Negotiating identity: impact on self-management practices in people with asthma and limited health literacy in Malaysia

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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A longitudinal qualitative study to explore and optimize self-management in mild to end stage chronic kidney disease patients with limited health literacy: perspectives of patients and health care professionals

Patient Education and Counseling ◽

10.1016/j.pec.2021.05.016 ◽

2021 ◽

Author(s):

Marco D. Boonstra ◽

Sijmen A. Reijneveld ◽

Ralf Westerhuis ◽

Janne M. Tullius ◽

Johanna P.M. Vervoort ◽

...

Keyword(s):

Health Care ◽

Chronic Kidney Disease ◽

Health Literacy ◽

Kidney Disease ◽

Health Care Professionals ◽

Self Management ◽

Limited Health Literacy ◽

Literacy Perspectives ◽

Limited Health ◽

End Stage

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Developing an Asthma Self-management Intervention Through a Web-Based Design Workshop for People With Limited Health Literacy: User-Centered Design Approach

Journal of Medical Internet Research ◽

10.2196/26434 ◽

2021 ◽

Vol 23 (9) ◽

pp. e26434

Author(s):

Hani Salim ◽

Ping Yein Lee ◽

Sazlina Sharif-Ghazali ◽

Ai Theng Cheong ◽

Jasmine Wong ◽

...

Keyword(s):

Health Literacy ◽

Action Plan ◽

Real Life ◽

Mobile App ◽

Self Management ◽

Primary Care Center ◽

Long Term Conditions ◽

Web Based ◽

Limited Health Literacy ◽

Limited Health

Background Technology, including mobile apps, has the potential to support self-management of long-term conditions and can be tailored to enhance adoption. We developed an app to support asthma self-management among people with limited health literacy in a web-based workshop (to ensure physical distancing during the COVID-19 pandemic). Objective The aim of this study is to develop and test a prototype asthma self-management mobile app tailored to the needs of people with limited health literacy through a web-based workshop. Methods We recruited participants from a primary care center in Malaysia. We adapted a design sprint methodology to a web-based workshop in five stages over 1 week. Patients with asthma and limited health literacy provided insights into real-life self-management issues in stage 1, which informed mobile app development in stages 2-4. We recruited additional patients to test the prototype in stage 5 using a qualitative research design. Participants gave feedback through a concurrent thinking-aloud process moderated by a researcher. Each interview lasted approximately 1 hour. Screen recordings of app browsing activities were performed. Interviews were audio-recorded and analyzed using a thematic approach to identify utility and usability issues. Results The stakeholder discussion identified four themes: individual, family, friends, and society and system levels. Five patients tested the prototype. Participants described 4 ways in which the app influenced or supported self-management (utility): offering information, providing access to an asthma action plan, motivating control of asthma through support for medication adherence, and supporting behavior change through a reward system. Specific usability issues addressed navigation, comprehension, and layout. Conclusions This study proved that it was possible to adapt the design sprint workshop to a web-based format with the added advantage that it allowed the development and the testing process to be done efficiently through various programs. The resultant app incorporated advice from stakeholders, including sources for information about asthma, medication and appointment reminders, accessible asthma action plans, and sources for social support. The app is now ready to move to feasibility testing.

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Developing an Asthma Self-management Intervention Through a Web-Based Design Workshop for People With Limited Health Literacy: User-Centered Design Approach (Preprint)

10.2196/preprints.26434 ◽

2020 ◽

Author(s):

Hani Salim ◽

Ping Yein Lee ◽

Sazlina Sharif-Ghazali ◽

Ai Theng Cheong ◽

Jasmine Wong ◽

...

Keyword(s):

