Assessing the Prevalence and Association of Acculturation and Health Literacy Levels in Spanish-Speaking Hispanic Patients at Midwestern Community Health Centers in the USA.

BACKGROUND: Predictions from the US census indicate that by 2060 one of every three individuals living in the nation will be of Hispanic origin. Hispanics experience health disparities manifested with higher rates of chronic conditions such as hypertension and diabetes in contrast with other US population groups. Health literacy and acculturation have been well identified as key contributors for this issue. However, very few studies have examined the association between health literacy and levels of acculturation in Spanish-speaking Hispanics living in rural and urban areas of the USA. OBJECTIVE: To assess the prevalence and association of acculturation with low levels of health literacy and demographic variables in Spanish-speaking Hispanics in the US Midwest. METHODS: We measured levels of acculturation in Spanish-speaking adult Hispanics (N = 401) accessing community health centers in rural and urban Nebraska. We used a survey that included the Bidimensional Acculturation Scale for Hispanics/Linguistic Proficiency Subscale (BAS/LP) and the Short Assessment of Health Literacy in Spanish (SAHL-S). RESULTS: We observed similar acculturation levels with rural and urban status participants. A total of 85% of the total participants had low levels of acculturation to US culture. Of the 15% of the participants who showed themselves to be bicultural, 81% reported adequate levels of health literacy in Spanish. CONCLUSIONS: Our findings are consistent with previous studies that report the associations between acculturation and health literacy levels are significant. This study underscores the importance of considering the cultural aspects of the Hispanic community for the development of health literacy interventions and education programs.

Effectiveness of DVD vs. group-initiated diabetes prevention on information uptake for high & low health literacy participants.

OBJECTIVE: This study evaluates the effectiveness of technology versus in-person, group-initiated diabetes prevention to enhance comprehension of learning objectives between patients with differing health literacy (HL). METHODS: Evidence-based content through either a DVD (n = 217) or in-person, group class (n = 225) to initiate the intervention. A teach-back call was used to assess comprehension of, and reinforce, learning objectives. Chi-squared was used to determine differences between conditions (DVD vs Class) and HL levels (High n = 361 vs. Low n = 81) and regression analyses were used to examine relationships. RESULTS: DVD participants performed significantly better across teach back questions (15.4 ± 2.5 v. 14.8 ± 2.6, p < 0.01), demonstrated comprehension in fewer teach-back rounds (1.9 ± 0.7 v. 2.1 ± 0.7, p < 0.01), and answered more questions correctly on the first try (4.2 ± 1.6 v. 3.4 ± 1.8, p < 0.01). Models for HL levels and modality by HL level were statistically significant (p < 0.01) favoring the DVD. CONCLUSION: Initiating a diabetes prevention program with the use of a DVD appears to be a superior option to in-person, class sessions. Teach-back and teach-to-goal strategies enables participants of both high and low health literacy levels to receive and confirm mastery of diabetes prevention objectives. PRACTICE IMPLICATIONS: A teach-back call may improve information uptake increasing the likelihood of health behavior uptake.

Changes in Leisure Time Physical Activity Preferences and Hypertension Risk.

Objectives: In this study, we examined the association between changes in leisure time physical activity (LTPA) preference (the extent to which participants liked or disliked certain types of physical activity) and the incidence of hypertension; we also assessed whether the association differed between urban and rural China. Methods: Based on longitudinal data from 2687 Chinese adults between 2004 and 2011, we performed multivariate logistic regressions were to assess the aforementioned association. We conducted stratified analyses to examine the urban-rural differences in this association. Results: The mean age was 40.0 (Standard Deviation = 12.5), and the mean BMI was 23.7 (Standard Deviation = 3.3). Adjusted estimates show that relative to respondents with no changes in LTPA preference, respondents who reduced preference were more likely to develop hypertension (OR = 1.92, 95% CI = 1.13-3.28). This association, however, was statistically significant among urban residents (OR = 2.19, 95% CI = 1.04-4.60), but not rural participants. Conclusions: Changes in LTPA preference and development of hypertension were significantly correlated, especially among urban Chinese. Hypertension prevention programs may identify the groups at elevated risk by examining levels and changes of LTPA preferences.

