Health literacy and cancer screening: A systematic review – 2015 [US]
Inadequate health literacy may be a reason for the lack of awareness and/or knowledge about the importance of completing cancer screening tests within U.S. Preventive Services Task Force (USPSTF) recommended intervals, and may be a contributing factor to cancer screening disparities. This study evaluated published evidence about health literacy and screening for bowel, breast, cervical and prostate cancer. The researchers found that there is a trend for the association of inadequate health literacy and lower cancer screening rates within recommended guidelines. Taking into consideration the strong relationship between health literacy and other health outcomes, the researchers recommended that further research is warranted into health literacy and cancer screening behaviours. They further recommend that health care providers address the possible influence of inadequate health literacy by engaging patients using pictorial representations of cancer screening tests, checking for understanding using the teach-back methodology, and ensuring that cancer screening status is documented and updated in medical records. By addressing the health literacy of patients, providers can assist them in the cancer screening process.
Patient portals and patient engagement: A state of the science review – 2015 [US]
Patient portals are recognised as a promising mechanism to support greater patient engagement, yet questions remain about how health care leaders, policy makers, and designers can encourage adoption of patient portals and what factors might contribute to sustained utilisation. This study reviewed the literature on encouragement and support of patient engagement through the patient portal, and provided a summary of future directions for patient portal research and development to meaningfully impact patient engagement. 120 studies were identified and grouped into five major topics (patient adoption, provider endorsement, health literacy, usability, and utility). These studies underscore the importance of evaluating health literacy and health numeracy separately in order to identify specific risk factors and design flaws that could impact patient comprehension and ultimately jeopardize the accuracy of patient input and interpretation of results. The literature showed that patients responded better when medical jargon and abbreviations were translated into “patient friendly” language. The researchers recommend including health literacy assessments and participatory scenario-based “think-aloud” sessions in usability testing of consumer health information systems. The researchers note that while health literacy has been identified as an important factor in the successful use of patient portals, few studies have used validated health literacy measures, making it difficult for future research to build on the findings. Research demonstrates that specific aspects of health literacy, mainly numeracy and familiarity with medical terminology, greatly impact the ability of patients to accurately input data and interpret the information provided in the patient portal. The direct relationship between health literacy and effective use of the patient portal supports the argument for the use of specific health literacy heuristics as part of overall usability testing.
Association between health literacy and medical care costs in an integrated healthcare system: a regional population based study – 2015 [US]
Low health literacy is associated with higher health care utilisation and costs; however, no large-scale studies have demonstrated this in the Veterans Health Administration (VHA). This research evaluated the association between the health literacy of 92,000 veterans and their subsequent VHA health care costs over a three-year period. The researchers found that the average per patient cost for those with inadequate and marginal health literacy was significantly higher than adequate health literacy. Meeting the health literacy needs of these patients could produce economic savings of 8%. The researchers argue that health systems must prioritise a national approach that supports individual health literacy needs, builds knowledge to improve individuals' decision making skills and focuses on system wide organisational changes that improve the usability and navigation of health care services for patients. The researchers note that there has been an evolution from the focus of health literacy as an individual responsibility, to a perspective that holds the organisation and system accountable for designing service delivery in a way that meets the health literacy needs of all patients.
Medication adherence in patients with rheumatoid arthritis: The effect of patient education, health literacy, and musculoskeletal ultrasound – 2015 [Aus]
Despite an increasing range of disease modifying agents which halt disease progression, poor patient medication adherence is a significant barrier to the management of rheumatoid arthritis. This review examined the effectiveness of existing educational and health literacy interventions targeting medication adherence in patients with rheumatoid arthritis. The review found that poor medication adherence is a complex issue. Low educational levels and limited health literacy are contributory factors. Up to 42% of patients with chronic musculoskeletal disease may have low health literacy. Existing educational interventions appear ineffective at improving medication adherence, probably due to an overemphasis on provision of biomedical information. The researchers recommend that clinicians view patients as active decision makers and reduce the emphasis on biomedical information and focus on the patient’s beliefs around clinical management. The researchers suggested that improving patient health literacy skills rather than semantic disease knowledge may help raise medication adherence. The researchers proposed an audio-visual patient education intervention that combines live musculoskeletal ultrasound with basic medical information.
