Neurocognitive Performance Differences Between Black and White Individuals with HIV Disease are Mediated by Health Literacy

2021 ◽  
Author(s):  
Ilex Beltran-Najera ◽  
Jennifer L. Thompson ◽  
Anastasia Matchanova ◽  
Kelli L. Sullivan ◽  
Michelle A. Babicz ◽  
...  
Keyword(s):  
Health Disparities ◽  
Health Literacy ◽  
Adult Literacy ◽  
Black Americans ◽  
The United States ◽  
Hiv Disease ◽  
Neurocognitive Performance ◽  
Brain Health ◽  
Mediation Analyses ◽  
Significant Mediator

Objective: Brain health disparities have been reported for Black Americans with HIV disease, who are disproportionally affected by the epidemic in the United States. The current study investigated whether the neurocognitive disparities experienced by Black Americans with HIV disease may be at least partly attributable to health literacy. Method: Participants were 61 White and 25 Black participants (ages 27-70) with HIV disease enrolled in studies at an urban academic center in Southern California. Neurocognitive function was assessed by an age-adjusted global score from the Cogstate battery. Health literacy was measured by a composite score derived from the Rapid Estimate of Adult Literacy in Medicine, Newest Vital Sign, and 3-Brief. Results: Bootstrap confidence interval mediation analyses showed that health literacy was a significant mediator of the hypothesized relationship between race and neurocognition; that is, there were no direct ethnoracial differences in neurocognition after accounting for health literacy. A follow-up inverted model to confirm the directionality of this association demonstrated that neurocognition was not a significant mediator of the relationship between race and health literacy. Conclusions: Low health literacy may help explain the observed neurocognitive health disparities for Black Americans with HIV disease. Future studies might examine the possible mechanism of this mediating relationship (e.g., access to health information, health behaviors, socioeconomics) and determine whether culturally tailored interventions that improve health literacy also confer brain health benefits for Black Americans with HIV disease.

scholarly journals Evidence for neuropsychological health disparities in Black Americans with HIV disease

2021 ◽  
pp. 1-26
Author(s):  
Jennifer L. Thompson ◽  
Ilex Beltran-Najera ◽  
Briana Johnson ◽  
Yenifer Morales ◽  
Steven Paul Woods
Keyword(s):  
Health Disparities ◽  
Black Americans ◽  
Hiv Disease

scholarly journals A Conceptual Framework for Understanding How and Why People Take Antibiotics Without a Prescription

2020 ◽  
Vol 41 (S1) ◽  
pp. s93-s93
Author(s):  
Larissa Grigoryan ◽  
Osvaldo Alquicira ◽  
Susan Nash ◽  
Melanie Goebel ◽  
Barbara Trautner
Keyword(s):  
United States ◽  
At Risk ◽  
Health Disparities ◽  
Health Literacy ◽  
Conceptual Framework ◽  
Healthcare System ◽  
Antibiotic Use ◽  
The United States ◽  
Clinical Encounter ◽  
Inadequate Health Literacy

Background: The reported prevalence of nonprescription antibiotic use in the United States varies from 5% among socioeconomically and ethnically diverse primary care patients to 66% among Latino migrant workers. Reports indicate that people obtain and take antibiotics from stores or flea markets in the United States, friends or relatives, and leftover antibiotics from previous prescriptions. This unsafe practice may lead to unnecessary and inappropriate antibiotic use and increases the risk of antibiotic resistance. As groundwork to develop an intervention to decrease nonprescription antibiotic use, we mapped reported drivers of nonprescription use to the Kilbourne conceptual framework for advancing health disparities research. Methods: The Kilbourne framework consists of 3 phases: (1) detection of health disparities and identification of vulnerable populations, (2) understanding why disparities exist, and (3) reducing or eliminating disparities through interventions. We focused on the first 2 phases and mapped the identified drivers of nonprescription antibiotic use onto the key domains of the Kilbourne conceptual framework: patient, healthcare system, and clinical encounter factors. We also conducted brief field research to explore anecdotal reports regarding availability of nonprescription antibiotics in our community. Results: We found 8 studies addressing factors related to nonprescription antibiotic use in the United States. These studies were primarily qualitative and included Spanish-speaking Hispanic and Latino immigrants. Figure 1 shows the proposed factors that may directly or indirectly predict nonprescription antibiotic use. Key potential factors are individual factors, psychosocial factors, resources, healthcare system factors, and clinical-encounter factors. For example, patients with inadequate health literacy may have poor access to care because of difficulty finding providers and choosing or navigating insurance plans; thus, they may be at risk for nonprescription use. At the same time, patients with inadequate health literacy may be at risk for using nonprescription antibiotics for a viral infection because of difficulty understanding medication labels or package inserts. The relevance of resources (availability) to nonprescription antibiotic use was supported by our research team’s purchase of amoxicillin, tetracycline, and metronidazole without prescriptions from a flea market in Houston, Texas. Conclusions: The Kilbourne conceptual framework provides a strong, comprehensive basis for research and intervention in the challenging problem of nonprescription antibiotic use. Ongoing research will test the proposed relationships between patient, healthcare system, and clinical-encounter factors and nonprescription antibiotic use outcomes. We are conducting a survey among both indigent and insured patient populations to identify the relative importance of these factors and to validate our proposed conceptual framework of nonprescription antibiotic use.Funding: This project was supported by grant number R01HS026901 from the Agency.Disclosures: None

scholarly journals Health Insurance Literacy and Health Disparities in the United States: A Literature Review

