Project

Health Literacy development and equity

Goal: Health literacy in LMICs, systematic approaches to developing health literacy interventions, health literacy at the village level, health literacy in refugees, work places, hospitals, rural areas, in National Health Surveys, the Organisational Health Literacy Responsiveness tool (for organisational self assessment and improvement), the CHAT - conversation health literacy assessment tool to assist practitioners/health promotion officers/intake workers understand clients/patients/people, eHealth Literacy, and more!

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Xavier Debussche
added a research item
Background Health literacy refers to the skills and resources needed to find, understand and use information and services to maintain good health. Health-related quality of life refers to a person's perception of his or her health status, i.e., physical, social and mental well-being. The objective was to describe health literacy and analyze the relationships with quality of life and the socio-demographic and clinical characteristics of people with type 2 diabetes in Ouagadougou, Burkina Faso. Methods This cross-sectional study involved 175 patients with type 2 diabetes recruited from the specialized departments of 5 hospitals. Health literacy was assessed by the multidimensional Health Literacy Questionnaire (HLQ) and quality of life by the EQ-5D-5 L (EuroQol, 5 dimensions and 5 levels). Standardized differences in means (effect size) were used to describe the magnitude of differences between subgroups. Results 80.5% of patients in the sample were under 60 years of age. There were more women (70.3%) than men, 77.7% of patients had less than a high school education and 57.7% were employed. The most significant health literacy difficulties were found for the scales "Appraisal of health information" (mean = 2.57 [2.48 - 2.66]), "Navigating the health care system" (mean = 2.95 [2.84 - 3.06]), and “Ability to find good health information” (mean=2.96 [2.84 – 3.09]). In terms of quality of life, the "Pain/discomfort" dimension was the most impaired. Small to large standardized differences were observed for several HLQ scales according to gender, education level, employment status, family history status, length of time with diabetes and blood glucose level. There was a significant correlation between the HL and HRQoL scales (r from 0.31 to 0.49). Conclusion This study objectively assessed the diversity of health literacy profiles on all scales of HLQ according to the socio-demographic status and specific characteristics of patients with type 2 diabetes. Building on the diverse health literacy needs can be a strategy to help reduce inequalities and improve quality of life in type 2 diabetes.
Maryvette Balcou-Debussche
added a research item
Ici notre projet consiste à présenter ce qui relève du travail sur le CONTEXTE, lors de situations d'éducation thérapeutique du patient, en lien avec la littératie en santé entendue comme la capacité à favoriser et développer l'accès à l'information des patients, leur compréhension de ce qui est en jeu et leur prise de décisions (Nutbeam, 1998). Les résultats présentés ont permis d'identifier et d'analyser les interactions entre les apprenants et le formateur, les obstacles à la compréhension, les rapports au langage (oral et écrit), les rapports au savoir, à l'éducation et à l'apprentissage, les rapports au contexte dans lequel s'inscrit l'action à mener par la personne touchée par la maladie chronique. En prenant appui sur les travaux menés par les chercheurs anglophones sur la littératie en santé, ces résultats permettent de souligner la nécessité de former les éducateurs en ETP à la prise en compte des difficultés d'accès des patients à l'information, à la compréhension et à la prise de décisions contextualisées. Ils soulignent la nécessité de tenir compte de la pluralité des contextes dans lesquels les savoirs s'actualisent. Le travail qui est proposé en ETP gagnerait à être pensé en perspective de ce que les patients vont en faire dans les contextes qui sont les leurs.
Xavier Debussche
added a research item
The burden of noncommunicable diseases (NCDs) is increasing worldwide with the European Region of no exception. This poses economic and social challenges, which contribute to persisting health inequities. Sustainable Development Goal (SDG) target 3.4 specifically focuses on reducing premature mortality from NCDs by a third through prevention and treatment, and promoting mental health and well-being. The promising role of health literacy is increasingly recognized in relation to the prevention and treatment of NCDs throughout the life course. In support of this, WHO has initiated National Health Literacy Demonstration Projects (NHLDPs) in the European Region to generate evidence and accelerate NCD intervention development. The current European NHLDPs use the OPtimising HEalth LIteracy and Access (Ophelia) approach. This manuscript presents the methods, aims, status and preliminary outcomes of the seven flagship European NHLDPs, which cover a broad scope of settings (such as schools, hospitals and communities), health conditions (such as cardiovascular disease, renal failure and chronic obstructive pulmonary disease) and life stages. While the long-term impact of these NHLDPs on the NCD curve is too early to predict, the processes of engagement and action in each of the projects are promising.
