Holly L. Mason

Relationships between health literacy and heart failure knowledge, self-efficacy, and self-care adherence

BACKGROUND It has been argued that only 12% of adults have the necessary health literacy to manage their health care effectively, which can lead to difficulties in self-care activities, such as medication adherence. Prior research suggests that health literacy may influence knowledge, self-efficacy and self-care, but this has not been fully examined. OBJECTIVE To test a model to explain the relationships between health literacy, heart failure knowledge, self-efficacy, and self-care. METHODS Prior to receiving clinic-based education, newly referred patients to 3 heart failure clinics completed assessments of health literacy, heart failure knowledge, self-efficacy, self-care, and demographics. Structural equation modeling was completed to examine the strength of the inter-variable relationships. RESULTS Of 81 participants recruited, data from 63 patients were complete. Health literacy was independently associated with knowledge (P < 0.001). Health literacy was not related to self-care. Self-efficacy was independently-associated with self-care adherence (P = 0.016). No other relationships were statistically significant. The model had good fit (comparative fit index = 1.000) and explained 33.6% of the variance in knowledge and 27.6% in self-care. CONCLUSIONS Health literacy influences knowledge about heart failure but not self-care adherence. Instead, self-efficacy influenced self-care adherence. Future research should incorporate additional factors that may better model the relationships between health literacy, knowledge, self-efficacy, and self-care.

Health Literacy and Self-Care of Patients with Heart Failure

Background and Research Objective:Todays complex healthcare system relies heavily on sophisticated self-care regimens. To navigate the system and follow self-care protocols, patients must be able to understand and use health information, which requires health literacy. However, nearly 90 million Americans lack the necessary health literacy skills to adequately care for themselves in the face of a complex healthcare system and self-care regimens. Understanding how to effectively care for ones self is thought to improve heart failure symptoms and patient outcomes, but little is actually known about how health literacy influences self-care in patients with heart failure. The purpose of this pilot study was to examine the relationship between health literacy and self-care of patients with heart failure. Subjects and Methods:Patients with a diagnosis of heart failure were recruited from a variety of community settings. Participants completed the Short-Form Test of Functional Health Literacy (measured health literacy), the Self-care Index of Heart Failure (measured self-care maintenance, management, and confidence), and a demographic questionnaire. Spearman ρ correlations were used to assess the strength of the relationship between health literacy level and self-care scores. Results and Conclusions:Among the 49 participants recruited, health literacy was positively related to self-care maintenance (Rs = 0.357, P = .006). Health literacy had a negative relationship with self-care management (Rs = −0.573, P = .001). There was no association between health literacy and self-care confidence (Rs = 0.201, P = .083). This project provides preliminary data regarding the association between health literacy and self-care in heart failure, showing support for higher health-literate patients performing more self-care maintenance, which has been shown to improve patient outcomes in heart failure. Patients with higher health literacy trended toward having greater self-care confidence, which can increase the likelihood of performing self-care, but this finding was not statistically significant. It was unexpected to find that lower health-literate patients performed more self-care management.

Medication Counseling Behaviors and Attitudes of Rural Community Pharmacists

There is a continued emphasis on developing the pharmacists medication counseling role to better serve the public. To understand this role, the present study utilized a shopper methodology to describe the extent to which 40 rural community pharmacists engage in five dimensions of counseling for each of two drug products. The study demonstrates a significant relationship between the attitudes toward counseling held by these practitioners and their actual counseling behaviors.

Burnout Among Pharmacists

A nationwide mail survey of a random sample of the American Pharmaceutical Association membership was conducted to study the degree of burnout among pharmacists and to identify individual and job characteristics that make a pharmacist susceptible to burnout. Analysis of 1,261 returned questionnaires (57.1% response rate) revealed moderate levels of burnout among pharmacists. The study found that the typical pharmacist who reported the highest level of burnout was a woman less than 40 years old, who works in a chain community pharmacy setting, and who has been in practice and in the same job for less than 10 years. Further work is needed to identify other personal and practice conditions that make pharmacists susceptible to burnout. In the meantime, employees are encouraged to establish interpersonal communications designed to identify and deal with signs of burnout.

Health-related quality of life and healthcare resource utilization by COPD patients: A comparison of three instruments

The aim of this study was to compare the SF-36 and two disease-specific instruments – St. Georges Respiratory Questionnaire (SGRQ) and Chronic Respiratory Disease Questionnaire (CRDQ) among chronic obstructive pulmonary disease (COPD) patients using healthcare utilization data. The three instruments were administered twice by telephone interview to 40 COPD patients separated by a 3-month interval. Healthcare utilization data were obtained for the 3 months immediately prior to each administration. Reliabilities for sub-scales on the three instruments ranged from 0.70 to 0.90 for the SF-36, from 0.78 to 0.85 for the SGRQ, and from 0.64 to 0.91 for the CRDQ. In general, the study sample had poor physical health, and somewhat better mental health. None of the demographic variables were significantly associated with either health status or utilization. Among the three instruments, the SF-36 explained the most variance in healthcare utilization. The aggregate scores such as the summary scores of the SF-36 and the total score of the SGRQ did not perform as well as the individual sub-scales of the respective instruments in explaining the variation in utilization. The conclusion that the SF-36 provides the best association to healthcare utilization data from among the three instruments studied should be interpreted with caution given the small sample size and relatively brief duration of the study.

Using attitudes and subjective norms to predict pharmacist counselling behaviors.

This field study examines the applicability of the central components of Fishbein and Ajzens model for the prediction of behavior to the medication counselling activities of community pharmacists. The findings from a sample of 40 pharmacists provide support for the attitudes-subjective norms model. Both the attitude and subjective norm measures are significant predictors of behavior for verbal instruction provided and the length of encounter time. Each of the other behaviors examined--written instruction provided, monitoring activity, and pharmacist approachability--is weakly to moderately influenced by one of the two independent variables.

Building a multi-institutional community of practice to foster assessment.

This paper discusses the development of a multi-institutional community of practice that formed over 5 years. This community of practice was intentionally designed to support the evolution of student learning and programmatic assessment within member colleges and schools. Critical phases to the community’s development are outlined, as well as its mission and goals. In addition, the community’s contributions to faculty development and the scholarship of assessment are detailed. Success factors are discussed to assist others who may wish to initiate assessment-related collaborations across institutional borders. The community’s vision for the future is also outlined.

Reenvisioning assessment for the Academy and the Accreditation Council for Pharmacy Education's standards revision process.

Assessment has become a major aspect of accreditation processes across all of higher education. As the Accreditation Council for Pharmacy Education (ACPE) plans a major revision to the standards for doctor of pharmacy (PharmD) education, an in-depth, scholarly review of the approaches and strategies for assessment in the PharmD program accreditation process is warranted. This paper provides 3 goals and 7 recommendations to strengthen assessment in accreditation standards. The goals include: (1) simplified standards with a focus on accountability and improvement, (2) institutionalization of assessment efforts; and (3) innovation in assessment. Evolving and shaping assessment practices is not the sole responsibility of the accreditation standards. Assessment requires commitment and dedication from individual faculty members, colleges and schools, and organizations supporting the college and schools, such as the American Association of Colleges of Pharmacy. Therefore, this paper also challenges the academy and its members to optimize assessment practices.