Neurocognitive Functioning is Associated with Self-Reported and Performance-Based Treatment Management Abilities in People Living with HIV with Low Health Literacy

Abstract Objective People living with HIV (PLWH) are at higher risk for poorer neurocognitive functioning and health literacy than uninfected persons, which are associated with worse medical outcomes. Aging research suggests that the effect of neurocognitive functioning on health outcomes may be more pronounced in those with low health literacy. We aimed to determine whether low health literacy might amplify the adverse effects of neurocognitive functioning on treatment management outcomes in 171 PLWH aged 40+. Method In this cross-sectional, observational study, participants completed a well-validated battery of neurocognitive, health literacy, and treatment management measures. A binary health literacy variable (low vs. adequate) was determined via established cut points on the well-validated health literacy tests. Treatment management outcomes included biomarkers of HIV (i.e., CD4 counts and viral load), self-management of HIV disease (i.e., self-reported medication adherence and self-efficacy for HIV disease management), and performance-based health-related decision-making. Results Forty-seven percent of the sample met the criteria for low health literacy. Multivariable regressions adjusting for clinicodemographic (e.g., race, socioeconomic status) covariates revealed significant interactions for self-efficacy for HIV disease management and health-related decision-making, such that neurocognitive functioning was associated with these outcomes among those with low, but not adequate health literacy. Conclusions Findings suggest that low health literacy may increase the vulnerability of PLWH to the adverse effects of neurocognitive impairment on health outcomes, or conversely that adequate health literacy may provide a buffer against the health risks associated neurocognitive impairment. Interventions targeting health literacy in PLWH may mitigate the effects of neurocognitive impairment on health outcomes.

Download Full-text

Intervention Based on Integration of Health Literacy and Health Outcomes in Hypertension “A Systematic Review”

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.6489 ◽

2021 ◽

Vol 9 (F) ◽

pp. 486-491

Author(s):

Samsiana Samsiana ◽

Syamsiar Siang Russeng ◽

Ridwan Amiruddin

Keyword(s):

Health Literacy ◽

Health Outcomes ◽

Hypertensive Patient ◽

Literacy Skills ◽

Self Management ◽

Bibliographic Databases ◽

Hypertensive Patients ◽

Adequate Health Literacy ◽

Low Health Literacy ◽

Patient Health

BACKGROUND: Hypertensive patients with low health literacy rarely visit health services, therefore, they have more chances of being hospitalized in comparison with those having a more adequate health literacy. AIM: This article aims to identify intervention based on integration of health literacy and its outcome in hypertensive patients. METHODS: Articles were searched using four bibliographic databases, namely, ProQuest, Science Direct, PubMed, and Google Scholar. PRISMA 2015 is used as a guideline for determining which articles are selected, one of the criteria being published on 2011–2021. RESULTS: A total of 25,264 articles were obtained from the four databases. Seven articles were selected after the extraction and incorporation of the inclusion criteria. The health outcomes of hypertension sufferers after receiving intervention based on integration of health literacy were divided into three groups; medical health outcomes, health literacy skills, and hypertension self-management behavioral. CONCLUSION: An intervention integrated with health literacy and considering the hypertensive patient health literacy in its own will increase the health outcomes of hypertensive patient.

Download Full-text

Comparison of Clinical Outcomes of Persons Living With HIV by Enrollment Status in Washington, DC: Evaluation of a Large Longitudinal HIV Cohort Study (Preprint)

10.2196/preprints.16061 ◽

2019 ◽

Author(s):

Jenevieve Opoku ◽

Rupali K Doshi ◽

Amanda D Castel ◽

Ian Sorensen ◽

Michael Horberg ◽

...

Keyword(s):

