Health Literacy and Alcohol Use Predict Optimal HIV-Related Clinical Outcomes Following a Skills- Based Adherence Intervention

Background: Patients referred for solid organ transplant with limited health literacy have been shown to be less likely to have access to transplantation. We examined the association between health literacy, health numeracy and post-transplant clinical outcomes (i.e. graft failure, non-adherence, readmissions, self-efficacy, or mortality). Methods: A search of Medline for publications during the period January 1946 to July 2016 that examined health literacy, numeracy, and outcomes of transplant recipients. Titles and abstracts were independently examined by three reviewers for exclusion, and the full-text was then reviewed for inclusion. Results: Of 247 citations, 12 met inclusion criteria including one review article and five randomized control trials (RCTs). Health literacy of recipients was measured using Newest Vital Sign (NVS) (n=2), Short Test of Functional Health Literacy in Adults (STOHFLA) (n=2), Rapid Estimate of Adult Literacy in Medicine (REALM-T) (n=1), and other knowledge questionnaires (n=5). Level of formal education was also examined as an assay of health literacy (n=3). Post-transplant outcomes were assessed through medication adherence (n=4), skin cancer incidence (n=2), graft loss (n=1), recipient mortality (n=1), kidney function (n=1), health-related quality of life (n=1), and self-efficacy (n=1). Eleven citations found limited health literacy to be associated with adverse post-transplant clinical outcomes, and one citation found no association between health literacy and non-adherence. Health numeracy was not studied in any of the citations. Conclusion: Health literacy is negatively associated with adverse post-transplant clinical outcomes. Future studies should analyze the association between health numeracy and clinical outcomes after transplant.

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Effects of Comorbid Alcohol Use Disorder on the Clinical Outcomes of Schizophrenia: A Nationwide Population-based Study

10.21203/rs.3.rs-322353/v1 ◽

2021 ◽

Author(s):

Soojin Ahn ◽

Youngjae Choi ◽

Woohyeok Choi ◽

Young Tak Jo ◽

Harin Kim ◽

...

Keyword(s):

Alcohol Use ◽

Clinical Outcomes ◽

Alcohol Use Disorder ◽

Medication Possession Ratio ◽

Small Sample ◽

Control Group ◽

Diagnostic Code ◽

Psychiatric Admissions ◽

Before And After ◽

The Impact

Abstract BackgroundAlcohol use disorder (AUD) is a common psychiatric comorbidity in schizophrenia, associated with poor clinical outcomes and medication noncompliance. Most previous studies on the effect of alcohol use in patients with schizophrenia had limitations of small sample size and a cross-sectional design. Therefore, this study aimed to use a nationwide population database to investigate the impact of AUD on clinical outcomes of schizophrenia.MethodsData from the Health Insurance Review Agency database in South Korea from January 1, 2007 to December 31, 2016 was used. Among 64,442 patients with incident schizophrenia, 1,598 with comorbid AUD were selected based on the diagnostic code F10. We performed between- and within-group analyses to compare the rates of psychiatric admissions and emergency room (ER) visits and medication possession ratio (MPR) with control patients having schizophrenia matched for the onset age, sex, and observation period.ResultsThe rates of psychiatric admissions and ER visits decreased after the diagnosis of AUD in both groups; however, the decrease was significantly greater in patients with comorbid AUD compared to the control group. While the case group showed an increase in MPR after the diagnosis of AUD, MPR decreased in the control patients. The rates of psychiatric admissions, ER visits and MPR were worse in the schizophrenia group with comorbid AUD both before and after the diagnosis of AUD.ConclusionsClinical outcomes were worse in the comorbid AUD group than in the control group before and after the diagnosis of AUD. Considering that patients with schizophrenia with comorbid AUD had poorer clinical outcomes even before the diagnosis of AUD, schizophrenia with comorbid AUD could be a distinct subtype of schizophrenia.

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Health literacy and exercise interventions on clinical outcomes in Chinese patients with diabetes: a propensity score-matched comparison

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001179 ◽

2020 ◽

Vol 8 (1) ◽

pp. e001179

Author(s):

Yan Wei ◽

Yingyao Chen ◽

Yingnan Zhao ◽

Russell Rothman ◽

Jian Ming ◽

...

