Sarah Mantwill

The Relationship between Health Literacy and Health Disparities: A Systematic Review

Objectives Health literacy is commonly associated with many of the antecedents of health disparities. Yet the precise nature of the relationship between health literacy and disparities remains unclear. A systematic review was conducted to better understand in how far the relationship between health literacy and health disparities has been systematically studied and which potential relationships and pathways have been identified. Methods Five databases, including PubMed/MEDLINE and CINAHL, were searched for peer-reviewed studies. Publications were included in the review when they (1) included a valid measure of health literacy, (2) explicitly conceived a health disparity as related to a social disparity, such as race/ethnicity or education and (3) when results were presented by comparing two or more groups afflicted by a social disparity investigating the effect of health literacy on health outcomes. Two reviewers evaluated each study for inclusion and abstracted relevant information. Findings were ordered according to the disparities identified and the role of health literacy in explaining them. Results 36 studies were included in the final synthesis. Most of the studies investigated racial/ethnic disparities, followed by some few studies that systematically investigated educational disparities. Some evidence was found on the mediating function of health literacy on self-rated health status across racial/ethnic and educational disparities, as well as on the potential effect of health literacy and numeracy on reducing racial/ethnic disparities in medication adherence and understanding of medication intake. Conclusion Overall the evidence on the relationship between health literacy and disparities is still mixed and fairly limited. Studies largely varied with regard to health(-related) outcomes under investigation and the health literacy assessments used. Further, many studies lacked a specific description of the nature of the disparity that was explored and a clear account of possible pathways tested.

The relationship between functional health literacy and the use of the health system by diabetics in Switzerland

Background: Observational studies from the USA have suggested that patients with low health literacy (HL) have higher health care costs and use an inefficient mix of health care services. To date, there were no studies from Europe that investigated the impact of HL on the use of the health system. The purpose of this study was to measure functional HL among persons having type 2 diabetes and to investigate the relationship between functional HL and health care costs and utilization. Methods: The study population were insured persons of the basic health insurance plan of the largest health insurer in Switzerland. Persons selected for participation had been reimbursed for diabetes medications in 2010–11, were aged 35–70 years and did not live in a long-term care institution. The level of functional HL was measured by one screening question. The following dependent variables were used: total costs, outpatient costs, inpatient costs, days admitted and number of physician visits attended. All multiple regression analyses were adjusted for age, gender, education, duration of diabetes, treatment with insulin (yes/no) and other chronic disease (yes/no). Results: High levels of functional HL were associated with lower total costs (P = 0.007), lower outpatient costs (P = 0.004) and less physician visits (P = 0.001). In the standard insurance plan with free access to all health professionals subgroup, the effects found were more pronounced. Conclusions: Persons with low functional HL need extra medical support, and therefore have higher health care costs.

Career development for early career academics: benefits of networking and the role of professional societies.

Whilst effective networking is vitally important for early career academics, understanding and establishing useful networks is challenging. This paper provides an overview of the benefits and challenges of networking in the academic field, particularly for early career academics, and reflects on the role of professional societies in facilitating networking.

EMPOWER-support of patient empowerment by an intelligent self-management pathway for patients: study protocol.

