Health Literacy, Health Numeracy, and Cognitive Functioning Among Bariatric Surgery Candidates

Minority ethnic patient groups typically have the highest bariatric surgery preoperative attrition rates and lowest surgery utilisation worldwide. Eligible patients of Pacific Island ethnicity (Pacific patients) in New Zealand (NZ) follow this wider trend.ObjectivesThe present study explored structural barriers contributing to Pacific patients’ disproportionately high preoperative attrition rates from publicly-funded bariatric surgery in Auckland, NZ.SettingPublicly-funded bariatric surgery programmes based in the wider Auckland area, NZ.DesignSemi-structured interviews with health sector professionals (n=21) were conducted.Data were analysed using an inductive thematic approach.ResultsTwo primary themes were identified: (1) Confidence negotiating the medical system, which included Emotional safety in clinical settings and Relating to non-Pacific health professionals and (2) Appropriate support to achieve preoperative goals, which included Cultural considerations, Practical support and Relating health information. Clinical environments and an under-representation of Pacific staff were considered to be barriers to developing emotional safety, trust and acceptance of the surgery process with patients and their families. Additionally, economic deprivation and lower health literacy impacted preoperative goals.ConclusionsHealth professionals’ accounts indicated that Pacific patients face substantial levels of disconnection in bariatric surgery programmes. Increasing representation of Pacific ethnicity by employing more Pacific health professionals in bariatric teams and finding novel solutions to implement preoperative programme components have the potential to reduce this disconnect. Addressing cultural competency of staff, increasing consultancy times and working in community settings may enable staff to better support Pacific patients and their families. Programme structures could be more accommodating to practical barriers of attending appointments, managing patients’ preoperative health goals and improving patients’ health literacy. Given that Pacific populations, and other patients from minority ethnic backgrounds living globally, also face high rates of obesity and barriers accessing bariatric surgery, our findings are likely to have broader applicability.

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The Impact of Health Literacy and Numeracy on Post-Transplantation Outcomes in Organ Transplant Recipients

Inquiry@Queen's Undergraduate Research Conference Proceedings ◽

10.24908/iqurcp.10560 ◽

2018 ◽

Author(s):

Mary Zhu

Keyword(s):

Health Literacy ◽

Clinical Outcomes ◽

Self Efficacy ◽

Organ Transplant ◽

Solid Organ ◽

Transplant Recipients ◽

Limited Health Literacy ◽

Health Numeracy ◽

Post Transplant ◽

Limited Health

Background: Patients referred for solid organ transplant with limited health literacy have been shown to be less likely to have access to transplantation. We examined the association between health literacy, health numeracy and post-transplant clinical outcomes (i.e. graft failure, non-adherence, readmissions, self-efficacy, or mortality). Methods: A search of Medline for publications during the period January 1946 to July 2016 that examined health literacy, numeracy, and outcomes of transplant recipients. Titles and abstracts were independently examined by three reviewers for exclusion, and the full-text was then reviewed for inclusion. Results: Of 247 citations, 12 met inclusion criteria including one review article and five randomized control trials (RCTs). Health literacy of recipients was measured using Newest Vital Sign (NVS) (n=2), Short Test of Functional Health Literacy in Adults (STOHFLA) (n=2), Rapid Estimate of Adult Literacy in Medicine (REALM-T) (n=1), and other knowledge questionnaires (n=5). Level of formal education was also examined as an assay of health literacy (n=3). Post-transplant outcomes were assessed through medication adherence (n=4), skin cancer incidence (n=2), graft loss (n=1), recipient mortality (n=1), kidney function (n=1), health-related quality of life (n=1), and self-efficacy (n=1). Eleven citations found limited health literacy to be associated with adverse post-transplant clinical outcomes, and one citation found no association between health literacy and non-adherence. Health numeracy was not studied in any of the citations. Conclusion: Health literacy is negatively associated with adverse post-transplant clinical outcomes. Future studies should analyze the association between health numeracy and clinical outcomes after transplant.

