Multimorbidity prevalence and patterns and their associations with health literacy among chronic kidney disease patients

Background Health literacy is the ability to deal with information related to one’s health. Patients with low health literacy have poor disease-management skills for chronic diseases, such as chronic kidney disease (CKD). This could influence the number and combination of their diseases. Methods We included adult patients with CKD stages 1–5 from the Lifelines Study (n = 2,742). We assessed the association between low health literacy and the number and patterns of comorbidities, considering them globally and stratified by age and sex, using multinomial logistic regression and latent class analysis, respectively. Results Low health literacy was associated with a higher number of comorbidities in the crude models, and after adjustment for age, sex, eGFR, smoking, and BMI. In the crude model, the OR for low health literacy increased from 1.71 (1.25–2.33) for two comorbidities to 2.71 (2.00–3.68) for four comorbidities. In the fully-adjusted model, the associations remained significant with a maximum OR of 1.70 (1.16–2.49) for four comorbidities. The patterns of multimorbidity were similar for low and adequate health literacy, overall and by sex, bur tended to be different for patients older than 65. Older patients with low health literacy had higher comorbidity prevalence and a relatively greater share of cardiovascular, psychiatric, and central nervous system diseases. Conclusions Among CKD patients, low health literacy is associated with more multimorbidity. Health literacy is not associated with patterns of multimorbidity in younger patients, but a difference was observed in older ones. Improving low health literacy could be an intervention efficient also in decreasing multimorbidity in CKD patients. Graphical abstract

Preferences and Experiences of People with Chronic Illness in Using Different Sources of Health Information: Results of a Mixed-Methods Study

Background: People with chronic illness are particularly dependent on adequate health literacy (HL), but often report difficulties in accessing, understanding, appraising, and applying health information. To strengthen the HL of people with chronic illness, in-depth knowledge about how they deal with health information is crucial. Methods: To this end, quantitative data from the Second Health Literacy Survey Germany (HLS-GER 2) and qualitative data from seven focus group discussions were used to examine the interest in health information, preferred sources of information as well as experiences and challenges with information management among people with chronic illness. Results: The results show that people with chronic illness have a great interest in health information and use very different sources of health information, preferring personal information from physicians most. The results also point to several challenges in health information management that seem to be influenced by the illness duration as well as by the experiences made with the respective sources. Conclusions: Overall, the study provides important starting points for intervention development for the provision and communication of health-related information, but also to research on health information behavior and HL.

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

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.

P032 Adequate health literacy predicts adherence to continuous positive airway pressure in adults with Obstructive Sleep Apnoea

Study Objectives Obstructive sleep apnoea (OSA) is a chronic disease with significant health implications and adequate adherence to continuous positive airway pressure (CPAP) is essential for effective treatment. In many chronic diseases, health literacy has been found to predict treatment adherence and outcomes. In this study, the aim was to determine the health literacy of a sleep clinic population and evaluate the association between health literacy and CPAP adherence. Methods A prospective cohort study was undertaken, recruiting 104 consecutive patients with a variety of sleep diagnoses attending the clinic. The Short Form Rapid Estimate of Adult Literacy in Medicine (REALM-SF), a validated questionnaire was administered to measure health literacy. In a sub-group of 91 patients prescribed CPAP for OSA, CPAP usage was measured, with adequate usage defined as greater than 4hrs/night CPAP therapy. Results 71% of the sleep clinic cohort was found to have adequate health literacy as measured by the REALM-SF. In those prescribed CPAP for OSA, inadequate health literacy was associated with a two fold increase risk for inadequate CPAP usage (adjusted odds ratio 2.75, 95% CI: 1.00 - 7.6, p = 0.05). There was a 1.7hr/night difference in median CPAP usage comparing those with adequate to inadequate health literacy (4.6hrs versus 6.3hrs/night). Conclusions The majority of this sleep disorders cohort had adequate health literacy as measured by the REALM-SF questionnaire. However inadequate health literacy appears to be an independent predictor of treatment adherence, and may represent a potentially modifiable risk factor of poor treatment outcomes in OSA.

