Health Literacy and Women's Reproductive Health: A Systematic Review

Background: Health literacy is thought to impact women's reproductive health, yet no comprehensive systematic reviews have been conducted on the topic. Our objective was to systematically identify, investigate, and summarize research on the relationship between health literacy and women's reproductive health knowledge, behaviors, and outcomes

Change in health literacy over a decade in a prospective cohort of community-dwelling older adults

BACKGROUND: Health literacy is often viewed as a static trait in longitudinal studies, which may over or underestimate an individual’s ability to manage one’s health. OBJECTIVES: We sought to examine health literacy over time among older adults using three widely used measures. DESIGN: A prospective cohort study. PARTICIPANTS: Community-dwelling adults ages 55 to 74 at baseline with at least one follow-up visit (N = 656) recruited from one academic internal medicine clinic and six community health centers in Chicago, IL. MEASURES: Health literacy was measured using the Test of Functional Health Literacy in Adults (TOFHLA), Newest Vital Sign (NVS), and Rapid Estimate of Adult Literacy in Medicine (REALM) at baseline and up to three follow-up time points. RESULTS: In unadjusted analyses, significant changes since baseline were found beginning at the second follow-up (mean (M) = 6.0 years, SD = 0.6) for the TOFHLA (M = − 0.9, SD = 0.95, p = 0.049) and the REALM (M = 0.3, SD = 2.5, p = 0.004) and at the last follow-up (M = 8.6 years, SD = 0.5) for the NVS (M = − 0.2, SD = 1.4, p = 0.02). There were non-linear effects of baseline age on TOFHLA and NVS scores over time (piecewise cubic spline p = 0.01 and p < 0.001, respectively) and no effect on REALM scores (B = 0.02, 95% CI − 0.01 to 0.04, p = 0.17) using multivariable mixed-effects linear regression models, controlling for race, education, income, and comorbidity. CONCLUSION: We found a negative relationship between age and health literacy over time as measured by the TOFHLA and NVS. Health literacy barriers appear to be more prevalent among individuals in later life, when self-care demands are similarly increasing. Clinicians might consider strategies to assess and respond to limited health literacy, particularly among patients 70 and older. REALM performance remained stable over 10 years of follow-up. This questions whether health literacy tools measure the same attribute. Prospective health literacy studies should carefully consider what measures to use, depending on their objective

Literacy disparities in patient access and health-related use of Internet and mobile technologies

Age and race-related disparities in technology use have been well documented, but less is known about how health literacy influences technology access and use

Health literacy and 30-day hospital readmission after acute myocardial infarction

ObjectiveTo assess the validity of a predictive model of health literacy, and to examine the relationship between derived health literacy estimates and 30-day hospital readmissions for acute myocardial infarction (AMI).DesignRetrospective cohort study.Setting and participantsA National Institute of Aging (NIA) study cohort of 696 adult, English-speaking primary care patients, aged 55–74 years, was used to assess the validity of derived health literacy estimates. Claims from 7733 Medicare beneficiaries hospitalised for AMI in 2008 in North Carolina and Illinois were used to investigate the association between health literacy estimates and 30-day hospital readmissions.MeasuresThe NIA cohort was administered 3 common health literacy assessments (Newest Vital Sign, Test of Functional Health Literacy in Adults, and Rapid Estimate of Adult Literacy in Medicine). Health literacy estimates at the census block group level were derived via a predictive model. 30-day readmissions were measured from Medicare claims data using a validated algorithm.ResultsFair agreement was found between derived estimates and in-person literacy assessments (Pearson Correlation coefficients: 0.38–0.51; κ scores: 0.38–0.40). Medicare enrollees with above basic literacy according to derived health literacy estimates had an 18% lower risk of a 30-day readmission (RR=0.82, 95% CI 0.73 to 0.92) and 21% lower incidence rate of 30-day readmission (IRR=0.79, 95% CI 0.68 to 0.87) than patients with basic or below basic literacy. After adjusting for demographic and clinical characteristics, the risk of 30-day readmission was 12% lower (p=0.03), and the incidence rate 16% lower (p<0.01) for patients with above basic literacy.ConclusionsHealth literacy, as measured by a predictive model, was found to be a significant, independent predictor of 30-day readmissions. As a modifiable risk factor with evidence-based solutions, health literacy should be considered in readmission reduction efforts