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Examining attitudes toward and ability to interact with an online personal health record: A case study in Saudi Arabia

International Journal of Healthcare ◽

10.5430/ijh.v6n1p1 ◽

2019 ◽

Vol 6 (1) ◽

pp. 1 ◽

Cited By ~ 1

Author(s):

Bandar Faisal Al-Mifgai ◽

Joseph Sharit ◽

Arzu Onar-Thomas ◽

Shihab Asfour

Keyword(s):

Saudi Arabia ◽

Health Literacy ◽

Health Systems ◽

Health Management ◽

Personal Health Record ◽

The Internet ◽

Personal Health ◽

Health Record ◽

Health Numeracy ◽

Electronic Health

Objective: This study examined the ability for adults from a developing country to use a personal health record (PHR) to perform health-management tasks. The effects of gender differences as well as differences in attitudes about using the internet to manage health prior to and after exposure to the PHR were also investigated.Methods: A simulation of a PHR based on a well-established U.S. online patient portal was designed and tailored for this particular study population. Two hundred and three adults with a mean age of 40.9 years were recruited from various areas in Saudi Arabia and asked to perform seven common health-management tasks of varying degrees of difficulty. Their electronic health literacy and health numeracy, as well as their attitudes about using online health systems for managing their health prior to and following their interaction with the PHR, were assessed using questionnaires.Results: After controlling for education, perceived health status, and comfort using the internet, electronic health literacy and health numeracy were still found to be significant predictors of participants’ task performance, but only for the more challenging health-management tasks. No important differences based on gender were found. Exposure to the PHR significantly increased the acceptability of using the internet for managing their health.Conclusions: The change in attitudes following interaction with the PHR suggests that many adults in this society could benefit from these electronic health systems, including females who, due to cultural considerations, may desire greater control in managing their health. However, the importance of electronic health literacy and health numeracy suggests the need for designs that minimize the impact of these factors for successful performance of health-management tasks.

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Does Lower Level of Education and Health Literacy Affect Successful Outcomes in Bariatric Surgery?

Journal of Laparoendoscopic & Advanced Surgical Techniques ◽

10.1089/lap.2018.0806 ◽

2019 ◽

Vol 29 (8) ◽

pp. 1011-1015 ◽

Cited By ~ 4

Author(s):

Stephen T. Mahoney ◽

Paula D. Strassle ◽

Timothy M. Farrell ◽

Meredith C. Duke

Keyword(s):

Bariatric Surgery ◽

Health Literacy ◽

Level Of Education ◽

Education And Health ◽

Successful Outcomes

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The impact of self-efficacy and health literacy on outcome after bariatric surgery in Sweden: a protocol for a prospective, longitudinal mixed-methods study

BMJ Open ◽

10.1136/bmjopen-2018-027272 ◽

2019 ◽

Vol 9 (5) ◽

pp. e027272 ◽

Cited By ~ 1

Author(s):

Maria Jaensson ◽

Karuna Dahlberg ◽

Ulrica Nilsson ◽

Erik Stenberg

Keyword(s):

Bariatric Surgery ◽

Mixed Methods ◽

Health Literacy ◽

Qualitative Study ◽

Self Efficacy ◽

Mixed Methods Study ◽

Inclusion Criteria ◽

Study Results ◽

Prospective Longitudinal ◽

The Impact

IntroductionA person-centred approach, to know about a person’s individual weaknesses and strengths, is warranted in today’s healthcare in Sweden. When a person suffers from obesity, there are not only risks for comorbidities but also increased risk for decreased health-related quality of life (HRQoL). After bariatric surgery, there are also risks for complications; however, healthcare service expects the person to have sufficient ability to handle recovery after surgery. The need is to investigate how a person’s self-efficacy and health literacy(HL) skills are important to determine their effect on recovery as well as HRQoL after bariatric surgery. It can, involve the person in the care, improve shared decision-making, and perhaps decrease complications and readmissions.Method and analysisThis is a prospective, longitudinal mixed-methods study with the intent of including 700 patients from three bariatric centres in Sweden (phase 1); 20 patients will be included in a qualitative study (phase 2). Inclusion criteria will be age >17 years, scheduled primary bariatric surgery and ability to read and understand the Swedish language in speech and in writing. Inclusion criteria for the qualitative study will be patients who reported a low self-efficacy, with a selection to ensure maximum variation regarding age and gender. Before bariatric surgery patients will answer a questionnaire including 20 items. Valid and reliable instruments will be used to investigate general self-efficacy (10 items) and functional and communicative and critical HL (10 items). This data collection will then be merged with data from the Scandinavian Obesity Surgery Registry. Analysis will be performed 30 days, 1 year and 2 years after bariatric surgery. One year after bariatric surgery the qualitative study will be performed. The main outcomes are the impact of a person’s self-efficacy and HL on recovery after bariatric surgery.Ethics and disseminationThe study has received approval from the ethical review board in Uppsala, Sweden (number 2018/256). The study results will be disseminated through peer-reviewed publications and conference presentations to the scientific community and social media.

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