Xavier Debussche
added a research item
Introduction. Dans un contexte de forte prévalence du diabète de type 2 à La Réunion, nous présentons ici les premiers résultats de la recherche mixte ERMIès, investigation sociologique qualitative associée à un essai d’intervention éducative. L’objectif est de mieux comprendre les stratégies, les écueils et les points d’appui sur lesquels des patients dits « mal équilibrés » construisent la gestion de leur maladie, en relation avec les séances d’ETP. Patients et méthodes. L’essai randomisé a inclus 100 patients, répartis en deux bras d’intervention (court et long) ; 44 patients (60±10 ans, 31 femmes, 25 sous insuline, 22 non diplômés, 12 sans emploi, 19 retraités) ont été vus en entretiens semi-directifs à domicile et, pour certains, en séance d’ETP. Ces observations ont fait l’objet d’une analyse de contenu des thèmes abordés et récurrents (logiciel NVivo10, QSR international). Résultats. La gestion ordinaire de la maladie se répartit autour de trois pôles : l’alimentation, l’activité physique et le suivi de la maladie. Le stress apparaît comme étant un élément signifiant souvent évoqué dans les discours. A domicile, tous les patients développent des pratiques effectives pour améliorer leur santé. Cependant, le sens qu’ils donnent à ces pratiques fait l’objet de nombreuses variations. Les réponses apportées sont fortement liées aux contextes dans lesquels les connaissances sur lesquelles ils ont travaillé lors des séances d’ETP s’actualisent. Discussion. Ces 1ers résultats apportent des éclairages sur la complexité de la gestion de la maladie par des patients pour qui le diabète ne peut guère constituer la seule préoccupation. La prise en compte des contextes différenciés dans la complexité de la gestion de la maladie permet de regarder autrement les patients « mal équilibrés » et de travailler sur de nouvelles perspectives, tant du côté de la formation initiale et continue que du côté des pratiques cliniques et d’ETP
Maryvette Balcou-Debussche
added a research item
Objectives Our objective was to evaluate the effectiveness of peer-led self-management education in improving glycaemic control in patients with type 2 diabetes in a low-income country (Mali). Methods We conducted an open-label randomised controlled trial. A total of 151 adults (76% women, mean age 52.5) with type 2 diabetes (HbA1c≥8%), treated in the diabetes consultation units of two secondary health centres in Bamako, were allocated to peer-led structured patient education (n = 76) or conventional care alone (n = 75). The intervention group received 1 year of culturally tailored structured patient education (3 courses of 4 sessions) delivered in the community by five trained peer educators. Both groups underwent conventional diabetes monitoring and follow-up. Primary outcome was the mean absolute change in HbA1c from baseline to 12 months. Results 177 education sessions were delivered to the intervention group. Patient attrition was 8%. From baseline to 12 months, the decrease in HbA1c levels was 1.05% (SD = 2.0; CI95%: 1.54;-0.56) in the intervention group compared with 0.15% (SD = 1.7; CI95%: -0.56; 0.26) in the control group, p = 0.006. Mean BMI change was -1.65 kg/m2 (SD = 2.5; CI95%: -2.25; -1.06) in the intervention group and +0.05 kg/m2 (SD = 3.2; CI95%: -0.71; 0.81) in the control group, p = 0.0005. Mean waist circumference decreased by 3.34 cm (SD = 9.3; CI95%: -5.56;-1.13) in the intervention group and increased by 2.65 cm (SD = 10.3; CI95%: 0.20; 5.09) in the control group, p = 0.0003. Conclusions Peer-led structured patient education delivered over 1 year to patients with poorly controlled type 2 diabetes in Mali yielded substantial improvements in glycaemic control and anthropometric parameters. This is of importance for the scaling up of efficient interventions in low-resource settings in the future. Trial registration ClinicalTrials.gov NCT01485913
Maryvette Balcou-Debussche
added a research item
This exploratory work has helped identify the health literacy skills of populations from the Mosson neighborhood in Montpellier as part of the “Solidarité Diabète” therapeutic education program. Health literacy defines the ability to understand, use and access health information and services. The capacity of professionals and structures to respond to health literacy needs is an important pillar of reducing health inequalities. Using the HLQ multidimensional questionnaire administered with associated qualitative interview to 21 people, the results highlight the weaknesses, but also the strengths in terms of health literacy. The data collected and the analyzes are useful for professionals, services and health structures that seek to provide concrete answers to the adaptation needs of the actions, for the persons concerned. The study shows the contribution of the exploration of health literacy in the implementation of actions in fragile population.
