How health care systems can begin to address the challenge of limited literacy.

Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 09/2006; 21(8):884-7. DOI: 10.1111/j.1525-1497.2006.00544.x
Source: PubMed

ABSTRACT Conclusion The growing literacy and health literature calls attention to the ways in which the U.S. health care system is inadequate
and even unjust, not only for the estimated 90 million U.S. adults with limited literacy, but for many other users to the
system. We have presented 3 overarching principles for health system transformation that focus on promoting productive interactions
between patients and providers, reorganizing health care delivery, and embracing a community level and ecological perspective.
We believe that instituting such changes could improve the quality of care not only for patients with limited literacy, but
for all health care consumers, and could contribute to the development of a more “health literate” society.

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    ABSTRACT: Low health literacy is associated with worse glycemic control among patients with diabetes; the relationship between health literacy and blood glucose among patients without diagnosed diabetes, particularly in resource-limited settings, is not known. Because emergency department patients are at risk for both low health literacy and undiagnosed diabetes, we examined their relationships among emergency department patients at the Georgetown Public Hospital Corporation in Guyana. We conducted a cross-sectional study across random time blocks from May to August 2012 among Guyanese emergency department patients without a diagnosis of diabetes. Health literacy was assessed by the Single Item Literacy Screener (SILS, range 1-5); low health literacy was defined as SILS ≥ 3. We examined the relationships among health literacy, random blood glucose (RBG), and point-of-care glycated hemoglobin (HbA1c). Of the 228 enrolled patients, 125 (54%) were female, median age was 43 years (interquartile range 38 to 53), mean body mass index (BMI) was 25.6 kg/m(2) (standard deviation 6.8 kg/m(2)), and 103 (45.2%) had low health literacy. The receiver operating characteristic area under the curve for RBG to detect elevated HbA1c (≥48mmol/mol) was 0.94 (95% CI: 0.91-0.97). After adjustment for age, sex, BMI, ethnicity, and education, the odds of having HbA1c ≥ 48 mmol/mol, consistent with undiagnosed diabetes, rose with decreasing health literacy (OR 2.2, 95% CI 1.2-3.8, p = 0.007, per point decrease in literacy). This pilot study of Guyanese emergency department patients without diagnosed diabetes found that low health literacy was common and was associated with higher HbA1c and random blood glucose.
    Diabetology and Metabolic Syndrome 04/2015; 7:31. DOI:10.1186/s13098-015-0028-1
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    ABSTRACT: This thesis contributes to our understanding of the moral dimensions of using self-management technologies in general practice. Through qualitative interviews with general practitioners (GPs) and patients with experience in home blood pressure monitoring (HBPM) utilization, it examines the influences of HBPM on the general practitioner-patient relationship, patient responsibility for their health and patient autonomy. The first part of this thesis provides an account of the ethical implications of self-management technologies and their related practices for the doctor-patient relationship (DPR), patients’ responsibility for their health and patient autonomy. This account is contrasted with models of the DPR drawn from the bioethics and clinical literature, and with the conceptions of patient responsibility and patient autonomy that inform these models. Self-management technologies and their related practices have the potential to be more ethically robust than ordinary care. They may be able to influence patients’ health agency by promoting their cognitive and emotional abilities and, through this, change health outcomes for chronically-ill patients. However, there are a number of pertinent ethical issues concerning mutual trust in the DPR, patient responsibility and patient autonomy that need further empirical clarification. Building upon the theoretical material covered in the first part of the thesis, the second half describes an empirical study, which consisted of a series of interviews with GPs (n = 13) and patients (n = 19). HBPM was used as a case study for self-management technologies. The interviews focused on participants’ experiences with HBPM as a means to collect experiential narrative material relevant to answer the research questions. The findings are presented across two domains: the GP-patient relationship and patients’ responsibility for their health. GPs’ and patients’ views of these ethical notions are presented comparatively. Mutual trust in the DPR plays an important role in promoting patients’ motivation to maintain their health, which in turn, underpins all dimensions of patients’ responsibility for their health. In the final part of the thesis, these two themes from the empirical findings are drawn together with the theoretical material. I emphasize the significance of these findings for the bioethics literature concerning the DPR, patient responsibility and patient autonomy and for the conceptual base of self-management technologies. The implications of these conclusions for bioethics, general practice and public health are then considered.
    05/2012, Degree: PhD, Supervisor: Braunack-Mayer, Annette Joy Rogers, Wendy Anne Stocks, Nigel Phillip
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    ABSTRACT: Background Chronic disease is the leading global health threat and impairs patients’ health-related quality of life (HRQoL). Low health literacy is linked with chronic diseases prevalence and poor HRQoL. However, the interaction of health literacy with chronic disease on HRQoL remains unknown. Therefore, we examined how health literacy might modify the association between chronic disease and their HRQoL impacts. Methods We conducted a health survey of 913 poor rural women aged 23–57 years in Northwestern China. We assessed health literacy and HRQol using the revised Chinese Adult Health Literacy Questionnaire (R-CAHLQ) and Euroqol-5D (EQ-5D), respectively. Low health literacy was indicated by a cut-off of less than the mean of the factor score. Self-reported preexisting physician-diagnosed chronic disease and socio-demographic characteristics were also included. We fitted log-binomial regression models for each dimension of EQ-5D to examine its association with health literacy and chronic disease. We also ran linear regression models for EQ VAS scores and utility scores. Results The low health literacy group was 1.33 times more likely to have a chronic disease than the high health literacy group. Pain/discomfort was the most prevalent impairment, and was more common in the low health literacy group (PR [prevalence ratio] = 1.23; 95% CI = 1.01, 1.50). Chronic disease strongly predicted impairments in all the EQ-5D dimensions, with PRs ranging from 2.14 to 4.07. The association between chronic disease and pain/discomfort varied by health literacy level (health literacy × chronic disease: P = 0.033), and was less pronounced in the low health literacy group (PR = 2.15; 95% CI = 1.76, 2.64) than in the high health literacy group (PR = 3.19; 95% CI = 2.52, 4.05). The low health literacy group had lower VAS scores and utility scores, and slightly less decrement of VAS scores and utility scores associated with chronic disease. Conclusions Health literacy modified the impacts of chronic disease on HRQoL, and low health literacy group reported less HRQoL impacts related to chronic disease. Research should address health literacy issues as well as root causes of health disparities for vulnerable populations.
    BMC Women's Health 04/2015; 15. DOI:10.1186/s12905-015-0190-5

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