2019 ◽  
Vol 3 (4) ◽  
Author(s):  
Emily Vardell
Keyword(s):  
Health Care ◽  
Health Disparities ◽  
Health Insurance ◽  
Health Literacy ◽  
Literature Review ◽  
The United States ◽  
Literacy Skills ◽  
The Body ◽  
Health Insurance Literacy ◽  
The U.S

This paper presents a literature review of health insurance literacy with a focus on specialized populations in the U.S. and how limited health literacy skills exacerbate health disparities. This discussion places this issue within the context of contemporary U.S. health care reform and makes connections between health insurance coverage and health disparities. This overview of the research on health insurance literacy covers research across the health insurance spectrum, from awareness of health insurance options to assessments of health literacy skills in specific populations as well as from readability of health insurance informational materials to the availability of multilingual services. In exploring the demographic variables associated with lower health insurance literacy skills, this paper reviews the body of current research in this area to make connections between populations more likely to have unequal access to health care and how having limited skills in navigating the U.S. health care system may compound these disparities. In addition, this paper proposes an Integrated Framework for Health Insurance Literacy as a method for further studying the connections between demographic factors, health coverage, health status, and health insurance literacy skills.

Translation in Health Literacy Research

2020 ◽  
pp. 409-430
Author(s):  
Xuewei Chen ◽  
Sandra Acosta
Keyword(s):  
Health Literacy ◽  
Adult Literacy ◽  
Limited English Proficiency ◽  
The United States ◽  
Functional Health ◽  
The United Kingdom ◽  
Literacy Survey ◽  
European Health ◽  
Immigrant And Refugee ◽  
Literacy Research

This chapter reviews the translation process for six health literacy instruments: Rapid Estimate of Adult Literacy in Medicine, Test of Functional Health Literacy in Adults (TOFHLA), European Health Literacy Survey Questionnaire (HLS-EU-Q), All Aspects of Health Literacy Scale, Newest Vital Sign, and Functional, Communicative and Critical Health Literacy. Some instruments, developed in the United States and the United Kingdom, targeted English-speaking populations only. Later, researchers translated several into the languages of immigrant and refugee groups with limited English proficiency. For example, the TOFHLA was translated and adapted to target Korean and Vietnamese Americans. Some instruments were translated and employed for conducting health literacy research worldwide. One example is the HLS-EU-Q for health literacy research conducted in Indonesia, Kazakhstan, Malaysia, Myanmar, Taiwan, and Vietnam. This chapter describes how health literacy instruments were translated into various languages and revised to account for cultural and health system differences across countries and population groups.

Neurocognitive performance differences between black and white individuals with HIV disease are mediated by health literacy

2021 ◽  
pp. 1-17
Author(s):  
Ilex Beltran-Najera ◽  
Jennifer L. Thompson ◽  
Anastasia Matchanova ◽  
Kelli L. Sullivan ◽  
Michelle A. Babicz ◽  
...  
Keyword(s):  
Health Literacy ◽  
Hiv Disease ◽  
Neurocognitive Performance ◽  
Black And White ◽  
Performance Differences

Health Literacy Among Bhutanese Adult Refugees in the United States: The Sociocultural Approach

2020 ◽  
Vol 70 (3) ◽  
pp. 258-276 ◽  
Author(s):  
Xia Chao ◽  
Boping Kang
Keyword(s):  
Health Literacy ◽  
Adult Literacy ◽  
Oral Tradition ◽  
Public Awareness ◽  
Language Education ◽  
The United States ◽  
Literacy Education ◽  
Functional Health ◽  
World Citizenship ◽  
Adult Literacy Education

Drawing on the accounts of literacy as socioculturally situated, this 2-year ethnography explores Bhutanese adult refugees’ health literacy at the intersection of their culture and experiences. This study illustrates the multifaceted relations between health literacy, culture, integration, and empowerment. This study indicates health literacy as sociocultural practice. Health literacy is mediated by Bhutanese adults’ oral tradition, language, education, and experiences over time. This study highlights health literacy as sociocultural participation—it resides in individuals’ community engagement. Rather than simply describing their limited functional health literacy as “a big problem,” this study recognizes Bhutanese adults’ ability to take action to improve personal and community health. This study challenges the deficit view rooted in adult literacy. It advocates integrating health literacy into adult literacy education to raise public awareness that health literacy promotes social justice, human rights, and world citizenship. Implications for a bottom-up approach to health literacy education are provided.

The Complexity of Health Disparities: More Than Just Black–White Differences

2021 ◽  
pp. 1-10
Author(s):  
Charles Ellis ◽  
Molly Jacobs
Keyword(s):  
Health Disparities ◽  
Clinical Outcomes ◽  
The United States ◽  
Careful Examination ◽  
White Americans ◽  
Speech Language Pathology ◽  
Death Rates ◽  
The Social ◽  
Health Related ◽  
Language Pathology

Health disparities have once again moved to the forefront of America's consciousness with the recent significant observation of dramatically higher death rates among African Americans with COVID-19 when compared to White Americans. Health disparities have a long history in the United States, yet little consideration has been given to their impact on the clinical outcomes in the rehabilitative health professions such as speech-language pathology/audiology (SLP/A). Consequently, it is unclear how the absence of a careful examination of health disparities in fields like SLP/A impacts the clinical outcomes desired or achieved. The purpose of this tutorial is to examine the issue of health disparities in relationship to SLP/A. This tutorial includes operational definitions related to health disparities and a review of the social determinants of health that are the underlying cause of such disparities. The tutorial concludes with a discussion of potential directions for the study of health disparities in SLP/A to identify strategies to close the disparity gap in health-related outcomes that currently exists.

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