Psychosocial Determinants of Self-Management Behaviors and Health Outcomes Among Older Adults

Chronic conditions have emerged as the primary cause of morbidity and mortality in the United States, and the prevalence of individuals contending with multiple chronic conditions, the co-occurrence of two or more chronic conditions, is increasing. Engaging in self-management behaviors is a core mechanism to promote health outcomes and prevent chronic disease complications. A sizable body of evidence has identified a number of psychosocial determinants of proper chronic disease self-management and health outcomes; despite this evidence, there has been slow progress in addressing these psychosocial factors to support proper self-management behaviors. This may be due to a lack of attention to the requisite skills individuals must employ to engage in self-care behaviors, and a lack of appreciation for the role which external contextual factors exert in health management. Therefore, as part of this dissertation I conducted three secondary data analyses with two National Institutes of Health cohort studies of older adults to investigate two understudied psychosocial factors, tangible social support and a daily routine, and their relation to older adults’ self-management behaviors and health outcomes. At the individual level I found that greater levels of daily routine were associated with better health status, but not urgent health care utilization. At the interpersonal level, the analyses related to social support underscored its multidimensional and complex nature. Contrary to my hypothesis, the second study observed a negative association between the frequency of functional support and adherence to asthma medications, while the third study found that unmet tangible support needs were associated with worse health status and greater urgent healthcare utilization. Differences in measurement between the two studies suggest that it is important to first isolate a need for tangible assistance in managing one’s health, and then examine perceptions related to the support’s availability and adequacy. In conclusion, as we seek to promote healthy aging, findings from this dissertation shed light on two psychosocial factors, a daily routine and unmet tangible social support needs, which could be leveraged, but also suggests that they must be acted on with simultaneous systemic changes

Psychosocial Determinants of Self-Management Behaviors and Health Outcomes Among Older Adults

Chronic conditions have emerged as the primary cause of morbidity and mortality in the United States, and the prevalence of individuals contending with multiple chronic conditions, the co-occurrence of two or more chronic conditions, is increasing. Engaging in self-management behaviors is a core mechanism to promote health outcomes and prevent chronic disease complications. A sizable body of evidence has identified a number of psychosocial determinants of proper chronic disease self-management and health outcomes; despite this evidence, there has been slow progress in addressing these psychosocial factors to support proper self-management behaviors. This may be due to a lack of attention to the requisite skills individuals must employ to engage in self-care behaviors, and a lack of appreciation for the role which external contextual factors exert in health management. Therefore, as part of this dissertation I conducted three secondary data analyses with two National Institutes of Health cohort studies of older adults to investigate two understudied psychosocial factors, tangible social support and a daily routine, and their relation to older adults’ self-management behaviors and health outcomes. At the individual level I found that greater levels of daily routine were associated with better health status, but not urgent health care utilization. At the interpersonal level, the analyses related to social support underscored its multidimensional and complex nature. Contrary to my hypothesis, the second study observed a negative association between the frequency of functional support and adherence to asthma medications, while the third study found that unmet tangible support needs were associated with worse health status and greater urgent healthcare utilization. Differences in measurement between the two studies suggest that it is important to first isolate a need for tangible assistance in managing one’s health, and then examine perceptions related to the support’s availability and adequacy. In conclusion, as we seek to promote healthy aging, findings from this dissertation shed light on two psychosocial factors, a daily routine and unmet tangible social support needs, which could be leveraged, but also suggests that they must be acted on with simultaneous systemic changes

Characteristics of Older Adults who Receive Assistance with Management of Multidrug Regimens