BackgroundDiabetes education together with patient empowerment has shown to be key to effective self-management behavior. When delivered through information and communication technologies (ICT), this solution has shown to lead to better health outcomes. However, the potential of ICT and their integration into the healthcare environment have not yet been fully exploited. ICT should be in particular used to facilitate communication and information exchange between patient and healthcare providers. In addition, systems should include components facilitating behavior change using empowerment approaches such as goal-setting.Methods/DesignFunded by the European Commission (FP7-ICT-2011-288209) a web/mobile based platform (EMPOWER) has been developed, which aims at supporting self-management activities of diabetes patients and their treating physicians in Germany and Turkey. The platform semantically integrates multiple information sources, such as electronic and personal health records (EHR/PHR). Patients can register patterns of daily living, record blood glucose levels, design disease management plans and set long- and short-term goals. The project actively involves the treating physician, who has the possibility to set recommendations for the patient and to monitor his/her progress on the platform.In the test-phase of EMPOWER, patients will be assigned to an intervention group and a control group. Data will be collected at baseline and three months after the intervention started. In addition, qualitative interviews will be conducted to collect extra information on usability and usefulness.Outcome measures include amongst others the Problem Areas in Diabetes questionnaire (PAID), the Summary of Diabetes Self-Care Activities and scales evaluating doctor-patient interaction. Physiological parameters, such as physical activity or blood glucose levels will be collected via the platform. Further, log files and number of logins will serve as independent variables.DiscussionThe interplay between multiple sources, including EHR, patients’ own registered information and physicians’ recommendations on one platform can have important practice implications. It might not only improve self-management activities in diabetes patients but it will also facilitate physician’s work, and ultimately the physician patient relationship.Trial registrationThe trial has been registered with Deutsches Register Klinischer Studien (German register of clinical trials) under DRKS00007699 on January 30, 2015.

Low health literacy and healthcare utilization among immigrants and non-immigrants in Switzerland

OBJECTIVE This study aimed at investigating the association between functional health literacy and knowledge on when to seek medical help for potentially harmless (overutilization) or serious (underutilization) situations among immigrants and non-immigrants in Switzerland. METHODS Data was collected among three immigrant groups and the native population (N=1146) in the German- and Italian-speaking part of Switzerland. Health literacy was assessed with the Short Test of Functional Health Literacy (S-TOFHLA) and three Brief Health Literacy Screeners. Over- and underutilization of healthcare services was assessed with items asking participants about when to seek medical help for minor, respectively major, physical symptoms. RESULTS Immigrants were more likely to seek medical help when unwarranted (overutilization). Health literacy, when assessed with the S-TOFHLA, was significantly associated with over- and underutilization. Yet, once controlled for covariates, the association between health literacy and overutilization was negative. Immigration background and micro-cultural differences emerged as important predictors of utilization. CONCLUSIONS Results suggest that functional health literacy is directly related to healthcare utilization. The effects might be amplified by (micro-)cultural differences. PRACTICE IMPLICATIONS Healthcare providers should be aware of differences in health literacy and utilization patterns among different population groups. Communication between patients and providers should be literacy and culturally sensitive.

Causal Attribution and Coping Maxims Differences between Immigrants and Non-Immigrants Suffering from Back Pain in Switzerland

Objectives This study aimed at investigating the relationship between causal attributions and coping maxims in people suffering from back pain. Further, it aimed at identifying in how far causal attributions and related coping maxims would defer between immigrants and non-immigrants in Switzerland. Methods Data for this study came from a larger survey study that was conducted among immigrant populations in the German- and Italian-speaking part of Switzerland. Included in the analyses were native Swiss participants, as well as Albanian- and Serbian-speaking immigrants, who had indicated to have suffered from back pain within the last 12 months prior to the study. Data was analyzed for overall 495 participants. Items for causal attributions and coping maxims were subject to factor analyses. Cultural differences were assessed with ANOVA and regression analyses. Interaction terms were included to investigate whether the relationship between causal attributions and coping maxims would differ with cultural affiliation. Results For both immigrant groups the physician’s influence on the course of their back pain was more important than for Swiss participants (p <.05). With regard to coping, both immigrant groups were more likely to agree with maxims that were related to the improvement of the back pain, as well as the acceptance of the current situation (p <.05). The only consistent interaction effect that was found indicated that being Albanian-speaking negatively moderated the relationship between physical activity as an attributed cause of back pain and all three identified coping maxims. Conclusion The study shows that differences in causal attribution and coping maxims between immigrants and non-immigrants exist. Further, the results support the assumption of an association between causal attribution and coping maxims. However cultural affiliation did not considerably moderate this relationship.