Association between leisure time physical activity preference and behavior: evidence from the China Health & Nutrition Survey, 2004-2011.

BACKGROUND: Previous studies have suggested that food preference is a good indicator of actual food intake and that sedentary activity preference is a significant predictor of lower physical activity level. But no studies have examined the direct relationship between leisure time physical activity (LTPA) preferences and actual LTPA behavior, especially studies using longitudinal data. This study seeks to determine the association between these two variables, and to assess whether the association differs between urban and rural areas in China. METHODS: A total of 2427 Chinese adults were included in the analysis. Spearman correlation coefficients were used to test the association between leisure time physical activity preference and behavior, followed by multiple logistic regressions to further examine the association after adjusting for possible confounding variables. Urban-rural differences in the association were investigated through stratified analysis. RESULTS: In the sample, 63.0% were from urban areas, 47.4% were men, and the mean age was 40. Adjusted estimates based on logistic regression show that LTPA preference was a significant predictor of actual LTPA behavior (OR = 1.05, 95% CI = 1.01-1.09). The correlation was found to be significant among urban residents (OR = 1.06, 95% CI = 1.01-1.10), but not in rural residents. CONCLUSIONS: The study illustrates the predictive value of LTPA preference for actual LTPA behavior. Changing LTPA preference to promote LTPA may be helpful in preventing and controlling chronic disease in China.

Assessing health literacy levels of Spanish-speaking Hispanic patients in Spanish at federally qualified health centers (FQHCs) in the Midwest.

OBJECTIVE: Evaluate health literacy levels in Spanish-speaking Hispanic adults accessing health care services in the Midwest. METHODS: Cross-sectional study of patients (n = 402) at two Midwestern federally qualified health centers. The assessment tool used in this study contained the Short Assessment of Health Literacy-S. RESULTS: A total of 36% of the participants had a low health literacy level (LHLL). Forty-five percent of males versus 31% of females demonstrated LHLL (p < .05). With respect to education level, 61% with less than a 7th grade education had LHLL compared with 17% with 7th grade education or more (p < .05). Additionally, 29% of the participants of Mexican origin had LHLL contrasted with 55% of the participants of non-Mexican origin (p < .05). CONCLUSIONS: Low levels of health literacy reported in this study are consistent with previous assessments. We observed statistically significant differences in LHLL based on gender, education level, and country of origin.

Disparities in Health Information Access: Results of a County-Wide Survey and Implications for Health Communication.

Health knowledge and behavior can be shaped by the extent to which individuals have access to reliable and understandable health information. Based on data from a population-based telephone survey of 1,503 respondents of ages 18 years and older living in Douglas County, Nebraska, in 2013, this study assesses disparities in health information access and their related covariates. The two most frequently reported sources of health information are the Internet and health professionals, followed by print media, peers, and broadcast media. Relative to non-Hispanic Whites, Blacks are more likely to report health professionals as their primary source of health information (odds ratio [OR] = 2.61, p < .001) and less likely to report peers (OR = 0.39, p < .05). A comparison between Whites and Hispanics suggests that Hispanics are less likely to get their health information through the Internet (OR = 0.51, p < .05) and more likely to get it from broadcast media (OR = 4.27, p < .01). Relative to their counterparts, participants with no health insurance had significantly higher odds of reporting no source of health information (OR = 3.46, p < .05). Having no source of health information was also associated with an annual income below $25,000 (OR = 2.78, p < .05 compared to middle income range) and being born outside of the United States (OR = 5.00, p < .05). Access to health information is lowest among society's most vulnerable population groups. Knowledge of the specific outlets through which people are likely to obtain health information can help health program planners utilize the communication channels that are most relevant to the people they intend to reach.

Health Literacy Among People with Serious Mental Illness.

People diagnosed with a mental illness are at higher risk of developing preventable chronic diseases; thus, health literacy improvements may have great potential to impact health outcomes for this typically underserved population. However, there is a dearth of research on health literacy of persons with severe mental illness. The purpose of this research was to investigate aspects of health literacy and identify factors associated with low literacy among adults with severe mental illness using three literacy assessment tools. Seventy-one adults with serious mental illness were assessed and a high proportion had limited literacy levels: 42% with the Single Item Literacy Screener, 50% with the Rapid Estimate of Adult Literacy in Medicine-Short Form, and 67% with the Newest Vital Sign. Findings suggest that individuals with certain mental illnesses and lower functioning may have more difficulty understanding health information and have limited numerical literacy.

