Investigating the impact of patient-centred labels on comprehension of medication dosing: a randomised controlled trial

ObjectiveThis study aims to implement a version of patient-centred labels (PCL) consistent with current labelling practice in Australia; assess the effectiveness of PCL in relation to the proportion of participants that correctly comprehend dosing instructions, and explore the proportion of correct comprehension of PCL in participants with both low and high health literacy.DesignRandomised controlled trial.SettingA large tertiary care hospital in Brisbane, Queensland, Australia.Participants121 participants with a majority born in Australia (65.3%), New Zealand (14.0%), the UK (6.6%) and Ireland (2.5%).InterventionParticipants were randomly assigned to either a panel of three PCL (n=61) or three standard labels (n=60) and asked to comprehend their assigned panel of labels.Outcome measuresDifference in the proportion of participants that correctly comprehend dosing instructions provided on PCL compared with standard labels. The two-proportion test was used to measure the impact of PCL on the proportion of participants correctly comprehending dosing instructions.ResultsA greater proportion of participants were able to accurately comprehend PCL compared with standard labels. The proportion of participants who were able to correctly comprehend dose instructions provided on all three labels was significantly higher in the group that received PCL; 23.3% standard vs 83.6% PCL, p<0.001. The effect was observed in both low and high health literacy participants. The proportion of participants with accurate label comprehension was higher in participants with low Newest Vital Signs scores (8.3% standard vs 85.7% PCL, p<0.001) and low Rapid Estimate of Adult Literacy in Medicine scores (10.5% standard vs 96.0% PCL, p<0.001) who received PCL.ConclusionThis study supports the use of PCL in Australian pharmacy practice. PCL provide simple, clear and explicit dosing instructions to patients. Implementing PCL may reduce the risk of misinterpreting dosing instructions by patients and improve quality use of medicines.Trial registration numberACTRN12621000083897; Results.

Do Japan’s Health Care Personnel Meet the Personal Health Goals of the “National Health Promotion Program”?

To improve health among the population and reduce the societal burden of care and health-related costs in a rapidly aging environment, the Japanese government launched the “National Health Promotion Program in the 21st Century” (HJ21), which contains goals concerning areas such as lifestyle behavior and the use of preventive medicine. While health care personnel are responsible for guiding others’ health choices, they may not maintain healthy lifestyles themselves. Whether these individuals are meeting the HJ21 goals has not yet been examined. This study aims to determine whether certified specialists in health management are meeting such goals, and to compare their performance with the national average. This is a cross-sectional survey study. Study participants, sourced from all prefectures in Japan, were specialists certified in health management. We measured data concerning demographic information, lifestyle (physical activity, nutrition, diet, sleep, rest, smoking, and alcohol use), and the use of preventive medicine. The study participants exhibited many characteristics of high health literacy. They had an overall healthy lifestyle and met most of the HJ21 goals of healthy lifestyle, and a high proportion underwent health maintenance examinations and cancer screenings. These practices and behaviors maybe associated with high health literacy and social engagement activities.

Patients’ Use and Perceptions of a Drug-Drug Interaction Database: A Survey of Janusmed Interactions

Janusmed interactions is a drug-drug interactions (DDI) database available online for healthcare professionals (HCP) at all levels of the healthcare system including pharmacies. The database is aimed at HCP but is also open to the public for free, for those individuals who register for a personal account. The aim of this study was to investigate why and how patients use the database Janusmed interactions, how they perceive content and usability, and how they would react if they found an interaction. A web-based questionnaire was sent by email to all users who had registered for Janusmed interactions as a “patient” (n = 3219). A total of 406 patients completed the survey (response rate 12.6%). The study shows that there is an interest among patients to use a DDI database to check their own or a relative’s medication. The respondents found the database easy to use and perceive they understand the information aimed at HCP. Most patients stated they would talk to their HCP if they found an interaction and not adjust their treatment by themselves. However, the respondents in this study are actively searching for information and seem to have high health literacy. Thus, the findings are not generalizable for the general population.

