Screening for Low Literacy in a Rheumatology Setting

Swearingen, Christopher J.; McCollum, Lauren; Daltroy, Lawren H.; Pincus, Theodore; DeWalt, Darren A.; Davis, Terry C.

doi:10.1097/rhu.0b013e3181fe8ab1

Cited by 30 publications

(21 citation statements)

References 31 publications

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“…The reported reliability was generally strong across most measures (Cronbach’s a or KR-20 = 0.70–0.98), with the exception of a few measures [64,65,81,107]. Eleven measures did not report reliability [22,38,58,69,79,99,100,112–115]. …”

Section: Resultsmentioning

confidence: 98%

“…While it makes intuitive sense that HL can be influenced by content/context, empirical data on the validity of content/context-specific HL measures are weak. For example, the TOFHLiD was no better at predicting dental health outcomes than was the TOFHLA [74], and the use of the REALM and REALM-Arthritis resulted in similar findings—neither was associated with physical functioning in the context of arthritis, erythrocyte sedimentation rate or pain [79]. These results have led some to suggest that we should increase the use of general HL measures, such as the REALM, rather than developing additional content/context-specific HL measures [79].…”

Section: Discussionmentioning

confidence: 99%

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State of the science of health literacy measures: Validity implications for minority populations

Nguyen

Park

Han

et al. 2015

Patient Education and Counseling

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Objectives To review the evidence supporting the validity of health literacy (HL) measures for ethnic minority populations. Methods PubMed, CINAHL, and PsycINFO databases were searched for HL measures between 1965 and 2013. Results A total of 109HL measures were identified; 37 were non-English HL measures and 72 were English language measures. Of the 72 English language measures, 17 did not specify the racial/ethnic characteristic of their sample. Of the remaining 55 measures, 10 (18%) did not include blacks, 30 (55%) did not include Hispanics, and 35 (64%) did not include Asians in their validation sample. When Hispanic and Asian Americans were included, they accounted for small percentages in the overall sample. Between 2005–2013, a growing number of REALM and TOFHLA translations were identified, and new HL measures for specific cultural/linguistic groups within and outside the United States were developed. Conclusions While there are a growing number of new and translated HL measures for minority populations, many existing HL measures have not been properly validated for minority groups. Practice Implications HL measures that have not been properly validated for a given population should be piloted before wider use. In addition, improving HL instrument development/validation methods are imperative to increase the validity of these measures for minority populations.

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Section: Resultsmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

State of the science of health literacy measures: Validity implications for minority populations

Nguyen

Park

Han

et al. 2015

Patient Education and Counseling

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“…[12], [13], [14], [15], [16], [17], [18], [19], [20] Due to significant heterogeneity of study design, participants, and outcome measures, the individual studies were compared in a narrative manner (Tables 1 and 2). …”

Section: Resultsmentioning

confidence: 99%

Impact of Health Literacy in Patients with Chronic Musculoskeletal Disease–Systematic Review

et al. 2012

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ObjectivesTo estimate the prevalence of low health literacy, and evaluate the impact of low health literacy on outcomes in patients with chronic musculoskeletal conditions.Data SourcesWe searched Embase, Pubmed, PsycInfo, and CINAHL in January 2011 for relevant studies, restricted to English-language articles.Study Selection and Data ExtractionStudies were included if they measured health literacy and/or reported on the link between outcomes and health literacy levels in patients with osteoporosis, osteoarthritis, or rheumatoid arthritis. We assessed risk of bias from participant selection, methods of measuring health literacy and functional outcomes, missing data, and potential for confounding.Data SynthesisWe reviewed 1863 citations and judged 8 studies to be relevant. Most were cross-sectional in nature, and five were based in the United States. Diversity in measurements, participant characteristics, and settings meant that results had to be synthesized narratively. Prevalence of low health literacy varied from 7% to 42%. Of the five studies that reported on musculoskeletal outcomes, only one showed an association (unadjusted) between low health literacy and greater pain and limitations in physical functioning. However, other studies, including those with multivariate analyses, found no significant relationship between health literacy and measures of pain or disease specific questionnaires. One clinical trial found short-term improvements in the mental health of patients with musculoskeletal conditions after an intervention to improve health literacy.LimitationsMost of the studies were cross-sectional in nature, which precludes interpretation of a causal relationship. The sample sizes may not have been sufficiently large to enable detection of significant associations.ConclusionsThe current evidence does not show a consistent association between low health literacy and poorer functional outcomes in patients with chronic musculoskeletal conditions. In the absence of a definite link, efforts to develop interventions to improve health literacy would not necessarily improve health service or patient-related outcomes.

