Cardiovascular health literacy and patient–physician communication intervention in women from disadvantaged communities

Abstract

Background

For many women in low socioeconomic status communities, limited health literacy is an obstacle to following medical guidance and engaging in health-promoting behaviours. Low health literacy skills are also associated with an increased risk of cardiovascular disease.

Design

A health literacy intervention was designed through focus groups with women in low socioeconomic status communities. The primary health literacy issue identified was communication challenges at doctors’ visits. A unique intervention tailored to the participants’ preferences was designed consisting of three workshops conducted in community women’s groups in low socioeconomic status Jerusalem communities. The intervention aimed to increase patient–physician communication skills through doctor visit preparation and better visit management, improve perceived efficacy in patient–physician interaction and expand cardiovascular disease knowledge.

Methods

Questionnaires were completed before and 3 months after the intervention, assessing knowledge of cardiovascular disease risk factors and symptoms, self-report of behaviours in preparations for a doctor’s visit, and perceived efficacy in patient–physician interaction.

Results

A total of 407 women from low socioeconomic status communities completed questionnaires. Post-intervention, the percentage of women that reported preparing for doctors’ visits increased significantly. Women with initially low levels of perceived efficacy in patient–physician interaction showed a significant increase in perceived efficacy, while initially higher perceived efficacy in patient–physician interaction participants showed a decrease. Participants also demonstrated an increase in knowledge of several risk factors for cardiovascular disease and heart attack symptoms.

Conclusions

A community-based cardiovascular health literacy intervention improved cardiovascular knowledge and reported doctor visit preparation in low socioeconomic status women as well as increased perceived efficacy in patient–physician interaction among participants with low baseline perceived efficacy in patient–physician interaction. This may lead to improved health care utilisation, preventing chronic illness.

Registered at ClinicalTrials.gov, https://www.clinicaltrials.gov, registration number: NCT03203018

Keywords

Health literacy women’s health cardiovascular diseases health communications

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References

Nutbeam

. Health promotion glossary. Health Promot Int 1986; 1: 113–127.

Miller

. Health literacy and adherence to medical treatment in chronic and acute illness: a meta-analysis. Patient Educ Counsel 2016; 99: 1079–1086.

DeWalt

Berkman

Sheridan

, et al. Literacy and health outcomes: a systematic review of the literature. J Gen Intern Med 2004; 19: 1228–1239.

Aaby

Friis

Christensen

, et al. Health literacy is associated with health behaviour and self-reported health: a large population-based study in individuals with cardiovascular disease. Eur J Prev Cardiol 2017; 24: 1880–1888.

Santos

. Better health literacy can make the difference when control of risk factors for cardiovacular disease and quality of life are concerned. Eur J Prev Cardiol 2017; 24: 1878–1879.

van Schaik

, et al. Cardiovascular disease risk and secondary prevention of cardiovascular disease among patients with low health literacy. Netherlands Heart J 2017; 25: 446–454.

Morony

, et al. Improving health literacy through adult basic education in Australia. Health Promot Int 2017; 33: 867–877.

Nutbeam

McGill

Premkumar

. Improving health literacy in community populations: a review of progress. Health Promot Int 2018; 33: 901–911.

Nutbeam

. The evolving concept of health literacy. Soc Sci Med 2008; 67: 2072–2078.

10.

Albus

. Health literacy: is it important for cardiovascular disease prevention? Eur J Prev Cardiol 2018; 25: 934–935.

11.

Berkman

Davis

McCormack

. Health literacy: what is it? J Health Commun 2010; 15(Suppl. 2): 9–19.

12.

Schillinger

Bindman

Wang

, et al. Functional health literacy and the quality of physician–patient communication among diabetes patients. Patient Educ Counsel 2004; 52: 315–323.

13.

Gazmararian

, et al. Factors associated with medication refill adherence in cardiovascular-related diseases: a focus on health literacy. J Gen Intern Med 2006; 21: 1215–1221.

14.