Understanding health empowerment in the context of online information seeking: the perspective of information processing (Preprint)

BACKGROUND Massive, easily accessible online health information empowers users to better cope with health problems. Most patients search for relevant online health information before seeing a doctor to alleviate information asymmetry. However, the mechanism of how online health information affects health empowerment is still unclear. OBJECTIVE To study how online health information processing affects health empowerment. METHODS A cross-sectional study included 343 samples who had searched online health information before the consultation. Respondents' perceptions of online information cues, benefits, health literacy, and health empowerment were assessed. RESULTS Argument quality and source credibility have significant and positive effects on perceived information benefits, but only argument quality has a significant effect on perceived decision-making benefits. Two types of perceived benefits in turn affect health empowerment. The effects of argument quality on perceived informational benefits and perceived decision-making benefits on health empowerment are significantly stronger for the high health literacy group than the low health literacy group (t = 7.156, p < 0.001; t = 23.240, p < 0.001). While, the effects of source credibility on perceived informational benefits and perceived informational benefits on health empowerment are significantly weaker for the high health literacy group than the low health literacy group (t = -10.497, p < 0.001; t = -6.344, p < 0.001). The effect of argument quality on perceived informational benefits shows no significant difference between high and low health literacy groups. CONCLUSIONS This study found that two information processing routes have significant effects on perceived benefits and health empowerment, the health empowerment processes of high and low health literacy groups are different.

Assessment of COVID-19 Knowledge Among University Students: Implications for Future Risk Communication Strategies

The purpose of this study was to describe population knowledge and beliefs about COVID-19 and current social media coverage to address a gap in what is known about risk communication during health crises. A survey with 27 questions was developed. Twenty-three percent ( N = 1,136) of respondents started the survey. Less than half of the students reported a high health literacy level (43%, n = 365/855). When asked where students have heard about COVID-19, the majority reported the Internet and social media. Students reported a basic level of COVID-19 knowledge, but few students (18%, n = 173/966) correctly identified all three signs and/or symptoms of COVID-19. Results highlight the need for an increased public health presence on social media and the urgent need to remain diligent in educating community members about COVID-19 myths.

Screening for health literacy at an urban academic cancer center.

e19034 Background: Low health literacy is more prevalent among older adults and minority populations, and it has been linked to excess health care utilization and poor health outcomes in cancer patients. Screening for health literacy may improve communication and care, such that discussions and information can be tailored to patient need. The purpose of this study was to describe health literacy levels and correlates among patients at an urban, NCI-designated cancer center. Methods: In September 2019, we began health literacy screening for each newly diagnosed, English-speaking cancer patient. Patients were categorized as having low, medium, or high health literacy using the BRIEF health literacy screener; results are visible in the EMR. For this analysis, we included patient age, gender, insurance type, race/ethnicity, and socio-economic status (SES), which was calculated using an Area Deprivation Index (ADI) ranging from 0 (no deprivation) to 100 (extreme deprivation). Data was summarized using descriptive statistics; ANOVA and Chi-squared tests investigated associations between patient’s health literacy levels and potential correlates. Results: Among 284 patients, 68%, (n = 195) were Caucasian, 25% (n = 70) were African American and 7%, (n = 19) identified as Hispanic, Asian American or some other race. Seventy-five percent (n = 211) were male; the mean age was 63 years (SD: 12). The mean ADI was 42 (SD: 28), indicating a low to moderate SES. Seventy percent (n = 200) had a high health literacy score, 20% (n = 57) had a medium score, and 10% (n = 27) had a low health literacy score. Only a patient’s race/ethnicity and the ADI were significantly associated with their health literacy score. Seventy-seven percent of Caucasian patients had high health literacy scores compared to 59% of African American patients and 48% patients of Hispanic, Asian or some other origin (P < .001). Patients with low health literacy had an ADI score (65.1) that was almost double the score of patients with high health literacy scores (38.5) (p < .001). Conclusions: Roughly one-third of patients seen at this urban cancer center did not have a high health literacy score. Socio-economic status was a stronger correlate to health literacy than patient age, marital status, or insurance type. EMRs should capture a patient’s SES in some manner, as this is strongly associated with health literacy.

