The Demographic Assessment for Health Literacy (DAHL): a new tool for estimating associations between health literacy and outcomes in national surveys.
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ABSTRACT:
SUBMITTER: Hanchate AD
PROVIDER: S-EPMC2533384 | biostudies-other | 2008 Oct
REPOSITORIES: biostudies-other
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Project description:Background:Socio-economic and demographic determinants of child growth at ages 0-5 years in developing countries are well documented. However, Precision Public Health interventions and population targeting require more finely grained knowledge about the existence and character of temporal changes in child growth associations. Methods:We evaluated the temporal stability of associations between height-for-age z-score (HAZ) of children aged 0-59 months and child, parental, household, and community and infrastructure factors by following 25 countries over time (1991-2014) in repeated cross-sections of 91 Demographic and Health Surveys using random effect models and Wald tests. Results:We found that child growth displayed relatively more time stable associations with child, parental, and household factors than with community and infrastructure factors. Among the unstable associations, there was no uniform geographical pattern in terms of where they consistently increased or decreased over time. There were differences between countries in the extent of temporal instability but there was no apparent regional grouping or geographic pattern. The instability was positively and significantly correlated with annual changes in HAZ. Conclusions:These findings inform about the generalizability of results stemming from cross-sectional studies that do not consider time variation - results regarding effects of child, parental, and household factors on HAZ do not necessarily need to be re-evaluated over time whereas results regarding the effects of infrastructure and community variables need to be monitored more frequently as they are expected to change. In addition, the study may improve the Precision Public Health population targeting of interventions in different regions and times - whereas the temporal dimension seems to be important for precision targeting of community and infrastructure factors, it is not the case for child, parental, and household factors. In general, the existence of temporal instability and the direction of change varies across countries with no apparent regional pattern.
| S-EPMC6351606 | biostudies-literature
Project description:Globally, no countries are on track to achieve the adopted global nutrition targets set for anemia in 2025. Given the linkages between water, sanitation, and hygiene (WASH) and nutrition, this secondary data analysis explores potential associations with anemia. Forty-seven demographic and health surveys were used to explore the association between unimproved water and sanitation and anemia in women and children with adjusted odds ratios (ORs) calculated by country and cumulatively. In over 60% of countries, children with off-premises water access had significantly increased odds of anemia. In over a quarter of countries, children exposed to surface water had higher odds of anemia. In Burundi, children were 1.65 times more likely to be anemic when reported to be living in households using surface water. However, in India, a protective effect was noted (adjusted OR: 0.70, P < 0.001) for surface water. In 60% and 65% of countries, women and children exposed to an open sanitation facility had higher odds of being anemic, respectively. There is evidence of an association between selected water and sanitation indicators and anemia. Promoting policies, practices and research that strengthen access to improved WASH should be considered for reducing anemia prevalence alongside standard nutrition interventions.
| S-EPMC6771505 | biostudies-literature
Project description:It is hypothesised that across two national surveys poor self-rated health will be independently associated with somatisation and will result in high rates of service use after adjusting for established diagnoses.Two cross-sectional population-based surveys were conducted in 1997 and 2007. The use of both surveys allowed replication of results.Australia.The 1997 and 2007 National Surveys of Mental Health and Well-Being were based on stratified, multistage area probability samples of persons living in private dwellings in Australia. The 1997 survey included 10 641 respondents aged 18-75 years, a response rate of 78%. The 2007 survey included 8841 respondents aged 16-85 years, a response rate of 60%.Self-rated health.Approximately 15% of the Australian population rated their health as fair or poor in both surveys. The independent relationship between self-rated health and somatisation was replicated across both surveys in multivariate analyses. Individuals with negative self-rated health were 4.1 times as likely to screen positive for health anxiety (OR 4.1, 95% CI 2.8 to 5.9) and 3.4 times as likely to be diagnosed with neurasthenia (OR 3.4, 95% CI 2.2 to 5.2), when compared with individuals who rated their health positively. Individuals with negative self-rated health were also more likely to use health services after controlling for demographics and mental and physical illness.These results confirm both of the study hypotheses: (1) that negative self-rated health was powerfully and independently associated with somatisation and (2) that this relationship manifested itself in high rates of service use, even after adjusting for an extensive range of demographics and psychiatric and physical conditions.
| S-EPMC3696865 | biostudies-other
Project description:BackgroundAvailable studies on the prevalence of infertility have proved to have certain limitations, with a scarcity of population-based studies and inconsistent reporting from surveys in countries at all income levels. We wanted to test the applicability of the current duration approach to data from the important Demographic and Health Surveys (DHS) program, funded by USAID since its inception in 1985, https://dhsprogram.com/.MethodsThe current duration approach assumes that there is a well-defined time of initiation of attempts to get pregnant and defines the current duration of a still ongoing pregnancy attempt as the time interval from initiation to interview. The DHS interviews do not have an explicit question about initiation. We focused on nullipari and substituted date of "establishment of relationship with current partner" for initiation. Our study used the current duration approach on 15 datasets from DHS during 2002-2016 in eight different countries from sub-Saharan Africa, Asia, and Latin America.ResultsWell-established statistical techniques for current duration data yielded results that for some countries postulated surprisingly long median times to pregnancy and surprisingly high estimates of infertility prevalence. Further study of the data structures revealed serious deviations from expected patterns, in contrast to our earlier experience from surveys in France and the United States where participants were asked explicitly about time of initiation of attempts to become pregnant.ConclusionsUsing cohabitation as a proxy for the initiation of attempts to get pregnant is too crude. Using the current duration approach with DHS data will require more explicit questions during the DHS interviews about initiation of pregnancy attempt.
