Health Literacy
Conditions
Keywords
Health Literacy, Geriatric health literacy assessment, Health literacy in tertiary care settings, Correlation of health literacy and health outcomes, BRIEF health literacy questionnaire, Visual Analogue Scale quality of life measure, Emergency room visits and hospitalization tracking in geriatric population, Patient-provider health literacy perception agreement, Patient, caregiver, and geriatric team health literacy alignment
Brief summary
Health Literacy is one's ability to understand health information well enough to make informed decisions about their health. Limited health literacy makes it hard for people to understand complex health issues and follow health care recommendations. Limited health literacy is associated with adverse health outcomes such as higher mortality, increased risk of emergency department visits and hospital admissions leading to higher medical costs. Although there are tools to assess health literacy, they are not widely used, so many healthcare providers do not measure their patients' health literacy levels adequately. Health care workers tend to overestimate their patients' health literacy. This is especially important for older adults who often have memory problems and multiple illnesses. This study will evaluate how doctors and team members in a geriatric clinic estimate their patient's health literacy and determine if this matches with the patients' health literacy as measured by a simple validated questionnaire. The investigators will also look at how a patient's relative or caregiver estimates their health literacy using a similar short questionnaire. The research team plans to follow up with a telephone call in 6 months, to see which health concerns if any have occurred since the clinic visit.
Detailed description
As treatments become more sophisticated and the healthcare system becomes more complex, health literacy (HL) assumes an ever-greater importance in the therapeutic alliance between healthcare professionals and patients. Limited health literacy causes difficulty in understanding one's health condition. As a result, it is associated with less adherence to self-care behaviours, increased mortality, increased hospitalizations, other adverse health outcomes, and high healthcare costs. In those over aged 65, health literacy is positively influenced by levels of educational attainment and literacy practices in the home, male gender, and weakly by informal learning and self-study and adult education experience. Negative associations include being foreign-born and failure to learn from exposure to various contexts. Understanding the health literacy of patients is particularly vital for geriatricians as older adults referred to geriatric medicine clinics already experience barriers to high quality care due to the frequent presence of cognitive impairment and multiple comorbidities. The interaction among these variables and health literacy in a tertiary care setting for older adults with cognitive impairment remains under-explored. Given the dependent state of many cognitively impaired individuals, the responsibility lies with geriatricians to adjust their communication and care strategies according to the HL levels of their patients. Studying the association between the accuracy of geriatrician-perceived HL and health outcomes could reveal the extent to which physician communication impacts these outcomes. Given these intertwined factors, a 6-month follow-up is crucial to capture the longitudinal associations of HL on patient outcomes, providing a more comprehensive picture of how these variables interact over time. This study's primary outcome is the evaluation of patient health literacy and the level of agreement between the geriatric team's perception and objectively measured health literacy. The secondary outcome is assessing how patient health literacy is associated with medication adherence and future planning. As well, the investigators hope to assess how patient health literacy is associated with emergency department visits, hospitalizations, hospital length of stay, remaining home, long-term care admission and mortality within 6 months.
Interventions
None listed
Sponsors
Hamilton Health Sciences Corporation
Study design
Observational model
OTHER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
65 Years to 110 Years
Healthy volunteers
No
Inclusion criteria
* Patients (both new and follow up) attending St. Peter's Hospital Geriatric Clinic * Willingness to participate in the study (caregiver can rate HL for patient if patient unable to) * Consenting to study (by patient or caregiver)
Exclusion criteria
* Behavior (e.g. behavioral and psychological symptoms of dementia) which may be aggravated by additional questions * Acute illness preventing participation * Terminal illness that would prevent 6-month telephone follow up * Previous participation in this study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Patient self-identified HL | At enrollment | The patient's self-identified health literacy based on the BRIEF, a 4-item measure of health literacy that has been validated for older adults. |
| Caregiver's perception of patient's HL | At enrollment | The caregiver's perception of the patient's health literacy based on the BRIEF-C, a tool based on the BRIEF, constructed to reflect the caregiver's perception of the patient's HL. |
| Patient self-identified quality of life | At enrollment | The patient's self-identified quality of life measured by the EQ-VAS, a visual analogue scale measuring quality of life on a scale of 0 to 100 |
| Geriatric Team's assessment of patient's HL | At enrollment | Geriatric Team will report HL as Adequate/marginal/inadequate. Level of adequacy (1,2,3) is optional |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Power of Attorney designation | At enrollment | Whether a patient has discussed and identified a power of attorney. |
| Number of patients remaining home | At enrollment | Whether the patient is living in community residence |
| Falls | At enrollment | Number of Falls in the past year |
| Number of ED visits | 6 months | Number of ED visits during follow up period (6 months) |
| Medication adherence | At enrollment | Low medication adherence is predictive of poor health outcomes for older adults and is associated with education level, health literacy, patient satisfaction, and sufficient communication. However, associations have not been delineated in an outpatient setting or using a validated HL scale. Adherence will be measured by dichotomous outcome (80% adherent vs non-adherent) according to the consultation note. |
| Hospital length of stay | 6 months | Number of days patient admitted to hospital during follow up period (6 months) |
| Long-term care admission | 6 months | Whether the patient was admitted to long-term care at follow up |
| Mortality | 6 months | Whether patient died during the follow up period (6 months) |
| Injurious Falls | 6 months | Frequency of falls experienced by the patient before the follow up period. |
| Number of hospitalizations | 6 months | Number of hospital admissions during follow up period (6 months) |
| Number of participants with existing community home care planning | At enrollment | Home and community care includes access to long-term or short-term nursing, home support, and other services. As well, the use of these services has a significant effect on healthy aging in place. However, it is currently unknown the extent to which HL may influence an individual's ability to obtain home care. |
| Number of participants with long-term care planning | At enrollment | Long term care planning includes discussion about or application to long term care facility admission. |
| Number of patients with code status discussion | At enrollment | Statement about advance directives or POST in medical record. |
Countries
Canada
Contacts
Primary ContactChristopher Patterson, Professor of Medicine
Backup ContactElaine Y Wang
Outcome results
None listed