Navigating the Health Care System: An Adolescent Health Literacy Unit for High Schools

Objectives Self-management of chronic diseases is rather complex, especially for patients with limited health literacy. In this review, we aim to disentangle the specific difficulties patients with limited health literacy face in relation to self-management and their associated needs with respect to self-management support. Methods We performed a literature search in five databases. We used a broad definition of health literacy and self-management was categorized into four types of activities: medical management, changing lifestyle, communicating and navigating through the health care system and coping. Included reviews described the relationship between health literacy and different domains of self-management and were published after 2010. Results A total of 28 reviews were included. Some clear difficulties of patients with limited health literacy emerged, predominantly in the area of medical management (especially adherence), communication and knowledge. Other associations between health literacy and self-management were inconclusive. Barriers from the patients’ perspective described mainly medical management and the communication and navigation of the health care system. Discussion Patients with limited health literacy experience difficulties with specific domains of self-management. For a better understanding of the relationship between health literacy and self-management, a broader conceptualization of health literacy is warranted, including both cognitive and behavioural aspects.

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Race and Blackness: A Thematic Review of Communication Challenges Confronting the Black Community Within the U.S. Health Care System

Journal of Transcultural Nursing ◽

10.1177/1043659619889111 ◽

2019 ◽

Vol 31 (4) ◽

pp. 397-405 ◽

Cited By ~ 1

Author(s):

Comfort Tosin Adebayo ◽

Kimberly Walker ◽

Maren Hawkins ◽

Oluwatoyin Olukotun ◽

Leslie Shaw ◽

...

Keyword(s):

Health Care ◽

Health Literacy ◽

Health Care System ◽

Care Delivery ◽

Cultural Safety ◽

Structural Factors ◽

Potential Health ◽

Communication Challenges ◽

The U.S ◽

Care System

Effective communication is integral to the patient–provider relationship. Yet, as a result of structural factors that ignore the unique health care needs of different populations of patients who identify as Black—both African American and African immigrants—are confronted with communication challenges during health care seeking encounters. Using cultural safety as a framework, in this article, we thematically review communication challenges specifically experienced by patients of African descent in the U.S. health care system. In our review, we focus on complications that might arise from discrimination, mistrust, health literacy, and impacts of culture and language barriers on health literacy. In conclusion, we offer recommendations for improving the health care experiences and potential health outcomes for this population, through nursing care and health care delivery.

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Does higher health literacy lead to higher trust in public hospitals?

10.21203/rs.3.rs-226997/v1 ◽

2021 ◽

Author(s):

Maja Bertram ◽

Urs Steiner Brandt ◽

Rikke Klitten Hansen ◽

Gert Tinggaard Svendsen

Keyword(s):

Game Theory ◽

Health Care ◽

Health Literacy ◽

Health Care System ◽

Empirical Data ◽

Health Care Professionals ◽

Social Groups ◽

Public Hospitals ◽

Future Research ◽

Care System

Abstract Background: Does higher health literacy lead to higher trust in public hospitals? Existing literature suggests that this is the case since a positive association between the level of health literacy and the level of trust in physicians and the health care system has been shown. This study aims to challenge this assumption. Methods: Based on theoretical arguments from game theory and analysis of empirical data, we argue that the association is better described as an inversely u-shaped curve, suggesting that low and high levels of health literacy lead to a lower level of trust than a medium level of health literacy does. The empirical analysis is based on a study of the Danes’ relationship to the overall health care system. More than 6,000 Danes have been asked about their overall expectations of the health service, their concrete experiences and their attitudes to a number of change initiatives. Results: Game theory analysis show that the combined perceived cooperation and benefit effects can explain an inversely u-shaped relationship between social groups and trust in the health care system. Based on quantitative, binary regression analyses of empirical data, the lowest degree of trust is found among patients from the lowest and highest social groups, while the highest degree of trust is found in the middle group. The main driver for this result is that while patients having low health literacy perceive that the health care system is not cooperative, patients with a high level of health literacy have high expectations about the quality, which the health care system might not be able to provide. This reduces the perceived benefit from their encounter with the health care system. Conclusion: It is important that health care professionals understand that some patient groups have a higher chance of cooperation (e.g., agreeing on the choice of treatment) or defection (e.g. passing a complaint) than others. In perspective, future research should undertake further qualitative examinations of possible patient types and their demands in relation to different health care sectors, focusing specifically on the opportunities to improve the handling of different patient types.