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“…Health literacy refers to “ the wide range of skills, and competencies that people develop to seek out, comprehend, evaluate and use health information and concepts to make informed choices, reduce health risks and increase quality of life ” [18]. It is one aspect of health decision-making, and although low literacy is associated with low health literacy, the two are not interchangeable [19]. Even before capacity is diminished, basic health literacy may be affected through mechanisms such as poor attention and memory as well as reduced language and reasoning skills.…”

Section: Discussionmentioning

confidence: 99%

Cognition in chronic kidney disease: a systematic review and meta-analysis

Berger

Masson

et al. 2016

BMC Med

163

143

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BackgroundCognitive impairment is common in people with chronic kidney disease (CKD) and associated with increased morbidity and mortality. Subtle changes can impact engagement with healthcare, comprehension, decision-making, and medication adherence. We aimed to systematically summarise evidence of cognitive changes in CKD.MethodsWe searched MEDLINE (March 2016) for cross-sectional, cohort or randomised studies that measured cognitive function in people with CKD (PROSPERO, registration number CRD42014015226). The CKD population included people with eGFR < 60 mL/min/1.73 m2, not receiving renal replacement therapy, in any research setting. We conducted a meta-analysis using random effects, expressed as standardised mean differences (SMD) with 95% confidence intervals (CI). Outcomes were performance in eight cognitive domains. Bias was assessed with the Newcastle-Ottawa Scale (NOS).ResultsWe identified 44 studies reporting sufficient data for synthesis (51,575 participants). Mean NOS score for cohort studies was 5.8/9 and for cross-sectional 5.4/10. Studies were deficient in NOS outcome and selection due to poor methods reporting and in comparison group validity of demographics and chronic disease status. CKD patients (eGFR < 60 mL/min/1.73 m2) performed worse than control groups (eGFR ≥ 60 mL/min/1.73 m2) on Orientation & Attention (SMD –0.79, 95% CI, –1.44 to –0.13), Language (SMD –0.63, 95% CI, –0.85 to –0.41), Concept Formation & Reasoning (SMD –0.63, 95% CI, –1.07 to –0.18), Executive Function (SMD –0.53, 95% CI, –0.85 to –0.21), Memory (SMD –0.48, 95% CI, –0.79 to –0.18), and Global Cognition (SMD –0.48, 95% CI, –0.72 to –0.24). Construction & Motor Praxis and Perception were unaffected (SMD –0.29, 95% CI, –0.90 to 0.32; SMD –1.12, 95% CI, –4.35 to 2.12). Language scores dropped with eGFR (<45 mL/min/1.73 m2 SMD –0.86, 95% CI, –1.25 to –46; 30 mL/min/1.73 m2 SMD –1.56, 95% CI, –2.27 to –0.84). Differences in Orientation & Attention were greatest at eGFR < 45 mL/min/1.73 m2 (SMD –4.62, 95% CI, –4.68 to –4.55). Concept Formation & Reasoning differences were greatest at eGFR < 45 mL/min/1.73 m2 (SMD –4.27, 95% CI, –4.23 to –4.27). Differences in Executive Functions were greatest at eGFR < 30 mL/min/1.73 m2 (SMD –0.54, 95% CI, –1.00 to –0.08).ConclusionsCognitive changes occur early in CKD, and skills decline at different rates. Orientation & Attention and Language are particularly affected. The cognitive impact of CKD is likely to diminish patients’ capacity to engage with healthcare decisions. An individual’s cognitive trajectory may deviate from average.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-016-0745-9) contains supplementary material, which is available to authorized users.

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Screening for Low Literacy in a Rheumatology Setting

Abstract: Low literacy is an important underrecognized problem in medical care, which may be assessed easily in standard care using the REALM or A-REALM. Further attention to literacy-associated barriers may reduce socioeconomic disparities in health.

Cited by 30 publications

References 31 publications

State of the science of health literacy measures: Validity implications for minority populations

State of the science of health literacy measures: Validity implications for minority populations

Impact of Health Literacy in Patients with Chronic Musculoskeletal Disease–Systematic Review

Cognition in chronic kidney disease: a systematic review and meta-analysis

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