Ramanakumar Anam

Health Literacy, Numeracy, and Graphical Literacy Among Veterans in Primary Care and Their Effect on Shared Decision Making and Trust in Physicians

Studies reveal high levels of inadequate health literacy and numeracy in African Americans and older veterans. The authors aimed to investigate the distribution of health literacy, numeracy, and graph literacy in these populations. They conducted a cross-sectional survey of veterans receiving outpatient care and measured health literacy, numeracy, graph literacy, shared decision making, and trust in physicians. In addition, the authors compared subgroups of veterans using analyses of covariance. Participants were 502 veterans (22–82 years). Low, marginal, and adequate health literacy were found in, respectively, 29%, 26%, and 45% of the veterans. The authors found a significant main effect of race qualified by an age and race interaction. Inadequate health literacy was more common in African Americans than in Whites. Younger African Americans had lower health literacy (p <.001), graph literacy (p <.001), and numeracy (p <.001) than did Whites, even after the authors adjusted for covariates. Older and younger participants did not differ in health literacy, objective numeracy, or graph literacy after adjustment. The authors found no health literacy or age-related differences regarding preferences for shared decision making. African Americans expressed dissatisfaction with their current role in decision making (p =.03). Older participants trusted their physicians more than younger participants (p =.01). In conclusion, African Americans may be at a disadvantage when reviewing patient education materials, potentially affecting health care outcomes.

Communicating global cardiovascular risk: Are icon arrays better than numerical estimates in improving understanding, recall and perception of risk?

OBJECTIVE Experts recommend that adults have their global cardiovascular risk assessed. We investigated whether icon arrays increase understanding, recall, perception of CVR, and behavioral intent as compared with numerical information. METHODS Male outpatient veterans, at an intermediate to high cardiovascular risk participated in a randomized controlled trial of a computer tutorial presenting individualized risk. Message format was presented in 3 formats: percentages, frequencies, and frequencies with icon arrays. We assessed understanding immediately (T1) and recall at 20 min (T2) and 2 weeks (T3) after the intervention. We assessed perceptions of importance/seriousness, intent to adhere, and self-efficacy at T1. Self-reported adherence was assessed at T3. RESULTS One-hundred and twenty male veterans participated. Age, education, race, health literacy and numeracy were comparable at baseline. There were no differences in understanding at T1 [p = .31] and recall at T3 [p = .10]. Accuracy was inferior with frequencies with icon arrays than percentages or frequencies at T2 [p ≤ .001]. There were no differences in perception of seriousness and importance for heart disease, behavioral intent, self-efficacy, actual adherence and satisfaction. CONCLUSION Icon arrays may impair short-term recall of CVR. PRACTICE IMPLICATIONS Icon arrays will not necessarily result in better understanding and recall of medical risk in all patients.

Simulating geriatric home safety assessments in a three-dimensional virtual world.

Virtual worlds could offer inexpensive and safe three-dimensionalenvironments in which medical trainees can learn to identify home safety hazards. Our aim was to evaluate the feasibility, usability, and acceptability of virtual worlds for geriatric home safety assessments and to correlate performance efficiency in hazard identification with spatial ability, self-efficacy, cognitive load, and presence. In this study, 30 medical trainees found the home safety simulation easy to use, and their self-efficacy was improved. Men performed better than women in hazard identification. Presence and spatial ability were correlated significantly with performance. Educators should consider spatial ability and gender differences when implementing virtual world training for geriatric home safety assessments.

An overactive bladder online self-management program with embedded avatars: a randomized controlled trial of efficacy.

OBJECTIVE To determine whether an avatar-based, online, self-management program is an effective therapeutic approach for women with overactive bladder (OAB). OAB is a highly prevalent symptom complex that significantly impacts health-related quality of life (HRQOL). Behavioral interventions can produce substantial improvement in symptoms and HRQOL. Online education programs offer patients with OAB an alternative to face-to-face self-management instruction. Evidence suggests that avatars (digital humans) embedded into online programs may help persuade and motivate patients to adopt healthy behaviors. METHODS In a 12-week, randomized, controlled trial, women (aged >55 years) with symptoms of OAB for at least 3 months were randomized to 2 versions of a 3-part, online, self-management program. After collecting the baseline metrics, the intervention group viewed a generic avatar coach with a self-avatar peer mentor designed to resemble the participant, and the control group viewed the identical online program with voice only. Participants viewed part 1 at week 1 and parts 2 and 3 at week 6. Participants completed daily bladder diaries throughout the 12-week period and OAB-related outcome measures at weeks 1, 6, and 12. RESULTS Forty-one women completed the study (mean age = 61 years, standard deviation = 6). The analysis of covariance of week-12 outcome measures with the baseline as covariates demonstrated significant improvements in the intervention group in OAB questionnaire HRQOL (P = .02; large effect), 24-hour frequency (P <.001; large effect), night-time urination (P <.001; large effect), urgency (P <.001; large effect), and urge incontinence (P <.001; large effect). CONCLUSION An avatar-based intervention embedded into an online self-management program improved OAB HRQOL and symptoms in women.