Multimorbidity patterns and its associations with health literacy in chronic kidney disease patients

Background Health literacy is the ability to deal with information related to one's health. Patients with low health literacy have poor disease-management skills for chronic diseases, such as chronic kidney disease (CKD). This could influence the number and combination of their diseases. Methods We included adult patients with CKD stages 1-5 from the Lifelines Study (n = 2,742). We assessed the association between low health literacy and the number and patterns of comorbidities, overall and by age and sex, using multinomial logistic regression and latent class analysis, respectively. Results Low health literacy was associated with a higher number of comorbidities in the crude models, and after adjustment for age, sex, eGFR, smoking, and BMI. In the crude model, the OR for low health literacy increased from 1.71 (1.25 to 2.33) for two comorbidities to 2.71 (2.00 to 3.68) for four comorbidities. In the fully-adjusted model, the associations remained significant with a maximum OR of 1.70 (1.16 to 2.49) for four comorbidities. The patterns of multimorbidity were similar for low and adequate health literacy, overall and by sex, and slightly different for patients older than 65. Older patients with low health literacy had higher comorbidity prevalence and a relatively greater share of cardiovascular, psychiatric, and central nervous system diseases. Conclusions This study showed that CKD patients have a high prevalence of comorbidities. Patients with low health literacy are more likely to have a higher number of comorbidities than patients with adequate health literacy. Moreover, the multimorbidity patterns are similar for both groups of health literacy, differing slightly at older ages. This age difference suggests that the negative effects of low health literacy develop when aging. Therefore, low health literacy could be an intervention target to decrease multimorbidity along the life course of CKD patients. Key messages Among CKD patients, low health literacy is associated with more multimorbidity. Health literacy does not affect patterns of multimorbidity in younger patients, but it does slightly in older ones.

Exploring Associations Between Health Literacy and Visual Impairment in Older Adults With Age-Related Macular Degeneration (AMD)

Date Presented 04/13/21 This study explored associations between health literacy and severity of visual impairment in older adults with age-related macular degeneration (AMD). The Short Test of Functional Health Literacy in Adults was used to assess health literacy for timed and untimed testing conditions. A one-way analysis of variance was used for analysis. Timed, 73% of participants had inadequate health literacy. Untimed, 100% of participants had adequate health literacy. All scores improved with the time limit removed. Time may be underrecognized factor of reading performance in older adults with AMD. Primary Author and Speaker: Jennifer Fortuna Contributing Authors: Tina Fletcher, Catherine Candler, and Karen Dunlap

A vesetranszplantációval kapcsolatos betegedukációs program tapasztalatai a kelet-magyarországi régióban