The Effect of Vaccine Literacy on Parental Trust and Intention to Vaccinate after a Major Vaccine Scandal

Health literacy, and more specifically vaccine literacy, might be an important factor in reducing the negative effects of exposure to misleading reports on vaccination. This study explores the association between vaccine literacy and vaccination-related outcomes after misleading reports on a scandal concerning locally produced childhood vaccines had emerged in 2016 in China. Data for this study came from a cross-sectional survey, which was conducted in April 2016 in Hangzhou, China. Data were collected in kindergartens and community health centers among parents of children up to 6 years of age. Data were analyzed for 1864 participants. Binary logistic regression models showed that, after controlling for socio-demographics and children’s age, parents who had better vaccine literacy (<0.05) were more likely to trust and choose domestically produced vaccines, which account for about 95% of the total vaccinations in China. This study provides evidence on a still largely understudied relationship between vaccine literacy and vaccination-related outcomes. Findings might suggest that higher literacy levels could reduce some of the negative effects of being exposed to misleading information on vaccination, eventually leading to less vaccination hesitancy.

Swiss Learning Health System: A national initiative to establish learning cycles for continuous health system improvement

The health system in Switzerland is considered as one of the best in the world. Nevertheless, to effectively and efficiently meet current and future challenges, an infrastructure and culture are needed where the best evidence is systematically made available and used, and the system evolves on the basis of a constant exchange between research, policy, and practice. The Swiss Learning Health System institutionalizes this idea as a multistakeholder national initiative to ensure continuous improvement through ongoing research and implementation. This article presents the objectives and mechanisms of the Swiss Learning Health System in the context of international initiatives to strengthen health systems and improve population health through learning cycles.

Validity of Three Brief Health Literacy Screeners to Measure Functional Health Literacy – Evidence from Five Different Countries

Self-reported health literacy measures have seen increased application throughout the last years, among those are the brief health literacy screeners (BHLS) developed by Chew and colleagues (2004). There has been little systematic research on the performance of these measures across different contexts, including countries and languages, to draw conclusions about their predictive power outside of the United States. This study aimed at replicating the original validation of the BHLS. Receiver operating characteristic (ROC) analysis was applied to data from Hungary, Italy, Lebanon, Switzerland, and Turkey. In addition, logistic regression models incorporating ROC analysis using BHLS as predictors were compared to models using socio-demographics only to identify individuals with inadequate and inadequate or marginal health literacy as measured with the Short Test of Functional Health Literacy in Adults. Analyses showed that in all cases the BHLS were not sufficiently able to identify individuals with different health literacy levels. Logistic regression models using socio-demographics only as predictors outperformed models using the BHLS. The findings highlight the limitations of using the BHLS outside the United States. Further, they question in how far self-reported health literacy measures are comparable across different contexts and whether thresholds for different health literacy levels are universally applicable.

Health literacy in Italy: a cross-sectional study protocol to assess the health literacy level in a population-based sample, and to validate health literacy measures in the Italian language

Introduction Health literacy (HL) concerns the knowledge and competences necessary for people to meet complex health demands. The aims of this study are to assess the level of HL in a sample using the Italian version of the Newest Vital Sign and the association of HL and selected antecedents with health outcomes, and to develop and validate the Italian version of the three Brief Health Literacy Screeners, two subjective numeracy items and the short form and the short-short form of the European Health Literacy Survey Questionnaire. Methods and analysis The study adopts a cross-sectional design and is being conducted in Florence, with information collected through telephone interviews. The population-based sample has been randomly selected using the registries of eight general practitioners (GPs). Based on a power calculation, 480 subjects will be included. Participants have been randomly offered two different questionnaires, each containing different HL measures. Data on sociodemographics and important antecedents and consequences of HL will be collected and the distribution of HL levels calculated. The mediating role of HL will be assessed using Preacher and Hayes’ model. To assess the concurrent validity of the HL scales, correlation and receiver operating characteristic analyses will be performed. Ethics and dissemination The study protocol has been approved by the Ethics Committee of the Area Vasta Centro. Results will be disseminated via scientific journals and conference presentations, and individual data made available to the GPs.