Computer-Based Programmed Instruction Did Not Improve the Knowledge Retention of Medication Instructions of Individuals With Type 2 Diabetes Mellitus

Purpose The purpose of this study was to investigate whether computer-based programmed instruction (CPI) with a dynamic avatar (DA) improves retention of medication information better than text (controls) or better than CPI with text (T-CPI), CPI with voice (V-CPI), or CPI with static avatar with text (SA-CPI). Methods Participants with type 2 diabetes mellitus were enrolled in a randomized controlled trial comparing TDS with CPI in 4 conditions (T-CPI, V-CPI, SA-CPI, and DA-CPI). CPI sequentially delivers segmented information in text or voice followed by a multiple-choice question. Immediately after the user selects an option, CPI delivers elaborated feedback. Satisfaction was measured immediately after the interventions, and medication knowledge was measured at 2 weeks. Results One-hundred fifty individuals (30 per group) with a mean age 62 years (standard deviation [SD] 7.99 years) participated. There were no baseline differences in race, body mass index, education, and health literacy. Medication knowledge retention at 2 weeks was not significantly different between the groups, df(4), F = 0.17, P = .95 (TDS, mean = 25.43, SD = 5.11; T-CPI, mean = 25.07, SD = 4.98; V-CPI, mean = 25.77, SD = 4.89; SA-CPI, mean = 25.83, SD = 5.31; and DA-CPI, mean = 24.93, SD = 6.25). Satisfaction scores were significantly lower for TDS, df(4), F = 3.11, P = .01. Conclusions CPI did not improve medication knowledge retention at 2 weeks. CPI led to higher patient satisfaction compared with controls.

Group-based differences in anti-aging bias among medical students.

Medical students (MS) may develop ageist attitudes early in their training that may predict their future avoidance of caring for the elderly. This study sought to determine MS’ patterns of explicit and implicit anti-aging bias, intent to practice with older people and using the quad model, the role of gender, race, and motivation-based differences. One hundred and three MS completed an online survey that included explicit and implicit measures. Explicit measures revealed a moderately positive perception of older people. Female medical students and those high in internal motivation showed lower anti-aging bias, and both were more likely to intend to practice with older people. Although the implicit measure revealed more negativity toward the elderly than the explicit measures, there were no group differences. However, using the quad model the authors identified gender, race, and motivation-based differences in controlled and automatic processes involved in anti-aging bias.

The Association of Graph Literacy With Use of and Skills Using an Online Personal Health Record in Outpatient Veterans

Personal health records (PHRs) are intended to increase patients’ access to and ownership over their health care information for self-management purposes. The purpose of this study was to determine the association of graph literacy with adoption of an online PHR and, among adopters with self-reported skills, the frequency of use and intent to return to use the PHR . We conducted a cross-sectional survey of veterans receiving outpatient care. We measured health literacy, numeracy, graph literacy, and Internet and PHR adoption and use. We compared subgroups of veterans using analyses of covariance. We used hierarchical logistic regression models to estimate the effects of the literacy variables on PHR use. A total of 600 veterans (age = 22–94) participated in the survey. After we adjusted for known covariates, we found that adopters of a PHR were more likely to demonstrate higher health and graph literacy than nonadopters. Among PHR adopters, self-reported frequent and skillful users were more likely to have higher graph literacy than lower frequency and less skillful users. Adopters with higher intentions to return to use the PHR were more likely to show lower graph literacy than those less likely to return to use the PHR. Inadequate graph literacy was associated with lower adoption of a PHR and, among users, with lower self-reported frequent use and skills . As PHR use becomes more widespread, stakeholders will need to consider patients’ levels of graph literacy when implementing PHRs.

Association of the CAN score with the FRAIL scale in community dwelling older adults

BackgroundFrailty is a state of vulnerability to stressors which results in higher morbidity, mortality and healthcare utilization. The FRAIL scale is used as a validated screening for frailty. The Care Assessment Need (CAN) score is automatically generated from electronic health record data using a statistical model that includes data elements similar to the deficit accumulation model for frailty and predicts risk for hospitalization and/or mortality.AimTo determine the correlation of the CAN score with the FRAIL scale.MethodsA cross-sectional study of 503 community-dwelling older adults. We compared the FRAIL scale with the CAN score.ResultsThe CAN score was significantly different between robust, prefrail and frail. Post hoc analysis revealed significant increases in scores from robust to prefrail and frail groups, in that order. The CAN score and FRAIL scale showed a correlation.ConclusionsThe CAN score show a moderate positive association with the FRAIL scale.