Xavier Debussche
added 2 research items
Health literacy (HL) refers to the social and cognitive skills for accessing, understanding and using health information and services to maintain health. It is a multidimensional concept, not limited in its modern acception to the sole ability in reading and interpreting health information or medical recommendations. HL is a known determinant of health outcomes but has been seldom used in clinical trials, either for the description of enrolled participants, or as an outcome. In this exploratory pilot study, participants of the ERMIES study showed a high mean score in some health literacy scales concerning health information and health services. Health literacy is a potential useful tool in clinical trials to describe populations, to detect selection bias, and to situate enrolled participants in their relation to health and resources for health. Studies should explore further these issues in controlled trials, and with the help of mixed methods.
Littératie en santé et précarité : optimiser l'accès à l'information et aux services en santé. L'expérience de Solidarité Diabète Health literacy and social insecurity: Optimize access to health information and services. Résumé. Le présent travail exploratoire a permis d'identifier les compétences en littératie en santé de populations issues de la migration du quartier populaire Mosson à Montpellier dans le cadre du programme d'éducation thérapeutique « Solidarité Diabète ». La littératie en santé définit les capacités à comprendre, utiliser et accéder aux informations et services en santé. La capacité de réponse des professionnels et structures aux besoins de littératie en santé est un pilier important de la réduction des inégalités en santé. A partir du questionnaire multidimensionnel HLQ administré à 21 personnes avec entretien qualitatif associé, les résultats objectivent les faiblesses, mais aussi les atouts en termes de 2 littératie en santé. Les données recueillies et les analyses sont utiles pour les professionnels, services et structures de santé qui cherchent à apporter des réponses concrètes aux besoins d'adaptation des actions, pour les personnes concer-nées. L'étude permet ainsi de montrer l'apport de l'exploration de la littératie en santé dans la mise en place d'actions en population fragilisée. MOTS-CLÉS : Littératie en santé-Population vulnérable-Maladie chronique-Health Literacy Questionnaire Summary. This exploratory work has helped identify the health literacy skills of populations from the Mosson neighborhood in Montpellier as part of the "Solidarité Diabète" therapeutic education program. Health literacy defines the ability to understand, use and access health information and services. The capacity of professionals and structures to respond to health literacy needs is an important pillar of reducing health inequalities. Using the HLQ multidimensional questionnaire administered with associated qualitative interview to 21 people, the results highlight the weaknesses, but also the strengths in terms of health literacy. The data collected and the analyzes are useful for professionals, services and health structures that seek to provide concrete answers to the adaptation needs of the actions, for the persons concerned. The study shows the contribution of the exploration of health literacy in the implementation of actions in fragile population.
Maryvette Balcou-Debussche
added a research item
In developing countries, financial and human resources are limited despite serious needs and multiple health challenges. More than three-quarters of the people with diabetes worldwide live in developing countries. Between 2000 and 2025, the rise in the number of people with the condition in these countries will be around 170%. In the developing world, diabetes, like other chronic diseases, is often ignored in terms of healthcare priorities; the focus remains largely on immediate and acute care rather than on prevention. The challenges involved in providing education to enable people to self-manage their chronic condition exist at three levels: patients, healthcare providers, healthcare systems.
Maryvette Balcou-Debussche
added 2 research items
Introduction La littératie en santé se réfère aux compétences et ressources nécessaires aux individus pour répondre aux demandes de santé complexes de la société moderne : accéder, utiliser, comprendre, appréhender et évaluer les informations et services de santé pour maintenir ou améliorer sa santé. Nous rapportons ici les premiers résultats d'exploration des profils de littératie en santé à la Réunion via le HLQ (Health Literacy Questionnaire). Patients et Méthodes Le HLQ, questionnaire aux propriétés psychométriques robustes, a été traduit et validé pour la France et pour la Réunion. Il explore 9 dimensions en 44 items. À titre exploratoire, le questionnaire a été administré en auto-remplissage ou avec aide en face à face à 191 patients consécutifs avec diabète de type 2 au CHU de Saint-Denis entre février et juillet 2015. Résultats L'échantillon était d'âge moyen 58 ± 12 ans, 111 femmes, 80 hommes, 22 % sans emploi, 34 % retraités, 25 % ≤ école primaire. Les scores les plus élevés ont été objectivés pour « Se sentir soutenu et compris par les professionnels de santé » (score moyen 3,35 ± 0,51 sur une échelle de 4) et « Capacité à s'engager avec les professionnels de santé » (score sur 5 : 3,86 ± 0,63) et les plus bas pour « Évaluation de l'information en santé » (3,00 ± 0,51, sur 4) et « Aptitude à trouver des informations de bonne qualité » (3,48 ± 0,69, sur 5). Discussions Ces données sont les 1res concernant les profils de littératie en santé dans le diabète de type 2 en France. Elles révèlent à la fois des leviers, notamment la capacité à s'engager avec les professionnels de santé, et des faiblesses telles que le niveau d'accès et d'utilisation des informations en santé. La prise en compte de ces résultats permettra de travailler sur les actions et priorités à mettre en œuvre pour répondre aux besoins spécifiques de littératie en santé des populations, notamment les plus vulnérabilisées.
