Health Literacy and Health Literacy Tools in Patients with Cardiovascular Disease and Diabetes: A Mixed Method Study
Introduction
Health literacy is a vital component in effective health communication between pharmacists and patients (1). However, there is high prevalence of poor health literacy across different populations (2). Health literacy is defined by the Institution of Medicine (IOM) as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (3). This definition was modified by Berkman et al. (2010) to “the degree to which individuals can obtain, process, understand, and communicate about health-related information needed
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Common types of tools include word-recognition tests and tests of functional health literacy. Word-recognition tests measure an individual’s ability to recognize and pronounce words in a list and are useful predictors of general reading ability. One of the most commonly used word-recognition test is the Rapid Estimate of Adult Literacy in Medicine (REALM), which is a list of 66 medical terms that can be completed in 3 to 5 minutes (23). The REALM-SF (24) and REALM-R (25) are abbreviated but correlated versions of the REALM and are considered equivalent to the original REALM tool. Tests of functional health literacy include word-recognition, reading comprehension, numeracy skills, and application to real-life situations. The gold standard of functional health literacy assessments is the Test of Functional Health Literacy in Adults (TOFHLA) (26). It takes a relatively long time to complete (22 minutes). The shortened version, the S-TOFHLA, takes about 12 minutes to complete and its results are well correlated with the original TOFHLA (27). Another test of functional health literacy is the Newest Vital Sign (NVS), which is one of the most recently developed instruments (28). It encompasses a nutrition label of ice cream and 6 questions that measure a patient’s reading, comprehension, and abstract reasoning …show more content…
In addition, the association between limited health literacy and medication non-adherence in this population will be assessed. Participants’ baseline characteristics will be obtained.
Phase 2: Designing an Intervention
Mixed methods (quantitative and qualitative) will be utilized to understand in-depth different facilitators and barriers to health communication with cardiovascular disease or diabetes patients having low health literacy. Interviews will be conducted with healthcare providers (physicians, pharmacists, nurses) working with this patient population to explore challenges in communication with patients having limited health literacy and potential means to enhance communication and improve health literacy among these patients. In addition, a survey will be developed by the investigators to explore barriers and facilitators of communication from the patients’ perspective. The main aim is to be able to design an intervention utilizing different tools to improve communication and health literacy. The intervention could include mixed-strategies such as appropriate educational aids that combine both pictures and text, pictograms, and oral counseling methods to achieve the best