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Navigational health literacy among people with chronic illness

Chronic Illness ◽

10.1177/17423953211073368 ◽

2022 ◽

pp. 174239532110733

Author(s):

Lennert Griese ◽

Doris Schaeffer ◽

Eva-Maria Berens

Keyword(s):

Social Support ◽

Health Care ◽

Chronic Illness ◽

Health Literacy ◽

Social Status ◽

Health Care System ◽

Chronically Ill ◽

Functional Health ◽

Functional Health Literacy ◽

Care System

Objectives People with chronic illness are particularly dependent on navigating and using the health care system. This requires navigational health literacy (HL-NAV). The article aims to examine the distribution and predictors of HL-NAV in a sample of chronically ill individuals. Methods Data of 1,105 people with chronic illness from the general population in Germany were collected in December 2019 and January 2020. HL-NAV was assessed by 12 items (score 0–100). Bivariate and multiple linear regression analysis were performed. Results HL-NAV score was 39.1 (SD 27.3). In bivariate analyses, HL-NAV was lower among chronically ill persons aged 65 or above, with low education, limited functional health literacy, low social status, financial deprivation, poor social support, multiple chronic conditions, and an illness duration of 6–10 years. In multivariate analyses, advanced age, lower education, less functional health literacy, lower social status, and less social support remained associated with lower HL-NAV. Discussion The results underline the importance of promoting HL-NAV among people with chronic illness. Strategies should aim at strengthening individual competencies taking into account the social and situational factors but also at reducing the demands placed on chronically ill people by providing user-friendly and trustworthy information on the health care system along the illness trajectory.

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Searching and dealing, confirmation and feeling – Participants’ approaches to learning in a health education setting

Health Education Journal ◽

10.1177/0017896916674240 ◽

2016 ◽

Vol 76 (3) ◽

pp. 326-336

Author(s):

Georg Førland ◽

Charlotte Silèn ◽

Monica Eriksson ◽

Karin C Ringsberg

Keyword(s):

Health Care ◽

Health Literacy ◽

Health Education ◽

Learning Strategies ◽

Health Care System ◽

Qualitative Content Analysis ◽

Approaches To Learning ◽

Education Programme ◽

Health Education Programme ◽

Care System

Objective: Health care is far from reaching the goal of people being part of their own care, and research is lacking on how to understand their perspective. This study explores people’s intentions with the act of learning before attending a health education programme at a Learning and Mastery Centre (LMC) in Norway. The aim of this study was to understand participants’ learning strategies for learning about their own health care in a health education setting. Methods: Data were collected through five group interviews and analysed using qualitative content analysis. Results: Findings revealed that participants’ intentions of how and what to learn were influenced by their life experiences and interactions with the health care system. Three main categories of experience emerged: (1) sharing experiences, (2) second opinion and (3) capturing the news, brought together under the comprehensive theme: searching and dealing, confirmation and feeling, which reflects the underlying meaning of the categories. Conclusion: Results encourage us to see learning as an active construction process underpinned by health literacy, including both people’s competencies and the health care system. If LMCs and similar health education initiatives are to make an important contribution to improving people’s health literacy, significant attention should be given in the planning and implementation of initiatives.

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Complementary Medicine Health Literacy among a Population of Older Australians Living in Retirement Villages: A Mixed Methods Study

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2016/5672050 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 7

Author(s):

Caroline A. Smith ◽

Esther Chang ◽

Suzanne Brownhill ◽

Kylie Barr

Keyword(s):

