The Effectiveness of Self-Management Interventions for Individuals with Low Health Literacy and/or Low Income: A Descriptive Systematic Review

Schaffler, Jamie; Leung, Katerina; Tremblay, Sarah; Merdsoy, Laura; Belzile, Éric; Lambrou, Angella; Lambert, Sylvie

doi:10.1007/s11606-017-4265-x

Cited by 72 publications

(76 citation statements)

References 64 publications

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“…Often this involves strategies such as using simple language and images, and breaking information down into smaller, more manageable amounts [ 7 ]. However, little emphasis is placed on reducing the cognitive demand of behaviour change strategies that promote actions such as planning, self-monitoring, and problem solving [ 8 , 9 ]. This represents an important research gap, particularly in the context of chronic conditions (including diabetes), as strategies that promote action play a key role in self-management behaviours such as healthy eating and physical activity [ 10 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of health literacy, screening, and participant choice on action plans for reducing unhealthy snacking in Australia: A randomised controlled trial

et al. 2020

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Background Low health literacy is associated with poorer health outcomes. A key strategy to address health literacy is a universal precautions approach, which recommends using health-literate design for all health interventions, not just those targeting people with low health literacy. This approach has advantages: Health literacy assessment and tailoring are not required. However, action plans may be more effective when tailored by health literacy. This study evaluated the impact of health literacy and action plan type on unhealthy snacking for people who have high BMI or type 2 diabetes (Aim 1) and the most effective method of action plan allocation (Aim 2). Methods and findings We performed a 2-stage randomised controlled trial in Australia between 14 February and 6 June 2019. In total, 1,769 participants (mean age: 49.8 years [SD = 11.7]; 56.1% female [ n = 992]; mean BMI: 32.9 kg/m 2 [SD = 8.7]; 29.6% self-reported type 2 diabetes [ n = 523]) were randomised to 1 of 3 allocation methods (random, health literacy screening, or participant selection) and 1 of 2 action plans to reduce unhealthy snacking (standard versus literacy-sensitive). Regression analysis evaluated the impact of health literacy (Newest Vital Sign [NVS]), allocation method, and action plan on reduction in self-reported serves of unhealthy snacks (primary outcome) at 4-week follow-up. Secondary outcomes were perceived extent of unhealthy snacking, difficulty using the plans, habit strength, and action control. Analyses controlled for age, level of education, language spoken at home, diabetes status, baseline habit strength, and baseline self-reported serves of unhealthy snacks. Average NVS score was 3.6 out of 6 (SD = 2.0). Participants reported consuming 25.0 serves of snacks on average per week at baseline (SD = 28.0). Regarding Aim 1, 398 participants in the random allocation arm completed follow-up (67.7%). On average, people scoring 1 SD below the mean for health literacy consumed 10.0 fewer serves per week using the literacy-sensitive action plan compared to the standard action plan (95% CI: 0.05 to 19.5; p = 0.039), whereas those scoring 1 SD above the mean consumed 3.0 fewer serves using the standard action plan compared to the literacy-sensitive action plan (95% CI: −6.3 to 12.2; p = 0.529), although this difference did not reach statistical significance. In addition, we observed a non-significant action plan × health literacy (NVS) interaction ( b = −3.25; 95% CI: −6.55 to 0.05; p = 0.054). Regarding Aim 2, 1,177 participants across the 3 allocation method arms completed follow-up (66.5%). There was no effect of allocation method on reduction of unhealthy snacking, including no effect of health literacy screening compared to participant selection ( b = 1.79; 95% CI: −0.16 ...

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Section: Introductionmentioning

confidence: 99%

Effects of health literacy, screening, and participant choice on action plans for reducing unhealthy snacking in Australia: A randomised controlled trial

et al. 2020

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“…Yet special attention must be taken to safeguard the validity of the original model. To account for patient's low literacy levels and to improve comprehension, the content should include examples, shorter questions, and brief definitions of the central MCP concepts [41,42].…”

Section: Discussionmentioning

confidence: 99%

Cultural Adaptation and Open Pilot of Meaning-Centered Psychotherapy for Puerto Rican Patients with Advanced Cancer

Torres-Blasco¹,

Castro-Figuero²,

Garduño-Ortega³

et al. 2020

SJEDU

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In Puerto Rico, cancer incidence increases significantly, and is accompanied with a greater risk of experiencing high levels of depressive symptoms, emotional distress, and reduced quality of life when compared to other minority ethnic groups. Studies suggest that interventions to attend distress in Latino patient population would benefit from including components that seek to improve patients' spiritual well-being. The purpose of this study is to identify the level of comprehension and acceptance of Meaning-Centered Psychotherapy (MCP) concepts. A mixed method design was conducted with in-depth interviews and open pilot data. A total of nine participants with advanced or metastatic cancer were sampled from an Oncology Clinic in the south of Puerto Rico. Six semi-structured interviews and six ethnographic notes with audiotape sessions were selected and transcribed. All material was analyzed, resulting in a sample of six semi-structured interview and six ethnographic note peer sessions. Patients showed low comprehension of the MCP concepts of meaning, the finite, and legacy. Patients showed low acceptance of death and its related concepts. They also reported high acceptance of integrating family members to their therapy. In order to tailor the intervention and improve comprehension, the content should include examples, shorter questions, and brief definitions. Additionally, there is a need to address death and its related concepts in end of life.

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“…Constraints on the actions triggered by people's digital medical gaze can be related to their gender, race (Lewis 2006), income and education levels (Yeo 2016), confidence in digital and health literacy skills (Schaffler et al 2018), or, most likely, a combination of all of these factors. 14 This is because mHealth tools do not operate in a vacuum.…”

Section: Doomed To Failmentioning

confidence: 99%

The Limits of Empowerment: How to Reframe the Role of mHealth Tools in the Healthcare Ecosystem

Morley

Floridi

2019

Sci Eng Ethics

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This article highlights the limitations of the tendency to frame health-and wellbeing-related digital tools (mHealth technologies) as empowering devices, especially as they play an increasingly important role in the National Health Service (NHS) in the UK. It argues that mHealth technologies should instead be framed as digital companions. This shift from empowerment to companionship is advocated by showing the conceptual, ethical, and methodological issues challenging the narrative of empowerment, and by arguing that such challenges, as well as the risk of medical paternalism, can be overcome by focusing on the potential for mHealth tools to mediate the relationship between recipients of clinical advice and givers of clinical advice, in ways that allow for contextual flexibility in the balance between patiency and agency. The article concludes by stressing that reframing the narrative cannot be the only means for avoiding harm caused to the NHS as a healthcare system by the introduction of mHealth tools. Future discussion will be needed on the overarching role of responsible design.

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The Effectiveness of Self-Management Interventions for Individuals with Low Health Literacy and/or Low Income: A Descriptive Systematic Review

Cited by 72 publications

References 64 publications

Effects of health literacy, screening, and participant choice on action plans for reducing unhealthy snacking in Australia: A randomised controlled trial

Effects of health literacy, screening, and participant choice on action plans for reducing unhealthy snacking in Australia: A randomised controlled trial

Cultural Adaptation and Open Pilot of Meaning-Centered Psychotherapy for Puerto Rican Patients with Advanced Cancer

The Limits of Empowerment: How to Reframe the Role of mHealth Tools in the Healthcare Ecosystem

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