Cohort Study ◽

Health Outcomes ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Hiv Care ◽

Disease Stage ◽

People Living With Hiv ◽

Hiv Disease ◽

Persons Living With Hiv ◽

Living With Hiv

BACKGROUND HIV cohort studies have been used to assess health outcomes and inform the care and treatment of people living with HIV disease. However, there may be similarities and differences between cohort participants and the general population from which they are drawn. OBJECTIVE The objective of this analysis was to compare people living with HIV who have and have not been enrolled in the DC Cohort study and assess whether participants are a representative citywide sample of people living with HIV in the District of Columbia (DC). METHODS Data from the DC Health (DCDOH) HIV surveillance system and the DC Cohort study were matched to identify people living with HIV who were DC residents and had consented for the study by the end of 2016. Analysis was performed to identify differences between DC Cohort and noncohort participants by demographics and comorbid conditions. HIV disease stage, receipt of care, and viral suppression were evaluated. Adjusted logistic regression assessed correlates of health outcomes between the two groups. RESULTS There were 12,964 known people living with HIV in DC at the end of 2016, of which 40.1% were DC Cohort participants. Compared with nonparticipants, participants were less likely to be male (68.0% vs 74.9%, P<.001) but more likely to be black (82.3% vs 69.5%, P<.001) and have a heterosexual contact HIV transmission risk (30.3% vs 25.9%, P<.001). DC Cohort participants were also more likely to have ever been diagnosed with stage 3 HIV disease (59.6% vs 47.0%, P<.001), have a CD4 <200 cells/µL in 2017 (6.2% vs 4.6%, P<.001), be retained in any HIV care in 2017 (72.9% vs 59.4%, P<.001), and be virally suppressed in 2017. After adjusting for demographics, DC Cohort participants were significantly more likely to have received care in 2017 (adjusted odds ratio 1.8, 95% CI 1.70-2.00) and to have ever been virally suppressed (adjusted odds ratio 1.3, 95% CI 1.20-1.40). CONCLUSIONS These data have important implications when assessing the representativeness of patients enrolled in clinic-based cohorts compared with the DC-area general HIV population. As participants continue to enroll in the DC Cohort study, ongoing assessment of representativeness will be required.

Download Full-text

Abstract P169: Health Literacy and Outcomes in Heart Failure: a Prospective Community Study

Circulation ◽

10.1161/circ.135.suppl_1.p169 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Matteo Fabbri ◽

Kathleen Yost ◽

Lila Finney Rutten ◽

Sheila Manemann ◽

Susan Weston ◽

...

Keyword(s):

Heart Failure ◽

Health Literacy ◽

Proportional Hazards ◽

International Classification Of Diseases ◽

Cox Proportional Hazards ◽

Low Literacy ◽

Adequate Health Literacy ◽

Low Health Literacy ◽

Increased Risk

Background: Growing evidence documents the association between low health literacy and poorer health outcomes. However, less is known about the relationship between health literacy and outcomes among patients with heart failure (HF). We examined the association of health literacy with risk of hospitalization and mortality in patients with HF. Methods: Residents in an 11-county region in southeastern Minnesota with incident HF from 1/01/2013 to 3/31/2015 were identified using the International Classification of Diseases, Ninth Revision code 428 (n=3715) and prospectively surveyed to measure health literacy using established screening questions. A total of 1992 patients returned a survey (response rate 54%); 1779 patients with complete clinical data and adequate follow up were retained for analysis. Health literacy, measured as a composite on three 5-point scales, was categorized as adequate (≤ 10) or low (> 10). Cox proportional hazards regression and Andersen-Gill models were used to determine the association of health literacy with mortality and hospitalization. Results: Among 1779 patients (mean age 74, 53% male), 10% had low health literacy. After a mean follow-up of 8±4 months, 72 deaths and 600 hospitalizations occurred. Low health literacy was associated with increased mortality and hospitalizations (Figure). After adjusting for age, sex, comorbidity, education and marital status, the hazard ratio for death and hospitalization in patients with low health literacy was 2.84 (95% CI: 1.63, 4.96) and 1.43 (95% CI: 1.04, 1.96) respectively, compared to patients with adequate health literacy. Conclusions: Low health literacy is associated with increased risk of hospitalization and death among patients with HF. Health literacy is critical to the self-management demands of living with heart failure. Evaluation of health literacy in the clinical setting may guide inventions to target patients with low literacy.

Download Full-text

Low Health Literacy is Associated with the Onset of CKD during the Life Course

Journal of the American Society of Nephrology ◽

10.1681/asn.2020081155 ◽

2021 ◽

Vol 32 (6) ◽

pp. 1436-1443

Author(s):

Matheus S. Gurgel do Amaral ◽

Sijmen A. Reijneveld ◽

Bas Geboers ◽

Gerjan J. Navis ◽

Andrea F de Winter

Keyword(s):