Health Care ◽

Health Literacy ◽

Health Information ◽

Complementary Medicine ◽

Health Care System ◽

Sufficient Information ◽

Care Providers ◽

Complementary Medicines ◽

Health Literacy Questionnaire ◽

Care System

Background. Older Australians are consumers of high levels of complementary medicines. The aim of this study was to examine health literacy in a population of older Australians related to their use of complementary medicine.Methods. A two-phase sequential mixed method design incorporating quantitative and qualitative methods was used in this study. The first phase consisted of a cross-sectional survey using a validated health literacy questionnaire and follow-up interviews with 11 residents of retirement villages. Interviews explored low scoring domains on the health literacy questionnaire.Results. Health literacy competencies scored higher for the domains ofhaving sufficient information to manage their health; felt understood and supported by health care providers; actively managed their health; and having social support for health. Three health literacy domains scored low includingappraisal of health information; ability to find good information;andnavigating the health care system.The findings suggest that participants had different experiences navigating the health care system to access information and services relating to complementary medicines. Two themes of “trust” and “try and see” provide insight into how this group of older Australians appraised health information in relation to complementary medicines.Conclusions. With a focus on self-care there is a need for improved health literacy skills.

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Are persons with a limited health literacy less satisfied with the German health care system?

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.049 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

K Achstetter ◽

J Köppen ◽

M Blümel ◽

R Busse

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Literacy ◽

Health Care System ◽

Medical Errors ◽

Private Health Insurance ◽

Perceived Discrimination ◽

German Health Care System ◽

German Health ◽

Care System

Abstract Background Health literacy (HL) is the ability to find, understand, appraise and apply health information with the aim of using this information to make decisions affecting the own health. Previous studies showed limited HL in around 50% of the German population. The assessment of the German health care system from the perspective of persons with limited HL is subject of this study. Methods In 2018, a survey was conducted among 20,000 persons with private health insurance in Germany. Survey items were based on the intermediate and final goals of the WHO Health Systems Framework. Questions comprised, for example, satisfaction with the health care system, responsiveness (e.g. perceived discrimination), access (e.g. off-hour care), and safety (e.g. medical errors). HL was assessed with the HLS-EU-Q16 questionnaire. Descriptive statistics and Chi-square test were used to analyze the data and group differences. Results Overall, 3,601 participants (18.0%) completed the survey (58.6 years ± 14.6; 64.6% male). Limited HL was seen with 44.6% (8.5% inadequate & 36.1% problematic), whereas 55.4% did not report limited HL (43.4% sufficient & 12.0% excellent). Very satisfied with the German health care system were 6.5% of the persons with limited HL (vs. 14.3%). Perceived discrimination within the last 12 months was reported by 11.0% of the persons with limited HL (vs. 5.1%). To get medical care on weekends, holidays or evenings outside hospitals was rated as “very hard” by 34.6% of the persons with limited HL (vs. 23.6%). The feeling that they experienced medical errors was reported by 18.7% with limited HL (vs. 11.5%) and 5.9% were unsure (vs. 2.2%). All results were statistically significant (p < 0.001). Conclusions Persons with limited HL were less satisfied with the overall German health care system in comparison to persons with not limited HL and reported more often perceived discrimination. Strengthening HL could help to improve satisfaction with the health care system. Key messages Limited HL among persons with private health insurance in Germany was found in 44.6% of the survey’s participants. Persons with limited HL indicated to be less satisfied with the German health care system and perceived more often discrimination in their health care.

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Experiences And Needs Concerning Health Related Information For Newly Arrived Refugees In Sweden

10.21203/rs.2.22431/v1 ◽

2020 ◽

Author(s):

Lena Mårtensson ◽

Per Lytsy ◽

Ragnar Westerling ◽

Josefin Wångdahl

Keyword(s):