Keyword(s):

Health Literacy ◽

Propensity Score ◽

Propensity Score Matching ◽

Clinical Outcomes ◽

Exercise Intervention ◽

Controlled Trial ◽

Literacy Intervention ◽

Chinese Patients ◽

Exercise Interventions ◽

Patients With Diabetes

IntroductionPatients with diabetes in China have low health literacy, which likely leads to poor clinical outcomes. This study aimed to assess the effectiveness of health literacy and exercise interventions on clinical measurements in Chinese adults with type 2 diabetes mellitus (T2DM).Research design and methodsA cluster randomized controlled trial was conducted from February 2015 through April 2017 in Shanghai, China. 799 patients with T2DM aged 18 years or older recruited from eight Community Healthcare Centers were randomized into one control arm and three intervention arms receiving 1-year health literacy intervention, exercise intervention or both as the comprehensive intervention. Propensity score matching was employed to minimize potential imbalance in randomization. The intervention-attributable effects on main clinical outcomes were estimated using a difference-in-difference regression approach.ResultsAfter propensity score matching, 634 patients were included in the analysis. The three intervention groups had decreased hemoglobin A1c (A1c) level after 12 months of intervention. The largest adjusted decrease was observed in the health literacy group (−0.95%, 95% CI: −1.30 to −0.59), followed by the exercise group (−0.81%, 95% CI: −1.17 to −0.45). However, A1c was observed to increase in the health literacy and the comprehensive groups from 12 to 24 months. No obvious changes were observed for other measurements including high-density and low-density lipoprotein cholesterols, and systolic and diastolic blood pressures.ConclusionsHealth literacy and exercise-focused interventions improve glycemic control in Chinese patients with diabetes after 12 months of intervention, and the health literacy intervention shows the greatest effect. Our results suggest that the interventions may have the potential to improve diabetes self-management and reduce diabetes burden in China.Trial registration numberISRCTN76130594.

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Differential associations of health literacy with Austrian adolescents’ tobacco and alcohol use

Public Health ◽

10.1016/j.puhe.2019.05.033 ◽

2019 ◽

Vol 174 ◽

pp. 74-82 ◽

Cited By ~ 1

Author(s):

L. Brandt ◽

M.-T. Schultes ◽

T. Yanagida ◽

G. Maier ◽

M. Kollmayer ◽

...

Keyword(s):

Health Literacy ◽

Alcohol Use

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A multifaceted intervention to improve mental health literacy in employees of a multi-campus university: a cluster randomised trial

Journal of Public Mental Health ◽

10.1108/jpmh-03-2013-0010 ◽

2014 ◽

Vol 13 (1) ◽

pp. 25-39 ◽

Cited By ~ 6

Author(s):

Nicola J. Reavley ◽

Terence V. McCann ◽

Stefan Cvetkovski ◽

Anthony F. Jorm

Keyword(s):

Mental Health ◽

Health Literacy ◽

Alcohol Use ◽

Help Seeking ◽

Mental Health Literacy ◽

Randomised Trial ◽

Intervention Group ◽

Cluster Randomised Trial ◽

Depression And Anxiety ◽

Content Type

Purpose – The purpose of this study was to assess whether a multifaceted intervention could improve mental health literacy, facilitate help seeking and reduce psychological distress and alcohol misuse in staff of a multi-campus university in Australia. Design/methodology/approach – In this cluster randomised trial (ACTRN12610001027000), nine campuses were paired, with one of each pair randomly assigned to either intervention or control. Interventions (which were whole-of-campus) included e-mails, posters, campus events, factsheets/booklets and mental health first aid training courses. A monitoring sample of staff were recruited from each campus. Participants had a 20-minute computer-assisted telephone interview at baseline, and at the end of academic years 1 and 2. The interview assessed mental health literacy, help seeking for mental health problems, psychological distress and alcohol use. The primary outcomes were depression and anxiety levels and alcohol use and pertained to the individual level. Six campuses were randomised to intervention and three to control and all campuses were included in the analysis. Findings – There were no effects on depression and anxiety levels and alcohol use. Recall of intervention elements was greater in the intervention group at the end of the two-year assessment period. Staff in the intervention group showed better recognition of depression, greater knowledge of the National Health and Medical Research Council guidelines for safe levels of drinking and a greater intention to seek help for alcohol misuse from a general practitioner. Originality/value – Future interventions should involve more focused interventions that include consideration of working conditions and their influence on mental health, as well as addressing mental illness among employees, regardless of cause.