Older Adults ◽

Health Literacy ◽

High Body Mass Index ◽

Total Sample ◽

Population Based ◽

Adequate Health Literacy ◽

Low Health Literacy ◽

Crude Model ◽

The Life Course

BackgroundHealth literacy, the ability to deal with information related to one’s health, is a predictor of health outcomes in CKD. However, research has not explored whether low health literacy predicts the onset of CKD.MethodsWe used data from participants of Lifelines, a prospective population-based cohort study of individuals living in The Netherlands, to assess the share of individuals with low health literacy by eGFR category, whether low health literacy is associated with CKD onset in the general population and in the subgroup of older adults, and whether established CKD risk factors mediate this association.ResultsIn the total sample of 93,885 adults (mean follow-up 3.9 years), low health literacy was more likely among individuals in worse eGFR categories, increasing from 26.4% in eGFR category 1 to 50.0% in category 5 (P=0.02). Low health literacy, compared with adequate health literacy, was associated with the onset of CKD in the total sample (3.0% versus 2.1%) and in the subgroup of older adults (13.4% versus 11.3%), with odds ratios (ORs) of 1.44 (95% confidence interval (95% CI), 1.31 to 1.59) and 1.21 (95% CI, 1.04 to 1.41), respectively. After adjustment for sex, age, education, and income, health literacy was associated with CKD onset only in older adults (OR, 1.25; 95% CI, 1.04 to 1.50). This association was mediated by hypertension and high body mass index (BMI) in the crude model, but only by BMI after adjustment (with BMI explaining 18.8% of the association).ConclusionsLow health literacy is a risk factor for CKD onset among older adults, which suggests that CKD prevention might benefit from strategies to address low health literacy.

Download Full-text

Health behavior predictors of medication adherence among low health literacy people living with HIV/AIDS

Journal of Health Psychology ◽

10.1177/1359105315569617 ◽

2016 ◽

Vol 21 (9) ◽

pp. 1981-1991 ◽

Cited By ~ 6

Author(s):

Jennifer A Pellowski ◽

Seth C Kalichman

Keyword(s):

Medication Adherence ◽

Health Literacy ◽

Health Behavior ◽

People Living With Hiv ◽

Low Health Literacy ◽

Living With Hiv ◽

Hiv Aids

Download Full-text

Evaluating the Need to Address Digital Literacy Among Hospitalized Patients: Cross-Sectional Observational Study (Preprint)

10.2196/preprints.17519 ◽

2019 ◽

Author(s):

Hanna Vollbrecht ◽

Vineet Arora ◽

Sebastian Otero ◽

Kyle Carey ◽

David Meltzer ◽

...

Keyword(s):

Health Literacy ◽

Digital Literacy ◽

Hospitalized Patients ◽

The Internet ◽

Technology Access ◽

Adequate Health Literacy ◽

Gender And Education ◽

Low Health Literacy ◽

Health Literacy Level ◽

Literacy Level

BACKGROUND Technology is a potentially powerful tool to assist patients with transitions of care during and after hospitalization. Patients with low health literacy who are predisposed to poor health outcomes are particularly poised to benefit from such interventions. However, this population may lack the ability to effectively engage with technology. Although prior research studied the role of health literacy in technology access/use among outpatients, hospitalized patient populations have not been investigated in this context. Further, with the rapid uptake of technology, access may no longer be pertinent, and differences in technological capabilities may drive the current digital divide. Thus, characterizing the digital literacy of hospitalized patients across health literacy levels is paramount. OBJECTIVE We sought to determine the relationship between health literacy level and technological access, use, and capability among hospitalized patients. METHODS Adult inpatients completed a technology survey that asked about technology access/use and online capabilities as part of an ongoing quality of care study. Participants’ health literacy level was assessed utilizing the 3-question Brief Health Literacy Screen. Descriptive statistics, bivariate chi-squared analyses, and multivariate logistic regression analyses (adjusting for age, race, gender, and education level) were performed. Using Bonferroni correction for the 18 tests, the threshold P value for significance was <.003. RESULTS Among 502 enrolled participants, the mean age was 51 years, 71.3% (358/502) were African American, half (265/502, 52.8%) were female, and half (253/502, 50.4%) had at least some college education. Over one-third (191/502, 38.0%) of participants had low health literacy. The majority of participants owned devices (owned a smartphone: 116/173, 67.1% low health literacy versus 235/300, 78.3% adequate health literacy, P=.007) and had used the Internet previously (143/189, 75.7% low health literacy versus 281/309, 90.9% adequate health literacy, P<.001). Participants with low health literacy were more likely to report needing help performing online tasks (133/189, 70.4% low health literacy versus 135/303, 44.6% adequate health literacy, P<.001). In the multivariate analysis, when adjusting for age, race, gender, and education level, we found that low health literacy was not significantly associated with a lower likelihood of owning smartphones (OR: 0.8, 95% CI 0.5-1.4; P=.52) or using the internet ever (OR: 0.5, 95% CI 0.2-0.9; P=.02). However, low health literacy remained significantly associated with a higher likelihood of needing help performing any online task (OR: 2.2, 95% CI 1.3-3.6; P=.002). CONCLUSIONS The majority of participants with low health literacy had access to technological devices and had used the internet previously, but they were unable to perform online tasks without assistance. The barriers patients face in using online health information and other health information technology may be more related to online capabilities rather than to technology access. When designing and implementing technological tools for hospitalized patients, it is important to ensure that patients across digital literacy levels can both understand and use them.

