Health literacy and older adults: Findings from a national population-based survey.

ISSUE ADDRESSED: With an ageing population and growing complexity and fragmentation of health care systems, health literacy is increasingly important in managing health. This study investigated health literacy strengths and challenges reported by older Australians (people aged 65 or over) and identified how socio-demographic and health factors related to their health literacy profiles. METHODS: The sample comprised 1578 individuals responding to the Australian Government's 2018 Health Literacy Survey, conducted between January and August. Regression modelling was used to estimate the association between each of nine domains of the Health Literacy Questionnaire (HLQ) and individual socio-demographic and health characteristics. The model allowed for correlation between HLQ scores that was linked to unobserved characteristics of individuals. RESULTS: Across the health literacy domains, few individuals received mean scores in the lowest score range. Key individual characteristics associated with higher health literacy were increasing age, English proficiency, higher education levels, better self-assessed health and having certain chronic conditions (cancer, hypertension and arthritis). CONCLUSIONS: Our findings suggest that, among those aged 65 or over, being older or living with chronic illnesses were associated with greater confidence in engaging with providers, accessing information and navigating health services compared to individuals aged 65-69 and those older individuals without chronic illness. Lower health literacy was associated with psychological distress and low English proficiency. SO WHAT?: Interventions to improve individual health literacy and organisation health literacy responsiveness to minimise complexity of the Australian health system are required. This may enhance uptake and use of health information and services for the underserviced members of the community.

Mobile phone penalties and road crashes: Are changes in sanctions effective?

INTRODUCTION: Road crashes are a major, preventable cause of death and serious injury. Being distracted by a mobile phone while driving can increase the risk of a crash by three to four times and increase crash severity. To reduce distracted driving, on 1 March 2017 the penalty for using a hand-held mobile phone while driving in Britain doubled to £200 and six penalty points. METHOD: We examine the effects of this increased penalty on numbers of serious or fatal crashes over 6 weeks either side of the intervention using Regression Discontinuity in Time. RESULTS: We find no effect of the intervention, suggesting the increased penalty is not effective in reducing the more serious road crashes. CONCLUSIONS: We rule out an information problem and an enforcement effect, concluding the increase in fines was insufficient to change behaviour. With very low detection rates of mobile phone use, our result could occur if the perceived certainty of punishment remained very low after the intervention. PRACTICAL APPLICATION: Future technology will increase the ability to detect mobile phone usage, and there may be fewer road crashes if the solution is to raise awareness of such technology and publicise numbers of offenders caught. Alternatively, a mobile phone blocking application could avert the problem.

Discrepancies in self-reported and measured anthropometric measurements and indices among older Australians: prevalence and correlates.

BACKGROUND: Anthropometric measurements and indices such as weight, height and Body Mass Index (BMI) are often used to assess overall health and nutritional status. Clinicians and epidemiologists often rely on self-reported weight and height to measure BMI. Differences between self-reported and measured weight and height can lead to differences between self-reported and measured BMI, biasing relative risks of diseases associated with differential BMI. METHODS: Applying regression analysis to a large nationally representative survey data with contemporaneous self-reports and measurements on 3412 individuals aged 65 or over, we provided estimates of the difference between self-reports and measurements of weight, height and BMI for older Australians, analysing demographic, socioeconomic and health correlates of estimated differences. RESULTS: We found both males and females underestimated weight, overestimated height and underestimated BMI and there was some evidence these differences increased with age. There was also evidence that these differences were associated with high levels of education and household composition. CONCLUSION: Although average differences were small, for many individuals the differences may be significant, indicating measurements should be taken in clinically focused research and practice. This is important as systematic underestimation of BMI in older adults can have implications for estimating the size of populations at risk of many health conditions, including diabetes, hypertension and functional limitations.

Spirituality and childbirth: An international virtual co-operative inquiry.

PROBLEM: Medicalised maternity systems do not address spirituality as an aspect of childbirth and its practices of care. Neglecting the spiritual nature of childbirth may negatively affect psychological, emotional and physical wellbeing. BACKGROUND: While there is growing interest in the spiritual side of childbirth there is a paucity of literature on the topic, and hence a lack of understanding generally about how to attend to women's needs for emotional and spiritual support in childbirth. AIM: To collaboratively and through consensus explore ways that spirituality could be honoured in 2st Century maternity care. METHODS: An online co-operative inquiry. Starting with a scoping exercise (N=17) nine co-inquirers continued to Phase One using online discussion boards and seven co-inquirers continued to Phase Two and Three. Co-inquirers were involved in international group work and individual reflective and transformational processes throughout. FINDINGS: Four reflective themes emerged: 'meaning and sense-making'; 'birth culture'; 'embodied relationships and intuition'; and 'space/place/time'. 'Spiritual midwifing' was an overarching theme. There were eight areas of individual transformation and actions concerning spirituality and birth: 1) disseminating inquiry findings; 2) motivating conversations and new ways of thinking; 3) remembering interconnectedness across time and spaces; 4) transforming relationships; 5) transforming practice; 6) generating reflexivity; 7) inspiring self and others to change, and 8) inspiring creativity. CONCLUSION: Spiritual awareness around birth experience emerges through relationships and is affected by the spatial environment. Spiritual midwifing is a relational approach to birth care that recognises and honours the existential significance and meaningfulness of childbirth.

