Health Literacy and Health Outcomes in Diabetes: A Systematic Review
TL;DR: There is little sufficient or consistent evidence suggesting that it is independently associated with processes or outcomes of diabetes-related care, and it may be premature to routinely screen for low health literacy as a means for improving diabetes- related health-related outcomes.
Abstract: BACKGROUND
Low health literacy is considered a potential barrier to improving health outcomes in people with diabetes and other chronic conditions, although the evidence has not been previously systematically reviewed.
Citations
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TL;DR: A systematic review of Web of Science/grey literature until 15th April 2020, to identify studies reporting physical/mental health outcomes in HCW infected/exposed to Severe Acute Respiratory Syndrome -SARS, Middle East Respiratories Syndrome -MERS, Novel coronavirus -COVID-19.
404 citations
TL;DR: Low literacy is associated with less diabetes-related knowledge and may be related to other important health outcomes, but it is unclear if these interventions can reduce literacy-related differences in outcomes.
Abstract: PurposeInadequate literacy is common among patients with diabetes and may lead to adverse outcomes. The authors reviewed the relationship between literacy and health outcomes in patients with diabetes and potential interventions to improve outcomes.MethodsWe reviewed 79 articles covering 3 key domains: (1) evaluation of screening tools to identify inadequate literacy and numeracy, (2) the relationships of a range of diabetes-related health outcomes with literacy and numeracy, and (3) interventions to reduce literacy-related differences in health outcomes.ResultsSeveral screening tools are available to assess patients’ print literacy and numeracy skills, some specifically addressing diabetes. Literacy and numeracy are consistently associated with diabetes-related knowledge. Some studies suggest literacy and numeracy are associated with intermediate outcomes, including self-efficacy, communication, and self-care (including adherence), but the relationship between literacy and glycemic control is mixed. Few ...
223 citations
Cites methods from "Health Literacy and Health Outcomes..."
...reviews were relied on to capture findings that appeared in the published literature before 2009.(12,13) Next, studies were selected that addressed 3 key domains: (1) tools to identify inadequate health literacy and numeracy among patients with diabetes, (2) the relationship between health literacy or numeracy and a range of diabetes-related outcomes, and (3) interventions to reduce health literacy– related differences in diabetes-related health outcomes and/or to promote positive outcomes among all patients with diabetes regardless of literacy/numeracy skills....
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TL;DR: Inadequate health literacy is a barrier to the American Heart Association meeting its 2020 Impact Goals, and this statement articulates the rationale to anticipate and address the adverse cardiovascular effects associated with health literacy.
Abstract: Health literacy is the degree to which individuals are able to access and process basic health information and services and thereby participate in health-related decisions. Limited health literacy is highly prevalent in the United States and is strongly associated with patient morbidity, mortality, healthcare use, and costs. The objectives of this American Heart Association scientific statement are (1) to summarize the relevance of health literacy to cardiovascular health; (2) to present the adverse associations of health literacy with cardiovascular risk factors, conditions, and treatments; (3) to suggest strategies that address barriers imposed by limited health literacy on the management and prevention of cardiovascular disease; (4) to demonstrate the contributions of health literacy to health disparities, given its association with social determinants of health; and (5) to propose future directions for how health literacy can be integrated into the American Heart Association’s mandate to advance cardiovascular treatment and research, thereby improving patient care and public health. Inadequate health literacy is a barrier to the American Heart Association meeting its 2020 Impact Goals, and this statement articulates the rationale to anticipate and address the adverse cardiovascular effects associated with health literacy.
204 citations
TL;DR: Recommendations are made for continued research emphasis on improving psychosocial aspects of living with diabetes, with greater attention to the situational context in which the self-regulatory processes underlying self-management occur.
Abstract: Diabetes is a chronic illness that places a significant self-management burden on affected individuals and families. Given the importance of health behaviors-such as medication adherence, diet, physical activity, blood glucose self-monitoring-in achieving optimal glycemic control in diabetes, interventions designed and delivered by psychologists hold promise in assisting children, adolescents, and adults with diabetes in improving their health status and lowering their risk of serious complications. This article first provides an overview of diabetes self-management and associated challenges and burdens. Socioeconomic status factors that may influence diabetes management and outcomes are briefly highlighted. We then review the evidence base for select psychosocial factors that may be implicated in diabetes self-management. Modifiable targets of psychological intervention are presented across 3 overarching domains: (a) knowledge, beliefs, and related cognitive constructs; (b) emotional distress and well-being; and (c) behavioral skills and coping. Important methodological issues facing future research are discussed, along with opportunities for psychologists in improving the care and treatment outcomes of individuals and families living with diabetes. In conclusion, we advocate for continued research emphasis on improving psychosocial aspects of living with diabetes, with greater attention to the situational context in which the self-regulatory processes underlying self-management occur. Psychologists have important roles to play in reducing emotional distress, improving patient knowledge, and providing training in behavioral skills to promote successful self-management and to support patient-centered diabetes care. (PsycINFO Database Record
181 citations
14 Oct 2016
TL;DR: Science literacy is desirable not only for individuals, but also for the health and well-being of communities and society as discussed by the authors. But science literacy has traditionally been seen as the responsibility of individuals, and, as a result, individual science literacy is limited or enhanced by the circumstances of that nesting.