Download Full-text

Correcting malapropisms: strategies to bridge cultural and socioeconomic gaps

International Journal of Human Rights in Healthcare ◽

10.1108/ijhrh-12-2015-0040 ◽

2017 ◽

Vol 10 (2) ◽

pp. 84-94

Author(s):

Israel Berger ◽

John A. Cartmill

Keyword(s):

Quality Of Care ◽

Health Literacy ◽

Health Outcomes ◽

Content Type ◽

Clinician Training ◽

Language Groups ◽

Low Health Literacy ◽

Socioeconomic Gaps ◽

Written Materials

Purpose Although patients and lay people are often more knowledgeable about medical conditions than their predecessors, the dominant culture’s increased involvement in understanding their health and making treatment decisions does not translate into consistently more informed patients. High health literacy is associated with both improved health outcomes and receiving better quality-of-care. Low health literacy disproportionately affects people from marginalized ethnic and language groups. Regardless of how a particular clinician feels about a patient, malapropisms and mis-attributions may cause patients to appear less intelligent or to have lower perceived health literacy, potentially affecting their healthcare experiences with other clinicians. The paper aims to discuss these issues. Design/methodology/approach This paper discusses the evidence for “up-skilling” patients and uses principles from conversation analysis to demonstrate how malapropisms can be corrected sensitively. Clinician training in skilled communication using the conversation analytic role-play method is also addressed. Findings Malapropisms are best corrected through modelling rather than calling attention to the error directly, as this allows the patient to save face. Explanations using drawings and clearly written materials may also be useful. Originality/value Helping patients to improve their communication with clinicians may lead to improved health outcomes through improved quality-of-care.

Download Full-text

Systematic Review of Health Literacy in Childhood Cancer Patients, Survivors, and Their Caregivers

Journal of Pediatric Psychology ◽

10.1093/jpepsy/jsaa009 ◽

2020 ◽

Vol 45 (4) ◽

pp. 373-385

Author(s):

Courtney Lynn ◽

Lauren Quast ◽

Hannah Rogers ◽

Karen Effinger ◽

Jordan Gilleland-Marchak

Keyword(s):

Systematic Review ◽

Health Literacy ◽

Health Outcomes ◽

Childhood Cancer ◽

Cancer Patients ◽

Cochrane Library ◽

Adequate Health Literacy ◽

Pediatric Cancer Patients ◽

Demographic Correlates ◽

The Impact

Abstract Objective This systematic review examined the literature regarding health literacy among pediatric cancer patients, survivors, and their caregivers. Specific aims were to identify and summarize measures used, levels of and demographic correlates of health literacy, effects of health literacy interventions, and associations between health literacy and health outcomes. Methods The search strategy was executed in the following databases: PubMed, EMBASE, PsycINFO, CINAHL, ERIC, and the Cochrane Library. Of the 842 unique studies retrieved, 9 met the inclusion criteria and were included in the systematic review. Results Studies used a variety of validated and study-specific measures with no measure emerging as the standard. Levels of health literacy were typically assessed subjectively and across studies the majority of those sampled self-reported adequate health literacy. Few studies examined demographic correlates of health literacy, precluding the identification of consistent predictors. Health literacy intervention research for this population is in its infancy and only pilot projects were identified; effects could not be evaluated. No studies assessed the impact of health literacy on health outcomes. Conclusions Very few studies assessed health literacy in pediatric oncology. As treatment for childhood cancer becomes increasingly complex, and patients and caregivers are expected to have adequate understanding of health information, health literacy is a critical construct that should not be overlooked.

Download Full-text