Russell L Rothman

Russell L Rothman
Vanderbilt University | Vander Bilt · Department of Internal Medicine

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93
Publications
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Publications

Publications (93)
Article
Full-text available
Background Validation studies of existing health literacy or numeracy tools among racial/ethnic minorities are limited. Objective This study assessed the validity of the Subjective Numeracy Scale (SNS), the Diabetes Numeracy Test (DNT-5), the Brief Health Literacy Screen (BHLS), and the Short Test of Functional Health Literacy in Adults (S-TOFHLA)...
Article
Patient–provider communication is modifiable and is linked to diabetes outcomes. The association of communication quality with medical mistrust is unknown. We examined these factors within the context of a low-literacy/numeracy-focused intervention to improve diabetes care, using baseline data from diverse patients enrolled in a randomized trial of...
Article
Objective: Child sleep problems are prevalent and have been linked to poor behavior, worse school performance, and obesity. Low health literacy (HL) is associated with suboptimal parenting practices and worse health outcomes, but the relationship between parent HL and child sleep-related issues is not known. We examined the association between par...
Article
Food insecurity is the 'limited or uncertain availability of nutritionally adequate and safe foods'. Our objective was to examine the association between food insecurity, diabetes self-care and glycaemic control. We conducted a cross-sectional analysis of baseline data from adult patients with Type 2 diabetes who were enrolled in a randomized trial...
Article
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Health literacy impacts health outcomes. However, the relationship to blood pressure is inconsistent. This study aimed to determine whether health literacy, assessed by clinic staff, is associated with blood pressure among patients with hypertension. The design was a cross-sectional study of a large sample of primary care patient encounters in 3 ac...
Article
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Background: Hispanics with diabetes often have deficits in health literacy (HL). We examined the association among HL, psychosocial factors, and diabetes-related self-care activities. Methods: Cross-sectional analysis of 149 patients. Data included patient demographics and validated measures of HL, physician trust, self-efficacy, acculturation,...
Article
This cross sectional study examined the relationship between parental health literacy (HL), diabetes related numeracy, and parental perceived diabetes self-efficacy on glycemic control in a sample of young children with Type 1 DM. Seventy primary caregivers of children (age 3-9 years) with Type 1 DM were recruited and surveyed at diabetes outpatien...
Article
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The three-item Brief Health Literacy Screen (BHLS) has been validated in research settings, but not in routine practice, administered by clinical personnel. As part of the Health Literacy Screening (HEALS) study, we evaluated psychometric properties of the BHLS to validate its administration by clinical nurses in both clinic and hospital settings....
Article
There is currently a lack of valid instruments to measure adolescent diabetes numeracy. The Diabetes Numeracy Test (DNT) was adapted for type 1 diabetes and was administered to 2 samples of adolescents. Sample 1 was administered the 39-item version of the DNT (DNT-39) with measures of self-management, responsibility, reading, and glycemic control (...
Article
Background: Limited research exists on physician-delivered education interventions. We examined the feasibility and impact of an educational tool on facilitating physician-patient kidney disease communication. Study design: Pilot feasibility clinical trial with a historical control to examine effect size on patient knowledge and structured quest...
Article
OBJECTIVE: Because existing numeracy measures may not optimally assess 'health numeracy', we developed and validated the General Health Numeracy Test (GHNT). METHODS: An iterative pilot testing process produced 21 GHNT items that were administered to 205 patients along with validated measures of health literacy, objective numeracy, subjective numer...
Article
PurposeThe purpose of this study is to describe the association between numeracy and self-reported dietary intake in patients with type 2 diabetes.Methods Numeracy and dietary intake were assessed with the validated Diabetes Numeracy Test and a validated food frequency questionnaire in a cross-sectional study of 150 primary care patients enrolled i...
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The relationship between HIV knowledge and HIV-related behaviors in settings like Mozambique has been limited by a lack of rigorously validated measures. A convenience sample of women seeking prenatal care at two clinics were administered an adapted, orally-administered, 27 item HIV-knowledge scale, the HK-27. Validation analyses were stratified by...
Conference Paper
Background: Mothers with limited literacy skills are more likely to have depressive symptoms; interventions that increase maternal literacy skills may also improve symptoms of depression, and associations are recognized between low health literacy and adverse health outcomes, yet research has yet to be conducted in a large sample of mothers of newb...
Conference Paper
Purpose : The CDC’s Healthy People 2020 has prioritized two postpartum outcomes: breastfeeding promotion and early screening and treatment of depression. Reviews have identified low health literacy (HL), which affects at least 1 in 4 women, as an independent risk factor for non-breastfeeding and depressive symptoms (Sanders 2009; Kaufman 2001). Pos...
