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Tailored education may reduce health literacy disparities in asthma self-management.

ABSTRACT: Although inadequate health literacy has been associated with lower asthma medication knowledge and worse metered-dose inhaler (MDI) technique, the relationship between health literacy and the capacity to learn asthma self-management skills is unknown.In this prospective cohort study of adults hospitalized for severe asthma exacerbations at two inner-city hospitals, we examined the relationship between inadequate health literacy and difficulties learning and retaining instructions about discharge medications and appropriate MDI technique.At hospital discharge, participants received one-on-one, 30-min, guideline-based, written and oral instruction about their asthma discharge regimen as well as appropriate MDI technique.Seventy-three patients were enrolled. Inadequate health literacy was identified in 16 (22%) participants. Before instruction, inadequate health literacy was associated with lower asthma medication knowledge (5.2/10 vs. 7.2/10, p < 0.001) and worse MDI technique (3.2/6 vs. 3.9/6, p = 0.03). However, inadequate health literacy was not associated with difficulty learning (p = 0.33) or retaining (p = 0.35) instructions about the discharge regimen. Similarly, inadequate health literacy was not associated with difficulty learning (p = 0.26) or retaining (p = 0.97) appropriate MDI technique. Results were similar in multivariable models adjusted for demographic characteristics and asthma severity indicators.These findings suggest that inadequate health literacy is a surmountable barrier to learning and remembering key asthma self-management skills.

SUBMITTER: Paasche-Orlow MK

PROVIDER: S-EPMC2718412 | biostudies-other | 2005 Oct

REPOSITORIES: biostudies-other

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Tailored education may reduce health literacy disparities in asthma self-management.

Paasche-Orlow Michael K MK Riekert Kristin A KA Bilderback Andrew A Chanmugam Arjun A Hill Peter P Rand Cynthia S CS Brancati Fred L FL Krishnan Jerry A JA

American journal of respiratory and critical care medicine 20050804 8

<h4>Rationale</h4>Although inadequate health literacy has been associated with lower asthma medication knowledge and worse metered-dose inhaler (MDI) technique, the relationship between health literacy and the capacity to learn asthma self-management skills is unknown.<h4>Objectives</h4>In this prospective cohort study of adults hospitalized for severe asthma exacerbations at two inner-city hospitals, we examined the relationship between inadequate health literacy and difficulties learning and r ...[more]

PMID: 16081544

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Project description:BackgroundCOVID-19 vaccines significantly reduce rates of hospitalization and death for those infected with the SARS-CoV-2 virus. Those facing social oppression, including people of color, experience heightened risk for COVID-19 and comorbidities, but are often mistrustful of governmental agencies and initiatives, contributing to low vaccine uptake and a reluctance to access vital health care services. Dialogue-based health literacy interventions may mitigate mistrust and increase access to health services and information, subsequently increasing rates of vaccination and other behaviors that reduce COVID-19 risk.ObjectiveTo improve health literacy and reduce COVID-19 disparities, the Westchester County Department of Health, in partnership with two universities, community- and faith-based organizations, and the Westchester County Department of Correction, co-developed a health education program for community members, correctional officers, and incarcerated jail residents in Westchester, New York. Specific objectives are to increase preventative health behaviors, positive attitudes toward use of public health protocols, full vaccination or intentions to vaccinate, health care information understanding, health provider care access, clear communication with health care providers, and personal health care decision-making.MethodsGrounded in dialogic learning, the program entails training community-based "trusted messengers" and correctional officers to lead health information sessions in community and correctional settings. During the grant period, the program intends for 80 community-based trusted messengers to receive training from the Department of Health and will be expected to reach a goal of 100 members (N=8000) of their communities. Correctional staff with experience delivering educational programs will be trained to facilitate sessions among 400 correctional facility residents and 600 correctional staff.ResultsPre-post surveys will assess changes in health behaviors, attitudes, and perceptions. The program has been administered in the correctional facility since February 2022, with information sessions expected to cease for correctional staff and residents in June 2022 and November 2022, respectively. An initial cohort of community-based trusted messengers began training in February 2022, and information sessions have been scheduled in various virtual and community settings since March 2022. As of April 2022, the two-pronged health education program has reached 439 correctional officers, 98 jail residents, and 201 community members countywide. Program evaluation findings will be released in future publications after study implementation is complete.ConclusionsFew studies have evaluated the combined effects of training-of-trainers (ToT) and dialogical learning models on behavior and health literacy. As the first known COVID-19-specific dialogue-based health education program that applies a ToT model in the community-based, correctional, and virtual settings simultaneously, this study fills a gap in current knowledge about health literacy and health behavior in marginalized populations. Thus, this evidence-based framework can remedy COVID-19 disparities while also addressing risks for a host of health-related issues at the community level, potentially serving as a best-practice model for future health programs.International registered report identifier (irrid)PRR1-10.2196/37713.