Összefoglaló. Bevezetés: A tudás mint potenciálisan módosítható faktor a megfelelő döntéshozatal előfeltétele. Célkitűzés: Kutatásunk során a krónikus vesebetegek körében vizsgáltuk az egyes vesepótló kezelési módokkal kapcsolatos ismereteket, elemeztük a tudást befolyásoló tényezőket, annak érdekében, hogy feltérképezzük a betegismeretek e területen megfigyelhető hiányosságait. Egyúttal tájékoztatást és ismeretterjesztést adtunk a vesetranszplantációval kapcsolatosan. Módszer: A betegek ismereteit befolyásoló tényezőket tíz magyarázó változóra korrigált többváltozós lineáris regresszióval értékeltük, melynél a függő változó a tudáspontszám volt. Követéses vizsgálatunk első adatfelvétele során az Eurotransplant-várólistán szereplő, vesetranszplantáció irányában kivizsgálás alatt álló, valamint a veseátültetést elutasító, 18 és 75 év közötti betegeket kerestük fel. Az első körös (alaptudásszintet rögzítő) adatfelvétel összesen 254, az ismeretátadás utáni második pedig 115 vesebeteg bevonásával valósult meg. Eredmények: Eredményeink alapján elmondható, hogy a felsőfokú (β = 1,502, p<0,001) és a középfokú (β = 2,346, p<0,001) iskolai végzettséggel rendelkező betegek egyaránt magasabb tudáspontszámot értek el az alacsonyabb iskolai végzettséggel rendelkezőkhöz képest. A korábban veseátültetésen már átesett betegek 2 ponttal magasabb pontszámot értek el a veseátültetésben még nem részesültekhez viszonyítva (β = 2,024, p<0,001). Szignifikánsan magasabb pontszámot értek el azok a betegek is, akik megfelelő egészségműveltségi szinttel rendelkeztek (β = 1,344, p<0,001). Eredményeink bizonyítják programunk hatékonyságát, mert a részt vevő vesebetegek szignifikánsan magasabb pontszámot értek el a tudásszintfelmérő teszten, több hónappal a betegedukációt követően is (p<0,001). Következtetés: Az általunk azonosított hiányosságok segíthetnek az egészségügyi szakemberek számára abban, hogy melyek azok a területek, amelyekre a betegoktatási és önmegvalósító programok során hangsúlyt kell fektetni a beteg-együttműködés és az eredmények javítása érdekében. Orv Hetil. 2021; 162(26): 1012–1021. Summary. Introduction: Knowledge as a potentially modifiable factor is a prerequisite for appropriate decision making. Objective: In our study, we examined the knowledge level related to renal replacement therapies and its influencing factors among chronic kidney disease patients, in order to identify the patients’ knowledge gaps. At the same time, we provided information, education on kidney transplantation. Method: Factors influencing the patients’ knowledge were evaluated using a multivariate linear regression adjusted for ten factors, where the dependent variable was the knowledge score. During the first data collection of our follow-up study, we contacted patients on the Eurotransplant waiting list, patients undergoing medical evaluation, and patients who refuse a kidney transplant, between 18 and 75 years old. A total of 254 patients were involved in the first round of data collection (recording the basic level of knowledge), and 115 in the second one (after the education). Results: Our results show that patients with both tertiary (β = 1.502, p<0.001) and secondary (β = 2.346, p<0.001) educational attainment achieved higher knowledge scores. Patients with previous kidney transplantation scored 2 points higher than those without (β = 2.024, p<0.001). Moreover, patients with adequate health literacy level achieved significantly higher knowledge scores (β = 1.344, p<0.001). Our results prove the effectiveness of our program since the participants achieved significantly higher scores on the knowledge test, even several months after the education (p<0.001). Conclusion: The gaps we have identified can help the healthcare professionals which areas need to be focused in patient education and self-management programs in order to improve patient collaboration and outcomes. Orv Hetil. 2021; 162(26): 1012–1021.

Knowledge and practice of home blood pressure monitoring 6 months after the risk and assessment management programme: does health literacy matter?

BackgroundLittle is known whether patients with lower health literacy could retain the practice and knowledge of home blood pressure monitoring (HBPM) after an educational programme.MethodsA cluster randomised controlled trial in five primary care clinics recruited participants with uncontrolled hypertension. Clinics were randomised either to a HBPM group education (Risk Assessment and Management Programme (RAMP-group), or individual counselling of self-management (RAMP-individual). Health literacy was assessed by the Chinese Health Literacy Scale for Chronic Care. Practice and knowledge of HBPM were surveyed by a 10-item HBPM knowledge checklist and patient record review 6 months after interventions. Predictors for regular HBPM and good HBPM knowledge were assessed by multivariate logistic regression models.Results287 participants (RAMP-group: 151; RAMP-individual: 136) were follow-up for 6 months. 272 participants completed the knowledge questionnaires (response rate 94.8%). 67.8% of the participants performed HBPM regularly, and there was no statistical difference between both interventions. Age more than 65 (adjusted odds ratios (aOR) 2.58, 95% CI 1.37 to 4.86, p=0.003), not working (aOR 2.34, 95% CI 1.10 to 4.97, p=0.027)and adequate health literacy (aOR 2.25, 95% CI 1.28 to 3.95, p=0.005) predicted regular HBPM. Participants in RAMP-group demonstrated a significant lower body weight than those in RAMP-individual (−0.3±2.0 kg vs +0.7 ±1.7 kg, p<0.001).The RAMP-group participants were eight times more likely to have full HBPM knowledge score than the RAMP-individual participants (aOR 8.46, 95% CI 4.68 to 15.28, p<0.001).ConclusionPatients could retain HBPM knowledge better after RAMP-group than RAMP-individual. Older, retired and patients with adequate health literacy were more likely to continue weekly HBPM 6 months after education.Trial registration numberNCT02551393.