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Adverse impact of marijuana use on clinical outcomes among psychiatry patients with depression and alcohol use disorder

Psychiatry Research ◽

10.1016/j.psychres.2017.10.026 ◽

2018 ◽

Vol 259 ◽

pp. 316-322 ◽

Cited By ~ 2

Author(s):

Amber L. Bahorik ◽

Cynthia I. Campbell ◽

Stacy A. Sterling ◽

Amy Leibowitz ◽

Adam Travis ◽

...

Keyword(s):

Alcohol Use ◽

Clinical Outcomes ◽

Alcohol Use Disorder ◽

Marijuana Use ◽

Adverse Impact

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A Multidimensional Electronic Hydroxyurea Adherence Intervention for Children With Sickle Cell Disease: Single-Arm Before-After Study

JMIR mhealth and uhealth ◽

10.2196/13452 ◽

2019 ◽

Vol 7 (8) ◽

pp. e13452 ◽

Cited By ~ 8

Author(s):

Susan Creary ◽

Deena Chisolm ◽

Joseph Stanek ◽

Jane Hankins ◽

Sarah H O'Brien

Keyword(s):

Sickle Cell Disease ◽

Clinical Outcomes ◽

Sickle Cell ◽

Electronic Device ◽

Medication Possession Ratio ◽

Directly Observed Therapy ◽

Cell Disease ◽

Baseline Values ◽

Adherence Intervention ◽

The Impact

Background Hydroxyurea is a disease-modifying medication for patients with sickle cell disease (SCD). Despite demonstrated efficacy, hydroxyurea nonadherence in clinical practice is common and results in worse health outcomes for nonadherent patients. Mobile Directly Observed Therapy (Mobile DOT) is a pilot-tested, electronic, multidimensional hydroxyurea adherence intervention for children with SCD. Mobile DOT includes sending daily text message reminders to patients to take hydroxyurea, patients recording and sending daily videos that capture their hydroxyurea administrations for the research team to review and track adherence, providing personalized feedback to patients about their adherence, and providing small monetary incentives to patients if they achieve high hydroxyurea adherence. Objective This study aimed to determine if Mobile DOT increases hydroxyurea adherence in children with SCD and to explore its impact on hematologic and clinical outcomes. Methods This was a single-arm, 6-month intervention study of patients with SCD on hydroxyurea who were aged ≤19 years and reported having access to an electronic device. Participants’ hydroxyurea adherence when they received Mobile DOT was compared with their adherence 6 months before and after receiving Mobile DOT. Participants’ medication possession ratio (MPR) was calculated from their pharmacy dispensing records and was used to measure adherence. Laboratory and clinical outcomes were abstracted from participants’ electronic medical records. Infrequently hospitalized patients who received at least 160 days of the intervention were considered to be engaged participants. Results Of 91 patients who were approached, 55 enrolled and 34 engaged with Mobile DOT. The median age of the engaged participants was 10 years (range 2-18.8 years), and 21 (62%, 21/34) participants were male, 28 (82%, 21/34) had hemoglobin SS SCD, and 19 (56%, 19/34) were prescribed hydroxyurea for at least a year before enrollment. With Mobile DOT, engaged participants’ median MPR increased from 61.7% to 84.4% (P<.001) and significantly more (67% vs 30%; P=.002) achieved ≥80% hydroxyurea adherence compared with baseline values. Engaged participants’ mean fetal hemoglobin (HgbF) levels and mean corpuscular volumes (MCV) improved significantly after 6 months of Mobile DOT (P=.04 and P=.001, respectively), but their adherence, HgbF levels, and MCV returned to baseline values during the 6 months after the intervention. Hospitalizations and the clinical outcomes that were measured occurred infrequently during the study. Nonengagement was associated with being female and having a recent SCD complication. In addition, having insufficient electronic data, being unable to quickly complete Mobile DOT each day, and not perceiving that Mobile DOT was beneficial may have further decreased engagement. Conclusions Mobile DOT shows promise as an effective intervention for some children with SCD. Modifications that may improve recruitment, reduce attrition, and increase engagement were identified and could increase the impact that Mobile DOT has on children with SCD. Trial Registration ClinicalTrials.gov NCT02578017; https://clinicaltrials.gov/ct2/show/NCT02578017

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Effect of a Consumer-Focused Website for Low Back Pain on Health Literacy, Treatment Choices, and Clinical Outcomes: Randomized Controlled Trial (Preprint)

10.2196/preprints.27860 ◽

2021 ◽

Author(s):

Paul William Hodges ◽

Leanne Hall ◽

Jenny Setchell ◽

Simon French ◽

Jessica Kasza ◽

...