Does inpatient health services utilization vary by remoteness in the medical financial assistance population? Evidence from Shaanxi province, China.

BACKGROUND: Medical Financial Assistance (MFA) provides health insurance and financial support for millions of low income and disabled Chinese people, yet there has been little systematic analysis focused on this vulnerable population. This study aims to advance our understanding of MFA recipients' access to health care and whether their inpatient care use varies by remoteness. METHODS: Data were collected from the Surveillance System of Civil Affairs of Shaanxi province in 2016. To better proxy remoteness (geographic access), drive time from the respondent's village to the nearest county-level or city-level hospital was obtained by a web crawler. Multilevel models were used to explore the impacts of remoteness on inpatient services utilization by MFA recipients. Furthermore, the potential moderating role of hospital grade (i.e. the grade of medical institution where recipient's latest inpatient care services were taken in the previous year) on the relationship between geographic access and inpatient care use was explored. RESULTS: The analytical sample consisted of 9516 inpatient claims within 73 counties of Shaanxi province in 2016. We find that drive time to the nearest hospital and hospital grade are salient predictors of inpatient care use and there is a significant moderation effect of hospital grade. Compared to those with shortest drive time to the nearest hospital, longer drive time is associated with a longer inpatient stay but fewer admissions and lower annual total and out-of-pocket (OOP) inpatient costs. In addition, these associations are lower when recipients are admitted to a tertiary hospital, for annual total and OOP inpatient expenditures, but higher for length of the most recent inpatient stay no matter what medical treatments are taken in secondary or tertiary hospitals for the most remote recipients. CONCLUSION: Our results suggest that remoteness has a significant and negative association with the frequency of inpatient care use. These findings advance our understanding of inpatient care use of the extremely poor and provide meaningful insights for further MFA program development as well as pro-poor health strategies.

Effectiveness of intensive, group therapy for teenagers who stutter.

BACKGROUND: Treatment of adolescents who stutter is an under-researched area that would benefit from greater attention. AIMS: To investigate whether an intensive treatment programme for older teenagers who stutter, aged over 16 years of age, is effective in reducing overt and covert aspects of stuttering. METHODS & PROCEDURES: A repeated-measures, single-subject experimental design was replicated across participants. The study consisted of a 5-week baseline phase, 2-week intensive treatment phase, 5-week consolidation phase and 10-month follow-up phase. Participants were asked to make ten video recordings at home during each phase, while completing a reading and a conversation task. Recordings were analysed in terms of the percentage of stuttered syllables using a simplified time-series analysis. Participants completed self-report questionnaires at predetermined times throughout the study. Data are presented for three males aged 17;7, 17;11 and 18;10. OUTCOMES & RESULTS: One participant completed all required recordings. Difficulties were encountered collecting follow-up data with the other two participants and data are available up to 5 months after the intensive therapy phase. A significant trend of reduced frequency of stuttering was found for all three participants during the intensive therapy phase. This trend continued throughout the consolidation phase and remained significant when available longer-term data were included in the analysis. Participants also reported increased self-efficacy about speaking and reduced overt and covert aspects of stammering. CONCLUSIONS & IMPLICATIONS: Findings show that this therapy programme for teenagers had a significant treatment effect for the participants studied in the short- and medium-term, however longer-term data were not available for all participants. Issues in conducting research with this client group are discussed.

Connecting stuttering measurement and management: III. Accountable therapy.

BACKGROUND: This paper is intended to contribute to the current debate in relation to persistent stuttering and evidence-based clinical practice. AIMS: The paper will describe the authors' intervention framework for persistent stuttering, which is guided by evidence from the fields of stuttering and clinical psychology. It supports the opinion that the components of therapy should be grounded in empirically based theories that offer an explanation for the nature of stuttering, its persistence and its individual complexity. It will argue that the goals of therapy should reflect the client's personal values and experience of stuttering, as well as the knowledge and skills of the therapist. MAIN CONTRIBUTION: The paper maintains that therapy for this disorder needs to account for the highly individual nature of the overt and covert dimensions of persistent stuttering and identify the formal and informal methods that measure progress and outcome. Current research and future directions will be touched on briefly.