Health Literacy and Regional Heterogeneities in China: A Population-Based Study

Background: Health literacy is essential to population health, yet few studies have described the geographic variation in health literacy in China. This study aimed to investigate the level of health literacy, its regional heterogeneities, as well as influencing factors of health literacy in 25 provinces or municipalities in China.Methods: The study was conducted among residents aged 15–69 years from 25 provinces or municipalities in China in 2017. Health literacy was measured using the Chinese Health Literacy Scale. MapInfo software was used to map the geographic distribution. Multiple logistic regression was used to adjust for the factors associated with the health literacy level in the overall and regional samples.Results: A total of 3,482 participants were included in the study, comprising 1,792 (51.5%) males and 1,690 (48.5%) females. Notable geographic variation was observed in health literacy levels. The proportion of respondents with adequate health literacy was 22.3% overall, 33.0% in the eastern region, 23.1% in the central region, and 17.6% in the western region. The proportion of adequate health literacy in the different provinces and municipalities ranged from 10.5% (Xinjiang) to 47.0% (Beijing). Being a female [odds ratio (OR) = 1.353; 95% confidence interval (CI): 1.146–1.597], having a high education level [OR ranging from 2.794 (CI: 1.469–5.314) to 9.458 (CI: 5.251–17.036)], having a high economic status [OR ranging from 1.537 (CI: 1.248–1.891) to 1.850 (CI: 1.498–2.284)], having a good self-rated health status [OR ranging from 2.793 (CI: 1.534–5.083) to 3.003 (CI: 1.672–5.395)], and having frequent community health education (OR = 1.588; 95% CI: 1.066–2.365) were independently associated with adequate health literacy.Conclusions: The health literacy level in the 25 provinces or municipalities of China is relatively low compared to the developed countries, and there are heterogeneities among different regions, between urban and rural areas, and among different social groups. Tailored health education and promotion strategies are needed for different subgroups of residents.

The Vienna self-assessment questionnaire: a usable tool towards more health-literate hospitals? Explorative case studies in three hospitals in Belgium

Background Strengthening the capacity of hospitals to take into account the level of health literacy of their public is a necessity to improve the quality of care. One way to develop adequate health literacy responsive policy and strategies in hospitals is the use of self-assessment tools to raise awareness, help prioritise action and mobilise stakeholders. The Vienna Health Literate Organisation (V-HLO) questionnaire, recently translated and adapted into French, is designed to meet this objective. In this study we have piloted the French version of the V-HLO (V-HLO-fr) tool in the main hospitals of Liège (Belgium) to explore its feasibility and gain a first insight into the strengths and weaknesses of the health literacy responsiveness of the participating hospitals. Methods We performed explorative case studies in three hospitals. Our mode of application of the V-HLO-fr was inspired by the ‘RAND Appropriateness’ method: first, individual members of an internal multidisciplinary panel filled out the questionnaire and then the results were discussed collectively in each hospital during a ‘round table’ meeting. The feasibility of the process was assessed by direct observation of the round tables and with semi-structured phone interviews. Results The V-HLO-fr tool was fully applied in the three targeted hospitals and the process seems to be acceptable, practicable and integrable. Strengths (e.g. the facilitation of patient navigation to the hospital) and weaknesses (e.g. the provision of easy to read, understand and act on health information materials) in terms of health literacy responsiveness have been highlighted. Conclusion V-HLO-fr can be a suitable tool for a needs assessment that allows hospitals to create awareness and formulate targeted actions to further strengthen their health literacy responsiveness. Its mode of application, formalised by taking inspiration from the RAND method, could be further improved by paying more attention to recruiting and supporting participants. The V-HLO-fr and its added value in real-world projects should now be further tested in a larger number of hospitals.