Low health literacy and evaluation of online health information. A systematic review of the literature – 2015 [Net]
This study aimed to review the existing evidence on the association between low health literacy and people's ability to evaluate the quality of online health information. 38 studies were reviewed. These indicated that low health literacy (and related skills) are negatively related to the ability to evaluate online health information and trust in online health information. Individuals with limited health literacy use evaluation criteria that do not correspond to the well-established quality criteria. The researchers concluded that public health officials and health care providers should pay attention to developing the information seeking and evaluation behaviors of patients with low health literacy and educate the on best practices when seeking and evaluating online health information.
Engaging patients in communication at transitions of care. Final report – 2015 [Aus]
This report, by a consortium from Deakin and Griffith Universities, aimed inform the future development of resources to assist health professionals, patients and their families to engage in communication at transitions of care in acute health facilities. This report contains the findings of the integrative review and a key stakeholder interview, a summary of tools and strategies employed within health services and concludes with guiding principles and key elements for effective patient-clinician communication. Health literacy is discussed between pages 28-34. Health literacy is discussed as barrier for both patients and clinicians.
Can community-based peer support promote health literacy and reduce inequalities? A realist review – 2015 [UK]
Community-based peer support (CBPS) has been proposed as a potentially promising approach to improve health literacy and reduce health inequalities. Peer support, however, is described as a public health intervention in search of a theory, and as yet there are no systematic reviews exploring why or how peer support works to improve health literacy. This review (191 pages), by Harris et al (2015) for the National Institute for Health Research, is a participatory realist synthesis and is aimed at developing a better understanding of the potential for CBPS to promote better health literacy and reduce health inequalities. Studies written in English describing CBPS research/evaluation, and related papers describing theory, were included. The researchers concluded that peer-support programmes have the potential to improve health literacy and reduce health inequalities but potential is dependent upon the surrounding equity context. More explicit empirical research is needed, which establishes clearer links between peer-supported health literacy and health inequalities.
eHealth literacy interventions for older adults: A systematic review of the literature – 2014 [US]
This paper, by Watkins and Zie (2014), reports findings from a systematic review of 23 articles on health literacy interventions and eHealth literacy interventions for older adults drawn from 28 relevant databases in nine fields. The eHealth literacy interventions in the sampled articles used eHealth literacy as an outcome of interest, applied learning theories, and occurred in informal learning settings such as senior centers and public libraries. In contrast, health literacy interventions (that involved ICTs as a key aspect of their interventions) often targeted specific health outcomes, applied health behavior theories, and occurred in both informal learning and clinical settings. These results indicate a significant gap in the literature on eHealth literacy interventions that use health outcomes for outcome measures. Additionally, most of the studies used no theoretical framework, and only seven studies were RCTs. These results highlight a great need to develop and assess theory-based interventions applying high-quality research design.
Health literacy measurement: An inventory and descriptive summary of 51 instruments – 2014 [US]
This article, by Haun et al (2014), aimed to provide a descriptive review of the psychometric properties and conceptual dimensions of published health literacy measurement tools. A review of medical articles and grey literature, and an environmental scan was conducted to identify health literacy measurement tools. For each tool, the researchers evaluated the conceptual dimensions assessed, test parameters, and psychometric properties. Of the 51 tools identified, 26 measured general health literacy, and 15 were disease or content specific, and 10 aimed at specific populations. The researchers found that the validation procedures for most of the tools are limited by inadequate power to ensure reliability across subgroups; represent a narrow set of conceptual dimensions with limited modes of administration; and most tools lack information on key psychometric properties. The researchers concluded that most tools were unsuitable for accurately determining patient health literacy skills and that significant work is needed to establish important aspects of the construct, convergent, and predictive validity for many tools. As researchers develop new measures, inclusion of a full range of conceptual dimensions of health literacy, more representative sampling for testing, and additional modes of administration will allow a more refined and flexible approach to research in this field.
Numeracy Skill And The Communication, Comprehension, and Use Of Risk-Benefit Information – 2007 [US]
Numeracy skills are an important aspect of health literacy. In this paper Peters et al (2007) review the literature on numeracy as a concept, examine why numeracy skills are important to health care decision-making, what the best practices are for the presentation of numeric health information and what strategies can be used to help less numerate people act more effectively and take charge of their health.