Interunit handoffs from emergency department to inpatient care: A cross-sectional survey of physicians at a university medical center.

BACKGROUND: Emergency department (ED) to inpatient physician handoffs are subject to complex challenges. We assessed physicians' perceptions of the ED admission handoff process and identified potential barriers to safe patient care. METHODS: We conducted a cross-sectional survey at a 627-bed tertiary care academic medical center. Eligible participants included all resident, fellow, and faculty physicians directly involved in admission handoffs from emergency medicine (EM) and 5 medical admitting services. The survey addressed communication quality, clinical information, interpersonal perceptions, assignment of responsibilities, organizational factors, and patient safety. Participants reported their responses via a 5-point Likert scale and an open-ended description of handoff-related adverse events. RESULTS: Response rates were 63% for admitting (94/150) and 86% for EM physicians (32/37). Compared to EM respondents, admitting physicians reported that vital clinical information was communicated less frequently for all 8 content areas (P < 0.001). Ninety-four percent of EM physicians felt defensive at least "sometimes." Twenty-nine percent of all respondents reported handoff-related adverse events, most frequently related to ineffective communication. Sequential handoffs were common for both EM and admitting services, with 78% of physicians reporting they negatively impacted patient care. CONCLUSION: Physicians reported that patient safety was often at risk during the ED admission handoff process. Admitting and EM physicians had divergent perceptions regarding handoff communication, and sequential handoffs were common. Further research is needed to better understand this complex process and to investigate strategies for improvement.

Disparities in visual impairment by immigrant status in the United States.

PURPOSE: To examine differences in visual impairment between immigrants and natives in the United States (US). DESIGN: This is a cross-sectional study of clinical vision examination data from the 2003-2008 National Health and Nutrition Examination Survey. METHODS: Analyses compare myopia, hyperopia, astigmatism, and visual acuity between noncitizens, naturalized citizens, and US natives. Visual acuity variables included having 20/40 or better corrected vision. Differences in 20/20 vision and legal blindness (20/200 or worse) were also examined. Respondents born in the United States were defined as US natives. Foreign-born respondents were categorized as either naturalized US citizens or noncitizen residents. Multivariate logistic regression of outcomes adjusted for sex, age, race/ethnicity, poverty, insurance, diabetes, and surgical correction for eyesight. RESULTS: A smaller percentage of noncitizens than US natives had myopia (18.8% vs 30.7%) or astigmatism (22.0% vs 30.9%). However, noncitizens using corrective lenses had an adjusted odds ratio (AOR) of 0.65 of having 20/20 vision compared to US natives (95% confidence interval [CI] 0.48-0.88). Differences in visual acuity for 20/40 and better vision were not statistically significant for corrective lens users. Among nonusers of corrective lenses, noncitizens were significantly less likely than US natives to have 20/40 or better vision (AOR = 0.54; 95% CI 0.39-0.74). Noncitizens also had up to 3.5 times the odds of being legally blind relative to US natives after adjusting for confounding factors (95% CI 1.52-7.83). CONCLUSIONS: Significant differences in visual acuity exist between immigrants and US natives. More research is necessary to identify underlying factors that may explain these disparities in visual impairment.

A qualitative study examining Latino functional health literacy levels and sources of health information.

The purpose of this study was to determine the health information sources used by Latinos in southwest Ohio, identify individual Latino residents' functional health literacy levels, and identify any access barriers to those sources of health information. Results show almost two-thirds had low acculturation levels to US culture. Overall, the major source of health information is a medical setting, followed by media technology (which included the Internet). However, when it comes to being ill, the primary source becomes a media choice, then medical. The barriers to accessing health information included language and lack of confidence/knowledge. Participants reported moderate satisfaction with the sources of health information available, and had an 'adequate' health literacy level in Spanish. This study was important because it filled an existing information gap for the Latino community, a racial ethnic minority population in the southwest Ohio area. With the results of this study, health educators and other health care practitioners might be better able to understand the health care needs of the Latino community and could essentially create improved and culturally competent health communications.