Limited health literacy link to poor health outcomes

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Limited health literacy has been linked to poor health and poor outcomes among patients with HIV, according to research presented at IDWeek 2016.

Dr Patrick G Clay, professor of pharmacotherapy at the University of North Texas System College of Pharmacy in Fort Worth, and colleagues assessed results from 78 participants in the online Health Literacy Assessment Using Talking Touchscreen Technology (HealthLiTT) survey to determine the health literacy levels of patients with HIV in North Texas.

Survey respondents were 73% male, 28% non-white, and on average, 43 years of age – 90% of respondents were high school graduates, and 93% resided in an urban setting. Overall, respondents performed better when figures were presented within the survey – for example, 94% and 69% correctly selected “Take with Food” and “Take with Water” when prompted. When provided directions without images, only 19% of participants answered correctly.

Additionally, 90% of respondents understood why various medications were being used; 63% could correctly recall how the drug worked, but 44% could not remember the likelihood of side effects.

Study limitations were that the survey was conducted in English only; survey results were not available for use in real-time; data was analysed separately; and the survey was conducted only when survey staff were present in the clinic; the survey was not offered at all times.

“HealthLiTT may improve patient education efforts by facilitating targeting of specific knowledge gaps in resource-limited settings,” the researchers concluded.

Background: Health literacy is “the ability to obtain, process, and understand health information needed to make informed health decisions”. Limited health literacy is related to poorer health and outcomes due to deficiencies in understanding basic health information. To address literacy needs, a baseline assessment is needed. The purpose of the survey is to assess the health literacy level of HIV patients in North Texas using a validated, online tool that can be used even in resource limited environments.
Methods: Participants at 4 distinct urban locations (an HIV specialty clinic, pharmacy, housing unit, and peer support group) gave verbal consent to complete the anonymous, online, audio-driven, validated “Health Literacy Assessment Using Talking Touchscreen Technology” (Health LiTT) survey. Questions assess ability to recall disease and medication understanding, read prescription labels and recall information after a simulated physician consultation.
Results: A total of 78 participants completed the survey (approx. 80% response rate). The average respondent was male (73%), non-White (28%), 43 years old (+/- 3.2 yr), completed high school (90%) and resided in an urban setting (93%). In interpretation of prescription labels, respondents performed better when figures were presented, with 94% (Take With Food) and 69% (Take With Water) correctly selected when prompted whereas questions on actions to take regarding label directions without images provided only 19% (Take on empty stomach) answered correctly. In disease state knowledge comprehension, 90% of respondents correctly understood both why medications were being used and consequences of incorrect administration. While 63% were able to correctly recall how the drug worked and less than half of respondents could recall the likelihood of side effects (44%) after a simulated physician counseling session.
Conclusion: Respondents performed better regarding general medication knowledge and following directions when images were provided, but performed worse when recalling specific drug information based on a pre-recorded simulation. HealthLiTT may improve patient education efforts by facilitating targeting of patient specific knowledge gaps in resource limited settings.

Patrick Clay, Homero J Silva, Jerome Uberu Jr, Erin K Carlson

Infectious Disease Advisor report
IDWeek2016 abstract

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