Examination of a nationwide cohort of individuals with high health literacy in terms of their health-related lifestyles and attainment of the goals of the “National Health Promotion in the 21st Century” Program

Background: In Japan, where the population is aging particularly rapidly, “healthy aging” is being advocated as a means of addressing the potential societal burdens caused by older adults’ need for nursing care and the high associated health-care costs. To improve healthy aging among the population, the Japanese government has launched the “National Health Promotion in the 21st Century” (HJ21), which contains goals concerning areas such as lifestyle behavior and use of preventive medicine. Low health literacy is associated with many health-related issues; however, whether individuals with high health literacy are meeting the HJ21 goals has not yet been examined. This study aims to determine whether a cohort with high health literacy are meeting such goals, and to compare the cohort’s performance with the national average. Methods: This is a cross-sectional survey study. Study participants, sourced from all prefectures in Japan, were professional specialists in health management certified by the Japanese Association of Preventive Medicine for Adult Disease. We measured data concerning the cohort’s demographic information, health perception, lifestyle (including physical activity) and use of preventive medicine. Results: The cohort showed many characteristics of high health literacy. The cohort had an overall healthy lifestyle and met most of the HJ21 goals; in particular, a high proportion underwent health-maintenance exams and cancer screenings. Conclusions: The high health literacy cohort showed a healthy lifestyle. Compared to the national average, a higher proportion of the cohort met the HJ21 goals and received preventive medicine.

Constructing a measure of health literacy in Sub-Saharan African countries

We sought to develop and evaluate a health literacy measure in a multi-national study and to examine demographic characteristics associated with health literacy. Data were obtained from Demographic Health Surveys conducted between 2006–15 in 14 countries in Sub-Saharan Africa. Surveys were the same in all countries but translated to local languages as appropriate. We identified eight questions that corresponded to the National Academy of Medicine (NAM) definition of health literacy. Factor analysis was used to extract one measure of health literacy. Logistic regression was employed to examine the relationship between demographic characteristics and health literacy. A total of 224 751 individuals between the ages of 15 and 49 years were included. The derived health literacy measure demonstrated good internal consistency (Cronbach’s α = 0.72) and good content validity. The prevalence of high health literacy overall was 35.77%; females 34.08% and males 39.17%; less than or equal to primary education 8.93%, some secondary education 69.40% and ≥complete secondary 84.35%. High health literacy varied across nations, from 8.51% in Niger to 63.89% in Namibia. This is the first known study to evaluate a measure of health literacy relying on the NAM definition utilizing a large sample from 14 countries in Sub-Saharan Africa. Our study derived a robust indicator of NAM-defined health literacy. This indicator could be used to examine determinants and outcomes of health literacy in additional countries.

Patients’ Experiences of Diabetes Self-Management Education According to Health-Literacy Levels

Diabetes self-management is an important part of patient care for those with diabetes. The purpose of this study was to explore patients’ experiences with diabetes self-management education and how these experiences differed by health-literacy levels. A descriptive qualitative design was conducted. In 2016, 20 patients with diabetes who took a formal diabetes self-management course at a university hospital in South Korea were interviewed. A conventional content analysis was conducted. Patients with low health-literacy misunderstood diabetes management, showed passive attitudes towards seeking information, and had difficulty obtaining detailed information. Patients with high health-literacy wanted systematic, in-depth, individualized counselling on lifestyle modifications and medications. Patients’ experiences with diabetes self-management education revealed differences in their health-literacy dimensions. In addition to practising health-literacy precautions, the content and delivery of diabetes self-management education need to be accommodated according to patients’ health-literacy levels to obtain better outcomes.