Ong

de Haes

Hoos

, et al. Doctor–patient communication: a review of the literature. Soc Sci Med 1995; 40: 903–918.

15.

Calkins

, et al. Patient–physician communication at hospital discharge and patients’ understanding of the postdischarge treatment plan. Arch Intern Med 1997; 157: 1026–1030.

16.

Greenberg K, et al. Health literacy and cardiovascular knowledge workshop in women from disadvantaged communities. In: 15th World Congress on Public Health, Melbourne, Australia, 2–6 April 2017.

17.

Ishikawa

, et al. Improving health literacy in a Japanese community population – a pilot study to develop an educational programme. Health Expect 2018; 21: 814–821.

18.

Maly

Frank

Marshall

, et al. Perceived efficacy in patient–physician Interactions (PEPPI): validation of an instrument in older persons. J Am Geriatr Soc 1998; 46: 889–894.

19.

Ziegler

Kastner

Blettner

. The generalised estimating equations: an annotated bibliography. Biometrical J 1998; 40: 115–139.

20.

Bar

. Missing data – mechanisms and possible solutions/Datos ausentes: mecanismos y posibles soluciones. Cult y Educ 2017; 29: 492–525.

21.

Fitzmaurice G and Verbeke G. Parametric modeling of longitudinal data: Introduction and overview. In: Fitzmaurice G, Davidian M, Verbeke G and Molenberghs G (eds) Longitudinal Data Analysis, Handbooks of Modern Statistical Method. Boca Raton, FL: CRC Press, 2008, pp. 31–40.

22.

Hardin

Hilbe

. Generalized Estimating Equations, Boca Raton, FL: Chapman and Hall/CRC, 2013.

23.

Hubbard

, et al. To GEE or not to GEE: comparing population average and mixed models for estimating the associations between neighborhood risk factors and health. Epidemiology 2010; 21: 467–474.

24.

Roter

. Patient participation in the patient–provider interaction: the effects of patient question asking on the quality of interaction, satisfaction and compliance. Health Educ Behav 1978; 5: 281–315.

25.

Greenfield

Kaplan

Ware

, et al. Patients’ participation in medical care: effects on blood sugar control and quality of life in diabetes. J Gen Intern Med 1988; 3: 448–457.

26.

Griffin

, et al. Effect on health-related outcomes of interventions to alter patients’ participation in medical care: effects on blood sugar control and quality of life in diabetes. The interaction between patients and practitioners: a systematic review of trials. Ann Fam Med 2004; 2: 595–608.

27.

Rivo

, et al. The impact of comprehensive pre-visit preparation on patient engagement and quality of care in a population of underserved patients with diabetes: evidence from the care management medical home center model. Popul Health Manag 2016; 19: 171–177.

28.

Kinnersley

, et al. Interventions before consultations to help patients address their information needs by encouraging question asking: systematic review. BMJ 2008; 337: 335–339.

29.

Frosch

Rincon

Ochoa

, et al. Activating seniors to improve chronic disease care: results from a pilot intervention study. J Am Geriatr Soc 2010; 58: 1496–1503.

30.

Deen

Rothstein

, et al. Asking questions: the effect of a brief intervention in community health centers on patient activation. Patient Educ Counsel 2011; 84: 257–260.

31.

Carman

, et al. Patient and family engagement: a framework for understanding the elements and developing interventions and policies. Health Aff 2013; 32: 223–231.

32.

Gerich

Moosbrugger

. Subjective estimation of health literacy – what is measured by the HLS-EU scale and how is it linked to empowerment? Health Commun 2018; 33: 254–263.

33.

Kruger

Dunning

. Unskilled and unaware of it: how difficulties in recognizing one’s own incompetence lead to inflated self-assessments. J Pers Soc Psychol 1999; 77: 1121–1134.

34.

Baartman

Ruijs

. Comparing students’ perceived and actual competence in higher vocational education. Assess Eval High Educ 2011; 36: 385–398.

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