Health Coaching Has Differential Effects on Veterans with Limited Health Literacy and Numeracy: a Secondary Analysis of ACTIVATE.
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ABSTRACT:
SUBMITTER: Nouri SS
PROVIDER: S-EPMC6445901 | biostudies-literature | 2019 Apr
REPOSITORIES: biostudies-literature
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Health Coaching Has Differential Effects on Veterans with Limited Health Literacy and Numeracy: a Secondary Analysis of ACTIVATE.
Nouri Sarah S SS Damschroder Laura J LJ Olsen Maren K MK Gierisch Jennifer M JM Fagerlin Angela A Sanders Linda L LL McCant Felicia F Oddone Eugene Z EZ
Journal of general internal medicine 20190212 4
<h4>Background</h4>Health coaching is an effective behavior change strategy. Understanding if there is a differential impact of health coaching on patients with low health literacy has not been well investigated.<h4>Objective</h4>To determine whether a telephone coaching intervention would result in similar improvements in enrollment in prevention programs and patient activation among Veterans with low versus high health literacy (specifically, reading literacy and numeracy).<h4>Design</h4>Secon ...[more]
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Project description:IntroductionHealth literacy and numeracy are linked to obesity and dietary behaviors. This study investigates whether the effect of a workplace behavioral intervention to prevent weight gain and improve diet differed by employee health literacy and numeracy.MethodsChooseWell 365 was an RCT of hospital employees testing a 12-month intervention using nudges and feedback to promote healthier choices, building on existing cafeteria traffic light labels (e.g., green=healthy, red=unhealthy). Health literacy and numeracy were measured with the Newest Vital Sign (range=0-6) and General Numeracy Scale (range=0-3). Mixed-effects linear models examined if intervention effects on cafeteria purchases, diet quality (Healthy Eating Index 2015, range=0-100), and weight change over 24 months differed by higher versus lower health literacy or numeracy. Data were collected in 2016-2020 and analyzed in 2020-2021.ResultsIn 12 months, 510 participants completed the Newest Vital Sign and General Numerancy Scale; 36.7% had Newest Vital Sign<6 (lower health literacy) and 31.6% had General Numerancy Scale<2 (lower numeracy). Intervention participants increased healthy purchases over 24 months compared with controls in both higher and lower health literacy and numeracy groups. At 12 months, Healthy Eating Index 2015 scores increased in intervention versus control participants with lower health literacy (5.5 points, 95% CI=1.51, 9.54) but not in those with higher health literacy (p-interaction=0.040). BMI did not differ by health literacy or numeracy.ConclusionsA behavioral intervention improved cafeteria food choices of hospital employees of varying health literacy and numeracy levels and improved diet quality among employees with lower health literacy, suggesting this group also improved food choices outside of work.
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Project description:Literacy and numeracy equally affect an individual's success in and beyond schools, but these two competencies tend to be separately examined, particularly in neuroimaging studies. The current resting-state fMRI study examined the neural correlates of literacy and numeracy in the same sample of healthy adults. We first used an exploratory "Multivariate Distance Matrix Regression" (MDMR) approach to examine intrinsic functional connectivity (iFC), highlighting the middle frontal gyrus (MFG) for both competencies. Notably, there was a hemispheric asymmetry in the MDMR-based MFG findings, with literacy associated with the left MFG, whereas numeracy associated with the right MFG (R.MFG). Results of post-hoc seed-based correlation analyses further strengthened differential contributions of MFG connections to each competency. One of the most striking and novel findings from the present work was that numeracy was negatively related to R.MFG connections with the default network, which has been largely overlooked in the literature. Our results are largely consistent with prior neuroimaging work showing distinct neural mechanisms underlying literacy and numeracy, and also indicate potentially common iFC profiles to both competencies (e.g., R.MFG with cerebellum). Taken together, our iFC findings have a potential to provide novel insights into neural bases of literacy, numeracy, and impairments in these competencies.
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Project description:BACKGROUND:Numeracy, health literacy, and cognition are important for chronic disease management. Prior studies have found them to be associated with poorer selfcare and worse clinical outcomes, but limited data exists in the context of heart failure (HF), a condition that requires patients to monitor their weight, fluid intake, and dietary salt, especially in the posthospitalization period. OBJECTIVE:To examine the relationship between numeracy, health literacy, and cognition with 30-day readmissions among patients hospitalized for acute decompensated HF (ADHF). DESIGN, SETTING, PATIENTS:The Vanderbilt Inpatient Cohort Study is a prospective longitudinal study of adults hospitalized with acute coronary syndromes and/or ADHF. We studied 883 adults hospitalized with ADHF. MEASUREMENTS:During their hospitalization, a baseline interview was performed in which demographic characteristics, numeracy, health literacy, and cognition were assessed. Through chart review, clinical characteristics were determined. The outcome of interest was 30-day readmission to any acute care hospital. To examine the association between numeracy, health literacy, cognition, and 30-day readmissions, multivariable Poisson (log-linear) regression was used. RESULTS:Of the 883 patients admitted for ADHF, 23.8% (n = 210) were readmitted within 30 days; 33.9% of the study population had inadequate numeracy skills, 24.6% had inadequate/marginal literacy skills, and 53% had any cognitive impairment. Numeracy and cognition were not associated with 30-day readmissions. Though (objective) health literacy was associated with 30-day readmissions in unadjusted analyses, it was not in adjusted analyses. CONCLUSIONS:Numeracy, health literacy, and cognition were not associated with 30-day readmission among this sample of patients hospitalized with ADHF.
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Project description:BACKGROUND:Health literacy and numeracy influence many health-related behaviors and outcomes. Health literacy and numeracy have been assessed objectively and subjectively, but interrelationships among the measures and the consistency of their association with health knowledge have not been examined. OBJECTIVE:To increase understanding of the structure and interrelations among objective and subjective health literacy and numeracy and how these constructs relate to knowledge of risk factors of two major diseases. DESIGN:Secondary analysis of cross-sectional survey data, weighted to be representative of the general US population of non-institutionalized adults. PARTICIPANTS:Participants (N?=?1005, 55.2% response rate) were recruited from GfK KnowledgePanel. The unweighted sample included 52% women, 26% racial/ethnic minorities, and 37% with no college experience. MAIN MEASURES:Objective health literacy, subjective health literacy, objective numeracy, subjective numeracy. Objective and perceived knowledge of diabetes and colon cancer risk factors were also assessed. KEY RESULTS:Confirmatory factor analyses indicated that a model with correlated (r?=?0.16-0.56) but separate factors for each of the four literacy/numeracy constructs best fit the data (RMSEA?=?0.055 (95% CI 0.049-0.061), CFI?=?0.94). Consistency between measures in classifying people as having adequate or limited health literacy or numeracy was 60.9-77.1%, depending on the combination of measures. All four literacy/numeracy constructs were independently associated with objective diabetes knowledge and objective colon cancer knowledge (all ps?<?.04). Subjective (but not objective) literacy and numeracy measures were associated with diabetes perceived knowledge (all ps?<?.02). No literacy/numeracy measures were associated with perceived colon cancer knowledge. CONCLUSIONS:We identified objective and subjective health literacy and numeracy as four distinct but related concepts. We also found that each construct accounts for unique variance in objective (but not subjective) disease knowledge. Until research uncovers what psychological processes drive subjective measures (e.g., motivation, self-efficacy), research investigating the relationship between health literacy and health outcomes should consider assessing all four measures.
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