| S-EPMC7707157 | biostudies-literature
Project description:BackgroundThe World Health Organization describes health literacy as a critical determinant of health and driver of citizen empowerment and health equity. Several studies have shown that health literacy is associated with a range of socioeconomic factors including educational attainment, financial position and ethnicity. The complexity of the health system influences how well a person is able to engage with information and services. Health organisations can empower the populations they serve and address inequity by ensuring they are health literacy responsive. The aim of this study was to develop the Organisational Health Literacy Responsiveness self-assessment tool (Org-HLR Tool), and an assessment process to support organisations with application of the tool.MethodsA co-design workshop with health and social service professionals was undertaken to inform the structure of the tool and assessment process. Participants critiqued existing self-assessment tools and discussed the likely utility of the data they generate. A review of widely used organisational performance assessment tools informed the structure and self-assessment process. The Organisational Health Literacy Responsiveness (Org-HLR) Framework (with seven domains/24 sub-domains) provided the structure for the assessment dimensions of the tool. The performance indicators were drawn from raw data collected during development of the Org-HLR Framework.ResultsTwenty-two professionals participated in the workshop. Based on the feedback provided and a review of existing tools, a multi-stage, group-based assessment process for implementing the Org-HLR Tool was developed. The assessment process was divided into three parts; i) reflection; ii) self-rating; and iii) priority setting, each supported by a corresponding tool. The self-rating tool, consistent with the Org-HLR Framework, was divided into: External policy and funding environment; Leadership and culture; Systems, processes and policies; Access to services and programs; Community engagement and partnerships; Communication practices and standards; Workforce. Each of these had 1 to 5 sub-dimensions (24 in total), and 135 performance indicators.ConclusionsThe Org-HLR Tool and assessment process were developed to address a gap in available tools to support organisations to assess their health literacy responsiveness, and prioritise and plan their quality improvement activities. The tool is currently in the field for further utility and acceptability testing.
| S-EPMC6128002 | biostudies-literature
Project description:Contraception is one of the most important health interventions currently available and yet, many women and couples still do not have reliable access to modern contraceptives. The best indicator for monitoring family planning is the proportion of women using contraception among those who need it. This indicator is frequently called demand for family planning satisfied and we argue that it should be called family planning coverage (FPC). This indicator is complex to calculate and requires a considerable number of questions to be included in a household survey.We propose a model that can predict FPC from a much simpler indicator - contraceptive use prevalence - for situations where it cannot be derived directly.Using 197 Multiple Indicator Cluster Surveys and Demographic and Health Surveys from 82 countries, we explored least-squares regression models that could be used to predict FPC. Non-linearity was expected in this situation and we used a fractional polynomial approach to find the best fitting model. We also explored the effect of calendar time and of wealth on the models explored.Given the high correlation between the variables involved in FPC, we managed to derive a relatively simple model that depends only on contraceptive use prevalence but explains 95% of the variability of the outcome, with high precision for the estimated regression line. We also show that the relationship between the two variables has not changed with time. A concordance analysis showed agreement between observed and fitted results within a range of ±9 percentage points.We show that it is possible to obtain fairly good estimates of FPC using only contraceptive prevalence as a predictor, a strategy that is useful in situations where it is not possible to estimate FPC directly.
| S-EPMC4642361 | biostudies-other
Project description:BackgroundThere has been limited work comparing survey characteristics and assessing the quality of child anthropometric data from population-based surveys.ObjectiveTo investigate survey characteristics and indicators of quality of anthropometric data in children aged 0-59 months from 23 countries in the West Central Africa region.MethodsUsing established methodologies and criteria to examine child age, sex, height, and weight, we conducted a comprehensive assessment and scoring of the quality of anthropometric data collected in 100 national surveys.ResultsThe Multiple Indicator Cluster Surveys (MICS) and Demographic and Health Surveys (DHS) collected data from a greater number of younger children than older children while the opposite was found for the National Nutrition Surveys (NNS). Missing or implausible height/weight data proportions were 12% and 8% in MICS and DHS compared to 3% in NNS. Average data quality scores were 14 in NNS, 33 in DHS, and 41 in MICS.ConclusionsAlthough our metric of data quality suggests that data from the NNS appear more consistent and robust, it is equally important to consider its disadvantages related to access and lack of broader socioeconomic information. In comparison, the DHS and MICS are publicly-accessable for research and provide socioeconomic context essential for assessing and addressing the burden of undernutrition within and between countries. The strengths and weaknesses of data from these three sources should be carefully considered when seeking to determine the burden of child undernutrition and its variation within countries.
