Promises and Challenges of Medical Patient Healthcare Portals in Underserved Communities

As a safety-net medical center that serves many underserved communities, Einstein Medical Center Philadelphia (EMCP) faces many challenges in providing healthcare to its communities. To improve those services, EMCP has released a new IT healthcare portal (app). This chapter describes some of the promises and challenges EMCP is currently facing in their attempts to convince communities in its catchment area to adopt that healthcare portal. The challenges are discussed in the contexts of poor social determinants of health (SDOH), unique social factors, as well as the importance of managing community trust in EMCP within the broader contexts of underserved communities of which the new portal is only part of the story. This is not a typical case of IT adoption. The challenges at hand are not only technical but to a large degree social, dealing in part with issues of cultural diversity, perceived lack of respect, and poor health literacy.

Health Literacy during Pandemic and Education

The COVID-19 pandemic has highlighted the importance of health literacy. This commentary discusses the consequences of poor health literacy and argues that we need to improve health literacy. Better health literacy has the potential to improve community trust, alleviate the health disparities and improve the results of the immediate response required in the early stages of a pandemic. The commentary argues that health literacy has to be addressed as part of mandatory school curriculum. Methods on how to improve and provide equitable access to education are also discussed.

Low COVID-19-related practice increases the risk of poor health literacy in international students

Background Health literacy (HL) is the ability to access, understand, appraise, and apply health information, making it crucial for navigating coronavirus and COVID-19 information environments. The objective of this study was to determine the health literacy of international students who could not return to their countries after announcement of the coronavirus disease (COVID-19) pandemic and their perspective and behavior about COVID-19.MethodsA cross-sectional study was conducted involving 399 international students. A 73-item questionnaire consisting of health literacy (23 items), knowledge, attitude and practice about Covid-19 (37 items), and sociodemographic characteristics (13 items) was answered by the students. The relationship between the HL score and various variables was determined using univariate and multiple binary logistic regression. Results Of the 399 international students, 322 (80.7%) participated. The HL of the international students was found to be poor (78.0%) and good (22.0%). Participants’ COVID-19-related behaviors: 8.4% of the participants’ knowledge level was good, and 38.5% had high COVID-19 related practice. Multivariate models showed that HL was independently and significantly associated with COVID-19 related practice (OR= 6.27; 95% CI: 2.45 - 15.79; p=0.000). ConclusionThis study revealed that international students’ HL was poor and that low COVID-19 related practice increased the risk of low HL in international students. According to the findings, further efforts should be made to enhance levels of HL and COVID-19-related behavior of international students.

TINGKAT PENGETAHUAN MASYARAKAT TENTANG KLASIFIKASI ISTILAH KASUS PASIEN COVID-19 (STUDI DESKRIPTIF)

COVID-19 or Corona Virus Disease-19 is a disease that caused by a new type of corona virus. In March 2020 WHO declared a pandemic COVID-19. In Indonesia, cases of COVID-19 were first reported on March 2, 2020 and until September, 2020 it has passed 200,000 confirmed cases. Poor health literacy, coupled with the absence of synergy and the lack of knowledge regarding the COVID-19 outbreak made the handling of the outbreak carried out by the government stutter. One of the important information for the general public is the definition of the terms cases related to COVID-19. This study aims to determine the level of public knowledge about the definition of case terms related to COVID-19. Data dollection was done online by using google form. The sampling technique was quota sampling, the response rate (RR) of this study was 91% of the target 100 samples. Data were analyzed using IBP SPSS Statistic version 10. The results obtained were related to 5 questions regarding the definition of the terms PPT, OTG, ODP, PDP and confirmation cases, respondents gave the percentage of correct answers below the average (62.4%) percentage of the overall questions. A massive education is needed considering the low level of public knowledge about the issues in this research. It takes cross-sectional and cross-programmatic collaboration to solve this problem quickly.

Measuring the constructs of health literacy in the Iranian adult Kurdish population

Background Health literacy is essential to self-care, which is an important precedence to improve the quality of healthcare services and a key factor in health. It also plays a pivotal role in decision-making in various health fields. Therefore, policymakers consider health literacy to be a primary tool to promote community health and enhance the proper use of healthcare services. The present study aimed to assess the health literacy status of the Kurdish population in Kurdistan province, Iran based on the nine constructs of the Iranian health literacy questionnaire (IHLQ) individually and collectively and determine the significant effects of demographic variables on health literacy. Methods This cross-sectional study was conducted on the Iranian adult Kurdish population living in the urban and rural areas of Kurdistan province, willing to participate during April 2017–September 2018. Data were collected using the IHLQ. The sample size was determined to be 980 people, with 490 in the rural areas and 490 in the urban areas. The researchers visited potential participants at their doorstep, asking them to complete the questionnaire. The willing participants were assisted in completing the IHLQ in case they were illiterate; the questions and answers were read by the researchers to the participants, and the responses were recorded. Results About 50.4% (n = 494) of the Kurdish population had poor health literacy, while 34.0% (n = 333) had average health literacy, and 15.6% (n = 153) had good health literacy. Meanwhile, 60.2% of the participants obtained poor scores in the construct of health information access, and 74.1% (n = 726) obtained poor scores in the individual empowerment construct. In addition, the analysis of the adjusted model indicated that education level (lowest β = 7.42; P = 0.001) and in male participants (β = − 1.10; P = 0.001) were significantly associated with higher health literacy. Conclusion According to the results, the investigated Kurdish population mostly had average or low health literacy. Therefore, proper strategies should be adopted to enhance the health literacy of this population and increase their access to health information. Furthermore, effective training should be provided to these individuals (especially vulnerable social groups) to improve their individual capabilities to compensate for poor health literacy.