Article
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To assess parental attitudes towards type 1 diabetes clinical trials (T1DCTs) and factors that impact willingness to enroll their children with and without diabetes. A cross-sectional survey of parents of children with type 1 diabetes was administered at an academic clinic and a diabetes educational event. Survey response rate was 36%. Of 166 parti...
Article
Full-text available
Limited literacy skills are common in the United States (US) and are related to lower HIV knowledge and worse health behaviors and outcomes. The extent of these associations is unknown in countries like Mozambique, where no rigorously validated literacy and numeracy measures exist. A validated measure of literacy and numeracy, the Wide Range Achiev...
Article
Early infant diagnosis (EID) is the first step in HIV care, yet 75% of HIV-exposed infants born at 2 hospitals in Mozambique failed to access EID. Before/after study. Two district hospitals in rural Mozambique. HIV-infected mother/HIV-exposed infant pairs (n = 791). We planned 2 phases of improvement using quality improvement methods. In phase 1, w...
Article
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Little is known about the relationship among acculturation, literacy, and health skills in Latino caregivers of young children. Latino caregivers of children < 30 months seeking primary care at four medical centers were administered measures of acculturation (SASH), functional health literacy (STOFHLA), numeracy (WRAT-3) and health-related skills (...
Article
The association between depressive symptoms and patient-provider communication was examined in adult primary care patients with diabetes. Most communication was not patient-centered, but did not differ by level of patient's depressive symptoms.
Article
To assess the health literacy and numeracy skills of Spanish-speaking parents of young children and to validate a new Spanish language health literacy assessment for parents, the Spanish Parental Health Literacy Activities Test (PHLAT Spanish). Cross-sectional study of Spanish-speaking caregivers of young children (<30 months) enrolled at primary c...
Article
The objective was to evaluate the reliability and validity of brief subjective measures of numeracy and general health literacy in the adult emergency department (ED) setting. A convenience sample of adult ED patients completed subjective measures of general health literacy (Short Literacy Survey [SLS]) and numeracy (Subjective Numeracy Scale [SNS]...
Article
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1) describe and determine the feasibility of using cell-phone-based ecological momentary assessment (EMA) to measure blood glucose monitoring and insulin administration in adolescent Type 1 diabetes, 2) relate EMA to traditional self-report and glycemic control, and 3) identify patterns of adherence by time of day and over time using EMA. Adolescen...
Article
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Although low health literacy and suboptimal medication adherence are more prevalent in racial/ethnic minority groups than Whites, little is known about the relationship between these factors in adults with diabetes, and whether health literacy or numeracy might explain racial/ethnic disparities in diabetes medication adherence. Previous work in HIV...
Article
The purpose of this study was to develop a measure of psychosocial barriers to adherence in adolescents with type 1 diabetes (T1D) and examine relationships to patient characteristics, adherence, and hemoglobin A1C (A1C). Barriers to diabetes adherence (BDA) items were generated by researchers, clinicians, and patients. Adolescents aged 12-17 with...
Article
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Unlabelled: Abstract Background: Patient web portals (PWPs) offer patients remote access to their medical record and communication with providers. Adults with health literacy limitations are less likely to access and use health information technology (HIT), including PWPs. In diabetes, PWP use has been associated with patient satisfaction, patient...
Article
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Although deficits in health literacy and numeracy have been described among Latinos, the impact of low numeracy on diabetes outcomes has not been studied. Study objectives were (1) to establish the reliability and validity of a 15-item Spanish, diabetes-specific numeracy measure (Diabetes Numeracy Test [DNT]-15 Latino) and (2) to examine the relati...
Article
Low mother/infant retention has impeded early infant diagnosis of HIV in rural Mozambique. We enhanced the referral process for postpartum HIV-infected women by offering direct accompaniment to the location of exposed infant testing before discharge. Retrospective record review for 395 women/infants (September 2009 to June 2010) found enhanced refe...
Article
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Patients with poor numeracy skills may have difficulty participating in shared-decision making, affecting their utilization of colorectal cancer (CRC) screening. We explored the relationship between numeracy, provider communication, and CRC screening. Data were from the 2007 National Cancer Institute Health Information Trends Survey. Individuals ag...
Article
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To assess the evidence for interventions designed to prevent or reduce overweight and obesity in children younger than 2 years. MEDLINE, the Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, and references from relevant articles. Included were published studies that evaluated an intervention designed to prevent or reduce overw...
