Medication health literacy measure: development and psychometric properties.

BACKGROUND AND PURPOSE: Low levels of health literacy are prevalent worldwide. This report details development and psychometric properties of a health literacy measure for oral medications based on design of the Newest Vital Sign. METHODS: The measure was completed during the baseline interview. A principal components analysis evaluated dimensionality of the measure. Cronbach's alpha assessed subscale internal consistencies. RESULTS: Internal consistencies and reliability for the subscales were acceptable for a new instrument (alpha = .661, alpha = .686, alpha = .400). A 3-factor structure explained 65.34% of the total variance. Divergent validity with the Rapid Estimate of Adult Literacy in Medicine (REALM) was established. CONCLUSIONS: Our data indicates that the medication health literacy tool is multidimensional, valid, and reliable. This information is important in light of emerging evidence of the impact of health literacy on medication adherence and health.

Pathways of psychosocial factors, stress, and health outcomes after liver transplantation.

The impact of stress and individual factors on health outcomes in general medicine and transplantation are well documented. Few researchers have investigated the complex relationships between these constructs. This longitudinal study assessed coping style, self-regulatory ability, hostility, and social support at baseline among a cohort of 130 adult liver transplant recipients at the Starzl Transplant Institute, University of Pittsburgh Medical Center, and followed those subjects with interview and medical records data about personal and transplant-related stress, physical and mental health outcomes throughout the first post-transplant year. Results show a number of strong bidirectional relationships between coping style, self-regulatory ability, hostility, the caregiver relationship and family environment, personal and transplant-related stress over the second half of the first post-transplant year, and health (especially mental) outcomes at 12 months post-transplant. Stress mediates the relationship between psychosocial factors and mental health outcomes. The importance of those relationships to researchers and clinicians is discussed.

Individual and environmental correlates and predictors of early adherence and outcomes after liver transplantation.

CONTEXT: Little is known about patients' contribution to health outcomes after liver transplantation. Yet, in other transplant recipients, nonadherent behavior is directly related to the leading causes of morbidity and mortality in liver transplant recipients. OBJECTIVE: To examine patient and environmental factors in relation to all aspects of adherence to the posttransplantation regimen and health outcomes in the first 6 months after transplantation. DESIGN: A descriptive analysis of individual and environmental factors in relation to adherence and health outcomes at 6 months after liver transplantation. PARTICIPANTS, SETTING: One hundred fifty-two adult liver transplant recipients at the University of Pittsburgh Medical Center. MAIN OUTCOME MEASURES: Adherence to medication taking, appointment keeping, lifestyle changes, mood, quality of life, and clinical markers of liver function. RESULTS: Nonadherence was prevalent (47% with appointments, 73% with medication); relapse to drug/alcohol use occurred among a few recipients (5.6%), all with a history of substance abuse before transplantation. Patterns of coping, decision making, attitude, and social support were correlated with adherence, clinical markers, and psychological function (r = 0.22-0.45). Avoidant coping, affective dysregulation, and caregiver support emerged as robust predictors of negative clinical and mental health outcomes (beta = .224-.363). CONCLUSION: This information about liver transplant recipients is important for researchers and clinicians. Researchers can develop guidelines by using stable but modifiable characteristics of patients to identify transplant candidates at risk of nonadherence. Such guidelines would enable clinicians to prepare patients better to manage the posttransplant regimen.

Liver transplant recipients: individual, social, and environmental resources.

CONTEXT: Patient characteristics are important in the liver transplant population because of proven associations between individual and environmental factors, treatment adherence, and health outcomes in general medical and other transplant populations. OBJECTIVE: To determine generalizability of the sample to other liver transplant populations and to establish reliability of measures used to assess individual and environmental resources. DESIGN: Cross-sectional analysis of baseline data in a longitudinal study of adherence and health outcomes. PARTICIPANTS, SETTING: Ninety first-time adult liver transplant recipients at the University of Pittsburgh Medical Center completed assessments of sociodemographic, health history, psychosocial, and environmental factors shortly after surgery; adherence and health outcomes were tracked throughout the study. RESULTS: The medical center cohort was older, less racially diverse, and contained more living donors than the national sample. Our sample was generally comparable to the medical center cohort on pretransplant sociodemographic and clinical characteristics. Reliability/internal consistency on psychological measures was similar between our sample and most published norms. The mean scores on all coping scales in our sample were higher than normative. Our patients indicated a more negative perception of family environment and perceived relationships with their primary caregiver more positively than did the normative group. CONCLUSION: The generalizability of our sample to the parent population and reliability of individual and environmental measures reported here will enable us to examine relationships and the value of patient and contextual resources for predicting treatment adherence and health outcomes among liver transplant recipients.

The clock drawing test is an independent predictor of incident use of 24-hour care in a retirement community.

BACKGROUND: It is unclear how early cognitive impairment affects future care needs. Furthermore, the Mini-Mental State Examination (MMSE), a commonly used screening tool in the clinical setting, tends to have a ceiling effect for early cognitive decline. One of the earliest changes in cognitive function is executive impairment. We examined the relationship between executive function, measured with a clock drawing protocol (CLOX1) designed to capture executive impairment, and incident need for increased level of care and total mortality. METHODS: Residents (n = 230) in independent living at a continuing care retirement community were followed for incident need for 24-hour care (mean 2.5 years). Baseline assessment included health status and physical and cognitive function. Time to event analysis was performed to determine the association of the CLOX1 score with the outcomes. RESULTS: Forty percent of residents had a CLOX1 score <12, and 10% had an MMSE score <26. The event rate for a CLOX1 score <12 was 30 per 100 person-years (p-y) and 13 per 100 p-y for a score > or =12. Similarly, the event rate was 34 per 100 p-y versus 17 per 100 p-y for MMSE <26 and MMSE > or =26, respectively. A CLOX1 score <12 was associated with a twofold higher risk of incident use of 24-hour care (hazard ratio 2.2; 95% confidence interval: 1.5-3.4) and death (hazard ratio 2.3; 95% confidence interval: 1.1-4.8) even after controlling for age, sex, comorbidity, and MMSE scores. The MMSE score was not an independent predictor of incident use of 24-hour care or mortality. CONCLUSION: The clock drawing test, scored for executive impairment, but not the MMSE, predicted incident use of 24-hour care and mortality in this cohort of independent older adults.