Health Literacy ◽

Action Plan ◽

Real Life ◽

Mobile App ◽

Self Management ◽

Primary Care Center ◽

Long Term Conditions ◽

Web Based ◽

Limited Health Literacy ◽

Limited Health

BACKGROUND Technology, including mobile apps, has the potential to support self-management of long-term conditions and can be tailored to enhance adoption. We developed an app to support asthma self-management among people with limited health literacy in a web-based workshop (to ensure physical distancing during the COVID-19 pandemic). OBJECTIVE The aim of this study is to develop and test a prototype asthma self-management mobile app tailored to the needs of people with limited health literacy through a web-based workshop. METHODS We recruited participants from a primary care center in Malaysia. We adapted a design sprint methodology to a web-based workshop in five stages over 1 week. Patients with asthma and limited health literacy provided insights into real-life self-management issues in stage 1, which informed mobile app development in stages 2-4. We recruited additional patients to test the prototype in stage 5 using a qualitative research design. Participants gave feedback through a concurrent thinking-aloud process moderated by a researcher. Each interview lasted approximately 1 hour. Screen recordings of app browsing activities were performed. Interviews were audio-recorded and analyzed using a thematic approach to identify utility and usability issues. RESULTS The stakeholder discussion identified four themes: individual, family, friends, and society and system levels. Five patients tested the prototype. Participants described 4 ways in which the app influenced or supported self-management (utility): offering information, providing access to an asthma action plan, motivating control of asthma through support for medication adherence, and supporting behavior change through a reward system. Specific usability issues addressed navigation, comprehension, and layout. CONCLUSIONS This study proved that it was possible to adapt the design sprint workshop to a web-based format with the added advantage that it allowed the development and the testing process to be done efficiently through various programs. The resultant app incorporated advice from stakeholders, including sources for information about asthma, medication and appointment reminders, accessible asthma action plans, and sources for social support. The app is now ready to move to feasibility testing.

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Does Depression and Anxiety Mediate the Relation between Limited Health Literacy and Diet Non-Adherence?

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17217913 ◽

2020 ◽

Vol 17 (21) ◽

pp. 7913

Author(s):

Ivana Skoumalova ◽

Andrea Madarasova Geckova ◽

Jaroslav Rosenberger ◽

Maria Majernikova ◽

Peter Kolarcik ◽

...

Keyword(s):

Health Literacy ◽

Hierarchical Cluster ◽

Cross Sectional Study ◽

Self Management ◽

Anxiety And Depression ◽

Depression And Anxiety ◽

Cross Sectional ◽

Limited Health Literacy ◽

Gender And Education ◽

Limited Health

Limited health literacy (HL), depression and anxiety are common in dialyzed patients and affect health outcomes and self-management. We explored whether depression and anxiety mediate the association of HL with diet non-adherence (DN-A) in dialyzed patients. We performed a cross-sectional study in 20 dialysis clinics in Slovakia (n = 452; mean age: 63.6 years; males: 60.7%). Hierarchical cluster analysis was performed to create three HL groups. Logistic regression adjusted for age, gender and education was used to explore whether depression and anxiety mediate the association of HL with DN-A. Patients in the moderate HL group were more likely to be non-adherent to diet (OR (Odds Ratio)/95% CI: 2.19/1.21–3.99) than patients in the high HL group. Patients in the low HL and moderate HL group more likely reported depression or anxiety. Patients reporting depression (OR/95% CI: 1.94/1.26–2.98) or anxiety (OR/95% CI: 1.81/1.22–2.69) were more likely to be non-adherent with diet. Adjustment for depression reduced the association between moderate HL and DN-A by 19.5%. Adjustment for anxiety reduced the association between moderate HL and DN-A by 11.8%. Anxiety and depression partly mediated the association of HL with DN-A. More attention should be paid to treating patients’ psychological distress to ensure adequate adherence with recommended diet.

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A systematic review of interventions addressing limited health literacy to improve asthma self-management

Journal of Global Health ◽

10.7189/jogh.10.010428 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Hani Salim ◽

Siti Nurkamilla Ramdzan ◽

Sazlina Shariff Ghazali ◽

Ping Yein Lee ◽

Ingrid Young ◽

...

Keyword(s):

Systematic Review ◽

Health Literacy ◽

Self Management ◽

Limited Health Literacy ◽

Limited Health

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Health literacy levels and its determinants among people with asthma in Malaysian primary healthcare settings: a cross-sectional study

BMC Public Health ◽

10.1186/s12889-021-11194-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

H. Salim ◽

S. Shariff Ghazali ◽

P. Y. Lee ◽

A. T. Cheong ◽

N. H. Harrun ◽

...

Keyword(s):