Article
Limited health literacy is common in the United States and associates with poor clinical outcomes. Little is known about the effect of health literacy in patients with advanced kidney disease. In this prospective cohort study we describe the prevalence of limited health literacy and examine its association with the risk for mortality in hemodialysi...
Article
Describe intervention processes associated with an Internet self-management problem solving program for adolescents with type 1 diabetes, and relate participant characteristics to program use. Forty-one adolescents with type 1 diabetes, aged 13-17, participated in an Internet intervention. Participants reported psychosocial self-management barriers...
Article
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Health numeracy is an important component of health literacy that affects diabetes care. This article details current research in the field by highlighting efforts to address health literacy and numeracy as a means of improving diabetes education, self-management, and glycemic control. The authors provide evidence from their past and ongoing resear...
Article
To assess parental health literacy and numeracy skills in understanding instructions for caring for young children, and to develop and validate a new parental health literacy scale, the Parental Health Literacy Activities Test (PHLAT). Caregivers of infants (age <13 months) were recruited in a cross-sectional study at pediatric clinics at 3 academi...
Article
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The mechanisms underlying the relationship between health literacy, numeracy, and glycemic control are unclear. We explored the role of diabetes self-efficacy in the predicted pathway linking health literacy and numeracy to glycemic control (A1C). Adults with type 1 or type 2 diabetes mellitus (N = 383) were enrolled in a cross-sectional study at p...
Article
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Although once considered a disease of adults, the prevalence of type 2 diabetes in youth is increasing at a significant rate. Similar to adults, youth with type 2 diabetes are at increased risk for developing hypertension, lipid abnormalities, renal disease, and other diabetes-related complications. However, children and adolescents with type 2 dia...
Article
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After achieving glycaemic control, many type 2 diabetic patients relapse to clinically significant levels of hyperglycaemia. We sought to determine the optimal frequency of telephone contact by nurse practitioners that was necessary to prevent glycaemic relapse. This parallel, randomised controlled trial ran from June 2002 to February 2006 at an ac...
Article
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OBJECTIVE To report results from YourWay, an Internet-based self-management intervention for adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODS A total of 72 adolescents with type 1 diabetes, ages 13–17 years, were randomized to a usual-care-plus-Internet support or a usual-care group. The intervention was designed to enhance problem-so...
Article
Depression and low self-efficacy are both associated with worse glycemic control in adults with diabetes, but the relationship between these variables is poorly understood. We conducted a cross-sectional study examining associations between depressive symptoms, self-efficacy, and glycemic control among men (n = 64) and women (n = 98) with type 2 di...
Article
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To examine the relationships among patient characteristics, labor inputs, and improvement in glycosylated hemoglobin (A1C) level in a successful primary care-based diabetes disease management program (DDMP). We performed subanalyses to examine the relationships among patient characteristics, labor inputs, and improvement in A1C level within a rando...
Article
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OBJECTIVE To understand physician behaviors and attitudes in managing children with type 2 diabetes. RESEARCH DESIGN AND METHODS A survey was mailed to a nationwide sample of pediatric endocrinologists (PEs). RESULTS A total of 40% of PEs surveyed responded (211 of 527). Concordance with current monitoring guidelines varied widely, ranging from 3...
Article
Despite a heightened focus on improving quality, recent studies have suggested that children only receive half of the indicated preventive, acute, or chronic care. Two major areas in need of improvement are chronic illness care and prevention of medical errors. Recently, health literacy has been identified as an important and potentially ameliorabl...
Article
To assess parental understanding of body mass index (BMI) and BMI percentiles by using standard versus color-coded charts; to investigate how parental literacy and/or numeracy (quantitative skills) affects that understanding. A convenience sample of 163 parents of children aged 2 to 8 years at 2 academic pediatric centers completed a demographics q...
Article
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Diabetic patients with lower literacy or numeracy skills are at greater risk for poor diabetes outcomes. This study evaluated the impact of providing literacy- and numeracy-sensitive diabetes care within an enhanced diabetes care program on A1C and other diabetes outcomes. In two randomized controlled trials, we enrolled 198 adult diabetic patients...
Article
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Concerns about the safety and efficacy of over-the-counter cold medications have led to a recent US Food and Drug Administration public health advisory against their use in children <2 years of age. Our goal was to examine caregiver understanding of the age indication of over-the-counter cold medication labels and identify factors, associated with...
Article
Portion-size estimation is an important component of weight management. Literacy and numeracy skills may be important for accurate portion-size estimation. It was hypothesized that low literacy and numeracy would be associated with decreased accuracy in portion estimation. A cross-sectional study of primary care patients was performed from July 200...