Keyword(s):

Health Literacy ◽

Clinical Outcomes ◽

Internet Use ◽

Mean Difference ◽

Low Back ◽

Treatment Choices ◽

Health Literacy Questionnaire ◽

Dimension 2 ◽

Secondary Outcomes

BACKGROUND The internet is used for information related to health conditions, including low back pain (LBP), but most LBP websites provide inaccurate information. Few studies have investigated the effectiveness of internet resources in changing health literacy or treatment choices. OBJECTIVE This study aims to evaluate the effectiveness of the MyBackPain website compared with unguided internet use on health literacy, choice of treatments, and clinical outcomes in people with LBP. METHODS This was a pragmatic, web-based, participant- and assessor-blinded randomized trial of individuals with LBP stratified by duration. Participants were randomly allocated to have access to the evidence-based MyBackPain website, which was designed with input from consumers and expert consensus or unguided internet use. The coprimary outcomes were two dimensions of the Health Literacy Questionnaire (dimension 2: “having sufficient information to manage my health;” dimension 3: “actively managing my health;” converted to scores 1-100) at 3 months. Secondary outcomes included additional Health Literacy Questionnaire dimensions, quality of treatment choices, and clinical outcomes. RESULTS A total of 453 participants were recruited, and 321 (70.9%) completed the primary outcomes. Access to MyBackPain was not superior to unguided internet use on primary outcomes (dimension 2: mean difference −0.87 units, 95% CI −3.56 to 1.82; dimension 3: mean difference −0.41 units, 95% CI −2.78 to 1.96). Between-group differences in other secondary outcomes had inconsistent directions and were unlikely to be clinically important, although a small improvement of unclear importance in the quality of stated treatment choices at 1 month was found (mean difference 0.93 units, 95% CI 0.03 to 1.84). CONCLUSIONS MyBackPain was not superior to unguided internet use for health literacy, but data suggest some short-term improvement in treatment choices. Future research should investigate if greater interactivity and engagement with the website may enhance its impact. CLINICALTRIAL Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001292369; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372926 INTERNATIONAL REGISTERED REPORT RR2-10.1136/bmjopen-2018-027516

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Effects of comorbid alcohol use disorder on the clinical outcomes of first-episode schizophrenia: a nationwide population-based study

Annals of General Psychiatry ◽

10.1186/s12991-021-00353-3 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Soojin Ahn ◽

Youngjae Choi ◽

Woohyeok Choi ◽

Young Tak Jo ◽

Harin Kim ◽

...

Keyword(s):

Alcohol Use ◽

Clinical Outcomes ◽

Alcohol Use Disorder ◽

Small Sample ◽

First Episode ◽

Control Group ◽

Diagnostic Code ◽

Psychiatric Admissions ◽

First Episode Schizophrenia ◽

The Impact

Abstract Background Alcohol use disorder (AUD) is a common psychiatric comorbidity in schizophrenia, associated with poor clinical outcomes and medication noncompliance. Most previous studies on the effect of alcohol use in patients with schizophrenia had limitations of small sample size or a cross-sectional design. Therefore, we used a nationwide population database to investigate the impact of AUD on clinical outcomes of schizophrenia. Methods Data from the Health Insurance Review Agency database in South Korea from January 1, 2007 to December 31, 2016 were used. Among 64,442 patients with first-episode schizophrenia, 1598 patients with comorbid AUD were selected based on the diagnostic code F10. We performed between- and within-group analyses to compare the rates of psychiatric admissions and emergency room (ER) visits, and medication possession ratio (MPR) between the patients with comorbid AUD and control patients matched for the onset age, sex, and observation period. Results The rates of psychiatric admissions and ER visits in both groups decreased after the time point of diagnosis of AUD; however, the decrease was significantly greater in the patients with comorbid AUD compared to the control patients. While the comorbid AUD group showed an increase in MPR after the diagnosis of AUD, MPR decreased in the control group. The rates of psychiatric admissions, ER visits, and MPR were worse in the comorbid AUD group both before and after the diagnosis of AUD. Conclusions The results emphasize an importance of psychiatric comorbidities, especially AUD, in first-episode schizophrenia and the necessity of further research for confirmative findings of the association of AUD with clinical outcomes of schizophrenia.

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