Abstract: Science is a way of knowing about the world. At once a process, a product, and an institution, science enables people to both engage in the construction of new knowledge as well as use information to achieve desired ends. Access to science—whether using knowledge or creating it—necessitates some level of familiarity with the enterprise and practice of science: we refer to this as science literacy.Science literacy is desirable not only for individuals, but also for the health and well- being of communities and society. More than just basic knowledge of science facts, contemporary definitions of science literacy have expanded to include understandings of scientific processes and practices, familiarity with how science and scientists work, a capacity to weigh and evaluate the products of science, and an ability to engage in civic decisions about the value of science. Although science literacy has traditionally been seen as the responsibility of individuals, individuals are nested within communities that are nested within societies—and, as a result, individual science literacy is limited or enhanced by the circumstances of that nesting. Science Literacy studies the role of science literacy in public support of science. This report synthesizes the available research literature on science literacy, makes recommendations on the need to improve the understanding of science and scientific research in the United States, and considers the relationship between scientific literacy and support for and use of science and research.
173 citations
References
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01 Jan 2009
TL;DR: Physicians should consider modification of immunosuppressive regimens to decrease the risk of PTD in high-risk transplant recipients and Randomized trials are needed to evaluate the use of oral glucose-lowering agents in transplant recipients.
Abstract: OBJECTIVE — To systematically review the incidence of posttransplantation diabetes (PTD), risk factors for its development, prognostic implications, and optimal management. RESEARCH DESIGN AND METHODS — We searched databases (MEDLINE, EMBASE, the Cochrane Library, and others) from inception to September 2000, reviewed bibliographies in reports retrieved, contacted transplantation experts, and reviewed specialty journals. Two reviewers independently determined report inclusion (original studies, in all languages, of PTD in adults with no history of diabetes before transplantation), assessed study methods, and extracted data using a standardized form. Meta-regression was used to explain between-study differences in incidence. RESULTS — Nineteen studies with 3,611 patients were included. The 12-month cumulative incidence of PTD is lower (10% in most studies) than it was 3 decades ago. The type of immunosuppression explained 74% of the variability in incidence (P 0.0004). Risk factors were patient age, nonwhite ethnicity, glucocorticoid treatment for rejection, and immunosuppression with high-dose cyclosporine and tacrolimus. PTD was associated with decreased graft and patient survival in earlier studies; later studies showed improved outcomes. Randomized trials of treatment regimens have not been conducted. CONCLUSIONS — Physicians should consider modification of immunosuppressive regimens to decrease the risk of PTD in high-risk transplant recipients. Randomized trials are needed to evaluate the use of oral glucose-lowering agents in transplant recipients, paying particular attention to interactions with immunosuppressive drugs. Diabetes Care 25:583–592, 2002
3,716 citations
TL;DR: Low health literacy was consistently associated with more hospitalizations; greater use of emergency care; lower receipt of mammography screening and influenza vaccine; poorer ability to demonstrate taking medications appropriately; poorer able to interpret labels and health messages; and, among elderly persons, poorer overall health status and higher mortality rates.
Abstract: Health literacy has been associated with health-related knowledge and patient comprehension. This systematic review updates a 2004 review and found 96 eligible studies that suggest that low health ...
3,457 citations
"Health Literacy and Health Outcomes..." refers background or result in this paper
...A recent review by Berkman and colleagues explored the relationship between health literacy and health outcomes in patients of all ages and was not limited to any patient groups.(4) Their findings were similar to ours, particularly on the relationship between health literacy and disease knowledge, and they reported inconsistent results regarding other outcomes that were not addressed in our review, such as healthcare utilization and costs....
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...Low health literacy is recognized as a stronger predictor of a persons’ health than age, income, employment status, education level, or race,(3) and is associated with a wide range of adverse effects on care processes and health outcomes.(4,5) Low levels of health literacy are more prevalent in minority populations, among persons for whom English is a second language, people with low levels of income and education, and people with a compromised health status and elder communities—the very same populations that carry the greatest burden of chronic conditions....
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TL;DR: The paper concludes that both conceptualizations are important and are helping to stimulate a more sophisticated understanding of the process of health communication in both clinical and community settings, as well as highlighting factors impacting on its effectiveness.