| S-EPMC5496063 | biostudies-literature
Project description:BackgroundThe key metric for monitoring the progress of deworming programs in controlling soil-transmitted helminthiasis (STH) is national drug coverage reported to the World Health Organization (WHO). There is increased interest in utilizing geographically-disaggregated data to estimate sub-national deworming coverage and equity, as well as gender parity. The Demographic and Health Surveys (DHS) offer a potential source of sub-national data. This study aimed to compare deworming coverage routinely reported to WHO and estimated by DHS in pre-school aged children to inform global STH measurement and evaluation.MethodologyWe compared sub-national deworming coverage in pre-school aged children reported to WHO and estimated by DHS aligned geospatially and temporally. We included data from Burundi (2016-2017), Myanmar (2015-2016), and the Philippines (2017) based on data availability. WHO provided data on the date and sub-national coverage per mass drug administration reported by Ministries of Health. DHS included maternally-reported deworming status within the past 6 months for each child surveyed. We estimated differences in sub-national deworming coverage using WHO and DHS data, and performed sensitivity analyses.Principal findingsWe compared data on pre-school aged children from 13 of 18 districts in Burundi (N = 6,835 in DHS), 11 of 15 districts in Myanmar (N = 1,462 in DHS) and 16 of 17 districts in the Philippines (N = 7,594 in DHS) following data exclusion. The national deworming coverages estimated by DHS in Burundi, Myanmar, and the Philippines were 75.5% (95% CI: 73.7%-77.7%), 47.0% (95% CI: 42.7%-51.3%), and 48.0% (95% CI: 46.0%-50.0%), respectively. The national deworming coverages reported by WHO in Burundi, Myanmar, and the Philippines were 80.1%, 93.6% and 75.7%, respectively. The mean absolute differences in district-level coverage reported to WHO and estimated by DHS in Burundi, Myanmar, and the Philippines were 9.5%, 41.5%, and 24.6%, respectively. Across countries, coverage reported to WHO was frequently higher than DHS estimates (32 of 40 districts). National deworming coverage from DHS estimates were similar by gender within countries.Conclusions and significanceAgreement of deworming coverage reported to WHO and estimated by DHS data was heterogeneous across countries, varying from broadly compatible in Burundi to largely discrepant in Myanmar. DHS data could complement deworming data reported to WHO to improve data monitoring practices and serve as an independent sub-national source of coverage data.
| S-EPMC7462292 | biostudies-literature
Project description:It has been widely recognised that a significant proportion of the world's population suffer inequalities in accessing high quality healthcare and wider services. Within healthcare, antimicrobial resistance (AMR) is a global threat to public health affecting all healthcare systems and growing at an alarming pace. To ensure that national AMR campaigns developed by Public Health England are inclusive of all populations within the target audience a health equity assessment tool (HEAT) was used. The project leads for each campaign completed the HEAT independently with a follow up meeting with the study team to discuss and clarify the responses. A trend analysis was carried out with common themes being used to provide recommendations. The campaigns have demonstrated equality and diversity based on the requirements of the Equality Act 2010, particularly age, sex, and race protected characteristics. Some notable results include the translation of website materials in over 30 languages and reaching individuals in 122 countries. It was however noted that several of the protected characteristics were not applicable. The continuous development of resources with collaboration from a variety of diverse user groups would be advantageous towards aiding future campaign reach. The use of the HEAT has demonstrated the ease and cost-effective way to assess any health inequalities and would be a useful addition to antimicrobial stewardship and public health campaigns.
| S-EPMC6784169 | biostudies-literature
Project description:Physical literacy is becoming increasingly popular in sport, recreation, physical education and physical activity settings and programming. We developed an environmental assessment tool to evaluate the extent child and youth activity programs implement physical literacy across four domains: environment, programming, leaders and staff, and values and goals. The Physical Literacy Environmental Assessment (PLEA) tool was developed in 3 phases. First, the PLEA tool was created, content validity established, and physical literacy leaders were consulted. In the second phase, the PLEA tool was completed and tested by 83 child and youth programs and it was validated with individual physical literacy assessments completed on children in programs that scored in the top 10% and bottom 10% on the PLEA tool. Third, a National consultation was conducted, and program leaders provided feedback on the PLEA tool. In Phase 1, the PLEA tool was modified and shortened from 41 to 29 indicators, based on feedback from physical literacy content leaders. In Phase 2, participants in programs that scored in the top 10% had significantly higher scores on the upper body object control domain of PLAYfun (p = 0.018), and significantly higher PLAYself scores (p = 0.04) than participants in programs that scored in the bottom 10%. In Phase 3, over 80% of program leaders identified the PLEA tool was useful, and relevant to their areas of practice. The completed PLEA tool is a 20-item environmental assessment tool to evaluate to what degree child and youth programming implement physical literacy across four domains: environment, programming, leaders and staff, and values and goals. The application and validity of the PLEA tool beyond child and youth physical education, sport, dance and recreation sectors, such as in early years programs, should be investigated.
| S-EPMC7077881 | biostudies-literature