Article
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Understanding the reasons and eliminating the pervasive health disparities in diabetes is a major research, clinical, and health policy goal. We examined whether health literacy, general numeracy, and diabetes-related numeracy explain the association between African American race and poor glycemic control (A1C) in patients with diabetes. Adults wit...
Article
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Diabetes self-management education is an important component of comprehensive diabetes care. Patients with low health literacy and numeracy may have difficulty translating information from traditional diabetes educational programs and materials into effective self-care. To address this potential barrier to successful diabetes teaching and counselin...
Article
Numeracy, the "ability to understand and use numbers in daily life" is an important but understudied component of literacy. Numeracy-related tasks are common in health care and include understanding nutrition information, interpreting blood sugar readings and other clinical data, adjusting medications, and understanding probability in risk communic...
Article
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The purpose of this study was to document barriers and facilitators of self-management as perceived by adolescents with type 2 diabetes. Focus groups were conducted with adolescents diagnosed with type 2 diabetes. Adolescents aged 13 to 19 years were recruited from an academic medical center diabetes clinic. Between 2003 and 2005, 6 focus groups we...
Article
Intensification of glycemic control is associated with weight gain, however, less is known about weight change during the maintenance phase of glycemic management. On the basis of current models of energy homeostasis, we hypothesize that insulin use will result in less weight gain than oral antidiabetic agents in patients with well-controlled diabe...
Article
Low numeracy skills and obesity are both common. Numeracy skills are used in healthy weight management to monitor caloric intake. The relationship between obesity and numeracy skills in adult primary care patients is unknown. A cross-sectional study enrolled adult, English-speaking primary care patients. BMI was assessed by self-report; numeracy an...
Article
Full-text available
In 2003, the National Assessment of Adult Literacy (NAAL) found that approximately 90 million Americans have basic or below basic literacy skills and that 110 million have basic or poor quantitative (numeracy) skills.1 Low literacy and numeracy skills are independently associated with poor understanding of health information, poor health behaviors,...
Article
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Low literacy and numeracy skills are common. Adequate numeracy skills are crucial in the management of diabetes. Diabetes patients use numeracy skills to interpret glucose meters, administer medications, follow dietary guidelines and other tasks. Existing literacy scales may not be adequate to assess numeracy skills. This paper describes the develo...
Article
The influence of a patient's quantitative skills (numeracy) on the management of diabetes is only partially understood. To examine the association between diabetes-related numeracy and glycemic control and other diabetes measurements. Cross-sectional survey. 2 primary care and 2 diabetes clinics at 3 medical centers. 398 adult patients with type 1...
Article
Full-text available
Type 2 diabetes is a growing problem among adolescents, but little is known about self-management behaviors in this population. Our aim was to examine self-management behaviors and glycemic control among adolescents with type 2 diabetes. From 2003 to 2005, a telephone survey of adolescents with type 2 diabetes was performed. Chart review obtained m...
Article
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To examine how adolescents with type 2 diabetes and their parents/primary caregivers perceive the adolescents' weight and the relationship of those perceptions to diet and exercise behaviors and perceived barriers to healthy behaviors. Interviews were conducted with adolescents and their parents about perceptions of the adolescents' weight, diet, a...
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Transitions to patient-centered health care, the increasing complexity of care, and growth in self-management have all increased the frequency and intensity of clinical services provided outside office settings and between visits. Understanding how electronic messaging, which is often used to coordinate care, affects care is crucial. A taxonomy for...
Article
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To determine if health literacy is associated with knowledge of colorectal cancer (CRC) and CRC screening tests, with perceived benefits and barriers to CRC screening, with perceived risk of CRC, with reported self-efficacy for completing CRC screening and with receipt of CRC tests. A convenience sample of 99 subjects completed a health literacy as...
Article
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Patients with chronic medical conditions such as diabetes mellitus need to self-manage their condition for optimal outcomes. The degree to which patients with diabetes feel competent or self-efficacious in managing their diabetes has been related to behaviors such as dieting or exercise as well as to indicators of glycemic control. A diabetes-speci...
Article
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Diabetes mellitus is a chronic illness that affects the world on an epidemic scale. It requires complex healthcare and considerable economic resources. Diabetes disease management programs use a variety of strategies to improve clinical outcome measures and reduce costs. Studies have demonstrated the effectiveness of these programs on reducing glyc...
Article
Comprehension of food labels can be important for patients, including those with chronic illness, to help follow dietary recommendations. Patient comprehension of food labels was examined, along with the relationship of comprehension to their underlying literacy and numeracy skills. From June 2004 to April 2005, a cross-sectional study of 200 prima...