Abstract Many older adults manage multiple chronic conditions requiring adherence to multidrug regimens, yet half are non-adherent, increasing their risk of hospitalization for poorly controlled chronic conditions. Few studies have investigated whether caregivers support medication-related behaviors of community-dwelling older adults. We interviewed 97 patient-caregiver dyads participating in a cognitive aging cohort study to identify factors associated with caregiver assistance in managing multidrug regimens. Patients completed a neuropsychological battery covering five cognitive domains. Health literacy and patient activation were measured using the Newest Vital Sign and Consumer Health Activation Index, respectively. Caregivers reported their medication-related involvement. Predictors of involvement in medication-related tasks were examined using logistic regression models. Patients were on average 71 years old, managing 4 comorbidities and prescribed 5 medications. The majority were female (73%) and identified as Black (46%) or White (47%). Caregivers’ mean age was 65 years; half were female (53%), were predominantly spouses (57%) or children (26%), and lived with the patient (61%). 31% of caregivers ordered patients’ prescribed medications, 40% helped manage their medications, and 50% spoke with the patient’s clinician about their clinical care. Cognitive impairment (OR 2.60, 95% CI 1.08-6.25), limited health literacy (OR 2.97, 95% CI 1.26-6.97), and ≥3 comorbidities (OR 2.14, 95% CI 1.06-9.30) were associated with medication management assistance. Patient activation, gender, cohabitation, or relationship were not associated. These findings suggest that caregivers are assisting with older adults’ medication management and should be included in clinical discussions about medication management, especially among patients with cognitive impairment, low health literacy or multimorbidities.</jats:p

Characterizing Literacy and Cognitive Function during Pregnancy and Postpartum

Objective The objective of this study was to characterize health literacy and cognitive function in a diverse cohort of pregnant women. Methods Pregnant and postpartum women underwent in-depth assessments of health literacy/numeracy and the cognitive domains of verbal ability, working memory, long-term memory, processing speed, and inductive reasoning. Differences by demographic characteristics and gestational age were assessed using chi-square tests and multivariable logistic regression. Results In this cohort of pregnant (N = 77) or postpartum (N = 24) women, 41.6% had limited health literacy/numeracy. Women were more likely to score in the lowest quartile for literacy and verbal ability if they were less educated, younger, nonwhite or had Medicaid. These factors were associated with low scores for long-term memory, processing speed, and inductive reasoning. Although there were no differences in literacy or cognitive function by parity or gestational age, postpartum women were more likely to score in the lowest quartile for processing speed (adjusted odds ratio [aOR]: 3.79, 95% confidence interval [CI]: 1.32–10.93) and inductive reasoning (aOR: 4.07, 95% CI: 1.21–13.70). Conclusion Although postpartum status was associated with reduced inductive reasoning and processing speed, there were no differences in cognitive function across pregnancy. Practice Implications Postpartum maternal learning may require enhanced support. In addition, cognitive skills and health literacy may be a mediator of perinatal outcomes inequities.</jats:p

Structural and functional support among US older adults with asthma: cross-Sectional associations with medication adherence

ObjectivesDisadvantaged older adults may benefit from social support in adhering to their medications, but the multidimensional nature of social relationships makes it difficult to identify the most relevant domain. We examined associations of structural and functional support with medication adherence among a cohort of older adults with asthma.DesignCross-sectional analysis of the Asthma Beliefs and Literacy in the Elderly cohort study.SettingOutpatient clinics in New York, New York, and Chicago, Illinois, USA.ParticipantsEnglish-speaking and Spanish-speaking older adults (≥60 years) with asthma.Outcome measuresMedication adherence was measured using dose counts from inhaler and self-report.ResultsAmong 383 participants, the mean age was 67 years, 38% identified as Hispanic, 33% identified as black, 52% reported monthly incomes ≤US$1350 and 64% demonstrated poor adherence to their asthma controller medication. Structural and functional support were weakly correlated (r=−0.15, p=0.005). In adjusted analyses, structural support was not associated with medication adherence. Participants who received infrequent functional support in managing their medications had lower odds of poor adherence according to dose counts (OR 0.51, 95% CI 0.26 to 0.98), but not when assessed via self-report (OR 0.81, 95% CI 0.44 to 1.48).ConclusionThe receipt of frequent functional support in managing medications was associated with poor adherence to asthma controller medications. Further research is needed to better understand the manner and context which functional support operates in relation to medication adherence among older adults.</jats:sec