Project description:BackgroundSupported asthma self-management improves health outcomes. However, people with limited health literacy, especially in lower-middle-income countries (LMICs), may need tailored interventions to enable them to realise the benefits. We aimed to assess the clinical effectiveness of asthma self-management interventions targeted at people with limited health literacy and to identify strategies associated with effective programmes.MethodsFollowing Cochrane methodology, we searched ten databases (January 1990 - June 2018; updated October 2019), without language restriction. We included controlled experimental studies whose interventions targeted health literacy to improve asthma self-management. Selection of papers, extraction of data and quality assessment were done independently by two reviewers. The primary outcomes were clinical (asthma control) and implementation (adoption/adherence to intervention). Analysis was narrative.ResultsWe screened 4318 titles and abstracts, reviewed 52 full-texts and included five trials. One trial was conducted in a LMIC. Risk of bias was low in one trial and high in the other four studies. Clinical outcomes were reported in two trials, both at high risk of bias: one of which reported a reduction in unscheduled care (number of visits in 6-month (SD); Intervention:0.9 (1.2) vs Control:1.8 (2.4), P?=?0.001); the other showed no effect. None reported uptake or adherence to the intervention. Behavioural change strategies typically focused on improving an individual's psychological and physical capacity to enact behaviour (eg, targeting asthma-related knowledge or comprehension). Only two interventions also targeted motivation; none sought to improve opportunity. Less than half of the interventions used specific self-management strategies (eg, written asthma action plan) with tailoring to limited health literacy status. Different approaches (eg, video-based and pictorial action plans) were used to provide education.ConclusionsThe paucity of studies and diversity of the interventions to support people with limited health literacy to self-manage their asthma meant that the impact on health outcomes remains unclear. Given the proportion of the global population who have limited health literacy skills, this is a research priority.Protocol registrationPROSPERO CRD 42018118974.

Project description:BackgroundHealth literacy is a multidimensional concept that is considered a primary public health concern. This concept is often neglected in research, and the evidence regarding health literacy in college students is limited. The aim of this study was two-fold: to determine the needs and limitations of health literacy among college students and to explore the relationships among the nine dimensions of health literacy and sociodemographic factors, including age, gender, nationality, year of study, field of study, smoking status, history of chronic diseases, use of on-campus gym, and the intention to exercise on-campus.MethodsThis study was conducted using a cross-sectional approach. A total of 520 college students participated in this study. The average age was 21.03 years (SD = 2.29), with 47.5% males and 52.5% females. Data were collected using a demographics questionnaire and the Health Literacy Questionnaire (HLQ). In addition to descriptive statistics, multivariate analysis of variance (MANOVA) and follow-up analyses were performed to explore any statistically significant mean differences among levels of health literacy and sociodemographic factors.ResultsThe levels of health literacy on the nine HLQ scales were lower than the levels reported in the literature. Multivariate analysis showed a significant effect of age, gender, smoking status, year of study, and field of study on the level of health literacy. Follow-up analyses revealed that female students, students from the health-related faculties, and those who do not smoke have higher levels of health literacy compared to their counterparts. A detailed comparison between the levels of the HLQ scales was made based on students' demographic characteristics. The field of study had the most prominent effect on the level of college students' health literacy; mean differences were statistically significant (p < .001), and effect sizes were large (ranging from .66 to 1.35 for the nine scales of the HLQ).ConclusionCollege students' health literacy is influenced by demographic characteristics. Such variations could amplify some of the existing health disparities. The implications of the findings on health, health promotion, and interprofessional education are discussed.

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Tailored education may reduce health literacy disparities in asthma self-management.

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Tailored education may reduce health literacy disparities in asthma self-management.

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