Laura M Curtis

Publications (2)5.96 Total impact

• Article: The Influence of Health Literacy on Comprehension of a Colonoscopy Preparation Information Leaflet.

  Samuel G Smith, Christian von Wagner, Lesley M McGregor, Laura M Curtis, Elizabeth A H Wilson, Marina Serper, Michael S Wolf
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  ABSTRACT: BACKGROUND:: Successful bowel preparation is important for safe, efficacious, cost-effective colonoscopy procedures; however, poor preparation is common. OBJECTIVE:: We sought to determine whether there was an association between health literacy and comprehension of typical written instructions on how to prepare for a colonoscopy to enable more targeted interventions in this area. DESIGN:: This is a cross-sectional observational study. SETTING:: This study was performed at primary care clinics and federally qualified health centers in Chicago, Illinois. PATIENTS:: Seven hundred sixty-four participants (mean age, 63 years; SD, 5.42) were recruited. The sample was from a mixed sociodemographic background, and 71.9% of the participants were classified as having adequate health literacy scores. INTERVENTION:: Seven hundred sixty-four participants were presented with an information leaflet outlining the bowel preparatory instructions for colonoscopy. MAIN OUTCOME MEASURES:: Five questions were used to assess participants' comprehension of the instructions in an "open book" test. RESULTS:: Comprehension scores on the bowel preparation items were low. The mean number of items correctly answered was 3.2 (SD, 1.2) of a possible 5. Comprehension scores overall and for each individual item differed significantly by health literacy level (all p < 0.001). After controlling for sex, age, race, socioeconomic status, and previous colonoscopy experience in a multivariable model, health literacy was a significant predictor of comprehension (inadequate vs adequate: β = -0.2; p < 0.001; marginal vs adequate: β = -0.2; p < 0.001). LIMITATIONS:: The outcome represents a simulated task and not actual comprehension of preparation instructions for participants' own recommended behavior. CONCLUSIONS:: Comprehension of a written colonoscopy preparation leaflet was generally low and significantly lower among people with low health literacy. Poor comprehension has implications for the safety and economic impact of gastroenterological procedures such as colonoscopy. Therefore, future interventions should aim to improve comprehension of complex medical information by reducing literacy-related barriers.
  Diseases of the Colon & Rectum 10/2012; 55(10):1074-1080. · 3.13 Impact Factor
• Article: Literacy, Cognitive Function, and Health: Results of the LitCog Study.

  Michael S Wolf, Laura M Curtis, Elizabeth A H Wilson, William Revelle, Katherine R Waite, Samuel G Smith, Sandra Weintraub, Beth Borosh, David N Rapp, Denise C Park, Ian C Deary, David W Baker
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  ABSTRACT: Emerging evidence suggests the relationship between health literacy and health outcomes could be explained by cognitive abilities. To investigate to what degree cognitive skills explain associations between health literacy, performance on common health tasks, and functional health status. Two face-to-face, structured interviews spaced a week apart with three health literacy assessments and a comprehensive cognitive battery measuring 'fluid' abilities necessary to learn and apply new information, and 'crystallized' abilities such as background knowledge. An academic general internal medicine practice and three federally qualified health centers in Chicago, Illinois. Eight hundred and eighty-two English-speaking adults ages 55 to 74. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), Test of Functional Health Literacy in Adults (TOFHLA), and Newest Vital Sign (NVS). Performance on common health tasks were globally assessed and categorized as 1) comprehending print information, 2) recalling spoken information, 3) recalling multimedia information, 4) dosing and organizing medication, and 5) healthcare problem-solving. Health literacy measures were strongly correlated with fluid and crystallized cognitive abilities (range: r = 0.57 to 0.77, all p < 0.001). Lower health literacy and weaker fluid and crystallized abilities were associated with poorer performance on healthcare tasks. In multivariable analyses, the association between health literacy and task performance was substantially reduced once fluid and crystallized cognitive abilities were entered into models (without cognitive abilities: β = -28.9, 95 % Confidence Interval (CI) -31.4 to -26.4, p; with cognitive abilities: β = -8.5, 95 % CI -10.9 to -6.0). Cross-sectional analyses, English-speaking, older adults only. The most common measures used in health literacy studies are detecting individual differences in cognitive abilities, which may predict one's capacity to engage in self-care and achieve desirable health outcomes. Future interventions should respond to all of the cognitive demands patients face in managing health, beyond reading and numeracy.
  Journal of General Internal Medicine 05/2012; 27(10):1300-7. · 2.83 Impact Factor