2,082 citations
"Health Literacy and Health Outcomes..." refers background in this paper
...Numeracy skills are ability to use numeric information for tasks, such as interpreting medication dosages and food labels.(1,2) Low health literacy is recognized as a stronger predictor of a persons’ health than age, income, employment status, education level, or race,(3) and is associated with a wide range of adverse effects on care processes and health outcomes....
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TL;DR: Low literacy is associated with several adverse health outcomes and future research, using more rigorous methods, will better define these relationships and guide developers of new interventions.
Abstract: OBJECTIVE: To review the relationship between literacy and health outcomes DATA SOURCES: We searched MEDLINE, Cumulative Index to Nursing and Allied Health (CINAHL), Educational Resources Information Center (ERIC), Public Affairs Information Service (PAIS), Industrial and Labor Relations Review (ILLR), PsychInfo, and Ageline from 1980 to 2003 STUDY SELECTION: We included observational studies that reported original data, measured literacy with any valid instrument, and measured one or more health outcomes Two abstractors reviewed each study for inclusion and resolved disagreements by discussion DATA EXTRACTION: One reviewer abstracted data from each article into an evidence table; the second reviewer checked each entry The whole study team reconciled disagreements about information in evidence tables Both data extractors independently completed an 11-item quality scale for each article; scores were averaged to give a final measure of article quality DATA SYNTHESIS: We reviewed 3,015 titles and abstracts and pulled 684 articles for full review; 73 articles met inclusion criteria and, of those, 44 addressed the questions of this report Patients with low literacy had poorer health outcomes, including knowledge, intermediate disease markers, measures of morbidity, general health status, and use of health resources Patients with low literacy were generally 15 to 3 times more likely to experience a given poor outcome The average quality of the articles was fair to good Most studies were cross-sectional in design; many failed to address adequately confounding and the use of multiple comparisons CONCLUSIONS: Low literacy is associated with several adverse health outcomes Future research, using more rigorous methods, will better define these relationships and guide developers of new interventions
1,863 citations
TL;DR: Inadequate health literacy may contribute to the disproportionate burden of diabetes-related problems among disadvantaged populations and efforts should focus on developing and evaluating interventions to improve diabetes outcomes among patients with inadequate health literacy.
Abstract: ContextHealth literacy is a measure of patients' ability to read, comprehend,
and act on medical instructions. Poor health literacy is common among racial
and ethnic minorities, elderly persons, and patients with chronic conditions,
particularly in public-sector settings. Little is known about the extent to
which health literacy affects clinical health outcomes.ObjectivesTo examine the association between health literacy and diabetes outcomes
among patients with type 2 diabetes.Design, Setting, and ParticipantsCross-sectional observational study of 408 English- and Spanish-speaking
patients who were older than 30 years and had type 2 diabetes identified from
the clinical database of 2 primary care clinics of a university-affiliated
public hospital in San Francisco, Calif. Participants were enrolled and completed
questionnaires between June and December 2000. We assessed patients' health
literacy by using the short-form Test of Functional Health Literacy in Adults
(s-TOFHLA) in English or Spanish.Main Outcome MeasuresMost recent hemoglobin A1c (HbA1c) level. Patients
were classified as having tight glycemic control if their HbA1c
was in the lowest quartile and poor control if it was in the highest quartile.
We also measured the presence of self-reported diabetes complications.ResultsAfter adjusting for patients' sociodemographic characteristics, depressive
symptoms, social support, treatment regimen, and years with diabetes, for
each 1-point decrement in s-TOFHLA score, the HbA1c value increased
by 0.02 (P = .02). Patients with inadequate health
literacy were less likely than patients with adequate health literacy to achieve
tight glycemic control (HbA1c ≤7.2%; adjusted odds ratio [OR],
0.57; 95% confidence interval [CI], 0.32-1.00; P
= .05) and were more likely to have poor glycemic control (HbA1c ≥9.5%;
adjusted OR, 2.03; 95% CI, 1.11-3.73; P = .02) and
to report having retinopathy (adjusted OR, 2.33; 95% CI, 1.19-4.57; P = .01).ConclusionsAmong primary care patients with type 2 diabetes, inadequate health
literacy is independently associated with worse glycemic control and higher
rates of retinopathy. Inadequate health literacy may contribute to the disproportionate
burden of diabetes-related problems among disadvantaged populations. Efforts
should focus on developing and evaluating interventions to improve diabetes
outcomes among patients with inadequate health literacy.
1,732 citations
"Health Literacy and Health Outcomes..." refers background in this paper
...One study reported that lower health literacy was associated with retinopathy and stroke, but not with nephropathy, lower extremity amputation or ischemic heart disease.(10) The other study showed no association between health literacy and self-reported complications....
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...The relationship between health literacy and self-reported complications was explored in two studies, both adjusted for potential confounders.(10,20) One study reported that lower health literacy was associated with retinopathy and stroke, but not with nephropathy, lower extremity amputation or ischemic heart disease....
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