Understanding Medicare With Hearing Loss

Medicare has become an increasingly complex program to navigate with numerous choices available to beneficiaries with important implications on their financial exposure and access to care. While research has identified poor health literacy as a barrier to understanding Medicare, little information is available on the experience of individuals with hearing loss. Using the Medicare Current Beneficiary Survey (2016), a nationally-representative sample of 10,841 beneficiaries, we examined if difficulty understanding Medicare was associated with reported trouble hearing, while controlling for socio-demographic and health literacy factors. Compared to no trouble, Medicare beneficiaries with a little or a lot of trouble hearing had 44% (95% CI OR:1.34-1.55) and 63% (95% CI OR: 1.44-1.83) increased odds of reporting greater difficulty with understanding Medicare. The existing tools to support Medicare beneficiaries understand and navigate the program must evolve to meet the needs of those with hearing loss- a highly prevalent condition among Medicare beneficiaries.

Impact of Socioeconomic Status and Race on Sepsis Epidemiology and Outcomes

Background Socioeconomic status (SES) is a complex variable that is derived primarily from an individual’s education, income, and occupation and has been found to be inversely related to outcomes of health conditions. Sepsis is the sixth most common admitting diagnosis and one of the most costly conditions for in-hospital spending in the United States. The objective of this review is to report on the relationship between SES and sepsis incidence and associated outcomes. Content Sepsis epidemiology varies when explored by race, education, geographic location, income, and insurance status. Sepsis incidence was significantly increased in individuals of Black race compared with non-Hispanic white race; in persons who have less formal education, who lack insurance, and who have low income; and in certain US regions. People with low SES are likely to have onset of sepsis significantly earlier in life and to have poorly controlled comorbidities compared with those with higher SES. Sepsis mortality and hospital readmission is increased in individuals who lack insurance, who reside in low-income or medically underserved areas, who live far from healthcare, and who lack higher level education; however, a person’s race was not consistently found to increase mortality. Summary Interventions to minimize healthcare disparity for individuals with low SES should target sepsis prevention with increasing measures for preventive care for chronic conditions. Significant barriers described for access to care by people with low SES include cost, transportation, poor health literacy, and lack of a social network. Future studies should include polysocial risk scores that are consistently defined to allow for meaningful comparison across studies.

Subjective Generic Health Literacy and Its Associated Factors among Adolescents: Results of a Population-Based Online Survey in Germany

Profound data on adolescent health literacy are needed as a requirement for the development of health literacy promoting interventions. This paper aims to study the level of generic health literacy among adolescents and to explore associations between health literacy and socio-demographic (age, sex, family affluence, migration background), social (social support by family and friends) and personal (self-efficacy) factors. We conducted a representative cross-sectional online survey. Four health literacy dimensions were captured among 14–17 years old adolescents living in Germany (n = 1235) with the “Measurement of Health Literacy Among Adolescents-Questionnaire” (MOHLAA-Q). Descriptive, bivariate and multiple logistic regression analyses were used to analyse the data (n = 1202). We found poor health literacy levels—to varying degrees—in all examined health literacy dimensions: dealing with health-related information (8.41% with many difficulties), health-related communication skills (28.13% with low skills), attitudes toward one’s own health and health information (8.81% with passive attitudes) and health-related knowledge (22.73% with low levels). We identified significant associations between poor health literacy levels and all factors studied except for age. Our results indicate a need for the implementation of evidence-based health literacy-related promoting interventions, preferentially in education and training institutions.

Health Literacy and Recall of Postoperative Instructions in Patients Undergoing the Lapidus Procedure

Background: Active participation in patients’ own care is essential for success after Lapidus procedure. Poor health literacy, comprehension, and retention of patient instructions may be correlated with patient participation. Currently, there is no objective measure of how well patients internalize and retain instructions before and after a Lapidus procedure. We performed this study to assess how much of the information given to patients preoperatively was able to be recalled at the first postoperative visit. Methods: All patients between ages 18 and 88 years undergoing a Lapidus procedure for hallux valgus by the senior author between June 2016 and July 2018 were considered eligible for inclusion. Patients were excluded if they had a history of previous bunion surgery or if the procedure was part of a flatfoot reconstruction. Patients were given written and verbal instructions at the preoperative visit. Demographic and comprehension surveys were administered at their first visit approximately 2 weeks postoperatively. A total of 50 patients, of which 42 (84%) were female and 43 (86%) had a bachelor’s degree or higher, were enrolled. Results: Mean overall score on the comprehension survey was 6.2/8 (±1.2), mean procedure subscore was 1.8/3 (±0.64), and mean postoperative protocol subscore was 4.4/5 (±0.8). The most frequently missed question asked patients to identify the joint fused in the procedure. Conclusion: Although comprehension and retention of instructions given preoperatively was quite high in our well-educated cohort, our findings highlight the importance of delivering clear instructions preoperatively and reinforcing these instructions often. Level of Evidence: Level II, prospective cohort study.