Health Literacy ◽

Action Plan ◽

Cross Sectional Study ◽

Self Management ◽

Cross Sectional ◽

Limited Health Literacy ◽

Healthcare Settings ◽

History Of ◽

Limited Health ◽

Asthma Action Plan

Abstract Background Limited health literacy among people with asthma is associated with poor adherence to self-management activities, thus poor clinical outcomes. This study aimed to determine the prevalence of health literacy level and its determinants among people with asthma in the Malaysian primary healthcare settings. Method A cross-sectional study was conducted among participants aged > 18 years with asthma who attended five primary health clinics in Malaysia. Systematic random sampling was employed with a final sample of 550 participants. The questionnaires included the validated Malay version of Health Literacy Scale (HLS) and asthma control questionnaire (ACQ). Statistical analysis was done using SPSS version 25. Multiple logistic regression was performed to determine the determinants for limited health literacy. Results The participants mean age of the participants was 48 (SD15.4) years. Most of the participants were women (64%) and of Malay ethnicity (51.1%). Nearly half had a secondary level of education, n = 112, (45.8%). Mean duration of asthma diagnosis is 20.6 (SD 15.9) years. More than half (62.5%) had a family history of asthma. About half (50.9%) had uncontrolled asthma, with 87.3% self-rated themselves as having controlled asthma. About a third (29.1%) received education on of asthma action plan, but only 7.1% of these owned a written version an asthma action plan. Limited health literacy accounts for 60.5% of the participants. The significant determinants for limited health literacy included lower educational attainment (p < 0.001), family history of asthma (p = 0.034), < 20 years duration of asthma diagnosis (p = 0.031) and not receiving asthma action plan education (p < 0.001). Conclusion In this study population, more than half of the people living with asthma were found to have limited health literacy, which was associated with not having received self-management education supported by an asthma action plan. Future interventions should include strategies that ensure they meet the needs of people with limited health literacy.

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Malaysian Health Literacy: Scorecard Performance from a National Survey

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18115813 ◽

2021 ◽

Vol 18 (11) ◽

pp. 5813

Author(s):

Norrafizah Jaafar ◽

Komathi Perialathan ◽

Manimaran Krishnan ◽

Nurashma Juatan ◽

Masitah Ahmad ◽

...

Keyword(s):

Health Literacy ◽

Nationwide Survey ◽

Population Based ◽

Average Score ◽

Future Health ◽

Limited Health Literacy ◽

Health Literacy Level ◽

Prevention And Health Promotion ◽

Literacy Level ◽

Limited Health

Health literacy is an indicator of a society’s ability to make better health judgements for themselves and the people around them. This study investigated the prevalence of health literacy among Malaysian adults and provided an overall picture of the society’s current health literacy status, which has not been previously assessed. The study also highlighted socio-demographic markers of communities with limited health literacy that may warrant future intervention. A population-based self-administered survey using the Health Literacy Survey Malaysian Questionnaire18 (HLS-M-Q18) instrument was conducted as part of the National Health Morbidity Survey 2019 in Malaysia. The nationwide survey utilized a two-staged stratified random sampling method. A sample of 9478 individuals aged 18 and above, drawn from the living quarter list, participated in the study. The health literacy score was divided into three levels; limited, sufficient, and excellent. Findings showed a majority of the Malaysian population had a sufficient health literacy level in all three domains—healthcare, diseases prevention and health promotion (49.1%, 44.2%, and 47.5%, respectively)—albeit leaning towards the lower end of the category with an average score of 35.5. The limited health literacy groups were prevalent among respondents with older age (68%), lower education level (64.8%), and lower household income (49.5%). The overall health literacy status for Malaysia was categorized at a lower sufficiency level. Future health literacy improvements should focus on communities with a limited health literacy level to improve the overall score.

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Health literacy level in a various nephrology population from Québec: predialysis clinic, in-centre hemodialysis and home dialysis; a transversal monocentric observational study

BMC Nephrology ◽

10.1186/s12882-021-02464-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Annabel Boyer ◽

Yannick Begin ◽

Julie Dupont ◽

Mathieu Rousseau-Gagnon ◽

Nicolas Fernandez ◽

...

Keyword(s):

Health Literacy ◽

Observational Study ◽

Health Information ◽

Healthcare Providers ◽

Significant Proportion ◽

Good Health ◽

Sufficient Information ◽

Home Dialysis ◽

Limited Health Literacy ◽

Limited Health

Abstract Background Health literacy refers to the ability of individuals to gain access to, use, and understand health information and services in order to maintain a good health. It is especially important in nephrology due to the complexity of chronic kidney disease (CKD). The present study sought to define health literacy levels in patients followed in predialysis clinic, in-center dialysis (ICHD), peritoneal dialysis (PD) and home hemodialysis (HHD). Methods This transversal monocentric observational study analysed 363 patients between October 2016 and April 2017. The Brief Health Literacy Screen (BHLS) and the Health Literacy Questionnaire (HLQ) were used to measure health literacy. Multivariate linear regressions were used to compare the mean scores on the BHLS and HLQ, across the four groups. Results Patients on PD had a significantly higher BHLS’score than patients on ICHD (p = 0.04). HLQ’s scores differed across the groups: patients on HHD (p = 0.01) and PD (p = 0.002) were more likely to feel understood by their healthcare providers. Compared to ICHD, patients on HHD were more likely to have sufficient information to manage their health (p = 0.02), and patients in the predialysis clinic were more likely to report high abilities for health information appraisal (p < 0.001). Conclusion In a monocentric study, there is a significant proportion of CKD patients, especially in predialysis clinic and in-centre hemodialysis, with limited health literacy. Patients on home dialysis (HHD and PD) had a higher level of health literacy compared to the other groups.

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