeutic alliance to enhance the success of interventions targeting improvement in hemodialysis treatment adherence.…”

Section: Introductionmentioning

confidence: 99%

<p>Interventions Incorporating Therapeutic Alliance to Improve Hemodialysis Treatment Adherence in Black Patients with End-Stage Kidney Disease (ESKD) in the United States: A Systematic Review</p>

Blumrosen¹,

Desta²,

Cavanaugh³

et al. 2020

PPA

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Background: In the US, Blacks with end-stage kidney disease (ESKD) have a four-fold higher prevalence rate of hemodialysis treatment and higher subsequent rates of hemodialysis treatment nonadherence and hospitalization compared to their White peers. Nonadherence to prescribed dialysis therapy is an underestimated life-threatening behavior, because of its association with increased morbidity and mortality. Few studies have specified and systematically evaluated targeted methods of increasing hemodialysis treatment adherence among Black hemodialysis patients with added focus on therapeutic alliance, a rewarding patient-centered relationship between patients and providers, based on common goals and objectives. This review seeks to evaluate the state of the science to determine the salience of a therapeutic alliance for the development of effective interventions positively impacting hemodialysis treatment adherence among Black patients. Methods: Medline (via PubMed), Embase (OvidSP), Cumulative Index of Nursing and Allied Health Literature (CINAHL; EBSCOhost), and PsycInfo (ProQuest) databases were used to search for abstracts with the keywords "dialysis", "therapeutic alliance", and "treatment adherence and compliance", including all underlying index terms and alternative variations of terms, in order to cover the entire scope of the field. Only randomized clinical trials and pre/postintervention studies published in the previous 10 years (2009-2019) and including a proportion of Black patients >25% were included for review. Results: Only three intervention studies met these criteria, for a total aggregated sample of 130-mean age 58.1 years and 53% female. None of these studies was composed exclusively of Black patients (range 62%-91.3%), nor did they present data specifically for Blacks. Despite the lack of robust data informing strategies to improve hemodialysis adherence among Blacks with ESRD, a limited number of intervention studies have reported positive effects on hemodialysis attendance. Discussion/Conclusion: Further research is warranted to fill this significant gap in our understanding of theoretically based, therapeutic alliance-enhanced, and culturally tailored hemodialysis treatment-adherence interventions among Blacks.

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Health Literacy and Education as Mediators of Racial Disparities in Patient Activation Within an Elderly Patient Cohort

Cited by 47 publications

References 49 publications

High Patient Activation Is Associated With Remission in Patients With Inflammatory Bowel Disease

High Patient Activation Is Associated With Remission in Patients With Inflammatory Bowel Disease

A qualitative inquiry of old people's health literacy in situations of health uncertainty

<p>Interventions Incorporating Therapeutic Alliance to Improve Hemodialysis Treatment Adherence in Black Patients with End-Stage Kidney Disease (ESKD) in the United States: A Systematic Review</p>

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