Health Care ◽

Health Literacy ◽

Focus Group ◽

Health Care System ◽

Qualitative Content Analysis ◽

Contextual Knowledge ◽

Health Issues ◽

Related Information ◽

Health Related ◽

Care System

Abstract Background Owing to communication challenges and a lack of knowledge about the health care system, refugees may be at risk of having limited health literacy, meaning that they will have problems in achieving, understanding, appraising and using health information or navigating in the health care system. The aim of this study was to explore experiences and needs concerning health related information for newly arrived refugees in Sweden. Methods A qualitative design with a focus group methodology was used. The qualitative content analysis was based on seven focus group discussions, including 28 Arabic and Somali speaking refugees. Results Four categories emerged. ‘Concrete instructions and explanations’ includes appreciation of knowledge about how to act when facing health problems. ‘Contextual knowledge’ comprises experienced needs of information about the health care system, about specific health risks and about rights in health issues. ‘A variation of sources’ describes suggestions as to where and how information should be given. ‘Enabling communication’ includes the wish for more awareness among professionals from a language and cultural point of view. Conclusion Concrete instructions and explanations are experienced as valuable and applicable. Additional information about health issues and the health care system is needed. Information concerning health should be spread by a variety of sources. Health literate health organizations are needed to meet the health challenges of refugees, including professionals that emphasize health literacy.

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Digital Health Literacy and Preparedness: Comparison of Veterans Health Affairs Users and Other Veterans Nationally (Preprint)

10.2196/preprints.32764 ◽

2021 ◽

Author(s):

Charlie Wray ◽

Janet Tang ◽

Amy Byers ◽

Salomeh Keyhani

Keyword(s):

Health Care ◽

Health Literacy ◽

Social Isolation ◽

Health Care System ◽

Digital Health ◽

The Internet ◽

Social Risk ◽

Veterans Health ◽

Va Health Care System ◽

Care System

BACKGROUND As health care systems shift to greater use of telemedicine and digital tools, an individual’s digital health literacy has become an important skill set. The Veterans Health Administration (VA) has invested resources in providing digital health care; however, to date, no study has compared the digital health literacy and preparedness of Veterans receiving care in the VA to Veterans receiving care outside the VA. OBJECTIVE Describe digital health literacy and preparedness among Veterans who receive care within and outside the VA health care system and examine whether receiving care in the VA is associated with digital preparedness (having >2 digital health literacy skills) after accounting for demographic and social risk factors. METHODS We used cross-sectional data from the 2016-18 National Health Interview Survey to identify Veterans (age>18) who obtain health care either within or outside the VA health care system. We used multivariable logistic regression models to examine the association of sociodemographic (age, sex, race, ethnicity), social risk factors (economic instability, disadvantaged neighborhood, low educational attainment, and social isolation), and health care delivery location (VA and non-VA) with digital preparedness. RESULTS Those who received health care within the VA health care system (n=3,188) were younger (age 18-49: 33.3% [30.7-36.0] vs. 24.2% [21.9-26.5], p<0.01), were more often female (34.7% [32.0-37.3] vs. 6.6% [5.5-7.6], p<0.01) and identified as Black (13.1% [11.2-15.0] vs. 10.2% [8.7-11.8], p<0.01), and reported greater economic instability (8.3% [6.9-9.8] vs. 5.5% [4.6-6.5], p<0.01) and social isolation (42.6% [40.3-44.9] vs. 35.4% [33.4-37.5], p<0.01) compared to Veterans who received care outside the VA (n=3,393). Veterans who obtained care within the VA reported higher digital health literacy than those who obtained care outside the VA, endorsing greater rates of looking up health information on the internet (51.8% [49.2-54.4] vs. 45.0% [42.6-47.3], p<0.01), filling a prescription using the internet (16.2% [14.5-18.0] vs. 11.3% [9.6-13.0], p<0.01), scheduling a health care appointment on the internet (14.1% [12.4-15.8] vs. 11.6% [10.1-13.1], p=0.02), and communicating with a health care provider by email (18.0% [16.1-19.8] vs. 13.3% [11.6-14.9], p<0.01). In adjusted analysis, age >75 (aOR: 0.59, 95% CI 0.45-0.76), low educational attainment (aOR: 0.40, 95% CI 0.34-0.48) and social isolation (aOR: 0.78, 95% CI 0.66-0.92) were associated with a lower likelihood of being digitally prepared. Receiving health care from the VA was the only characteristic associated with higher odds (aOR: 1.36, 95% CI 1.12-1.65) of being digitally prepared. CONCLUSIONS Despite these demographic disadvantages to digital uptake, Veterans who receive care in the VA have higher digital health literacy and appear more digitally prepared than Veterans who do not receive care within the VA – suggesting a positive, system-level influence on this cohort.

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