Richard H Osborne
added an update
Richard H Osborne
added 2 research items
Health literacy has become an increasingly important concept in public health. We sought to develop a comprehensive measure of health literacy capable of diagnosing health literacy needs across individuals and organisations by utilizing perspectives from the general population, patients, practitioners and policymakers. Using a validity-driven approach we undertook grounded consultations (workshops and interviews) to identify broad conceptually distinct domains. Questionnaire items were developed directly from the consultation data following a strict process aiming to capture the full range of experiences of people currently engaged in healthcare through to people in the general population. Psychometric analyses included confirmatory factor analysis (CFA) and item response theory. Cognitive interviews were used to ensure questions were understood as intended. Items were initially tested in a calibration sample from community health, home care and hospital settings (N=634) and then in a replication sample (N=405) comprising recent emergency department attendees. Initially 91 items were generated across 6 scales with agree/disagree response options and 5 scales with difficulty in undertaking tasks response options. Cognitive testing revealed that most items were well understood and only some minor re-wording was required. Psychometric testing of the calibration sample identified 34 poorly performing or conceptually redundant items and they were removed resulting in 10 scales. These were then tested in a replication sample and refined to yield 9 final scales comprising 44 items. A 9-factor CFA model was fitted to these items with no cross-loadings or correlated residuals allowed. Given the very restricted nature of the model, the fit was quite satisfactory: chi2WLSMV(866 d.f.) = 2927, p<0.000, CFI = 0.936, TLI = 0.930, RMSEA = 0.076, and WRMR = 1.698. Final scales included: Feeling understood and supported by healthcare providers; Having sufficient information to manage my health; Actively managing my health; Social support for health; Appraisal of health information; Ability to actively engage with healthcare providers; Navigating the healthcare system; Ability to find good health information; and Understand health information well enough to know what to do. The HLQ covers 9 conceptually distinct areas of health literacy to assess the needs and challenges of a wide range of people and organisations. Given the validity-driven approach, the HLQ is likely to be useful in surveys, intervention evaluation, and studies of the needs and capabilities of individuals.
Richard H Osborne
added a research item
Health literacy is a concept that recognizes that people have different capacities to find, understand, and use health information, with different experiences that shape their willingness and confidence to do these tasks, and different ways in which they prefer to receive and engage with information. It is a humbling concept for health service providers and health educators because it carries within itself the recognition that there are many people whose needs we have failed to meet because we have not fully understood those needs. The drive to incorporate health literacy into public health practice is intrinsically linked with the concept of equity (Paasche-Orlow and Wolf, 2010). A health literacy approach can meet the needs of people who are not responding to current approaches to improve their access to health services, to change their health behaviors, and/or to increase their participation in actions and advocacy to improve health in their communities. Health literacy is less of a concern for people with whom current health-care approaches are already effective. The concept of health literacy has evolved considerably since it was first coined in 1974, as have the means to measure it. Consequently, there has also been an expansion in the number and breadth of health literacy interventions. Modern definitions include multiple dimensions of health literacy, consider multiple settings, and recognize that there are social as well as individual components to health literacy. While there are many definitions, those that are more recent overlap substantially.
Richard H Osborne
added an update
Journal of Diabetes Research
Optimising Health Literacy and Access (OPHELIA)of service provision to community dwelling older people with diabetes receiving home nursing support
Dianne Goeman, Sue Conway, Ralph Norman, Jo Morley, Rona Weerasuriya, Richard H Osborne, and Alison Beauchamp
 
Richard H Osborne
added a project goal
Health literacy in LMICs, systematic approaches to developing health literacy interventions, health literacy at the village level, health literacy in refugees, work places, hospitals, rural areas, in National Health Surveys, the Organisational Health Literacy Responsiveness tool (for organisational self assessment and improvement), the CHAT - conversation health literacy assessment tool to assist practitioners/health promotion officers/intake workers understand clients/patients/people, eHealth Literacy, and more!